Published September 28, 2016
Volume 25, Number 9



By Jay Hipps

When looking at the career choices made by Paul Smith, CEO of the Network Joint Venture, LLC, created by Tenet Healthcare and John Muir Health, it is not difficult to find the early influences that helped steer him towards that field.
“My mother was a nurse and had the classic nursing mindset: bend over backwards to help others,” he says. “When I was in college, she was getting much further along in her career and she would always work during Thanksgiving, Christmas and on Mother's Day. Her philosophy was always, ‘there are hundreds of young moms out there that want to be home with their families,’ and she remembered how special that was.”
Paul SmithSmith fully understood the reason for her sacrifice. “She would always come home with stories of looking after patients and how grateful their families were. Growing up in that environment, it's just burned into you that there's something special, something different about health care, over and above any other field. It really is impactful.”
Smith was born and raised in Montreal, Quebec, and moved with his family to Atlanta when he was a teenager. He studied business at the University of Georgia and remained at the school to earn an MBA in finance, with a minor in marketing, in 1991.
“Because of my mother’s influence, I knew I wanted to go into consulting and health care,” he says. “The reason for consulting, and my logic as a graduating 23 year old was that I would be exposed to a number of different types of health care businesses and locations before making a decision (on a direction within the field). I wasn't sure if I wanted to go into managed care and work for a Blue Cross type organization — I had that opportunity at the time — or if I wanted to go to a community hospital, or a large physician practice. There were a number of directions I could have gone and consulting would provide that wide swath of experience.”
Leaving school, his first projects as a consultant involved managed care and managed care administration, which he describes as “a very complex field.”
“You were able to get into the nitty gritty of the industry and from there I went into healthcare consulting, working with hospital clients, and with  employers to help them manage their own health care expenses, which allowed me to see it from that angle — the large pulp and paper company in the South whose healthcare costs were growing at 15 or 18 percent a year, asking, ‘Paul, how do we fix it? What can we do?’” he says. “Having interacted with the managed care side and the hospital side, you get a sense that everybody's just really busting their rear ends to be efficient and do it right, but the industry overall at the time wasn't cooperating very well. I did an 18 month project with the Pentagon working on TriCare (the military’s health care system) and that was eye opening as well.”
After 10 years as a consultant, he moved to Tenet upon the recommendation of a former associate. “She and I had been colleagues for a good while and she loved it (at Tenet),” he says. “She reached out and had me interview a couple of times.”
It was a better fit than he could have possibly imagined.
“I was in a good position in my consulting role but I was offered a position within Tenet in the Midwest, in St. Louis, managing a number of hospital development activities that I loved,” he says. “I was perfectly geared for it and that was my big jump out of consulting into a health system that at the time had over 100 hospitals. I appreciated their dedication as well — the same type of people that my mom worked with and my mom experienced. It was nice being in that setting 100 percent of the time as opposed to being in the consulting setting. That was 2001, I'm still with Tenet and I love the company.”
Hospital development — working to grow the services that a hospital offers — has been a big part of Smith’s career ever since. Sometimes, it actually meant helping build a new hospital from the ground up.
“In Bartlett, Tennessee, our project was to build a hospital. That's an investment that doesn't show a return for many, many years, but we saw within that market there was just a huge hole — people having to travel a long way to receive even the most basic care,” he recalls. “So Tenet spent the money and put in a hospital there and it was quite rewarding to go through that process from beginning to end.”
Most of Smith’s work, in fact, is focused on improving people’s access to care, which is a task that can present a variety of hurdles.
“One of the issues within health care is the money,” he says. “Our community needs an MRI. Well, it may be expensive, but it is an important piece of equipment for a community. How do we make that work? That's the role of the development person.”
Smith stayed with his same development team at Tenet through 2014, when he was assigned to a project in San Ramon, at one of the organization’s leading hospitals. “San Ramon Regional Medical Center has been around since 1990,” Smith says. “It's always at or near the top of the list within the Tenet organization, the top four or five for quality and for patient and physician satisfaction. It's just one of those four or five lead hospitals consistently.”
