5 years and 1 pandemic in: RWJBarnabas CFO discusses the latest on the $6B health system

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It's been five years since Robert Wood Johnson Health System and Barnabas Health merged to form the West Orange, N.J.-based giant RWJBarnabas Health. CFO John Doll spoke with Becker's about the challenges of the pandemic, current projects and his priorities for 2021.

Interview has been edited lightly for length and clarity.

Question: It's been five years since the merger of Robert Wood Johnson Health and Barnabas Health. How are things going five years in, and how has the pandemic affected the health system's strategic plan?

John Doll: Five years in, we are thrilled with the progress. We embarked as two organizations that were very successful with common goals about advancing academics in our state, ensuring that the patients that we serve had access to the highest-end specialists and the best care and empowering all that through integrating our facilities under one infrastructure. We've made a tremendous amount of progress. We all view ourselves as one family. 

One of the most successful things we've accomplished in the last five years is our high-reliability journey, which is focused on patient safety. The work of our clinicians has empowered all of our employees to speak up for safety. It culminated in a training program led by our clinicians, such that every employee in our system is trained on a system of values that is very focused on ensuring safe patient care and a culture that supports continuous learning and improvement. That was really something that brought us all together. 

We've also had a lot of success in our partnership with Rutgers in advancing the medical education programs at our facilities, and we are continuing to redesign those so that at some point we become a national model for training the providers of the future.  

Q: What are some of the trends you noticed during the pandemic?

JD: It's been quite a year. What I noticed the most was the constant change of it all. If you think about where we were a year ago — and the Northeast was hit very hard in the early stages of the pandemic — we were still learning quite a bit about how to deal with it clinically, how to adjust our processes, whether that is something as simple as a visitor policy or where and how care is delivered. In all those things, we learned and evolved very rapidly. Our high-reliability structure really was a hidden asset in that because part of the values that had become a part of our culture involved empowering all of our staff to question things, to come up with new ideas. In the situation that we went through, those methods were very powerful and impactful. That culture and that framework was used to adapt, and we have had to continue to adapt very rapidly over the last year. And I think that's not going to change.

Q: What do you think has set you apart from other health systems in the last year?

JD: We announced and effectuated during the pandemic a transition of our emergency room and hospitalist groups into a system employment model. There was always tight collaboration, but it was amplified by the change in structure. That resulted in a lot of advances in collaboration on care for patients with COVID-19. 

An example is all the work we've done around monoclonal antibodies. We used that therapy more frequently and helped patients avoid admission and manage their fight with the disease in a very effective way from home. That wouldn't have been possible without the collaboration of our infectious disease doctors and the emergency room physicians who were treating those patients on the front line. That structure certainly helped us.

Q: In terms of your organization's COVID-19 response, is there anything you would do differently or encourage colleagues to be more mindful of in the future?

JD: We're through it now and a lot of it was because of really heroic efforts. But throughout each stage of the crisis, I think we weren't ahead of it enough. The most basic example is the infrastructure around vaccinations, which is highly functioning in New Jersey now. Though we actually have more capacity to vaccinate people than demand at the moment, that structure could have been built sooner. I just don't think anybody anticipated the FDA's approval of their use so quickly. 

We also didn't have sufficient stockpiles of equipment and other supplies. We now have that in place and with better systems of rotating our emergency stockpiles. There was investment in that in anticipation of the second potential wave so that if there was another interruption in the supply chain, we were protected from it.    

Q: What are your top priorities as CFO in 2021?

JD: It's completing and updating our long-term strategic plan, much of which has been validated by the pandemic. That really focuses on continued investment in our academic profile, further integration of our acute care facilities, focusing on care in a region as opposed to individual entities and a diversification of our revenue and assets to be more inclusive of ambulatory ventures. We started that journey several years ago. We believe it is important for health systems as the industry transforms to integrate care; both to manage costs and ensure a seamless integration across venues. We're doubling down on that effort. 

Connected with that is the rollout of our new IT platform, Epic. We are on schedule to go live at the end of this month and again at the beginning of October. 

Q: Are there any other projects you have coming up in the next two years? 

JD: We're very excited about a couple of facility projects and transactions. We're building a new cancer pavilion for the Cancer Institute of New Jersey, which is adjacent to our hospital in New Brunswick. It will aggregate and provide more space for the clinical researchers that provide care and develop new treatments for cancer at the Cancer Institute. It's an $800 million construction project. 

And we have announced two mergers into the system; one with Trinitas Regional Health system and one with St. Peter's University Hospital, both supportive of our strategy. They are facilities that overlap communities we serve, and we know that aligning those facilities in such a way so that the programs are complementary is the best way to ensure those communities have the best care.

Q: Do you have any concerns for the next year? 

JD: The same as anyone else … what the new normal is, and rethinking whether it's telemedicine, or remote work or whatever other things that need to happen. So those changes are always difficult. It's difficult to predict exactly what's going to happen, but we're watching all those things. I think it would be foolish not to be worried.

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