Latest / Becker’s Healthcare Podcast / Dr. Peggy Duggan, Executive Vice President Chief Physician Executive Chief Medical Officer, Tampa General Hospital

Transcript

Dr. Peggy Duggan, Executive Vice President Chief Physician Executive Chief Medical Officer, Tampa General Hospital · Becker’s Healthcare Podcast

• 0:02
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:11
  speakers to Chicago April.
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  This series event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:23
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:27
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:32
  This is Laura Dirda with the Becker's Healthcare
• 0:35
  podcast. I'm thrilled today to be joined by
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  doctor Peggy Duggan, executive vice president, chief physician
• 0:40
  executive, and chief medical officer at Tampa General
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  Hospital. Doctor Duggan, it's a pleasure to have
• 0:45
  you on the podcast today.
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  Pleasure to be here. Fantastic. Well, I I'm
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  excited for our discussion because I know Tampa
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  General is really on the cutting edge of
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  a lot of things happening in health care
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  today and, you know, some particularly
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  really fascinating things and just serving the patients
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  more in patient experience. And so I'm looking
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  forward to digging in. But before we do,
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  can you tell us a little bit more
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  about yourself and Tampa General Hospital?
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  Oh, sure. Happy to. So, as you stated,
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  I'm the chief physician executive at Tampa General,
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  and Tampa General
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  is a, large academic health system in the
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  central part of Florida. So we are we
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  the anchor is really our academic medical center,
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  which is in Tampa, but we
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  are a six hospital system. We have three
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  community hospitals north of us that came into
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  the system about two and a half years
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  ago.
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  We manage a a hospital on the other
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  coast,
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  a true rural hospital, and then we just,
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  made an agreement to take on DeSoto Hospital
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  to the south of us, so another true
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  rural hospital. We are really working
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  both
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  in the large academic medical space but also
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  providing care to the rural citizens of the
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  state of Florida.
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  In addition to that, we have about 150
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  ambulatory sites and that covers pretty much anything
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  a patient could need,
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  urgent care, imaging,
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  ambulatory clinics,
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  specialty clinics, so really a wide range of
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  care
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  can
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  be really received at Tampa General Hospital in
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  many environments,
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  basically to provide care to patients in their
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  communities at the level of care we provide
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  at the AMC.
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  For myself,
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  I am
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  here, I've been here about five years this
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  month, so January is my fifth year anniversary
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  here at Tampa General as the chief physician
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  executive.
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  I came from Boston where I did most
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  of my training and my most of my
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  work had had been at the Brigham Women's
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  Hospital. I was there for about twenty two
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  years as a,
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  academic breast surgeon and as a physician leader
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  in their system. So, but coming to Tampa
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  has been a lot of fun. We've had
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  a lot of things done here at Tampa
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  General and it's,
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  you know, we we are innovative, as you
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  said, and on the cutting edge of a
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  lot of activity in the health care space.
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  So it's been a great five years.
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  That's amazing to hear. And, you know, really,
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  really fantastic to think about and, understand a
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  little bit more of Tampa General's growth as
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  well. Now in looking at the last year
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  or so, what was the most important initiative
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  that you led? What did you do, and
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  what were the results?
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  Yeah. So for me personally, and it's really
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  a two year journey for this mission, but
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  my biggest,
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  I'd say, and most impactful project was a
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  full redesign of our critical care
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  delivered at Tampa General and across the system.
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  So at the academic medical center, we have
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  about two ten
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  critical care beds, so the size of a
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  pretty typical community hospital we have in critical
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  care beds.
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  So a big project,
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  lots of specialty units,
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  lots of different ways people were providing care.
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  So what we set about doing is really
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  creating
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  a series of standards
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  so that we were simplifying and standardizing care
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  across units based on specialty,
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  but also staffing,
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  bringing in more
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  critical care providers as both MDs and APPs
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  to be the support,
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  for the nursing crew that takes care of
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  the patients day in and day out. And
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  so by doing that, we've really created
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  an
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  ICU center of excellence. It's been incredibly,
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  empowering to the teams and incredibly impactful to
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  our patients. And I can just give you
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  a few statistics, but we've had a
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  a significant drop in central line infections.
