Building Championship Teams in Healthcare: Mike Fidgeon’s Leadership Journey

๐ŸŽ™๏ธ How Does Athletic Leadership Transform Healthcare Organizations? Mike Fidgeon’s Story

In this inspiring episode, Mike Fidgeon, CEO of Hillcrest Family Services, shares how he translated lessons from Duke University athletics into leading a comprehensive behavioral health organization. His journey demonstrates how combining athletic discipline with compassionate leadership creates transformative healthcare services.

โœจ Key Insights You’ll Learn:

  • Converting athletic discipline into organizational excellence
  • Building mission-driven healthcare teams
  • Leading with dignity and compassion
  • Evolving traditional services for modern needs
  • Creating sustainable high-performing teams

๐ŸŒŸ Key People Who Shaped Mike’s Journey:

  • His Parents: Career social workers inspiring service to others
  • Providence Mentor: Provided early leadership opportunities
  • Duke Coaches: Taught leadership through athletics
  • Providence Team: Supported through challenging transitions
  • Gary Gansmer: Previous CEO who built strong foundation

๐Ÿ‘‰ Don’t miss this powerful conversation with a healthcare leader who proves athletic excellence and compassionate care can create transformative organizations.

LISTEN TO THE FULL EPISODE HERE

Transcript

Intro: Welcome to another edition of inspired stories where leaders share their experiences so we can learn from their successes how they’ve overcome adversity and explore current challenges they’re facing.

Anthony Codispoti: Welcome to another edition of the inspired stories podcast where leaders share their experiences so we can learn from their successes and be inspired by how they’ve overcome adversity. My name is Anthony Kodespode and today’s guest is Mike Fidgen, CEO of Hillcrest Family Services. They are a results focused organization that adds direction to those who have lost their way, to those suffering from addictions who need to get back on track and they’re here for individuals who have dependencies but want to work toward independence. At Hillcrest they provide many services but with only one focus that’s results. Mike has been the CEO of Hillcrest for four plus years. He is responsible for driving fiscal efficiency, clinical quality and strategic growth in a balanced and data driven approach.

He leads a team that recognizes that all healthcare begins with brain health. He’s been the CEO and COO of a publicly traded company. While there he helped drive a 35% improvement in EBITDA through the successful reorganization of over 130 business units.

He also executed the sale of the business for $230.7 million which exceeded the targeted sales price by more than 50%. Mike is highly skilled at developing high performing teams focused on scaling multi-site operations while maximizing quality of service, revenues and profits. Now before we get into all that good stuff, today’s episode is brought to you by my company Add Back Benefits Agency where we offer very specific and unique employee benefits that are both great for your team and fiscally optimized for your bottom line. One recent client was able to add over $900 per employee per year in extra cash flow by implementing one of our proprietary programs. Results vary for each company and some organizations may not be eligible.

To find out if your company qualifies contact us today at addbackbenefitsagency.com. Now back to our guest today, the CEO of Hillcrest Family Services, Mike Fidgen. I appreciate you making the time to share your story today.

Thank you for having me, Anthony. So Mike, as I look at your rather impressive work experience, I see a common thread of helping healthcare related companies. Now your skills would be valuable in a wide range of business types. What drew you to this particular industry?

Mike Fidgeon: Yeah, that’s a great question. Really, I credit my parents for that, right? They were career social workers. My mom and dad both made careers in parole and probation. My dad worked in DC for the district court and from his entry level as a graduate of Villanova University till the day he retired as the deputy director for adult parole and probation there. And then my mom, after four children, grew up and started to take care of themselves.

She got into the same work as a parole probation officer in Maryland. So my parents were always great about impressing on their children that life is tough. And no matter how hard you’re having it, somebody out there is having it in a more difficult way. And if you go out there and you seek those folks out and find ways to help them solve their issues, you’ll discover that yours quickly evaporate. And I’ve tested that my whole life and it’s unfortunately proven very true.

Anthony Codispoti: And so right out of college, did you get right into the healthcare space or did it take a little while for you to find your way there?

Mike Fidgeon: Yeah, I did a little traveling. I came out of school and I was actually pre-med when I went to college and had hopes of pursuing a career in orthopedic medicine. But I traveled around the country trying to just spend a little bit of time seeing things before I got bogged down with medical school and those types of endeavors, which I knew I was going to have to apply my full being to. After traveling the country, North America, I worked for a short while, saved up money and did a world tour and traveled for another year and spent the better part of that on a small war-torn island in Indonesia called Timor. And that was really where I think I really discovered that I needed to go back and do what my parents had inherently kind of seeded in all of their children, which was to find a way to help those that were less fortunate.

And I came back and got in about 1990, I think, was when I got into working with youth that were being diverted from corrections facilities and being given an alternative to more institutional types of care and worked in a wilderness program that kind of launched my career in this mental and behavioral health space.

Anthony Codispoti: So let’s talk about the position that you had at Providence Service Corporation. That’s the publicly traded company that I referenced in the intro. How did that particular opportunity come about?

Mike Fidgeon: Yeah, so I got into Providence Service Corporation at an interesting time. I had left the wilderness residential program back in the early 90s and started to work in what then was called home and community-based services. And I worked for a couple of competitive businesses within the borders of the state of Virginia. And a company formed out in Tucson, unbeknownst to me until they started to shop companies to acquire. And one of the companies they acquired I had worked with was Family Preservation Services of Virginia.

So that was their first acquisition on the East Coast. And I was actually not working for Family Preservation at the time, but I was asked to come back. I think there was a need for people that were willing to help to develop high-performing teams as Providence knew that they were going to largely through acquisitions start to grow the business at that time up and down the Eastern Seaboard.

And so I signed up and signed on in 1997 or 1998. Providence was a relatively new organization having started about a year, year and a half before that and started as a general manager for that company that they had acquired and then was a part of a team that focused on growing the business on the East Coast.

