Children's National Health System: Lessons from a Physician-Leader

Added on Jul 21, 2017

Children's National Health System: Lessons from a Physician-Leader

By Diana Mahoney

Running a hospital wasn’t necessarily one of Dr. Kurt Newman’s aspirations during his 30-year career as a pediatric surgeon, but his experience “in the trenches of care” makes him well suited for the role.

Nearly six years into his tenure as president and chief executive officer of Children’s National Health System in Washington, D.C, Dr. Newman recently reflected on how his surgical background has helped him navigate the unprecedented challenges facing today’s health care executives as they work to meet the demands of a changing industry.

“When I was offered the position, I thought a lot about what I could bring to the table. Although I wasn’t a professional manager and I didn’t have an MBA, I did have a valuable perspective—I knew what it was like to be a physician in the hospital and on the front lines,” he said in a keynote presentation at Press Ganey’s 2017 Pediatrics Executive Leadership Summit. “I realized that bringing that identity to the table would add credibility and authenticity to my leadership and decision making.”

That mindset has fueled Dr. Newman’s leadership journey thus far, and it has informed the strategic vision that has helped him guide the Children’s National network—which comprises eight regional outpatient centers, an ambulatory surgery center two emergency rooms, an acute care hospital and collaborations throughout the Washington, D.C. region—while staying true to the organization’s mission “to excel in care, advocacy, research and education.” 

In his presentation, Dr. Newman described a number of practices that have been instrumental to his success as a physician leader, and from which the following lessons can be gleaned. 

  • Lead from within
  • Take the bus
  • Trust your instincts
  • Refocus when necessary
  • Be transparent
  • Make it fun
  • Encourage innovation

Lead from Within

“When I began as CEO, I started my day in the same way I had as a surgeon for 30 years: rounding with the nurses and teams, and I continue to do that whenever I can,” Dr. Newman explained. In fact, members of the executive team round on patients and families with the staff seven days a week. “I feel most excited when I’m out there with the troops, because that’s when things get done and decisions get made.” 

In addition to increasing his presence and availability to staff and families through regular rounding, Dr. Newman also physically relocated the President/CEO office to a central location so that he is easily accessible and able to be more actively involved with employees, patients and families on a daily basis. In this way, he is able to keep his finger on the pulse of the organization, and can best understand the needs of the caregivers and of the patients and families being served. 

“We all know that often the best ideas for improving the patient experience come from the front line, so being present to listen and respond to these ideas can streamline the improvement process and enhance staff engagement.” 

Take the Bus

This advice reflects a less-formal way to lead from within. “At Children’s National, we have a lot of parking off-site for our employees. I learned that one of the best ways to get ideas from our employees was to ride the parking shuttle,” Dr. Newman said. “I’ve gotten so many great ideas just by listening to some of the conversations that happen going to and from the parking lots.” 

One notable example, he said, was a conversation with a nurse who mentioned how useful it would be to have an onsite pharmacy in the hospital so families could get their children’s medicine before leaving. The discussion was the impetus for an initiative that culminated in a relationship with Walgreens to open an outpatient pharmacy in the health system’s Sheikh Zayed Campus for Advanced Children’s Medicine. In addition to enabling families to fill prescriptions on site before leaving the hospital, the pharmacy offers medication consultations, immunizations and other services.

Trust Your Instincts

When he took on the role of CEO, “there was a lot of concern about me because I didn’t have an MBA and I didn’t have a strong finance background,” Dr. Newman said. What he did have, however, was an understanding of people and a fundamental belief “that if we took care of our people the right way and kept patients and families at the center of everything we did, the finances would follow.” 

To date, this approach has worked, Dr. Newman said. “We have had five straight years of improved financial performance, two credit upgrades, our market share is going up—all of the things that people look at from a business perspective,” he said. “What is great is that we have a terrific chief financial officer who is fully committed to the mission, along with our chief operating officer, who is a nurse, our chief legal officer, who is also a nurse, and our chief information officer, who is a physician. So we are very much a doctor- and nurse-run organization, which really influences the kinds of things we are doing and how we make decisions.”

Refocus When Necessary

Inevitably, leaders and organizations can get so caught up in managing every day challenges that their vision of the big picture doesn’t stay in the forefront. “Sometimes you lose your way. Maybe you stop listening as intently or being as aware of details as you should be,” Dr. Newman said, sharing an example from his own experience. “I received a thank you letter from a young mother whose baby was treated for a brain tumor. She explained how grateful she was for the care they’d received and for all of the everyday heroes they’d encountered. But she also brought up some of the things that we were not doing well, and they centered on care coordination and hand-offs.” In this mother’s experience, different teams were not talking to each other as they should be and this led to some confusion and unnecessary waiting, he explained. 