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  So about half of what we had, in
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  f y twenty six.
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  And same for, urinary tract infections, two things
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  that are really plagued critical care patients. So
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  had significant improvement. But what's most
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  compelling for us is our mortality. So our,
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  ICUs, you know, we compare ourselves when we
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  think about where does the general sit kind
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  of in the world of hospitals. We compare
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  ourselves to the other large academic medical centers.
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  And so when you look at our ICU
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  mortality,
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  we are in the ninth percentile in the
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  large academic medical group
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  that shares their data with the Busyant database.
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  So really impressive work that the teams have
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  done
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  and really has driven
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  great outcomes for our patients. So, it's been
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  a joy to watch. You know, we really
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  just got it started, and then the team
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  we we built,
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  ran with it, and it's just been a
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  joy to watch them,
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  drive those improvements.
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  In addition to that, we've done a house
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  wide
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  safety
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  work just really working on the safety and
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  quality of care for our patients. TEMP General's
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  primary goal is delivering the highest quality care,
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  and for doing that and engaging really all
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  of the teams,
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  and when I say all, I mean everybody,
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  like our finance team is engaged and
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  our
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  IT team is engaged in this work because
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  we all come to work to care for
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  patients every day, we've moved
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  our ranking in that Vizient academic
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  cohort to the twenty fourth percentile in the
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  country.
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  And we're talking about all the large academic
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  medical centers, the Mass General's, the Vanderbilts, the
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  Stanford's. So we feel really good about the
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  work we've done and how we've driven,
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  and shown the quality of the work and
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  the care we provide at Tampa General with
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  while caring for some of the sickest patients,
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  certainly in our in our state.
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  Absolutely. That's fascinating to hear. And, you know,
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  I I think a really powerful example of
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  how you can, you know, get,
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  initiative started,
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  kind of create the vision of what you're
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  looking for, and then let your teams really,
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  take the lead on making sure they're successful
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  and then continue to grow and iterate
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  on them. And I think especially when you
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  look at quality, patient safety,
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  initiatives, metrics, and and moving the needle there,
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  what do you think has been really the
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  the biggest,
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  I guess, thing that your teams have been
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  able to,
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  do and accomplish and overcome in order to
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  create some of these results that are truly
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  magnificent?
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  Yeah. I I think a couple of things,
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  building a lot of infrastructure,
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  so so resourcing. Right? Things that, needed to
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  be built so that
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  that that patients were getting the the most
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  efficient
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  and effective care. And I'll give a very
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  simple example.
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  We built out a new peripheral IV team.
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  That does not sound like a big important
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  project,
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  but what it's done,
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  is a number of things. So that new
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  team, you know, places all the peripheral IVs
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  in the building
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  for patients who are not in our critical
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  care units. Those nurses place those. It's decreased,
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  the infection rate, honestly, the MRSA, the the
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  the really resistant bug rate that spreads from
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  patients in the building, it's decreased that significantly.
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  And it's given our nurses, our bedside nurses,
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  time back with their patients so that they
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  can really spend the time
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  providing
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  nursing care and the support that patients need.
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  So sometimes
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  it's simple things or things that wouldn't seem
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  like a big
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  needle mover,
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  but when you build the infrastructure and then
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  you let the teams
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  really
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  go after the work, that's a huge benefit.
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  The other thing we do a lot of
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  here is look at our data, right, and
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  so we look where we're challenged
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  and we analyze that data and look for
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  the why of that data. So dig really
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  deep into why something is sitting where it
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  is. Like, you know, we've done a ton
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  of work on length of stay. Why were
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  we sitting where we were? And then going
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  after, well, how do you remove those barriers
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  for the teams? Because the team wants to
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  do the right work. Everybody comes to work
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  to deliver great care. But sometimes there's barriers
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  for them that as leaders, our job is
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  to,
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  identify those and really, tick them off so
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  that they can, the teams can be more
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  effective.
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  That makes a lot of sense. Thank you
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  so much for digging a little bit deeper
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  there. Now looking ahead, what are some of
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  your big priorities as well as headwinds you're
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  focused on for 2026?
