Q&A with David Blom

Striving to Be ‘Part of the Solution’

By
From the July 2013 issue of Columbus CEO
  • Photo by Ryan M.L. Young

David Blom’s corner office in OhioHealth’s corporate headquarters affords him a view of downtown Columbus, stretching from the southeast to the northwest. From here, Blom, 58, can watch a medical helicopter land on the roof of Grant Medical Center, one of the 10 hospitals he oversees as president and CEO of OhioHealth. He sees employees hustling between corporate and government offices. He witnesses the poverty in South Side neighborhoods.

The view both troubles and inspires Blom in his work. “A part of every community’s life is the quality of its health-care resources and the cost of its health-care resources,” he says.

OhioHealth serves patients in a 40-plus county region through its hospitals, 20 health and surgery centers, hospice and rehabilitation facilities, and home health-care providers. Blom meets regularly with government leaders, employers and insurance providers to improve patient care while striving to lower costs. “That’s increasingly a role that OhioHealth is trying to play. Be part of the solution, not the cause of the problem,” he says.

In his 11 years as president and CEO, Blom has increased operating margins from 1.7 percent to 10.1 percent, seen revenue grow from $1.4 billion to $2.5 billion and streamlined the system’s various health-care facilities into a unified entity operating under a common vision. Major projects under way include an overhaul of the organization’s information technology system and a $321 million, 409,000-square-foot tower to house the Neuroscience Institute at Riverside Methodist Hospital.

This year marks Blom’s 30th with OhioHealth, which has 18,000 employees in addition to 2,800 doctors. Recently, the nonprofit has earned an Aa2 credit rating from Moody’s Investors Service and an AA+ rating from Standard & Poor’s. Fortune ranked OhioHealth No. 69 on the magazine’s 2013 “100 Best Companies to Work For” list. Truven Health Analytics named OhioHealth one of the top five large health systems nationwide, based on its survey of health-care facilities’ use of data collection and comparison to improve patient care and business results.

 

Q: How have you seen health care and the organization change in that time?

A: Health care is a big issue. It’s one that is becoming a bigger issue. It’s in the news, [a] topic of conversation. Everyone’s feeling it, aren’t they? The government’s feeling it. The federal Affordable Care Act is intended to provide greater coverage at lower cost. It didn’t do that, but that’s what was intended. … Employers are feeling it. I had a meeting this morning with 50 employers. … Employers are all worried about health care and how they’re going to pay for it and [asking], ‘What’s the Affordable Care Act going to do to us—or for us?’

Employees are worried about it because as employers are feeling it, they’re shifting the risk … to employees. So it’s really a huge community topic, and the system we have is not sustainable. This trajectory of health care is not sustainable. It costs too much and not enough people are covered.

I think our long-term goals were really defined in 2001 and 2002. … We used to have a board at Riverside and Grant and Doctor’s, and we had the OhioHealth board, we had a Marion board. We had all these boards. Our boards wisely [combined into one]. … Jack Chester, Mike Endres, John Zeiger, Tom Hoaglin were all people who were on our board who were very vocal on this. They said, ‘You know, Dave [and to each other], our job shouldn’t be to maximize any one of our individual hospitals. Our job should be to take what we have and serve the community as best we possibly can with everything that we’ve got.’

That kind of set the direction for the organization. We went from all these boards and board members in 2001, to 2002 we have a much smaller group, and they’re not focused on individual institutions, they’re focused on the community and how we use these individual institutions collectively to serve that community. … That set the roadmap for our long-term goals.

If you think about the big projects we’ve done since that time, it all kind of plays off that. … Within that, the short-term goals are just those activities and goals that are needed at that time to get through that period of time and those market forces and those challenges to really fulfill that long-term goal.

 

Q: Did you face resistance as you were combining those boards?

A: Change is always hard. You always have a third of the people that are right there and a third of the people who are waiting to see which way it’s going to go and a third of the people who are going the other way. No matter what change you’ve got, you always kind of have that. But you have to paint a vision that’s brighter than what exists, then spend enough time with people and understand their concerns to deal with that resistance in a way that they come along.

It’s not just the boards. I’ve had to deal with that with physicians and staff, but you just have to manage that the right way. Give people time. Give people time and the motivation to get on board.

 

Q: Is this combining of boards a trend in the industry overall or something OhioHealth has engineered?

A: I think it’s a trend overall. I think that we got at it earlier than most, and I think that we’ve done a very effective job at leveraging what we have to serve the community very, very well.

