Joey Wahler (Host): It's an often overlooked topic. So, we're discussing healthcare leadership in a correctional system. Our guest is Dr. Sam Soltis. He's a retired Deputy Director of Health Services for the South Carolina Department of Corrections. Dr. Soltis also serving as ACHE's liaison to the National Commission on Correctional Healthcare, and he is winner of ACHE's Lifetime Service and Achievement Award.

This is the Healthcare Executive Podcast from the American College of Healthcare Executives, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, please visit ache.org. And a reminder, you don't need more tools, you need results. Med-Metrix helps health systems deliver solutions that turn revenue cycle management into predictable yield end to end or where you need it most.

Find out how at med-metrix.com. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Soltis. Welcome

Samuel Soltis, PhD, LFACHE: Thank you, Joey. Appreciate it.

Host: Absolutely. So first off, we have to start with congrats on winning ACHE's Lifetime Service and Achievement Award. So, what does that honor mean to you?

Samuel Soltis, PhD, LFACHE: Well, thank you very much, Joey. I really appreciate it. it was truly an honor, and I was very humbled when I received the word that I received this award from ACHE. And it especially was very meaningful to me because it was represented and given to me by colleagues and other healthcare leaders, and that meant a lot.

And upon receiving the award, I kinda started to look back on 34 years of my career in service across healthcare, and I realized that this award is also because I had the privilege to work with so many wonderful individuals, from doctors to nurses to board members, staff, students. But I can't stop there. I have to also thank God for the gifts that He's given me, and especially to my wife, Maureen, and my family for all the support and encouragement they gave me throughout my career. So truly, this award is representation of all the people that invested in me over the years.

Host: Very well said, Doctor, and I'm sure they all appreciate you recognizing them as well. So, what would you say more so than anything else initially led you to a career in healthcare?

Samuel Soltis, PhD, LFACHE: Well, this really started very early on in my undergrad studies at Oral Roberts University in Tulsa, Oklahoma. I volunteered at their City of Faith Hospital as a patient escort, and that allowed me to see hospitals from the inside. And what I saw was departments, patients, patient care providers all working toward the same goal, and that was for patient care. And I wanted to get a profession that allowed me to help people, to provide leadership, and to be able to problem solve and also have an impact on healthcare delivery. And so at that point, I realized that healthcare administration would allow leaders to help clinical people such as nurses, physicians, staff to help treat patients and make healthcare better for them.

So, this early experience that I had in college really helped me to see that healthcare wasn't really just an industry, but it was a mission. And that's why healthcare administration became more than a career to me. It really became my calling. It set me on a path that ultimately led to a 34-year career in healthcare leadership, and it's a decision that I never regretted. And simply, I wasn't just looking for a job, I feel I was looking for a purpose.

Host: And so indeed, in finding your purpose, your calling, as you say, and how wonderful that you did find that. So many people don't. Those that do are certainly very fortunate in this life. How did you come to the realization that correctional healthcare would be your specific direction? Because as you well know, it's certainly not the healthcare path that's most often traveled, if you will, right?

Samuel Soltis, PhD, LFACHE: That's very true. Like many healthcare leaders coming out of grad school after getting their MHA, you're presented with a lot of career options, career paths, mostly hospital administration, nursing home administration, or consulting. And that was what it was when I was coming out of school. Healthcare administration and corrections, not even on the radar. Never even heard about it. So actually, like most people, you end up doing it by happenstance.

So me, I started out my career in hospital administration. And that path led me through hospital strategic planning, business development, onto nursing home administration, dialysis administration, then into Department of Juvenile Justice in South Carolina, and into adult corrections in South Carolina.

But each of these roles prepared me for the next one. And how this all came about to get into correctional healthcare, Maureen and I were married in the year 2000. I was offered a job and an opportunity in Columbia, South Carolina to be an area administrator for dialysis. After two and a half years, it wasn't really for me. I didn't like it. started looking for another job. And I had a friend who was a nurse at the Department of Juvenile Justice in South Carolina. And she said, "Hey, they're looking for an administrator to take over their healthcare in the department. You'd probably do very well. And if you're interested, I'd apply." I did. I got the job.

And when I got to the juvenile department, I realized that these juveniles came from very, very troubled backgrounds. They just didn't have access to healthcare, whether it was because they didn't have financial resources in their family, their family situation. And because of that lack of access, a lot of them had never even seen a physician or a dentist prior to coming into corrections.

