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Dr. Brian Johnson, president, West Penn Hospital
The COVID-19 pandemic remains an immense challenge for health care providers around the world. But in every crisis lies opportunity for change — and for hospitals, the changes came fast.
“COVID has tested and confirmed our ability to pivot quickly,” says Brian Johnson, MD, president of AHN West Penn Hospital. Dr. Johnson, an internist who previously served as West Penn’s chief medical officer, was appointed president in December 2020, at the beginning of COVID’s first winter surge.
Despite remarkable innovations in patient care and surgical technologies, health care is historically resistant to wide-scale operational change. The industry is vast yet fragmented, with diverse stakeholders and radically different technologies associated with different specialties and disease states.
For years, the thinking had been that health care is too big, too complex, and too uncoordinated to allow for rapid, systemic change.
And then came COVID-19.
“Change-management is hard, especially in a hospital — or in any work setting — where you have a lot of people who are used to doing things a certain way,” Dr. Johnson says.
“But if we can pivot quickly with COVID — make important changes to the way we operate, and take care of patients safely and effectively — we can do it any time and any way we want. We don’t have to wait for the next public health crisis.”
Bill Toland: Obviously, COVID-19 continues to test the fortitude of hospitals and their caregivers. What are the biggest challenges you’ve seen?
Dr. Brian Johnson: One of the biggest challenges — for us, and for every other health care institution in the country — is around workforce retention. We’re seeing it with nurses, surgical techs, respiratory therapists, imaging technologists.
There are a lot of reasons for retention and recruitment challenges — but burnout related to the pandemic is a big one. We’ve seen a significant percentage of nurses leave the profession over the last two years due to the pandemic, and an even larger percentage is considering it.
It’s really stressing the system.
Bill Toland: How do we address it?
Dr. Brian Johnson: Across AHN, we’re doing a lot around recruitment to get people in the door — signing bonuses and so on.
But ultimately, the goal here is to create an environment where people want to come to be part of the culture of caring we take pride in. That means making it a rewarding place to be, making sure that all of our employees realize that their work is truly important and their opinion truly matters, and helping team members to see that they have the ability and the autonomy to make patient care different and better where they see fit. It’s a different day here, and I want people to see that.
Bill Toland: And how do you help team members see that?
Dr. Brian Johnson: The first step is getting the right people in the right places, at every level of the organization. From the C-suite to the directors to the managers to the front line, we need to put people into the right roles, so that that they can succeed and feel empowered to best serve our patients.
Transparency and credibility are also vitally important. You have to include every employee in the decision-making process, you have to listen to them when they make suggestions, and you have to close the loop and tell them how we’re acting on the suggestions.
Here’s one example — not long ago, a few of our employees told us we needed to shore up the care transitions between post-anesthesia units and our surgical post-operative units. So we formed a committee of nurses from both teams, and they collaboratively came up with a new handoff process that worked well for our nurses, our particular facility, and most of all for our patients.
Feedback from our clinicians and front-line staff is the key ingredient to our decision-making. Everyone has a skin in the game.
Bill Toland: Is that why you continue to see patients? To keep that skin in the game, so to speak?
Dr. Brian Johnson: Absolutely. Having that patient touchpoint is really impactful. I see patients every Friday, and a lot of them, I’ve known for 15 years — it’s important to me that I continue to be a part of their care journey. I’m not sure I could ever give that up.
The other thing is, I feel like I have to experience what’s going on in health care myself, keep my boots on the ground, in order to understand what the doctors and nurses are dealing with every day. The “physician” part of “physician executive” is critical to effective leadership.
Aerial view of AHN West Penn Hospital.
Bill Toland: A lot has been made lately about how urban hospitals are evolving — from large, all-purpose medical centers to intensive care hubs that specialize in a few areas. Do you see that happening in this region?
Dr. Brian Johnson: Yes. There was a time when every hospital did everything, or at least tried to. And there are still some of those.
But I really don’t think that will be the case in the long term. What we’ll see is hospitals putting more resources into their centers of excellence — certain facilities are going to be very good at a handful of things, and another center may be very good at doing something else. A heart hospital, a cancer hospital, a transplant hospital. We’re already seeing that at AHN and elsewhere.
That’s the way we are going to be able to bring the highest quality care to our patients. Frankly, it’s the path to sustainability as well. It’s hard to be all things to all people, and there just aren’t enough specialists and surgeons to go around.
Bill Toland: Will you see those kinds of changes at West Penn?
Dr. Brian Johnson: We already are. We have a wonderful women’s and obstetrical program at West Penn, and the AHN Autoimmunity Institute is based here.
Going forward, we have a lot of plans to augment our surgical and cancer capabilities, which is where I anticipate West Penn will be growing over the next few years.
One example is surgical oncology with Dr. David Bartlett’s group, likely being hubbed here at West Penn. Dr. Bartlett’s group performed its first surgical oncology case at West Penn on August 5, and we’re excited to see that program have a larger presence here.
Thoracic surgery will continue to grow here as well — it’s a program that hadn’t been at West Penn for almost 10 years, and I think it’s been missed. It will fit nicely with our overall plan of being a center of excellence that offers all types of cancer care.
Our gynecological oncology program is growing every year as well, and I think it’s going to continue to grow, complementing our existing cancer and surgical services.
Finally, we’re building a $14 million Melanoma and Skin Cancer Center and research hub on the second floor of the Mellon Pavilion, thanks to a generous grant from the West Penn Hospital Foundation.
Bill Toland: With the focus on specialties, the “hospital as a gateway to care” model seems to be fundamentally changing.
