Bob Garrett displays an inner cool that some might say seems surprising for a man at the center of many complex and exciting initiatives that are bringing dramatic improvement to the health care landscape here in New Jersey and beyond. As Co-CEO of the state’s largest, most comprehensive, and most integrated health network, Bob takes his transformation mission in stride.
Bob and his team at Hackensack Meridian Health, led with Co-CEO John K. Lloyd, former head of Meridian Health, are maestros when it comes to doing their due diligence, nailing the right strategy, and then executing against plan. From cementing a ten-year vision to creating a new private medical school – from scratch, mind you– to taking conventional disease treatment and re-imagining how to better connect health and care to keep people and communities well, Bob is a virtuoso.
It took one internship, at Mercy Hospital in Rockville Center, for this Connecticut native and political science major to know he had found his calling. “I loved what I saw,” he recalls, “and I thought, I really want to be involved with this.” The numbers speak for themselves: 33,000 team members; 6,500 credentialed physicians; 16 hospitals; 180 locations.
With a worldview informed by connecting with global leaders and rising entrepreneurs at the World Economic Forum in Davos, hosting health care panels at Vatican conferences, and working closely with Governor Murphy’s office on important issues like behavioral health care solutions and New Jersey’s innovation economy, Bob Garrett has his head up and his eyes on the health care horizon.
HumanizeMD thanks Bob Garrett for taking the time to talk with us about the important changes going on in health care today, and the future of health care he is helping to lead.
HMD: For an outside observer, it’s hard to keep up with the pace of advancement at Hackensack Meridian Health. There’s breakthrough news happening at HMH on almost every major health care front. Bob, before we delve into specific initiatives, can you explain your role in leading the organization to set so many precedents for the future state of health care, not just in New Jersey but at a national level?
RCG: My job, in essence, is to orchestrate excellence so that wecan be sure that our health network is providing top quality care,giving people in our communities the best possible patient experience, and keeping health care affordable. All three are equally important and, as Co-CEO, I want to live up to our mission to transform health care.
There are a lot of people in the industry who are pessimistic about the future of health care. I know there’s a lot of disruption,a lot of uncertainty, but I’ve never been more optimistic than I am now. There are great opportunities to do more, to do better –we just need to take advantage of them.
It’s my role to help us be focused, be agile. I think we are an agile organization, even as large as we are, with 6,500 credentialed physicians and 33,000 team members. I’ve learned a lotof lessons over the years about perseverance, so whether I’m opening a hospital or spending ten years to pioneer our own medical school, I know how to keep focused on a positive future and spread that optimism.
HMD: In July, 60 students in the inaugural class of the Hackensack Meridian School of Medicine at Seton Hall University launched their medical careers with a traditional White Coat ceremony,symbolizing the compassion and duty inherent in the medical profession. Why was this ceremony especially meaningful for you?
RCG: It was special for many reasons, but one of the great things about starting a new school of medicine from scratch – and I’ve been working on this project for a decade is that you can truly innovate.
Immersion is key to an innovative curriculum at Hackensack Meridian School of Medicine where our students team up with families in stressed areas such as Asbury Park, learning first hand the health challenges that families can have and their role in keeping entire communities well, based on an approach that focuses equally on maintaining health and curing illness.
As we have come to recognize the importance of social factors on health outcomes, we better understand that health and wellness occur in the community, not in the hospital. I’m proud to see this vision reach fruition and to deliver on our goal to change medical education to better prepare physicians of the future.
For me, the White Coat ceremony launched this inaugural class and our new innovative school of medicine.
HMD: How will this new medical school help resolve the growing physician shortage in New Jersey and meet new challenges in health care delivery?
RCG: I see this as an alternative for the current “brain drain” where many young people from New Jersey are going to medical schools outside of the state. Research shows that physicians often practice where they train, so the Hackensack Meridian School of Medicine is a solution which will help the state ease a shortage of an estimated 3,000 doctors by 2020. We will ramp up to 150 students next year, so ultimately it will be a medical school of 600 students.
