Hospital system’s CEO ponders its past, future

Since he announced his retirement plans 10 months ago, Barry Ostrowsky, chief executive officer of RWJBarnabas Health, has spent his days trying to prepare the board of directors, the new executive team and the rank-and-file employees for the change that’s about to come.

Ostrowsky said he is confident the incoming team is up to the task. But after leading New Jersey’s biggest health care system for the past decade, he has learned a simple truth.

“You don’t know the job until you’re sitting in the job,” he said.

Ostrowsky will retire at the end of the year, ending an 11-year tenure that coincided with a historic time for the health care industry.

He oversaw a health care network with: 12 acute-care hospitals, including Robert Wood Johnson University Hospital in New Brunswick, Saint Barnabas Medical Center in Livingston and Monmouth Medical Center in Long Branch; 38,000 employees; and $6.6 billion in annual revenue.

And he steered the company through new demands brought by the Affordable Care Act; mergers and consolidation; and the deadliest pandemic to hit the U.S. in 100 years.

Colleagues say Ostrowsky’s legacy is a vision of a health care system that could do more than treat patients in doctor’s offices and hospitals. It also could help with social services like food insecurity or affordable housing — public health issues traditionally left to others, or ignored.

The vision itself “might have been the easy part,” said Mark Manigan, 50, who was tapped last March to succeed Ostrowsky. “The harder part is being the kind of leader and kind of person who, over a sustained period of time, brings together disparate organizations and different cultures and different boards. All of that through one-on-one relationship building to develop the trust that you need to pull something like this together.”

Ostrowsky, 72, lives in South Orange with his wife, Bobbi. They have two children, David and Allison, and three grandchildren. Before leaving, Ostrowsky spoke to the USA TODAY Network New Jersey.

Q: What are some of the changes of the past decade that stand out for you?

Ostrowsky: “In New Jersey and across the country (we’re) building health care systems as opposed to simply relying on standalone hospitals and technology that the hospitals have had to include in order to ensure state-ofthe-art health care service. In New Jersey, it wasn’t that many years ago we didn’t have a medical school. And now we’ve got a number of medical schools, and we’re training terrific future generations of clinicians about whom I have no trepidation. They’re young. They’re articulate. And they’re caring. And they’re not becoming doctors for the money because, frankly, those days are over. … It’s not that you’ll starve necessarily; you’re going to make a decent income. But it’s not Wall Street and things of that nature. And so when I meet with the medical students in the Rutgers Medical School, with which we are affiliated, I’m meeting people driven to be physicians or nurses or technicians by motivation that’s other than financial return. It’s really nice to see.”

Q: How well prepared was RWJ Barnabas for the pandemic?

Ostrowsky: “One of the facets of this was to be living through an evolving education with a real live virus. This was not some benign happening that you could study as it was happening. We kept changing some of our positions scientifically as we learned more. And that was frustrating to everybody. …

“There was a special committee appointed by the governor to look at various policies dealing with COVID. One of the policies was about the removal of a ventilator from a patient in favor of connecting another patient because there were not enough ventilators. How do you decide to remove a ventilator from patient A and make it available to patient B, knowing the patient is going to die when you take him or her off the ventilator? And we spent many a long night trying to come up with this policy. And it just was incredible to me that we’re talking about the United States, that we’re going to have to make that life-or-death decision because there aren’t enough ventilators. And, I mean this sincerely, we came within a couple of days of having to make those decisions.”

Q: If a pandemic happens again, is the industry better prepared?

Ostrowsky: “I don’t think anyone can predict how we’ll react until it actually happens. I don’t tend to quote Mike Tyson very much, but I think he said everybody has a plan until you get punched in the face. That’s true. We’ve got lots of plans. And then it turns out that the thing we’re trying to battle didn’t read those plans, and we’re going to have to revise those plans. But I guess the point of your question is, yes, we’ve learned, yes, we’re better prepared. But I wouldn’t want anyone thinking that we’ll flick a switch and be in operational mode to the optimal outcome. The next time something like this happens, we’ll be better, but not perfect.”