So, I realized I could have a real impact on helping their healthcare needs and helping them when they were released, that they would have a better understanding of how to take care of themselves. And not only that, as you work there, you realize you may also be able to impact their lives for when they get out.

And if I may, I'd like to tell you a little story about how that all came about. Our agency director, after a year when I got there, he came in based on a new election, new governor, and was appointed as the agency director at the Department of Juvenile Justice, and his name was Bill Byars, and he was a family court judge, and he came in and took the agency over, and he did not want to see these juveniles looked at as inmates.

So, the first thing he did was take them out of jumpsuits and put them in khakis and polo shirts. He wanted to treat them as youth, not as criminals. And the other thing he did, which helped me to see a lot of this, he implemented a lot of things that they could do. They did upholstery, they did woodwork, they did metalwork And he would invite them every month to our management meeting of about 100 department heads and managers, bring in the juveniles, let them display what they had made and explain it to the management staff in front of these people.

None of them had probably ever done public speaking or anything like that, but he just brought them and you could see the juvenile self-esteem just elevate every time they did this. And I realized, you know, you could really impact the lives of these people and these kids. And one of the things I did that helped with this is I was able to collaborate with Clemson University and their phys ed, their nutrition department, and we brought to a health fair every year down to the prison for the juveniles. And what that did, it not only taught them nutritional value and the needs and exercise, then they also had some fun during that time as well. So, again, being able to impact them when they left.

But then, after that, eight years go by and our director, another election takes place, another new governor, he gets asked to move to the adult corrections department. Soon as he gets there, he calls me and says, "I want you to come over and head up the healthcare system in the adult corrections." I accepted that job. And when I got there, I realized these inmates weren't much different than the juveniles, except their healthcare needs that were not met were much more severe, much more intense. And they had mental health needs that were significant. They may have never received consistent care from a physician or a dentist. Same type of thing, just to a higher degree and higher level. And a lot of them had chronic diseases when they came in because they hadn't taken care of themselves in earlier in life.

So, correctional healthcare really became much bigger for me. It became bigger than prison medicine. It became a way to affect public health, a way to improve lives, and an opportunity to improve communities when the inmates got released because we were able to diagnose their needs, treat their chronic diseases, improve their mental health, and provide preventative care. And these are things that go way beyond prison walls that you're having an impact on. So, I realized that point, healthcare wasn't simply where I worked in a prison, it was where really I could make the greatest difference.

Host: Absolutely. And you mentioned, Doctor, that one initiative with Clemson that you were behind. So during your time in correctional healthcare, any other key initiative or program that you're most proud of for helping develop?

Samuel Soltis, PhD, LFACHE: Ah, yes. There are several, but I'll try to just give you a couple. But my philosophy was always to build partnerships and collaboration. it's all about relationships to me. Leadership is about relationship. And in healthcare organization, you can accomplish so much more together than you can alone.

And some of the things that we did, and I'll just give you a couple examples, I would really collaborate everywhere I was with my leadership team and my staff. That was a key. And when I walked into the Department of Corrections, just to give you an example, we had 25 prisons across the state, 25,000 inmates, and seven doctors. Now, that is not enough to take care of those amount of patients, obviously. I had a great medical director that I built a great rapport with and great relationship. He and I collaborated and started to brainstorm, "How can we get more physicians?" Again, because a lot of doctors don't want to work in corrections.

So, how do we do that? Well, one of the things we did was we collaborated with the University of South Carolina School of Medicine, and they helped us advertise, they helped us market, and they helped pass the word through their physicians and in their school as well.

When I retired, at that time, we had 20 physicians, multiple PAs, multiple nurse practitioners and, again, physicians from the USC School of Medicine and specialties came in to work behind the fence in our specialty clinic. And that helped us, because we didn't have to transport inmates out of the prison and beyond the fence. So, it helped our security department because a lot of people don't realize when you move somebody out, two security officers have to go with every inmate, and that reduces the security in the prison, and taking them out also increases a risk to the community for possible escape, et cetera. So, that was a big collaboration that we did. I also collaborated with the USC School of Infectious Disease Department. I collaborated with the South Carolina Medical University in Charleston, collaborated with the Department of Health, and I'll get into that one a little later, and Clemson, as I had said earlier.

