Akron Children's CEO On Independence, Collaboration

Christopher Gessner shares strategies the organization takes to remain independent while meeting the needs of its pediatric patients and their families.

Akron Children's Hospital is a pediatric acute care hospital headquartered in Akron, Ohio. It's about 40 minutes south of Cleveland, Ohio, and operates as an independent regional pediatric health system, Christopher Gessner, president and CEO of the hospital, told HealthLeaders.

Additionally, the organization has another hospital in Youngstown, Ohio, more than 30 primary care practices, dozens of pediatric specialties, and ongoing partnerships with other health systems and universities in Northeast Ohio. The organization also recently launched an accountable care organization to concentrate on value-based payment arrangements with the Medicaid HMOs in Ohio.

The organization, which has an annual revenue of about $1 billion, looks to partnerships and collaboration to remain successful and independent.

Gessner spoke with HealthLeaders earlier this week about Akron Children's Hospital and shared strategies the organization takes to remain independent while meeting the needs of its pediatric patients and their families. He also shares advice for other independent healthcare organization executives and larger organizations that acquire independent hospitals.

This transcript has been edited for clarity and brevity.

HL: What pain points are you currently experiencing as an independent hospital?

Gessner: We're experiencing labor shortages for our specialties; nursing specialties and respiratory therapy imaging. Those same shortages are impacting us whether we're independent or part of a larger system.

We also are experiencing pressure to provide care at a lower cost point, but still provide high-quality care that's pleasing for patients and families. There is also a lot of pressure to improve access to care.

I don't think the key pain points that we're experiencing are related to being independent; they're just general pain points for the healthcare industry overall.

HL: What benefits do Akron Children's Hospital's workforce, patients, and communities gain from your organization being an independent entity?

Gessner: We're independent and we're solely focused on pediatric healthcare. Our mission is specialized, and we can concentrate all of our time, talent, resources, and effort to meeting the needs of the pediatric and adolescent population in Northeast Ohio. That clarity of mission and objectives helps make decision-making a little easier and it also allows us to move quickly and respond in a timely manner to meet unmet needs.

I'll give you an example. We have behavioral health programs within Akron Children's, and they range from integrated therapists in our primary care practices, to outpatient clinics for therapy and psychiatry, to intensive outpatient programs, group therapy, and then we have an inpatient unit. But with the recent rise in behavioral health issues for teenagers and kids, we've been able to respond quickly and create outpatient centers that are the bridge between clinic visits and inpatient stay. The goal would be to try to keep kids from ever needing an inpatient stay, or if they do need an inpatient stay, to provide the care and structure they need, but allow them to live at home, go to school, and have a normal life. We saw that happen in the marketplace, and we responded quickly, opened a center on our Youngstown campus in Boardman, and now we're planning to open two more centers over the next two years.

In terms of speed to market and ability to quickly meet needs, it's helpful to be independent because we're not vying or competing against other interests within a large system in terms of capital or personnel.

HL: What is the competition like for pediatric organizations in Ohio and what strategies have you implemented to compete in the marketplace?

Gessner: We have healthy competition amongst the children's hospitals in Ohio and we collaborate in terms of advocacy within the state for Medicaid, population health, behavioral health issues, health equity, and minimizing health disparities. We also collaborate on patient safety. But we do compete significantly in our own marketplace.

In Northeast Ohio there is Rainbow Babies, which is part of the University Hospitals health system, and there is Cleveland Clinic Children's Hospital essentially right next to each other in Cleveland. We're 40 minutes south of there, so there's some competition for patient volume and activity. About two hours to our southwest is Columbus, which is Nationwide Children's Hospital.

So, when we start to expand our territory, sometimes we end up vying for patients in those peripheral areas outside of Akron.

The strategies that we've focused on are fundamental and basic, and that is to be incredibly accessible and bring care close to families and children. We like to do a lot of outreach with our specialty pediatric services. We usually partner with adult systems to become their pediatric partner and perhaps rent space on their campuses or nearby.

