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Business Observer Friday, Jul. 14, 2017 1 year ago

Tough Replacement

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Jim Nathan has done more for the health care sector in Southwest Florida than nearly any other hospital executive over the past 40 years. How did he do it?
by: Mark Gordon Managing Editor

When Lee Health executive Jim Nathan says he has worked all his life in health care, he's going all the way back to when he was a shy and pudgy second-grader.

Back then, in Ohio and New York in the 1950s, Nathan says his dad was a “professional patient,” with a laundry list of medical obstacles that included tuberculosis. Nathan would visit his dad in the tuberculosis-only hospital, but due to a quarantine, the closest son got to father was climbing a pine tree outside the window to glance into the room.

Around that time, Nathan picked up some health care volunteer work. He told children's stories on shortwave radios that were beamed into the tuberculosis rooms. In third grade, he did fundraising for the American Cancer Society and the American Lung Association.

“I spent my life growing up around hospitals,” says Nathan. That goes all the up to the day in late April when he hit the Lee Health board with a rattling announcement: He intended to relinquish his day-to-day leadership role and executive title — the beginnings of a two-year moving-on period that's not officially a retirement.

Nathan, with plans to travel with his wife, Karen, for at least a few months, both in the state and abroad, actually did spend a few working years outside health care. That happened in the 1960s, soon after the elder Nathan healed from his medical issues. Jim went to work with his dad for a bit, when the pair got into a financing business. That included helping customers lease cars, then a relatively new concept.

“But I always had a yearning that I was meant to do something else,” says Nathan. “When I told my dad I was going to work in hospitals, my dad said, 'I spent my whole life trying to get out of hospitals, and you're going into one?'”

Nathan enrolled in a master's degree program at Xavier University in Cincinnati, in health care administration. In 1975, he interviewed at Lee Memorial Hospital in Fort Myers for a one-year stint as an administrative resident to fulfill his practicum requirement.

That post led to a promotion and then a few more bumps up the leadership ladder. After 42 years that cover two separate stints, Nathan is exiting the organization.

Nathan's widely considered by many in the Southwest Florida business and medical community as the guiding force who turned Lee Health from a cash-poor, flailing, one-site hospital into a regional health care juggernaut. Today, Lee Health, a nonprofit, is one of the largest public health systems in Florida. It has 1,426 beds spread through four acute care hospitals and two specialty hospitals; more than 1 million patient contacts a year; and 13,000 employees and 4,500 volunteers. Lee Health's four acute-care hospitals account for at least nine of every 10 Lee County hospital beds.

“Jim personifies Lee Health,” says Lee Health Board Chairman Dr. Sanford Cohen. “He's been a giant in the community, both as a health care executive and a community advocate.”

While Nathan, 70, is leaving full-time work at Lee Health, he's reiterated in multiple interviews with the media that this isn't a retirement. Instead, he will work through the end of his contract, in March 2019, at the organization as an on-call executive to consult with the board and system leadership. Dr. Larry Antonucci, Lee Health COO since 2011, was named president and CEO of the organization shortly after Nathan's announcement.

In a recent interview with the Business Observer, Nathan reflected on his career, the struggles of the health care industry and what's next in his life. Edited excerpts:

Rough start: Nathan was named president of what was then Lee Memorial Health in 1982. “We had virtually no cash, no ability to borrow, and we were rapidly becoming an inner-city hospital without a sufficient population of commercially insured patients to fulfill our mission,” Nathan recalled at the Lee Health board meeting where he announced his career transition.

Another hurdle: Most of the employees, and hospital leadership, were ambivalent, at best, about changing or growing in any profound way. Not Nathan. “I was able to change the mindset, to one where we needed to grow,” Nathan says in a Business Observer interview. “We had to be creative and aggressive, not to be big for being big's sake, but be bigger so we can do all the things we needed to do and treat all the people we needed to treat.”

