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Over time, every hospital develops a personality a workplace culture unique to its history, its style and work tempo, its values, and the community it serves. That personality can have an outsized impact on the success of a hospital, and the success of the teams working inside of it.
But how do you go about building that culture, and developing that identity, for a brand-new hospital?
“We took time, prior to opening, to think about issues related to structure and process,” says Katie Farah, MD, chief medical officer of AHN Wexford Hospital. “Because we’re not trying to repair our own history and habits, we’ve been able to build a culture where everybody feels empowered, is more likely to feel included, and is more likely to be engaged with the patient and each other.”
That work of developing a culture and everything else went on for three years prior to AHN Wexford opening in autumn 2021. Dr. Farah and the rest of the hospital’s leadership team (Allan Klapper, MD, president; Amy Cashdollar, chief operating officer; Lisa Graper, MSN, chief nursing officer; and Tom Hipkiss, chief financial officer) leaned on the vision and values already established at AHN but also cultivated a workplace unique to AHN Wexford.
Bill Toland: So where do you start when you’re building a hospital’s identity from scratch?
Dr. Katie Farah: From the beginning, we worked on building a high-reliability organization, which really focuses on giving the best care to the patient, in a safe, reproducible, effective, and efficient way. It started with implementing the micro-behaviors that lead to better care and outcomes purposeful hourly rounding, testing efficiency, adverse events reporting, and so on. Caregivers thrive in a culture of safety, transparency, and clinician and employee engagement, and that’s what we wanted here at Wexford.
We were able to get many systems in place before the first patient came through the doors, and we were able to set our standards and get input and buy-in from our employees and stakeholders.
We wanted to ingrain the AHN Wexford culture from the start, and I believe we did that.
Bill Toland: Was that easier to do with a blank slate?
Dr. Katie Farah: In many ways, yes.
The fact is, we recruited people from within the network, as well as out-of-state clinicians who came from a different culture and had a different way of doing things. It provided us with a potpourri of different workplace experiences and life experiences, which can be a good thing. We want a variety of ideas and initiatives, which over time helps us to innovate and raise the bar.
This may be self-evident, but when you don’t have patients to care for yet, you have more time to communicate, brainstorm, and research best practices. In every area of the hospital including the emergency department, inpatient floors, radiology, lab, the operating room, and the ICU we established effective communication protocols between providers and strong interdepartmental partnerships before the opening.
And now that we are live, we are still leveraging those tools and relationships. It helps with the day-to-day operations and clinical care, and it also helps when we are problem-solving in real time. The foundation we laid and the trust we built are paying off now.
Bill Toland: You’re the chief medical officer, which means you lead the hospital’s physician staff. How did you go about building that team? Were people beating down the doors to work at AHN’s newest hospital and work in those big new operating suites?
Dr. Katie Farah: We have physicians from all over including providers who moved here from out of state, physicians who are local but new to the network, as well as employed physicians and independent private practitioners. But yes, there was a lot of interest in being here, from inside and outside of AHN.
In terms of our own AHN physicians, we have a number of specialists and surgeons who are based downtown but rotate through AHN Wexford throughout each week. So in many cases, we are able to provide access to the same specialists, the same skill level, and the same clinical programs as you will find at our larger hospitals in the network.
Bill Toland: What about recruiting nurses and support staff? Was that made easier by having a brand-new hospital?
Dr. Katie Farah: Recruiting has been, and continues to be, a challenge for all hospitals at this time. We are all short of where we want to be, of course. But relatively speaking, I think we did have a bit of an advantage, because people wanted to work in a nice new building, and they want a fresh start.
I also think, once they have been here for a while, they see that we really are doing things the right way. Because of the communication channels that I referenced earlier, we're able to solve a lot of problems in real time. When the staff see that their opinion matters, that we listen to and solve problems, and that what they are communicating to us is important, they truly feel more empowered and more engaged.
Bill Toland: Over the last few years, there has been much focus on nursing burnout, for good reason. Can you talk about the physician side of it?
Dr. Katie Farah: Think about a physician’s life: A physician goes to school for many years, graduates, and develops a feeling of accomplishment. Then we simply want to take care of our patient the best way we know how.
What happens, I think, is that pretty quickly physicians can lose autonomy, especially in a big health care system. Physicians are given their schedule and practice location. When physicians are surveyed, some of the top dissatisfiers are loss of autonomy, chronic fatigue, and electronic health record burnout.
Ultimately, physicians want a voice in that. That's why here at AHN, and with Highmark Health’s help, we are putting physicians in leadership positions. They are the ones who know what is best for their patients. I think just giving physicians that voice, encouraging their engagement and demonstrating the impact of their input, is an important part of mitigating burnout.
But certainly, the other elements including physical exhaustion and EHR fatigue are real factors.
Bill Toland: Working long hours is part of the physician culture. How do you tell people who are hard-wired to work 12-hour days to slow down, focus on wellness, remember to decompress? It’s one thing to tell people to practice self-care it’s another thing to invest in it organizationally.
Dr. Katie Farah: Correct. You have to provide and get their input on the structure and process, which in turn empowers physicians. But you also have to do the little things that make their lives easier and allow them to focus on their patients.
Most physicians want to provide the best care to their patients. And sometimes there are frustrations when they cannot for reasons such as electronic medical records navigation or care path delays. As CMO, in collaboration with our executive team, I am aiming to improve the total clinician experience, which has a lot of components.
Beyond that, we are listening to our physicians when they tell us they need tools to succeed. For example, we built a physicians’ lounge because physicians expressed to us that they needed a place to touch down and be able to take a deep breath. We took care of some parking issues, which was also a dissatisfier. We added more hydration stations once we realized there weren’t enough, as per request.