Anthony Codispoti: So you mentioned that they needed somebody with the skills to develop high-performing teams. How is it that you developed that skill of developing high-performance teams?

Mike Fidgeon: Yeah, serendipitously, by luck in a lot of ways, but also through just years of sports, quite honestly, I grew up as your quintessential jock, if I may, starting in sports and rec leagues. And then following that into public schools and then when public schools didn’t offer the level that I wanted to play at, I transferred into a private school, my sophomore year of high school for school in Maryland that had a good reputation for La Crosse in particular. And I played La Crosse in football and that was my ticket to some both financial aid and scholarship opportunities. I knew I wanted to play a Division I sport and was recruited to a few Division I schools for La Crosse, not as much for football.

So I ended up going to Duke University and playing La Crosse at Duke for all four years, was thrown into environments with talent around me that far exceeded mine. And so I think the first thing to learning how to develop high-performing teams was learning to be a good teammate, learning to be a follower of great leadership, paying attention to your coaches, absorbing all that you could, and then applying those things that you learned in practice and in chalk talks and film reviews to the field when the whistle blew and your feet hit the field and it was game time. And then adjusting and adapting and overcoming the adversity that you had on the field.

So I just I learned to do that for myself first as a team member and a follower and then as many folks that stick with it long enough, you’re given the opportunity to take on more responsibility as you grow with any team. And I took advantage of those opportunities not just in sports, but also in my life after college with business and was always willing to say here I am, send me.

Anthony Codispoti: So you were in high school, you loved La Crosse so much that you transferred into a private school so that you could kind of level up your own skills. You got some financial assistance to come to Duke and play Division I La Crosse, which tells me that you were pretty good, but you get there and you’re no longer the top guy, right? Is that transition kind of hard?

Mike Fidgeon: Oh, absolutely. I was talking to my now 32 year old daughter this morning about that lesson that I had. She was talking about struggling with interacting with people and being worried that she’d upset them.

And I told her that her granddad used to impress on me when I was younger that I just needed to ask for what I needed and ask for clarity and that the worst anybody could ever say to me was no, right? And so it was about getting used to having people say no and not letting failure be the end of you or somebody not being inclined to help you in the way that you wanted their help or to guide you in the path in the way that you wanted to, that you get enough at bats if you weren’t willing to give up and with time, those challenges and losses would eventually lead to successes too. And you’d figure out how to sort the two out and replicate the strengths and the things that led to a little bit of grit and tenacity that kept you hanging in there long enough to absorb things and apply them and get better. So I always felt like that was the secret to it because Duke was the opportunity for me both academically and in terms of athletics. I heard from a lot of people that I was a bigger fish in a very small pond that went to a big pond and felt like a very small fish when I arrived there and I really had to apply myself to just be able to level up, as you said. And a lot of that just was hard work and drive.

Anthony Codispoti: I mean, some people get thrown into that situation and it’s completely demoralizing to them. Their sense of identity has been stripped from them. They were top dog and whatever it was they were doing. In your case, the cross and you come to a place, still a good player, but their guys were playing at a level above you. I mean, I think the approach that you took is certainly the right one and has certainly served you well.

But do you think that that was sort of innate in you? Was there any consideration along the way to just throw in the towel? Because that’s what some people do. So what is it kind of at Mike Vigeon’s core that made him not follow that path?

Mike Fidgeon: Yeah, again, you’re asking some really great questions that get to the core of my being. I think, yeah, there were opportunities to throw in the towel and the desire to do that. Certainly at times when I was playing sports at Duke and at times prior to that and since that. Whether it’s sports or business, there are always those periods and places that mark crucible like experiences in your life. And I think, I wanted to give up, but I hung on a little bit longer and something that felt like it was meant for bad turned out really good for me. And I’m glad I turned the corner.

But none of those things came. You talk about it being innate. I think a lot of the experience was learned. I was a product of a family that my mom went through a divorce when I was young and remarried and had two more children with my dad, my stepdad.

I referred him as my dad who raised me and my sister and two other brothers and sisters. And there was just a lot of things that at different times, I think we could have complained about. But I think with the influence that I’ve already mentioned that they had in terms of the way that they taught us to take on adversity, a lot of that conveyed. And sports was a great Petrie dish, if you will, to really kind of sharpen the drive and the tenacity and realize that losing is not the end of the day if you’re learning. And if you view the experience of losing as not losing, but hey, we either win or we learn something here. And that effectively was, I think, what resulted in not being bashful when you got beat up pretty good or lost something that was pretty important to you, that life was going to go on. Don’t let your highs be too high and your lows be too low. Life’s very cyclic in nature and things come around.

Anthony Codispoti: Yeah. So let’s talk a little bit more about Providence Service Corporation. I mean, what you achieve there is incredibly impressive. I just threw out a couple of the stats. I’ll mention them again. A 35% improvement in EBITDA, that’s off the chains. Like that is huge. And you did that by successfully reorganizing over 130 business units.

Now, obviously, that’s not Mike in there redoing each of them, but that’s Mike overseeing and coaching a team that’s doing that to the point where you execute a sale of business, which exceeded the targeted sales price by more than 50%. Talk to me a little bit about what was going on there, that this was sort of an up and to the right kind of hockey stick kind of growth curve for you.

Mike Fidgeon: Yeah, I’m going to correct you on some of the language that you’ve used, you’ve used the word two or three times you. And where I would start would say, it was never me. If it was just me alone, then would never have had the accomplishments as a team that our team had. Right. So it was very much a we experience.

I think the other thing I learned through the experiences I’ve already mentioned was anytime you are a part of a high performing team and you’re surrounded by people that are really good, if not and frequently better than you at what you’re doing, you get better too. Right. And the more that you can rely on the person to your left and the person to your right in order to get the mission accomplished, right. When you can see the sum of the parts as being more important and bigger than the individual efforts, right.

