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Welcome everyone to the Becker's Healthcare podcast series. I'm Rah Mohammed,
writer and moderator with Becker's Healthcare.
I'm absolutely thrilled to have with me today Dr. Nav. Dang,
chief medical officer at Geisinger Community Medical Center. Doctor,
it's very nice to have you on the podcast today. How are you?
I'm good.
Thank Great, great. Glad to have you on. To get us started,
would you mind please introducing yourself and telling us a bit about your
background and organization?
Yeah, thank you Mariah, for the opportunity and uh,
it's my pleasure to be here. So my name is Nni Dan.
I have been in healthcare for about 25 years and at
Geisinger for about eight years.
I'm an internal medicine physician and have been in various leadership
positions within Geisinger Health.
Most recently as system chief quality officer,
where I led efforts around patient safety and quality across
inpatient areas across 10 hospitals and system
chair of inpatient medicine as well.
I currently serve as the Chief Medical Officer at Geisinger Community Medical
Center in Scranton, Pennsylvania.
Our campus is a level two trauma center with close to
290 beds and is one of the teaching sites
for Geisinger Commonwealth School of Medicine medical students,
various residencies and fellowship programs.
A brief introduction about Geisinger Health as a health system.
Geisinger is an integrated healthcare delivery model with a strong
focus on value-based care.
We take pride in taking care of our patients through the whole continuum of
care. Our vision is making better health,
easier for the patients and communities we serve.
Geisinger is focused on three key strategic priorities,
which are managing total health, operational excellence,
and access and ease of use.
Good, wonderful.
Thank you so much for giving us that background on you and your organization.
Um, the first question that I really wanted to ask you, doctor,
is can you tell me about your most successful project or initiative from the
last year? What issues were you trying to solve and also what drove the success?
Yeah, thank you Maria for the question. Um,
so there are couple of initiatives that come to mind, which I would,
uh, like to share today.
Our teams at Geisinger are laser focused on improving quality,
patient safety and patient experience for our patients and the communities
we serve.
We have embarked on a journey to zero harm and worked
extremely hard to reduce preventable harm.
There has been a significant focus on reducing and
preventing patient harm across the clinical enterprise.
One initiative that comes to mind is our work around reducing
central line associated bloodstream infections across the system.
We assembled a multidisciplinary team of clinicians,
which included physicians, nursing staff,
infection control team, and our vascular access team,
and created a system task force.
We used our proven care approach and standardized our
insertion and maintenance practices for central line care.
We also created an escalation process to get central lines out
in a timely manner.
The root cause analysis process helped us to discover
areas of opportunity and develop appropriate action plans.
We closely tracked compliance of our process measures and
created an audit process which led to about 50%
reduction in central line associated bloodstream rate across all our
hospitals in Scranton.
At Geisinger Community Medical Center.
We had eight months without a central line associated
bloodstream infection this year and have also seen significant
improvement in primary bloodstream infection as well.
We are also seeing significant improvements in our catheter
associated urinary tract infections.
Hospital acquired c diff infections and went associated pneumonia rates
because of our JO journey to zero harm.
The second initiative that I would like to talk to you
about today,
there is a significant focus on value-based care across the
organization. During covid,
we saw a significant challenge with inpatient mobility
for our patients due to isolation and some of the other challenges
in terms of taking care of our covid patients. As such,
our physical therapy and nursing teams worked diligently to
refine mobility efforts at the campus.
We instated a mobility challenge,
which awards the unit who has the highest number of steps with
a golden sneaker award.
We have more than tripled the total number of steps currently and we continue
to improve.
This has enabled us to improve patient outcomes and decrease
post-acute utilization.
Our skilled nursing facility and inpatient rehab facility
utilization post discharge has been below benchmark
and because of these efforts,
we are able to discharge 80 to 85% of our
patients home from the hospital.
This has also enabled us to have top
desire performance in bundles, payment care improvement,
advance initiative by C M s,
which really focuses on value-based care and cost of and total cost
of care. So that was, um,
two initiatives. The third one that I would like to describe,
which has been very successful in improving access within the hospital
and re represents one of our strategic objectives,
is our efforts concerning length of stay and throughput.
We have been able to improve our length of stay by 15
to 20% by instituting multidisciplinary
rounds, which we call boost rounds on each unit.
A greater representation of the inclusive culture at Geisinger
is that members of our care team come together and design care plans
alongside our clinicians.
Some epic tools in place such as expected day of discharge
and medically ready buttons keep our care teams focused
on proactive discharge planning from the time of admission.
To answer your question, Maria, about what drove success.
So couple things there.
We have developed a unit-based diode leadership model,
which we call accountable care unit model,
where a physician and nursing leader dyad work together
towards driving change and improving clinical outcomes.
The secret sauce, in my opinion,
is high reliability organization methodology and
multidisciplinary approach to caring for our patients.
So those were some of, um, the initiatives, uh,
and also, um,
some of the key areas that helped us to drive
success.
Wow, that is totally wonderful.
Thank you so much for sharing those three initiatives. As you know,
the clinical workforce has changed a lot in the last few years.
What challenges are you still facing and how do you see the clinical workforce
evolving?
Yeah, thank you. Uh, Maria, this is another great question.
Let me take a stab at this. Um, and I'm not sure if you,
um, looked at the Medscape survey report from 2023,
but about 52% of physicians reported
experiencing burnout,
which is a negative change from 2018 numbers at
42%.
So there has been 10% increase in physician
burnout. Um, in last five years,
23% physicians reported depression,
which is again a worsening statistic from 2018 at
15%,
61% physicians reported that too many bureaucratic
tasks is the number one reason for burnout and lack of
respect from coworkers at 36% is the second
reason. Second most common reason for physician burnout.
In my opinion,
clinician burnout is the biggest challenge and burnout was present even
before covid, but COVID has significantly worsened it.
There is a lot of focus from our system on
clinician wellbeing and there are many programs developed at
Geisinger to support clinician wellbeing.
We are not leaving the burden of solving this issue just on our clinical teams.
There are system solutions being developed for this particularly
critical issue.
Our chief wellness officer at Geisinger is leading
different work stream to improve clinician burnout
in terms of clinical workforce evolvement.
I feel programs like virtual nursing,
telehealth services and AI can significantly
help to improve access to care.
Human touch and patient-centric approach is still going to be the key,
but AI and digital tools to improve patient outcomes will
be crucial to evolving the healthcare space.
So those were some of the thoughts I had.
Absolutely. Thank you so much for sharing that insight. And Doctor,
before I let you go,
the last thing I wanted to ask you is what is your best advice for aspiring
physician and nurse leaders?
Another great question.
So I would say that time spent at bedside caring for
patients is critical.
My advice for aspiring physician and nurse leaders
would be to commit to lifelong learning
because I believe that leadership is an acquired skill
and our aspiring leaders must commit to be lifelong learners.
Another thing I feel about leadership,
it's a huge responsibility and humility and empathy
are key to becoming a successful leader.
So those would be some of my thoughts. Maria.
Wonderful, wonderful. Thank you so much for those final thoughts, doctor.
This has been an amazing and informative discussion. So I, again,
I wanna thank you so much for coming on Becker's Healthcare and I look forward
to connecting with you again soon.
Thanks again for the opportunity. I appreciate it.
Of course.
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