Along with the opening of this state-of-theart medical school,Seton Hall University has relocated its College of Nursing and School of Health and Medical Sciences to create an Interprofessional Health Sciences (IHS) campus spread across Nutley and Clifton, helping to revitalize this major economic hub on the site of the former Hoffman La Roche campus. Students benefit from a three-year program, so they can save on a fourth year of tuition and start their residencies a year early at one of HMH’s 16hospitals, or stay on and obtain a graduate degree. Our Board of Trusteeshas established a $100 million endowment fund for scholarships, ensuring top students will be able to afford a medical education.
More than 2,100 students applied for the 60 spots. Diversity is well represented in the class, with students speaking a total of 25 languages. We wantour physicians to mirror the communities they serve. Women make up half of our class. Many of the students overcame their own challenges to get to where they are, which again, made the White Coat ceremony very special.
HMD: In 2017, you and your wife Laura donated $2.65 million to create the Robert C. and Laura C. Garrett Endowed Chair for the School of Medicine Dean. You were the first donors to make a gift of this magnitude to the new medical school.
RCG: Laura and I were thrilled to create this endowment to recognize the highest standards required in a leader of our medical school. The gift honored Dr. Bonita Stanton, founding dean of the Hackensack Meridian School of Medicine at Seton Hall University, who has practiced globally with distinction as a physician academician and will continue to bring the highest standards in medical education to the next generation of physicians.
Endowed chairs are among the highest honors conferred in academia and the $15 million donated in support of endowments at Hackensack University Medical Center reinforce its role as one of the top ranked academic medical centers in the country.
My wife and I wanted to make sure the school kicked off in the right way,and we’re very proud to have been able to endow this Chair. This school will be part of our legacy of improved health care for future generations.
HMD: Let’s talk about how the new Memorial Sloan Kettering–Hackensack Meridian Health partnership will transform patient care through collaboration, innovation and advanced technologies.
RCG: This is a time of unprecedented change in cancer care. The goal of this partnership is simple – to find more treatments for cancer faster while ensuring that residents have access to the highest quality, most individualized cancer care, where and when they need it.
Combining industry leading expertise and deep local roots is helping our new organization to accelerate research and discovery, advance the continuum of care for cancer patients and their families, and create new hope for cancer patients.
Our future outpatient cancer centers will be jointly owned and operated,a first for Memorial Sloan Kettering, and guided by exceptionally uniform standards. Clinicians on both sides have developed one hundred clinical standards that will define how cancer care is administered at these jointly owned centers across the state. So, if you are a patient in South Jersey or North Jersey or Central Jersey, you’ll receive the same world class standard of care,close to home.
Patients will benefit from precision medicine, immuno therapy, cell-based therapies, earlier cancer diagnosis, and an unmatched continuum of care that will support them throughout active treatment and beyond into survivorship. Equally as exciting, our communities will have greater access to hundreds of clinical trials to improve care for many types of cancer.
HMD: In August, HMH and Carrier Clinic, a leader in behavioral health with a 100-year history in New Jersey, announced plans to merge with a goal to deliver unsurpassed behavioral health care to the tri-state region. Why did you see a need to focus on behavioral health care?
RCG: The state of behavioral health care in New Jersey can be applied across the country. It’s fragmented at best and broken at worst. We see behavioral health issues growing as a significant problem in our society. Plus, there’s so much linkage between medical disease and behavioral health diseases. Almost 50 percent of people that have a primary medical diagnosis have a secondary behavioral health diagnosis, and in our emergency departments,about a third of patients have behavioral health issues.
We felt we needed a first class partner to help us take the lead as we did with Memorial Sloan Kettering in cancer care. Carrier is nationally recognized; they have great outcomes. We partnered on a couple of projects to get to know one another and were very impressed with their leadership and their clinical community, so we felt this collaboration could be a good fit. We plan to open an addiction treatment center next year in New Jersey.
