Distinguished Speakers Series: Kent Thiry, DaVita

Wow, after that introduction I don't think there's anything left to talk about, is there? Going downhill, very nicely done, so.

Damn, these are tough questions already. I would, I would say what we believe at the village is that we're sort of sharing life's journey, the continuous process of growing as a human being and hopefully as a leader. Given the kind of roles that so many of you will play and so I would hope that we've provoked a few thoughts in all directions as to how we can accelerate our stumbling down that path.

Yeah I think what I would say about DaVita's experience with intrapreneurship is that we're a persistent, sort of tenacious B at this point. I don't think we're a role model for success, nor have we failed to try or failed in each try. And I think to create and sustain a sense of intrapreneurship is a bit of a journey in and of itself, because there's a lot of internal pressures that make it difficult. And so we are fervent believers. We think it's terrible to create a big company that then has to survive by buying other big companies. It's terrible to become a big company and be too narrow, so that you cannot sustain growth forever. And so we think it's a absolute strategic imperative to get good at intrapreneurship. And so many companies don't, which is why they go away. They go away because they can't attract the talent. They go away because they don't develop the new services, or they're overpaying for them because they have to buy them too far downstream. So we believe in it passionately, and we're hoping to improve our grade from a B in the next decade.

Yes and no. The no in that we are absolutely passionate about delivering integrated care to every patient we touch, and we started doing it before it was cool in America, and we'll never give up on that. Having said that, whenever you have a string of disappointing earnings performances, you need to stare at why. In this particular case, 80% of the difficulties come from reimbursement cuts. And so our issue was in appropriately handicapping and forecasting reimbursement cuts, as opposed to running the business differently. Where our clinical outcomes and our economic outcomes for society continue to be outstanding, but we've got to adjust the cost structure given the dramatic contraction in reimbursement, which affected us disproportionately for reasons I won't torture you with. But it's actually quite remarkable that we've sustained what we've sustained, given the massive cuts we've taken. But change in general strategy, no. Change in operating strategy, of course, because we have to address the cost structure.

Yeah, I would give a sort of a two-part answer. One is, I was raised in a small town in Wisconsin, and so I've actually lived in a community. And I think some people who are raised in certain environments nowadays have never actually lived in one, and that sense of citizenship, and that you're kind of in it together, and the community cares about the community, and people feel some allegiance to the community. That's how I was raised. It was a community of only 12,000 folks. And so I think that was pivotal, because I think communities are very different from just sterile collections of people. And you can have two blocks in a suburb, that they look exactly the same. They're socioeconomically the same, demographically the same. In one, the neighbors care about each other and watch out for each other's kids and watch out for suspicious people and respect each other's property. And another one where they don't even know each other's names. And so something creates a community. So half was, I think, just how I was raised and how I appreciate the power of community. But second was conceptually that I believe that CEOs and companies should feel an immense moral responsibility to help take care of the people that work in their enterprise, and add value to their lives beyond a paycheck. And in fact it's this beautiful reality, that there's so much good we can do for the world just by creating a better place to work, separate from what you do on charity boards and separate from your philanthropy. And in our case, separate from what we do to take care of patients. It's an amazing opportunity to achieve your net worth ambitions while doing good for people by being a differentially healthy place for people to work. And in searching for the language to do that, it was about 18 months in that I realized just talking about mission and values and more abstract concepts of social contracts wasn't cutting it with, now we have 20,000 technicians that make 15 bucks an hour. There was nothing wrong with that, but when I would ask people, how do people behave in a healthy community, every single person could give an articulate answer. They had never been to college, had never talked to a CEO before. Everybody could say, well this is how people behave in a healthy community. And so I came back for some trips where I was just talking to a lot of teammates, and announced to the board of directors that we were now a village and my title was mayor. And they almost fired me, 'cause they thought I'd finally really lost it. To be honest I was quite nervous in starting to use the language, because it was so weird. And now it's totally common. I mean if you come and walk our hallways, you'll hear the term 'village' used 10 times as often as you'll hear the word 'company.' And you'll hear me described as the 'mayor' five times as often as 'CEO.'

