Latest / Becker’s Healthcare - Clinical Leadership Podcast / Reducing Friction and Aligning Physicians Around Better Care with Dr. Peggy Duggan

Transcript

Reducing Friction and Aligning Physicians Around Better Care with Dr. Peggy Duggan · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  - The strategic agenda facing hospital and health system
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  - Hello. This is Franchesca Matthews with the Becker's
• 1:00
  - Clinical Leadership Podcast.
• 1:02
  - I'm thrilled to be joined today by doctor
• 1:04
  - Peggy Duggan, executive vice president, chief physician executive,
• 1:07
  - and chief medical officer of Tampa General Hospital.
• 1:10
  - Doctor Duggan, thank you so much for being
• 1:12
  - here today. Oh, thank you for having me.
• 1:15
  - Yeah. Excellent. We're excited. We can jump in
• 1:17
  - with, sort of broad topic that's,
• 1:20
  - you know, big in health care right now
• 1:21
  - and has been for some time,
• 1:23
  - physician burnout.
• 1:24
  - Where, from your perspective, does physician burnout stand,
• 1:27
  - and what's actually changed to move the needle
• 1:30
  - over the next last few years?
• 1:32
  - Yeah. I think physician burnout is is really,
• 1:36
  - I wanna say it's stable.
• 1:39
  - It's not getting that much better, but I
• 1:41
  - don't I think it's actually,
• 1:43
  - not getting worse either.
• 1:45
  - My philosophically,
• 1:46
  - I I believe,
• 1:48
  - you know, a lot of burnout comes from
• 1:50
  - difficulty
• 1:50
  - in in getting the work done and not
• 1:53
  - the work. Right? So physicians love taking care
• 1:56
  - of patients, and there are a lot of
• 1:57
  - barriers to making that easy.
• 1:59
  - And so,
• 2:02
  - when people think about the joy in medicine,
• 2:04
  - I always think if we can take up
• 2:06
  - the friction out and make it easy for
• 2:08
  - providers, physicians, advanced practice providers
• 2:11
  - to really
• 2:13
  - be with their patients, have time with their
• 2:15
  - patients,
• 2:16
  - and,
• 2:17
  - not feel rushed and hurried,
• 2:19
  - or doing their work at night when they're
• 2:21
  - home with their families. Those are the big
• 2:23
  - ones I think we've been really working on
• 2:25
  - here at TTIP General
• 2:26
  - to provide,
• 2:28
  - a better environment for our docs to be
• 2:30
  - delivering care.
• 2:32
  - Mhmm. Mhmm. Absolutely. That that speaks to what
• 2:35
  - I've been hearing a lot recently in my
• 2:36
  - reporting for physician leadership that it's not even
• 2:39
  - so much a burnout problem as it is
• 2:40
  - one of moral injury and be struggling to
• 2:42
  - be able to do the everyday task. So
• 2:44
  - it sounds like you're really targeting that at,
• 2:45
  - like, a systemic level.
• 2:47
  - Yeah. We sure are. A couple of things,
• 2:49
  - right, using MB and AI, which I think
• 2:51
  - is pretty common across the industry now, but
• 2:54
  - really driving that, not just with our physicians,
• 2:56
  - but with our nursing team as well.
• 2:59
  - Try to take
• 3:00
  - the computer
• 3:01
  - away from being the, you know, the barrier
• 3:03
  - between me and my patient. You know, I
• 3:05
  - I trained and took care of patients
• 3:08
  - thirty years ago, and so you never had
• 3:09
  - a computer between you and a patient, and
• 3:11
  - you were never typing. You were writing, but
• 3:13
  - not typing. And so that sense of disconnection
• 3:16
  - that the documentation has created
• 3:19
  - really has been improved with the ambient listening.
• 3:22
  - Even if you have to go back and
• 3:23
  - work on the note,
• 3:24
  - the environment, the moment with the patient is
• 3:26
  - quite different, and so our providers are really
• 3:29
  - reacting very strongly to that. The docs
• 3:31
  - love it and,
• 3:32
  - feel like it gives them the time they
• 3:34
  - need to be with their their patients directly.
• 3:37
  - Mhmm. Absolutely.
• 3:39
  - Something else that we discuss a lot, with
• 3:41
  - the clinical leadership podcast is compensation models and
• 3:44
  - how they're changing and evolving.
