A Leader Looks Back and Ahead

Mary Greeley’s outgoing President and CEO on the hospital’s growth, quality, culture, and future.

Brian Dieter will retire after 17 years as Mary Greeley’s president and CEO. During his tenure, Mary Greeley saw growth in a range of services and significant facility improvements. The medical center also received a range of recognitions including the Malcolm Baldrige National Quality Award in 2019, and Magnet designation in 2019 and 2024. Baldrige is the nation’s leading measurement of quality improvement, while Magnet is the nation’s top recognition of nursing quality. Mary Greeley is one of a few organizations nationally to hold both the Baldrige and Magnet honors.

In this exit interview, Dieter discusses his legacy at Mary Greeley and why the medical center is and will remain a vital component to quality healthcare in central Iowa.

The average tenure of a hospital CEO these days is five years. You more than tripled that, which is probably some sort of record. What do you attribute to this longevity?

We fell in love with the community and the opportunity here and continued to find ways to make a difference. If any of those factors had changed, then it would have been a time to look elsewhere. Fortunately, none of them did. 

The elements for success were here. We had a highly engaged medical staff that wanted to continue to grow and develop, and that led to new opportunities: development of a more significant cardiology program, including interventional coverage, adopting novel technology, robotic advancements in surgery, advancements in radiation oncology. We were able to stay relevant to our patient base and continue to grow and expand services that made sense for us.

Our emphasis on specialized care and a personal touch really led to some pretty significant success. We both deployed technology to stay on the current edge of medicine and also remembered the personal side of what we do. Both gave us the opportunity to expand our influence in central Iowa.

Whether you’re talking about our inpatient tower, our new obstetrics and pediatrics units, our new behavioral health unit, our first responder and emergency medical services – these advancements are all possible because we have a supportive community, the financial wherewithal, and a board that is fully invested in the community. More and more hospitals are controlled by larger and larger corporations, frequently with headquarters further and further away from the communities they're trying to serve. Once you've seen a community-based, community-focused, community-led hospital, the other side doesn't look very attractive. 

When you look back at the 17 years in this role, what are you most proud of? What has brought you the most satisfaction?

Establishing a problem-solving, quality-improvement mindset. Always being ready to ask, "How can we continue to get better?" When we started on that journey, I didn't know what we needed, how it would look, I just knew that we had to prepare to compete. And hospitals compete in a very strange way. Patients largely have choices where they're going to go, and all things being equal, we'd love for the people in our community to choose to stay in Mary Greeley. People sometimes have a bias towards larger and better. So, we wanted to make sure that we could at least have quality as good or better than places that people might drive to.

We also draw people in from smaller communities, because of our technology deployment and the fact that we just have more specialty care than a lot of the surrounding facilities. We wanted to demonstrate not only that we do these things, but we're really good at the work.

It's not the buildings, although I love the way our campus looks. It's not an award, although I celebrate each and every one. It's not a department or a single advancement. It’s the approach to what the hospital does right now, and how we take on challenges and continuously strive to get better. We always have an eye towards what's next, and what's better, and how we can take steps to get there. We've embedded that, and I'm proud of that.

What's the most challenging part of this job?

It doesn't matter if you're in the hospital, at a meeting somewhere, whether it's a Saturday, Sunday, you're on vacation, on holiday, at a friend's house, at a lake or in the mountains, you never unplug.

When you play an important role in a community, there are a lot of people with ideas and perceptions of what you should be. As a community hospital, you're trying to balance your constituencies. There's also a very real economic reality that says hospitals cannot be all things to all people. The hospital's here 24 hours a day, seven days a week. One of the hardest things is trying to truly unplug.      

What did you learn about being a leader? And what tips do you have for an aspiring leader?

First, words always matter. There's no such thing as off- camera, there's no such thing as offstage, and people do pay attention to the things that you pay attention to, the things that you speak of, and the things that you do. 

Also, your memory is almost certainly not as good as you think it is, so it's a heck of a lot easier if you tell the truth all the time. People do remember the words that you use, and the things that you've said, so honesty is the best policy. If it's going to be known, it might as well be known as soon as we can know it.      

Second, if something is worth doing, it's probably worth talking about. Nobody wants to be surprised. And so when we talk about the changes that we tried to make in the organization, and adopting a mindset of continuous improvement, one of the things I was really careful to do was not talk about it being a program, or give it a cute set of names, but ultimately demonstrating what the skills were, and make it as relevant as possible.

I think we've done a good job. Our employee engagement scores continue to demonstrate that people feel valued to be part of the organization. They feel that their voice matters.

Third, say hello to everybody you see, and try to remember names. Some claim that I know everybody's name here, which is not true. There are 1,400 people that work here. But those that I know, I want to call them by name. 

You never recognize where the benefit of all this is going to show up. But when you tell people how it's going to be to the best of your knowledge and you can explain things, that just builds credibility. Leadership is one layer of credibility, hopefully laid on the next, laid on the next, laid on the next. Just like if you're painting or baking a cake, it doesn't really matter how good the top layer is if you've got some flaws underneath. Honesty, credibility, and relatability are all part of that equation.

You’ve recently talked a lot about respect in the context of a healthcare environment. Why has that topic become important for you?

I value respect and humanity. I think we have lost a bit of that in our society, and I lament that loss. I truly believe in the best in all people, and I truly believe that people are trying to do their very best. I recognize that patients and loved ones come here with a lot going on in their lives. Nobody wants to be sick, nobody wants to have somebody they love or care for sick or injured. At the same point, I think there ought to be a bright line between sharing concerns and abuse. What we're grappling with locally and nationally in healthcare is what I consider an erosion of respect.

