"I've never heard someone tell me, 'You just don't understand,' because they know I do."
Steven Gabbe, MD, took the helm of Ohio State University Wexner Medical Center in 2008, when the healthcare industry was plagued with uncertainty. A new president had just been elected, new healthcare policy was going to reshape the entire industry and the medical center itself was getting ready to dive into its largest construction project to date.
Indeed, Dr. Gabbe had a full plate when he entered his role. Under his leadership, however, OSU Wexner Medical Center used these challenges as opportunities to enhance the culture among medical professionals and other staff, improve quality of care and patient satisfaction and create structures that will allow for the maintenance of these improvements long after he leaves his post.
Dr. Gabbe will step down as CEO at the end of February. In the meantime, Becker's had the opportunity to catch up with him and discuss some of the biggest challenges and successes he experienced during his tenure, his plans for the future and advice to other physicians and healthcare leaders.
Question: Can you describe Wexner Medical Center and the healthcare industry in general when you became CEO in 2008?
Dr. Gabbe: The biggest changes were coming to the healthcare industry during that time. President Barack Obama was elected and we anticipated there would be changes in healthcare legislation — which ultimately led to the Patient Protection and Affordable Care Act — and people were uncertain about what that would do to our traditional models of care and reimbursement.
Right about that time, we were preparing to go to our board of trustees with a plan for the largest construction project in the history of the university: a $1.1 billion expansion that would include the new James Cancer Hospital and Solove Research Institute and Critical Care Center. We were very fortunate to obtain a $100 million federal grant that allowed us to build a radiation and oncology floor in the hospital. It is probably one of the few radiation floors above ground in the country. As a patient, if you're diagnosed with cancer and told you are going underground every day for six weeks for radiation treatment, it's not very uplifting. Now patients getting radiation will be able to see the sunlight and the beautiful parks around the hospital.
Q: What were some of the biggest challenges you've faced during your tenure?
Dr. Gabbe: I think one of the biggest challenges we faced was preparing for the changes that were brought in by the PPACA. But overall, the biggest challenges were changing the culture of our medical center. For example, the PPACA emphasizes not volume, but value. We were no longer getting paid for how many tests and procedures we provided patients, but for doing it right and safely. This required a big culture change.
Another cultural change was implementing our electronic medical record system throughout our health system. The transition from paper records to only electronic ones required participation in all departments. In October 2011, we threw the switch to systemwide electronic medical records. It was the "big bang."
With this change, we had to educate over 14,000 people to be well-versed in the EMR. We worked really hard to give everyone the resources they needed to learn it. Having EMRs is so important for quality and safety and determining patient outcomes. Now we actually have over 100,000 patients who have access to their records on OSUMyChart. They don't have to call the office or wait for the doctor to call them — they can go to OSUMyChart and communicate electronically with their physicians.
Also, to improve safety, we brought Crew Resource Management, a quality safety practice based on the aviation industry, to the medical center. It uses checklist tools, similar to the aviation industry, to reduce errors. We've trained over 5,000 physicians and nurses in CRM, and that has helped us become one of the safest and highest-quality hospitals in the country. This year we were ranked third for excellence in patient safety and quality by the University HealthSystem Consortium and received the 2014 Quality Leadership Award.
Q: What were some of Wexner Medical Center's biggest accomplishments during your tenure?
Dr. Gabbe: We've had several major accomplishments over the last six or so years; the completion of our new hospital and its completion on time, on budget and on scope for the project; our remarkable success in patient quality and safety and satisfaction scores; and our strong financial position at this time despite the changes in healthcare.
I think even more important is the great team of people we've assembled over the last six or seven years — people we've promoted from within and recruited from outside of the organization have really made a difference. It isn't only the ambulatory clinics we've built or the medical center expansion, but the people who really make change happen.
Q: The Wexner Medical Center has shown remarkable improvement in patient care under your leadership. What kinds of efforts led to these improvements?