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  Yeah. So a couple of big priorities are
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  things that are in motion, but we really
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  wanna scale and drive. So a huge opportunity
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  for us, and we have one of the
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  largest
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  programs in the country, but we still wanna
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  continue to grow is our hospital at home
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  program.
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  So we have a a group of patients
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  who are inpatient level of care, but are
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  cared for in their home
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  by our nurses, by our advanced practice providers,
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  and our physicians. We designed that program
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  with our chief
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  innovation officer, Doctor. Peter Chang, and that
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  program has really allowed us to take some
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  of our lower acuity patients
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  from our ED or from our inpatient
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  unit and bring them home receiving the same
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  level of care they receive in the hospital.
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  That's a huge win for everybody.
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  The patients love it, they're home with their
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  family, the teams love caring for patients in
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  their home environment,
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  And I think one of the things we've
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  seen as a side effect of that is
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  when you're in someone's home, you can see
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  some of the reasons why they either return
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  to the hospital,
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  maybe
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  their dietary
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  habits or some of their other
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  activities, you can see it and you can
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  make an intervention. And that
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  population of patients has the lowest readmission rate
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  in our system because
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  of that ability to see outside the hospital
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  walls what are some of the challenges our
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  patients are facing.
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  And our I think our other big,
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  initiative really to scale is this idea of
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  moving to what can we move to ambulatory?
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  So we have a, I'd say, a nascent
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  project that's really in growth, but we call
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  it think ambulatory first,
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  and that's led by one of our associate
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  chief medical officers,
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  doctor Asa Opsner.
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  And that work is really driving the patients,
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  who can be taken care of in an
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  ambulatory space to an ambulatory clinic. And if
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  we just take a second to explain the
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  why of that, you know, if you're an
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  emergency medicine physician or a hospitalist, you have
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  a lot of responsibility
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  to make sure the patient gets what they
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  need. Even if it could be done outpatient,
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  you can't just send them to get that
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  outpatient care without making sure that it really
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  happens and that there's follow-up.
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  So what we've done is create an environment
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  where the providers
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  know that the patient is going to get
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  what they need very consistently.
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  We built it with them, which is one
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  of the, I think, keys to the success
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  is really building it with the teams that
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  are gonna be using a resource, and it's
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  really taken off. And
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  the other thing I'll say
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  is that we needed this for a long
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  time. Right? And I think probably most hospital
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  systems do.
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  And it was, and that's what really drove
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  its success. Like, we were meeting the needs
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  of our emergency medicine physicians. They don't wanna
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  admit patients they don't have to, but they
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  do want to make sure the patients get
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  what they need. So we created that for
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  them. And it's really
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  taken a lot of patients who would be
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  admitted out of the hospital
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  and allowed those beds to be available for
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  sicker and more complex patients, which is really
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  what, certainly, at our our academic hospital is
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  why we're here.
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  That's amazing to hear. And I think it's
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  really helpful to understand that why behind the
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  ambulatory
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  focus and and shift,
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  because, you know, so often, I think that's
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  lost within,
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  the dynamics of making such a big change.
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  But Yeah. Really understanding that, it seems like
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  it helped propel and accelerate some of that
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  movement and action at Tampa General.
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  It sure has. And as far as,
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  thinking about headwinds, which are big for 2026.
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  Right? I think our biggest headwind is uncertainty.
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  And so it's just hard right now to
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  know where all is going to land as
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  particularly as it comes
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  to payers. Right? So
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  we're here
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  working very hard to make sure our patients
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  get the highest quality care, which I'm very,
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  I'm a very close partner with our chief
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  financial officer,
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  and we both agree, like, when you provide
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  the right care, it's usually also,
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  from an economics perspective, more efficient and and
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  really
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  benefits the business.
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  But the uncertainty is gonna,
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  be a challenge for us,
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  and being focused on fiscal responsibility
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  this year is going to be very important
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  as we live into the coming years. I
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  think that's again true for all health systems,
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  we've all been challenged,
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  especially after the pandemic,
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  things have shifted dramatically
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  in how care is delivered, and I think
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  we're, you know, it's a wait and see
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  for many of us to see how the
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  payers are going to react and how we're
• 13:23
  going to move forward. So the uncertainty can
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  be challenging,
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  but I think for us, we always look
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  for the opportunity in that, and we've got
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  a number of big initiatives going on to
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  really drive,
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  cost management
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  so that we can be in the best
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  position,
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  possible for any changes that come.