Then you can start to have an appreciation for what a group of people can do collectively. And so that hockey stick that you mentioned at Providence was such a so many people were involved in that at a level of leadership. There was probably about six or seven people, including myself, that had opportunities at different times to be the lead dog or to play a very critical role in leading a function or a department or a team that was instrumental in some of the statistics that you mentioned about that organization. But at the same time, none of that work got done without the 7,000 employees, I like to refer to employees as colleagues, right, or 7,000 colleagues that were executing day in, day out with the work that actually was what was being valued, right.

The delivery of care to individuals and the groups of people that was paid largely under taxpayer dollars, Medicaid and Medicare. And we managed to translate both for the board level all the way down to the, you know, direct line level service delivery colleagues, why what what we were doing mattered, right. So if if our board wanted to communicate in earnings per share to somebody that that language mattered, they knew how to translate what Mike and his team could describe as the work that was happening in homes and communities and in the trenches and under the bridges, etc.

and why that was valuable. And then we could help the folks that were, you know, didn’t really care quite honestly give a damn about earnings per share, they came to the work to make a difference in somebody’s life. And we were able to help them understand why what they were a part of was just monumental that there were wasn’t another organization at that point in time that had done something uniquely in home and community based services that was very asset like not facility based doing what they were doing and and the reach that they had to to change lives and and that that just fueled their their motivation that they brought to the organization to begin with.

Anthony Codispoti: So a small part of what there may be no small part of what you’re describing there is the ability to kind of communicate to different groups of people in a way that gets them excited about what motivates them for some people at CPS, its earnings per share and for a lot of folks, you know, working on the direct line, they get up, they get out of their beds every morning so they can come and they can help people, they can make a difference in their lives and being able to communicate that to the different team members in a way that sort of, you know, talks to their brains and gets them excited is what helps to fuel everybody forward.

Mike Fidgeon: Yeah, absolutely. I think, you know, what what I hear and what you just said is mission alignment, right? So here at Hillcrest Family Services, one of the first things I did was to work with, you know, developing and even reconstituting a team of leaders. And within the first three months, we recreated an updated mission vision and value statement for the organization. And that mission is meeting people as they are today and guiding them to where they want and need to be tomorrow. So, you know, relating that back to sports, it’s kind of like, hey, we got to decide on, you know, what the name of our team is, how good we want to be, why we want to be good, what our fight song is, what our team colors are, what our brand recognition is going to be, etc., etc. And then we’re going to, you know, create a playbook and set out in that direction to execute on, on just that.

So the mission has been, you know, critical, but I think what makes the work, you know, gain results is that the people that stay with this type of work over a course of time have a personal mission alignment, right? There is, there is something in their life either they have direct or indirect struggles with mental health, behavioral health, substance use, they have somebody in their family who has struggled. They grew up in a family and they were the caretaker of their siblings. They lost somebody at a young age and went through grief that they didn’t know they would experience and recover from. And somebody helped them along the way and they want to become one of those helpers. So you find that the folks that really can lead as well as deliver the care in this space come at it from a very personal space, place, and many of them have their own personal mission statement.

I, I honed one in over the course of time that I used to carry my wallet that was a paragraph long and then it became three sentences and then two sentences and now it’s just two words, help others, right? Period. That’s my personal mission statement.

Anthony Codispoti: So the opportunity with Providence Service Corporation, pretty good size company, execute a sale, you looking for new opportunities. How is it that the opportunity with Hillcrest specifically came about? Still a decent size organization, not the same kind of scale as where you were before. What drew you to Hillcrest?

Mike Fidgeon: Yeah, the interesting time, it was an interesting time of life, right, for me. And I’m probably on a continuum of default decision making to very intentional decision making. I tend to be, you know, I’ll worry about it when I get to the fork in the road and I’ll decide there as opposed to I know exactly what I want my path to be, when, how, why, you know, where, etc. And so when, when the business sold, we sold Providence Service Corporation’s behavioral health vertical to Malina Healthcare, a Fortune 500 health plan. Back in 2015, at that time, Providence had three other verticals that they had acquired and built into the business with an on emergency transportation business, global workforce development business, and a 700 mobile nurse practitioner health assessment business at the time that they decided to part with the behavioral health component of the organization. And so when we went through that, that sale to Malina, it was a, it was an interesting time because Malina had a hypothesis about how that that organization could benefit people. They had about 8 million, 8 million people under their health plan in 13 states in Puerto Rico at that time, and they had the belief that many of them that were costing a lot on the medical side were either undiagnosed or under diagnosed with behavioral health challenges. And they thought our business could address that. And even if it didn’t make money on the behavioral health intervention spend, it could bring their medical care down.

For instance, the the diabetic with schizophrenia is much more costly to a health plan as a diabetic with untreated schizophrenia, and then a diabetic who is receiving treatment for schizophrenia and therefore better able to manage their higher cost diabetes. Great plan, but within 14 months, the Malina business hit headwinds and decided to take a new approach with their leadership and changed out their leadership team. And when the new CEO came in, he his focus as it should be was to really get back to executing as a health plan. And they got rid of all a number of different businesses that they acquired along the way like ours 14 months earlier. And so it went back out to sale 18 months after. And I came out of the business then because I wanted to see our business come together and pursue the management buyout with a PE sponsor.

And we got to a letter of exclusivity, horseshoes and hand grenades, right? It didn’t it didn’t score any points ended up releasing that commitment and selling to another PE shortly thereafter. And I had to sit out for for a year on a non compete.

I did some consulting long enough to realize I wasn’t a very good consultant because I couldn’t charge people for my time very well. And I was a team oriented person. I wanted people around me.

So I ultimately, and then COVID hit, right? I ultimately rethought what I wanted to do. And I decided I wanted to get back to doing something that I enjoyed in my past, which was running a business like I did in Virginia as I was moving through the ranks of Providence that I never did anything long enough and well enough to get good at it. And I wanted to try again to see if I could get good at it.

