Latest / Becker’s Healthcare Podcast / Paula Ferrada, Chair of Surgery at Inova Fairfax Medical Campus

Transcript

Paula Ferrada, Chair of Surgery at Inova Fairfax Medical Campus · Becker’s Healthcare Podcast

• 0:02
  The most important health care decisions don't happen
• 0:05
  in isolation.
• 0:06
  They happen when leaders come together.
• 0:08
  Becker's sixteenth annual meeting brings together more than
• 0:11
  3,500
• 0:12
  hospital and health system executives this April in
• 0:15
  Chicago.
• 0:16
  With 800 speakers from Ascension,
• 0:18
  Cleveland Clinic, CommonSpirit and more, the conversations get
• 0:22
  real. Leaders will share how their scenario planning
• 0:24
  for policy shifts, breaking through value based care
• 0:27
  barriers, and building clinical teams that translate
• 0:37
  event
• 0:38
  details,
• 0:39
  visit beckershospitalreview.com
• 0:41
  and click on the events tab in the
• 0:43
  upper right.
• 0:46
  This is Laura Dirdo with Becker Healthcare Podcast.
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  I'm thrilled today to be joined by doctor
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  Apala Farada, who is the chair of surgery
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  at Inova Fairfax Medical Campus and system chief
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  for trauma and acute care surgery at Inova
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  Health. Doctor Farada, it's a pleasure to have
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  you on the podcast today.
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  Hi, Laura. Thank you for having me. The
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  pleasure is all mine.
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  Absolutely. Now I'm excited for our conversation because
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  I know there's so much happening at Inova
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  right now and certainly at the forefront of
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  a lot of the innovation and and transformation
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  within the health care space. And so it'll
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  be great to hear from you about, some
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  of the cool things you're doing as well
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  as perspective on the future. But before we
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  dive in, can you tell us a little
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  bit more about yourself and the Nova Health?
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  Oh, yeah. Of course.
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  So I am, I am a trauma surgeon
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  by training.
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  I,
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  I am an immigrant. I came, from Colombia
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  twenty five years ago to this country,
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  for training, surgical training. I did,
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  research and internship in University of Miami, Jackson
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  Memorial Hospital.
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  Then I went to residency at the Beth
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  Israel Deaconess in Boston,
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  and I did a critical care fellowship at
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  Pittsburgh. Then I did another,
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  fellowship at the University of Maryland shock trauma
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  and acute care surgery as our first acute
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  care surgery fellow.
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  I was at,
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  at Virginia Commonwealth University for eleven years, where
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  I served as director of the ICU and
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  the critical care fellowship fellowship as well as
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  member of the board and professor of surgery.
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  And I joined Inova Health
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  in 2021
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  as the division and system chief for trauma
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  and acute care surgery.
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  In,
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  twenty twenty five January,
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  I,
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  I started the the to serve at Inova
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  Health as the chair of surgery for Fairfax
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  in addition to that.
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  A little bit about Inova Health. I think
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  the reason why I love coming to work
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  every day
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  is the fact that,
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  I believe when we talk about psychological safety,
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  it's not a slogan. It's actually something that
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  we live and breathe.
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  So every time that we think about changing
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  a metric or changing a number or improving
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  in something,
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  I strongly believe that everybody from the people
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  that work in cleaning the floors or the
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  cafeteria or security
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  to the clinicians,
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  the healers that are at the bedside,
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  to the administrators that are working really hard
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  to make sure that we have enough resources
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  to do what we need to do.
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  We are all working really hard for the
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  patients. The patient is at the center of
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  our all all of our decisions,
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  which
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  fulfills me tremendously
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  because,
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  I think that
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  what keeps us as healers, the people that
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  that are that are doing health care,
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  because we wanted to help people.
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  What keeps us going is not losing sight
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  of our mission and our purpose, which is
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  helping others.
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  That's amazing to hear. And it definitely is
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  so important to keep that mission front and
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  center and have that patient care, really,
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  as at the heart of everything you do.
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  Now when you're thinking about the last year
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  or so, what was the most important initiative
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  you led? What did you do, and what
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  were the results?
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  Several initiatives in the last year. I think
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  that,
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  what some of the things that we have
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  done is basically
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  transformative
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  based in culture, actually.