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  And I do think,
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  those changes will roll out over the next
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  couple of years, but this year, for me,
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  it feels like just the headwind is uncertainty
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  is gonna be with us. And keeping focus,
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  while there's a lot of uncertainty, will be
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  the challenge for the leadership team. Right? Keeping
• 13:58
  our teams focused and not distracted by that,
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  uncertainty.
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  That's such a great point. I mean, you
• 14:05
  can't control exactly what the uncertainty is gonna
• 14:08
  bring or what payers might do in policy
• 14:10
  shifts.
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  But to have that kind of reaction, the
• 14:13
  messaging to the team,
• 14:14
  is really critical.
• 14:16
  How do you,
• 14:17
  communicate some of these things to the teams
• 14:19
  when, you know, you're looking at fiscal responsibility,
• 14:22
  trying to understand efficiency and
• 14:24
  cost cutting while at the same time, you
• 14:26
  know, continuing to keep them focused on the
• 14:28
  patient care side. What what does that look
• 14:31
  like, or how are you, rolling out some
• 14:33
  of these initiatives that you mentioned,
• 14:35
  to really make sure that you're you're doing
• 14:38
  the best you can to, push these initiatives
• 14:40
  forward?
• 14:41
  Yeah. So I think a lot of it
• 14:43
  we do by partnering.
• 14:45
  Again, like I said, our chief financial officer,
• 14:47
  of course, is driving
• 14:49
  the work to
• 14:51
  improve efficiency from a cost per containment perspective.
• 14:55
  But efficiency is quality, and we spend a
• 14:57
  lot of time on that. Right?
• 14:59
  Inefficient care is not high quality care for
• 15:01
  patients.
• 15:02
  And so he and I are great, again,
• 15:04
  great partners. We share the work on our
• 15:06
  length of stay initiatives.
• 15:08
  And then I think for the teams, they
• 15:10
  see the chief physician executive and the chief
• 15:14
  financial officer aligned.
• 15:16
  That's
• 15:17
  really helpful. If myself and Mark Runyon, who
• 15:20
  is our chief financial officer, were not aligned,
• 15:24
  it would be really hard for the teams
• 15:25
  to be focused. So it's a we it's
• 15:27
  deliberate work.
• 15:29
  He and I work together on,
• 15:31
  kind of how we bring initiatives forward and
• 15:34
  how they're,
• 15:35
  talked about. We cosponsor
• 15:37
  a lot, so that, again, people see us
• 15:39
  at the table together.
• 15:40
  And,
• 15:42
  we learn from each other. Right? So he
• 15:44
  and I have I've learned a lot from
• 15:45
  my CFO, and he's learned a lot from
• 15:47
  me,
• 15:48
  about how we can really help propel the
• 15:50
  teams. Because nothing gets done,
• 15:53
  Like, we can make all the initiatives we
• 15:55
  want,
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  but nothing actually gets done if the team
• 15:58
  doesn't get behind it. Right? They can,
• 16:01
  people can do a lot of lip service
• 16:03
  to an activity or they can get behind
• 16:05
  it and get after it. And at Tampa
• 16:06
  General, that's one of the things I've been
• 16:08
  most impressed with in my time here. People
• 16:10
  really get after the work we want to
• 16:12
  achieve.
• 16:13
  And so we just make it easy for
• 16:15
  them to see that
• 16:17
  quality of care is more efficient and is
• 16:19
  also more cost effective. And we tie all
• 16:21
  of that so that the care teams
• 16:24
  identify it as we need to do this
• 16:26
  for, you know, a myriad of reasons. In
• 16:28
  addition,
• 16:28
  of course, and John, of course, our president,
• 16:31
  is a great communicator,
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  we talk a lot about how we can't
• 16:35
  provide the care we want if we can't
• 16:38
  make a margin. Right? This doesn't work. And
• 16:40
  so even as an particularly as a not
• 16:42
  for profit, we're really putting it all back
• 16:44
  into the community and the business.