Q: The U.S. Federal Trade Commission recently blocked a proposed merger between RWJ Barnabas and Saint Peter’s Healthcare System in New Brunswick. Are hospitals getting too big?

Ostrowsky: “I think there’s advantage to consolidation. I think there’s advantage to these mergers, all of which needs to be proven, because nothing that we do is being done for anything other than trying to be more effective and helping the community. I spoke to each of the FTC commissioners and that was my point. This is why we’re doing it, not because we needed to. It wasn’t about getting bigger, adding revenue numbers to our balance sheet and all that.

“We thought, and I still am convinced, that if these mergers and consolidations are planned correctly, and executed appropriately and have as their simple goal the better servicing of the communities that rely on the participants in the transaction, if you put that package together, these mergers and consolidations make sense. If they’re driven out of ego just to get bigger or say that you have more institutions than the person and the system down the street, then they may not nearly make as much sense.”

Q: Let’s say I give you a magic wand and say, fix health care once and for all so that it provides affordable, quality care. Where do you start?

Ostrowsky: “If I really wanted to change health care, I would create a public utility out of it. It’s got nothing to do with government ownership. I would recapitalize all of it in a private-public way, I would ensure that a perfectly appropriate regulatory body oversees how you rationalize all these assets, I would require that this now-utility take on not only health care but social service.

“Now, this is an undertaking that is probably fantastical. But the truth is, it’s very difficult to have competitive health care systems ensure the greatest level of coverage access and all that, while they’re still competing with one another. There’s a practical aspect to that that you can’t change. So that would be to me something that would change radically and improve, undoubtedly, the health care industry as I see it. …

“Something that is both doable and more practical than what I just said, (beyond) this move to ambulatory care, digitally based care, is the fact that we have a Medicare program that won’t pay for (making homes safer for seniors to) live in, but would still be willing to pay for pelvic fractures because people fall in an ‘unseniorized’ living environment. (That) just doesn’t make any sense. Plus, it is very expensive. So I think there needs to be policy made as to what and how we fund things that are in health care.”

Q: We’ve come through a pandemic that shined a light on the public’s growing distrust of institutions. What impact does that have on health systems?

Ostrowsky: “You remember when the pandemic was in its earliest stages, people staged almost spontaneous acts of respect for all the clinicians. They sent in food, they had parades, and these clinicians became heroes. And then in some real twist of fate, the same clinicians who were being lauded for their heroic acts, all of a sudden were complained about for a variety of reasons. The policies that institutions had to adopt the limit visitation and a series of other things brought on public response. So I think it was a time of mixed emotions, depending on what period you look at, during the worst of the pandemic.

“But I think the word ‘trust’ is the key. You cannot help the community unless you have the community’s trust. You can’t help a person unless the person trusts you. And I think … one of the challenges of institutional health care in particular is to gain and maintain the trust of the people they’re serving. Without trust, there’s no progress. And without trust, there isn’t the ability to really have the optimal impact for good.”

Q: What do you think makes a good leader? What do you look for when you are hiring leaders?

Ostrowsky: “I don’t think you can learn leadership on Zoom. I don’t think that’s how you develop leadership skill. I think leadership skill is about taking a real interest, and making a real investment in the lives of the people that you’re going to lead. … You have to build trust. You have to advocate for the folks you’re wanting to lead. You have to know what’s important to them both in and outside the office. You don’t have to be intrusive or nosy, but you have to do more than just simply consider them one of the people who you manage.”

Q: How do you feel about retirement? Are you going to miss the job?

Ostrowsky: “Well, people are complaining about this permanent smile. I’m gonna miss the people at every level of the organization.

And that’s what I’ll miss the most. But I think I’m very excited about this opportunity of retirement. I have no plans to do anything else. I’ll retain my position on a number of boards of directors, which will keep me intellectually stimulated for sure.”