Latest / Becker’s Healthcare - Clinical Leadership Podcast / David Marcozzi, MD, MHS-CL, Senior Vice President and Chief Clinical Officer at University of Maryland Medical Center

Transcript

David Marcozzi, MD, MHS-CL, Senior Vice President and Chief Clinical Officer at University of Maryland Medical Center · Becker’s Healthcare - Clinical Leadership Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - Hi. Welcome to the Becker's Healthcare podcast. My
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  - name is Paige Twenter, and I'm an editor
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  - with Becker's.
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  - I'm so excited to be joined today by
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  - doctor David Marcozzi.
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  - Doctor Marcozzi is at the University of Maryland
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  - Medical System, and
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  - I would love for you to just introduce
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  - yourself briefly,
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  - for the audience. That sounds great.
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  - Yeah. Thanks, Paige. Yeah. My name is Dave
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  - Marcozzi. I'm an emergency physician, still practice,
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  - but I am the chief clinical officer of
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  - the University of Maryland Medical Center, which is
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  - a two campus
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  - health care,
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  - system,
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  - inside the University of Maryland Medical System.
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  - And I'm also the associate dean,
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  - for our school of medicine.
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  - And on the quality
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  - side, this is a question I know a
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  - lot of other chief clinical officers,
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  - are faced with answering every single day just
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  - in their daily tasks. What does it take
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  - to expand
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  - quality and patient safety
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  - directives
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  - as a kind of organizational
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  - or operational responsibility, not just for a single
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  - quality department?
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  - Yeah. Paige, I think you you're asked to
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  - steer kicking us off with the right question.
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  - And I think number one, our chief medical
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  - office, our chief clinical officers grapple with this
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  - question.
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  - Our medical center, healthcare grapples with it. But
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  - truthfully,
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  - if we're whether or not we're in healthcare
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  - or whether or not we're in we're making
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  - cars in Ford,
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  - or planes for,
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  - for Boeing,
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  - I think we've all started to realize that
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  - quality cannot be a separate standalone entity
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  - inside an organization.
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  - Quality has to be woven within
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  - how we conduct business. We whatever entity we
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  - are involved in, we have to actually make
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  - it fundamental to the work we need to
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  - do just as much as a profit loss
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  - statement is in front of us, just as
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  - much as we look at data and infrastructure.
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  - And that, to me, it has has tenants
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  - in a few things. When I say the
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  - word woven,
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  - there's a culture that just is accepting of
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  - it. It is not a stand alone. It
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  - is woven and integrated within every concept of
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  - decision making,
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  - and,
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  - and how we make,
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  - how we make an appropriate,
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  - prioritization.
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  - Number two, it's around behavior. Once you have
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  - culture
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  - adopted, it's one of the behaviors that we
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  - make work easier to do the right thing
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  - and accomplish the quality of safety goals we
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  - all want to achieve,
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  - in health care. And then number three, how
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  - do we assure that we have the data
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  - that measures what we need to do in
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  - the right way,
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  - down from a very granular level inside units
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  - to physicians
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  - and up to the boardroom?
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  - And we at the medical center, we within
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  - our system are are working to achieve all
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  - of those tenants, but I'll I'll end with
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  - this as the last pillar of what I'm
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  - speaking to. It
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  - never
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  - ends.
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  - The road around quality and safety, the road
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  - around high reliability
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  - continually needs attention,
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  - continually needs messaging, and continually needs champions to
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  - make sure we never back away of that
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  - as a priority for all of us.
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  - It's
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  - culture,
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  - behavior,
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  - and then data to back it up.
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  - Yeah.
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  - With the, like, daily task of this, do
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  - you ever just feel fatigued
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  - at constantly
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  - striving?
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  - I don't.
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  - The reason why is I'm always anchored in
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  - the care that my mother received inside health
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  - care, and you kinda go back to your
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  - own we all go back to our own
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  - stories.
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  - But it's truthfully,
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  - it's simply just about the patient that we
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  - deliver care to.