HMD: What are you doing to make a difference through this new alliance?
RCG: Our primary goal is to expand access dramatically. Far too many people are waiting too long for care.We want to do some things differently in this area. We already have a massive ambulatory care network in place and plan to add a behavioral health component. We’ll open behavioral health urgent care centers because patients having an acute episode shouldn’t have to sit in an emergency department waiting for treatment.
Our goal is to create more addiction treatment centers in New Jersey. Too many residents are leaving New Jersey to go out of state for treatment.Florida, California and North Carolina are common destinations. This causes a burden to families, as a lot of these patients are younger, even adolescents.
The merger with Carrier will enhance research to improve behavioral health care and provide additional opportunities for our medical students pursuing psychiatry residencies and fellowship programs. We want to create world class addiction treatment centers right here in New Jersey, and we believe Carrier Clinic is going to help us to accomplish that.
HMD: What other types of care transformation initiatives are taking place,and how can value based “bundled” payments mean cost savings for patients?
RCG: What we’re doing is taking our top disease entities and approaching them in a very different way to achieve better results. Teams have been established around cardiovascular health, diabetes, different types of cancer and other diseases and conditions, and we’re looking through a new lens of improving quality, improving patient experience and ultimately making health care more affordable.
We’ve taken evolutionary actions such as creating bundles of care with insurers. This is the next threshold in value based health care, or patient centric practice – a new direction that is making the traditional fee based mode lless prevalent.
At the beginning of this year, Dr. Andrew Pecora, our chief innovation officer, oversaw the creation of an upfront payment model for breast cancer patients at HMH’s John Theurer Cancer Center,in partnership with Horizon Blue Cross Blue Shield of New Jersey, and now we have added bundled care for knee, hip and spine procedures.
With bundled care, hospitals receive an upfront payment from insurance companies for an agreed upon price for treatment. We accept 100 percent of the risk for all the care we provide. So, it provides an incentive for us – and all providers to make sure the patient receives high quality, cost effective care for every step of treatment, such as pre-surgical and postoperative care. It ultimately makes health care more affordable.
This program is one example of the ways we are reshaping how health care is delivered, helping enhance care coordination, improving outcomes and delivering greater value.
HMD: You believe that innovation is in your DNA at HMH. How is innovation creating a new foundation for innovative care at Hackensack Meridian Health?
RCG: We are eager to connect with individuals and companies at the forefront of enhancing care transformation, and so we have created an ideation center in partnership with the New Jersey Institute of Technology. The Agile Strategies Lab is the first incubator of its kind for health care advances in New Jersey. The Lab, located in Newark, is designed to help create and launch the next wave of problem solving in health care through better devices, improved technology and more efficient services to provide high quality of care, lower costs and an enhanced patient experience.We intend to leverage the combined skills of entrepreneurs,major corporations, research scientists, students and NJIT faculty to solve our challenges with novel strategies and products.
Our Board of Trustees also had a lot of great foresight when they committed $25 million to create an Innovation Center, helping companies develop trailblazing products and services. Seed money from the Innovation Center is helping to launch ideas to the point where they can become viable and receive financing from venture capitalists.
HMD: What kind of progress have you made with new product development?
RCG: We’ve already had 10 companies pitch us their ideas. We call it the Bear’s Den because we can’t say Shark Tank but the strategy is similar. The Bear’s Den is led by Dr. Andrew Pecora, president of physician enterprise and chief innovation officer at HMH, and our judges include a patent attorney, medical and financial experts, and Co-CEO John Lloyd. If we like you, we might invest in you.
In June, we invested in a new product created by Pillo Health,a leading in-home digital care management company. Pillo leverages voice first technology and artificial intelligence. Sitting on a countertop, Pillo uses voice and video technology to remind people to take medication at the appropriate time. It dispenses their medications, digitally coordinates prescription refills and connects individuals in their homes with physicians,caregivers and loved ones.
