David T. Feinberg, MD, associate vice chancellor and CEO of the UCLA Hospital System, discusses the importance of a patient-centered approach to quality care and how hospitals can improve patient satisfaction by eliminating waste.
Question: The next few years in healthcare might be described as a "perfect storm," with the implementation of EMR, fee cuts and regulatory changes through health reform. What do you see as the number one priority for UCLA Hospital System over the next year?
Dr. David Feinberg: That question, to me, is really easy. Our focus today, tonight, next year and in 100 years is on the patient in front of us. If we take great care of our patients — and that means they get the absolute highest quality and incredible compassion and are treated with dignity and respect and in a culturally sensitive way. If you were to ask patients to rate us on a scale of 1-10 or refer us to a friend, 99 percent of patients will give us [the highest score]. I tell people here, "Don't worry about healthcare reform. Don't worry about the awards that used to concern us. Just worry about the patient." When you think about the patient — and that patient is a politician, is an employee, is a voter, is a mom — they will make sure the UCLA health system survives what you described perfectly as a "perfect storm."
Q: How do you use your role as CEO to drive that focus on patient care?
DF: I probably spend about 40 percent of my time in patient bedrooms, meeting with patients. We're a pretty big system. We have four licensed hospitals, we perform more organ transplants than any hospital in the U.S. and [Ronald Reagan UCLA Medical Center is] consistently in the [top five hospitals in the country] in U.S. News & World Report. But I want to spend my time with patients. I ask, "Is there anything we can do to make your visit and your family more comfortable? Is there any way you could see us improve your care?"
We have a host of 100 managers that do that, and we're all happy to help somebody to the commode. We're all happy to pick up trash. Every one of our team members, from housekeeping to physicians, is focused on alleviating suffering by promoting health and delivering acts of kindness. Everybody you come in contract with, it's in their job description. They must be smiling; they must make eye contact. When the housekeeper arrives, he says, "My name is David, I'm your housekeeper. I'm going to clean the room, so is there anything in particular you'd like me to focus on?"
For our hiring practices, we use a Ritz-Carlton tool called Talent Plus. Ritz-Carlton has a cut-off of [scoring 75 and above on the Talent Plus survey] for hiring. We've gone to 90 and above. In the past, if a nurse had the [appropriate experience], the right specialty, good references, he or she would be hired. Now they also have to screen at above 90 percent on this talent interview that looks for really service-minded individuals. You create an organization where like-minded people are working together and believe in the cause.
Q: Ronald Reagan UCLA Medical Center is a major teaching hospital. How do you make sure you're not only hiring, but developing, the best physicians for the future of healthcare?
DF: We do a couple of things. We have one of the most diverse medical school classes in the country. UCLA is incredible around diversity. Thirty percent of undergrads don't have a parent who went to college. We look for those who are less advantaged and try to get them into the system, and we teach humanism from day one in medical school. We reward faculty on the kind of grades they get from med students on how humanistic they were at the bedside.
For resident applications, we've started to roll out Talent Plus. We compete for these very, very bright people who want to do their post-medical training with us, and we have decided that if you're not service-minded, we don't want you. We're [adding] Talent Plus to our residency applications.
Q: Your patient satisfaction rates are very high, especially considering how busy you are. How did you accomplish that?
DF: When I [started here], our patient satisfaction scores were in the 30th percentile. We heard a lot of bad stuff from patients — we didn't have enough bed pans, no one introduced themselves, no one was dressed right. Now when I go into a room, there are five or six business cards on the table with cell phone numbers. You sit in the room and see people come in, and whether they know who I am or not, they [interact with the patient] in the most professional, humanistic way.
It's very service-minded. We have 24-hour room service and an executive chef trained in a culinary institute, and you can order food at any time. We now make professionally produced DVDs for everyone — housekeeping, physicians and nurses — that shows [how to perform common processes]. Most people who go into healthcare are good people, but no one told them, "This is the way you take a patient from the wheelchair to the table for an x-ray." We've standardized that work so it's very clear how you do that.
We get 100 patients a day for elective surgery, and three years ago, if someone walked up and they weren't on the list, the [front desk staff] might say, "We don't have you on the list. Dave who?" The script that everybody says now whenever anybody walks up is, "We've been expecting you." We still make mistakes, but we figure them out behind the scenes. "We've been waiting for you" is the concept when you show up at the hospital.
All the staff also carry around "service recovery tools." In my pocket, I have coupons to Starbucks, coupons for massages, $20 gas cards, meal coupons and parking validation. I talked to a family the other day that had a little problem with parking, and I said, "Here's a Shell gas card, I'm so sorry you had a delay." When I first came here, I met a gentleman dying of cancer and we had lost his dentures, or he had not brought his dentures in. We'd spent so many hours filling out forms, and this guy just wanted his teeth so he could eat before he died. Now, if anyone mentions they've lost their teeth, within 24 hours they will have teeth in their mouth, without forms.
