Dr. Daniel Feinberg, Chief Medical Officer of Pennsylvania Hospital, joins the podcast to discuss his background, his focus on employee engagement & patient safety, what effective healthcare leader needs to be successful in the next 2-3 years, and more.
Note: This is an AI generated transcript, not edited by a staff writer and is solely intended for educational purposes.
This is Laura Duda with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Dr. Daniel Feinberg, chief Medical Officer of Pennsylvania Hospital, Dr. Feinberg, it's a pleasure to have you on the podcast today. Thank you. It's a pleasure to be here. Thank you. Now, I know we have a lot to talk about. There's so much happening in healthcare and a lot of exciting things too. But before we dive into my questions, can you tell us a little bit more about yourself and your background? Sure. Uh, so my clinical background is that I'm a clinical neurologist that specialize in neuromuscular diseases. And, uh, when I started working at Penn Medicine, uh, I practice at one of the three Philadelphia Penn Medicine hospitals. Um, I was really thinking about leadership and academic medicine, and then I, uh, transitioned really to learning more and spending more time, uh, with quality improvement activities. Uh, really many of them, uh, geared towards the development of the emr. Uh, and I ended up being very involved with the Epic, uh, work at Penn Medicine, uh, and was the patient safety officer for over a decade before I became Chief Medical Officer in 2010. Uh, so my, I would say my background is really in informatics, patient safety, and then, uh, really quality improvement in regulatory functions have followed, and, and now I, I really think about myself as a connector. I work very closely and oversee case management and social work. I oversee our advanced practice, uh, providers, uh, and really think, spend a lot of my time thinking about the continuum of care and how we function, uh, most effectively in a environment of paper performance and, uh, managing episodes of care. Well, that's a fascinating career journey. It seems like you were just able to continue to build upon your experiences and interests outside of, you know, practicing medicine as you were taking on new roles and responsibilities within the health system. And I'm interested, especially when you think about mentioning, um, kind of facilitating how the healthcare transformation is going through, uh, value-based care and some of the other things that you're overseeing, you know, what have you learned, um, coming into this position on the administrative side and leadership, um, you know, that has really helped you be effective to connect the teams and make sure that everybody's moving in the right direction to where healthcare is headed? I, I think that, uh, one of the things I've, I've learned, uh, to do is just really be a good listener and understand what stakeholders, uh, are, uh, challenged by at the times, whether it's providers, whether it's our nursing staff, whether it's the outpatient, uh, access that we have, uh, challenges with, uh, and really trying to connect the dots with all these moving parts that ultimately, uh, produce high value, uh, care for our consumers and our, uh, community. Um, the, the East coast of the United States has been slow to adopt true full risk, um, uh, payment models, uh, than other parts of the country. So we are heavily engaged in things like the cms, uh, B P C I program, uh, and we have, uh, contracts with our private payers, uh, and we're learning a lot right now and asking a lot of questions based on the data that we're getting, how much of our improvement comes from real patient care changes and, and changing workflow. How much of our improvement comes in the form of better documentation and better coding that more accurately reflects how sick our patients are, and also can link to reimbursement, uh, going up with, in the form of higher case fixed index, for example. So I think that, um, I view my partners as, um, certainly in nursing, in operations, and really in all the, uh, clinical, uh, specialties, whether it's pharmacy or the therapies, and really, I've found that we've had the most success when we all work together and are all growing in the same direction. Absolutely. You know, that is fascinating to hear about and definitely appreciate you sharing that with us, because I think that's something that a lot of organizations are trying to figure out and trying to understand how they can best, uh, maneuver within where healthcare is headed. Now, when you think about your particular role, what issues are you spending most of your time on today? So, um, I would say three main, uh, areas, uh, and they're not in any specific order, but employee engagement to me is absolutely critical. We know that there's been a lot of challenges in the healthcare workforce across the country, and we just wanna make sure that we're providing the kinds of support and flexibility that our employees are looking for. And I, I, under the rubric of employees, I'll, I'll say employee physicians, uh, and employee providers as well. Uh, there's a lot of burnout, uh, in that, uh, community. And, uh, we're really paying a lot of attention through listening sessions through, uh, we call them stay interviews. So instead of waiting until someone leaves the organization, finding it out, finding out about their concerns, we actually talk to people while they're here and really try to get feedback from them. That's one area. The second is probably closely linked, and that is workplace safety. So hospitals and healthcare, uh, environments have changed. Uh, there's a lot more, uh, interaction between patients and