Well half, I probably didn't figure it out. I was still stumbling, and when I was at Bain I was regarded as a strong team builder, but at that point for me team building was the means. If I created a better team, they would do more work, they would do more motivated work, they would do more for the client. We'd all get bigger bonuses, get promoted. So I was regarded as a good team builder, but it was the means, and better business outcome was the end. And then somewhere along the line, as I started to work subsequent to that in running companies, I flipped, where profit became the means, business success became the means, and the end became having a positive impact on the world. You do almost all the same things in either case, but texturally is very, very different. And so I think I was just stumbling, and it evolved and emerged as opposed to showing up with a plan.

I mean I'll probably stumble on this one and you can redirect. First of all, the way we think about it, getting the most value from leadership is in our lives. This is the way we should live, mindful lives where we care about our values and how we behave. We believe the biggest value is in that. And then of course we know derivatively, if people are happier and there's more trust, you'll have more productivity, you'll have better clinical outcomes, you'll have higher retention. So we get that, but that's not why, it's just like you don't want you to teach your kid a lot about how to live well and work hard in school just because you want them to have a higher income. You want them to have a good life. And of course you also aspire for them to have a solid income. So I think in terms of where we get value, I think it's mainly that. And I'm forgetting the second part.

Well there's probably a false premise loaded in that question, which the people that have worked with me for a while here can say. He can talk about it, but he sure as hell can't do it. But don't say that right now because I flew all the way here. I think when you have got lots of weaknesses, but, what I understand, people's sense is that I'm relatively sincere about caring about the people that work at DaVita. And I'm persistent in trying to work on ways to make that better. And so they cut me a lot of slack when I mess up, either in a business way or a behavioral way. Because at this point a whole bunch of 'em trust my intentions. And not in some naive fairytale kind of way. You can't pay everybody what you'd like to. You can't ignore the fact that sometimes you buy and sell things and all the rest. So we don't pretend, just like if you're a mayor of a village, there's times you have to tear down homes to expand a road. There's times you got to change zoning in a way that leads to issues for people. But it's all part of protecting the village. So I think where I get reasonably good scores is on basic intentionality.

Who gave him all this stuff? This is really good. I've had 360 done every 12 to 18 months at my request with an outside consultant, who comes in and and collects feedback. There were a couple things. You get a 360, you change right away, you're appalled at facing certain behaviors. And then there are other things. When I took this job I was 43, there's other things that are more deeply ingrained in you. And to attack them, for me I had to get quite serious. So for some of them, like the ratio of the negative feedback to positive feedback, which, I had a very good ratio with more junior people, and the more senior you got, the worse my ratio was. And so I really had to think about why that was. And I tended to have unfair expectations for people who got paid a lot, and I thought that we just all had to be relatively ruthless in working on getting better and better and better, because it's what we deserved, given what we were differentially paid. But that was the totally wrong paradigm, because the senior people were good people too, and they needed a reasonable ratio. And for a couple of these areas I had to give myself a daily score. Because the analogy I always use, it was like an alcoholic. My brother is 13 years sober now. In the beginning he had to win that battle every day. And so I had to give myself daily scores so I could crack the habit of doing the negative feedback. And had to force myself to explore why I was doing it, as a part of that daily journey. Because it was a deep enough issue, I was not going to just suddenly have an epiphany and behave better. I would behave better for four weeks after the 360, and then I'd regress to my prior level.

Unfortunately it was not of the strategic variety. No, I think I felt... the pressure I felt for the organization to succeed, and because the organization's succeeding was required in order to be able to do profit sharing for people to continue to grow, to sustain and retain the great leaders or good leaders, the rest. And so when.. I would have too short a fuse and saying oh my god, this kind of stuff could put everything at risk. And so anger was a grotesquely inappropriate reaction, but nonetheless one that I would have. And it took years to, in a couple of these areas now I get much better scores than I used to. Because I still get them checked every 12 to 18 months. But it was a real journey to get there.

