Northwest Permanente CMO Dr. David Parsons' advice for hospital execs: 'People detest ambivalence'

In this special Speaker Series, Becker's Healthcare caught up with colorectal surgeon David Parsons, MD, who is the director of operations, hospital services and surgical specialties and the regional CMO of Portland, Ore.-based Northwest Permanente, a 1,190-physician medical group part of Kaiser Permanente.

Dr. Parsons will give a presentation alongside Northwest Permanente Chief of Staff Tim Borne at Becker's Hospital Review 7th Annual CEO + CFO Roundtable titled "Instant team effectiveness: How to quickly create surgical safety success" at 12:45 p.m. on Tuesday, Nov. 13. Learn more about the event and register to attend in Chicago.

Question: What keeps you excited and motivated to come to work each day? 

Dr. David Parsons: I have been practicing surgery for 20 years. I am blessed to do what I do and to have the privilege to care for patients and make a difference when they are at the most vulnerable times of their lives. I love operating, and I love solving problems.

I also enjoy my administrative duties, which undoubtedly help many more patients through a completely different mechanism than one-on-one direct patient care. For example, I am proud to be part of a leadership team that did significant work to reduce surgical site infections to the degree that we are continuously ranked among the best hospitals in the United States in this regard, based on National Surgical Quality Improvement Plan benchmark data. Preventing infections after surgery improves quality and affordability.

Q: What major challenges, financial or otherwise, are affecting hospitals in the markets you serve? How is your hospital responding? 

DP: The biggest challenge is providing value. We all understand quality, but the real challenge is providing high-quality care and outstanding service while keeping care affordable. I am fortunate to work for Northwest Permanente — part of integrated healthcare system Kaiser Permanente — an organization that puts equal emphasis on quality, service and affordability, while also focusing on making the work sustainable and joyful for those who provide healthcare.

Q: If you could pass along one piece of advice to another hospital executive, what would it be? 

DP: Listen to the people you lead and be honest about which problems you can solve and which ones you can't. People usually don't mind being told no as long as you are direct and honest about the reasons why. People detest ambivalence.

Q: What initially piqued your interest in healthcare? 

DP: I grew up in a medical family: My mother was a nurse anesthetist and my father was a neurosurgeon. While my father discouraged me from going into medicine — in his opinion, in the 1970s and 1980s, things were changing for the worse — I realized at an early age a career in healthcare would provide an opportunity to do meaningful and worthwhile work. I also witnessed the gratitude and respect that both of my parents received in their fields. Sometimes actions and observations speak louder than words. I specifically chose a career in surgery because I have always appreciated manual work (i.e. fixing things).

Q: What is one of the most interesting healthcare industry changes you've observed in recent years?

DP: The shift in emphasis from productivity-based reimbursement to value-based reimbursement is interesting. In my own organization, we have always used this principle, and I think it is a good approach. The entire health-care industry has a long way to go to achieve high-quality, affordable care for everyone in America, and it will be interesting to see how this evolves.

Q: How can hospital executives and physicians ensure they're aligned around the same strategic goals?

DP: Ultimately, it comes down to placing the patient in the center of all decisions. Healthcare is complex, and we all have our own perspectives, but if we always ask what is best for the patient, we will usually make the right decisions. I have a great relationship with my hospital executives. While we may not always agree, we are collegial and respectful to each other, and we have had great success in developing strategies and solving problems together.

Q: What is one piece of professional advice you would give to your younger self? 

DP: There are going to be great days and really bad days. Be resilient and frequently remind yourself what an incredible privilege it is to be able to do what we do.

Q: Describe the most challenging decision you had to make as a healthcare executive. Why was it so challenging?

DP: There have been many challenges, but I find that asking individuals to leave our medical group to be the most challenging. This is difficult because I tend to put myself in their shoes and I know that such an action has a huge impact on the individual’s career and life in general. I have never regretted these decisions, because a highly reliable organization must have the right people on board. Having said that, those decisions are never easy.

Q: What do you see as the most vulnerable part of a hospital's business? 

DP: I can only speak from the perspective of my own healthcare system. Hospital care is associated with high costs, and in our system there is a relatively narrow margin. The challenge is providing high-quality, affordable care for those who need it and working within an integrated system that takes a longer view of the patients' care. Our ultimate goal at Kaiser Permanente is to keep people as healthy as possible so that they don't require hospital care as much. When they do need to be in the hospital, we want to make sure they receive timely and appropriate care so they can recover as quickly as possible and get back to a better stage of health. This approach, in theory, sustains our hospitals by assuring that the "right" patients are there receiving care.

Q: What's one conviction in healthcare that needs to be challenged? 

DP: We need to move away from the paternalistic approach to medicine. Patients need to share in the decision-making around their care, and they need to share in the responsibility of taking care of themselves. We need to challenge the traditional model of care delivery, which is largely focused on acute illness. We must emphasize prevention. We must understand not only the medical problems that contribute to illness, but also the psycho-social-economic contributors to health. We must enlist the community to help us keep our patients healthy and to help them thrive. Until we do this broadly, we will not solve the healthcare crisis in America.

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