Some of the accomplishments that these collaborations provided beyond the physicians, infectious disease was probably one of the biggest that we did. I was able to collaborate with the School of Medicine, with their infectious disease department, and a lab director that I had who her passion was really infectious disease. As much as she was in lab, she loved infectious disease. And so, we had a lot of that in the prison. We had four thousand inmates with hepatitis C, we had several hundred with HIV, many with tuberculosis. And so, she came to me and said, "You know, I really think we need a department." And I had sat down with her, we brainstormed it with the infectious disease department at USC. Their physicians got on board. She took the ball and ran with it, presented a plan, and we implemented a department within the prison. And just as that happened, the medications known as Sovaldi and Harvoni were approved, and those were medications that helped to cure hepatitis C. We were just treating with passive treatments that we could try to help them, but they would eventually die of cirrhosis of the liver. These drugs actually cured them.

However, our obstacle was the cost was $80,000 per inmate for a twelve-week regimen of medication. In a prison, we couldn't afford $80,000 for 4,000 inmates that we had with hep C. The cost was exorbitant. So, we collaborated with the Department of Health. I found someone in Florida that told me how they did it. And so, we went back to the Department of Health and said, "We've got a plan. Here's how they did it in Florida." We implemented that. We were able to purchase the meds through them at least 50% to 70% reduction in cost. And we tried it out on five patients, and believe it or not, they cured those five patients.

So then, we just started to tier the patients in the priority level of severity and began treating them. And to this day, they're still doing that, and I thought that was a very, very successful accomplishment that we did. How we not only reduced what the risk would be to the public when they were released, because now they were cured.

Host: How exciting, huh?

Samuel Soltis, PhD, LFACHE: Yeah. And one more that I'd like to tell you about if I can if we have time.

Host: Please.

Samuel Soltis, PhD, LFACHE: We implemented for the first time ever an in-house hospice department at the prison. I had another staff member that was extremely passionate about hospice. It was her background where she came from, and she was seeing a lot of these inmates with terminal disease, terminal illness, dying in their cells. And it's just such an inappropriate way for someone to spend their last days. And she came to me and said, "You know, I think we can do better." And she took that ball and ran with it, and we together put a department together. She trained the nurses, she trained the inmate staff who became inmate workers and sat with the patients and became friends to them. And she developed an area where she painted the walls a different color so they were calm and relaxing and soothing. She put different beds in and just made the environment so much better for these patients to live out their last days. And really, it's my belief that every person deserves that dignity and compassion and comfort during their final days, regardless of their life circumstances.

Host: Doctor. as mentioned earlier, correctional healthcare is often overlooked, including as a career path for healthcare executives. So, what are some common misconceptions about the field, and how do you then encourage leaders at different stages of their careers to consider such work as you once did?

Samuel Soltis, PhD, LFACHE: Sure. Well, Joey, there certainly are misconceptions that people do have about working in this environment. And one is people feel it's a dangerous environment. And then, others feel that you have poor quality healthcare in prisons. Executives, I believe, look at it as a dead-end executive career path, and that there's little opportunity for innovation.

And in my experience, it was exactly the opposite. I found this to be one of the most challenging environments that I ever worked in. And for a leader, I find it very challenging. It gives you a lot of opportunity for innovation and a lot of other opportunity to collaborate with others to come up with decisions. You have an opportunity to oversee an entire healthcare delivery network behind the fence, which is very unique. It gives you an ability to increase the healthcare of a very underserved population, in my opinion. And it has a significant public health impact as well.

So, I would say to these people, don't judge correction healthcare by its stereotypes. Judge it more by its mission, the opportunities that it presents, the impact that you can have, and the service that you can provide. To me, correctional healthcare challenged me every single day that I worked there. And, ultimately, it became really the most fulfilling part of my career.

Host: And I want to pick up on that, Doctor, because naturally correctional healthcare offers a very unique patient population to say the least. You touched earlier on how part of this for you was all about offering the same healthcare and compassionate healthcare despite these inmates being in a far different situation than usual. So, how did you approach that? How did you manage to try to provide the same service and compassion in a far different setting than healthcare providers are accustomed to? How do you pull that off?

Samuel Soltis, PhD, LFACHE: My philosophy working there was you always see the person before you see the inmate. Healthcare professionals are there not to judge, but to provide care. So, you know, you look at these inmates, and many of them never had healthcare in the life outside of prison, and that was due to many reasons. Some had very, very limited financial resources, which also provided a limited access to care. And because of that, they didn't get consistent physician care. Some never even saw a physician. Same goes with dental. A lot of people never even saw a dentist before they hit prison doors, which is very unfortunate.

So for me, it became an opportunity to treat diseases for these people, improve their healthcare, to educate them. A lot of them didn't have any background or education of their own how to take care of themselves, and to restore their dignity, by restoring their health. So to me, the leadership responsibility is to create a culture of compassion and professionalism that should be expected every day in your organization.