I might go backwards for one second on the anger thing. And tell a little story, because I think it gets to, again, once you start achieving certain positions with certain responsibilities and authority and the rest, in my case we had 10, 12 years, where we were a very, very high-performing company from a stock price point of view and clinical differentiation and other things. And in that situation, the CEO becomes quite powerful. And it's easy to also there forget, a little bit numb to the criticisms that might come in the 360, because you kind of go, other people don't get the pressure that you're under. And all the rationalizations you might do and the stress that you feel, and all the rest. And there's a limit to how much people will push, because at that point you're just at the peak of your sort of perceived and actual power and efficacy and the rest. And so I felt, a time or tow, that was when I was worried I was not intensely enough pursuing my own personal growth in those realms. So a couple times I took my 360 back and gave it to my parents, my wife and my kids. And that was particularly humbling, which is what I was worried I needed. And the one story I sometimes tell is I gave it to my daughter, who was 13 at the time, Christina, and she's now 27, and she read it and came back downstairs and said, 'Daddy, I read the report.' And I said, 'Okay honey, what did you learn?' And I was hoping she was going to say, Daddy, they say you're a strong leader and they say they like working with you and they say they're proud of all the village's accomplishments. And she didn't say any of that. Instead she goes, 'Daddy, I don't get it, because you tell us that if someone does their best that's what counts in life. And in here it says sometimes people do their best but you're disappointed and you get angry with them and make them feel bad. So what's up with that, Daddy?' You know, my jaw kind of drops, and I'm staring at my little beloved daughter and I'm asking myself why in the hell I gave her the report. And finally I said, well Christy, Daddy just hasn't grown up enough yet in that way. And now she's totally befuddled because she says you're older than the hills. And my understanding is they let you run the place, and you can't even behave the way you tell a 14-year old. A 13-year-old. Anyway, I think, keeping yourself on a growth trajectory requires having people around who will be very objective with you, and sometimes requiring very structured programs of self-awareness, at least for me. On to the uniform. It was not intentional. Well I... half and half. Once we decided we wanted to be a community first and a company second, we sat down like you would if you were doing a project or in in my parlance if it was a Bain case team working and saying, okay we want to create a differentially healthy place for people to work that feels like a community. Because a community doesn't have to be a geographic area. Community can be a religion, it can be a tribe, it can be a book club, it can be a family, it can be best friends. There's certain attributes of what represents a community. And we want to be a community first, company second. And we established sort of five, six pillars, which I still have the slide, of what it takes to create a sustainable community. And one of the boxes was language and another was traditions, rituals et cetera. That's what healthy communities have. And so the notion of having some of our own phrases and words made a lot of sense to us, that's what healthy cultures do. And then it was just by chance that for the very first meeting... The first nine months of my time at DaVita, we woke up every morning knowing that if a single bank asked for a single dollar we were bankrupt, because we couldn't pay. We had broken every covenant, we were close to missing payroll on 8,000 people. So every day for nine months that's how we woke up. Nonetheless, we started from day one, working on this notion of creating a special place to work. And so we had the first time where the top 110 people came from around the country. And we were at the Crowne Plaza in Redondo Beach, California, and that night we had our first dinner. And I'm meeting all these people for the first time, except for maybe the 15 that were at corporate, on the second floor of a Cheesecake Factory where we had the dinner, that's all we could afford. And at the last minute, couple days before, I said, go buy, at that point, some costumes, because I'd recently seen a movie called The Man in the Iron Mask. And I said we're going to need a skit, it's going to be a pretty brutal day. We're going to go over our financial situation, we're going to talk about the the dream of creating the greatest dialysis company the world had ever seen, and sharing life's journey and a whole bunch of 'em are going to think it's a bunch of bullshit, and sort of retention rhetoric, and wondering about this MBA who, his last company got taken over, and is he just going to flip this? And so it's going to be quite a day, and so let's, for fun, do a skit at the end. And we wrote a skit that sort of roughly paralleled our story and the Musketeer story. And at the end of that night we did, I led the team in 'One for all, all for one.' And, now, there was some alcohol involved at that point, but the response was kind of amazing. And you go, wow it's just way more energetic than you ever would have thought. I can still remember, I got goose bumps. But you say, okay, it was a skit, everybody'd been drinking. We're all tired, we're all scared if our company's going to go bankrupt. And then fast forward three months and we had our first nationwide meeting with all the managers and above which, so it's 600, 700 people. Anyway, said, you know, my god, we're working so hard, let's do the same skit. And then the third night we did the skit and we handed out little musketeer hats and swords, and did it. And once again, it just sort of blew you away at the end of the night, the energy. But again, just sort of dismissed it, everybody again, not that we do this all the time, but there'd been drinking involved again. But then emails started coming in and subsequently and with people showing pictures. 'I put my hat and sword up on the bulletin board in my clinic in New York City,' 'my clinic in Tulsa, Oklahoma.' And people started putting at the bottom of their emails, 'One for all,' or 'One for all, and all for one.' And it took me about two, three weeks to realize, oh my God, we really struck a chord. And fast forward it all the way then, that we realized how much people want those words to be true. And if they sense they might be true, they say them with great energy. And then we also, at that point I decided we were going to work on some other phrases. Because if you have a tribe that is spread across the country, you have to have shared language. You have to have shared stories. And so right in that same period we worked on other call-and-response, all of which means something to us. And I won't torture you with what they are, but they mean something to a very high percentage of our people. And it's way more powerful to say them that way, 4,000 people cheering in a room, than delivering some boring speech.