Respect for science, for knowledge. Respect for the caregiver. As leaders, it's our job to be protective of that respect and to dole out some of that respect. People do great things. When I get to attend a presentation at the hospital where we're going to recognize somebody, I always hope the person who wrote the nomination is present. I always try to seek them out and thank them.                

During COVID, one of the concerns I had was that our people were doing extraordinary work, and the only witnesses were other employees who were also doing extraordinary work. We had a very difficult time recognizing it. That’s why we invited Courtney Crowder, the reporter, to come tell that story. Through her eyes and her voice, those extraordinary events and the impact it had on our patients and their families, and our staff would be told through an extensive series in the Des Moines Register. That is out of respect. I'm in awe of the most basic medical procedure that we can do here at the hospital because I can't do those things. I think that's respect. I'm also in awe of the people whose work ensures that the lights are kept on here at the hospital, that the medical gases are here for our patients, that food gets prepared and delivered, that rooms get cleaned. These positions are deserving of our respect.

We take a lot of pride in Mary Greeley’s culture as a great place to receive care and work. How would you describe our culture?

It's an environment where people are encouraged to go above and beyond. They also get to see it in others, so it becomes not just a rare exception, but it becomes more and more prevalent. We had a patient who was turning one, who very much was at risk of not having anybody to celebrate her birthday, and we saw a nurse make sure that she did have a celebration, despite the fact that she was working three 12s in a row, and had her own family.

Those things are not exceptions, they're exceptional. I think the other really important piece is a lack of complacency. We want to continue to get better, and we find ways to do it. We catch people doing the right thing. When we make a big deal of that, it's likely to increase the chances of it happening again.

What is the biggest change you’ve seen during your tenure?

I was thinking about the beginning of my career, in 1985, when it was desk phone only and then we moved onto the BlackBerry era, which at that time was the smartest phone you could have. Now look at all the levels of connectedness we have.

What if 2025 is the starting point and you fast forward 40 years to 2065? It boggles the mind, but I think Mary Greeley is positioned to take advantage of whatever comes. Our intellectual curiosity as an organization, with a well-knit, caring group of supportive individuals looking to do the right thing for patients and families, means we'll probably make some small bets on technology deployment, whether it's AI or the future of AI.

But I think the piece that hasn't changed and which gives me the greatest hope going forward is that this hospital is a center of caring. Sometimes the technology can get in the way, sometimes it can be an aid. When we keep our focus on the patient and their family, we find a lot of really good things happen. We're better positioned than most healthcare organizations to keep that focus, and that's what gives me great hope for the future.

What's this place going to look like in 10 or 15 years?

I think the evolution of a community hospital will continue. A lot of our story quite frankly depends on
what happens in some of our smaller rural communities. We've certainly seen that with regards to the growth in our obstetrics program. I know there are significant efforts to really fortify rural obstetrics care. That's a big challenge for Iowa health policymakers, and I'm anxious to see what that becomes.

I believe that as a community hospital, care to new families is extraordinarily important. It sets a good foundation for being the hospital that families identify as their own.

A lot of our future vibrance is linked to the vibrance of Iowa State University, and the companies, whether they're startup or established organizations, that wish to locate in and near our community. A solid population base is important for the health of our community, and ultimately, it's important for the health and the growth of our hospital, and our ability to attract staff and physicians and others that will work here.

The emergency department, and the services that support it, in particular surgical services and cardiovascular services, will continue to be vital. We have this dual challenge, which is to provide care for people who have multiple chronic conditions today, and to prevent the onset of those same chronic conditions in the next generation. I'm unsure how we'll manage to do both given the financial contraints, so I'm hopeful that, as a society, we'll start recognizing preventative care can ds  But it's not going to save us the dollars that we're going to need to take care of people who already have multiple chronic conditions, or whose health is such that they need restorative care.

I hope we'll begin to see some of the benefits of society embracing a more intentional approach towards both individual and public health.

Anyone who works in healthcare, whether in a clinical role or not, has that story they carry with them always. That unforgetting interaction with a patient, a family member, a member of the staff. Do you have one?

I have two that are bookends in my career. One happened just a few weeks after I became CEO. I visited a retired minister named Warren. I knew his daughter and son-in-law. I shared with him, I confessed maybe, that I was rather new to visiting patients, but I expected that in my role as CEO, I would need to get comfortable with it. I said, "But it's a little awkward for me." He asked me "Well, why is that?" And I said, "Well, I feel like if somebody is in the hospital, the last thing they need is me stopping by." If you're sick enough to be in a hospital, rest is extraordinarily precious. And I said, "So if somebody's got the choice between talking to me for 10 minutes and resting, I figured they'd rather maybe just rest." And he stopped me, and said, "Well, Brian, it's not about you." And I thought, "Well, that was a pretty good kick in the butt."

And then just recently, I was walking back to my office, on the second floor, and I ran into a woman who was heading the opposite way, and she stopped, and she said, "Is the ICU on this floor?" And I said, "Yes, it is." But people don't ask about the ICU and the location just casually, and I figured there must be a reason that she needed to get to the ICU, and so I said, "I want to take you there."

And this is one of the things that is important, and maybe part of our culture, is that when possible, I always want to encourage our staff to walk a patient or a visitor to their destination to ensure that they get there. I made sure that I traced our path through the hospital in such a way that she'd be able to repeat the steps and would also know where her car was.

We got to the ICU, and we talked to our volunteer who was at the desk who asked if we would just have a moment in the family waiting area. I sat down with her, and we started talking a little bit, and she asked me what my role was here. And of course, I told her, and she said, "Well, you must have a lot of things to do." And I said, "I have nothing to do that's more important than talking with you." And I truly felt that that was part of what Warren wanted me to do. Her husband passed that day, but I felt like those 15 minutes that I spent with her were a gift.