• 3:46
  - How have you changed the physician compensation model
• 3:49
  - if at all, and how has that landed?
• 3:51
  - Yeah. So we have a,
• 3:53
  - the primarily, our physicians at Tampa General Hospital,
• 3:56
  - our academic group is, they're docs at University
• 3:59
  - of South Florida. That's our academic partner.
• 4:02
  - So,
• 4:04
  - what we do is, like most academic medical
• 4:06
  - centers, have a flood funds flow
• 4:09
  - over to the University of South Florida so
• 4:11
  - that we can have,
• 4:13
  - adequate
• 4:14
  - reimbursement
• 4:15
  - and and payments for our positions.
• 4:17
  - One thing we've done is redesigned that in
• 4:19
  - the past year so that we have standards
• 4:21
  - around kinda where they fall in compensation,
• 4:24
  - models
• 4:25
  - and also what we're
• 4:27
  - valuing. So,
• 4:29
  - obviously, productivity
• 4:31
  - is an important part. I always tell our
• 4:33
  - physicians,
• 4:35
  - we get paid that way.
• 4:37
  - So that's how we can pay you. Right?
• 4:38
  - So we can't ignore,
• 4:40
  - the way the industry works in payment models.
• 4:43
  - But also, we've done a lot of work
• 4:45
  - around decreasing
• 4:47
  - the,
• 4:49
  - like, buying time down for people who are
• 4:51
  - doing administrative tasks. So they don't have the
• 4:54
  - same burden,
• 4:56
  - around their,
• 4:57
  - patient load if they're doing administrative tasks. Like,
• 5:00
  - for me, for instance, I have a physician
• 5:03
  - who it leads our sepsis program, and it's
• 5:05
  - quite a big endeavor.
• 5:07
  - And I I pay for about 40% of
• 5:09
  - his overhead and time in order for him
• 5:11
  - to really focus on our our sepsis work.
• 5:14
  - And that's driven a great, you know, driver
• 5:16
  - of improvement
• 5:18
  - for our patients where we have a, you
• 5:19
  - know, really wonderful results in our sepsis patients
• 5:22
  - and their outcomes.
• 5:24
  - But also,
• 5:25
  - that provider, that doc, he really loves the
• 5:28
  - work, and he can focus on his patients
• 5:30
  - when he's
• 5:32
  - on service. He's a hospital medicine doctor. So,
• 5:35
  - creating environments like that as well, where we
• 5:38
  - do need our physicians engaged in administrative work
• 5:41
  - or how we are driving the operation,
• 5:44
  - I wanna give them the time to do
• 5:45
  - it well. So that's one of the things
• 5:47
  - we've done here at Tampa General is really
• 5:49
  - valuing
• 5:50
  - that time that physicians are giving to us
• 5:52
  - and to our patients to drive improvements.
• 5:55
  - We really need to make that space for
• 5:57
  - them.
• 5:58
  - Mhmm. Mhmm. Absolutely.
• 6:00
  - Digging a little more into the economics around
• 6:03
  - physician employment, we we talk a lot as
• 6:05
  - as well about employed versus independent practice and
• 6:08
  - those dynamics. Yeah. I'm curious how employed and
• 6:10
  - independent dynamics are playing out in your market,
• 6:12
  - and in your community, what you're
• 6:13
  - seeing there. Yeah.
• 6:15
  - So we really have,
• 6:17
  - an interesting model here at Tampa General. You
• 6:19
  - know, prior to being at Tampa General, I
• 6:21
  - was at the Brigham Women's Hospital, and that
• 6:24
  - really is a fully employed model.
• 6:26
  - Coming here, we have a a a small
• 6:29
  - employed group of docs at Tampa General.
• 6:32
  - Then we have the University of South Florida
• 6:34
  - docs.
• 6:35
  - They've come together in a clinically integrated network.
• 6:37
  - So that's really created an environment where we're
• 6:39
  - providing consistent care across all of our, what
• 6:42
  - I'll call our employee docs, even though they're
• 6:44
  - not employed by the hospital.