Dr. Brian Johnson: The very premise that has supported this health care model for so long — that you need to bring patients into your building for an exam in order to provide optimal care — is being challenged.
Telehealth is already changing how we operate. We can dispense care while the patient is at home. We can care for patients between hospitals. For example, you have a patient who’s at the heart hospital, and they need a rheumatology consult. We can do that consult remotely from that patient’s room, rather than have that rheumatologist drive 50 miles, or rather than transporting the patient.
Delivering specialty medicine to inpatients virtually is going to be a big part of medicine going forward.
Bill Toland: For years, hospitals have served two somewhat conflicting purposes — acute care for people with health emergencies, and planned management of patients with chronic health issues. That second purpose, chronic care management, seems like it is ripe for disruption or outsourcing.
Dr. Brian Johnson: Just look at the impact continuous glucose monitors have made. Using those devices for my patients has made a tremendous impact in terms of how their blood sugar is controlled. The devices transmit their sugar levels to me, and I can alter their dosing in real time, over Epic and MyChart.
Five years ago, that wasn’t possible — so I would’ve had to wait for that patient to come in and see me in the office, read all of their hand-written blood glucose readings to see if I had to make a change, and then wait a few more months to see if we needed to make adjustments again. Now I can do that on a weekly basis — it’s better for the patient, and frankly keeps them out of the hospital.
Bill Toland: What role does the community hospital play in the specialty hospital environment?
Dr. Brian Johnson: The community hospital is still going to have a significant role to play. Not everybody can travel to the city to get the care they need. So you’re going to see the advancement of community-based facilities that have a few high-quality specialties and programs, complemented by telehealth specialties, so that they can take care of more things, and bring more types of care close to home.
Patients will be visiting the tertiary or quaternary care facility only when it’s needed, rather than as a matter of course. Say you have a patient in Washington County who needs a cardiac assessment done. They can go to Canonsburg, get the work-up, then see a cardiologist or cardiovascular surgeon from the city via virtual visit. If you need to escalate it, you escalate it. But in many cases, the first time that patient sees the inside of the tertiary care facility may be for surgery, because all of the preliminary stuff was taken care of at the community hospital or via telehealth.
Bill Toland: That future is being accelerated by COVID-19, it seems.
Dr. Brian Johnson: Sure. You always try to find the positives in a difficult situation.
As clinicians, we’ve learned a lot about ourselves — and a lot about our patients — over the last two years. We asked them to adapt along with us, and they did, particularly when it came to telehealth and virtual medicine. And for many of our patients, they may be better off as a result — patients with mobility or transportation issues, patients confronting socio-economic issues, and so on.
For them, care is now a click away. On our end, we’ve increased our remote bandwidth with video visits and telephonic visits, and we’ve strengthened our care management and care coordination tools in the offices. COVID really ramped up those capabilities, and they’re here to stay.
Bill Toland: Silver linings aside, I can’t imagine it was an easy time to lead a hospital.
Dr. Brian Johnson: Clinically, we eventually figured it out.
Emotionally, that took longer. Managing the emotional and psychological stressors that we all felt — the shortages, the long hours, the uncertainty about how the disease worked and how to best treat it early on — was the challenge. We didn’t know a whole lot about COVID, and it was hard to leave your work behind you at the end of your shift. Even going home was a stressor, because we didn’t know if we had been exposed or might be taking COVID home with us to our families.
Things are slowly improving, but we have a journey ahead of us.
Fortunately, we have an incredibly resilient team here at West Penn, and incredible leadership at AHN and across the enterprise. From day one, we have led the region’s COVID-19 response — from testing to vaccinations and everything in between — and I’m so proud to be part of an organization that always puts the community first.
Were it not for his mother, Brian Johnson might have ended up working on a family farm in Washington County, Pennsylvania.
“I still have plenty of family out there, working in agriculture,” Dr. Johnson says.
But his farming career, such as it was, never progressed beyond occasional hay baling. As a high schooler, he instead worked summers alongside his mother Linda — a medical technologist — at a group physician practice in Bentleyville, Pa., greeting patients and filing paperwork.
“That’s where I learned the ins and outs of primary care medicine and lab work,” Dr. Johnson says.
Still, medicine wasn’t a preordained career path. There were no doctors in his family, and by the time he graduated from Bentworth High School and enrolled at Washington & Jefferson College, he knew only that he wanted to work in a science field rather than a corn field.
A few semesters into his education at Washington & Jefferson, his path to medicine was becoming clearer, and after college, he attended and graduated from Temple University’s medical school. Clinical rotations brought him to West Penn Hospital in 2004, and he returned as a resident two years later. He has called West Penn his professional home ever since.
“I never had a thought, in medical school or throughout my residency, that I would eventually move into the administrative side of medicine,” Dr. Johnson says. “I was more focused on clinical care and teaching. Being a CMO or president never even occurred to me.”
But good organizations like Allegheny Health Network and West Penn, he says, challenge employees to grow and develop, and are able to cultivate new leaders as a result. He became the hospital’s chief medical officer in 2017, and its president in late 2020.
“I’ve been here for the entirety of my career, and I’m grateful for all the strong leaders and mentors I’ve had along the way,” he says. “They helped to prepare me for this role.”
He also learned valuable leadership skills from his father, Ron, a Bentworth High School teacher who coached Dr. Johnson in baseball and other sports at all levels. Through sports, Dr. Johnson — who played baseball, golf and basketball in high school — learned all about hard work and being part of a team.
“If it wasn’t for my mother’s and dad’s encouragement to further my horizons and continue to get better, I wouldn’t be where I am today,” he says.
Dr. Johnson lives in Sewickley with his wife, Michelle, and his three children.
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