• 16:46
  We have to have a margin in order
• 16:48
  to be successful with quality. It doesn't work
• 16:50
  any other way.
• 16:52
  That's really, really inspiring and, helpful to understand.
• 16:55
  And I I think, you know,
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  especially given, as you mentioned, some of the
• 16:59
  potential challenges that are ahead, a great way
• 17:02
  to look at things and, you know, breaking
• 17:03
  the line with between the chief physician executive
• 17:06
  and CFO too, is just really inspiring to
• 17:09
  see. Now,
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  I wanted to ask, what do you think
• 17:12
  the hardest thing you'll have to do in
• 17:13
  the coming year will be?
• 17:15
  Yeah. So I I think the hardest thing
• 17:17
  is one of the things actually our our,
• 17:20
  president and CEO speaks about a lot and
• 17:21
  that's care coordination.
• 17:23
  Care coordination,
• 17:24
  of course,
• 17:26
  is really
• 17:27
  what the patients need us to do to
• 17:28
  make sure their journey
• 17:30
  really works for them and they're getting what
• 17:32
  they need.
• 17:33
  Like a lot of
• 17:35
  academic health systems, we do a lot of
• 17:36
  care coordination.
• 17:38
  But some of it is in,
• 17:40
  I'd say siloed or service line specific
• 17:43
  or focused.
• 17:44
  So those we've identified. Those teams are doing
• 17:46
  great work in that episode of care. Right?
• 17:49
  They're really helping the patient during an episode
• 17:51
  where they need that help and they need
• 17:53
  certain things, like oncology is different than heart
• 17:55
  and vascular is different than,
• 17:58
  neuro, right, neurology.
• 18:01
  But what the patient does
• 18:03
  is they cross all of our silos in
• 18:05
  their care. Right? So they're receiving care in
• 18:07
  the outpatient setting, at our hospital, in our
• 18:10
  community hospitals,
• 18:12
  across to the East Coast,
• 18:15
  and we need to align coordination with the
• 18:18
  patient journey.
• 18:20
  That's not gonna be an easy thing to
• 18:22
  do. I think it's a required thing to
• 18:24
  do, but we're we're starting an initiative
• 18:27
  this year where we're really gonna take a
• 18:29
  couple of our leaders, again, our chief transformation
• 18:31
  officer,
• 18:33
  ambulatory,
• 18:34
  officers, and one of our,
• 18:36
  associate,
• 18:38
  CMOs, and they're gonna really look at how
• 18:41
  do we tie
• 18:42
  all the coordinating we do to what the
• 18:44
  patient's whole needs are. It's gonna move a
• 18:47
  lot of people's cheese around, and that's never
• 18:50
  easy.
• 18:50
  But I think if we keep focusing on
• 18:52
  what's the need of the patient, that that
• 18:54
  will come along. I think that's probably our
• 18:56
  gonna be our biggest challenge, but it's a
• 18:58
  great one to tackle, and we have the
• 18:59
  right team to do it.
• 19:01
  Absolutely. I love that. And, you know, looking
• 19:03
  at the people, of course, having the team
• 19:05
  in place and understanding the mission is critical,
• 19:08
  but then I can imagine, is there technology
• 19:10
  involved? How are you really thinking about the
• 19:13
  transformational side of this? Yeah. And that's why
• 19:15
  why the chief transformation officer, PJM, is such
• 19:18
  a critical partner in all of this because
• 19:20
  for the team to be successful across silos,
• 19:23
  we need tools for them that speak to
• 19:25
  each other. Right? And so that will
• 19:28
  from a strategic and a a and a,
• 19:30
  tools perspective, that's a key component
• 19:33
  and why we need someone like him part
• 19:35
  of that work
• 19:36
  because the the care teams know what, like,
• 19:39
  what they're trying to get to the patient
• 19:41
  or for the patient. But how do we
• 19:44
  communicate across
• 19:45
  and not duplicate efforts for some patients
• 19:48
  and provide less to other patients? How do
• 19:50
  we how do we spread that out, and
• 19:52
  how do we use, you know, tools like
• 19:54
  AI to support
• 19:56
  that so that we can take what we
• 19:57
  have and amplify it across more patients as
• 20:00
  well?
