Rebuild trust. The pandemic has shaken the trust of team members — trust that they will be safe at work, and that they will get the support and resources they need. I talked to the CEO of a large safety net hospital who told me he’s having trouble hiring people for jobs such as environmental services because people would rather work at Starbucks than risk their health and their families’ health. Another CEO told me that her number one job right now is to rebuild trust — with her team members, and with the community.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview M. Bridget Duffy.
M. Bridget Duffy, MD, is the Chief Medical Officer of Vocera Communications, Inc., the leader in clinical communication and collaboration solutions on a mission to protect and connect patients, families and healthcare professionals. As the Chief Medical Officer, Dr. Duffy plays a key role in new product innovations, acquisitions, customer relations, and accelerating the adoption of technologies that safeguard the physiological, emotional, and physical well-being of healthcare workers.
Empowered by professional experiences and personal stories, Dr. Duffy inspires leaders across the country to disrupt the status quo and reimagine the future of healthcare. Prior to her appointment at Vocera, Dr. Duffy co-founded and served as Chief Executive Officer of ExperiaHealth, a company that collaborated with healthcare leaders to improve the patient, family and staff experience through solutions that improve communication and restore human connections. ExperiaHealth was acquired by Vocera in 2010.
Dr. Duffy was an early pioneer in the creation of hospitalist medicine and launched programs to accelerate clinical discovery in the field of Integrative and Heart-Brain medicine, helping establish the Earl and Doris Bakken Heart Brain Institute. She was also the country’s first chief experience officer (CXO) in healthcare, establishing that role at the Cleveland Clinic in 2006 and making experience improvement a top strategic priority there and across the nation. Dr. Duffy is considered the founder of the experience improvement movement and is a frequent speaker on redefining safety to include protecting the physical and emotional well-being of frontline healthcare workers.
In 2020, Becker’s Hospital Review included Dr. Duffy on two of the publication’s women to watch lists. In 2019, she was named a Top 25 Women Leader in Healthcare Software by Healthcare Tech Report proceeded by recognition as a Female Healthcare IT Leader to Know by Becker’s Healthcare in 2019 and 2018. In 2017, Dr. Duffy was named a “Women of Influence” by Silicon Valley Business Journal and one of the “Most Powerful Women in Healthcare IT” by Health Data Management. In 2015, she was named “Woman of the Year” by Women Health Care Executives and selected as one of the “Most Influential Women in Bay Area Business” by San Francisco Business Times. Dr. Duffy was also recognized as a “Health IT Change Agent” by Health IT Outcomes in 2014 and named among the “Top 50 in Digital Healthcare” by Rock Health. Additionally, she earned the Quantum Leap Award for taking the risk to spur internal change in the field of medicine, and was featured in HealthLeaders magazine as one of “20 People Who Make Healthcare Better.”
Dr. Duffy attended medical school at the University of Minnesota and completed her residency in internal medicine at Abbott Northwestern Hospital in Minneapolis, Minnesota. She is a founding partner of the CEO Coalition and a co-founder of the National Taskforce for Humanity in Healthcare. Dr. Duffy also serves on the board of directors for Evolent Health, Inc., Kids Care Dental & Orthodontics, and is on the advisory board of Maven Clinic.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
The backstory to my path centers on my parents. They taught their seven children to give a voice to the underserved and to stand up for injustice. They turned those beliefs into action on Indian Reservations and in health clinics in underserved communities around the world. So, during the last month of my residency in internal medicine, while sitting at the foot of my patient’s bed after a long night on-call, I decided to take action as well. As I watched specialist after specialist came into the room, glance at the chart, check the machines keeping my patient alive, and then leave without ever touching my patient, I knew that I wanted to be a different kind of doctor. I wanted to be the voice and advocate for that patient and their family. So, I helped create one of the early “hospitalist” programs, which led to a movement around the country. Since then, I have been relentless in my mission to strengthen human connection in health — whether as a physician in the trenches, the first healthcare chief experience officer in the country, the chief medical officer of a Silicon Valley tech company, or a founding partner of a CEO Coalition focused on protecting the safety and well-being our nations’ healthcare workers.
Can you share the most interesting story that happened to you since you began your career?