And there were a number of different other factors that played into the decision to relocate to Iowa in particular and come to this company. But I’ll leave it at that for now.

Anthony Codispoti: Did I just hear you say that you weren’t at the previous role long enough to get good at it?

Mike Fidgeon: Yeah, I had a lot of what I call battlefield promotions, right? So Providence was a remarkable journey. I was with them for 23 years and I literally started and in fact, I remember AOL was how we communicated by email back then and my I probably still have the email address. It was FPSgeneral at AOL.com and the general stood was basically when I met my boss, they sent a COO out from Tucson to take over the business after the founding CEO of the company they acquired wasn’t going to be able to get the job done. And my boss who hired me basically said, you’ll be a generalist. I don’t know exactly what role you’ll play. But I’ve been told that we need to hire you because we don’t want you working with our competitors here or in other places. And you can really be a part of a team that helps to accelerate what we want to do on the Eastern Seaboard. So yeah, you’re a generalist.

I don’t have a really good position description for that. So I decided Family Preservation Services, FPSgeneral at AOL.com would be my email address. And that’s how it played out. I started and I brought to the organization some operational strengths that focused on the financial efficiency. Other people took care of the quality on the clinical side and I learned the language and interfaced with them. And then I was about business development and growing programs which meant growing and developing people. And so I ended up more in the operational roles with a couple other colleagues who did the business growth and the clinical assurance pieces of it as we started to acquire businesses and grow businesses up and down the Eastern Seaboard. So as soon as we got successful, I got more territories, more programs more oversight.

That’s what I refer to as battlefield promotions where I hadn’t really mastered the last job. I was just starting to get my head wrapped around it and looking forward to doing it when somebody said, hey, no, you’re running the state of Virginia, but I need Virginia, DC, North Carolina and Delaware covered. Are you willing to step up?

And as I said earlier, my attitude was always, yeah, here I am. Send me. You don’t seem to be asking or requiring any prerequisite. So I’ll give it the old college try. Send me and coach.

Anthony Codispoti: So I want to talk just for a second about that year that you had to take off because of the non-compete. For people who are hard drivers, they like being busy, they like being around people, you just record scratch, like everything stops all of a sudden. So you had some consulting things, but it’s not the same as having that same drive and purpose and getting out of bed every morning for this big picture. What was that year like for you, mentally, emotionally?

Mike Fidgeon: Yeah, it was excruciating as the word that comes to my mind for a lot of different reasons. And a reference back to something I said earlier, life has its seasons, right? There’s a cyclical nature to things. So it’s not that there weren’t some good times in that.

There were some things I really enjoyed. I didn’t know what LinkedIn was or have a LinkedIn presence. And because I had time on my hands, I started to, I’m a networker, right? So I started to interface with really interesting people to me on LinkedIn and everybody’s, everybody was interesting to me. And so before I knew it, you know, three months later, I’m talking to people on a regular basis on LinkedIn and WhatsApp, I think was being used at that time.

We do conferences and stuff. And I had friends in Israel and Saudi Arabia and Australian and, you know, you name it, right? I mean, we were having global discussions about all sorts of things.

And so I really very much enjoyed that time and learned how to be with myself, right? While also being connected remotely through those sorts of things and getting that, it scratched around being in conversation at the very least with other people. But then there was also the side of it that was working from home, you know, having my best friend be my dog at that time, my wife worked in a hospital setting and she left early and she came back late at night and was tired. And when COVID hit, she was in an ED and, you know, there was a lot of unknowns as, I don’t think I need to explain to anybody. And we even, you know, because of the demands of her job, got an apartment closer to the hospital for her.

So she didn’t have to make, you know, trip late at night through country roads to get home. And I eventually, you know, yeah, I was depressed. I was, I really struggled at that point in time as it related to having been a part of something that was not just team oriented, but was felt like it was a big deal, you know, and then all of a sudden to kind of be solely focused on what I might be able to offer by way of consulting, which again, was not my strength, you know, I think I discovered the more I did it, it’s not that I didn’t have some effective engagements and enjoyable things that I did, but it wasn’t the continuity that I wanted and the relational aspects of the work that I wanted just wasn’t in that.

Anthony Codispoti: Any parallels to that lacrosse experience coming to do being the big man and the longer the big man, you kind of have to reestablish a new identity. And now you’re transitioning from one role to, you know, I don’t know what I’m doing next and kind of find yourself again.

Mike Fidgeon: I think that I think, yeah, I’ve always drawn on past experiences. So there’s no doubt there was that connection. I also think it was an appreciation or an awareness that, you know, there were, there are seasons to life and ageing is a reality of that, right? I was, I’m 58 now. And, you know, I’ve been in this job for, for, you know, almost five years. So I was 50, you know, 53 when I came to Dubuque and it was, you know, I was 50, 51 at the time that I thought after I left Providence Service Corporations Behavioral Health Business sold to Molina that, you know, I thought I was still relevant, right?

Like I struggled with coming to discover over the course of a couple years that 53, 54, at least in the work that I had done was in some ways considered, I don’t know that holds the right word. You know, I’d assume that the experience, the path, etc., would have been more highly valued than somebody that who had just completed their MBA and, you know, didn’t have that life experience to draw on. But I came in second for a lot of really great jobs, if that makes sense, right? I had, I had plenty of interest, but I wasn’t landing the big, you know, COO, CEO job that I had hoped for. And when I looked at the people that did land them, it was, you know, somebody out of an industry that either didn’t make sense or they just didn’t have the experience, etc., again, no discredit to, to organizations that I think chose really good leaders, but it was a wake-up call to me. And so I reassessed, you know, what was important and what I wanted to do.

And I think that’s where I kind of made the decision to not pursue the corporate thing and look more at, you know, getting, getting my hands dirty again, rolling my sleeves up and being a leader, but as a part of a smaller community.