 

Q: Given the expansion you’ve overseen, how has it helped with your increased revenues, your operating margins?

A: The financial results are not an end game. They’re a means to an end. Our mission is to improve the health of those we serve, and our good, solid financial results that I’m proud of help us achieve that.

We’re not here to be a financial enterprise. We’re here to take care of people. In fact, we’re here to take care of people during some of the most vulnerable times of their lives, right? Happy moments, sad moments and in-between, and moments of crises during your life. … In order to do that well, you have to have your associates and your physicians—everyone in the organization—engaged, energized, passionate about what they do in order to achieve levels of excellence [in] giving service. Because we’re not making widgets, we’re taking care of people.

 

Q: What are some strategies you use to inspire energy, engagement and passion?

A: The balanced scorecard approach has been around for years. It’s used in lots of industries around the country, but we just are a little bit maniacal about it. Maybe that’s not the right word. … but we are on it.

We measure four things. … One is quality of care. We’ve got a whole staff of people dealing with the quality of care, the measurement part of it. We use national standards, and it all rolls up to one number. So everyone’s passionate about the quality of care. Then we look at the quality of our customer service, the patient experience, how well has that been? Everyone in the organization can touch that. Even if you don’t touch a patient, you’re touching someone who does. So the guy in plant operations, or the person in housekeeping, or the person working in billing and collection, they may not be touching the patient but they’re touching somebody that does.

We train for it. We monitor it. We motivate [for] it. We teach it. We use best, best practice around the patient experience, so that’s the second part of the balanced scorecard. The third part is financial: How well are we doing, and how much does it cost? Because without having good, solid financial results, you can’t do the other things well.

The last one may be the most important, and that’s employee morale, employee engagement, physician morale and physician engagement. We measure it. We measure it by cost center, and we manage it. We need to know how people feel about working here. We need to know what’s on their minds and what we can do to make it better, and for our doctors, how well are we doing taking care of their patients?

We focus on those, hold people accountable, but we support them. I think one of the things that helps us get there is people are proud to work here, because they recognize how we serve this community, and that means a lot to them. People get into health care for very altruistic reasons, and we help keep that altruism alive in their spirit.

 

Q: Have you always conceived of health care as a customer service?

A: I think of health care as we’re here to care for patients and families during the most vulnerable times of their lives, and our job is to make that as good an experience as it can possibly be. Whether it’s health or end of life or whether it’s a birth or there’s a trauma, our job is to make that as positive an experience as we can, from a scientific as well as from an experiential standpoint.

 

Q: When you reflect on the recognition OhioHealth has received, what does that mean to you?

A: There are several recognitions that mean an awful lot to me. One is the Fortune recognition, not because we’re on Fortune, but because it just represents how the associates feel about us and how we appear to others. I can’t tell you the number of people who have chosen or at least explored working here because of that Fortune [ranking]. Even doctors are bringing it up. We had a doctor in town the other day from the Mayo Clinic [who] was interested in a job, and during the first couple minutes I talked to her, she brought up the Fortune [list].

The other one that means a lot to me is our ratings with the financial industry. We’re doing a good job being stewards of our assets. That means a lot. Health care is expensive. We’re trying real hard to make it less expensive. Being a good steward of our community’s assets is important, and we are.

The third one would be Truven, because we’ve got a lot of people working really hard to deliver the best quality care we possibly can. The Truven award isn’t anything you apply for. … Someone’s looking at the data, and it shows up. And you either show up looking good or you’re not on it. I kind of like that. There’s no gamesmanship. There’s no art in filling out the application. There’s none of that. You can’t lobby for it. It isn’t based on someone’s opinion. It’s just what the data shows.

 

Q: That must feel nice.

A: It felt great. You know, you don’t work to achieve those awards, but when you set high standards—and each of these segments of our balanced scorecard—and the national recognition comes because you’ve achieved … it feels good to the organization, and it builds pride in the organization.

 

Q: How do you anticipate OhioHealth will be affected by the Affordable Care Act?

A: If I am short-term focused and a little bit selfish, I like it. Because theoretically, we’ll have more people covered, and they’ll have resources to cover. Now, if Medicaid expansion doesn’t happen, I might change my tune. But if I think about the act and what it was intended to do and the way it was written and the way they say they’re going to implement it, if I’m short-term focused and a little bit selfish, I like it.