Yeah, so I'm 61, I've been a CEO since I was 35. So it's 20, 26 years. What I realized X years ago, I don't know what X is, is the good news for me, is I love what I do. And there's just, obviously I interact with a lot of CEOs. And so many of 'em bitch about their job. And talk about, you know, it's hard in this way, and it's unfair in this way. And I just sit there at the dinner or whatever, and say, right, quit, you know. What's your problem? You got enough money. If you're not loving what you do, what a joke to keep doing it when you've got choices. And so I think the answer on that one is simple, I think part of the art of life, people talk about work versus personal life balance, I say no, the art of life is not balancing the two. The art of life is creating a third slice, which is when you do things that are both. And for me, for example, being here, this is work because I hope some of you think about coming to DaVita. This is also, when I was in your seat back in 1981 to '83, my dream was to be able to talk about issues like leadership and more conscious capitalism with young leaders that are going to change the lives of a lot of people. That was my dream, so for me, a day like today is actually very special, personally, for my dreams. Separate from, hopefully, I add some frigging value for my company, and some of you think about interviewing. So I think that's what has allowed me to keep going.

These are the most probing questions I've ever had. You guys did not tell me what this... I love this 'cause it's... the whole idea of doing these things is so you get to hear what it's really like, separate from the pablum. I've wanted to be an elected official since I was probably 10 years old. I used to read every book on Abraham Lincoln. That was always my dream, to serve my country and the world that way. And if I hadn't gotten into health care, and then if I hadn't developed this sort of psychological model of wanting to create differentially healthy place for real people to work, I would have probably left the for-profit sector a long time ago. Because in the old days I had that more classic paradigm of for-profits for making money and establishing financial independence, and then you switch over and do something that's not for profit and charity-oriented. That model is fine, but there's this alternative model of staying in the for-profit world and adding lots and lots of value for the world. And so it was a big decision, and I don't know if I will do it later in life. But what I was forced to have to think about a lot was how much of my doing that was for reasons of ego,

that it would be really cool to be a governor, versus a rational assessment of, over the next six years, which way am I more likely to add more value? Probabilistically by keeping this job and doing what I do and making money, all of which is going to be given away. We're never going to spend any of it. Or spending a year-and-a-half running for office, winning, and potentially getting almost nothing done because it's a very polarized legislative situation. And even though I think my athletic ability is relatively a good fit for that sport, nonetheless doing something new, you always have to discount how quickly you'll get good at it. And so I might be staring at myself suddenly being 67 and having spent five years and not added that much value. And I would have tried, I would have felt very good about my effort, but in the end, at my age, you don't want to just get good grades for effort. Given my alternative path is very high probability I can get good stuff done. So that was the calculus, how much ego, and what's highest and best use? And then lastly, in part because of some of the issues we've had in the company from a performance point of view, would it be an irresponsible time for me to leave the village that I love? And the answer on that one was, there were variables across all that spectrum of issues, but it would not have been a great time for a departure.