Anthony Codispoti: So let’s talk about Hillcrest. We’ve kind of talked around it a little bit, but like, let’s roll up our sleeves and maybe a good way to approach this is talk to people listening. We’re like, I wonder if Hillcrest is for me or one of my loved ones. Like, give them kind of a little presentation of here’s who Hillcrest can help and here’s how we do it. Yeah.

Mike Fidgeon: So I’ve got a, I’ve got a book on my desk here that’s 400 pages long that was written by my predecessor, CEO of of 30, almost 40 years here in the seat before me. Gentlemen by the name of Gary Gansmer, still play pickleball with him to this day and he introduced me to that sport. So yeah, the legacy is amazing here. This organization dates back to 1896. It began as an orphanage and was basically the place. If you’ve been to Dubuque or you haven’t been to Dubuque, it’s on the Mississippi River Tri-State area. It’s where Illinois, Wisconsin and Dubuque all converge. One bridge you can drive across and keep going all the way to Chicago and the other one you can drive across a bridge that’s a half a mile apart from each other on the Mississippi River that’ll take you to Madison, Wisconsin. And Dubuque has a bluff. So at Mississippi River level, you’re below the bluff and then if you drive west, you eventually have to go up hills in order to get above the bluff.

And Hillcrest sits above the bluff on a seven acre campus. And back in 1896, a woman by the name of Dr. Nancy Hill basically took in single mothers who it just wasn’t fashionable to be pregnant without a father. And so they got sent above the bluff to have their children and then to come back down after things were resolved and resolution usually meant adoption. So that’s the way the organization started and over time it continued to focus on the disadvantage and the marginalized and over the years it started to spread out a little bit more into residential services, especially for delinquent teens and teens that had substance use issues. And in the 70s and 80s, just a fast forward a bit when other states were pumping a lot of money into residential care, it rode that wave. And so the facilities at one time here on campus alone had over 200 kids.

We have less than 20 on campus today. We’ve got a 70 bed facility for adults with what they refer to as a persistent mental illness or chronic mental illness that the closest thing that they’re gonna have to community based living and care is in that facility. And when they can’t be stepped down we run five person adult group homes as a way to bring them closer to community as well. So the organization and what I’m trying to bring to it is a bit of a pivot to what my experience of provenance was, which is more asset light service delivery, get into the schools, get into people’s homes, get into the community centers, go out away from your office and the campus and go find the homeless under the bridge or out in the woods and assess and approach for what it is that they need in order to solve their challenges and issues which typically involve mental health and substance use issues as well as food and Maslow’s hierarchy, right?

Housing, et cetera. So yeah, I think that’s somebody that’s coming into care here is gonna have the traditional opportunity for things like outpatient counseling and prescribing services, but we can also go to them. We deliver school services in about 10 schools here in a 10 county area in and around Dubuque. And we also have what are called a serve of community treatment teams that are those types of organizations or groups of people that go out and find people and meet them as they are and where they are in the community as opposed to having people come to us to either be in a facility or to receive services in one of our buildings.

Anthony Codispoti: So correct me if I’m wrong, Mike, but it sounds like a pretty significant percentage of your patient population is dealing with some kind of a substance abuse situation, but not all of them. Some of them have some mental health issues that are, there is no substance issue there. Is that correct?

Mike Fidgeon: Yeah, that’s true. And I don’t know off the top of my head, so I won’t even try to throw a dart at it because I might get it wrong. The national average say for co-occurring, right? How many people show up with both mental health and substance use, but it’s fairly common, right?

And chicken and egg, do I drink because I’m depressed or am I depressed because I drink? We’ll be asking ourselves that question, along with this is a glass half empty or full for eternity, but I think the cool thing is that we’re gonna meet people as they are and where they are in their journey and regardless of whether or not their mental health deteriorated as a result of substance use issues or their substance or their mental health issues led them to use substances as a way to cope for things that they didn’t have control over or felt out of place or unable, inadequate around, et cetera. And then they found a way to just be able to manage that through substances as a coping tool. Yeah, we try to stabilize where people need to be stabilized and for each person, it really depends. You start with an assessment and you develop a treatment plan and you work from there and you are really trying to help and work with people to draw out their own desires and wants to begin with and then assess what those needs are as well within the context of where they live and their family or lack of family support resources or lack of support resources and try to obtain what I used to often refer to as a minimum sufficient level of functioning for people, right?

That’s gonna vary from person to person depending on how they grew up and what resources they do or don’t have as to what stability means for them as well as for society.

Anthony Codispoti: As you think about whether it’s kind of locally, regionally or nationally, other groups that are doing similar things to Hillcrest, what do you think you guys do that sets you apart?

Mike Fidgeon: Yeah, there’s so many. This space from my time back at Providence and I’m gonna go back to 2015 because I can see our slide deck pretty well when we were selling the business. Mental and behavioral health is just highly fragmented. At that time, the number 14,000 sticks out in my mind as organizations that deliver mental health across 50 states, mental and behavioral health services and they range along the continuum from your UHS hospital systems, Acadia, some of these psychiatric hospital facilities all the way down to a small group of private practitioners that might be in a therapy office that they share together as a way to just share resources but at the end of the day, they’re really private practitioners seeing one client at a time throughout the day.

So I think that the part of the challenge in the U.S. is that that fragmentation just didn’t happen because providers and organizations designed it that way. A lot of the businesses that I’ve been a part of, Providence and Hillcrest included, have been predominantly funded by Medicaid and or Medicare dollars, so people on government assistance. And there’s been some private insurance, there’s certainly private insurance in this space and there’s self-pays and sliding scales but at the end of the day, Hillcrest is what’s known as a safety net provider, meaning that if somebody’s uninsured or underinsured and unable to buy or pay for their care, it doesn’t mean they’ll get denied care. In fact, one of our facilities that we repurposed on campus is a mental health urgent care center where you can walk in off the street and be assessed and hopefully connected to the right services at Hillcrest or elsewhere in the community. But it’s really the way that funding at the federal, state and local levels, counties, municipalities, driven by boards of supervisors, city council, et cetera, designate the delivery of this sort of safety net care that has caused it to be very fragmented. There’s, the organizations are as diverse and somewhat lack structure following the various funding which can come and go. And sometimes, as a result of various political agendas too that are out there.

