TH: What was John Knox like when he was a pre-teen and a teenager in Detroit?
JK: Well, probably the pretty average teen. I was interested in a limited number of sports. I loved tennis. But very much into school. I always enjoyed school. I always loved learning. I was very much dedicated to being a student. But I had a very nice childhood. My parents were very supportive. Wasn't one of those kids that had arguments with their parents. I was easy to get along with, as far as my family goes. I had a very happy childhood.

TH: Brothers and sisters?
JK: Yes. I have on sister, Kim, who is back in Michigan. She's a banker. She's married to a fireman. They have three girls. She and I keep in close contact. My mother now lives right next door to my sister in East Point, so everybody's pretty close there.

TH: How did you become interested in the medical field?
JK: It was just something that I became interested in as I was going through school. I always liked sciences. In college, I took a real interest in biology. Majored in that with a minor in chemistry. I didn't know exactly what I wanted to do when I got through with my undergraduate degree. I finished my master's in biology then decided I was going to take a crack at a doctorate in biology but just found out I wasn't cut out for the research end of that. That caused me to look at other avenues, one of which was medical technology because I did have interest in lab work. So I did that for a while and decided that that wasn't something I wanted to do all my life. So I started to go back to school and get an MBA. A lot of this is serendipity. Just kind of moved along from one step to the next and found that I liked management. I was put in a supervisory spot in the lab and found I enjoyed it, so the MBA fit in real well. That opened a lot of new avenues for me and I started to get involved in the administrat ion of the hospital. It was just one thing after the next.

TH: When I visited with Rusty Knight (of Mercy Medical Center), we talked about the size of this community and number of health-care facilities. Rusty's take was that Dubuque is unusual in having two hospitals offering the various services. What's your take on Dubuque and being a two-hospital community?
JK: See, I don't find it unusual because I guess that's the atmosphere I've always been in, having been CEO at two other hospitals. The first setting I was in, we had three hospitals in the town. Coincidentally, one of them happened to be a Mercy, part of the Trinity system, just like this Mercy is. The other one was Port Huron Hospital and then I was at a hospital maybe 15 minutes away in St. Clair. Why the hospital industry has been set up like that, I'm not clear, but it seems like it is not unusual to have two, three hospitals in a town. As a matter of fact, in that particular setting, the hospitals were closer than what we have here in Dubuque. Even having them within five minutes away to me is not that big a surprise. And the second facility I went to in Warren, Mich., also had three hospitals. Much larger town. That had more like hundreds of thousands of people in the town, but there, again, there was great competition. You know, there's good and bad sides to that. The good side is you have compet ition, because I think if you have just one hospital there's a tendency maybe not to be as up-to-date, as sharp as you need to be because there's nobody else in town taking care of folks. But the downside is that there is some cost efficiencies that maybe you lose because you've got three places doing what two places doing the same sort of things. In this town, of course, that's the case. With the exception of cancer and open heart.

TH: In anticipation of the changeover of John Deere participants to Finley, what changes have been made here to accommodate the anticipated if not realized increase in patient volume?
JK: Well, a number of things. In the ER, where we saw probably the biggest jump, we have moved back a little bit earlier the double-physician coverage that we have. We've found that with the John Deere addition, we were seeing a faster upswing in volume by about 11 in the morning. So we've moved back our double-physician coverage to that time to accommodate the volume. Our Convenient Care, which is a separate area right behind the ER that takes care of the less acute cases, we have made some structural changes there to accommodate the new volume. We are also going to add a nurse in there because we're seeing a lot more cases in Convenient Care. We're doing some restructuring towards the front of the hospital as well in terms of expanding the waiting area for the emergency room. We also moved our pre-admission testing to another area of the hospital because that was suffering from shortage of space. So we've made some physical changes. We've made some staffing changes. We're watching very closely our inpatient census. If it continues to be at the level it is, we will have to add some nurses and we're looking at doing that. So we're trying to react as quickly as possible as the volume comes.