I cold-called a person after reading a story about him that was so compelling — without realizing he was a gazillionaire, had invented the pacemaker, and founded a little company called Medtronic! That phone call changed my life. And it happened after a long and tiresome night of being on-call. I came home to an article in my mail about a man named Earl Bakken who had retired to Hawaii but had a vision to build the most healing hospital in the world. I called him up and said, “I want to help make your vision a reality.” He said, “Okay,” and we had a more than 20-year journey together focused on humanizing the delivery of medical technology. He died in 2018 at the age of 94. I miss his calls every few months telling me, “Bridget, we have to go faster to humanize healthcare.” I still hear him every day as I strive to make healthcare better for everyone.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
I can’t think of a funny mistake, but I can tell you my greatest fear: public speaking. Even in small groups, which made daily rounding on patients in front of my chief resident and staff painful. That was true for me until one day a cardiologist pulled me over and said, “beta blockers!” He was one of the best public speakers I knew. I asked him how he did it — and that was his reply! Knowing he was also anxious speaking in public changed my life. I learned to overcome my fear and I now have the courage to have a voice to lead change.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
The phrase I use all the time with my team which is my modus operandi is “covert with integrity.” When you’re working to fix a broken system, you can’t always work within the existing structures and rules. Covert with integrity is not about breaking rules just to break them, but about moving forward on the most expeditious path to achieve the desired outcome, and without compromising your integrity or that of your work.
Are you working on any exciting new projects now? How do you think that will help people?
I am collaborating with CEOs of health systems cross the country and other industry leaders to spark a movement to redefine safety in healthcare to include health justice and make psychological and emotional safety as important as the physical safety of healthcare team members around the globe.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is one who values the sacredness of the relationship with a patient — whether you are a nurse, doctor, parking valet, phlebotomist, or billing clerk. Every interaction matters and can either ease the burden or add to the burden of illness.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
I don’t think that any health system leaders were “at a complete loss” as to how to handle this crisis. I think they were faced with a lot of factors that made their jobs extremely challenging. For the most part they and their teams rose to the challenge admirably and with a lot of creativity.
First, COVID was a novel virus, so there we initially didn’t know exactly how it was transmitted. That left leaders scrambling to adjust processes, technologies, and even their physical environments to do everything they could to mitigate infection spread. We learned that our supply chains need to be more proactive and resilient to a global crisis to ensure we have access to adequate PPE to keep team members safe — whether they work on clinical teams or environmental services or other support teams. We also learned that we need to expand our definition of PPE to include communication technologies so that team members don’t have to risk contamination to communicate with their colleagues.
Second, also because COVID was a novel virus, we lacked treatment protocols. That meant that doctors, nurses, and other care team members whose professional identity — and personal calling — stems from helping were left often unable to help. Add to that the fact that for infection control reasons hospitals stopped allowing visitors, and team members carried an enormous emotional burden of both witnessing unprecedented levels of death, but also bearing witness to the passing of patients. We learned that healthcare team members need much greater emotional and psychological support than we have traditionally provided.
Third, we saw a public health infrastructure and public health professionals that were not supported by the politicization of a public health issue. That led to mixed messaging and sensationalism when what we needed was science-based communication and a clear understanding that scientific understanding would evolve as we learned more about the virus and its treatment. It also led us to recognize the structural inequities that led to Black and brown communities and poorer communities being hit harder by the virus.
Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
There are thousands, if not hundreds of thousands of stories of healthcare leaders and team members being heroes. In the fall of 2020, my team and I reached out and spoke to leaders at health systems and asked them what they were most proud of. They told us they saw team members run into the fire over and over again, showing up for work when they weren’t sure how much risk they were putting themselves or their families in. They told us about nurses making sure video calls happened between dying patients and their families — and then holding the hands of those patients so no one had to die alone. They told us about environmental services team members cleaning so effectively, and team members following protocols so assiduously that there were no documented in-hospital transmissions of the virus.
The thing is, though, healthcare team members don’t want to be heroes; they want to be healers. As leaders, we need to reimagine the system so that it never asks this much of healthcare team members again. That means supporting team members’ safety and well-being in ways we have only imagined in the past. It means investing in processes and technologies that ease the burden of the workload on team members so they can focus on the thousands of human interactions that make healthcare function and lead to healing. It means coming together as a nation and recognizing that healthcare is essential infrastructure and that the health and well-being of the people who work in healthcare are national assets.
Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Rebuild trust. The pandemic has shaken the trust of team members — trust that they will be safe at work, and that they will get the support and resources they need. I talked to the CEO of a large safety net hospital who told me he’s having trouble hiring people for jobs such as environmental services because people would rather work at Starbucks than risk their health and their families’ health. Another CEO told me that her number one job right now is to rebuild trust — with her team members, and with the community.
- Redefine and recommit to team member safety. The pandemic amplified pre-existing issues such as injustice and workplace violence, and introduced new safety concerns around infection and death. More than 3,600 healthcare team members died of COVID-19 in the first year of the pandemic. I’m working with 10 CEOs in the CEO Coalition to create a renewed definition of team member safety that encompasses safeguarding team members’ emotional and psychological safety, promoting health justice, and protecting their physical safety. We need all leaders, as well as national and local governments to commit to healthcare team member safety and well-being or we will face a crisis in healthcare that will last for years if not decades to come.
- Expand the definition of PPE to include communication tools. When team members had to adopt new infection prevention approaches to protect themselves and other patients from COVID-19, too many of them found that donning PPE left them cutoff from colleagues. They had to learn to write backwards on windows or risk infection by using devices like cell phones in contaminated areas. We need to expand the definition of PPE to include communication technology so no team member has to risk contamination to communicate with her peers and deliver exceptional care.