For example, Pillo can alert a family member if an elderly relative misses a medication dose. Pillo can also connect a patient or family member with a physician via video conference and provide an on-screen display of essential medical data as obtained from the patient’s electronic medical record.
HMD: A little over two and a half years ago, you and John Lloyd,who was CEO of Meridian Health prior to the merger, became Co-CEOs of Hackensack Meridian Health. Some people said it wouldn’t work for two strong, longtime CEOs to co-partner. Can you tell me why it has been successful?
RCG: It’s worked in our case for a couple of reasons, First, John and I have very complementary strengths and that’s how we divided up the organization. My background and my strengths have been in a more traditional hospital setting, and Hackensack University Medical Center was a major, nationally recognized medical center with a big emphasis on academics and research.Work began on the medical school years ago. Meridian excelled in their plan to create a major health care system with a broad ambulatory care network but were less evolved on the research and academics, so we each had something that the other needed.
It’s a true story that we challenged each other over dinner one night to write down on a piece of paper what areas we each thought we should be responsible for. “You know, John, what do you want to do and Bob, what do you want to do?” We exchanged our pieces of paper right there and we agreed about 90, 95 percent on what we felt our roles should be.
Another reason that this partnership works is that we had a succession plan in place from the beginning because, no matter how well you know and respect each other, no matter how complementary your strengths,if you don’t have a succession plan it’s going to be like the Wild West.Now John will retire at the end of the year and I’ll take over as the sole CEO, as we had always planned.
As much as we have been friends for a long time, we also worked hard to make this work and I think we are roles models as well and I think we’ve done really well together.
HMD: What do you see as John Lloyd’s legacy after so many years as a leader in health care, and as Co-CEO at HMH?
RCG: There’s no doubt that John is leaving an indelible mark on healthcare in New Jersey and beyond.
John was a visionary when it came to seeing the need to develop a full continuum of care to deliver comprehensive health services to communities. Now,everybody wants that full continuum of care and you hear about different health systems developing ambulatory care and post-acute care services. John saw the need for that early on and did it very well.
In addition to understanding the right strategy, John could get so much done because of his personality and his ability to connect with people. Whether you’re in a board room with John or at a community event or rounding on the floor with front-line team members, it’s the same John Lloyd. He’s just real and authentic and he connects with people. He’s an excellent leader and people want to follow him.
HMD: That infectious enthusiasm and ability to lead is an important quality in an organization with 33,000 team members and 6,500 physicians.How did you and John manage to build a new culture when you combined your organizations?
RCG: When we envisioned HMH we had some great initiatives and some great strategies but we knew that if we didn’t develop a unified culture over time, none of it was going to work. We focused on it and I think that the way you do that with 33,000 team members at all levels of the organization is to make it really simple.
We wanted to develop core messages in such a way that everybody,at any level or corner of the organization, would be able to relate. And we took this into consideration in developing our mission statement, our vision and our core beliefs. Our mission statement basically states that we’re all here to transform health care. All 33,000 team members can relate to our vision, which is that innovation is in our DNA.
HMD: How have you used your core beliefs to enhance employee engagement?
RCG: Collaborative, courageous, creative and compassionate are the four C’s that form our core beliefs. Each team member takes a test to see which C they score highest in, and they love it! John and I have been going around doing these pop culture events, with tent cards illustrating the four core beliefs. Team members who attend want us to sign their side of the card. “Oh I’m creative, could you please sign it?”
It’s providing people with a simple, universal way to relate, so whether you’re a world class bone marrow physician or a person who ensures that our patient environment is clean and safe, there’s something that every single person can hold in their hand and whatever decisions they need to make throughout the day, they can just check back to our core beliefs.
We developed the four C’s earlier this year and we’ve been rolling them out at Town Hall meetings and popup events across the organization. We even had a pep rally at Met Life Stadium, where I got to do my first zip line across the stadium. I loved it. I’d do it again in a minute.