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  - And,
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  - if you anchor our yourself there and they
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  - come to work and, you know, whether or
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  - not we are exceedingly doing very well in
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  - a in a quality measure or we have
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  - work to do to improve a quality measure.
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  - At the center of that is some person's
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  - mother, father, sister, brother,
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  - that has experienced that either great quality or
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  - quality that needs improvement.
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  - And,
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  - that is what energizes me to get out
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  - of work,
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  - and, and, get in here and start to
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  - make a difference. And I use the word
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  - to my team, let's get after it. So
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  - how do we get after it to to
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  - shore up where we don't have the best
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  - practices
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  - and make sure that we don't back away
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  - from anything we're achieving and doing well on.
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  - But I
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  - to date and and what are we on?
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  - The 09/09/2026,
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  - it still energizes me to come to work
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  - to try and make a difference.
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  - On the point of making
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  - a difference and, an aspect of quality is
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  - just care coordination,
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  - like, strong throughput.
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  - At MMC,
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  - when it comes to, like, access redesign,
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  - patient flow,
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  - capacity constraints that, you know, other health systems
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  - and hospitals are doing,
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  - what is your system
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  - doing to make sure that care is available
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  - for patients who need it most?
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  - So so I don't know any hospital across
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  - our nation who's just sitting around with pay
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  - nurses and docs just twiddling their thumbs waiting
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  - for patient care. There is an unbelievable demand
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  - to the health care delivery system and how
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  - we support patients in the outpatient sector, the
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  - inpatient sector to get care, support health, not
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  - just get care, support health, which means social
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  - determinants, etcetera. So there's a lot of work
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  - we as healthcare needs to embrace. There's a
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  - lot of work that needs to be done
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  - outside of healthcare that we all need to
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  - embrace,
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  - but that's work that we we need to
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  - think through. From an academic medical center lens,
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  - capacity is a strategic resource.
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  - And what we have started to ask ourselves
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  - is,
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  - how do we think about delivering
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  - high quality exceptional academic tertiary and ternary care
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  - without potentially requiring that care to be delivered
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  - through an inpatient bed?
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  - And, we just published some work
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  - in a journal of,
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  - venous and lymphatic disorders
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  - around an example. I'm going to give an
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  - example page.
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  - So we have a patient at the hospital
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  - x,
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  - that is dying in front of the emergency
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  - physician from a pulmonary embolism
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  - and their blood pressure is very low,
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  - and they're calling that for physicians calling. I
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  - know I need help. Can you help me
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  - get there? And there are no at the
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  - academic medical centers that could potentially help this
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  - person. There are no beds available.
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  - So what we put in place,
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  - and we're really proud of this work is
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  - we now bring a patient from an emergency
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  - department with no beds in our facility available
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  - because of the complexity
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  - and the capacity of what we have. Bring
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  - them into our suite,
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  - able to do a clot extraction right there,
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  - stabilize them, observe them for a period of
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  - time and repatriate them back to their sending
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  - facility to do the the work that needs
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  - to get done around their hypercalag
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  - hypercoagulable
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  - condition that resulted in their pulmonary embolism. So
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  - their physiology normalizes.
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  - We then send them back and it allows
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  - the preservation
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  - of care for those who need inpatient care,
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  - vice, who could be done as round trips
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  - or or, some of these higher level interventions,
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  - but they can be repatriated back to their
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  - sending facility. And we're doing that across multiple
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  - different procedural
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  - opportunities
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  - that require tertiary high level care that might
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  - not need an inpatient bed inside our hospital
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  - for the care to be delivered in a
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  - longitudinal fashion. So that's one area of opportunity
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  - that that we are really capitalizing on inside
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  - Maryland,
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  - inside Maryland system, to think about how we
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  - reserve the ability to care for people, but
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  - still provide access to patients who need that
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  - advanced level care.
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  - What does it take to set up a
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  - suite like that? Like, what what's the first
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  - step you would recommend?