I think that that lesson applies to no matter what healthcare setting you're in, whether you're taking care of a patient in a hospital setting, a nursing home setting, a dialysis setting, or a correctional setting. Every patient wants the same thing when they're getting treated with healthcare. They want to be treated with dignity, they want to be treated with compassion, and they want to know that someone's listening to them and that their wellbeing really matters. And so to me, the greatest healthcare leaders create cultures where those values are really played out every single day.

Host: And you did a great job there, Doc, because you actually gave me a two for one there answering what would have been my next question, which is, how do you apply all of that philosophy to healthcare leadership in general? So, switching gears now a little bit. How would you say ACHE and your local chapter support your career and professional development? How about that?

Samuel Soltis, PhD, LFACHE: Well, ACHE was a part of my career from the very, very beginning. When I was doing my master's at Ohio State in Healthcare Administration, we were encouraged to become student members, and I did become a student member while I was there, and took that membership and did the advancement process with American College right on up to fellowship. And now, I'm a life fellow. So, it's been with me my whole career. No matter where I worked, I was involved in local and state chapters for the American College. I attended the annual congress in Chicago as often as I could. And I learned very early on that ACHE wasn't just a professional association, but it was a group of people that were leaders in the community, committed to learning, and really served and helped each other.

I did find ACHE to have a lot of career benefits for me. One was continuing education. It provided a great amount of continuing ed. The networking that you were able to establish, especially with your local and state chapters, because people were facing the same issues, where we worked, and you were able to bounce ideas off one another and network and have a relationships with one another that you could tap into.

It provided leadership development, ability to share ideas, and I think it provided lifelong friendships, professional friendships, which are today still invaluable. But it provided one other thing for me, Joey. It provided an opportunity for professional service. And what I mean by that is I got approached by ACHE and the National Commission on Correctional Healthcare to represent ACHE as their liaison on the NCCHC Board of Representatives. That was a multidisciplinary board, about 30 to 35 members of all the largest associations in the country. The American Medical Association, American Nurses Association. You name it, they were there. And it was really one of the greatest privileges of my career to do that for 10 years for ACHE, and it helped me in correctional healthcare as well. I served on multiple boards, multiple committees for NCCHC while there, and I even helped to establish a subsidiary for them for technical assistance for prisons and jails, which was a great accomplishment for them.

Probably about my fifth year into the NCCHC board, I was elected the chair of the board. That was a great honor to be selected by your peers to chair the board. And my initiative while I was chair was to encourage students and young professionals to consider correctional healthcare as a meaningful career path. At that point, I worked very closely with Deb Bowen, the CEO and president of ACHE. She had great ideas on how to get this information out to students and young professionals. And with her ideas, I went back to NCCHC and we implemented several of them. I was able to work with the board of directors and with the staff at NCCHC, and I worked with the NCCHC Foundation board, and we created scholarships for students and young professionals to come to the NCCHC annual conference every year free of charge.

Then, I also worked with the board and the staff to create webinars, career webinars and blogs, career blogs that we put on the NCCHC website, primary targeting young professionals and students. And finally, through the board, we were able to do student panels at our annual conferences for NCCHC, and that began to provide college outreach. And I'm proud to say that these still continue today.

Host: And speaking of today, in helping to bring you to this point, who are some of the healthcare leaders that influenced and inspired you along the way?

Samuel Soltis, PhD, LFACHE: There was certainly one that was the most probably the most tremendous impact on my career, and it was early on, right in the beginning, and his name was Tom Saxton. He was the CEO of Wilkes-Barre General Hospital in Wilkes-Barre, Pennsylvania. And he took me on in a residency between my two years at Ohio State for a summer residency.

And then, after that summer residency, when I graduated from Ohio State, he offered me a two-year fellowship to come back and work at the hospital for two years as basically a training, as an administrator. And then, following that two years, he offered me my first career, executive opportunity. He hired me on at the hospital.

And the learning experiences that he put me through were just invaluable, beginning with rotating me through every single department in the hospital from top to bottom. Even working with the nurses on their days, evening, and night shifts, and weekends to show me that a hospital wasn't just a day shift job, it was a 24/7 operation. And then, during the fellowship, he would take me with him and provided me access to all the board meetings, the medical staff meetings, executive meetings, community functions. Wherever he went seemed I was going with him, and that was truly invaluable. We'd have weekly mentoring sessions every week. He'd sit me down in his office, and that was just a time to debrief and talk about what happened, what questions I had, and then he'd pose questions to me. And that was such a great learning experience.

