Article

Dignity Health physician executive removes barriers to pandemic innovations

September Online

Dr. Keith Frey, chief medical officer for Dignity Health Arizona, is responsible for physician integration and engagement, evidence-based practice and system redesign, and physician leadership development. He's been with Dignity Health for almost seven years. Last year, Dignity Health aligned with Catholic Health Initiatives to form CommonSpirit Health.

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Dr. Frey

Frey has overseen novel approaches that have helped the six Dignity Health hospitals in Arizona meet their needs for protective gear as they battled the COVID-19 pandemic, which surged in early summer in the state and began to ease in August. By late in the month, the infection had claimed almost 5,000 lives in Arizona. Frey spoke with Catholic Health World Associate Editor Lisa Eisenhauer in mid-August about adaptive problem solving, efforts to inoculate doctors against burn out, and how supply chain and health delivery issues and innovations surfaced in the pandemic will influence the reset of the health care ecosphere going forward. His comments have been edited for length and clarity.

As a senior leader, a big part of my role is not to get in people's way, to see their bright ideas, to encourage my colleagues, and to understand what barriers are in their way and help get those barriers out of the way, whether they're policies, procedures, finances. So, though I spent 30-plus years directly taking care of patients and training several generations of young primary care doctors, at this time in my career my primary role is to support and train my clinical leaders so they can make the right decisions, that they have the right leadership skills, and they have permission to basically move forward in a very innovative way.

The pandemic has caused real stress on the health care system in general and parts of it specifically, such as in getting supplies like personal protective equipment and some of the drugs and other materials. We're starting to improve here in Phoenix. We're in our fifth week of a decline, and we're just starting to take a little bit of a breath. We realize that this isn't over yet.

Dignity Health St. Joseph's Hospital & Medical Center (in Phoenix) is a sophisticated academic tertiary care center. Many of our physicians and scientists within St. Joseph's Barrow Neurological Institute wanted to focus on how we could use some of our capability with 3D printing and innovation to create N95 masks that filter out 95% of the particles. Our team quickly invented and tested one that actually had a better filtration protection than the ones that were available.

After they modeled and tested various materials on nurses and physicians to find the right way, we then trademarked that and handed it off to some manufacturing partners like Honeywell and 3M so that they could begin to help us produce more.

Another example is a very innovative colleague of mine, Dr. Ron Gagliano, who at the same time we were inventing these masks, created a reusable isolation gown design with a local tailoring shop, because we were running low on those, too. After fabricating some of these and getting the fit correct, we partnered with a local startup fabrication company that spun out of Arizona State University. Then we found appropriately weighted and impervious material from a fabrication supplier in North Carolina and had the Arizona National Guard fly bolts of it in for us so that by April we were self-producing these reusable isolation gowns.

The beauty of that story is not only the quick intervention and the ability to start producing thousands of these for us and other divisions within CommonSpirit Health, but most of these gowns historically have been onetime use -- use them and throw them away. The ones that Dr. Gagliano's team invented and fabricated have up to 100 washes. So, it was not only a way that we could stabilize that supply but actually be somewhat environmentally friendly because we were reducing the throwaway rate.

Even pre-COVID-19, of course, physician burnout has been a rising issue. The data is clear that American doctors and nurses are very stressed. There are a lot of reasons for that including pressures on throughput, changes in reimbursement, and challenges with how the electronic medical record doesn't always make it efficient in a hospital and clinic. I was asked to take a lead to assemble a team to think about what were the drivers of physician burnout for our CommonSpirit Health physicians and begin to address them.

There's a tool that Mayo Clinic invented but a vendor now offers. It's an app where a doctor can, in less than 60 seconds, answer nine questions and it gives them a sense of how relatively healthy or burned out they are emotionally and physically.

We were all ready to push that out to 25,000 physicians at CommonSpirit Health on March 1. Everybody was so busy with COVID-19 that we held off. But, by mid-May we realized that we were running a marathon. Our care teams were getting fatigued and stressed, and we went ahead right before Memorial Day to roll it out. Since then, we've had almost 1,200 physicians across the country who have used this tool. We cannot see their individual results because that's private to them, but I can see de-identified trends across the organization and some of the stress points for our doctors.

We're using this to help us build the next set of tools. One of the things we're piloting right now in our Northwest (Washington) division is a peer-to-peer support program where we're training doctors to be more aware of their colleagues who might be burned out, and to be a peer who can come alongside to at least be a sounding board.

I do think because of the pandemic there's been a reset in health care that will be long lasting. We have long wondered why we couldn't get more virtual health care underway. The COVID-19 crisis has helped us accelerate and see the value of screening patients to determine which ones probably should come in to be seen and which ones could probably safely be managed at home.

Another part is that we've offshored a lot of very, very important materials — the protective equipment and some medications — to other parts of the world. I think what we'll see is a repatriation. We really cannot afford as a health care system to be so vulnerable in some of our supply chains going forward.

I think, finally, this has been a real reminder of the importance of partnering with public health. I don't have a magic wand for COVID-19. Until we get a vaccine to prevent it, the medicines that are out there are not really clear if they're helping all that much. But what is helping is pretty obvious - masking, social distancing, hand washing, and not congregating in groups. So, we've had a very strong partnership with our public health officials, both from the state governor's office right on down into the municipalities, to really get the message out that while we get through this wave right now, let's all do everything we can to protect each other.

I worked for Providence Health System in the 1990s, and then I spent 15 years at Mayo Clinic. Both are great organizations. I'll tell you one of the things that brought me back into a faith-based organization like Dignity Health was the fact that we are taking care of everybody regardless of their full ability to pay, their ethnicity, and their situation. The community has trusted us for many decades, and they still trust us. That's because our mission is vital and it's played out every day in the caregivers who come and take care of these folks.

CommonSpirit has five values — compassion, inclusion, integrity, excellence and collaboration. These five values are obvious to me every day when I interact with people. So, I'm proud to work for this organization because this is more than words on paper. This is the way people who are part of our team live out their careers and lives.

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