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  - Yeah. So so the first thing is to
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  - start to try and figure out what patients
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  - do we do does physiology normalize after a
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  - procedure
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  - that we then because of a advanced level
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  - procedure that we could then usually, historically, we
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  - would admit to our facility for a day
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  - or two to watch and work up for
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  - the additional issues.
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  - Okay. So let's start to think about that
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  - and our physicians
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  - and our perioperative services really started to try
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  - and have a brainstorming session.
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  - And TAVRs is another one. How we think
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  - through the ability to repair,
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  - valves to assure that we can do that
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  - safely. Number one, can we do it safely?
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  - Number two, what are the mechanisms
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  - pre procedurally we need to put in place
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  - to allow that patient to come in safely,
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  - get the procedure,
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  - be be observed,
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  - and then a key portion of it as
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  - we send back a pulmonary embolism, as we
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  - send back a TAVR to, the sending facility,
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  - we need to make sure we educate that
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  - facility on how to care for that person
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  - pro post procedurally. Hey. Here's what we would
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  - think about with regard to the continuum of
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  - care or the care you need to continue
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  - to provide once we've done the procedure. So
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  - it's not just thinking about access to care
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  - inside a suite
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  - that gets the cloud extracted is the continuity
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  - of care with the sending facility
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  - into our facility then back.
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  - It's the quality level handoff.
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  - It is patient you're exactly right. It's patient
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  - handoff. It's let's oh, all of a sudden
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  - we have a safety event. Oh, we we
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  - didn't the team that we'd sent that that
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  - sent us wasn't aware of how to care
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  - for that. Okay. That's an educational opportunity. How
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  - do we make sure that we, from a
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  - nursing physician standpoint,
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  - make sure that that care team knows how
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  - to care for that patient?
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  - And maybe the night team didn't know what
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  - the day team did know. These are all,
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  - you know, we've learned how to do this
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  - better and we continue to think about how
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  - to continue to to broaden out that aperture
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  - to make sure we're delivering safe care, but
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  - also providing access to the high level care
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  - that we can provide.
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  - We have time for one more question. So,
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  - I know I we talked about four questions,
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  - but
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  - I'll just kinda leave it more general if
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  - that's okay. What's
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  - one thing that we haven't talked about yet
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  - that you think would be remiss if we
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  - didn't include in our conversation today?
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  - Well, I'll give you some experience that I've
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  - had in the job that I presently have
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  - and some previous experience. So, you know, I
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  - was a I was a colonel in the
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  - in the army.
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  - I worked in government for a while.
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  - It's almost like chapters of a life. I
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  - was, I was an ER doc.
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  - Now I have this position and always learn
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  - from different experiences and I recognized when I
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  - had those different experiences
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  - how to number one be humble, how to
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  - form the right team and trust the team
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  - and drive and be focused on the right
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  - mission. And if you're focused on the mission
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  - and set the goals for the right team,
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  - then then really everything you can accomplish everything.
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  - And we saw it in the pandemic. You
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  - know, I led the systems response during the
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  - pandemic.
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  - Form the right team,
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  - Set the goals and then what is the
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  - mission do we need to accomplish.
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  - Have extreme ownership of problems. Everyone owned the
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  - problem. It wasn't just quality. It wasn't just
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  - safety. We all said, let me figure out
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  - how I can help solve this problem. And
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  - if you have the right team, set the
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  - right mission in place to do it, then
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  - really, I think health care has a significant
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  - opportunity in next upcoming, you know, couple years.
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  - Certainly with AI and adoption, but to put
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  - the right team in place, to me, we're
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  - in an inflection point in health care and
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  - I look forward to the next the next
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  - few, for a few years to, to be
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  - part of it.
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  - Yeah. Great. Well, thank you so much, doctor
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  - Marcozzi, for joining us today. I very much
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  - value, you know, you sharing your time and
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  - expertise with us. Paige, you're great. Thanks very
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  - much.