Jan. 8, 2018

A 30-minute window around 8 a.m. is peak time for coffee orders at Avera McKennan’s Prairie Center cafe.

David Flicek knows it.

So when he’s in town, he’s likely behind the counter.

“I tend to stop here and will make whoever’s in line their coffee and their eggs,” he said.

A bond with barista and cancer survivor Mary Merrill began a decade ago as Flicek started helping out in the bistro as part of his rounds through the hospital.

The fact that he’s now Avera McKennan’s CEO hasn’t changed his approach.

“I try to help Mary because I don’t like to see her backed up,” he said. “And it’s a way to check in with employees.”

After that, he typically walks through several floors of the hospital, stopping to talk with staff and patients. It’s not a part of the job that feels like work.

“I love talking to people, solving problems. I like to figure things out,” he said.

“I like listening to the staff on what their day-to-day trials and tribulations are, so I can help fix it. I see my job as removing barriers from frontline staff. I work for them as opposed to putting up roadblocks and making it harder to do their work. That takes listening. We have 100 years of culture, and it can be hard to change, too.”

Flicek’s career, though, has put him in the thick of health care’s changes – from its delivery models to its centralization. His new dual role has him overseeing the largest hospital in the Avera system in addition to the network of clinics he helped build as head of Avera Medical Group.

When he replaced retiring CEO Dr. David Kapasksa last year, he became the 17th top administrator in the history of the hospital, which is run by the Benedictine and Presentation sisters.

“Avera McKennan is a very different place today that it was 25 years ago,” said Fred Slunecka, Avera Health chief operating officer, who led McKennan for more than 20 years and hired Flicek in 1995.

“Twenty-five years ago, clinics were a minor part of the overall budget and a relatively small number of people. Today, it’s an essential component. So I think Dave’s selection just helped solidify the role of physicians and physician leadership and the integration of hospital care with clinic care. He’s the perfect person to further develop the integration between the hospital and the clinic.”

Building bridges

Flicek’s life literally began at Avera McKennan.

He was born there in 1962, went to nearby St. Mary School and graduated from O’Gorman High School. He earned a degree in health administration from USD and worked in the Twin Cities after graduation, where his wife, June Nusz, became a partner in an architectural engineering firm.

Flicek joined the health system that would become Allina Health, following five mergers in less than a decade.

“So every two years we had a new mission and vision statement,” he recalls. “And being young, I kept getting more responsibility because it was one of those events where if you’re willing to work hard and raise your hand they will give you more responsibility.”

His role evolved into buying physician practices and providing practice management within the system.

“It was a lot of business development,” he said. “Buying a practice involves doctor contracts, leasing, a lot of negotiation and trying to find middle ground so both sides feel they won.”

By the mid-1990s, he oversaw the east region, his son had just turned 2, and Avera called.

At the time, the system’s only clinics were in Dell Rapids and Flandreau.

Slunecka dug into how Flicek had gone about buying practices and building the system.

“We were looking at the time for a clinic manager that could engage well with physicians, and Dave had the technical skills and experience, but he just had a style about him I think everyone felt really good about,” Slunecka said.

He offered Flicek the job.

“I interviewed and turned him down,” Flicek said. “I had 350 doctors and they had seven. I said call me in five years. So they did a national search.”

And then Avera called back.

“And the following day, we (unexpectedly) had someone want to buy our house,” Flicek said. “On Saturday, I accepted the job and sold the house. It was like God was in the wings because that was totally out of the blue.”

‘Master deal maker’

Fast-forward more than two decades, and Avera Medical Group has grown from two clinics to 200 locations in five states, and from about 15 physicians and advanced practice providers to approaching 1,000.

At first, Flicek’s supervisor acquired the practices and turned them over to him to run, “but very quickly it became clear Dave was a master deal maker as well,” Slunecka said. “He had just tremendous skills when it came to negotiating a fair contract with a whole host of independent physician groups.”

Because Avera Medical Group was so new, “you had to convince them we knew what we were doing and then that we would follow through and be good partners and keep our word,” he continued.

“And that’s where Dave really shone. He was so good at managing those relationships and making sure we honored every word we ever said.”