When physicians see that we respond to their concerns, and that we are listening, they are more engaged, and feel less of that burnout. If our physicians, nurses, and employees are cared for, our patients will in turn receive exceptional care, because the caregiver experience is so closely intertwined with patient experience and patient outcomes.
Over the last few years, our chief clinician wellness officer Dr. Tom Campbell and his team have done a great job on big-picture issues related to clinician wellness. It is such important work. But it’s just as important that we do what we can on a local level to make sure we are addressing those issues. Clinician wellness is one of our top initiatives, and we take it very seriously.
Bill Toland: What’s the biggest surprise you’ve experienced since AHN Wexford opened?
Dr. Katie Farah: Good question. First, I’d say that no two days are the same. When you are seeing patients and focused on your practice, you are always in that clinical mindset. In leadership, you are dealing with operational efficiency issues, personnel issues, clinician dynamics, and infrastructure issues. The issue might be as trivial as a leaky faucet, or something such as a furnace failure, or even a disaster plan such as dealing with a massive snowstorm. We also tackle daily quality, patient safety, and efficiency issues, which always offer improvement opportunities and learning experiences for our team. So we have to be prepared for anything.
As a clinician, you’re used to being in control, you’re used to managing the care of the patient. You know what the formula is, and you know how to fix whatever the issue is. But as a leader in a hospital, it is much more of a team effort. You’re listening to the different disciplines, different parts of the organization regulatory, finance, patient safety, quality leads, infection prevention and you are doing a lot of planning and implementation of proactive operational excellence skills.
The important thing to recognize is that everybody has something to contribute, and you really have to make sure you look at every situation with a wide lens. That means putting aside your own experiences and biases, and appreciating the sum total of values, beliefs, work ethics, strengths, and weaknesses within your group of people. In order to be a strategic planner, you have to be a good listener.
Bill Toland: Now that AHN Wexford has been “lived in” for a few months and you have a few scuff marks on the walls, what kind of feedback are you getting from patients and staff?
Dr. Katie Farah: That is a good insight when you open, it’s all about the beautiful marble floors, all the sunlight, the windows, the open feel, and how new everything looks. Patients definitely notice it, and it has an impact on mood and patient experience.
But after that, it’s all about the service you receive inside. So every day, we try to improve what we have. And there's always room for improvement, in every area efficiency, quality, safety, infection prevention, and patient experience. We are always striving to get better.
Bill Toland: Most physicians want to help patients that’s why they study medicine in the first place. Did you find it difficult to make the transition to hospital leadership?
Dr. Katie Farah: I have been in practice for 15-plus years as a therapeutic gastroenterologist. Around year 10, I realized that I enjoyed problem-solving in an effort to create new processes to improve outcomes. I also have a passion to improve how health care is delivered. So I’ve spent the last five years working toward this, primarily within the Division of GI as its chief quality officer. And eventually, I wanted to do something outside of the scope of gastroenterology, to oversee a wider spectrum.
I still have an active GI practice in the North Hills I have an exceptional physician's assistant, Janelle Porter, who runs my clinic on a day-to-day basis. I perform procedures two days a week, and I round in the hospital as CMO as well as a gastroenterologist.
Bill Toland: Almost all of our physician leaders at AHN continue to practice, even if it’s just a few days a month. Why is that important?
Dr. Katie Farah: To lead other physicians, and to be trusted by them, you have to understand their frustrations. You need to be able to relate to the issues they have. It’s hard to do that without being in their shoes at least part of the time.
And like you said, most of us went into medicine because we love to take care of patients. I would never want to give up that part of my practice, because it is so rewarding.
I do appreciate the effort AHN and Highmark Health have made to put physicians in leadership positions across the organization. We have such a big emphasis on physician and clinician engagement here, because at the end of the day, the physicians really know best when it comes to the best care for their patients. Getting their input on best practices, evidence-based care models, and cost of care is vital not just for our organization, but for our industry.
Finally, as leaders, we need to understand the fact that because of the COVID-19 pandemic, it has become a very difficult and challenging time to provide health care effectively and efficiently.
Bill Toland: Your time at AHN predates becoming part of the Highmark Health team. What’s the biggest change you’ve seen since then?
Dr. Katie Farah: I think the biggest change was the collective realization among those of us at AHN that Highmark Health was all-in and here to stay. It didn’t take long before we noticed everything made available to us the capital, the latest technologies, and the resources and tools needed to execute on key issues and initiatives.
There are so many things that go into providing the best possible care for your patients, whether it is supplies, technology, staff, or analytics tools that allow us to measure our performance and function. Having all the tools we needed was key.
Bill Toland: Was there an “aha moment,” when you and others realized that the partnership would work? Certainly there must have been some skepticism about a health insurer working so closely with an existing hospital system.
Dr. Katie Farah: I was still working in GI in 2013, but yes, I noticed it pretty quickly. It didn’t take long to realize that AHN and Highmark Health have the same long-term mission, which is to provide high-quality care at lower cost with the best outcomes.
With colon cancer screenings, for example, Highmark Health was genuinely interested in that screening process, how we could make it better for the patient by improving access to care, and how we could eliminate waste and costly missed opportunities. We wanted to increase access to screenings, while also being cognizant of the potential of lost dollars from overutilization and unnecessary testing.
So AHN worked with Highmark Health to identify our own best practices for eliminating waste where it existed. And we also worked to provide colon cancer screening more efficiently, while identifying areas of opportunity where underutilization exists and where underserved populations needed more screening access.
We found that by working together we were able to decrease waste, improve screening rates, and diagnose colon cancer sooner. As such, the cost of treating colon cancer and its complications decreased. It is great for the patient, and it is great for the system.