Hospital and health system CEOs are continuously tasked with making strategic decisions for their organizations, and the approaches they take with these decisions vary.
For Bill Robertson, CEO of Tacoma, Wash.-based MultiCare Health System, the approach many times has been "both/and," meaning exploring multiple viewpoints and concepts.
Mr. Robertson joined MultiCare as president and CEO in 2014 from Gaithersburg, Md.-based Adventist HealthCare. He then decided to forgo the president title in 2022, when the health system split the president and CEO roles, and Florence Chang took the president position.
While he has taken the "both/and" approach many times with decision making while at the helm, he told Becker's he recently abandoned this approach relating to a partnership decision. Mr. Robertson shared more about this recent decision as part of a phone interview on May 22.
Editor's note: This is a regular series of conversations with CEOs of the nation's health systems. Responses were lightly edited for length and clarity.
Question: What's the most difficult choice you've had to make for your organization in the last 12 months?
Bill Robertson: Every organization has potential opportunities from a strategic perspective. We in MultiCare tend to work from a "both/and." It's not like we're always doing "either/or." We choose to do "this" and "that." That's how our approach is. Within the last 12 months or so, we were working toward a "both this and this" strategic opportunity relating to building partnerships in the Pacific Northwest. And I came to a place where I had to actually make the decision to at that point abandon the "both/and" and choose one or the other of the partnerships to focus on. That was a really hard decision, and we did make that decision.
And yesterday, we announced that Bellevue, Wash.-based Overlake Medical Center & Clinics are going to be affiliating with MultiCare as the leader of our North Sound region. After three or four months of regulatory process, we expect to have Overlake Medical Center part of the larger MultiCare family. We're very excited about that. But I had to make a decision to choose between. I couldn't be "both/and" anymore. I had to do one or the other. Both are really interesting opportunities. It was a difficult decision, but the right decision, and we're very excited that decision has played out. Because there was no certainty at the time that the decision would end up with Overlake choosing through their process that MultiCare would be their long-term partner.
Q: If you could go back in time 10 years, what would you tell yourself to start doing, or start learning about?
BR: If I had started this 10 years ago thinking about it, my organization would be in an interestingly better position today relative to the nursing shortage than we are. My team has been over the last year or year and a half working to redesign the clinical model used for nursing. And if I could go back 10 years, when we could relatively easily recruit nurses, and nurses were not choosing to go off and be agency staff, I would have been way more focused on redesigning the nursing care model. I would be working with people to do that.
It was really clear we were going to have to do that at some point. And it took a global pandemic and nurses dramatically changing how they thought about their roles at hospitals to get us to the stage where we're redesigning the nursing clinical model. My team's done a great job, and has done great presentations about the success we're generating. But if we had 10 years under our belt, we'd be in a way better place.
Q: What ended up being a bigger deal than it might have seemed at one point?
BR: Toward the end of the pandemic, there was a massive set of legislation at the federal level that pumped billions of dollars into the economy. And at the time, I had a lot of anxiety, because it felt to me that that was priming us for inflation. But a lot of pundits of the time said it's not going to do that. Then we had transient inflation, which clearly has not been transient. The political class and the business class, we probably underestimated the overheating of that massive influx, combined with the legacy issues of COVID, and we're dealing with that in healthcare. So, a much bigger deal than people probably thought things like infrastructure bills were going to create in the general economy.
Q: What's an unpopular (or uncommon) leadership or healthcare opinion you have?
BR: If you look at healthcare today, there tends to be this move toward health systems becoming operating companies. That means they move a lot of the decision making related to their distributed delivery assets toward a more corporate structure, because they're going to get more efficiency in the decision making and more consistency in the decision making. And I have this odd idea that actually healthcare is way more local than that centralized decision making does.
It's really hard for a corporate person to build all the relationships necessary in every market where business units operate. So the idea that being an operating company is the ideal model for healthcare, I reject. I think it's a mix of things like holding company behavior for some things, where you build the right teams in the relevant markets or the relevant clinical activities, and you let them have a lot of leeway to lead and make decisions in the best interest of patients and team members and market position. And then, for a more limited set of things, you have an operating company model where you have the economies of scale that a shared revenue cycle platform delivers, or a treasury function, or maybe group purchasing. But the day-to-day local strategic agenda is ill served by the "everything is an operating company" model. It is not a broadly embraced worldview, as I have observed.