Make the patient, not technology, the focus again — It’s critical for health systems to not let themselves become over-enamored with technology. Instead, the focus should be on the patient and processes and let technology enhance the patient-caregiver relationship, not micro-manage or replace it. Currently, the healthcare model is generally 80% technology, 10–15% physical evidence, and 5–10% patient interaction. The dependence on technology has created high costs in terms of both money and lives.
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 Dr. Jeffrey Kuhlman.
Dr. Jeffrey Kuhlman joined the physician leadership team at AdventHealth in 2013 and leads clinical transformation serving as Chief Quality & Safety Officer. He is the co-author of Transformative Healthcare, a book that shares a physician-led prescription to save thousands of lives and millions of dollars.
During Dr. Kuhlman’s thirty-year career in Navy Medicine, he was the longest-tenured physician assigned to the White House (1997–2013) serving as senior flight surgeon for President Clinton, director of the White House Medical Unit for President George W. Bush, designated as the Physician to the President by President Obama and provided care for former President George H. W. Bush at Camp David and Walker’s Point.
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?
I was raised in a university town near Chattanooga, Tenn., the second of eight children, by a nuclear physicist father and academically gifted mother. Education was valued and respected. The physicians I encountered were humble, intellectually curious and dedicated to caring for people. They were valued and respected. I perceived being a physician as a challenge, and that’s how I wanted to serve.
Can you share the most interesting story that happened to you since you began your career?
Military service provides extraordinary opportunities for those willing to go where needed. During Desert Shield and Storm (1990–1991), I was one of a handful of doctors left in the high desert at the world’s largest military base. There, I delivered hundreds of babies of mothers whose spouses had rapidly deployed to the Middle East. Being able to support them in their time of need was rewarding. I noticed most named their child after the military member they feared may never meet their newborn.
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?
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I share with those I mentor: “on my first day of medical school, they taught me three things, listen to your patients they will tell you what is wrong with them, don’t be over-enamored by technology and for every patient, give them something for their time of need; a medicine, a procedure, or a shoulder to lean on and a hand to hold.”
Are you working on any exciting new projects now? How do you think that will help people?
When I was working as a chief medical officer at our 3,000-bed flagship hospital, AdventHealth Orlando, I had a chance to lead a team working with frontline physicians and nurses to improve the care of patients. We developed a data-driven, evidence-based program to permanently transform healthcare. The improvement methodology, based on change management principles, focused on engaging caregivers in more conversations and operation decisions, which saved thousands of lives and millions of dollars. With Daniel Peach, executive director of clinical innovation for AdventHealth, we shared our experiences in a fourteen-episode series of podcasts, Transformative Healthcare. Daniel and I have had the opportunity to present internationally and have contributed multiple presentations in peer-reviewed journals. Coming this summer, our book Transformative Healthcare will be available from AdventHealth Press.
How would you define an “excellent healthcare provider”?
The patient-caregiver relationship is the basis of excellent healthcare. Trust and knowledge are of paramount importance. The patient must trust you have their best interests (physical, mental and spiritual) in mind. You can’t just have the information — you have to have current clinical competence, the most up-to-date approaches, understand the pathophysiology, and be able to communicate effectively with the patient. For the decade I was privileged to serve at the White House, I strived for “no politics, no policy just trusted medical advice.”
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?
The U.S. public health infrastructure has been completely dismantled, barely existent and minimally funded, and because of the pandemic, we saw the effects that a delicate health infrastructure placed on the American health system. Even before the pandemic, the U.S. struggled with the neglected pandemic “Diabesity” (type 2 diabetes and obesity), and COVID-19 exacerbated the risk for chronic conditions, making people who had these types of conditions critically ill very quickly, which placed a huge amount of stress on health systems across the country.