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  We changed metrics,
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  and now we're doing so much better, but
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  everything is based in cultures. At,
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  Fairfax Hospitals, we do we do about above
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  above 40,000
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  procedures,
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  per year.
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  And,
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  we manage,
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  over 50,
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  operating rooms as well as procedure rooms, and
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  surgeons are
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  are Inova employees and non Inova employees. So
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  it's a complex matrix.
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  We,
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  improved
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  our first on time start for the operating
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  room from the fifties to over 75%.
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  And,
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  that was a lot of work in culture,
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  in communicating
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  well between nurses and surgeons and anesthesia, and
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  understanding that we're all part of the same
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  team. We all want the best for the
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  patient. We also improved,
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  significantly
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  in any or delays.
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  And as we got faster and efficient,
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  that actually had a better impact in our
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  safety. So when we started looking at,
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  safety metrics for the operating room, you would
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  think people were some people were a little
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  nervous. Why why all the rush were were
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  focusing on efficiency?
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  And by being fast, we might forget some
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  things. But it turns out when the work
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  is based in trusting each other, in helping
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  each other, in giving each other the benefit
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  of the doubt,
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  because we're in an environment where every voice
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  matters and you can speak up and, and
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  and we know that we have each other's
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  best intention at heart, then safety actually got
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  better as well, which was wonderful to see.
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  Then, another initiative that we did, but this
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  was,
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  an entire health care system for the operating
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  room was use utilizing lean task, which is
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  an AI,
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  based,
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  program that helps us improve our operating room
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  use.
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  We are using 40% more of the time
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  that was opened before.
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  And, again, this imply also having
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  a lot of trust between team members. No?
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  Knowing that
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  nothing that you're gonna do that is new
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  is not going to is going to,
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  if you're doing something that is new, people
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  are gonna resist sometimes. People are gonna be
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  afraid of of something different, something new. But
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  the fact that we, again,
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  communicated this well,
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  understood that even though that ENT or trauma
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  or neurosurgery or ortho or general, We don't
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  work, in isolation,
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  but actually operating room use
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  effective operating
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  room use helps all the patients and as
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  the consequence,
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  all the teams. Right? When we work together,
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  with each other, the patient benefits, but we
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  also benefit from that, cohesive work.
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  That's amazing to hear. And you're really cool
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  that you have the opportunity to,
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  change the culture and get yourself into a
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  place where you have that efficiency as well
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  as great outcomes and,
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  patient experience as well and and having that
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  supportive partners and technology. I know LeanTos is
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  a great company. We work very closely with
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  us as well too and has been very
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  transformative in a variety of ways. And so,
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  in putting all of those things together,
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  I'm curious. Where do you see some of
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  the big,
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  priorities as well as headwinds for 2026?
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  What's top of mind for you?
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  That's an interesting an
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  interesting question. I think that we, will continue
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  to work and improve operating room utilization
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  and access for patients' urgent cases and and
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  otherwise,
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  elective cases.
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  I think that,
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  a couple of things that I didn't mention.
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  This was what we did,
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  last year with the OR, but also what
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  we did in trauma is now we have
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  a level one trauma center in Fairfax.
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  Then we were able to obtain a designation
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  for a level two trauma center in Loudoun.
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  So now we have a trauma system.
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  And,
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  again and again, literature has been showing that
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  trauma systems save lives. If you are traumatized,
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  you have a trauma of any kind, penetrator
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  or blunt,
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  and you end up in a place where
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  you have a trauma system, your chances of
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  surviving,
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  injuries that other people don't is, twenty percent
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  better if you're in a if you're in
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  a trauma system. So again, Inova again with
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  a great initiative and understanding and vision
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  of the mission of serving this population and
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  this community
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  and increasing survival, increasing collaboration.
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  So I think that all of those things
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  are in my mind when,
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  when we're talking about
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  what the future holds.
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  What I think when we focus in
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  keeping the patient in the center and focusing,
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  in basically,
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  having
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  strategies
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  that are value based
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  instead of
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  instead of just service based. Right? That's,
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  more than a reimbursement strategy. It's a it's
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  a moral stance.
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  Got it. And that's so helpful to understand.