If I’m long-term focused and I have a little broader perspective on society and our country, it doesn’t do it. Because all we’re doing is covering more people and not reforming health care. So calling it health-care reform is a misnomer. The only way you reform anything is if you change the behavior of the people that you’re trying to reform, right? How do you reform something? … Mayor Coleman’s talking about reforming education. You’re talking about changing the behavior of the administration, teachers, how it’s paid for, incentives.

Well, if you’re going to reform health care, you’ve got to change the behavior of everyone also. Which means you’ve got to change the behavior of consumers [so] they’re feeling some accountability of their health and their behaviors. Am I eating a cheeseburger every night and eating chips, or am I being a little more conscientious about my health? Am I exercising, or am I a couch potato? Do I feel some accountability for my behavior and how that impacts my health and, oh by the way, the cost of my health care?

If you’re a doctor, the behavior you have to change is: What are you doing to keep people well, not just treat their sickness? If I’m a hospital administrator, what am I doing to keep a population healthy rather than counting the number of surgeries I’m going to do tomorrow? And if I am an insurer, what am I doing as an insurer with the financial vehicle, the financing, to incent people to have a healthy behavior, encourage doctors to deliver wellness and prevention, and encourage the hospitals to provide wellness services rather than just sick services?

The health-care reform bill didn’t do any of that. It didn’t do any of that. Now there’s some pilot projects, ACOs [affordable care organizations], and those are all well-intended and they yield something, but they’re not of sufficient scale to change the trajectory of what it is that we have.

There are some employers that are reforming health care. We are reforming health care for our employees and their families, that’s because we changed the behavior of our associates to be conscious about their health. We are providing financial incentives and other incentives to physicians to keep our people healthy. I as an employer am incented for employees to stay healthy rather than get sick. That’s what it takes to reform health care.

 

Q: What role does OhioHealth play in promoting community health?

A: I think we have an important role. First of all, we’re the largest provider, so we touch lots of people. … I don’t think we’re doing a good enough job yet doing that, but we are working with some insurers. We’re working with some insurance companies that are adopting a lot of the things we’re doing with OhioHealthy [OhioHealth’s employee wellness program] and we’re helping them implement. We have an employer services group that are working with employers to help them understand what they can do to lower the health-care costs and improve employees’ health. So we’re doing it through the insurance companies, and we’re doing it directly with employers.

 

Q: You sit on the boards of the Columbus Foundation, Columbus 2020 and the Columbus Partnership. What have you learned about the health needs of the community from that service, and how do you bring that back to OhioHealth?

A: I’ve really enjoyed the civic engagement that I’ve had. It’s been more focused around economic development for the city, and I’m really proud of what’s being accomplished. Alex Fischer and Kenny McDonald, the Columbus 2020 board and the city and the state are more aligned than I’ve ever seen them around achieving a real competency for this community at economic development. I think we’re now regarded as pretty good at it, and the results are there. Look at the job growth that we’ve had in his community.
         We’re blessed in Central Ohio to have a lot of really good health-care providers. They’re good quality. Our costs are about the national median. They’re all doing well financially. We’re blessed here in Columbus to have what we have. Here in Columbus, we don’t have a separate tax for the indigent. … We don’t have a separate charity hospital. … So having the health-care community as part of the ongoing conversation in the community is important. My colleagues from Mount Carmel and Ohio State kind of feel the same way.

But increasingly, I think the voice of the health-care community needs to be one of understanding the pressure government and the business community feels on health care and being part of the solution, not being a cause of the problem.

 

Q: Do you work with state legislators and city government?

A: Absolutely, it’s an ongoing dialogue. It’s something that I am deliberate about. We have a wonderful government relations staff here that keep us connected at the right place at the right time.

 

Q: As the city draws more of the middle class back Downtown, as people are drawn back to the urban center, do you think quality of life among Columbus’s underserved populations is also being improved?

A: That’s a problem. Look south. Point to a doctor’s office.

 

Q: It’s hard. There aren’t many gyms. There aren’t health food stores.

A: Yeah, but you could look north [and] they’d be tripping over each other. … So that’s part of the issue of the Medicaid expansion is to provide coverage to those people who don’t have it. The problem with this is the people that don’t have insurance and don’t qualify for even Medicaid; their kids generally qualify for Medicaid, but the adults don’t. So their care is episodic and transactional rather than longitudinal and managed. A lot of these people can’t get access, so their problem escalates to the point of crisis and then where do they go? Where do they go? Emergency rooms. The most expensive place you can possibly get health care and the least longitudinal.

