In its former incarnation as Hamilton Hospital, what is now Robert Wood Johnson University Hospital Hamilton was described to its new chief executive officer Anthony J. Cimino as the “little hospital in a cornfield.” Today, with more than 1,850 employees, 650 medical staff physicians, and an array of specialty services, the hospital has come of age. As Cimino observes: “We have built this into a first-class medical institution in the region.”
Cimino is not just blowing off steam. The hospital received independent confirmation of its excellence in 2004, when it won the Malcolm Baldrige National Quality Award, established by Congress and awarded by the president to recognize organizations for excellence in quality and performance. “We were and still are the only hospital in New Jersey and one of only eight in the country that has won this award,” says Cimino.
Although Cimino has not previously run a healthcare institution, he comes to his position at RWJ Hamilton with 21 years of experience on the hospital’s board, the past 10 as finance chair. He also served on the parent board at Robert Wood Johnson New Brunswick from 1995 to 1999. But his experience is wide, including the county freeholder board, the military, a retail business, and corporate work.
Cimino’s executive experience includes being one of a triumvirate running the Schoor De Palma (now CMX) engineering firm for 15 years, the last two as president; serving in governmental office, including a two-year stint as state commissioner of personnel; and six years of military service with the New Jersey National Guard, where he achieved the rank of second lieutenant. “My leadership training in the National Guard as well as in elective office helped me ascertain how to lead people and to insure we were all working together as a team,” he wrote in an E-mail. He also gained fundamental business expertise, he says, running his carpet business.
Cimino has not moved far from his roots. A lifetime resident of Hamilton and a product of its public schools, Cimino lived elsewhere only during college and early in his career. He graduated from Providence College in Rhode Island in 1969 with a degree in history.
Although he started graduate school in history at Georgetown University, Cimino left to do six years of reserve duty in the New Jersey National Guard. He had signed up in college to help replace a group of guardsmen who had been deactivated after serving in Vietnam.
While a reservist, Cimino also worked for Proctor & Gamble in sales and marketing but after a year decided to return to a family business. His uncle, Harry Trebbi, was a partner in a carpet and home furnishings retail store on North Olden Avenue, and Cimino joined him in the business. His father was a liquor salesman and his mother a bookkeeper.
In 1978 Cimino and his uncle left to form their own retail carpeting business, Harry Trebbi and Company, and when his uncle died in 1981, Cimino bought the business from his uncle’s family and rebranded it as Cimino’s Lawrence Carpet Shop. His wife, Gail, ran the business until 1999.
In 1977, even before he and his uncle started their carpeting business, Cimino entered the political arena as a member of the Hamilton Board of Education, where he was twice elected president.
Cimino traces his interest in politics back to the 1960s. “As a kid, I had paid attention and listened to John Kennedy and his call for public service and was always intrigued by that,” he says. “In the late ’60s I worked for his brother’s president campaign while I was in college.”
Cimino lost a 1981 run for the Hamilton Township Council but in November, 1982, won an election for Mercer County Freeholder. He served from 1982 to 1988, including time as president of the board, and was then elected to the New Jersey General Assembly. He was a legislator until 1992, when Governor Florio invited him to join his cabinet as commissioner of personnel. Responsible for 235,000 positions in New Jersey’s civil service system, he was also a member of the State Pension and Health Benefits Commission and the Executive Commission on Ethical Standards.
In 1994 Cimino moved to the private sector, joining the engineering firm Schoor De Palma. He was acquainted with the president and chief executive officer of the firm through business and political associations, and they contacted him when his term as commissioner ended. They were looking for a person to advance their sales and marketing at a critical juncture in their sector. “The world of that industry was changing from a world of professional service — hanging out a shingle and having people come in — to a world of having to understand how the business related to the rest of the world,” says Cimino.
“The transition from carpet store owner to the president of a major engineering firm was not that difficult,” he wrote in an E-mail. He found that the skills he had learned in retail were applicable in the corporate sphere as well. Fundamental to both, he says, is the ability to listen to clients and communicate to them what they can expect, and of course a grounding in finances and how to control expenses.
At Schoor De Palma, he was part of an executive management team of three that took the firm from a $19 million to a $144 million company and from 143 to 1,050 employees. His original function was to create a marketing plan and help drive business development. He went on to become executive vice president, a member of the board of directors, senior executive vice president, and finally president.
