The CEO of UCLA Hospital System arrived at his new job in 2007 with a mission - to transform UCLA's already technologically great hospitals into the most-compassionate environment of healing in the country. By Anne Burke
DAVID T. FEINBERG, M.D., M.B.A., ACKNOWLEDGES THAT he is obsessed. “I am singularly focused on this issue,” he says. As the chief executive officer of UCLA Hospital System, which includes campuses in Westwood and Santa Monica, he is, of course, intensely interested in the quality of the medical care that is delivered to patients. But his obsession goes beyond that. For Dr. Feinberg, a great hospital isn’t truly great unless it is also humane and compassionate, a place that treats patients and their families not only with medicine, but also with dignity and respect.
“We’re the No. 3 hospital in the country, according to U.S.News & World Report, and we have Nobel Prize winners and we invented the PET scan and we came up with Herceptin and we diagnosed the first case of AIDS – and none of that is what matters most,” says Dr. Feinberg, who is triple-board certified in child and adolescent psychiatry, adult psychiatry and addiction psychiatry, and who previously headed the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA. “If you or someone in your family is sick, you don’t really care that you are in an I.M. Pei-designed building. You care about whether the people around you know what’s going on. Are they explaining things in a way that you understand? Are they making you feel safe? Are they treating you like a human being?”
Treating patients like human beings. It’s a concept that should not be alien in a medical setting but is for too many hospitals. In fact, it appeared to be so at UCLA when he took over the role of CEO two years ago, Dr. Feinberg says. He determined to change that and to make UCLA’s hospitals places that are renowned for their caring environment as well as their technical excellence. The proof of his efforts is evident: Patient-satisfaction scores in recent independent national surveys have escalated from the 38th percentile overall to the 96th. At Santa Monica-UCLA Medical Center and Orthopaedic Hospital, where Emergency Department scores had been in the single digits, those scores have exceeded the 99th percentile, as have results for women’s services there.
From hospital staff at every level introducing themselves to patients, to helping lost families find their way in the hospital, to picking up errant bits of trash on the floor, Dr. Feinberg leads by example. He spends an average of 40 percent of his time speaking with patients and families, and he not only hands them his business card but he also writes down his cell-phone number and invites them to call him, day or night, if there is anything they want to talk about. “The only thing I ask of people is that they not be bashful,” he says. “I want to hear from them.” He even carries complimentary valet-parking stickers, gas cards and meal vouchers in his pockets to give to patients or family member as a way to compensate them if something doesn’t go as smoothly as it should.
Los Angeles-based freelance writer Anne Burke talked with Dr. Feinberg about his mission and his vision for UCLA’s hospitals.
UCLA MEDICINE: Of all the initiatives you might have undertaken early in your tenure as CEO of UCLA Hospital System, why did you choose improving the patient experience as your first?
DR. FEINBERG : When I got this job, I began to meet with patients in our hospitals – this was when we were still in the old building – to go into their rooms and talk with them. What I learned was, we are providing miracles. We do things with kidneys that no one else does. We do brain surgeries that no one else does. And people tell me over and over, “It’s a miracle, we’ve been to five hospitals, and this is the first one that got it right,” and it moved me to tears.
But there was another theme that I heard, and that was, despite these miracles, one-out-ofthree of these patients and their families said they would not refer a friend to us. And a lot of people from our own surrounding communities – Beverly Hills, Brentwood, Bel Air, Santa Monica – weren’t coming to us; they were going to other hospitals. There was something missing in the experience that patients were having here. What I discovered in my walking around and talking with people was that the food wasn’t hot, the drapes didn’t close, the air conditioning didn’t work, there weren’t enough bedpans, nurses didn’t introduce themselves, and unit secretaries didn’t make eye contact when someone would ask them a question. One senior leader of this hospital even said to me in a meeting that he would no longer hospitalize a member of his family here because when his father was a patient here, he found the care to be, while very good medically, callous in terms of how his father was treated.
UCLA MEDICINE: That’s a pretty bleak assessment.
DR. FEINBERG: Yes, it is. And after a couple of months of doing this, it became very clear to me that what was missing was the concept that there’s no more-important person in this hospital than that patient. I want every patient and their family to be treated like they are the most important people here and to receive the same level of care and consideration that I’d want for my family. We’re not being authentic and true to our mission if what we provide is not in every way good enough for our own families.
Not only do I want the most-technologically advanced hospital for my family, I want them to receive care that is compassionate. I want them to be treated with dignity and respect. I want the people they come into contact with, at every level, to connect with them emotionally. I want every one of their needs to be met because when someone is in the hospital, they are in their most-vulnerable state. They have given up their own food. They have given up their own bed and room. They have given up their own clothing. They have given up their privacy.
UCLA MEDICINE: What have you asked the staff to do to change the perception that UCLA is not a welcoming place?