Nathan led and facilitated more than a dozen startup units or acquisitions at Lee Memorial over the next decade, from buying Cape Coral Hospital to launching a regional trauma center.

Come together: In 1997, with Lee Memorial in its best financial position in a decade, Nathan decided to leave the organization. He went to work for a small health care consulting firm to tackle an issue that dominates today's health care headlines — the growing gap between Americans who have health insurance and access to affordable care and those who don't.

Relating it to today's polarized debate, it's a case of a dejà vu for Nathan that goes back to the 1980s, when he wrote about the topic for industry journals. “The nation is as divided now as it was when I was writing the same things 30 years ago,” Nathan says.

No easy fix: Nathan says the crux of the solutions to health care issues shouldn't be political, but policy driven. (While he has issues with Obamacare's payment structures, Nathan says the former president's plan experimented with ways to get more people health care, while Trumpcare, he says, erases some of those gains.) The executive says when the debate goes political, it's a loser for everyone.

“I believe in the free markets and the free-market economy, but we are spending a lot of money and we are not spending in the right places for the right reasons,” Nathan says. “There's nothing in the free market that says 'I'm a free market entity and I have an obligation to provide health care for people who can't forward to pay it. And that's a problem.”

Come back: While Nathan is passionate about the issues, he missed working for a bigger organization when he stepped away from Lee Memorial the first time. Nathan adds that the job wasn't as fulfilling than being in a place that actually does the medical work. “I failed miserably,” quips Nathan, “along with anyone else who tried to fix health care.”

So he rejoined Lee Health in a leadership role in 2000. The next 17 years mirrored Nathan's first go-around, in terms of aggressive growth and expansion to treat more people and families. The list includes the expansion of LeeSar, a national leader in medical supply, a regional cancer center, multiple outpatient centers, implementation of a comprehensive, system-wide electronic medical records system, and the opening of Golisano Children's Hospital.

Move on: In anticipation of his shifting role, Nathan has spent considerable time the past year re-establishing a leadership structure at Lee Health. That includes a mission to reduce silos and how and when doctors and medical personnel communicate with non-medical colleagues. Another goal has been to separate strategy from operations, to improve accountability. “I feel good about the organization of the transition,” says Nathan. “I have no regrets.”

Good advice: The best business lesson Nathan learned came from his dad, who told his son that “even if you don't have money, make sure you pay your bank on time because you will need them someday, but they might never need you again.”

Smooth style: Nathan says his leadership style is to avoid micromanaging, bring lots of optimism and find ways for varying groups and sides to become allies toward a common goal. “A lot of leadership is trying to paint a picture of where we want to go, not telling people where we are going,” he says. “I wanted to be a leader who allows people to make mistakes and not jump all over them. I wanted to let people learn.”

His catchphrase with employees, senior staff and volunteers: “A great vision will never be a real vision if it doesn't become a shared vision.”

Next up: Nathan, in his not-retiring mantra, is doing a lot of things that look like retirement. There was a June trip to a friend's North Carolina lake house, where Nathan, with a satisfying smile, says, “I took a nap on a boat for a few hours.” Nathan and his wife, Karen, also have plans later this summer to visit adult children and grandchildren in Milwaukee. There's also a forthcoming trip to Switzerland and Italy. Says Nathan: “My wife told me she owns me until September.”

At a glance: Lee Health

Founded: 1916, first as Lee County Hospital, later became Lee Memorial Hospital
Headquarters: Fort Myers
President and CEO: Dr. Larry Antonucci
Operating revenue, fiscal 2017: $1.7 billion
Operating margin: 4.5%
Capital expenditures budget, 2017: $90 million
Employees: 13,000 and 4,500 volunteers
Doctors: More than 250 employed primary care and specialty physicians and more than 1,100 physicians on the medical staff
Facilities: Four acute care hospitals and two specialty hospitals, with a total of 1,426 beds
Source: Lee Health

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