Cimino’s experience with Robert Wood Johnson Hamilton began in 1988, only 17 years after what was originally Trenton General moved to Hamilton, when he was invited to join its board as a trustee. He served as its vice chair from 1990 to 1994, then as chair from 1995 to 1999.
The hospital started small in 1971 but grew steadily under its first administrator, Jack White. When Michael Bryant took the helm in the late 1980s, about the time Cimino joined the board, the hospital was experiencing significant growth fueled by development in Hamilton Township.
During Bryant’s tenure, Cimino was part of the initial discussions about affiliation with Robert Wood Johnson. For the first few years the affiliation was a loose one, but in 1994 Hamilton Hospital formally affiliated with the Robert Wood Johnson University Hospital Health System and Network in New Brunswick and took its name. “This is a close-knit community and has great deal of feeling of independence,” says Cimino. “But we thought at the time it was important to align Hamilton Hospital with a larger player to be able to bring more service to the community.”
A primary consequence of this partnership was that in-state tertiary care services, like open heart and oncology, were now more accessible to Hamilton’s residents. “Rather than going to New York or Philadelphia, they could get good-quality care in New Brunswick,” says Cimino, “which ameliorates strain on the family.”
In 1995 the hospital also established a partnership with the Cancer Institute of New Jersey, and it opened the Hamilton Regional Health Network, which became its outpatient service facility.
“We were not a completely full-service operation at that point,” says Cimino. “We did not have births, and we thought, given the size of our community, it was important for us to have that option.” So in 1996 the hospital opened the Women and Infants Pavilion, which also enhanced the hospital’s women’s health program. This step, in Cimino’s estimation, made the hospital full service, which was critical to its growth. Also contributing to the growth were the hospital’s attending physicians, who were bringing more patients to the campus and doing more procedures at the hospital.
In March, 1998, Christy Stephenson stepped in as the hospital’s president and chief executive officer. During her tenure renovations were completed on a new emergency department. “When we expanded the emergency department, we thought the expansion was too big,” says Cimino. “Actually we take in 52,000 people a year, and we are the busiest emergency department in the county. So we didn’t overbuild, and if we had added more thousands of feet, we would have been better off.”
Several other departments also opened during Stephenson’s years: new intensive care, and telemetry units; a sleep center; a new home for the Cancer Institute of New Jersey Hamilton, and the Center for Health and Wellness. The center not only includes a physicians’ service, but it probably has the largest community education outreach program in the state. “It touches the lives of upwards of 150,000, with its classes, lectures with physicians, health screenings, and outreach in local senior centers,” says Cimino. “In concepts President Obama is looking at in terms of wellness and community education as well as prevention, we are well ahead of the curve as relates to healthcare reform.”
Under Stephenson the hospital also handled the crisis of treating 1,500 people who feared contamination by anthrax in letters that had passed through the regional mail processing center on Klockner Road. Mayor Glen Gilmore contacted Christy Stephenson, who quickly got on the phone with the Centers for Disease Control and began issuing Cipro to postal workers. “The hospital became ground zero for dealing with the anthrax problem,” says Cimino. “It was a difficult and challenging situation obviously, because the country was in a great deal of stress over 9/11 and other incidences of anthrax around the country.” The hospital has a plaque in its foyer in thanks for its actions.
What Cimino remembers most about Stephenson’s tenure, though, is the energy that the hospital focused on working toward the Baldrige award. The award application outlined the hospital’s many strengths, which the committee recognized when granting the award to RWJH Hamilton in 2004.
A prime consideration was communication in the hospital. “They cited the fact that we are constantly communicating with staff as well as having the staff understanding the import of patient satisfaction,” says Cimino. “The staff and administration are in constant dialogue with attending physicians.” The award citation noted that “the leadership team works within a system that links all management functions with unhindered communications at all levels.”
The award citation also mentioned innovative programs. The 15/30 program, launched in 1998, guarantees that emergency room patients will see a nurse within 15 minutes of arrival and a physician within 30, and if not, emergency room fees are waived. Another, called Walk in My Shoes, has employees work in departments other than their own to encourage cross-training, information sharing, and fresh insights.
RWJH Hamilton also saw numerous areas of improvement from 1999 to 2003, during which it was New Jersey’s fastest growing hospital. Employee satisfaction increased on several measures: regarding benefits, from 30 to over 90 percent; participation in decision-making, from 40 to 90 percent; and employee recognition, from 70 to 97 percent. Retention in 2003 was 96 percent for all employees and 98 percent for registered nurses. Furthermore, the hospital had reduced its rates of mortality, hospital-acquired infections, and medication errors to among the lowest in the nation.