• 20:02
  That makes a lot of sense. You know,
• 20:03
  it's really exciting to see how you're able
• 20:05
  to integrate those types of tools and technology
• 20:07
  and
• 20:08
  data into, the broader initiatives that are making
• 20:11
  patient care as well as the patient experience
• 20:13
  a lot better.
• 20:15
  One last question for you. Where do you
• 20:17
  see some of the best opportunities for organizational
• 20:19
  growth moving forward?
• 20:21
  Yeah. For for me, I spend a lot
• 20:23
  of time thinking about,
• 20:26
  again, growing that hospital at home platform
• 20:28
  so that we can take care of patients
• 20:30
  in their home and then create beds for
• 20:33
  patients who need to be at, the AMC.
• 20:36
  We are actually,
• 20:37
  also
• 20:39
  at one of our community hospitals creating a
• 20:41
  similar hospital at home program, so again, decanting
• 20:44
  patients from the inpatient setting and giving them
• 20:47
  their care in their home. That's creating
• 20:50
  inpatient beds without building a building. So that
• 20:53
  that is really impactful. And then the shift
• 20:55
  as much to ambulatory as possible, and that
• 20:58
  includes our ASCs and our ThinkAmbulatory
• 21:01
  First platform.
• 21:03
  Those get up and really moving quickly
• 21:05
  that creates
• 21:06
  capacity in our AMC
• 21:08
  that will allow us to care for more
• 21:10
  sick and complex patients.
• 21:12
  We also have a major initiative
• 21:15
  we're kicking off in January on efficiency,
• 21:18
  and looking at where can we be more
• 21:20
  efficient
• 21:21
  on the inpatient side so that we can,
• 21:24
  again, more effectively deliver care to patients.
• 21:27
  And, you know, when we do that, and
• 21:29
  I say this all the time, when we
• 21:31
  more effectively and efficiently get the care the
• 21:33
  patient needs to them, they naturally leave the
• 21:36
  facility
• 21:37
  earlier and sooner and get back to their
• 21:39
  family. So we're kicking off a major initiative.
• 21:41
  And, again, this is one of the areas
• 21:43
  where myself and the CFO are cosponsoring this
• 21:46
  work,
• 21:47
  to bring it across the finish line and
• 21:48
  get really up and moving some more opportunities
• 21:50
  for our patients to get what they need
• 21:52
  in a more efficient fashion.
• 21:54
  I think the other,
• 21:56
  opportunity for us with growth is really,
• 21:59
  the use of AI in all of this.
• 22:01
  So we use AI pretty extensively at Temple
• 22:04
  General, and that's gonna drive some of our
• 22:06
  efficiency work, both on the inpatient side and
• 22:09
  the ambulatory side, being able to see and
• 22:12
  identify what patients' needs are, and also taking
• 22:14
  some of the
• 22:16
  kinda more menial tasks that team members do,
• 22:19
  in, like, really digging through charts and having
• 22:22
  AI do that for us so they can
• 22:24
  be out with patients or with the nursing
• 22:26
  team supporting them,
• 22:28
  and getting care to the patients more effectively.
• 22:31
  So we've seen some great improvements with our
• 22:33
  AI efforts as well.
• 22:35
  I love that. Doctor Duggan, thank you so
• 22:37
  much for joining us on the podcast today.
• 22:39
  This has been such an amazing conversation. We've
• 22:41
  covered so much ground and really cool to
• 22:43
  see the transformation happening at Tampa General. I
• 22:45
  I'm looking forward to seeing you in April
• 22:47
  as well at our annual meeting. I know
• 22:48
  you'll be speaking on a lot of these
• 22:50
  themes, and continuing to share, you know, more
• 22:53
  behind the scenes of what you're doing at
• 22:54
  Tampa General. So I'm looking forward to seeing
• 22:56
  you there. It's been my pleasure. Thanks, Lauren.
• 22:59
  I'm looking forward to it as well.