Absolutely, and we'll put healthcare aside for a moment, but a big difference, just even the last 10 years now, is companies are asked to take positions on social issues. So what do you think about lesbian gay et cetera rights? And what are you willing to say publicly? Are you willing to sell products or services to certain people? What are you going to say about Charlottesville publicly? When are you willing to criticize the president? 10 years ago, the incidence of CEOs being asked internally or externally to take stands on these kinds of things was literally one 20th what it is today, and it involves some very careful reckoning. So for example, on one of these issues, I want to go to it, I simultaneously polled a bunch of people in our organization and the board of directors. And the people in the organization were 80% in favor of my taking a very public stance, in writing with the media. 80% of our board was against it. And these are good, thoughtful people. They just said, we don't have a dog in that hunt. Yeah, your private views are your own, but putting the company at risk is irresponsible. You have lots of patients you're accountable for and all the rest, because if you're subject to political retaliation, you're going to not be able to give raises to nurses, they're going to leave, your clinical quality's going to go down, people are going to be hurt. That's just a new part of life for a CEO.

Yeah, so we in general, we lean towards hiring for athletic ability and character, versus specific skill sets or experience sets. We do that because we believe that growing general managers and leaders is the single best thing we can do for our village. And unless you have that philosophy at the lower levels, people don't accumulate the set of experiences which allow them to be excellent general managers and leaders. And so we need to have more fluidity in how people move around and demonstrate athletic ability and accumulate less in any one category but more overall. And then we need young people who are brave enough to do that, because no matter what they say when they're in the second year in school, they're, suddenly they're doing well in one area and they're comfortable with their boss, and you know they get their, know they're going to keep doing well, and you say, why don't you move into a whole nother area where you're actually going to be behind everybody 'cause you don't have domain knowledge, and it's going to be with a new boss, and suddenly all the things that they thought strategically go out the window. And by the way, they're just had their first baby, and they want to make sure they maintain this optimal control over their work-life balance and all the rest. So that's what we mean, that we believe in general athletic talent, and then we invest disproportionally compared to most companies to develop it. And then we need people who are oriented that way.

Or advice.

Yeah and there's one in the middle. It's a little dark up here, so you might have to wave your hand.

Yeah so I don't, there's no pat answer to this. Because each one of these different situations is a bit different, whether it's North Korea or Charlottesville or gay rights or gay marriage or whatever. So the answer's always different, and I think what we're developing over time is a set of sort of filters for thinking about it, which is kind of, to what extent can we say something that we think is reflective of the overwhelming majority of our people? Because some company's come out with something, and literally half their employees, for our parlance its teammates, disagree. Well, a CEO should be real careful before he or she says something that half... And so for example in some of these cases, we have 75,000 teammates. We have a very substantial percentage who voted for President Trump, and they're thoughtful people with good hearts and good brains, and they did that. And so, if I'm going to say something critical of the president, I better be damn thoughtful about making sure that it's said in a way that is not inconsistent with their basic view of the person. And is more transactional. So there's questions like what percentage of your employees do you think think that way or not and why. Second is, what realistic probability do you have of impact, of making a difference? Third is, for how many of your teammates will they be exceptionally pleased that you, really like the fact their company is taking that stance? It's legitimate to count that. Fourth is how will your customers react, customers, clients, partners? Fifth, what expectations are you creating for commentary on future issues? And if you say yes to commenting on one and then you don't on the next, are you going to get reamed for that? And then so you have to be prepared to explain why. Six or seven, whatever number I'm on, is to what extent are we at risk of getting retaliated against because we live in a world where we deal with Congress all the time, and I sit with the senators from both parties all the time, as well as in state legislatures. Seventh is of course your basic moral code. Eighth is is it going to be more a thing about what I believe versus what the village believes? So, then nine of course is what's the tone going to be? And is there a way, because so often, when these things pop up, it's almost like you're given a relatively binary choice: say this or nothing. The world's way more nuanced, and so in many cases we think it's an opportunity, and at least one or two times we achieved it, by writing something that sort of, everybody said okay, that's a useful way to parse it. It's not binary, it's not black and white. You don't have to demonize people. You can express disappointment, you can talk about why you feel disappointed, why you're uncomfortable. That's very different from saying, you know, so and so's a schmuck that really messed up. So those are some of the filters that are emerging, now that we've had, we go through it with more and more frequency. The first time we didn't have any such list, and you know I just ended up talking to a bunch of people.