And there was one in particular experience that I'll never forget, and I tell people to this day, I tell this story. He came back from vacation one week and he sat me down in our session and he said, "You know, Sam, I've been gone for a week. Nobody missed me." And I'm thinking to myself, "You're the CEO. What do you mean nobody missed you? Of course, we did." And he said, "No, I'm serious. Nobody missed me. But you take the guy that works the boiler room, take him out for a week, everybody in the hospital is going to miss him." And so, that taught me that everyone in the institution matters, from environmental services right up to the CEO.

And another lesson I learned from him was just walking around with him, being with him in all these different opportunities. Even walking the halls of the hospital, he would greet staff by their name. He would ask them about their family, their children, their grandkids, their vacations. He knew things about them.

And as I talked to the staff without him around, they would just tell me how much they respected him and how much they liked him because he didn't feel he was above them not to talk to them, not to be interested in them. And I really learned at that point, you need to learn your staff's names, you need to ask about their families, and you need to build relationships with them as well and respect everyone in the hospital or everyone in your organization. So, was the biggest impact for me, and he impacted my mentoring as well.

Host: Very well said indeed. And speaking of the word mentoring, Doc, who are you mentoring yourself today? How about that?

Samuel Soltis, PhD, LFACHE: My mentoring really always began with my leadership team. I always like to mentor them wherever I was, whatever job I was in, and young administrators when I had the opportunity. And one opportunity I really enjoyed, after I got my PhD at the University of South Carolina, I was offered a role to adjunct teach in their MHA program, and I got to mentor those students, which was just a great experience for me.

Their passion for the profession. They were new, young, and eager, and that was really, really great. I like to help people discover their strengths. I like to help develop them and empower them and encourage them, and I like to help them reach their potential. And that's what I try to do every time I mentor, and then give them opportunities to succeed. Because to me, one of the greatest satisfactions of a long career is to see the people you've mentored become successful leaders. So, I always say to myself, "If I can be able to pass along even a small part of what my mentor, Tom Saxton, gave to me, I'd consider that one of my most meaningful accomplishments in my career."

Host: Well, you led me beautifully there, Doc, into my next question. Just a couple more for you here, starting with this. For those just starting out in healthcare leadership, what advice would you offer? You've done such a great job of touching on various things along those lines. But if you had to put an overall bow on it, what's the most important piece of advice for people starting out in any walk of the industry?

Samuel Soltis, PhD, LFACHE: Well, I would say it all starts with relationships. I would say you've got to build the trust with your employees, your physicians, your board members, your community leaders, because these are going to become your greatest resources, especially in times of trouble or difficult times. I would tell young leaders, never stop learning.

Find yourself mentors like I did. Continually read, attend conferences, stay curious, always want to learn. And in doing that, remain humble. Ask questions. Ask questions of your staff. Don't be afraid to learn from people around you. People that do the work usually have the best solutions to your problems, and I found that most of the time the greatest things I implemented were their ideas. So, don't be afraid to do that.

And I would say value everybody's contribution, but never ever think you have all the answers, because you don't. And leadership, like I said, is continuous learning. I'd say looking back on my career, certainly your technical skills, your education, that can open doors. But truly, your character, your humility, integrity, and the way you treat people are how you're going to be remembered and your legacy as a leader will be remembered.

Host: And no question, it's the person behind the resume, right? So in summary here, now that you're retired, what is next for you?

Samuel Soltis, PhD, LFACHE: Well, beyond improving my golf game now that I'm living in Florida, it really opens another chapter of service for me. I plan to really go and speak to high school students at their job fairs or in their classrooms. I do have an opportunity that that may present itself that I can do, and I'd like to introduce healthcare administration to them as a career path, but in particular, correctional healthcare administration.

I also want to volunteer at my church and help mentor young people there and continuing service and encouraging wherever I can. So to me, retirement's not the end. It just provides another way for me to serve.

Host: Very well said. Well, folks, we trust you are now more familiar with healthcare leadership in the correctional system. Dr. Soltis, really a pleasure getting to know you during this discussion, and congrats on a great career, a unique career. And such a great job of eloquently describing everything that went into it for you, particularly more than anything, the passion you've had for it that comes right through. Do enjoy retirement. Hit them straight, as they say. And thanks so much again.

Samuel Soltis, PhD, LFACHE: Thank you, Joey. I appreciate it.

Host: Same here. For more information, please visit healthcareexecutive.org. If you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of the Healthcare Executive podcast from the American College of Healthcare Executives.