Sunday Interview: Robert Granger, president and CEO of St. Francis Hospital

chwilliams@ledger-enquirer.comApril 19, 2014 

Robert Granger has been in Columbus for more than eight years, running St. Francis Hospital as president and chief executive officer.

Working in Pensacola, Fla., the Oklahoma native didn't know Columbus was in his future when a job headhunter reached out to him.

"I'd never heard of Columbus, Ga., before I got the phone call to ask me if I would consider coming to interview here," Granger said. "And I hate to admit that, but it's absolutely true."

Today, he calls the city "a hidden jewel," as he directs massive physical and cultural changes at St. Francis.

Last week, he sat down with Ledger-Enquirer reporter Chuck Williams to discuss the hospital, the local and national health care climate and the Green Bay Packers.

Here are excerpts of the interview, with some of the questions edited for length and the order of some of the questions rearranged for clarity.

This is a very interesting time to be in the health care business, is it not?

You know, it's been interesting to be in the health care business the entire time I've been in the health care business. But as times go, there's certainly a lot of uncertainties in our world, for sure.

How long have you been doing this?

I've been working in health care since 1985.

What are the uncertainties now?

They tend to all run around the same thing -- the structure of how health care is going to be paid for. Health care is very expensive and it is very, very difficult for our economy to shoulder the cost of the health care, and that's been an ongoing battle as long as I have been in the health care business. Except when it's your family member that's ill, then you want everything that possibly can be done and it's not a question of cost. So, in the abstract, health care is too expensive on a global GDP conversation, but when you have someone who's ill, then you need whatever you need done and you want it done regardless of the cost. So that "push and pull" is always a challenge.

Has the Affordable Care Act complicated that equation?

I think it's our latest round of uncertainties in health care. It certainly added some different dynamics to the situation. I always say if anyone can tell you how the Affordable Care Act is going to play out, they are either a consultant trying to sell you something or they have a political agenda. I don't personally have a view of exactly where I think it's all going to go. I think there are just way too many uncertainties right now.

We're talking about the global health care situation. There is also a very local health care situation too. How do you distinguish between those -- or are they the same thing?

I think certainly our situation in Columbus is a microcosm of the entire global health care situation. Our local companies that are employers here struggle with the cost of health care every day. They want to be competitive and compete on an international scale, and we have big companies based here with large work forces, so they have to balance their health care cost just like everyone else. So, I think many of the challenges employers on a national basis are feeling like we feel here in Columbus. And conversely, all the other pressures and dynamics that are in the health care business are certainly here as well.

Dynamics like what?

Shortage of primary care physicians, that's a big one in Columbus. It's hard for Medicare patients to find access to a primary care physician. It's hard for folks to have access to primary care if they don't have just the top level insurance. That's a difficulty.

What are the circumstances that are unique to this community?

One of the unique situations here in Columbus, of course, is the large military presence that's not unique in the sense that there are certainly other communities like us. But compare on a percentage-wise of the population, it's certainly a much larger percentage of our situation. Tri-Care is a challenging payer for both physicians and hospitals to have to manage.

Why is Tri-Care so challenging?

It's a very bureaucratic process, No. 1. There's a lot of referrals and secondary paperwork that needs to be done before someone can get treatment off post. And it's a very poor reimbursement payer. It pays well below cost for the services you provide a Tri-Care patient.

And a substantial part of this community is on Tri-Care?

Very big.

If you look around your hospital, it has certainly changed in the 8 1/2 years you've been here. How is it most different today?

I think probably the biggest change we've made is in our culture. The board of trustees -- before I ever knew where Columbus, Ga., was -- made a decision they wanted to change the culture of St. Francis and they wanted to integrate and involve the physicians in the decision-making and the leadership of the hospital.