During this period the hospital’s market share in cardiology grew from 20 to nearly 30 percent, in surgery from 17 to 30 percent, and in oncology from 13 percent to above 30 percent; its emergency room volume doubled; and its occupancy rate grew from 70 to 90 percent.
Summarizing why the hospital received the Baldrige award, Cimino says, “They looked for an alignment from the very bottom of the organization all the way through the very top of the organization to understand whether everyone was driving toward the same goal line, which was quality for delivery of care in this region.”
The next chief executive officer, Ellen Guarnieri, served from January, 2006, to June, 2009. When she took the job, she anticipated staying only two years, and after two and a half decided to return to her work as a healthcare consultant.
In the meantime, Cimino had been thinking about leaving CMX, but the firm’s owner, the private equity firm Trivest in Miami, asked him to assume the presidency; he agreed to stay on, but only for a limited period of time. In April, 2009, he retired, figuring he would look at consulting opportunities — but he didn’t have time because in June he was offered his new position. “This opened up, and I was honored that my colleagues on the board as well as those ultimately responsible for the hospital as our parent all thought it was a good idea that I step in as president and CEO,” he says.
Cimino is not worried about competition from the other four area hospitals: Capital Health’s two operations, Mercer Hospital and Helene Fuld; the St. Francis Medical Center in Trenton; and the University Medical Center at Princeton. Referring to new facilities being built by Capital Health in Hopewell Township and the University Medical Center at Princeton in Plainsboro, he says, “We welcome those new facilities. At the end of the day, regionally, it is about the delivery of healthcare for everyone. I applaud what Capital is going to do and what Princeton is up to.”
But he immediately starts to outline the advantages of Robert Wood Johnson Hamilton. “We are already aligned with a tertiary care medical system, and they are still in the process of being built,” he says. “Our window of time is here. We can advance our services because we are already on the ground and in position.”
Much of the hospital’s physical plant is fairly new, including the Lakefront patient tower with its modern dining facility and garden. To create these facilities, the hospital raised in excess of $3 million in a capital campaign. “Our relatively new facilities have definitely been a strength for the hospital,” Cimino said in an E-mail. “Our bucolic setting provides a beautiful scene and ease of access for our patients, staff, and our doctors.”
The Lakefront tower has 64 private rooms, and the hospital plans to renovate some older patient rooms to create more private rooms.
A potential advantage in attracting and keeping employees is the associated daycare center, Lakeview Child Center, set up in 1985 for children from age six weeks to six years. “Part of why we started it was because of our own population,” says Cimino. “It’s about someone being on campus here or in one of our centers and people being comfortable that their children are okay,” he explains. Whether or not parents check in at lunchtime, they know they are close by in an emergency. “It creates a happier employee and better productivity,” says Cimino.
Later the center was opened to the general public, and it has multiplied, with six locations in Mercer County and one in Manalapan; the centers exist under a separate corporation but work collaboratively with the hospital.
The hospital has also added four unusual outdoor garden spaces, which it calls Grounds for Healing. Based on research that patients in healthcare facilities with views of nature have shorter post-operative stays, experience fewer post-operative complications, and take less pain medication, the hospital partnered with Grounds for Sculpture in Hamilton to create spaces on the hospital campus that combine art with nature.
The first garden was built in 2001 to complement the new, freestanding building for the Cancer Institute of New Jersey at Hamilton, whose drug infusion treatment area on the first floor is surrounded by floor-to-ceiling windows. Because patients might spend hours looking into this area, the design team sought patient input. The resulting garden is relatively abstract, intricate enough to maintain a patient’s attention for long periods, and comfortable. It features a soothing waterfall, is wheelchair accessible, and has many shaded areas for sun-free patient seating, some under trellises draped with wisteria.
This garden and the other three, located at the entrance, outside the cafe, and outside the Women and Infants Pavilion, are not only soothing for patients, visitors, and staff, but also distinguish the hospital from others in its service area. “The Grounds for Healing do offer a competitive advantage because, while we are providing an excellent quality of care, we are doing so in a beautiful, peaceful setting that our patients can look out and enjoy or people can visit,” writes Cimino in an E-mail.
The four Grounds for Healing have been funded through individual philanthropy, including a statue donated by the Johnson Atelier.