families and our staff that didn't occur before, uh, in a negative, in a negative way, uh, threatening, uh, threatening voices, sometimes threatening physical, uh, activity. And in my hospital's case, we have a large behavioral health, uh, program, and that actually inserts an additional stress, uh, potentially in our staff because we know that, uh, behavioral health in this country has a lot of room for improvement in terms of, uh, taking care of the community in a better way. And because of the stresses of the pandemic and the economy, uh, we, we are seeing that stress come out in our patients and their families, uh, and in some case, our staff, uh, as well. And then, uh, the third, the third thing I would list is, uh, I'll call it loosely quality outcomes. And that includes things around patient safety, and I would say quality of operations and quality of financial performance falls in that, in that, uh, sphere as well. Uh, we at Penn Medicine are on the journey to high reliability. Uh, we've really spent a lot of time over the last few years educating people on the principles of high reliability and what it means to be a high reliability organization. Uh, and we've, uh, really developed our tactics to achieve our goals in line with that. That's so interesting to hear about it indefinitely as you're talking through some of the different issues. The employee engagement for sure is something that I know across the board people are trying to understand and figure out. And I, I love the idea of the stay interviews that you were talking about. Um, you know, throughout those conversations, was there anything interesting that came up or any themes that were common among those who were, uh, staying at Pennsylvania Hospital and really wanted to be part of the organization going forward? Yeah, I would say one theme, uh, that, uh, came out was people have a desire to, uh, grow, uh, and having opportunities, whether it's to, uh, to follow their dream, to get an advanced degree, uh, whether it's a, uh, a program where they get a certificate, uh, program, or whether they just have opportunities to have stretch assignments that allow them to explore areas which aren't native to their, uh, own job per se. Um, I would say that those kinds of, uh, issues were more common that we heard than, uh, we think salaries should be increased, we need better benefits. Uh, and, uh, really it, to me, it spoke very loudly about the engagement piece, about meeting people where they are and understanding what drives people to either come to an organization or stay to an stay in an organization. So it's, it's actually been a very positive process. That's great to hear, and definitely good to, to know those results are, are making sense and, and you're able to make changes and, um, really develop a workplace in, in the type of queer pathways that are most exciting and invigorating for the team will also bring great patient care. So that's awesome to hear. Now, what are you most excited about right now? So, I, I'm excited about a lot of things in healthcare. I think we really have a chance to transform many things over the next, uh, few years. I'll start with something that really, uh, maybe obvious to a lot of people, but during the pandemic, as difficult as it was for us, uh, barriers were broken with respect to things that were not well done before, like virtual care, uh, whether it's telemedicine or other types of virtual care. Um, and we've even, uh, really seen an extension toward more interest into caring people, caring for people rather at home, uh, whether it's called hospital at home or other ways of caring for people. Uh, at home, at Penn Medicine, we're very focused on the measures, uh, discharged to home. So not sending people necessarily to a skilled nursing facility or an acute rehabilitation center, uh, after their care, but really trying to support them at home as much as we can. Um, and virtual care has allowed us to do that. Sometimes it's inter interchange between patients and our organization with text messages. How are you doing? Do you have all the medications? Do you need, uh, do you feel sicker today than you did yesterday when you went home? Things as simple as that. Uh, patient experience outreach, uh, through virtual, uh, means, uh, real time, not waiting until, you know, several weeks after hospitalization. And then certainly, uh, we've built a really nice, uh, system in our system that can have direct outreach to, uh, patients, by trained clinicians who can elevate some of the concerns to the right direction. Maybe it's a practice, maybe it's a, a certain physician, uh, or maybe it's something that they need, like medications, uh, coming to their home that were left out before they, before they left. Uh, so I think those, those barriers that we've already broken and that the, the guardrails have sort of come off a little bit in a positive way for us to innovate. The second thing I think is, that's exciting to me is the shift toward ambulatory care. We know that hospital care is the most expensive care in our system, and the more we can shift to ambulatory care, uh, one, it's better for patient experience. Patients want to go home, patients want to be, uh, treated in a more efficient way. Uh, and it's definitely less expensive for our whole healthcare system. And then the, the third thing I would say is the opportunity to focus on performance or value-based care. So more and more, because of these models that are evolving with outpatient care, virtual care, discharging patients to home, we can see how we're performing as an organization, and the incentives are very strongly aligned with us to do well financially if we are able to innovate in these spaces