Becker's Hospital Review

64 THOUGHT LEADERSHIP Remaining Independent and Competitive in Today's Healthcare Environment: 5 Questions With Marin General CEO Lee Domanico By Erin Dietsche G reenbrae, Calif.-based Marin General Hospital wouldn't be what it is today without Lee Domanico. Mr. Domanico, who currently serves as CEO of Marin Health- care District and Marin General Hospital, helped the hospital transi- tion from a large system to a successful freestanding facility. He over- saw Marin General's recent process of raising $400 million in public funding for recapitalization and led the hospital to break ground on a new facility in July. He holds bachelor's and master's degrees in indus- trial engineering. Mr. Domanico previously served as CEO of Moun- tain View, Calif.-based El Camino Hospital Domanico. Here, Mr. Domanico spoke with Becker's Hospital Review about the re- capitalization and construction processes and how Marin General stays competitive despite its freestanding status. Note: Responses have been lightly edited for length and clarity. Question: How have your industrial engineering degrees helped or hindered your career in healthcare administra- tion? Lee Domanico: It's actually been helpful in two areas. e first is that those degrees have taught me how to approach and analyze problems. In addition, back in the mid-70s, industrial engineering techniques were being applied to hospitals. Early on, the degree allowed me to get into the hospital industry, where I had the opportunity to study nearly every aspect of the hospital operations over a couple years, including scheduling and staffing. It allowed me to analyze issues, and at the same time, the degrees al- lowed me to enter the healthcare industry when the demand for an in- dustrial approach was high. Q: Why has Marin General decided to stand alone despite the continued uptick in healthcare mergers? LD: In most health systems, there are hospitals that contribute to the corporation and there are hospitals that tend to be receivers. In decid- ing to stand alone and become independent, we had the opportunity to commit 100 percent to our community as opposed to contributing to other communities throughout a large healthcare system. In addition, we had to reconstruct the hospital due to the age of the fa- cility as well as California seismic standards. As an independent hospi- tal, we knew we'd have the opportunity to go to voters and raise capital through a general obligation bond. at would have been impossible as part of a large healthcare system. ere is a combination of three elements that allow any hospital to remain independent. e first is a medical community that seriously decides to partner with the hospital. We had that in place. e second is a geography that creates some barriers to entry. We have that. To the south we have the Golden Gate Bridge, to the east we have the bay and to the west we have the ocean and the mountains. Marin County's a defined community, and we felt we had some barriers to entry because of our geography. Finally, you need an alternative revenue source. at was the GO bond. We had voters who could support the building of the hospital, so we felt we had the strong backing of a community. We had those three things going for us: a cooperative medical com- munity, good geography and an alternative revenue source for capital. Q: Marin General recently raised $400 million in public fund- ing for recapitalization. Could you discuss that process? LD: Passing a GO bond is much like passing any measure. It's a specific campaign that's run by a campaign consultant we use who works with various hospitals and school districts. It's very sophisticated. Process-wise, we analyze who the likely voters will be and within the like- ly voters, who the likely yes voters will be. For example, senior citizens are likely to vote yes for healthcare. While we do general public education about the matter, we also conduct focused communication with those likely to vote and support the measure. We run a phone bank and call our likely voters to get them committed to voting. California requires a 66.6 percent approval, and we got 68 percent. Q: This summer, Marin General broke ground on a new fa- cility. How's the construction coming along? LD: We continue to be on budget, and we hope to be finished in early 2020. e project is underway, and we are in the process of putting the foundation in. e steel should go up in early 2017. e facility will be at the intersection of highly complex medical care and healing. In addition to all the advanced technology, the hospital's designed to be a healing environment. We have tons of natural light, and we have about nine gardens around the campus and on some of the rooops. We also have a sound engineer who's working with the architect to make the hospital quiet for patients. Additionally, in order to free up space, we completed a parking garage to move all our staff off the surface lot into a parking garage, which came in 2.5 percent under budget. Q: How does Marin General stay competitive despite many larger facilities in the surrounding market? LD: We stay competitive through collaboration and partnering. In 2010 when we became independent, we partnered with over 150 physicians. "When you become a freestanding independent hospital, the doors that were closed due to competition become open."

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