Welcome to another episode of Impact Unfiltered, where we dive deep into honest conversations with leaders creating real change in healthcare and beyond. In this session, host Stuart sits down with Dr. Randy Smith — an enrolled member of the Choctaw Nation of Oklahoma who serves as Executive over Health and Human Services for the Kiowa Tribe and CEO of Kiowa Health Services in western Oklahoma. He also holds a PhD in leadership and is a former rural college president.
Dr. Randy Smith shares how the Kiowa Tribe is launching its own primary care clinic and pharmacy this summer — a venture projected to generate more revenue for the tribe than the casino does. He explains why tribally-run healthcare consistently outperforms IHS on customer service and billing, and why a rural EMS service is next on the roadmap.
Together, they dig into the rural “brain drain” hollowing out small communities across America, why tribes are uniquely positioned to anchor those communities, and Dr. Smith’s deeply held belief that leadership — passion, follow-through, and removing obstacles — is the single limiting factor on everything else.
Tune in for a conversation about rural healthcare, tribal economic development, and why celebrating every touchdown matters as much as scoring it.
1. Introduction to Impact Unfiltered and Episode Overview
- The podcast’s mission: real conversations with leaders driving change in healthcare, business, and community
- Setting the scene at the Self-Governance Conference
- Introduction of guest: Dr. Randy Smith of the Kiowa Tribe
2. Background and Role of Guest (Dr. Randy Smith)
- Enrolled member of the Choctaw Nation of Oklahoma (200,000+ members)
- Executive over Health and Human Services for the Kiowa Tribe
- CEO of Kiowa Health Services in western Oklahoma
- Kiowa Tribe has roughly 10,300 citizens — mid-sized by Oklahoma standards
- Holds a PhD in leadership; former rural college president
3. Launching a Tribal Clinic and Pharmacy
- The Kiowa Tribe is standing up its own clinic and pharmacy, opening by end of summer
- Historically, IHS has been the primary provider across Oklahoma’s 8–9 service units
- Roughly a third of Oklahoma tribes are now moving to operate their own clinics
- Tribally-run healthcare delivers better customer service, longer hours, and stronger responsiveness
- Major revenue generator — at Kiowa, the clinic and pharmacy will generate more revenue than the casino
- New clinic will see both native and non-native patients with extended hours
4. Diversifying Beyond Casino Revenue
- Dr. Randy Smith: tribes need a portfolio of revenue, not just gaming
- Rural economic development projects, especially healthcare, are an effective path
- Plans include adding a rural EMS system with advanced life support
- Medical transportation feeds the clinic; extended pharmacy hours feed the community
5. Stepping Into the Rural Healthcare Gap
- Rural hospitals and clinics struggle with unsustainable reimbursement rates
- Most rural residents live more than an hour from a major medical facility
- Traditional IHS facilities can only see native patients — a tribally-run clinic bridges that gap
- Quote: “We all make those rural communities sustainable long term.”
6. Stopping the Rural Brain Drain
- USDA statistics show a 10-year outflow from rural America to urban areas
- People leave for jobs, stability, housing, and education access
- Tribes can stabilize rural communities through workforce development, economic development, healthcare, education, broadband, power generation, tribal colleges, and vocational programs
- Most tribes are in rural areas — making them natural rural revitalization leaders
- Many rural Oklahoma communities would not exist today without tribal investment
- Quote: “If we can help stabilize our rural communities… we’re going to stop that outflow of migration.”
7. Leadership as the Limiting Factor
- Leadership is the single most critical factor for the success of any project
- Tribes that lack leaders willing to stand up and follow through stall out — even with great ideas
- Dr. Randy Smith trains tribal councils and city councils on board governance, fiscal oversight, and CEO interaction
- Good leaders accept risk and mistakes as part of the work
- Flourishing tribes are the ones with strong, decisive leadership
8. Where Leadership Comes From
- Dr. Randy Smith credits parents, coaches, and teachers more than coursework
- “Nothing can constitute for failure in the home” — early modeling shapes lifelong leadership
- Athletics taught him how to win, lose gracefully, and coach
- He watches and learns from leaders at conferences — both good and poor decisions
- Integrity, passion, enthusiasm, and a desire for excellence are daily-renewable traits
9. The Leader’s Real Job
- Set tone, vision, and culture
- Fix problems and remove obstacles so staff can focus on external customers
- Build a workplace people want to return to
- Quote: “A good leader gets to set that tone every day. If they come to that chair with passion and enthusiasm and a great attitude, it infects everything.”
10. Benchmarking and Celebrating Wins
- Keep a log of project progress; celebrate at each milestone
- In the rush of daily work, leaders forget to celebrate accomplishments
- Three-to-five-year goals should be measured by concrete deltas — “we have a clinic now, with extended hours, with outstanding customer service reviews”
- Quote: “When you score a touchdown, you get to celebrate in the end zone.”
11. The Follow-Through Problem in Indian Country
- Dr. Randy Smith — 25 years in Indian country — names a hard pattern
- Great ideas often lack the leadership to push through to completion
- Time, energy, money, and effort get invested but projects stall short of finishing
- Quote: “Let’s see these things through to completion and finish them.”
12. Borrowing Confidence from a Trusted Coach
- Leaders sometimes lack confidence and need to borrow experience from a trusted advisor
- Great basketball players never reach greatness without a great coach
- Dr. Randy Smith offers himself as a resource — tribes and rural communities can reach out for training, perspective, or consultation
13. Closing Remarks and Gratitude
- Host recognition of Dr. Randy Smith’s vision and energy
- Appreciation for his offer to help other tribes considering the same leap
- Encouragement for rural tribes to step into community-wide leadership