There’s a health-care episode, then the next time they may go to Grant, and the next time they may go to Mount Carmel West, and they don’t know what [the other hospitals] did. Now, over time, I think the information systems that everyone’s putting in will help alleviate some of the discontinuity. But that’s still few years away, and it still doesn’t really solve the problem.

The underserved need to be served. We need to have them enrolled. Medicaid expansion is probably the best way to do it. I understand the problems in all that, and I know it’s expensive. I think it’s more expensive not covering them than covering them because of the episodic and crisis nature of what people have.

 

Q: OhioHealth is overhauling its IT systems now, is that right?

A: It’s a big job, we’re just getting started. This is a three-year deal. I’m excited about it … our big Care Connect project. It’s taking everything we’ve got in the whole system and putting it under the same information system. So a patient that we treat in Forest, Ohio, where the hospital they use is in Hardin … that clinical information is as visible at Grant as it is for a patient [treated] at Grant. It’ll all be connected. The patients will have their records no matter where they are in the system, so it’s a pretty exciting project.

I’m real excited about it, but it’s a huge project. I feel good about it because our employees want it, our doctors are yearning for it, and we have a wonderful leadership team that is implementing it. We picked some of our best leaders and they’re on this project. Whenever you put your best talent on something, your anxiety levels drop a notch or two.

 

Q: How good are you at delegating tasks to your staff?

A: One of the most important things I do is picking talent, putting them in the right seats, giving the context for the work that needs to be done and providing them the resources to get it done. If I don’t do that well, I’m not doing my job.

 

Q: What informed your decision to pursue the Neuroscience Institute expansion?

A: Riverside today is about 50 percent private beds. When you go to the hospital, you’re not really looking for a roommate. So we needed to deal with that, and I needed a clinical and a business strategy that would enable that to make sense economically. As we thought about what clinical service shows the greatest promise of growth technologically in the future, it’s neuroscience.

I kind of look at neuroscience in 2013 as I looked at heart in the late ’70s and early ’80s. … Open heart surgery was not new, but just evolving. Angioplasty was kind of new, and drug-eluting stents hadn’t even been invented yet. So the whole cardiology world was evolving, and it blossomed. It’s blossoming today. I kind of feel that way about neuro today, how we’re able to take care of stroke patients.

Ten years ago … when people had strokes, their faces were droopy, they couldn’t talk, they dealt with rehab for years. Neuro is just in the beginning stages of that science. So we saw an opportunity at Riverside. … Riverside’s one of the top five stroke hospitals in the national already in terms of volume. We said, ‘This is where we should invest our resources.’

I really didn’t have super-clear vision of what it is we wanted to do. So we got all our neuroscience doctors together and we rented the Blue Jackets plane and we all together flew to Seattle, 30 of us. Seattle has one of these very sophisticated neuro programs, one of the top two or three in the country.

We spent two days seeing what was possible. We saw things we liked and didn’t like, things we were doing better, but we came back with a common vision and a common resolve for what it is that we wanted. And everyone bought into this vision of having one of the top five neuroscience programs in the country. What you see over on Olentangy River Road is the culmination of that work.

 

Q: Have you had a mentor who shaped your development professionally, maybe personally?

A: I’ve had more than one. Some of the best professional advice I’d gotten real early on was to learn to understand who your mentors are and what they can offer you. I never asked somebody if they’d be my mentor, they just knew.

In 1975, I was a student at Ohio State. I was working at night at University Hospital. … There was a lady named Connie Mansfield that I worked for. She and I were talking one time about what I was going to do when I grew up, and I wasn’t sure yet. So she sent me over to see her husband, Ed. [Edgar Mansfield] was the president and CEO of Riverside Hospital. He was the guy that built Riverside.

The predecessor to Riverside was White Cross Hospital in the Short North. They built Riverside in 1959 way out in the country on North Broadway (laughs).

He encouraged me to get into hospital administration and gave me a number of people to talk to and experiences that made me decide that that’s what I should do. … He was a mentor of mine, started in 1975, until he died several years ago.

 

Q: What were you studying at Ohio State?

A: Business

 

Q: How do you think he’d feel about the status of health care today?

A: He’d be disturbed. He’d be proud of our organization as to how it performs within the context of health care generally, but he’d be disturbed about health care. He was a very frugal guy. He didn’t waste a penny. He would see the level of expenditures, just how it’s all done, and he’d be really concerned about the dollars that are being spent.