I was the guy lucky enough to get hired to help implement that strategy, and that's really been, I think, the impetus behind all the changes that you have seen. We call it the Culture of One, and we put a major, major emphasis on really integrating and involving the physicians and the leadership of the hospital in the decision-making, not only about big strategic things like our new service lines, but also day-to-day how the hospital operates, how their needs are met, how their patients' needs are met, and that has really changed, I think, the way health care is perceived to be delivered at St. Francis.

Physician partnership has not necessarily been the model in Columbus, right?

There are certainly situations where the dynamics between the physicians and the hospitals are tense. That may have been the case here in Columbus years ago; it's certainly not the case here at St. Francis anymore. We have put a lot of time and energy in what I said about this Culture of One and what we call our physician partners. We have well over 100 physician partners that are fully integrated with St. Francis and probably another 50 or 60 that are very closely affiliated with us.

Outside the culture, there have been sweeping physical changes to facility, right?

Once every 60 years or so you do have to fix the place up. ... We had made some investments probably 15 years ago in the ER and in the ORs and those infrastructures were solid. But the main core of the hospital really hadn't been touched since the '70s, and it needed a complete refurbishment. And frankly, for what people pay for health care, they just don't want a roommate. The biggest single complaint we've always gotten at St. Francis the entire time I've been here has been about having to have a semi-private room. And in just a few more weeks no one will ever have to complain about that again at St. Francis. We'll be an all-private room hospital.

When you came to Columbus, what did you know about this city?

When the recruiter talked to me about an opportunity in Columbus, Ga., I had to look it up on the map -- I knew nothing about Columbus.

What do you know about Columbus now?

What a hidden jewel it really is. I always say if you've lived here your whole life, you don't know how good you have it. Until you come here, folks like myself who have been other places, this is just an awesome place to live. The lifestyle here is great, the community is wonderful. We have a lot of pluses. Sure we have challenges and we have issues in our community, but this is a great place to live.

One of the issues St. Francis was facing years ago when I came was the idea that it was hard to recruit physicians to Columbus. It's not hard to recruit physicians to Columbus. If we can get them here for an interview and show them what we have -- and I'm not talking about the hospital, I'm talking about the community. If we can get physicians here to see this community, we do a real good job in getting them to come here. This is a real hidden gem from a lifestyle and quality-of-life standpoint. And it's only gotten better in the time I've been here.

Are y'all constantly recruiting physicians?

Every day.

And you're currently looking for physicians in what specialties?

Vascular surgery. We're currently recruiting two new vascular surgeons that I'm told will be signing their contracts. So, I'm excited about that. They will be here this summer. We're looking for intensivists to help run our ICUs. We need at least one if not two more intensivists to join our team. We're always recruiting hospitalists. That program has continued to grow.

Hospitalist. Is that the old family practice doctor?

I would say that's probably a good analogy, although I'm not sure they would agree with that. But I think from the layman's perspective, that's a pretty good analogy. They're the core generalist that comes to the hospital. The typical primary care physician in our community now pretty much stays in their office and takes care of folks on an in-office basis, and they usually have a partner they work with in the hospital that's their hospitalist partner.

Do you think the new Mercer Medical School will be successful here?

Sure, absolutely. I don't know whether it will ever grow to the four-year campus that I know is being talked about. I always struggle with why would you want to replicate the cost of the first two years when the main Mercer campus is only 90 minutes away. It would seem more efficient on their main campus. But the third- and fourth-year program here just makes perfect sense and we're excited about where it can grow and what it can be.

St. Francis is a partner in that, correct?

Absolutely. That's a true community collaboration between Columbus Regional, St. Francis and Mercer. It really takes all three of us to make it work. Two of the three couldn't do it; it really takes all three.

Columbus Regional and St. Francis have been incredibly competitive over the years. Is that an accurate statement?

I wouldn't say incredibly competitive, but competitive. It's a competitive marketplace.

Have there ever been discussions to try to merge the institutions or to get the two institutions working together on levels more so than what we're seeing today?