• 6:46
  - And then we have a number of larger
• 6:48
  - contract groups that provide some of our services
• 6:51
  - and an open medical staff, so we have
• 6:52
  - private practice as well. We have a very
• 6:54
  - mixed model here,
• 6:56
  - and I've learned a lot in my time,
• 6:58
  - especially coming from a fully employed model,
• 7:00
  - of the value of all of those options.
• 7:03
  - It creates some real,
• 7:05
  - synergies I've seen and,
• 7:07
  - you know, the contract groups are have different
• 7:10
  - they work for a different company, but we
• 7:12
  - align our goals together. So with
• 7:14
  - our physicians who are employed, our physicians who
• 7:17
  - are, under contract, or physicians who are really
• 7:20
  - private practice, we still align our values around
• 7:23
  - the patient care. And I've seen that
• 7:25
  - a lot of people talk about comp driving
• 7:27
  - behavior, and it does. There's no question about
• 7:29
  - it. But the other thing I've seen, and
• 7:32
  - I think it's not,
• 7:34
  - considered enough is we really don't need to
• 7:36
  - pay physicians to wanna have good outcomes.
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  - So we show their data transparently
• 7:41
  - regardless of their employment
• 7:42
  - model. They really wanna work on improvement, and
• 7:44
  - that's how we
• 7:46
  - really, get everyone aligned and on the same
• 7:49
  - page here at Tampa General. The other thing
• 7:51
  - we're blessed with here,
• 7:53
  - is our medical staff. And so all of
• 7:55
  - those people, right, are on our medical staff,
• 7:58
  - but the medical staff leadership
• 8:00
  - really
• 8:01
  - supports the work of, the physicians
• 8:04
  - and our advanced practice providers, but also creates
• 8:06
  - standards.
• 8:07
  - So they're our partner, which is unusual, I
• 8:10
  - think, to have a medical staff that's that
• 8:12
  - engaged in partnering with the administration of the
• 8:14
  - hospital. It's how it's meant to be, frankly,
• 8:16
  - but it's not often that it's, fully independent
• 8:20
  - but aligned. We're really fortunate here to have
• 8:22
  - those relationships.
• 8:24
  - Yeah. And just to follow-up there, you you
• 8:25
  - mentioned a few few things about the alignment
• 8:28
  - and the synchrosities that you have within your
• 8:30
  - system, especially across these different,
• 8:32
  - employment models and levels of independence. And I'm
• 8:35
  - curious, what is the most important thing in
• 8:37
  - keeping all these teams aligned and making sure
• 8:39
  - that everybody's working towards the same goals? And
• 8:41
  - that's, you know, kind of a a big
• 8:42
  - task when you think about it. But task,
• 8:44
  - and we've gone after it, over outcomes, patient
• 8:47
  - outcomes because that's what everybody cares about. And
• 8:50
  - my example I used a little earlier of
• 8:52
  - our sepsis work was a really cornerstone
• 8:55
  - of bringing that everyone together because, you know,
• 8:58
  - we know,
• 8:59
  - you know, how to treat sepsis. We know
• 9:01
  - early intervention matters,
• 9:03
  - and we have a great system here, AI
• 9:06
  - driven system that allows us to screen all
• 9:08
  - of our patients continuously in the hospital,
• 9:11
  - and that allows us to identify patients who
• 9:13
  - are at risk of sepsis and intervene early.
• 9:16
  - Well, it doesn't matter if you do that
• 9:17
  - if you don't provide the right care.
• 9:20
  - And so sepsis care is well known, and
• 9:22
  - that was one of the first things when
• 9:24
  - I got here five and a half years
• 9:26
  - ago that we really went after because it's
• 9:28
  - mortality, like, it it's tied to survival.
• 9:31
  - Very easy to get physicians behind saving lives.
• 9:34
  - They just need the help, and and so
• 9:36
  - that's been a that was a really good
• 9:38
  - first step for us. And now working through
• 9:41
  - patient experience and driving improvements there and other
• 9:44
  - kind of more focused based on service line
• 9:47
  - improvements, readmission, and other things. But sepsis was
• 9:50
  - our big first step.
• 9:51
  - And because physicians hard to argue about life
• 9:54
  - saving treatment. Right? And so the the docs
• 9:57
  - got behind it pretty readily, and we were
• 9:58
  - able to partner,
• 10:00
  - and it's driven other alignment that we've been
• 10:02
  - able to leverage.