At one point, Avera Medical Group was buying a practice every three months. Flicek spent much of his time on the road, building the physician relationships that led to the system’s growth. The clinics now see 1.7 million patient visits annually.

“It’s been a great journey,” he said. “And I think we’re well on our way. After 25 years here at Avera, I feel very comfortable where we’re headed.”

Tad Jacobs, chief medical officer of Avera Medical Group, is the physician counterpart to Flicek, the administrator.

“I’ve known Dave since he joined, and having someone that physicians can talk to and feel they can trust, who will tell them the straight story and follow up with them, is really key,” Jacobs said. “What amazes me is how he remembers these deals he made over the years in terms of what he promised. He remembers amazingly.”

The trust that has been built is critical in physician recruitment, Slunecka agreed.

“And he will maintain that same sense of trust with the entire staff like he has with the physicians,” he said.

“One of his greatest strengths is he has built a very solid team of clinic managers. His management team is rock solid and would walk over hot coals for him. They’re smart and loyal and work incredibly hard. And I think that’s what brought him to the top as we were making decisions about how to replace Dr. K. His team-building skills are extraordinary.”

The ability to bring people together has been critical as Avera, like other health systems, has centralized many functions across its regions.

It’s something Flicek taps into as he helps guide efforts to centralize the system’s 13 services lines. He talks with pride about recent moves to adjust the emergency service line to serve patients faster and how “we’ve saved millions in capital purchases by standardizing equipment. If that were just the role of an administrator, this wouldn’t work. But physicians are at the table doing heavy lifting, and that’s why this has been so successful.”

Shared mission

After starting his career navigating a new mission statement every other year, Flicek was quick to embrace Avera’s steadfast values. While the organization has evolved over its century-long history, “our mission is rooted in the Gospel of Christian values,” he said. “But to me, that’s ‘Let’s do the right thing for the right reasons at the right time.’ It’s important you’re true to your word. A handshake is how a deal should be done that supports the mission.”

It’s something he has kept top of mind in recruiting hundreds of physicians. And it has helped Avera to achieve 3 percent physician turnover in an industry that averages 10 percent to 12 percent, he said.

“I think a vision is shared, and if they share the vision, they will follow you. We have to make sure they’re a good fit, and as hard as it is to turn someone down, we have when it’s not a good fit,” he said.

“I think we have a really good culture driven innately by our founders, the sisters. We’re fortunate in health care to still have the nuns. The sisters are on our boards. They’re actively involved in our ministry. They set the direction really well. I think it will be up to us to carry that forward.”

His agenda for the first full year as CEO is a lengthy one.

Avera on Louise – the largest construction project in the city’s history – likely will announce several new components to the development at 69th Street and Louise Avenue.

The Avera McKennan campus is undergoing $40 million in renovations, including a new intensive care unit and inpatient rehabilitation floor.

Hundreds of employees will move to a building recently leased on the Citibank campus.

And there are ongoing operational challenges to tackle, including workforce development.

“We’re trying everything we can,” he said, explaining a new boot camp developed to work with entry-level employees through their first 90 days to make sure they’re in a position that’s a good fit.

“I’m bullish about Sioux Falls,” he added. “I think it’s a great community. And I sell it so much to physicians coming from the Cleveland Clinic or East or West coasts. Our school systems, public and private, offer great choices for folks. From an economic perspective, you can’t go wrong. Everyone is busy. Our greatest challenge is we need more people to take the jobs.”

Outside of work – and he acknowledges there’s not much time outside of work – Flicek enjoys the outdoors. He likes to hunt, golf and fish, and estimates he has been to every state park, including many hikes through Good Earth near his home. His community involvement includes work with the South Dakota Symphony, LifeSource and Center for Family Medicine.

Slunecka calls him “a tremendous, fun guy to be around.”

“He always wants to make sure you’re having a good time and wants to make sure he’s having a good time, and that makes work life enjoyable and dramatically reduces the stress when you can work with someone who has fun with it.”

At the same time, “his capacity to absorb the work is unbelievable,” Jacobs added. “He’s not afraid to take it on and absorb it like a sponge. I believe he’s the right guy at the right time.”