I think there is strong board leadership at both organizations that would love to see the organizations collaborate more than they do. That is clearly something that we talk about a lot and I'm relatively certain it is discussed a lot across town as well.

Part of the difficulty with all of that: The federal policy against anti-trust and anti-competitive behavior... makes it really hard. I will say we also collaborate more than some people realize. For example; we could not individually recruit a gynecologist to our community but we did collectively. We actually have a gynecologist that works for both hospitals and he sees patients at both facilities. That was a big deal two or three years ago, and now we do it and it works.

Will we see more of that?

I hope so. I think cancer is an area where there is a natural collaboration between the parties that most people don't realize. The predominance of cancer surgery in Columbus is done at St. Francis. We have always been the cancer surgery hospital.

The John B. Amos Center is a tremendous medical and radiation oncology cancer center. And the physicians who do surgery here and the medical and the radiation oncologist at Amos have an outstanding and collaborate relationship. I would personally like to see that more formalized. It's a little challenging to figure out, but I think that's an area where we already collaborate well and I think if we could figure out how to make it more formal, we could even take cancer care in our community to a greater place than it already is.

What are the obstacles to a more formalized relationship in that and other ventures?

It's just complication. Money is always part of every conversation at any business. There's economic issues, there's political issues, there's just all sorts of stuff that goes with it.

You've got to have willingness to discuss on both sides and it's also got to make sense at the right time for both sides for things to get looked at. And again, I will say to you probably the biggest barrier is the federal position on anti-competitive behavior between health care providers.

To have everything under one roof in a community this size is problematic?

You would have to get a special anti-trust waiver from Washington, D.C., to be able to do that. Not that it might not be a good idea, but it would be against federal policy today to do that.

How would you describe the philanthropic nature of this community?

It is so generous. This is such a wonderful community in the way that people give. And the breath and depth of how deep that is in our community, how ingrained it is in our culture.

Folks just want to do the right thing and help the community have things it should not have. Frankly, the Butler Pavilion we just constructed would not have existed had it not been for the community support we have. The RiverCenter would not be here without the community support we've had. You can just look around at the community at the different wonderful things that exist here because folks have been so generous with their own personal resources. It is way beyond anything I've ever seen. I've lived in Fort Lauderdale where there's an awful lot of money and philanthropic activity and there's nothing like Columbus.

Is that one of the things that makes Columbus a gem?

Oh, certainly. Not only the fact that it exists and that there's such a spirit of servant leadership in our community that exists that is so ingrained in the whole business culture here in our town... but the resources it has provided to the community. Our community should not have the RiverCenter. It's way nicer than our community should have, but it's here and it's a tremendous draw.

Define servant leadership.

I would say to me servant leadership means putting your organization and others first. Then anything you personally may aspire to, or putting the needs of the community above even your own organization in our case, which we try to do.

Different people have different definitions of it, right?

I think that's also true. To me I think it follows the Biblical model of putting yourself at the feet of those you serve, and thinking of an organization as an upside-down pyramid is often the way I think of it. I have a tremendous team here at St. Francis that does a lot of things, and you're sitting here talking to me because I'm the leader of this organization. I'm nothing without all of the great folks who work here every day. I can't do any of their jobs. My job is to help them be successful and help them take care of people, and that's what I enjoy.

Had you ever heard the term "servant leadership" before you got here?

I don't think I heard it in the context of the business culture before.

Do you see it in this town?

Oh absolutely. You see it everywhere. I think it goes from the influence of those who have been here for so long setting the business culture. It's just an expectation of the way business is conducted in our community that you sort of adhere to those principles.

I see you have a Green Bay Packers hard hat in your office?

My dad was from Wisconsin, so even though Oklahoma is home, and growing up in the '60s with a dad from Wisconsin, it was pretty easy becoming a Packers fan. It wasn't always easy staying a Packers fan, but it's now really entertaining to hear my children talk about the fact that they are Packer fans because their dad was a Packer fan.

I understand you go to Packer games. Are you a season ticket holder?