TH: In terms of the other programs, I see that you're looking at a diabetes center to get started this summer, I think. The groundbreaking is in June?
JK: Right. Well, we've always had the diabetes center, but the difference is we've been renting space. We thought by having a permanent home for it would actually over the long term reduce our costs because we wouldn't be paying the rent. Plus we also need the expansion space as well because diabetes, as you know, has been climbing astronomically. We're seeing more and more cases each year. It's a service we need to expand.

TH: To clarify, you have a program now, but you see an expanded program once you are able to get this facility under way.
JK: Right. And the other piece we're going to tie into it is weight management. Because diabetes largely results from people, not always, but folks who are not controlling their weight. If you can keep weight down, you reduce the risk of diabetes. So we have a weight management component that's going to go into this building as well.

TH: I asked about surprises you've encountered in your job. Same question, but related to the Dubuque community. Were there some aspects or features of Dubuque that you surprised you, positively or negatively?
JK: Not a surprise, but what took me a while to get used to is a little bit different atmosphere than what I was used to in Michigan. Dubuque is unique, I think, in the standpoint that it does have a small-town type of atmosphere, but yet it offers a lot of the big city amenities. The fact that it has its own symphony, it puts on its own plays. It has good shopping. Lots of restaurants. A nice waterfront that's been developed. Those are all things you would see in a bigger town. So that was a pleasant surprise. There's kind of a tight-knit feeling in Dubuque, and that sometimes take a bit to break into. I think people here are very close-knit. You always hear jokes about you can be here a lifetime and not be considered a real Dubuquer. I think that takes a while to get used to and to break into. But after being here for three years, I think I am starting to break in and feel more part of the community.

TH: How expensive is it for The Finley Hospital to give care to people who don't have insurance, have financial problems? A lot care you end up giving away.
JK: We do.

TH: Can you calculate that?
JK: We can. (Losses to bad debt or unspecified charity care: $771,916; community-based initiative costs, including health screening and educational presentations: $1.06 million; difference between Medicare cost and reimbursement: $6.2 million; difference between Medicaid cost and reimbursement: $664,255.) I'm not talking about the difference between our charges and what we get paid by Medicare, this is our costs and what we get paid by Medicare. So it's a substantial number. But when you look at it, who else is going to take care of these people? If you don't have resources and you a true emergency -- there are cases that come in our ER that if we didn't take care of them, they wouldn't make it. You can't just stop and say, "Well, now tell me, can you pay for this?" If they can't, you just shoo them out the door? We've got to take care of them. I think that's a real problem in this country. We have to think about how we're going to take care of them.

TH: Speaking of people who smoke too much, it appears to me that you don't smoke...
JK: Used to. I gave it up.

TH: You're reformed. It appears that you keep in pretty good shape. What do you do in your spare time?
JK: I run routinely. I'm not much of an outside runner, most of it's on the treadmill. But I do that every night. Sit ups and some weights and that sort of thing. Occasionally, my son will run me around the racquetball court. Not often enough but occasionally. So I do get some exercise.

TH: Where did you and your wife, Karen, meet?
JK: Actually, through a best friend of mine. A fellow that I went to high school with and then college. He had a party that I went to and I met Karen there. She happened to be in the same business. Karen's a nurse and has been forever. She's now a nurse practitioner. She's going for her doctorate now in public health. We had similar interests since we're in the same field. That's how we got together.

TH: So, what's a good day for you at work?
JK: Well, I guess a good day is when I really have a sense of accomplishment. That we did something new, we pulled if off successfully. There's been a lot of things that I think have happened that are positive. Implementing a new service successfully gives you a feeling of satisfaction. Bringing on the John Deere business and pulling that off was a great sense of accomplishment. And then I get a great thrill out of seeing when I see the results of our patient satisfaction or I look at our outcomes because we track certain quality outcomes very closely. When those all come back and they're good, that gives me a great deal of satisfaction. So that's a good day. Or when I got a complaint from a physician that I could take care of quickly. That's also a good day.

TH: Do you travel? Have you climbed Mount Everest or anything?
JK: No. As a matter of fact, I haven't traveled a lot. My wife, we're celebrating our 25th anniversary this year, so we promised each other that we would go to France this year. It's the first time we've gone across the ocean.