 

Q: How do you strike a work-life balance?

A: It’s a conscious decision. I really encourage everyone at work here to have good balance. If you get out of balance one place or the other, neither home [nor] work is going to go well. So let’s not upset the balance. I missed very few of my kids’ events. I missed very few soccer games. I just made it a priority. I hope that it’s that way with everyone here at OhioHealth. I can’t run their lives, but I don’t like people working beyond some reasonable, normal hours. If you’re not happy at home, eventually you’re not going to be happy at work. And if you’re not happy at work, you’re eventually not going to be happy at home.

 

Q: Do you set any rules for yourself at home, like ‘my iPhone is off, my computers are off’?

A: Well, the iPhone thing I’ve got to work on that a little bit. I’m getting into some bad habits, because I just got one. I had a BlackBerry, and that wasn’t nearly as enticing as the iPhone.

I do have some rules. I work out three times a week and I have for 25 years. Now, some of those workouts are kind of pitiful, I’ll tell you that. But at least I can say I put on a pair of sweats and I worked out. And that’s helped me with my health.

I try not to go to the office on weekends. I’ll take some work home, but Sunday nights, don’t even talk to me. Sunday night is family time. Sunday is family time, so don’t even think about calling me. It’s got to be a big problem for you to bother me on a Sunday night.

 

Q: What kind of entertainment do you enjoy? Do you listen to anything? Do you read?

A: When I’m at the gym, I’m usually watching something on the tube. I’m not a music-at-the-gym guy. I’m news or sports. Quite often, I’ll save the workout for a basketball game or a football game, takes your mind off it.

I like to fish, fly fishing. I hunt in the fall, play golf in the summer. … I have a kayak that I use a lot.

 

Q: What’s the biggest fish you’ve caught?

A: I’ve got an 8-foot sailfish hanging in my den that I caught.

 

Q: Where did you catch it?

A: Florida. I caught a 160-pound halibut once. I caught a 24-inch brown trout on my fly rod. But I don’t have any monster stories.

 

Q: Is there anything we haven’t covered that you’d like to talk about?

A: Our job is to provide health care during the most vulnerable times of your lives in the best way we possibly can, even including end of life. Have you ever seen our Kobacker House?


Q: That was a groundbreaking institution at a time when palliative care wasn’t common. It’s a valuable service. It’s hard when you’re losing somebody.

My dad died there, at the first Kobacker House. I was there for 21 days in a row, every morning and every evening. I saw it, I felt it. I’d been in that place 100 times, for meetings or something. But you go in there with your dad on the cart next to you, it’s a little different deal. I was there twice a day and I saw what they did, experienced the unbelievable staff, a few little miracles here and there. I don’t mean that lightly. I saw we were turning people away almost every day. I said, ‘We need a bigger one, a new one.’

I originally thought we should just add on to it. People a whole lot smarter than I am came up with a different idea, and thank God they did. So we built it in a really cool place, back in the woods, walking paths around it, accommodations to stay overnight right next door to it. It’s really a pretty special place.

OhioHealth delivers 11,000 babies a year. Every one of our OB units is nice: It’s shiny and it’s modern, room for families to gather and celebrate, and we built it to do that. Well, why shouldn’t we build a place to celebrate the end of life also, and deal with all of the emotions of that? We built a place to deal with the emotions of birth, why not have a place to deal with the emotions of transition out of life?

I think we did a really good job with that. I had very little to do with the design. I get lots and lots of comments about Kobacker House. Not just Kobacker House, but our whole hospice program. I guess that’s an example of how we think about health care.

People may not consider how much the environment affects the quality of care and the emotions that are involved. But … having that space to mourn and be close and private with dignity are important.

My dad was a minister. He was a Presbyterian minister. My mother always played the piano in church, all that. They had favorite hymns. I can remember a couple times when my sisters would show up, we’d wheel my dad down the hallway to the room where there’s a piano and my mom would play my dad’s favorite hymns. You know, that’s kind of a special time. You can’t do that if you’re in the ICU. But those are the times, that’s the remembrance that my family has of my dad’s passing is those moments. I feel pretty blessed to be able to help do that.

Kitty McConnell is a reporter for Columbus CEO.

 

Portions of this article are reprinted from the July 2013 issue of Columbus CEO. Copyright © Columbus CEO.