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  I think especially,
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  thinking about that trauma system that, you know,
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  makes such a big difference for patients as
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  they're coming in and can truly get the
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  care that they deserve and have the best
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  chances of, surviving and continuing to have great
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  quality of life. I think, you know, when
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  you look at building systems of care like
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  that, that's a huge undertaking and, something that,
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  you know, takes a lot of energy and
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  resources,
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  on people's side as well as, you know,
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  doing the building and everything else. And so,
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  you know, when you're putting those types of
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  things together,
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  what do you do? Or, I guess, what's
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  the first steps,
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  to coming together, as an executive team and
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  really making it happen? I think, you know,
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  there's so many health systems right now that
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  are trying to
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  do great things for their patients, but might
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  feel like they've got a little bit of
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  a roadblock when they think about some of
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  the headwinds that you've mentioned today as well.
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  And so,
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  how do you just keep yourself focused and
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  and, coming together to create these types of,
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  outcomes?
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  Yeah. That's, thank you for that question. I
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  think that, the number one thing for me
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  is so when you have when you have
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  your your clarity, when you have clarity in
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  your mission, your purpose, your vision,
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  and have,
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  that mission, vision, and purpose communicated
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  as clear as you see it with the
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  team that is with you,
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  understanding that that again, as leaders, I see
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  I see this mistake in leadership not only
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  in surgery, but above and beyond.
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  As leaders, we are serving the team,
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  and there's not there's not somebody that is
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  better or somebody that is less than. We
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  are all together in in it for for
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  the same reason, which is making the patients
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  better, respecting everybody's opinion, and seeking feedback.
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  Not seeking feedback just to,
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  to check a box, but to seek feedback
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  with humility
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  because every environment is different. And so in
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  some environments, it could be the the issue
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  could be that different issues than other environments.
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  Right? So you need to listen,
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  exactly what the issue is at your at
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  locally at your health care system
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  and respecting
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  the voices that are bringing the concerns to
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  you by,
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  you know, not reacting, not retaliating,
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  but taking feedback as what it is, which
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  is golden.
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  Having respect for everybody in your team,
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  and I think
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  clear communication, which is interesting.
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  If you communicate too little, then people,
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  start, you know, filling the gaps with
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  what they feel or the biases that they
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  that they bring. But if you communicate too
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  much, people then get burned out from some
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  communication. So I think what we all are
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  trying to continue to try to figure out
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  is what's the right amount and right way
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  of communication so everybody,
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  understands
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  the the same, message and we share a
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  mental model.
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  That's helpful to know, and I appreciate it.
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  It sounds like you've got, really a strong
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  system of making sure you can achieve that
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  clarity, and then everyone moves forward in the
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  same direction.
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  I'm curious. What do you think the hardest
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  thing you'll have to do next year will
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  be?
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  I think that there are many things that
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  will be hard next week next year. I
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  think that,
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  I I there is there is not one
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  thing only. We all are dealing with,
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  the changes
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  that are happening
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  at the national stage and on the global
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  stage.
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  Those changes will have impact in our health
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  care health care systems in our communities.
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  And those ripple effects, we're gonna see some
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  of them this year and some of them
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  in the years to come.
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  And I think that
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  the the question is not what are gonna
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  be the hardest things to deal with.
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  There are gonna be many hard things to
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  deal with, not only one. Is how are
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  we gonna deal with those things
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  by,
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  again, having clear where your message is. Right?
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  Having clear,
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  what's
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  how you wanna approach it.
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  For example, I what I believe, Paulo Forada,
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  is understanding
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  instead
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  of doing,
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  fee for service, understanding value care better. Right?
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  So instead of asking how many procedures did
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  you do and you're so proud because of
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  the volume,
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  I start asking how did this matter for
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  patients.
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  When data becomes a tool to learning instead
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  of, like, either punishment or praise based on
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  just num on just, like, volume. Right? When
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  teams feel safe enough to surface delays, failures,
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  missed opportunities
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  because,
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  that's how we improve instead of, adding blame
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  or,
• 14:14
  shame to the process.
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  It requires some humility and alignment
• 14:20
  and, continues to be focused on that continues
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  for all of us to be focused on
• 14:24
  that.
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  But and also it requires for us to
• 14:28
  be willing to trade short term comfort
• 14:31
  for long term trust.
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  But I think if we all ask healthcare
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  systems in The United States to get this
• 14:37
  right, I think healthcare will become more human,
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  more sustainable, more honest,
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  and,
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  and again, it will become better for patients.
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  Now, can I predict what is the worst
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  case scenario? I can't.