DR. FEINBERG: It is about real change, not just perception. We are going back to the basics, making sure that meals come on time, that everybody who enters a room – whether they are a doctor, a nurse or a housekeeper – introduces him- or herself, that nobody in this hospital dies alone. If a nurse is told that someone is dying, and there’s no one in the room with that patient, then I want that nurse to sit with that patient and hold that patient’s hand and to not have to worry about doing the rest of his or her job – it will be taken care of – because there is nothing more important for them to be doing at that moment.
I think that when it came to these things, we had lost our way. We thought if you put “UCLA” on the wall, that was good enough, and our message to a patient was that it was a privilege for you to get to see us instead of it is a privilege for us to care for you. Now, all of our senior executives at Ronald Reagan UCLA Medical Center have committed to visiting patients, and we have 150 managers in Santa Monica who do so there every Friday. Patients don’t care if it’s the chief executive officer or the chief nursing officer – they care that it is someone who says to them, “You don’t need any other numbers at UCLA – if you need anything, I’ll take care of it for you.” That’s a very comforting feeling for a patient.
UCLA MEDICINE: Why do you think things had evolved the way they did?
DR. FEINBERG: In the course of a single lifetime, UCLA has gone from having no hospital to having one hospital to now having several hospitals. Other competitive institutions – Mass General, Cleveland Clinic, Johns Hopkins, Mayo Clinic – have been around much, much longer. We came up very fast, and our focus was on leading-edge medical care and technology. It was a meteoric rise that centered on pushing the envelope of medical science and understanding. That is great, and I don’t want to diminish our achievement. But we were so focused on getting there, I think that is perhaps why we lost our way, as I’ve described.
UCLA MEDICINE: Have you noticed a change?
DR. FEINBERG: Absolutely, a big change. When I told our leadership team that they had to go up on the floors and meet with patients, I think many of them felt awkward about it at first because it was not what they were used to doing. The pushback was, “We don’t have time, that’s not what we do. We go to meetings and try to solve things.” My response is that in any business, you want to get as close to your customers as possible. And in our case, our customers are lying in beds upstairs. It is so easy to get close to them – just go upstairs and sit down and give them your card and talk to them. And that is what they are doing.
UCLA MEDICINE: What feedback have you heard from your staff?
DR. FEINBERG: I’ve heard, “Thank you. This is why I came into healthcare.” People have chosen to work in this field because they want to help people. This is just tapping back into that ideal. Isn’t this what we’re supposed to be doing?
And we’re also the only hospital in California where everybody is in uniform, which helps from a patient-safety standpoint because patients know who’s coming in their room. Not only do our staff introduce themselves, if they are in royal blue they are a nurse, if they’re in khaki green they’re a care partner, etc. So as a patient, you know whom to ask for medicine and whom to ask for a glass of water. If it is someone in black, they are a member of the lift team, and they are there to help reposition or move the patient.
I don’t think any of this is a brilliant vision. To me, it is nuts and bolts.
UCLA MEDICINE: Managers are talking to patients, taking their pulse, as it were, and members of the staff are introducing themselves when they enter a room. How else are you seeing this initiative being played out?
DR. FEINBERG: Here is an example. A young woman had a terrible brain tumor, and she and her family came here for her surgery. Our surgeon spent 25 hours in the operating room, and he saved her life. While the woman was in the Intensive Care Unit after her surgery, her husband literally took up residence in the waiting room next to the ICU. I asked him how things were going, and he was very happy with the care she was receiving, and everything was good. But, there was one thing we could do better, he told me. He slept on a couch in the waiting room, and whenever he rolled over, the lights came on because they are on a sensor. “I keep waking up all night long,” he told me, and he put a sticker over the sensor so the lights wouldn’t come on and he could sleep. The next day I visited with him, and I asked him how things were going, and he said, “My God, this place, you can’t believe what this place is like. It’s so incredible!” I didn’t really understand what he was saying. He was kind of thanking me, and then he motioned toward the sensor – and it was gone! And in its place there was a light switch. So, somebody had heard that he was having trouble sleeping because the lights kept coming on when he rolled over, and they called engineering, and someone came and replaced the sensor with a light switch so he could sleep without a problem.
On the other side of the wall next to him, we were doing medicine that nobody else in the world is doing, and in the waiting room, it was like Ritz Carlton-level service where someone heard his need and responded to it.
UCLA MEDICINE: That’s a pretty good story.
DR. FEINBERG: It’s phenomenal. I wish I had thought of doing that.
UCLA MEDICINE: Ultimately, what do you want to see come of your initiative?
DR. FEINBERG: I want there to be a permanent change in culture in which the patient always is first and foremost and we recognize that it is a privilege for us to be serving them, and not the other way around. That is the way we are supposed to do things. We take care of people. We bring life into the world. Sometimes we save lives. We help people at the end of their life. It is a place of healing and hope, and we should treat people not just with great medicine but also with the kindness and compassion that they deserve.