The project in question was a partnership being formed between John Muir Health and Tenet’s San Ramon Regional Medical Center, a 123-bed acute care hospital. The two organizations would team up to operate that facility and to jointly develop outpatient services at locations throughout the Tri-Valley, as well as up the I-680 corridor as far as Alamo. “John Muir has been a great partner and together we’re offering Pleasanton area residents access to local physicians, a local hospital (San Ramon) and convenient local services like Urgent Care and the full service imaging center at the Pleasanton Outpatient Center,” said Smith.
“This project was one of the first of its kind — certainly for Tenet — with a not for profit and a for profit health system, and it was just a wonderful marriage of like minded people with similar goals,” he says. “We just want to provide extend access to health care for people wherever we can, and there's an element of recognition that the independent practice of medicine is important. A number of physicians in this market will continue to remain independent, and we encourage that. We also have an opportunity for physicians who would prefer to be employed.”
Smith spent over a year traveling to San Ramon every week from his Midwest home, working to get the outpatient network off the ground. “It wasn't too long before they offered the permanent position,” says Smith. “That was, as you might guess, a big decision. I've got a wife and five children.   Leaving friends and your roots is a big deal.”
The decision to move only came after a memorable visit one August. “I remember that first day. We came through Pleasanton and it was blue sky and there were crowds of people heading off Main Street to the park,” he says. “We followed them and it was all picnic baskets and wine and live music and 70 perfect degrees, and my wife kind of looked at me and said, 'I think I could get used to this.'”
Now that Smith is on site every day, there is a lot that excites him about what the Network Joint Venture is accomplishing.
“People love choice and they love convenience, and there is a whole array of choices for them. How do you make it work?” Smith says. “One of the things that we've done that is exciting is this concept of a one-stop shop -  that you can come into the Pleasanton Outpatient Center and have primary care and urgent care and your imaging and lab and your specialists all right there. We’ve had overwhelming response to the concept. The other piece that is exciting is the technology. Technology is expensive, but the great thing is you can come into that urgent care and you can walk across and get your x-ray done, go upstairs to your primary care doctor and they all can see your results and have it on your medical record, or you can go to San Ramon Regional Medical Center and you have it there as well. That kind of connectivity, it’s important.”
Smith notes that the Joint Venture is also working on a variety of initiatives which will expand patient access to care.
“In the near term we're building a physician network, so we've got a number of primary care and specialty physicians from Livermore up to Alamo. We're adding imaging services, what we call ancillaries, throughout that area so that a resident in downtown Pleasanton has a convenient place to go. Next are specialty physicians, who are now coming into the Pleasanton Outpatient Center so that when you come in, you can have that one-stop shop experience. It’s a huge plus that you can come back to the same building, for example, and the cardiologist will be here.’”
Smith explains that having all the doctors under one roof creates advantages that may not always be obvious. “Having all the specialists practice in a common setting creates a subtle, informal dynamic. It's those interactions in the hallway and at lunch that are invaluable, the informal discussions between the cardiologists and the internal medicine physicians about how to treat something. Those become formalized meetings for heart failure, diabetes, different types of diseases, and it becomes a very collegial environment. We've seen that already in this outpatient center.”
He reports that the organization is also looking to expand services in Livermore. “We have primary care physicians out there now and we’re working to bring more specialty physicians as well,” he says. “Right now, for those patients who have to travel to visit with their specialists, we're trying to make things a little easier for them.”
Above all, Smith continues to recognize the importance of the care and services that he is helping enable his organization to provide.
“It's real life — it's not just money and technology. You're changing someone's life,” he says. “I'm an administrator, so I do my own little part even if I don't have the same type of stories that my mother told. But I'm still in an industry that I'm proud of.”

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