Rob Bull: ‘In these times, you have to be a bold thinker’
Hospitals often create a rigid dividing line between clinical and non-clinical work. Rob Bull, VP Finance, Technology and Innovation, and CFO at Southlake Regional Health Centre rejects that division and sees a much bigger role for Accounting and Finance. “We absolutely play a role in improving clinical care.”
In this conversation with CMEPP, Rob talks about what drew him to healthcare, the challenges of moving to Canada from the UK, and why CMEPP is a valued partner for Southlake.
Rob, your career path has been colourful and diverse. You’ve had jobs in mining, the pharmaceutical industry, and predominantly healthcare. When you studied accounting and finance, was that your plan?
One of my first jobs was part of my undergrad degree in accounting and finance. I did a co-op with the Welsh Office, which at the time was the central UK government’s department for Wales. The economy of Wales is traditionally based in agriculture, heavy industry, coal mining and steel mining. With those industries gone or in decline, a lot of those communities hadn’t really rebounded. There was a lot of regeneration money coming in from the UK Government and the European Union and as part of my role, I was involved in assessing grant applications from communities and businesses. I remember sitting in a meeting listening to a small community ice cream business present their case for funding and that really inspired me. I saw firsthand the good that the public sector can do.
When I graduated, I got a job at PwC in Cardiff, working in the public sector division. I got to see a whole range of government agencies and what they do. Healthcare was the one I liked the best. I come from a small village in Wales where everybody knew the local doctors. The doctors were almost celebrities. I’ve always known what healthcare can do in communities and how important it is.
What year did you move to Canada and what prompted the move?
My wife and I moved here in 2003. We wanted a different life experience for us and our two children. A lot of British people go to commonwealth countries like Canada, Australia or New Zealand. We saw Canada as a nice happy medium between Britain and America. I was also fortunate that I was able to move with my job at PwC. We did it with the intent that if we liked it, we would stay.
Your job title at Southlake is VP Finance, Technology and Innovation. You’re also the CFO. One of your key projects is sustaining the hospital’s financial health during a period of incredible funding restraint. Every hospital in Ontario and across the country is experiencing that same pressure. So how are you doing it?
Yeah, it’s tough. Going from year to year, it’s always a challenge because typically the inflationary increases we get from government aren’t sufficient to cover the inflationary increases on the cost side.
We’ve done some creative things at Southlake. We were one of the first hospitals (pre-COVID) to create an “@home” program and helped create the funding and accountability model for others to follow. Our goal with Southlake “@home” is to move people home with the appropriate supports in place. Often the barrier to getting people home is not that they don’t have a home to go to; it’s that they don’t have the appropriate supports. They need that support organized. So rather than be stuck in a rigid home care pattern where you get so much nursing care per week, the funds are adjusted to deal with whatever the patient needs via a direct funding relationship between the hospital and a home-care provider. Sometimes that’s care and sometimes it’s assistance with daily living activities, like getting groceries.
You recently gave a talk on value-based procurement. Why do you think value-based procurement is an essential tool? It was great to see your responses to the questions in terms of “Don’t let the little barriers hold you back. This is something you really should embrace.”
Michael Porter and Elizabeth Teisberg introduced the “value agenda” to healthcare almost 20 years ago and it’s evolved over time. The way procurement usually works is – here’s what I want, whoever gives me the lowest price, that’s who I’m going to buy it from. It was largely about price. This was unsatisfactory to the vendors who would say, “You’re forcing us into a box by making us compete on price alone. Let us be creative, we think we can give you a better solution.” It was also unsatisfactory to clinicians and other end-users who were frustrated at not being able to access what they saw as better overall solutions to the problem they were trying to solve.
Value-based procurement is moving away from just bottom-line price and talking about value. How we approach it is, I try and purchase an outcome, not a device – whether that’s an outcome of higher patient satisfaction, lower readmission rates, a shorter length of stay, whatever. We don’t just want a pacemaker; we want a better outcome for the patients who will need a pacemaker. From start to finish, a pacemaker insertion is in that patient journey somewhere, but that’s not the only bit we’re concerned with. We want you to talk about the whole continuum. So, vendor, tell us how you will help us get there.
