A CEO Walks Into a Patient Room: Q&A With Dr. David Feinberg, CEO of UCLA Health System

David T. Feinberg, MD, is the CEO of UCLA Hospital System, associate vice chancellor of UCLA Health Sciences, and the first person to tell you 99th percentile isn't good enough.

A psychiatrist and former medical director of UCLA's Resnick Neuropsychiatric Hospital, Dr. Feinberg assumed his post as CEO in 2007. Patient satisfaction scores have increased from the 38th to 99th percentile at UCLA since then, due in part to his intent focus on the patient experience. He distributes his cell phone number to patients and employees, welcoming their calls all hours of the day. He doesn't believe in red tape or bureaucracy, but firmly believes in miracles. Here, Dr. Feinberg shares his leadership philosophy and explains why he won't be content until every UCLA patient is completely satisfied.

Q: A Los Angeles Times article from May 13 mentioned you pass out your business card to patients and encourage them to call your cell phone. How do you maintain this level of accessibility?

Dr. David Feinberg: I started visiting with patients when I ran the psychiatric hospital here. Many of the patients were suicidal or homicidal, most didn't want to be admitted, but they would still hug us and thank us at discharge. It was an old building in poor condition, but we seemed to provide a level of care that went beyond the structure. When I got this job, I went into patient rooms because I was really scared. There was a lot about running a large academic medical center that I didn’t know. I spent time with patients to decrease my anxiety — it was something I knew how to do.

After three months, I learned two things. One: UCLA performs miracles. We perform more organ transplants than any other hospital in the country. We invented PET scans. We diagnosed the first case of AIDS. I learned about all of these great accomplishments, but I also learned that people wouldn't refer us to a friend. We ranked in the 38th percentile for how many patients would refer us to family or friends. That was because they didn't know who their physician was, no one made eye contact, the place was dirty, the air conditioning didn't work, hot food wasn't hot and TVs didn't work.

I figured I could never be as smart as UCLA's miracle workers but I could make this a more compassionate place. Now I visit patients because it's the most fun part of the job. I love talking to families, and our patient satisfaction has gone to the 99th percentile. When I'm in a room and staff members come in, it's a totally different experience. Everybody is giving business cards and writing cell phone numbers down — not just me.

Q: Can you recall a memorable experience you've had with a patient?

Dr. Feinberg: I met a grandmother last week who was dying of metastasized breast cancer. Her daughter was having a baby in northern California, and she wasn't going to be able to see the baby. Our nurses heard about and had the daughter transferred here. The mother was induced, the grandson was born and the nurses gave him to the grandmother to hold.

Just last night, I received an email from a urologist, telling me about this incredible moment. He was explaining something to a Spanish-speaking patient, and his Spanish was broken. So the nurse sees this interaction. She leaves the room and comes back with a laptop with [Skype] and connects the urologist with a Spanish-speaking translator. The urologist said, "The nurse saw I wasn't doing a good job and she immediately fixed it, without even saying anything."

Q: UCLA Health recently joined the National High-Value Healthcare Collaborative. Do you think healthcare is shifting from a philosophy of competition to collaboration?

Dr. Feinberg: We've always been collaborative. We're a relatively new player in healthcare. We were singled out by Dartmouth Clinic for the cost of care for Medicare patients who died here versus those who died at Mayo Clinic. It was something like $96,000 versus $45,000. We said we'd like to learn more about it. Really, though, materials published have shown that variance is much less if you make certain adjustments, such as socioeconomic class and the severity of the condition.

Still, I think we waste tons of money everyday. The work Dartmouth is doing is exactly what we want to be a part of: sharing data, sharing best practices and this whole goal of improving value through higher quality and less cost. Yes, we want to be a part of that. We were knocking on the door, asking to be a part of that. We believe healthcare is shifting from volume- to value-based. We have a lot of expertise, but we also have a lot to learn. We might have the best organ transplant survival rate, but there's room for improvement with our end of life care. These collaborations allow us to share what we know and learn from others.

Q: What has been one of your proudest moments at UCLA thus far? When was a moment you left the office and felt good about something you accomplished that day?

Dr. Feinberg: I'm a psychiatrist, and I always had this fear that I wouldn't be therapeutic for a rape victim. And I remember seeing my first rape victim — she was in her young 20s, worked as a waitress. She experienced this terrible rape scene. I don't know why it was my worst fear to counsel her, maybe because [rape is] so brutal.

We have a great rape treatment program here, and I referred her to our program. I received a long thank-you note from her about how kind I was and how well her treatment was going, and I thought, 'Good job Dave, you did it.' For some reason, that's something that's always scared me. It was, I think, a traumatic event that personally made me feel like a healer.

Q: You're known for outstanding communication with patients, but how do you maintain employee engagement? Do you make yourself as accessible to them as you do patients?

Dr. Feinberg: I don't differentiate. Employees have my cell phone number. I tell them to call me any hour of the day. If they have any problems, I tell them to email me, call me, page me — I'm here. Please get in touch with me. If something isn't going right at work and we can fix it, I want to know right away. I want to do my best to get the bureaucracy out of the way.

Q: You've also said you want patients to be treated like members of your own family. What other philosophies, events or people influence your leadership style?

Dr. Feinberg: I had great mentors. One of them is a gentleman named William Simon Jr. He said to me, when I got this job, "You're going to have thousands of decisions coming at you everyday. You need to focus on one or two things and that's all you can really change." So this idea of singular focus has stayed with me. I chose to focus on improving our connection in a human level with our patients. My family is also really supportive. My parents are really good with people, and my wife is a great partner.

Q: UCLA has made major strides in the last few years, particularly in patient satisfaction scores. How do you recommend hospital executives/managers handle negative feedback? How do you approach criticism?

Dr. Feinberg: Well, I'm the most critical of all — 99th percentile patient satisfaction sucks. That puts us in 99th percentile among hospitals, so 85 out of 100 patients would recommend us to family or friends. All that means to me is that we have failed miserably with 15 patients and families. And I wanted those patients treated like my family. I'm critical of myself everyday. We can't ever mess up. We need 100 out of 100 patients to be satisfied and it has to stay that way. This 99th percentile is terrible, but it's much better than where we started.

I'm critical of myself, and I don't care about the other stuff. That's a distraction. Talk about whether I'm overpayed or underpayed — that comes with the territory. I just hope I leave this place better than I found it. We have more applications to UCLA's undergrad program than any other university in the country. A third of our undergrads are the first in their family to go to college. We're owned by the people of California. I'm so proud to be part of this place.

Q: With illness and disease, hospitals aren't always the most optimistic work environments. How do you keep morale high among employees?

Dr. Feinberg: Our morale is really high. Employee satisfaction is high. Even if we're faced with difficult cases that don't go well, or people don't recover, I think it's important for us to be kind and alleviate suffering. If we can do those two things, we're living up to our mission.

Our true north is serving others, making our patients more comfortable. It might seem tough but it's very inspiring, even when it means you're crying with the family. Personally, everyday when I'm walking into work I think three words: passion, humility and integrity. If I can get those three right, I'm doing my job.

Q: Healthcare reform has spurred change left and right, and it can be difficult to keep up with deadlines, new programs and developments. With your busy schedule, how do you remain informed on the politics, legislation and other issues affecting healthcare delivery?

Dr. Feinberg: I don't think that's my job. I think my job is to take care of the patient right in front of us. The next patient is a donor, voter and citizen. If they believe UCLA is here to serve them, they won't let anything bad happen to us. We see 1.5 million patients per year. That's our answer to healthcare reform. That focus [on patients] is crucial.

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