Anthony Codispoti: So I talk to a lot of business leaders and while some of them say the labor market is softening a little bit, it’s still pretty tight for most of the people I talk to. So I’m always curious to better understand, especially someone with your background and developing and leading teams. What are some things that you’re finding success with in terms of recruiting and then retaining good folks?

Mike Fidgeon: Yeah, and I wish I could bring the bell on this and say, we’ve- You figured it out. Yeah, we’ve got Rubik’s Cube solved on this issue, right? If you were to ask me, especially now, not just for Hillcrest, but for businesses like Hillcrest, especially in Iowa, but it’s a national phenomenon, there’s a huge workforce development shortage, specifically in behavioral mental health care, as opposed to primary care on the medical side. Not to say that there’s not workforce and retention challenges there as well, but whatever healthcare is dealing with, behavioral healthcare’s challenges are five times worse.

Lacking technology, lacking the financial backing, the business acumen as a result of the lack of funding and money, and that drives talent, right? It’s not uncommon in my 30 plus years of doing this work that many people that work here make, on average, 35 to $45,000 a year, and that’s not adjusted on a regular basis for inflation. You need to get to your higher credentialed a licensed therapist, prescribers, licensed therapist is somewhere in the range of $60,000 to $80,000 base salary here. A prescriber might be making $90,000 to $140,000. Depending on how they’re paid and how the organization structures their work in relation to child psychiatrist or psychiatrist, which are unicorns, right?

Very hard to come by these days. So, but this phenomenon has been exacerbated in some ways by COVID and in other ways, COVID brought in telehealth, which is a double-edged sword. It allows people to expand the workforce remotely, but it also creates some real challenges in terms of people that are credentialed and could be delivering care locally, serving people outside of their own communities, if not outside of their own states in the way that that works today, and paying a premium for these, think health care refers to them sometimes as travelers that will tend to travel in order to work gigs in different localities as a temporary worker. And so the temporary nature of some of the workforce has just driven the cost up in the service industry. I would say used to be 65 cents to 70 cents of every dollar goes to payroll, we’re approaching 80 cents and up, depending on whether or not you expect a particular program to break even or be a loss leader in some way, shape, or form, or just part of a continuum of care that you have to deliver and might be delivering at a loss.

Anthony Codispoti: So thinking about sort of the big picture of the P &L, are there graded things there at Hillcrest that you’ve been able to do in terms of either driving more revenue or decreasing those expenses to help balance out the budget situation?

Mike Fidgeon: Yeah, so it’s a great question. When I came into my role here in the middle of COVID, July 2020, and the business in 2019 had shut a school that had built in 2012, which was a part of the reason that there were 200 kids on this campus at that time. So there was a natural inflection point in the business pre-COVID as a result of some changes where the school system here locally brought because of funding that they brought and their schools decided to bring the solution back and house for themselves. For us, the residential side of our business is something that we’ve focused on because there’s a lot of demand in Iowa, the behavioral mental health system at a statewide level here is rather antiquated, archaic. It’s, they haven’t built in the funding and the resources to do some of the things that I was accustomed to doing at Providence Service Corporation through the portfolio of businesses that we had that spanned 28 states and three Canadian provinces at that time. Iowa ranks pretty low across 50 states in DC when you look at some of the measures of mental health, for instance, I think it’s 51 on bed space for psychiatric needs compared to the number of people in the state. And so while my focus has been to move away from putting people in facilities and taking care of them in residential settings because Providence was really about building community-based capacity and diverting people from those types of settings or creating capabilities to step them down sooner.

So they didn’t have to be in a high cost, high restrictive setting longer than was clinically indicated or needed. Haven’t really been able to do that here as much as I thought I might be able to because the funding system and the politics and the structure of Iowa mental and behavioral health has caused us to lean back a little bit on what I refer to as kind of the cold burning furnaces that keep the lights on, right? Our residential programs, although we are seeing some good pickup on that assertive community treatment team I mentioned, getting out into the community and the schools, I do believe there’s opportunity there.

And then the middle ground is traditional outpatient and prescribing services for folks that may need a session of therapy a week or may need to have a medication in order to manage their mental and behavioral health care needs as opposed to more intensive services that may require multiple visits a week, if not some form of residential care.

Anthony Codispoti: Mike, I’d be curious to hear about a particular challenge, either personal or professional, that you’ve gone through, had to work through, overcome and some of the lessons learned going through that.

Mike Fidgeon: Yeah, is your question in the context of here at Hillcrest or how broadly are you asking?

Anthony Codispoti: It could be Hillcrest, it could be a previous job situation or it could be something on the personal front. Generally the right answer is whatever popped into your head first.

Mike Fidgeon: That’s the problem, like four things popped into my head, like I’m the master of, we’re in the problem business, so welcome problems, at the point in time of which there’s no problems, we’ve solved them all, then we’re probably out of business. Yeah, I think, let me choose one and I think I’ll distance myself a little bit from Hillcrest so I don’t get run out of town on a rail. The experience I think at Providence, I’ve talked about it a little bit, probably that doldrum period after coming out of that corporate job, there were so many of those battlefield promotion experiences, everything was new and fresh and I used to use the visual analogy of a roller coaster. You can hear the chain click, click, click in the old school one when you’re going up the hill, anticipating the ride and things are going well and it’s a rush coming down the backside of that and then if you’re fortunate, you get a few more of those ups and downs but when it needs to be repaired or brought into the shop or shut down, et cetera, those are painful times in any business and I think the upward ride and the thrill of things is a lot of fun until your hockey stick plateaus and goes the other way, right? And that’s where you’re really tested as a leader. When you have to learn what the acronym RIF means and you have to be the one that delivers that or worse yet, you feel responsible for not having acted sooner or put in place some things when the funding and times were better that you really focused and put under a microscope because you wanted to avoid that reduction in fall and force. You didn’t wanna become a smaller team. You didn’t wanna be less competitive in a particular geography. You didn’t wanna lose market share.