Just in my head.

Yeah, but now that I did it, actually Kenny, if you took notes, that was not a bad damn list.

And the fervence with which your teammates believe in some of this stuff, you know... They'll come and demand, they'll say, how can you not write about this? And in particular, my case, given the governor thing and everything else within the Colorado, the media, there's a reasonable chance that what I say will get printed. And so they'll say, we need to have your voice. I say, well first of all, it's not really my voice. You have sort of, the village owns 60% of this voice, and I get 40 or whatever the numbers are. So first of all, and second, it's a currency to be deployed carefully.

Yeah so on the first one, a couple of my favorite interviewing techniques or practices that helped me get a feeling for the person is begin with the end in mind. I always ask about career and life aspirations. I want to know how articulate and thoughtful the person is about what they want to do with their own life. And then typically I'll ask why. And then separately, if the person's been out of school a while, I ask 'em to go through every single decision they made: what college, what major, what first job, what graduate school, what concentration in graduate school, what job, whatever, but I said I don't want to hear about anything great you did any of those places. Yeah I just want to know why you chose what you chose each time. So I'm just very big on why's. And then the third one is I'll ask about failures. Tell me when you want a do-over. Give me a time when you really wish you could do something over. And it's amazing how many people, and particularly older successful executives, what a terrible time they have admitting to a failure. And if they do, but it was, you know, "The odds were stacked against me," you know "I inherited a terrible division." It's just like when you ask people for weaknesses, and then 60% of executives will say, "Well I'm impatient. But it's because I'm so demanding and have such high standards." And you'll say, what a crock. I mean, if you do not know that you have worse weaknesses than that, then we don't want you here, because we're a lot about self-awareness and self honesty. We all have faults, we all behave poorly sometime. That's the way we're all the same. What differentiates them from others is those who can talk about it in a reasonably thoughtful, self-aware way. Because if you can't, you're not even close to the journey of dealing with it. On the broader issue, I'll just answer one part and then not ramble on. Every single interview, which of course is never that way across the entire village, the candidate gets evaluated according to the mission and values. And just think about it, how many places say, well we really care about our mission we really care about our values, but they interview people and it's not explicitly part of the discussion. And to me that's like if you were Coach K, you were recruiting somebody to be guard of the basketball team and you didn't watch them shoot. Ridiculous, 'cause shooting's a big part of what you want the guard to do. Well you talk about your values. We know it's highly imperfect, but by being on the form, it reminds our teammates that they should think about values when they're deciding when they want to give an offer to Tammy or Fred. And often they'll talk about it, which then reminds them of, you know, we're supposed to care about it. And for some candidates they'll go, wow, I actually kind of resonate with that. And it creates a sort of positive karma. And so that's something we do to broadly encourage it.

Where is he? Where is this person?

Ah. Voice of God.