There are four season tickets in my name, but there are actually seven here in Columbus that share the tickets.

How many games do you see a year?

In person, one. Maybe if there is another game nearby. I have been known to go to Atlanta and wear a green jersey in the Falcons stadium.

You go to Green Bay once a year?

Usually once a year. There's eight home games a year and there are seven of us who are in partnership and somebody might want a second game or we will sell it to somebody else who wants to go.

I'm about to find out a lot about your personality: Do you want to go in September or December?

See, the good part about it is our seats are inside, so it really doesn't matter. The waiting list for outside seats is 60 years long so they built some end zone seats that were inside seats, and the waiting list is only seven years long for those. So, we were very blessed to have inside seats.

You are a sports fan, obviously. Describe the feeling when going into Lambeau Field.

The first time I went in there it was like hallowed ground. I'd watched it on TV growing up and being able to walk in and see the history, the Packer Hall of Fame is nicer than the NFL Hall of Fame in Canton, Ohio. I actually have been able to go to both. The Packer Hall of Fame is just spectacular for any football fan. If you're anywhere near Wisconsin you need to go by there and enjoy it.

Who is your favorite all-time Packer?

Bart Starr, just because he was the quarterback of my youth, and getting to meet him a few years ago here when he came to town was just a tremendous treat.

So you are a hockey player. Do you play in the adult league here?

We do. The city has graciously provided the community with a nice ice rink and I've been playing since I was a kid, and I've played in the adult league here since it started.

Did both your kids go through the public school system here?

My daughter graduated from Northside High School and my son graduated from high school in Florida.

You employ a lot of people who come out of the public school system as well as the technical college system and the university. What is your take on the educational product this community is producing?

I'll talk about the nursing programs first because that's very important to St. Francis. By far. nursing is the No. 1 hire that we do, and the two nursing programs, Columbus Tech and Columbus State, are fantastic programs. We are really blessed as a community to have those. Columbus State is a tremendous resource for us for not only nurses, but other professions as well.

Columbus Tech also provides us a great source of education for more of the technical jobs -- the X-ray techs, lab techs, that kind of stuff. I served on the Muscogee Educational Excellence Foundation board for a long time and I am a very huge proponent of the public school system here. I know it has its critics. I know they have their challenges, but when you talk about hidden gems in our community, I think our public school system is one of those. My daughter went through high school here and she did fantastic and has gone on to do great in college and I'm very pleased with the quality of high school education she got here in Columbus.

If you could go back and talk to the class coming out of the University of Oklahoma right now -- and some of them who want to be hospital executives or work in the health care industry -- what would you tell them that you wish someone had told you 30 years ago?

It would have saved me a lot of years of heartache if someone had talked to me about the importance of collaboration in health care between providers -- and by that I mean the physicians, the nurses, and how much teamwork it really takes to make health care work right. And that is lessons I have learned throughout my 30-plus years in health care.

If someone had really made me understand how health care works off the front end, I think it could have saved me a few bumps and bruises along the way. There are just tremendous people in health care. The nurses here, the dedication you see, and they are here before the crack of dawn, they're here late at night -- the doctors do the same thing. The dedication that you see and the compassion you see from these folks, the doing for others. Now they get paid, some get paid very well for what they do, but they do it because they love it and they do it because they care for people.

The thing I enjoy most about my job is when one of them comes to me and says thank you for getting me or helping me do whatever because it made Mrs. Smith get better. That's the personal satisfaction I get out of my job.

How valuable is a top-notch clinical physician?


What is the No. 1 character trait you see in a top-notch clinical physician? Specialist?

Strength in character. They have to be very strong willed. They have to know and have the strength in their own self to hold someone's heart in their hands. That takes a certain amount of chutzpah that I don't have. To be able to look inside of a scope and to look inside someone's head to know what they're looking at, and start taking scissors to things inside someone's head, that's a skill at a level of inner strength that I don't have.

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