HMD: Speaking of zip lining, how do you manage to stay above it all in terms of work/life balance?
RCG: A long time ago someone told me it’s a lifestyle and not a job. That’s true. I try to spend as much time as I can with family and friends, and many of our close friends are Hackensack Meridian Health people as well.
We get away, but often it’s no further than from our home in Morristown to our beach house in Spring Lake, where I love to walk on the boardwalk. I thrive on running into team members, people I know and people I don’t know and talking with them about what’s going on. This takes a certain personality type that I have, and it has helped me keep a lot of balls in the air and be successful at it.
Aside from people, my other great passion is travel. Seeing what’s different,seeing what’s going on. I’m fortunate to have twice been invited to participate on a panel as part of the Unite To Cure Conference at the Vatican.This year’s conference was themed How Science, Technology and 21stCentury Medicine Will Impact Culture and Society.I’ve also been fortunate to host a panel on the global transition of health care delivery at the World Economic Forum in Davos, Switzerland.
I work out four days a week, play some racquetball, and I do actually sleep pretty well, although I often say sleep is overrated!
New Integrative Approaches to Mental Illness and Substance Abuse
Depression, anxiety, and other behavioral health conditions are not only increasing in incidence, but have traditionally been treated almost exclusively with medications. Additionally, substance abuse and addiction are often intertwined with behavioral
An Integrative Approach to Managing Mental Illness
Health psychologist Lisa Sussman, Psy.D., a member of the Integrative Health & Medicine program at Hackensack Meridian Health, is part of a team utilizing a unique care model based on Five Pillars of Health and Well-being to help manage mental illness, stress, and overall mind-body health with complementary techniques. Studies show that mindfulness, meditation and targeted nutrition, for example, offer improved
results for managing mental health.
The Five Pillars include Nutrition, Sleep, Activity, Resilience, and Purpose. Dr. Sussman adds, “We believe that these pillars are fundamental to the health and well-being of every human being.”
“Integrative health and medicine techniques provide nonpharmaceutical methods to manage pain or the symptoms of mental illness,” says Dr. Sussman. “Some of these methods include cognitive-behavioral therapy, mindfulness, positive psychology, Emotional Freedom Technique (EFT), and other energy based interventions.”
“There are many health interventions available to guide people in learning skills which not only help them adjust to their medical status, improve quality of life and change their mindset, but also to shift into and maintain a resilient lifestyle which promotes positive mind-body change, healing, and wellness,” concludes Dr. Sussman.
Building Resilience for Behavioral Health Clients
Kathleen Welshman, RN, a Certified Integrative Nurse Health Coach with Hackensack Meridian Integrative Health & Medicine, partners with clients to help create transformation and sustainable lifestyle change.
Welshman recently launched a Personal Resilience Empowerment Program (PREP) for home-based behavioral health clients to encourage sustainable healthy lifestyles. The program supports clients with a persistent mental illness as well as the comorbidity of a chronic health condition such as hypertension, diabetes or substance abuse.
Based on the Five Pillars of Health and Well-Being, PREP helps clients attain a goal each week. At the end of the eight-week program, clients will have developed an individualized self-care plan. Welshman believes that identifying one’s true purpose and values in life are a motivating factor to create desired change.
Medication-Assisted Treatment for Opioid Addiction
Historically, the majority of drug treatment centers in the U.S. have subscribed almost exclusively to an abstinence-only model to treat opioid addiction, based on an interpretation of the 12 steps of the Alcoholics Anonymous and Narcotics Anonymous programs.
“With tens of thousands of people dying each year from drug addiction, healthcare leaders are revisiting their response to treatment,” says Mary Pat Angelini, CEO of Preferred Behavioral Health Group, which last year provided community behavioral health prevention, intervention and treatment services to 27,000 individuals in New Jersey.
Angelini adds, “Studies show that Medication-Assisted Treatment (MAT) can cut mortality rates among clients with substance use disorder substantially. MAT is creating longer periods of sobriety which provide the person who is addicted with time to get the supportive counseling they need to embark on lifetime of recovery.”