Right, so, some folks in the room aren't too healthcare oriented, so I'll try to be really concise and say, well first, for a matter of principle, we actually use the village metaphor for making decisions. So in tough decisions we think about what if you were mayor of a village and it's in a recession? What do you do? If there's technological disruption, what do you do? So with real families and real citizens, and we try to live that way. And in our village, everyone would have access to health care. To me it's a basic... In our community everyone would have access to health care. It doesn't mean there aren't resource constraints on exactly what that can look like for everyone. But as a basic condition. Second, the health care people whine a lot. We have the most generously funded health care system in the world, and so get over it. We waste a lot, and we own that as an industry, and we, by not doing enough ourselves, have created a world where politicians who are short-term and superficial on this subject are making a lot of decisions because we haven't done well enough ourselves. And so we shouldn't be pointing the finger at them, we should be pointing the finger at ourselves, and then them, because they're screwing up so badly. And so for us, we're going to get by. We're not going to suddenly... and no one is going to suddenly go belly up. They're going to whine and we should just keep on getting better every year, no matter exactly what the funding is. And in some years it'll be good, in some years it'll be bad. That's how we think of it. And we have our own piece of legislation where it's just getting introduced in the Senate and the House. Kidneys, about our DaVita Kidney Care division, but both in Kidney Care and Medical Group we are the clinical leader in both of those entire segments of the American healthcare world, and we're very very proud of that, and we love it, because we're forcing our competition to chase us, so we're affecting patients we don't even touch. But in kidney care, which is 7% of the Medicare budget, we have got legislation which will allow us to transform kidney care for all the dialysis patients across America. And we have an unusual level of bipartisan support. We passed the House Ways and Means Committee 39 to one a year ago this time. Nothing passed the House, it's the Power Committee in the House, nothing substantive passed that polarized committee 39 to one much less even 22 to 20, whatever the numbers add up to. And so if you don't whine, and you work on it, as we did for years, we now have this beautiful piece of bipartisan legislation that may very well pass, which is virtually unheard of for a single slice. And we will save hundreds of millions of dollars for the system while dramatically improving quality. And that's what other industry segments should do, is appropriately pressuring these people to perform. But separate from that, get out there and do your job and improve care and reduce cost. And if you're not doing that you're a crappy provider and you're a crappy health plan. And we got a bunch of them that spend too much time blaming the government and not looking in the mirror. Not that I feel strongly, but...

Yeah, so Paladina Health, I get excited about a lot of things, but Paladina Health, the idea, for those who might not recall it, this is where we go to employers and help them. We have an on-site or a near-site primary care clinic, and it is beautiful, what it does. Because you have lots of real-world people who, to go to a normal primary care physician means they got to make an appointment, it's three weeks out. From where they work or home, it's a drive. They got to take time off, it disrupts taking the kids to school or whatever else. They're gone for a long time, they go there they sit and wait, they get seven minutes with the doctor. Productivity, it's abysmal, both in terms of inefficiency and in value and follow-up because of the way... In this case it's a very focused group, they have our physician's cellphone number and can call it 24/7 in most cases, and if there's follow-up and so we'll check, and then the physician and the staff will follow up to see are you taking your meds, are you losing some weight, are you doing whatever else, which has a tremendous difference in terms of actual teammate slash patient engagement. And for us, for like-minded employers, it creates this ability for employers to demonstrate that you care about people and you care about helping them take care of themselves and their family. And then over time we hope to evolve our service capability so we can become more and more of a partner in health and prevention versus more treatment, which is where we're about now. So that's the the notion behind it.

A lot. I could show you the scars on my back and the empty spots in our wallet. We decided if I was a better CEO, we would have gone outside of the US 10 or 12 years ago. But I wasn't, so we did five six years ago. And we decided to very aggressively and went into 10 other countries in relatively short order, knowing that we would make a bunch of mistakes, but we were in a hurry to learn. For a whole bunch of reasons. And so we did that, I would say two things in particular. One is the absolute, it's so self-evident to say that you want locally raised executives, but the energy it takes to get there is so great. And the real-world obstacles that come from the amount of time it takes to fly to Germany or to Saudi Arabia or to India or to China or to Brazil, all of which we're active in, really disrupts any kind of normal search process. And so I would have really twisted, maybe even gone to fewer countries, so that we could have allocated myself and other persons more time to finding the right needle in the haystack locally as opposed to having that take two or three years. So again, we would have said the right thing, and then I went out and talked to a bunch of other friends, CEOs who had, running multinational companies for a long time and got the right advice, but it needed a much more radical approach. And then the second thing, I asked the different CEOs was about our culture. And the consensus was that stuff you do is weird in America. Forget it in Saudi Arabia, in China and in Poland and in Colombia, and so leave it at the airport. And so for the first year and a half I slash we took their advice, and we started up in these places, and we didn't talk about the village, and we didn't do this stuff we do. Because I took the advice. And I was giving a talk in India to 125 software engineers, and it's a talk, I could tell, it went totally flat, and so I went up to the boss after, and he and I had enough of a relationship, I said, "Be honest with me, that didn't go that well." And he said, "KT, go walk through their cubicles." Because they had come in on a day off to be with me. "Go walk to the cubicle, you'll see they've got the mission and the values up, they've got village imagery up, they've got the timeline of their growth within the village. And so they know about it, they've read about it, they thought they were a part of it. And now they feel like, they're like foreigners working for a village as a subcontractor but not a part of it." And I was so angry with myself and appalled. I went and immediately sent a voice mail back to the States saying, "From this moment forward we are one village across the world. Multiple neighborhoods, one village. And I'd much rather make that mistake than the mistake we're making now." And what we found out is that our values are not DaVita values and they're not American values, they're universal values. And you could pick seven other ones, I mean we had a list of 100 and went through a nine-month process, an election process for people to choose the ones that they most wanted to be emphasized. And from that moment forward, we've been one village. And some of our healthiest neighborhoods in the world are outside the US, and part of that is because people in the US especially, after you've worked with us for a while kind of take what we do for granted. People in other countries don't.