Currently, the 5,000+ hospitals in the U.S. are designed to care for the critically ill and the sickest of individuals needing constant care. The pandemic showed a need for a better-managed care plan for preventing diseases and conditions like obesity and diabetes. Looking forward and reflecting on lessons learned from the pandemic, health systems should create plans that focus on prioritizing preventative medicine and not only on treating patients when they become critically ill. By doing this, we can help prevent added stress on health systems and have a healthier public.
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.
My daughter and daughter-in-law are experienced nurses in AdventHealth’s busy emergency departments. During every shift, they cared for individuals suffering from COVID-19, as many hospitals did across the country as they reached capacity. With the amount of changing information being thrown at them every day and, for some, limited resources, shows our nation’s healthcare professionals are resilient.
The pandemic accelerated the need for healthcare professionals to adapt and quickly learn new technologies, like telemedicine and telehealth. Many health systems were able to successfully implement these tools, which not only benefited caregivers, but allowed patients to comfortably receive care from the comfort and safety of their homes.
Health systems across the country found ways to prioritize taking care of their teams and their families. At AdventHealth, our team developed a redeployment app for team members to find other areas within the organization where they were qualified to work, ensuring that they stayed employed and could serve where the needs were greatest. We expanded our employee benefits by including additional mental health services, provided hotel rooms for those who worked in COVID-exposed units to protect their family and community, and child-care.
As COVID-19 vaccinations became available, many health systems successfully found ways to plug themselves into their communities and help with vaccination efforts. Not only were AdventHealth team members excited to get their vaccine, but they volunteered to go where they were needed — and staffed vaccination sites. We transferred nurses across 10 U.S. states to pandemic hotspots to help.
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.
To truly transform healthcare, we need to:
- Listen to our caregivers. They know how to best care for their patients. When health systems create standardizing care guides, it’s critical to bring caregivers of different specialties caring for a specific disease into the conversation and process. By reviewing evidence, local data and experiences from the team, health systems can then develop a consensus-based, written algorithm that identifies and removes barriers and obstacles they face. At AdventHealth, we worked with our clinical teams and developed an emergency department chest pain algorithm that originally had 50 to 100 measures, and we simplified it to three key measurements. The guide created by the team not only helped increase team morale and ownership — but has saved money for the patient and health system and thousands of lives.
- Make the patient, not technology, the focus again. It’s critical for health systems to not let themselves become over-enamored with technology. Instead, the focus should be on the patient and processes and let technology enhance the patient-caregiver relationship, not micro-manage or replace it. Currently, the healthcare model is generally 80% technology, 10–15% physical evidence, and 5–10% patient interaction. The dependence on technology has created high costs in terms of both money and lives. When we gather input from doctors and nurses across AdventHealth, not once have we been asked to add more technology or another tower into our methodology — let alone lead with it. This is telling because we have realized that our healthcare professionals want to provide personalized care instead of tech-centric care.
- Avoid over reliance on data: encourage practice-based medicine. Currently, many healthcare systems rely on rigid step-by-step guidelines for care, or what I call “cookbook medicine.” The advantage of incorporating some evidence-based medicine is that it brings proven methods into the equation. The disadvantage is that evidence-based medicine is less personal. By tapping into more practice-based medicine, especially during times of crisis or combating a new disease, helps increase communication between teams and allows for knowledge sharing. It also allows for proper care to be determined up close, one patient at a time. It includes the story of that person’s life and utilizes that story in their care. When creating standardized care guides (or algorithms) at AdventHealth, we ask our caregivers, “how do you care for a patient with X?” We encourage the shift from the rigidness of evidence-based practice to the flexibility of practice-based evidence. This has prevented patients from getting lost in an abyss of data, caregivers becoming more passionate about their purpose, and has saved thousands of lives and millions of dollars.
- Engage frontline caregivers and improve team communication. It’s critical for health systems to find ways to engage and empower their frontline caregivers. By incorporating your medical staff in operational decisions, you will see positive impacts for both your patients and your teams. Working in collaboration with our medical teams when developing an algorithm for our emergency department in Central Florida, we were able to better manage patient flow by determining if the patient would receive the best method of care in the hospital or at home. This helped reduce care costs for patients and kept beds open for those who needed immediate critical care.
