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This is the Becker's Healthcare
Podcast created by the team of Becker's

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Healthcare, a multimedia company devoted
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Four new 15 minute episodes are released
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Thanks for listening.
Now here's the episode.

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Welcome everyone to the
Becker's Healthcare podcast
series. I'm Rah Mohammed,

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writer and moderator
with Becker's Healthcare.

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I'm absolutely thrilled to have
with me today Dr. Nav. Dang,

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chief medical officer at Geisinger
Community Medical Center. Doctor,

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it's very nice to have you on
the podcast today. How are you?

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I'm good.

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Thank Great, great. Glad to
have you on. To get us started,

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would you mind please introducing
yourself and telling us a bit about your

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background and organization?

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Yeah, thank you Mariah,
for the opportunity and uh,

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it's my pleasure to be
here. So my name is Nni Dan.

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I have been in healthcare
for about 25 years and at

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Geisinger for about eight years.

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I'm an internal medicine physician
and have been in various leadership

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positions within Geisinger Health.

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Most recently as system
chief quality officer,

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where I led efforts around
patient safety and quality across

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inpatient areas across
10 hospitals and system

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chair of inpatient medicine as well.

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I currently serve as the Chief Medical
Officer at Geisinger Community Medical

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Center in Scranton, Pennsylvania.

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Our campus is a level two
trauma center with close to

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290 beds and is one of the teaching sites

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for Geisinger Commonwealth School
of Medicine medical students,

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various residencies and
fellowship programs.

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A brief introduction about
Geisinger Health as a health system.

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Geisinger is an integrated healthcare
delivery model with a strong

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focus on value-based care.

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We take pride in taking care of our
patients through the whole continuum of

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care. Our vision is making better health,

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easier for the patients
and communities we serve.

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Geisinger is focused on three
key strategic priorities,

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which are managing total
health, operational excellence,

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and access and ease of use.

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Good, wonderful.

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Thank you so much for giving us that
background on you and your organization.

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Um, the first question that I
really wanted to ask you, doctor,

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is can you tell me about your most
successful project or initiative from the

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last year? What issues were you trying
to solve and also what drove the success?

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Yeah, thank you Maria
for the question. Um,

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so there are couple of initiatives
that come to mind, which I would,

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uh, like to share today.

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Our teams at Geisinger are laser
focused on improving quality,

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patient safety and patient experience
for our patients and the communities

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we serve.

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We have embarked on a journey
to zero harm and worked

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extremely hard to reduce preventable harm.

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There has been a significant
focus on reducing and

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preventing patient harm across
the clinical enterprise.

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One initiative that comes to
mind is our work around reducing

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central line associated bloodstream
infections across the system.

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We assembled a multidisciplinary
team of clinicians,

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which included physicians, nursing staff,

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infection control team, and
our vascular access team,

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and created a system task force.

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We used our proven care
approach and standardized our

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insertion and maintenance
practices for central line care.

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We also created an escalation
process to get central lines out

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in a timely manner.

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The root cause analysis
process helped us to discover

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areas of opportunity and develop
appropriate action plans.

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We closely tracked compliance
of our process measures and

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created an audit process
which led to about 50%

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reduction in central line associated
bloodstream rate across all our

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hospitals in Scranton.

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At Geisinger Community Medical Center.

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We had eight months without
a central line associated

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bloodstream infection this year
and have also seen significant

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improvement in primary
bloodstream infection as well.

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We are also seeing significant
improvements in our catheter

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associated urinary tract infections.

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Hospital acquired c diff infections
and went associated pneumonia rates

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because of our JO journey to zero harm.

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The second initiative that
I would like to talk to you

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about today,

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there is a significant focus
on value-based care across the

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organization. During covid,

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we saw a significant challenge
with inpatient mobility

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for our patients due to isolation
and some of the other challenges

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in terms of taking care of
our covid patients. As such,

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our physical therapy and nursing
teams worked diligently to

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refine mobility efforts at the campus.

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We instated a mobility challenge,

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which awards the unit who has
the highest number of steps with

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a golden sneaker award.

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We have more than tripled the total
number of steps currently and we continue

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to improve.

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This has enabled us to improve
patient outcomes and decrease

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post-acute utilization.