Another key strategy for us is being primary care driven. We have a huge primary care network of pediatricians, and we're establishing those offices and population bases around Northeast Ohio. Those enable us to not just be an episodic provider of care but to stay in touch with families and children throughout the continuum of care and meet their needs.

We've done a lot of vaccinations of children for COVID recently. We've been responding to try to educate parents who are nervous about getting their child vaccinated. We were sort of crossing the line from just healthcare providers to a public health entity for kids as well.

HL: What other organizations do you have partnerships with?

Gessner: Part of the success of being independent is you must be collaborative. You need to partner and work with agencies in the community, as well as other healthcare providers.

We partner with Mercy Health System, which has a lot of presence in Northeast Ohio. We cover their neonatal intensive care units and their delivery rooms. We have primary care pediatric offices on their campus. Sometimes, we staff their emergency department with pediatric specialists. We have telehealth connections to those places.

We partner with Aultman Hospital, which is a community health system in Canton, Ohio. We partner with the Summa Health System Akron Campus and have similar relationships where we provide maternal-fetal medicine physicians on their campus, we staff their NICU, we support their delivery room.

We have a great relationship with Cleveland Clinic. Even though we compete with Cleveland Clinic, we work together on our congenital heart surgical program. The surgeons work at both places, and depending on where the child lives and the acuity levels, we will direct that child to the appropriate site, whether that's Cleveland Clinic Children's Hospital or Akron Children's Hospital.

We also have university partners. Northeast Ohio Medical School is a huge partner. The vast majority of their medical student rotations occur at Akron Children's. We have partnerships with the University of Akron, Youngstown State, and Kent State University. Most of their nursing schools have rotations here, and we're fortunate to have great nursing schools in Northeast Ohio that need pediatric experience so they come to our hospitals and offices for that practicum.

We also have a good relationship with Stark State College, which is a community college. We provide scholarships to certain students in certain tracks, such as medical assistants, radiology techs, and lab techs, and we'll also cover expenses to help remove barriers for them coming to school, such as childcare and transportation. That's been incredibly successful for us.

We partner well, it's a competency of Akron Children's, and it's important for us to be able to be a good collaborator for us to stay independent.

HL: What messages do you have for other CEOs who lead independent healthcare organizations?

Gessner: Be a good collaborator. Understand your partner, meet with them on a regular basis, have rich conversations, try to understand what the synergistic opportunities are between your organizations. Be humble, listen, learn from them, and try to help them achieve their mission while achieving your mission.

The other thing is, you can't shy away from difficult decisions and think that by becoming part of a larger system those problems are going to go away. They are not. Hard problems, in terms of reducing costs and proving quality, they're there whether you're part of a big system or independent. You have to make those decisions and have the managerial courage to deal with those in an independent situation or as part of a large system.

HL: Do you have any messages for larger health systems and organizations that acquire independent healthcare organizations?

Gessner: I've spent a lot of time working at large health systems, so I do have some thoughts.

1. Stay in tune with the local community needs of the organization that's joining your system. Make sure you understand that mission and the local community. Make a real effort to meet unmet needs in that community.

2. Maintain a relatively lean corporate structure. Don't burden community hospitals and other hospitals that are part of your system with heavy corporate overhead. Make sure that the corporate costs that you allocate to them are competitive and market-based.

3. Make sure you still interface with caregivers; physicians, nurses, pharmacists, and therapists that are taking care of patients. They bring a whole different perspective to your conversations about allocating budgets, whether they're capital budgets or operating budgets, investment decisions about new programs. You need to stay connected with frontline caregivers and staff, so you've got to get out of your corporate office and travel to where the care is delivered.

HL: Do you have any final thoughts that you'd like to add?

Gessner: It's wonderful to be part of an independent hospital. What I enjoy is my relationship with the board of directors. I report directly to a community board that oversees our hospital, and they're some of the most dedicated, talented people I know. And I learn a lot from them.

Another key to being independent is having an outstanding committed board that is representative of the community and its diverse needs, and building, maintaining, and educating that board about the challenges in the healthcare industry is a big part of the CEO's job in an independent hospital.