Humanizing Behavioral Healthcare Design
With a growing number of individuals in the U.S. being diagnosed with mental health conditions, organizations are designing specialized facilities where patients can be treated with dignity.
At its Lakewood facility, which provides outpatient mental health and substance use disorder treatment and counseling, Preferred Behavioral Health Group is incorporating design elements to create a light and airy space with a comfortable, home-like feel, de-stigmatizing both the facility and the clients it supports.
“This paradigm shift in architecture parallels new ways in which mental illness and addiction is viewed by society,” says Angelini, “Patients are being treated with the expectation of holistic wellness that will aid in their long-term recovery.”
Preferred Behavioral Health group
Hackensack Meridian Health Integrative Medicine
Healthcare systems have increasingly begun to develop creative ways to improve performance and satisfaction for both patients and employees. As innovation becomes a mainstay in the healthcare industry, more organizations like Saint Peter’s Healthcare System and Hackensack Meridian Health are carving out leadership positions devoted exclusively to innovative processes and projects.
Engaging Patients and Staff for Better Outcomes
“I was initially hired as Director of Service Excellence at Saint Peter’s Healthcare System in 2001,” says Lisa Drumbore, “and I never looked back.” When Drumbore first started at St. Peter’s, customer satisfaction, or service excellence roles, were just beginning to emerge in healthcare. Drumbore wore many hats, with responsibilities from pastoral care to employee engagement.
In 2016, Drumbore was appointed as Vice President, Chief Experience Officer for St. Peters. “It made sense for a hospital so mission-focused to be ahead of the curve when it came to engaging patients and employees from a business perspective,” says Drumbore. “From a values perspective, we knew it was also the right thing to do.”
To improve performance, leadership must be willing to address fundamental issues within its culture and structure to transform the organization. Drumbore continues to be inspired by transformational principles from one of her favorite books, Ken Blanchard’s 2016 best-seller Lead Like Jesus, which illustrates the philosophy of servant leadership, a set of practices that enriches the lives of individuals, builds better organizations and ultimately creates a more just and caring world.
Traditional leadership generally involves the exercise of power by one at the “top of the pyramid.” By comparison, the servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible.
“Success is the result of focusing on culture, communications and fostering lasting, trusted relationships,” concludes Drumbore. “The initiatives that have moved the scores are the ones that have focused first and foremost on culture and leadership.”
Helping Caregivers Do What They Love Most
Increasingly, hospitals are launching innovation centers of their own to work with researchers and design thinkers to tackle the biggest challenges in clinical quality, patient safety, health information technology, healthcare costs, billing and payment, and access to care.
“Innovation can sometimes throw people off,” says Elizabeth Paskas, MSN, RN, NE-BC and Vice President, Experience Innovation & Consumer Services at Hackensack Meridian Health. “But sometimes innovation can be simply a new way of doing things that gets us where we want to be.”
Paskas spent 16 years in Hackensack UMC and for the last ten years worked as a nurse leader on units with opportunities for improvement. Her frontline experience has prepared her with fundamental insights to help caregivers find better ways to do what they already love – taking care of patients and getting the outcomes that they need.
“Change is not always easy,” says Paskas, “but one of the main ways we get buy-in is through a program called the Experience Innovation Café. This is a place where Hackensack Meridian Health team members can come together and share their input and propose options on the strategies, tools, techniques and technologies we want to put into place. We’ve found that this co-design process creates a lot of buy-in on decision making and usually improves the process because we have feedback from so many perspectives, including patients.”
Creativity and imagination are crucial to treating patients and engaging staff, from surgeons to housekeepers. At Hackensack Meridian Health and Saint Peter’s Healthcare, the results of these innovative ideas are making a positive difference in healthcare for New Jerseyans every single day.
Hackensack Meridian Health
Saint Peter’s Healthcare System