You didn’t want people to think that, you didn’t want your mark to be how well you managed downturns, right? But again, I use the word crucible. That’s the crucible, I think, where your greatest lessons come. I often say to people in one-on-one sessions here, the things that I think developed me the most would be the $4 million that our business lost in a contract in North Carolina. And remembering when I felt like I needed to go to the parent company CEO and say, hey, look, I know I just, on my watch, we’re owed $4 million from a managed care organization and no excuses. I can give you explanations, but not excuses.

And I’d understand if you wanted to fire me as a result of this and that CEO said, I’d be stupid to fire you right now, you owe me $4 million, go out and fix this problem. And while that was a little bit facetious, it’s really how I remember living it, right? Like, okay, that’s right. Draw on those sports things and say, hey, just because we’re down 10 with three minutes to play in a lacrosse game and we’re not gonna win it, doesn’t mean that we don’t clear the deck and say, okay, let’s compete with this team and win the last three minutes, right? And, you know, it doesn’t matter whether or not they had their second string or third, you know, it’s about how you develop that tenacity and how you learn in those processes. And I just can’t think when I think about my deepest learnings, they all came from remarkable failures or what was perceived by me at the time. And interestingly enough, when you reflected on that now as time has allowed for talking about things like that without any of the pain, you know, people that were there remember it differently, right? They remember, hey, I stayed with it. We got through it because of and fill in the blank and it usually had to do with attitude. It usually had to do with, you know, somebody having belief that we were gonna get through it and carrying that torch, you know, into really dark places and taking the lead on it and taking ownership and shielding, you know, people and finding a way to, you know, maintain people’s employment, even if it meant giving up some of the perks and the fun things to live to fight another day. So I’m full of cliches and wonderful adages, but so many of them tend to be pretty true at the end of the day.

Anthony Codispoti: Well, I could definitely tell that the grit and the resiliency that you learned through athletics has carried over well into other aspects of your life. Yeah. Mike, I’ve just got one more question for you, but before I ask it, I wanna do two things. Everyone listening today, like today’s content, please hit the like, share, subscribe button in your favorite podcast app. Mike, I also wanna let people know the best way to get in touch with you. What would that be?

Mike Fidgeon: Yeah, so my business account here at Hillcrest, I’m an email junkie and text junkie and all that sort of stuff, but you can Mike.Fidgen at hillcrest-fs for family services, fs.org is my business email here. And then my personal email is graydebbleswithinagrydebels, plural, the number 1717 at gmail.com. So just reach out to me or look for me on LinkedIn. I like to connect with people on LinkedIn as well.

Anthony Codispoti: So sorry, I lied. It’s gonna be two more questions because I wanna get voice to, what are the graydebbles? What is that?

Mike Fidgeon: Oh, the graydebbles, yeah. So bringing me back to your earlier questions and the journey that I made through Duke University. Back, let’s see, I already admitted my age at 58. So about 13 years ago at 45, I got pulled into playing Old Guy Lacrosse.

I didn’t know that Old Guy’s still played Lacrosse at age. I was actually approached by a guy at an indoor turf facility when I had some of my son’s friends and my son with me and we were throwing the ball around and the guy came over and said, you look like you’ve played before. And I said, long ago, far away. And he said, why don’t you come out and play with us? And I said, did you say player coach? And he said, I said play. And I said, do you have any, F and idea how old I am? And he goes, you look like you’re mid 40s. And I said, that’s right.

I just turned 45. He goes, yeah, I thought so. He goes, we’re a 45 plus adult league.

We play tournaments and you’re a young guy and we need you. And so I strapped the laces back up and it was phenomenal. It was a second lease on life. I’ve played 13 years of tournament lacrosse, which amounts to three or four trips a year where you go and do something you never did when you were 18 to 22 years old, which is you play four games in the course of three days. And I’ve played with the likes of Naval Academy alumni, Cornell alumni teams. And I was adopted by a group called Mr.

Bow out of Baltimore sponsored by a national Bohemian beer, right, Natty Bow. And they’re like brothers, they brought me into this. And so after doing it for a while, I decided I’d see a lot of alumni groups, the Brown Bananas, the Creaky Crimson, the Cornell Rusty Red, Syracuse, Burnt Orange. And so I said, Duke’s gonna have a team.

We’re gonna launch the great devil. So 10 years ago, next year, we’ll mark our 10th anniversary at Lake Plass in New York where we bring used to be a 45 plus and a 50 plus age group of guys. We’ve all stayed with it. So it’s now a 50 plus and a 55 plus age group we play in. And we do our best not to get hurt and not to embarrass our wives too badly.

Anthony Codispoti: Sounds like a lot of fun. Okay, on to the last question, Mike. Trace to hear about the role that tech and maybe even more specifically AI is playing or perhaps about to play and what you’re doing there at Hillcrest.

Mike Fidgeon: Yeah, great topic. You know, as I said earlier, you can probably appreciate this. I see a little bit of gray devil in your hair there. So, you know, behavioral health being, as I like to say, the Rodney Dangerfield of healthcare, right?