The results have been spectacular. We're running at 100 percent occupancy; we're packed. We're making a lot of money, but we don't talk about money. When I started, everything was about whether we were making enough money. Now every meeting starts with a patient story. Whether it's me with our 10 senior managers or a meeting with 150 managers, either a patient is there or we read a letter from a patient.
Q: As you said, UCLA Ronald Reagan is a very busy hospital that frequently treats severely ill patients. How do you keep patient satisfaction high in a place where one might expect high wait times?
DF: We measure everything. You can't smile or give enough Starbucks cards to make up for a 12-hour delay. We've focused on eliminating those 12-hour delays. If you're not admitted — and 80 percent of the patients that visit the ER are not admitted — the turnaround time back to your car is 52 minutes.
Again, our philosophy is, "There's no one more important than the patient." Even if it's a mom who brings in a kid with a raging ear infection, to her, that is the priority and she's got other kids and home and has to get back and pick them up. You can't make her wait nine hours because you've got a gunshot wound. We separate her at triage and really focus on taking all the waste out of her care. Can we get her financial information and get the kid's vital signs and make the turnaround very quick on all those procedures? Maybe we can even do it without putting the kid in a room. We're worked really hard on our throughput so the ER doesn't fill up mid-day and you have to send people upstairs for a bed.
Q: What, in your opinion, is the number one cause of patient dissatisfaction, and what advice would you give other hospital leaders on tackling that cause?
DF: We [as a healthcare industry] have lost sight of what we do. If you go back to the history of hospitals, they were to care for the poor that were ill. Historically, the biggest problems were infection control and standardized procedures, and we still need to [concentrate on those]. We need to wash our hands before every patient and treat patients like humans. We need to explain things and sometimes say, "We can't help you medically, but we can help with end-of-life decisions." We need to sometimes say, "We can't treat you here, but here's what else you should do."
There's plenty to do in terms of eliminating waste. We looked at our cardiovascular ICU, and the average number of chest x-rays per patient per day was 9. It wasn't like we went up there and said, "Let's waste money in America and do too many x-rays." It was about poor communication. Throughout healthcare, providers order tests even though the patient already had the test because the provider didn't have access to the patient's other records. We have to fix that. Now we're down to two [chest x-rays per patient per day] in the cardiovascular ICU. That's much less waste in our system that didn't add any value to the patient's experience.
Learn more about UCLA Health System.
Question: The next few years in healthcare might be described as a "perfect storm," with the implementation of EMR, fee cuts and regulatory changes through health reform. What do you see as the number one priority for UCLA Hospital System over the next year?Dr. David Feinberg: That question, to me, is really easy. Our focus today, tonight, next year and in 100 years is on the patient in front of us. If we take great care of our patients — and that means they get the absolute highest quality and incredible compassion and are treated with dignity and respect and in a culturally sensitive way. If you were to ask patients to rate us on a scale of 1-10 or refer us to a friend, 99 percent of patients will give us [the highest score]. I tell people here, "Don't worry about healthcare reform. Don't worry about the awards that used to concern us. Just worry about the patient." When you think about the patient — and that patient is a politician, is an employee, is a voter, is a mom — they will make sure the UCLA health system survives what you described perfectly as a "perfect storm."
Q: How do you use your role as CEO to drive that focus on patient care?
DF: I probably spend about 40 percent of my time in patient bedrooms, meeting with patients. We're a pretty big system. We have four licensed hospitals, we perform more organ transplants than any hospital in the U.S. and [Ronald Reagan UCLA Medical Center is] consistently in the [top five hospitals in the country] in U.S. News & World Report. But I want to spend my time with patients. I ask, "Is there anything we can do to make your visit and your family more comfortable? Is there any way you could see us improve your care?"
We have a host of 100 managers that do that, and we're all happy to help somebody to the commode. We're all happy to pick up trash. Every one of our team members, from housekeeping to physicians, is focused on alleviating suffering by promoting health and delivering acts of kindness. Everybody you come in contract with, it's in their job description. They must be smiling; they must make eye contact. When the housekeeper arrives, he says, "My name is David, I'm your housekeeper. I'm going to clean the room, so is there anything in particular you'd like me to focus on?"
For our hiring practices, we use a Ritz-Carlton tool called Talent Plus. Ritz-Carlton has a cut-off of [scoring 75 and above on the Talent Plus survey] for hiring. We've gone to 90 and above. In the past, if a nurse had the [appropriate experience], the right specialty, good references, he or she would be hired. Now they also have to screen at above 90 percent on this talent interview that looks for really service-minded individuals. You create an organization where like-minded people are working together and believe in the cause.