- Embrace human-centered leadership. Put simply, human-centered leadership is leading people with humanity. More specifically it is leadership that explicitly supports team members’ cognitive, emotional, physical, and spiritual well-being so they can maximize their human and healing potential. Health system leaders from across the country collaborated with us to create a mastery model that outlines how leaders can support humanity in every interaction.
- Reimagine human connection. One of the lessons of the pandemic is that we need human-connection to thrive. Never did we imagine a time when we would strip loved ones away from each other upon admission to the hospital. When in-person connection isn’t possible, we learned that purpose-built technology is essential to keep patients connected with their loved ones and their care teams. During the pandemic, nurses and other care team members had to go to heroic lengths to jury-rig solutions with whatever technology they could get their hands on. We need to reimagine human connection so that essential connections can happen via technology without disrupting nursing workflows or creating burdens on team members or loved ones.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
Physician shortages come from two factors: how many are entering the profession; and, how many are leaving the profession. Both are complex issues. The first is connected to how we attract and train physicians, and how much room we create in that pipeline. There’s currently legislation pending called the Resident Physician Shortage Act that aims to add 14,000 Medicare-funded resident slots into the pipeline. That act has more than 100 co-sponsors in the House of Representatives.
The issue of how many physicians are leaving the profession has to do with how physicians experience the work of being a doctor. We have burned out a generation of clinicians by viewing them as RVU generators instead of human beings in a caring profession. We need to restore humanity to healthcare by removing antiquated and cumbersome technologies and processes so that physicians can focus on the sacred healing relationship with their patient rather than experiencing patient care as a series of transactions and documentation.
How do you think we can address the issue of physician diversity?
The issue of physician diversity is also one that has to do with both pipeline and retention. On the pipeline side, we need to do a better job of supporting girls and boys from historically excluded groups as they rise through the education system to see that becoming a physician is an option, and that they can cultivate the compassion, skills, and drive necessary to become doctors. Organizations like Black Men in White Coats are working at this challenge. We also have to support and mentor these students as they work through their medical education so that it’s not only wealthy and privileged individuals who can afford to complete their educations. #MedGradWishList is a step in the right direction.
On the retention front, we need to rid our institutions of the systemic bias that leaves some physicians working in hostile environments, experiencing lower salaries (predominantly female specialties earn significantly less than those that skew male), and excluded from advancement opportunities.
How do you think we can address the issue of physician burnout?
I talked about this a little in your retention question. Burnout is an issue that my team and I have researched extensively. Frankly, we are equally if not more concerned about the impact of cognitive overload and burnout on nurses. It has grown worse during the pandemic for reasons I also discussed above. The solution has three necessary parts:
- Reduce the unnecessary trauma caused by poor systems. This is the most critical. We can’t expect physicians (or anyone) to thrive in systems that treat them as cogs in a machine. Inefficient processes, unrealistic “productivity” goals, poorly designed technologies, and unsupportive cultures all work together to create a toxic and traumatizing environment that leaders have a responsibility to improve.
- Invest in resources to help team members overcome the stress and trauma inherent to providing care. Physicians are responsible for life and death decisions. Even in a perfect system (which we don’t have), this is emotional work. We need to support clinicians with resources that support their natural resilience and remove the stigma attached to seeking help.
- Connect to purpose and joy. Purpose and meaning, together with factors such as giving clinicians autonomy and control over their work, are proven ways to reduce burnout. Leaders need to ensure their decisions are designed to maximize thriving, not just output.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
First, the questions above focused on physicians, but this challenge is not unique to physicians. We are facing a crisis in healthcare across the board — doctors, nurses, support team members (such as dietary and environmental services professionals) and others are questioning whether healthcare is a safe and supportive field in which to work. The pandemic has shaken their trust.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
I would like to start a movement that de-stigmatizes seeking help for emotional and psychological trauma. This comes from serving in the trenches during a pandemic or anyone seeking care for a behavioral health issue. To that end, I currently helped form the CEO Coalition to build a movement around the Heart of Safety, to redefine and recommit to team member safety and well-being. I think this is the most important issue that healthcare will face over the coming decade. We created a Declaration of Principles that puts a bold stake in the ground around a comprehensive definition of safety that includes protecting psychological and emotional well-being of team members, promoting health justice by declaring equity and anti-racism core components of safety, and ensuring physical safety, which includes a zero-harm program to eliminate workplace violence, both physical and verbal. We are working with the Institute for Healthcare Improvement and others to turn that Declaration into action so that we can ensure that healthcare team members are safe at work. If we don’t do this, we will face an exodus of healthcare talent and compassion that will cripple our ability to care for patients.
How can our readers further follow your work online?
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.