Another competitive advantage for the hospital, says Cimino, is the attention it is giving to information technology. It has more closely aligned its information technology system with that of Robert Wood Johnson New Brunswick and has put in place modules of an electronic medical record system. Using this system, it is expected that in early 2010 physicians will be placing all orders electronically, including medications.
Cimino has been married for 36 years and has three children and three grandchildren, with one more on the way. Dubbing his wife Gail “the bulwark of our family,” Cimino notes that although she is now a homemaker, she worked for years in their carpeting business. She has also been active philanthropically, as a founder of Central Jersey Area Girls Soccer, as president and board member of Sayen House and Gardens, and in PTA.
Cimino is a New York Yankees and New York Giants fan, and he enjoys golf, the Jersey Shore, and reading, especially biographies. He recently finished “Andrew Jackson” and Joe Torre’s “The Yankee Years” and is now reading “1960 The Campaign,” which involved three future presidents: Kennedy, Johnson, and Nixon.
More than most new guys on the block, Cimino is well aware of the problems facing every healthcare institution today. “There is a very rapidly changing dynamic both at the state as well as the federal level,” he says, “and we’re all paying close attention to what healthcare reform means and how the hospital will fare in healthcare reform.”
Hospitals may see resources from the federal government shrinking rather than expanding, and as a result, says Cimino, “we are going to have to be wiser and smarter about how we expend resources.” Complicating this scenario are states’ financial difficulties as a result of the current economic meltdown.
Another group that will be affected by healthcare reform is attending physicians. “We want to work in collaboration with physicians and foster greater and closer relationships with them as healthcare reform comes to be,” says Cimino. Potential initiatives include bundled services, whereby healthcare providers are paid a set fee for treating an entire illness. As a result, hospitals and doctors may end up sharing costs, but they could also share responsibility for any unnecessary complications.
“Physicians will potentially have to look at being more hospital based in what could be the new paradigm,” explains Cimino. “The way the dollars will ultimately be dispensed will require you to be linked in some fashion.”
Another issue in healthcare reform is electronic medical records. “There is already a significant amount of money in the stimulus to drive this, and it will be important for hospitals to be linked to their attendings and for everyone to be on the same information technology,” says Cimino.
One of Cimino’s goals as he starts to make his own imprint is to foster greater financial and clinical integration with Robert Wood Johnson Hospital New Brunswick and other hospitals in the system, including RWJ Rahway and the Children’s Specialized Hospital. He would also like to strengthen the hospital’s relationship with the University of Medicine and Dentistry of New Jersey. He cites surgeon Mark Anderson’s June transplant of an artificial heart, which followed three years of work on a transplant protocol, as an example of the kinds of scientific investigation that his hospital is exposed to through this connection. Robert Wood Johnson Hospital New Brunswick is the principal teaching hospital of the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School.
Already oncologists and other physicians from New Brunswick work regularly with doctors in Hamilton, which allows the hospital to bring more advanced care to its patients. Cimino would like to see more of the same in neurosurgery, cardiac care, and potentially other services, including sleep disorders.
Creating and strengthening these clinical alignments, he says, ends up reducing the cost of healthcare for everyone as dollars are spread over a bigger base. The hospitals together will be able to negotiate better prices. Or they may standardize items like artificial limbs and narrow the suppliers to the top two or three in terms of quality. “If you can get to levels of standardization, it can help reduce costs and provide high-quality care, and who benefits? Those who insure and the federal government,” Cimino says. Furthermore, when the doctors are all working on similar systems, each will have more people whose expertise can help them solve problems.
Another serious financial issue that all hospitals face is handling charity care. According to recent numbers, Cimino says, the hospital did $8 million in yearly charity care for which its reimbursement was only $450,000. “We have a social philosophy in our state where we need to take care of people who are ill, and that policy, in my opinion, should never change,” he says. If people are not taken care of, he adds, the result is greater healthcare issues for the individual and for society.
But unless the net of insurance coverage is widened, the state will have to figure out how to reimburse hospitals for charity care. “I’m not convinced that a government-sponsored program is the answer,” says Cimino. “I think that the government needs to work closer with private insurers and potentially drive a program that works through the private insurance industry.”
Cimino maintains that in some way, shape, or form private and public sectors must come together. “It is simply unacceptable in a country with our munificence that we have so many people who are uninsured,” he says. “The end result is that, although we are delivering basic healthcare, we are not providing quality. If we did so as a country, we would see enhanced productivity and people living in much more satisfying situations through the course of their lives.”