Tim Robinson never bargained on a job in healthcare.
He'd graduated with a major in psychology, but his first job was in finance at a shoe company. "I started writing policies and procedures for the stores. How exciting is that?" Robinson said.
It turned out, he had a knack for business.
After moving up the ranks working in finance and operations, he began looking for new opportunities when he learned about a finance job at the local hospital. Taking that first role at Nationwide Children's Hospital turned into a lifelong vocation over the last 23 years as he added roles including chief financial officer and chief administrative officer to his resume.
In July, he took on the job of CEO of Nationwide Children's Hospital on the retirement of Steve Allen, M.D. I caught up with Robinson recently to talk to him about his ambitions for the health system.
FierceHealthcare: What’d you learn from the shoe industry?
|More about Tim Robinson|
Family: Married to Jane and has three children: Lauren, Andrea and Jordan
A few words that describe his management style: Situational based upon the experience of the person, but always built on honesty and trust
Advice he’d give his younger self: Always focus on adding value, and the rest will take care of itself.
A book he recommends: Any of Walter Isaacson’s books
Tim Robinson: I’m not much of a merchant. But I learned the process of ‘It’s all about the people.' It’s all about the inventory. It is getting the buys right and managing effectively and the Ps and Qs associated with that. Obviously getting your name out there in an effective way.
FH: It must’ve felt like quite the jump to move from a totally different industry to healthcare ...
TR: Just the terminology, physician relations and payers and Medicaid and those types of things. I came in with a slightly different perspective on what you could and couldn’t do. We got into this risk-based arrangement pretty early in my tenure going at risk for a large Medicaid population. It was probably good that we didn’t know better.
FH: Let’s talk about that ACO. How’d it get off the ground 25 years ago to become what it is today?
TR: As a provider that was going to take responsibility for all the children in a 37-county area, we knew we were going to see these kids and we had to get closer to the dollar to eliminate some of that credit risk. That’s really how we started to get into it. We just knew if we were responsible for these kids, that we could do better by getting closer. And then as we got into it, we began to understand how to manage a population and how to build an infrastructure with data systems and care coordination and 'How do you manage the pharmacy spend from a pediatric provider’s perspective?' We had a lot of insight in terms of what’s best for these kids and the flexibility of being able to reallocate the dollars in the way we thought was most beneficial.
FH: And how did it perform financially?
TR: We all lose money on Medicaid; we have some big Medicaid shortfalls because it doesn’t cover our costs. But we’ve done much better than we would have under a more traditional method. So it’s been good for the organization and we’ve been able to demonstrate to the state and to others through academic work that we’ve actually been able to bend the cost curve and provide at a lower cost per child then when compared to the other health plans and to the state in the fee-for-service environment. So we’re adding value to the state, providing better care and better access. It’s been a winning formula for us and its something others in the state are starting to think about potentially emulating.
FH: What were some of the biggest lessons learned that other groups might be able to learn from?
TR: Data is incredibly important. You’re always looking through the rearview mirror because you’re reliant more on claims data. We can blend it with our EMR data and those types of things to get more real-time. But really being able to understand what the patterns and what the drivers are and where the white spaces are is incredibly important.
Have a tolerance for risk and make sure your board and others understand what that means: that you’re in a different business and there’s going to be more volatility but overall what we’ve seen and been able to demonstrate is that you can outperform.
FH: How do you think coming into the CEO role from the finance side of the house makes your approach different?
TR: The last two CEOs over the last 25 years were physicians, so I am a little bit breaking the mold. But I think what enabled that is: We as a leadership team really do come together—and we have the medical component and the administrative component together—to have a thoughtful exchange about those issues. It’s really about having a strong team with a lot of trust. That is one of those things that over my 25 years I’ve been able to do is build a lot of trust with our physician leaders and physician staff that made them comfortable that I was going to lead the organization in a way that was going to support the mission and support their aspirations, whether they be academic or a clinical perspective.
FH: What sort of changes are being built at Nationwide Children’s campus?
TR: We did a replacement tower for the majority of our inpatient beds. That was the big cornerstone of it. We’ve subsequently built our third research building and we have plans to start, in the summer, our fourth research building. One of the cornerstones of this plan is a 380,000-square-foot behavioral health pavilion. I think it will be the first of its kind in the country in terms of really bringing together crisis service, basically emergency services for psychiatric and behavioral health patients to day-hospital type of things, the inpatient and blending in research, and it’s all part of the broader strategic plan that will focus on prevention, research and access.
We also have a new conference center we’re building that has attention to simulation capabilities to support our quality and safety training. We want people to be trained and have those experiences before they get to the patient bedside, so simulation training is one of them. We have a few other clinical buildings as well and, of course, parking to support it all.
FH: What's next for Nationwide Children's?
TR: We're two and a half years into our strategic plan, and where we see the accelerators are continuing to invest in world-class clinical programs but really focusing on translating and integrating with research in a much more aggressive way.
That has created a whole opportunity for us. We've invested in the infrastructure from a tech commercialization perspective to really get discoveries out into the marketplace and to kids. So we've invested in clinical trial infrastructure and regulatory infrastructure and even a good manufacturing plant to produce vector for gene therapy. We've been very thoughtful in these areas where we know we can really contribute and how do we make sure those discoveries get to kids? Zolgensma for spinal muscular atrophy was discovered at Nationwide Children's and early on, we spun it out into a company and that company was acquired by Novartis and the FDA approved it in May.
We've now seen those kids getting these treatments and, what was really cool is, if we identify their disease earlier, we can have a more profound impact on them and prevent the symptoms. We lobbied for newborn screening in the state of Ohio so we could identify those kids. As a matter of fact, a lead investor came knocking on my door not too long ago and said, 'I have a treat for you.' He takes me down to the clinical trial area and shows me this five-month-old beautiful baby girl who was showing no symptoms because they caught it early through screening. I don't think her parents could even comprehend the bullet that she dodged. It's very powerful.