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Our skilled nursing facility
and inpatient rehab facility

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utilization post discharge
has been below benchmark

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and because of these efforts,

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we are able to discharge 80 to 85% of our

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patients home from the hospital.

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This has also enabled us to have top

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desire performance in bundles,
payment care improvement,

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advance initiative by C M s,

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which really focuses on value-based
care and cost of and total cost

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of care. So that was, um,

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two initiatives. The third one
that I would like to describe,

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which has been very successful in
improving access within the hospital

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and re represents one of
our strategic objectives,

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is our efforts concerning
length of stay and throughput.

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We have been able to improve
our length of stay by 15

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to 20% by instituting multidisciplinary

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rounds, which we call
boost rounds on each unit.

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A greater representation of the
inclusive culture at Geisinger

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is that members of our care team
come together and design care plans

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alongside our clinicians.

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Some epic tools in place such
as expected day of discharge

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and medically ready buttons
keep our care teams focused

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on proactive discharge planning
from the time of admission.

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To answer your question, Maria,
about what drove success.

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So couple things there.

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We have developed a unit-based
diode leadership model,

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which we call accountable care unit model,

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where a physician and nursing
leader dyad work together

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towards driving change and
improving clinical outcomes.

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The secret sauce, in my opinion,

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is high reliability
organization methodology and

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multidisciplinary approach
to caring for our patients.

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So those were some of,
um, the initiatives, uh,

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and also, um,

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some of the key areas
that helped us to drive

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success.

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Wow, that is totally wonderful.

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Thank you so much for sharing those
three initiatives. As you know,

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the clinical workforce has changed
a lot in the last few years.

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What challenges are you still facing and
how do you see the clinical workforce

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evolving?

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Yeah, thank you. Uh, Maria,
this is another great question.

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Let me take a stab at this.
Um, and I'm not sure if you,

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um, looked at the Medscape
survey report from 2023,

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but about 52% of physicians reported

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experiencing burnout,

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which is a negative change
from 2018 numbers at

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42%.

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So there has been 10%
increase in physician

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burnout. Um, in last five years,

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23% physicians reported depression,

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which is again a worsening
statistic from 2018 at

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15%,

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61% physicians reported
that too many bureaucratic

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tasks is the number one
reason for burnout and lack of

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respect from coworkers
at 36% is the second

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reason. Second most common
reason for physician burnout.

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In my opinion,

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clinician burnout is the biggest
challenge and burnout was present even

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before covid, but COVID has
significantly worsened it.

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There is a lot of focus from our system on

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clinician wellbeing and there
are many programs developed at

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Geisinger to support clinician wellbeing.

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We are not leaving the burden of solving
this issue just on our clinical teams.

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There are system solutions being
developed for this particularly

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critical issue.

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Our chief wellness officer
at Geisinger is leading

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different work stream to
improve clinician burnout

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in terms of clinical workforce evolvement.

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I feel programs like virtual nursing,

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telehealth services and
AI can significantly

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help to improve access to care.

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Human touch and patient-centric
approach is still going to be the key,

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but AI and digital tools to
improve patient outcomes will

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be crucial to evolving
the healthcare space.

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So those were some of the thoughts I had.

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Absolutely. Thank you so much for
sharing that insight. And Doctor,

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before I let you go,

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the last thing I wanted to ask you is
what is your best advice for aspiring

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physician and nurse leaders?

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Another great question.

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So I would say that time
spent at bedside caring for

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patients is critical.

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My advice for aspiring
physician and nurse leaders

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would be to commit to lifelong learning

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because I believe that
leadership is an acquired skill

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and our aspiring leaders must
commit to be lifelong learners.

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Another thing I feel about leadership,

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it's a huge responsibility
and humility and empathy

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are key to becoming a successful leader.

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So those would be some
of my thoughts. Maria.

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Wonderful, wonderful. Thank you so
much for those final thoughts, doctor.

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This has been an amazing and
informative discussion. So I, again,

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I wanna thank you so much for coming on
Becker's Healthcare and I look forward

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to connecting with you again soon.

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Thanks again for the
opportunity. I appreciate it.

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Of course.

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It's so important for leaders at the
top of organizations to keep learning,

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stay sharp,

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grow their networks to help our audience
better do this in a more simplified,

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personalized, and meaningful way.
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