• 10:04
  - Yeah. Absolutely.
• 10:06
  - Shifting to you a little bit specifically,
• 10:08
  - as
• 10:09
  - chief medical officer, you're in a position and
• 10:12
  - you've worked among the ranks of positions, but
• 10:14
  - now you're in a leadership role.
• 10:15
  - What's the hardest part of going from peer
• 10:17
  - to boss?
• 10:19
  - So I think and I've been to see
• 10:20
  - them all a long time now because I
• 10:21
  - was a chief medical officer back on my
• 10:23
  - own system. But the first
• 10:25
  - challenge, I think, for any physician entering leadership
• 10:29
  - is you really get
• 10:31
  - you you gravitate to what you're comfortable with.
• 10:33
  - And what I'll say is when I first
• 10:35
  - became a chief medical officer,
• 10:37
  - I was more focused on surgical
• 10:39
  - issues than anything else because I'm a surgeon,
• 10:42
  - and we had achieved surgery.
• 10:44
  - So I was immediately stepping on his toes.
• 10:47
  - He was a good friend, thankfully, and was
• 10:49
  - able to give me good advice. But I
• 10:51
  - think the chief medical officer,
• 10:53
  - to be successful,
• 10:55
  - there's two parts, I think. One is you
• 10:57
  - really have to have a clear vision of
• 10:59
  - what your purpose is. And so for me,
• 11:02
  - that's very easy,
• 11:03
  - you know, because I'm there's just a few
• 11:05
  - things that I really focus on. One is
• 11:08
  - we wanna get the best patient care possible
• 11:10
  - in in our facilities. Right? And so that's
• 11:12
  - easy. And the other one is I wanna
• 11:14
  - make it easy for the people delivering the
• 11:16
  - care. And so those are my two big
• 11:18
  - dots I always tell people that I focus
• 11:20
  - on every day.
• 11:21
  - And if you do that, if you create
• 11:23
  - an environment where people know
• 11:26
  - why you come to work every day,
• 11:28
  - that really helps move from kind of being
• 11:30
  - in the ranks and being a leader amongst
• 11:33
  - those in the ranks because people know my
• 11:35
  - why.
• 11:36
  - It's never about me. It's always about the
• 11:38
  - patients or them. And that that really helps,
• 11:41
  - but that takes time. So for anyone any
• 11:43
  - physician entering leadership,
• 11:45
  - it's a very long journey, I would say,
• 11:47
  - especially because
• 11:49
  - unlike other
• 11:50
  - fields, physicians leap into leadership frequently instead of
• 11:54
  - taking a road to leadership. Right? So sometimes
• 11:57
  - the first
• 11:58
  - title a leader will have is they'll be
• 12:00
  - a medical director for a bit and then
• 12:01
  - a vice president.
• 12:02
  - You know, like, it could be a big
• 12:04
  - leap. And so it takes time and and,
• 12:07
  - you know,
• 12:08
  - humility and openness to
• 12:11
  - feedback and accepting that you're gonna make some
• 12:13
  - errors is a really important,
• 12:16
  - part of that journey.
• 12:18
  - Mhmm. Mhmm. Absolutely.
• 12:20
  - And in that leap to the c suite,
• 12:23
  - we can say,
• 12:24
  - what what do c suite leaders often get
• 12:26
  - wrong about positions, and what do positions often
• 12:29
  - misunderstand or get wrong about leadership?
• 12:32
  - So we all have the same goal, and
• 12:33
  - I don't think we always
• 12:35
  - envision that. When I say that, you know,
• 12:38
  - again,
• 12:39
  - frequently,
• 12:40
  - and this is true in every institution I've
• 12:42
  - ever worked at, people administration,
• 12:45
  - particularly non physicians, do not understand the workflow
• 12:48
  - of a physician. They don't understand they have
• 12:50
  - clinic and hospital duties. They don't understand they're
• 12:52
  - in operating room and doing something else. And
• 12:55
  - so when the physician is out of sight,
• 12:58
  - there's a sense of not, you know, like,
• 13:00
  - that they're not engaged or they're not working.
• 13:02
  - People don't see the whole view. So it's
• 13:04
  - really important to understand the physician's
• 13:06
  - workflow,
• 13:08
  - what their week is made up of, and
• 13:09
  - how many,
• 13:10
  - and I remember this long ago in my
• 13:12
  - other institution.