Yeah let me... hit the second one first. Because the first few years of DaVita, we didn't agree. We would always have professors or consultants come through to help us think and brainstorm about how we could realize our dream of creating a seriously differentially healthy place for people to work, and send forth ripples of citizen leadership. But we wouldn't agree to have anything written about us because we didn't want to be distracted. And then we realized over time that, number one, that was foolish, because once some bad things started happening, if you didn't have positive press out there to balance it, you were going to be in worse shape. So you have to manage proactively on some of the positive stuff. And second, as we thought about it more and we started to get more momentum and people were paying more attention, we said we would like to provoke thought. And that's a way to affect people we'll never work with, and that's when we agreed to the Harvard case studies and the Stanford case study and some other stuff to be written. And then we also tried to win speaking engagements, not like this, but when I'm actually talking. I have a section, so I'm in a room with 40 CEOs. I'll go through some of the things we do in wellness. We have a silent retreat that happens in sort of a semi-monastery type thing in California. We have DaVita Great Outdoors where we take groups of 12 out in the woods and do reflections on their, three days with no devices, actually four days, three nights, no devices. Facilitated times for reflection on the village and on yourself and whether or not you're living life's values. We have academies where we have, every single teammate is invited to two days where it's all about self-awareness and our rituals, and our language, nothing about business, no applied training, and a technician's right next to a cardiologist. Every single, virtually every course in DaVita University is what we call DaVita-fied, which means there's elements of introspection and self-awareness, even in a course on financial management. And then we have our own Paladina working in our clinics. We do an annual "Match the Mayor," where for four to six weeks I do a, kind of a blog every other day, and we have software and everybody has a life goal, something to make their life healthier. It could be read a book a week, could be take a walk after lunch, could be lose weight. And I track what I'm doing every day according to the goals. And so they see the mayor fitting it in with plane trips and all the rest, so that's just six, seven, eight examples. If we were talking about this to a bunch of executives, I'd have another 17 for how we invest in wellness, both spiritual, mental, physical, emotional within our community, because that's the best thing to do. Because then these executives ask for copies of the decks. They copy down the idea they like the most or two, and then they take them elsewhere. So that's what we do internally, and then we try to, when asked, talk about it, because that's where you get the replication and the copying. On the first one... I don't remember.

So even at our big meetings, we have free yoga sessions, and well, I won't to do more of the list, because I think I answered, and given people up in the last row usually were thinking of leaving early, that I'm so glad you stayed and asked a question. Because I didn't lose you.

Wait one sec, wait one second, I got to do this. So I'm so impressed that on a Tuesday night before Thanksgiving you are here. I'm so impressed that I flew here on a Tuesday right before Thanksgiving. Give a pat on the back. Remember that, you guys. But I just, I rarely do this, but the questions were so awesome. That gets you out of your safety zone. So if you picture we're all in one company, and the words were true, one for all, and all for one. I just want you to feel what it's like if you imagine that you really did feel that way about each other and the quest we're on. Not that you're going to stay and work in the same company forever nothing outside of real life, but while you're together you have a special bond. So I'm going to call out "One for all," I'd like you to just say, "All for one" back, if you feel like it, to see what it's like, if it's said with energy and imagine some sincerity. So if we are to build the greatest dialysis company the world has ever seen let it be like this: One for all.

Damn straight, good night.