Dr. Gabbe: With all of our different efforts, and with Crew Resource Management specifically, unless the senior leadership is fully committed to the process, it just doesn't work. It will be a flavor of the month and then pass. I was trained in CRM before I came to OSU. I could have said I've done it before and don't need to do it again, but I went through the training with everyone else. As much as I possibly could, I would go to each of the CRM sessions and lead them off by telling people why it was important, what the expectations were and the difference the training was going to make.
It's essential to remember that you always have to bring every effort or project to the level of the patient and their families. Our observed level of expected mortality is one of the lowest in the country. In our case, about 40 percent of patients who would be expected to die because of serious conditions survive and go home to their families.
Q: Wexner Medical Center's financial indicators improved over the last several years, even during the recession, the recovery period afterward and during the implementation of the PPACA. How was this possible?
Dr. Gabbe: One large part of our strategy was to bring the ambulatory care we provide into the community. We built a series of multidisciplinary care centers around our community in key areas, including The Stefanie Spielman Comprehensive Breast Center, which is a specialized ambulatory center for breast cancer patients and our AfterHours clinic for patients with less serious emergency problems. As a result of all of this, our ambulatory visits have nearly doubled. These facilities also helped us identify patients who needed more serious care within our hospitals, which helped increase activity inside the hospital.
Because of our focus on quality, safety and patient satisfaction, more patients wanted to come here for their care. Volumes grew. We've also created the Patient Experience Council, which focuses on patient satisfaction, and the Patient Advisory Council, where patients and former patients can give us advice and feedback on their experiences.
We did something else that's pretty unusual. We supported about two dozen of our faculty and staff members, including physicians, nurses and administrative leaders, to go to The Ohio State University's Fisher College of Business to earn a master's in business operational excellence. They brought their skills in lean management and process improvement back to our medical center and presented them to our leadership team. We learned a lot from them and they are helping us improve our medical center.
Q: How does a practicing physician, executive and professor remain visible in his community? How do you balance that fourth realm of your life, your civic responsibilities?
Dr. Gabbe: Ohio State is a major part of the community in Columbus. In the medical center alone, we have about 17,000 employees and Ohio State has about 100,000 people on campus. We're a land grant university, and part of our mission is to improve the community around us. A good example would be our Partners Achieving Community Transformation, or PACT group, and the work we're doing to improve the neighborhood around our University Hospital East.
My wife, Dr. Pat Gabbe, has always been passionate about helping in the community. Together we're working on The Greater Columbus Infant Mortality Task Force, something that is a very important part of our commitment to our community.
Personally, I've had diabetes for almost 47 years. We are very active working with families, young adults and children with diabetes in both the Juvenile Research Foundation and the American Diabetes Association.
Q: As a practicing physician, what piece of advice would you give to new or upcoming physicians?
Dr. Gabbe: I would tell them that it truly is a marathon and not a sprint. This will hopefully be a 30 to 50 year career in healthcare, so enjoy each step along the way. You can't do everything in the first days, weeks, months or even years — remember that. You must maintain your work-life balance. Spend time with your families and do things you enjoy. This is truly important.
I would also emphasize that medicine is a very small world. You'll work with people early in your career and maybe again years later. You should maintain friendships and be supportive along the way.
Finally, I would tell them what my father always told me: Do good, and don't complain.
Q: What important lessons would you want to share with other healthcare leaders?
Dr. Gabbe: I would say you must be committed and passionate about the work you're doing. You have to be involved — not just watch from afar or sit in your office. You have to visit with patients and their families, and with doctors and nurses in the settings of their care. Go to the meetings where patient care and experience is discussed. You have to be a visible and engaged leader. I've never heard someone tell me, "You just don't understand," because they know I do.
Q: What are your plans for the future?
Dr. Gabbe: We're starting to receive manuscripts for the seventh edition of our obstetrics textbook, which is the leading textbook in the field. I'll also have more time to work in the Diabetes in Pregnancy clinic, as well as teach. I'll be involved in faculty mentoring, and I'll be spending a lot more time working on the infant mortality task force. I will be an ambassador to hospitals in our Ohio State Health Network as well as potential members and new partners.