• 13:14
  - When we went live with Epic, there was
• 13:16
  - a really big challenging area, and our chief
• 13:18
  - nurse just could not understand why the physicians
• 13:20
  - couldn't solve the problem.
• 13:22
  - Or because it didn't work in their workflow.
• 13:24
  - We had built it wrong, and and there's
• 13:26
  - no way it's gonna work if we don't
• 13:28
  - build it within their workflow. And so that
• 13:30
  - was a big lesson in, you know, really
• 13:32
  - for me too as a leader and how
• 13:34
  - did I support those physicians getting what they
• 13:36
  - needed in the solutioning
• 13:38
  - because it had been built without their input.
• 13:40
  - From a physician side, you know, what physicians
• 13:43
  - get wrong about administration
• 13:45
  - is that we don't care the administration doesn't
• 13:48
  - focus on the patients. It doesn't care they
• 13:50
  - care about the business. And that's not true.
• 13:52
  - Right?
• 13:53
  - Everyone is here to take care of patients.
• 13:56
  - The burden administration
• 13:57
  - carries is to be able to do it
• 13:59
  - all and fund it all, and so we
• 14:01
  - have to be able to
• 14:03
  - make the margin we need to make the
• 14:05
  - investments we want. Being at a not for
• 14:08
  - profit, it's a little easier
• 14:10
  - to speak that message, especially at a safety
• 14:13
  - net hospital. You know, for us to continue
• 14:15
  - to care for our patients
• 14:17
  - who have no insurance and, you know, really
• 14:20
  - don't have many options,
• 14:22
  - we need to be able to have some
• 14:24
  - areas of the organization
• 14:25
  - that are actually profitable so that we can
• 14:27
  - continue that work.
• 14:29
  - I'm not sure physicians tie those two together.
• 14:32
  - Like, they forget that's why we're going after
• 14:34
  - what we're going after because we're always gonna
• 14:36
  - take care of those patients who need us.
• 14:38
  - But in order to do that, we need
• 14:40
  - to have some profitability to reinvest.
• 14:44
  - Absolutely. Absolutely. Very resonant with with conversations I've
• 14:47
  - been having on the physician leadership side. Is
• 14:49
  - there anything else I didn't ask about that
• 14:51
  - you would like to add here?
• 14:53
  - I mean, for me, I think the biggest
• 14:56
  - takeaway
• 14:56
  - I would like everyone to
• 14:58
  - have is we are really all aligned around
• 15:01
  - the same goal, which is taking care of
• 15:04
  - patients, taking care of our fellow humans.
• 15:06
  - Right? And if we can step back every
• 15:08
  - once in a while and remember,
• 15:10
  - that's our big lie and it's true of
• 15:12
  - everyone in the building.
• 15:14
  - That will help us when things are difficult.
• 15:17
  - It helps bring us together. It helps us
• 15:19
  - solve problems together
• 15:22
  - and to respect each other's position and and
• 15:24
  - really value
• 15:26
  - to that journey to get to excellent patient
• 15:29
  - care, to get to incredible patient experience.
• 15:32
  - And so
• 15:33
  - it's it's a everyone should take a moment
• 15:35
  - every once in a while and remember that.
• 15:36
  - I just sat down unrelated
• 15:38
  - with my son this weekend about some of
• 15:40
  - his achievements. Right? I just said, don't don't
• 15:43
  - let the moment pass. Remember, this was great
• 15:45
  - work you've done. And we need to do
• 15:47
  - that ourselves as well because it's easy to
• 15:50
  - get caught up in the negative, especially now
• 15:52
  - where funding has changed. There's a lot of
• 15:54
  - headwinds.
• 15:55
  - We're still doing amazing work, and we shouldn't
• 15:58
  - forget that, and we should really tie it
• 16:00
  - to that every day.
• 16:02
  - Absolutely.
• 16:03
  - That's a nice place to end there. That's
• 16:05
  - all for I have for you today, doctor
• 16:07
  - Duggan. Thank you so much for joining us.
• 16:09
  - It has been a pleasure speaking with you,
• 16:10
  - and I look forward to connecting with you
• 16:12
  - again in the future. Thank you so much.
• 16:14
  - It was my pleasure.