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  But I know
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  being an immigrant and living in a place
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  like Colombia,
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  I know,
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  I know for a fact that the decisions
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  are taken at a larger scale in our
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  country and globally
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  will definitely affect health care,
• 15:08
  all of us. And so we just need
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  to be ready and have courage,
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  to the science path that are gonna continue
• 15:14
  to help our patients in need.
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  That's such a a sobering reminder and especially
• 15:21
  helpful to understand, you know, the gravity of
• 15:23
  the decisions being made across the board in
• 15:25
  the health care space and how,
• 15:27
  you know, you can put yourself into that
• 15:30
  transformation position.
• 15:32
  You know, I I especially appreciate when you're
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  talking about going from fee for service to
• 15:36
  more value based care and understanding
• 15:38
  how the clinicians are thinking about the outcomes
• 15:41
  they're achieving and the things that they're delivering
• 15:44
  to the patients,
• 15:45
  is truly amazing.
• 15:46
  Now
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  before we wrap up, I'm curious. Where do
• 15:49
  you see some of the best opportunities for
• 15:51
  organizational growth?
• 15:53
  I think that,
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  that's a great question.
• 15:57
  Are you asking me globally for the country
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  or in I know that? Because I think
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  what I see that is happening in The
• 16:03
  United States, we cannot
• 16:05
  we cannot deny it. It merges. Right? There's,
• 16:09
  tons of mergers and, some of them might
• 16:11
  be successful and some of them are not
• 16:13
  gonna be successful. We will see. But I
• 16:16
  think when, again,
• 16:18
  when merges are for the right reasons,
• 16:21
  with clear purpose, keeping the patient in the
• 16:23
  center,
• 16:24
  with a lot of respect for what, everybody
• 16:27
  does in the institutions where our mergers, then
• 16:29
  instead of a hostile takeover that becomes a,
• 16:34
  like a superpower, a great strength. Right? Or,
• 16:38
  it could be something completely different. But it
• 16:40
  has to come from the leadership. The respect,
• 16:43
  the understanding,
• 16:45
  the,
• 16:45
  the,
• 16:47
  ability to come together,
• 16:49
  and, again, be respectful also to the clinicians.
• 16:52
  Right?
• 16:53
  I'm super lucky
• 16:55
  that at iNova we have a leadership structure
• 16:58
  where it's not only
• 16:59
  an administration
• 17:01
  separate from a clinician.
• 17:03
  We have a, leadership structure that relies on
• 17:06
  triads or diets. So so you have you
• 17:10
  have less chances of having those
• 17:12
  those,
• 17:14
  you know, blind spots
• 17:16
  because you have people that come from different
• 17:18
  perspectives, bringing different things to the table. And
• 17:21
  I think that that's that's the piece that
• 17:23
  is very important. So every every voice really
• 17:26
  truly matters, not because you wanna have a
• 17:29
  token of representation of nursing or or administration
• 17:33
  or clinicians of any kind. It's because every
• 17:35
  voice matters. And I think that with time,
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  it's gonna become more,
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  critical. I think places are run just by
• 17:42
  administrators
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  without
• 17:44
  being in touch with the healers, the clinicians
• 17:46
  are at the bedside that actually understand what
• 17:49
  they need to do in order to continue
• 17:52
  this
• 17:53
  to serve patients well and continue by default
• 17:56
  keeping the the the
• 17:58
  a good margin and the healthcare systems afloat.
• 18:02
  I think if there's a disconnect
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  with with that with clinical,
• 18:06
  force versus administrative
• 18:08
  force, then we're basically going in different directions.
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  I think that,
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  I think that that we,
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  even if we speak different languages, I think
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  that that where where the secret sauce is
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  is when we can communicate well with each
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  other, share a mental,
• 18:26
  a mental model, and,
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  keep, keep always
• 18:30
  our north. What is our purpose to make
• 18:32
  patients better?
• 18:36
  I love that. Doctor Farada, thank you so
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  much for joining us on the podcast today.
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  This has been such a fun conversation, and
• 18:41
  I look forward to, connecting with you soon
• 18:44
  and and seeing you at our April annual
• 18:46
  meeting. I know we'll be speaking on a
• 18:48
  panel and certainly will be great to continue
• 18:50
  this discussion and and keep,
• 18:52
  connecting and sharing with the rest of our
• 18:54
  audience. So thank you so much.
• 18:56
  Thank you.