and be successful. So lot to be excited about, but those are just a few examples. I really think that it is inspiring to hear that the health system is, is taking these initiatives to really transform, become value-based. Seriously. I know that can be a challenge, especially when you're thinking about taking care out of the hospital, which traditionally has been so ingrained within the culture. And then, you know, to some degree the financial performance of, of the hospital as well. Um, you know, when you think about for clinicians, physicians, nurses, and others on the team, have they been able to adapt to that virtual care hospital at home, those types of touches, uh, pretty easily, or has it sometimes been a challenge to get everybody on board in, you know, really providing care in that way, uh, as well as, you know, with the patients who are needing the hospital stays? Well, I, I think the easiest answer to that is that, uh, our employees and our staff are patients as well. So they're seeing examples in their own family lives and lives of their friends where they're seeking this kind of care. One of the biggest groups of early adopters of virtual care have been our staff. So we have 40,000 employees in the health system, and many of them are taking advantage of telemedicine, uh, consults, uh, that are, uh, being done, uh, online or on demand, we call it. Uh, and it, I think that they're really the earliest adopters. I think transforming the care of the hospital itself and trying to shift more into the communities a work in progress. I think we have definitely really good examples of where that's working well. And then we have examples of things that we need to, uh, work harder at, uh, particularly with respect to, uh, behavioral health. Uh, mental illness is really complicated, and the typical post-discharge follow up, uh, that's needed to keep people safe and functional in their society, uh, is ver those challenges are different. I can imagine it takes a completely different set of skills and in really protocols to be managing somebody with the, coming from behavioral health side than, uh, the non behavioral health side. And as you mentioned, you know, bringing them back into, uh, society or having them leave the hospital, you know, definitely can be some, uh, risk involved there. Um, you know, when you are working through setting up some of this stuff and really making sure as much as possible. I know you talked earlier during our conversation about employee safety as well as workplace engagement and those kinds of things. Um, what have you found has been most important in, in really creating a program that is, uh, safe for your employees, team members as well as the patients in trying to integrate both the hospital care as well as, as leaving the hospital? Yeah, I think for the, for the employees, we've really tried to put things in place, uh, like enhanced security guard presence, especially in, in certain key areas like the emergency department and our behavioral health, uh, areas, uh, more roving security presence on the regular medical surgical floors, which frequently have now patients that are medically ill, but also have comorbid mental illness. And then in the, in the, with, for the patients themselves in the community, just trying to really work harder with the community resources. Uh, there's a lot of homelessness in inner cities, including Philadelphia, and we're trying to work with the shelters with community health programs. We have a community health worker program at Penn that's really terrific and helps, uh, many of our patients as well. But there's, there doesn't seem to ever be enough and we're, we're constantly trying to, uh, create more ways to keep people safe. That's great to hear. Now, before we wrap up our discussion, I just have one more question for you. As we've been talking throughout this conversation. Healthcare is changing a lot and definitely will continue to evolve over the next few years. What will the most effective healthcare leaders need to be successful in the next two to three years or so? I think number one is we need to listen. Uh, we need to listen to our consumers, our patients and families. And we li need to listen to our communities about what they're looking for, uh, in terms of access, in terms of, uh, ease of use of our facilities, communicating with, uh, patients in a, in a different way. And I think we, we have a head start there because again, we have that large employee base that we can tap on to really learn firsthand, uh, from them what, what we think is most important. Number two, I would say, uh, we need to have a really keen focus on people. Uh, both the recruitment of staff, the development of staff, and the retention of staff. People are our biggest assets. They're the reason that we're able to deliver great care, and that's what makes it rewarding to practice in an environment like mine. So we need to continue to really have, uh, that focus. And then last, I think we have to be innovative. We can't be afraid of things not working out always the first time, but be committed to that quality improvement cycle that builds upon itself and teaches us every circuit, uh, that we go through, uh, about how to be more efficient, how to, uh, improve the quality of care, improve the patient's safety metrics that we're all striving for. And to me, this is all about high reliability and continuing to strive, uh, to be a high reliability organization. Dr. Feinberg, thank you so much for joining us on the podcast today. This has been a really outstanding discussion and I look forward to connecting with you again soon. Thank you so much. It's been my pleasure.
This episode aired on 11/11/11.