Rob, you’ve got three big buckets within your portfolio: finance and innovation and technology, each of which by themselves is a huge area. How do you align all those three areas?
It might seem surprising, but they actually line up quite well, One of the reasons it works is having good people in the key positions. In a hospital, almost everything you do touches technology in some way or another. Take beds for example. In the old days, a bed was a bed; now a bed is a smart solution that’s connected to Wi-Fi and produces all kinds of data. So much of what we see on the innovation side touches technology or is technology-driven.
We’re part of The National Research Council Industrial Research Assistance Program (NRC IRAP) where they connect innovators and entrepreneurs with partners like us. The innovators are essentially asking for advice on how to take their ideas to market – “How do I turn this into something the health system’s going to want and is willing to pay for it?”
A lot of that is procurement and finance-based. It’s really hard to get a new product into a hospital because of our procurement rules. So a lot of what we’re doing with these entrepreneurs and innovators is talking about the business of healthcare – how you might want to position your product and who in the system is most likely going to want to pay for it. We see a lot of great ideas, but the hospital is often not the one you should be trying to sell to.
The data is a critical part of how you do your job but getting to those results is all about the people. I’m wondering about your philosophy around people management?
I think a big part of people management is to be bold in your thinking. The way I work with my teams is to encourage them to be creative, try new things in a safe space so we can be honest about what worked or what didn’t.
In hospitals, there tends to be a distinction between clinical and non-clinical. One of the things we’re trying to do in my portfolios is let people know that we’re not just back office. In Finance and Accounting; we’re actually strategic advisors to the various units in the hospital.
In procurement, we offer creative approaches to try and maximize value for the health system. In technology, we enable solutions that improve efficiency, satisfaction and patient outcomes. That brings me back to why I wanted to work in healthcare – I still believe we can use finance or accounting to make a difference. Not just to make sure the numbers are in the right place, which is important, but it’s a way of thinking, it’s a way of doing things differently.
Rob, why is CMEPP a valuable partner to Southlake?
Well, there are a couple of reasons. The main one is that CMEPP saves money for members. It’s a creative approach that enables hospitals to pool their premiums and know that CMEPP will oversee contracting for medical equipment servicing and repair. Otherwise, you would just be going back to the vendor every time and buying service which is often more expensive.
This is more on our facility side, but because CMEPP has a whole pool of equipment from different hospitals, it has valuable data, and this is very useful for knowing the repair record on certain pieces of equipment. CMEPP has knowledge about a range of equipment that a single hospital wouldn’t have.
The other advantage is the surplus going back to hospitals every year. Earlier this year, Southlake withdrew funds from our accumulated Surplus Account. The hospital has several large renewal projects underway, including putting in a PET-CT (the first in the region), adding linear accelerators, and a new state-of-the-art MRI to replace one of the older ones. We’ve also done a complete replacement of the IV fleet.
By themselves, these are all high-cost items so the ability to access funds from the surplus account – for even a portion of these expenses – was a real benefit for us.
It looks like you’re very active in the community – you sit on boards and are a mentor. Why is that kind of that community involvement important to you?
With the mentoring partnership in particular, the reason I got involved was that when I moved here, it was incredibly difficult emotionally, financially, in all kinds of ways. I was able to move laterally with my job, English is my first language, and I’m white. But it was still very difficult for me and my family even with all those advantages. So, I can imagine how much more difficult it would be for somebody coming without those advantages and I was motivated to share some of my experiences and coping strategies as well as trying to open some doors within my network.
I’ve done some of that with CPA Ontario as well, helping newcomers to Canada navigate trying to get a job that is commensurate with their skills. Another thing I do with CPA Ontario is talk with university students who are considering being an accountant and are interested in my path. Accounting’s been very good to me. I like to share with people that there’s much more to it than the stereotypical bean counting! It is a good profession, you can use your skills to make a difference, it can give you a good life.