- Prioritize moving healthcare outside the hospital walls and further into your communities. Healthcare systems should prioritize finding ways to engage in their communities to provide access to healthcare to those who need it the most. Whether that be activating programs to provide health services to underrepresented communities or combating vaccine hesitancy, health systems are uniquely positioned to address, engage, and partner with their communities and stakeholders on their area’s key issues. During the COVID-19 vaccine rollout, AdventHealth teamed up with churches across the country to offer vaccines on-site. At AdventHealth, we want to provide interventions and solutions to the challenges that act as barriers for people in the communities we serve, and in March of 2021, we hired our first Chief Health Equity Officer, Dr. Alric Simmonds, who will work to ensure that regardless of socio-economic status, gender, sex, age or race, every person we serve has equal opportunities to have equitable care and outcomes.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
To combat shortages, physicians should be encouraged to work with their highly skilled medical staff as a team to lay out the best approach for their patients. Health systems should also focus on incorporating automation tools for administrative tasks allowing physicians to spend more time with patients and less time doing admin work. Health systems can also engage in mentorship to help guide physicians who are struggling or new to practicing. At AdventHealth, we have recently implemented residency programs in rural areas with the hope of them staying there after completion.
How do you think we can address the issue of physician burnout?
Burnout in physicians is an issue that should be addressed immediately, especially as we continue to navigate the pandemic. To help with workforce burnout, physicians should be encouraged to engage their nurses, advanced practice clinicians, and other clinicians, who are highly trained, to create the best methods of care for patients. Administrative tasks are also huge barriers that take caregivers away from the reasons they wanted to practice in the first place, taking care of patients. With busy schedules and time restraints, physicians have expressed not having enough time with patients and want to make the patients the focus again, ensuring they receive the best care. With the lack of control physicians currently have in terms of patient care, the “red tape” affects the physician-patient relationship, which can lead to caregivers losing their sense of purpose as to why they joined the field in the first place. Removing barriers and obstacles that physicians face will help rejuvenate the purpose that led them into medicine, addressing personal and professional satisfaction.
What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
For health systems considering transforming and implementing changes, now is the best time to do it. The pandemic has shown us flaws that the U.S. healthcare infrastructure has, and it should be a priority to make a positive transformation by using lessons learned from the pandemic. To manifest change, health systems must allow their clinical workforce to join the conversation to create an impactful transformation. By doing this, not only will it keep that purpose within your teams, but it will ensure patients are receiving the best care.
We also saw communities working tirelessly with health systems to combat the pandemic, and we saw resiliency and impactful outcomes. If communities and health systems continue to find ways to work in partnership, we all will benefit from a healthier community and ensure all of those who need healthcare can get it.
Performance improvement tools will give you only short-term wins. Improvement methodologies based on change management give you true permanent change (transformation). When AdventHealth implements changes, the eight steps, penned by John Kotter, come to life in four phases of the improvement method: design, pilot, implement and sustain. By incorporating evidence-based medicine, data, and experiences from our teams, we create clinical improvements that have positive clinical outcomes for our patients and caregivers that aren’t centered around financial or administrative results.
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. 🙂
In caring for four U.S. presidents, I learned this from them:
- Lead a physically active life.
- Progress to a more plant-based diet.
- Have temperance in personal habits.
- Have a positive outlook and heart of gratitude.
This all comes back to whole-person care, which means addressing the physical, mental and spiritual needs of an individual as part of the patient-physician relationship. This approach can apply to caring for populations and can transform the health of entire communities.
How can our readers further follow your work online?
The Transformative Healthcare podcast can be found on your favorite podcast platforms.
The Transformative Healthcare book, coming this summer can be ordered from AdventHealth Press.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.