We just don’t get any respect. So, the tech in particular is something that costs money, right? Especially if you’re gonna innovate and stay ahead of the curve or be an early adopter. So we get kind of hand-me-downs from healthcare and other things, but occasionally, there will be folks that will target trying to solve the behavioral healthcare social worker conundrum for things like paperwork and the, again, antiquated to use that term, methods that are spreadsheet-like in nature for managing data. Electronic health records, which are used in both healthcare and in behavioral healthcare are notorious for being great data ingestors, but don’t really bring real-time data analytics out the way they should. So, whether it’s been AI technologies or some of the other predictive analytics types of things that are coming out where you feed information and there’s a repository on which the question you’re asking or the data you’ve given comes back out if you prompted the right way with an analysis across a lot of data lakes of information to bring you something really sharp and crisp and on point, I think is helping in a lot of different ways, especially, there’s a lot of note-taking tools out there now that with permission of a client, if you record a session, can give you real-time information back, how much you’re talking, how much the client’s talking, keywords they use that can help with some of the diagnostics, keywords you use that give a sense of what types of modalities of intervention you might be using, are you taking a brief solution-focused approach here or doing some cognitive therapy or other things that the practitioners are far more versed on than I am, and that takes a burden from a lot of the common pain points for folks delivering the work, which is the administrative task of not just keeping notes, but meeting a lot of requirements in a highly regulated environment that require a lot of time without the patient doing paperwork. So I think AI is helping with that a lot. For me personally, I dabble, I do a little bit more than dabble with chat GPT and the things that allow you to put presentations together and things like that because as a bit of a procrastinator, which is born out of being a perfectionist, I’m better at reacting to something that somebody gives me than just a whiteboard is hard, if you ask me to draw a blueprint on my dream home, but if you drew what you thought my dream home would be based on this hour of talking to me, I’d go, that’s great.

I’d put the deck all the way around it, and I’d put the bay window over here because that’s where the, so I can react to things better than I can build them. And I find that AI is a nice tool like that. If I’ve got a vision enough and put it in there, it can affirm things, it can make me think about it differently, but if I’m at an absolute blank, but I know how to prompt it, it’s pretty amazing to me when I’ve tested it just with my 30 plus years of knowledge in this space and asking it some stuff that I would think that you’d have to have lived in this to know this and ask it for a top five or an outline or something.

I’m like, yeah, that’s pretty good in terms of, however, the great and wonderful wizard is, or the Willy Wonkinator is pulling that information from the backside into something that resembles intelligence.

Anthony Codispoti: Years ago, a different venture of mine, I had a phenomenal copywriter that worked with me. And it was kind of similar to JetGPT and the way that you’re describing it is she would give me something to start with.

And it was like, oh, great. This is kind of what I had in mind, but let me sort of mark it up and give you some feedback. And at first it was really hard for her to receive that feedback because she took it as me being very critical of her work. And I had to tell her, like, you have done so much for me to give me something to start with. It would have taken me hours or days to get to this point. I said, what you’ve done is phenomenal. Like you’re just helping me sort of take it to the next level.

And now, right with JetGPT and Claude and some of these other platforms, it’s the same kind of thing, but on steroids, right? I don’t have to give her a project. And she goes away for hours or days and then comes back with something that I can then mark up. JetGPT did that for me in the course of seconds or minutes.

Mike Fidgeon: Did you just say, Claude, was that one of the ones? Claude.

Anthony Codispoti: Claude, I was going to say, my wife bought me for Father’s Day this year, the Claude note. And it’s just a, it records, right? If I had it running

Mike Fidgeon: here, certainly wouldn’t run it without your permission, but let’s say I had it running here, I could get a transcript, I could get a note summary, and I could get a mind map of what we’ve just spent an hour talking about. And I use that for different meetings, whether it’s one-on-one or weekly team meetings. And the nice thing is I can then go grab that whole transcript if I want a lot of content or the notes and I can throw it at JetGPT with a prompt. And based on this discussion around strategic planning, knowing this about Hillcrest, and I’ll inform it what I want to know. And we’re wanting to go in this direction, outline a strategic plan for the next three years and identify the barriers to success as well as the strengths we can build on. It’s like, again, what it puts out to me, I’m kind of, yeah, it would take me, I would get there, but I wouldn’t get there in 20 minutes. It would be like six months.

Anthony Codispoti: And you’ve probably been on a Zoom call, either you use this or you’ve seen other people who use it, they have a note taker that joins. And you can feed that note taker sort of prompts. So like, hey, this was a sales meeting. So I’m gonna want this kind of feedback or this was a team meeting where we discussed ideas. So I’m gonna want this kind of summary and feedback.

And so, yeah, after the meeting is over, it summarizes what everybody had to say. It gives you whatever sort of response to the prompts that you had filled in there. And it has like all of the to-dos, like the next steps that were mentioned. And it’s just, yeah, it’s such a tremendous time saver. So what we’re talking about with Hillcrest and sort of the clinical setting, having folks be able to take what was a very, you know, a time intensive process to take notes and then, you know, have to put them into some sort of a form after the fact so that, you know, you’re filing all the state requirements, the federal requirements and all of that.

And now, you know, be able to just have that meeting be recorded and then fill in most, if not all of that for you, so that you can spend a lot more time with the patient, right? I mean, that is, we’re getting there. And once we’re there, this is gonna be huge. Yeah, yeah, absolutely.

Yeah, so it’s gonna be fun to follow. Well, Mike, I wanna be the first one to thank you for sharing both your time and your story with us today. I really appreciate it.

Mike Fidgeon: Yeah, thank you, Anthony. I appreciate you inviting me to be a part of this.

Anthony Codispoti: Folks, that’s a wrap on another episode of the Inspired Stories podcast. Thanks for learning with us today.

REFERENCES

๐Ÿ”— Connect with Mike Fidgeon:

๐ŸŽฏ Special Thanks to Anthony Codispoti & AddBack Benefits Agency

๐Ÿ“„ Transcript Available: Building Championship Teams in Healthcare: Mike Fidgeon’s Leadership Journey

๐Ÿ“บ Watch on YouTube: Inspired Stories Podcast by AddBack Benefits Agency