Q: Ronald Reagan UCLA Medical Center is a major teaching hospital. How do you make sure you're not only hiring, but developing, the best physicians for the future of healthcare?
DF: We do a couple of things. We have one of the most diverse medical school classes in the country. UCLA is incredible around diversity. Thirty percent of undergrads don't have a parent who went to college. We look for those who are less advantaged and try to get them into the system, and we teach humanism from day one in medical school. We reward faculty on the kind of grades they get from med students on how humanistic they were at the bedside.
For resident applications, we've started to roll out Talent Plus. We compete for these very, very bright people who want to do their post-medical training with us, and we have decided that if you're not service-minded, we don't want you. We're [adding] Talent Plus to our residency applications.
Q: Your patient satisfaction rates are very high, especially considering how busy you are. How did you accomplish that?
DF: When I [started here], our patient satisfaction scores were in the 30th percentile. We heard a lot of bad stuff from patients — we didn't have enough bed pans, no one introduced themselves, no one was dressed right. Now when I go into a room, there are five or six business cards on the table with cell phone numbers. You sit in the room and see people come in, and whether they know who I am or not, they [interact with the patient] in the most professional, humanistic way.
It's very service-minded. We have 24-hour room service and an executive chef trained in a culinary institute, and you can order food at any time. We now make professionally produced DVDs for everyone — housekeeping, physicians and nurses — that shows [how to perform common processes]. Most people who go into healthcare are good people, but no one told them, "This is the way you take a patient from the wheelchair to the table for an x-ray." We've standardized that work so it's very clear how you do that.
We get 100 patients a day for elective surgery, and three years ago, if someone walked up and they weren't on the list, the [front desk staff] might say, "We don't have you on the list. Dave who?" The script that everybody says now whenever anybody walks up is, "We've been expecting you." We still make mistakes, but we figure them out behind the scenes. "We've been waiting for you" is the concept when you show up at the hospital.
All the staff also carry around "service recovery tools." In my pocket, I have coupons to Starbucks, coupons for massages, $20 gas cards, meal coupons and parking validation. I talked to a family the other day that had a little problem with parking, and I said, "Here's a Shell gas card, I'm so sorry you had a delay." When I first came here, I met a gentleman dying of cancer and we had lost his dentures, or he had not brought his dentures in. We'd spent so many hours filling out forms, and this guy just wanted his teeth so he could eat before he died. Now, if anyone mentions they've lost their teeth, within 24 hours they will have teeth in their mouth, without forms.
The results have been spectacular. We're running at 100 percent occupancy; we're packed. We're making a lot of money, but we don't talk about money. When I started, everything was about whether we were making enough money. Now every meeting starts with a patient story. Whether it's me with our 10 senior managers or a meeting with 150 managers, either a patient is there or we read a letter from a patient.
Q: As you said, UCLA Ronald Reagan is a very busy hospital that frequently treats severely ill patients. How do you keep patient satisfaction high in a place where one might expect high wait times?
DF: We measure everything. You can't smile or give enough Starbucks cards to make up for a 12-hour delay. We've focused on eliminating those 12-hour delays. If you're not admitted — and 80 percent of the patients that visit the ER are not admitted — the turnaround time back to your car is 52 minutes.
Again, our philosophy is, "There's no one more important than the patient." Even if it's a mom who brings in a kid with a raging ear infection, to her, that is the priority and she's got other kids and home and has to get back and pick them up. You can't make her wait nine hours because you've got a gunshot wound. We separate her at triage and really focus on taking all the waste out of her care. Can we get her financial information and get the kid's vital signs and make the turnaround very quick on all those procedures? Maybe we can even do it without putting the kid in a room. We're worked really hard on our throughput so the ER doesn't fill up mid-day and you have to send people upstairs for a bed.
Q: What, in your opinion, is the number one cause of patient dissatisfaction, and what advice would you give other hospital leaders on tackling that cause?
DF: We [as a healthcare industry] have lost sight of what we do. If you go back to the history of hospitals, they were to care for the poor that were ill. Historically, the biggest problems were infection control and standardized procedures, and we still need to [concentrate on those]. We need to wash our hands before every patient and treat patients like humans. We need to explain things and sometimes say, "We can't help you medically, but we can help with end-of-life decisions." We need to sometimes say, "We can't treat you here, but here's what else you should do."
There's plenty to do in terms of eliminating waste. We looked at our cardiovascular ICU, and the average number of chest x-rays per patient per day was 9. It wasn't like we went up there and said, "Let's waste money in America and do too many x-rays." It was about poor communication. Throughout healthcare, providers order tests even though the patient already had the test because the provider didn't have access to the patient's other records. We have to fix that. Now we're down to two [chest x-rays per patient per day] in the cardiovascular ICU. That's much less waste in our system that didn't add any value to the patient's experience.
Learn more about UCLA Health System.