“This was real wake up call to me to get focus back on the quality of the overall care experience for these complex patients and their families,” Dr. Newman said. Care coordination became the subject of a couple of grand rounds to which the mother was invited to share her perceptions. The discussions that ensued among doctors, nurses and other staff have since led to a number of innovative initiatives, including a program designed to improve care coordination for and handoffs for children with autism. “We realized we were not doing everything we could for these children and families by not thinking through some of the anxiety triggers and how to minimize them,” Dr. Newman explained. “Now we have a whole program and menu to better coordinate the care for those kids that come to the hospital for a lot of procedures.”

Be Transparent

In the fall of 2015, Children’s National became the first freestanding children’s hospital in the country to begin publishing its physicians’ patient experience ratings on-line. “The first phase included about 50 physicians who had 30 or more survey responses. Within the first six months, all of their ratings went up,” Dr. Newman said. Although this can partly be attributed to physicians’ competitive nature, the physicians’ scores rose because they were able to see where they were excelling and where they were falling short in the eyes of the families they were caring for, he noted.

“Now we are up to about 90 physicians, and it has been a terrific thing—both for the patient experience, but also for the physicians themselves,” Dr. Newman explained. “We began sending letters to those physicians with top quartile performance, and they are so proud and appreciative. Often these may not be the doctors who are publishing a lot of papers or getting academic recognitions. They are the ones who are out there really serving patients and families well, and they are excited to be recognized for their clinical care.”

To be most effective, transparency has to extend to safety and quality performance as well, Dr. Newman stressed. “The performance information can’t stay in the quality office. It’s got to get out to the people who are delivering and receiving care,” he said. For example, all of the doctors, nurses and managers receive a grid that keeps track of the organization’s hospital acquired conditions and serious safety events “so everyone can follow along with what’s happening and make changes quickly when we see a problem or pattern.”

Each of the system’s ICUs also have a large quality board that includes all of the different evidence-based care bundles for each patient with updates that come directly from the electronic health record, “so parents can walk by and see whether the mouth care was done, the bath was done right, whether there’s a Foley catheter in, and so forth,” Dr. Newman said. “Knowing that parents, doctors, nurses are all looking at the board really influences how things happen.”

Make It Fun

At children’s hospitals in particular, the physical and culturale environment of care can greatly influence the overall experience of care, particularly as some families essentially “move in” during the course of a child’s treatment, using every resource and amenity the hospital has to offer, above and beyond those available in the patient room. 

“Making our hospital a fun place to be and work—and energizing our donors and philanthropists around this idea—has been one of the most satisfying parts of my job, and I k now it makes a difference,” Dr. Newman said. “For example, we recently created a rooftop ‘healing garden,’ which is an outdoor area that gives patients and families a place to enjoy fresh air and simply being outside.” The idea, he explained, was triggered by a young girl with a terminal illness whose last wish was to get outside and feel the sunshine. “It was difficult because of the distance to a suitable outdoor area and the complex life support treatments that the patient needed, but our doctors, nurses and engineers figured out a way and it meant so much to this patient and her family.” It also buoyed the spirits of the caregivers who were able to make her wish a reality, he said. 

Following a successful fundraising campaign, the 7,200-square-foot space opened in April 2017 on the roof of the Children’s National main campus. It includes trees, flowers and a variety of plants and shrubs, a water feature, and a labyrinth for meditation. The idea for and realization of the healing garden demonstrates the importance of building a culture that supports a sense of innovation, engagement and teamwork, Dr. Newman said. “Everybody wants to come to work to make an impact. What better place than a children’s hospital to do this, and how better to do it than to improve the experience of care.”

Encourage Innovation

In addition to the lessons and examples above, Dr. Newman has also focused on empowering physicians as strategic partners. For example, through the system’s Sheikh Zayed Institute for Pediatric Surgical Innovation, which was founded in 2010 through a $150 million gift from the government of Abu Dhabi, physicians and scientists are working together to develop innovative products and medical devices that will make pediatric surgery more precise, less invasive and pain free through the development.

The Institute was borne out of discussions with surgeons and anesthesiologists “who were frustrated that intubation in pediatric surgery was not really taking on the same investment as it was in adult medicine,” Dr. Newman said. It comprises multi-disciplinary teams of clinicians and researchers who work together to bring innovative ideas to market.

Much of the research and development being undertaken by the institute is driven by ideas from clinicians who identify opportunities for products and technologies that will help meet the needs of pediatric patients more effectively.

“That is the culture we strive to create across the entire system—one that is built on innovation and where everyone is doing the right things for the right reason,” Dr. Newman said. “I’ve been incredibly fortunate to be able to lead an organization that encourages and supports this.”