The Healthcare CEO Podcast with Special Guest Dr. Charles Lockwood

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Welcome to the Healthcare CEO podcast. Join us as Daniel Fernandez, healthcare leader and patient experience advocate leads dynamic one-on-one discussions with healthcare executives, consultants, and other industry experts. Listen in as they share actionable insights and unique perspectives into the day in the life of a healthcare CEO.

*The following has been adapted from our full-length interview, which can be found here.

Meet Dr. Charles Lockwood

Dr. Lockwood is the executive vice president of Tampa General Hospital (TGH). He’s a senior vice president of University of South Florida Health. And he is the dean of Morsani College of Medicine.

Although Dr Lockwood is extremely knowledgeable on a variety of topics, we will focus on two major highlights today. (1) the guiding principles that have helped drive his decision making, especially during this time of Covid. (2) the huge amount of transformation that’s been taking place at USF over the past four years.

Guiding Principles and Being Nimble During a Pandemic

Daniel Fernandez (DF): So let’s kick things off. Obviously, Covid is a very hot topic these days. But, let’s talk about the guiding principles that you have in place and how they’ve helped move things along.

Dr. Charles Lockwood (CL): Our first guiding principle is what every physician should have — patients first. In this particular case, it required a level of nimbleness and audible calling that is a little bit unusual in healthcare. And we really kind of confronted a series of challenges. The first was the challenge that so many other centers faced, which was not having enough PPE and not having the collecting swabs that you need in order to do viral testing. And that was because early in the epidemic, the company that made the polyester Dacron swabs that were used for viral collecting actually were closed. They were in Italy. So I had literally in the first week asked my radiology department that was very skilled at 3D printing to see if they could create a 3D swab — a flocked nasopharyngeal swab. And within a week, they had a prototype that they tested, turned out to have viral recovery similar to the commercial product — actually a little better. And I was told about three weeks ago that 40 million of these were made worldwide. So that was a pretty good, nimble response to the crisis.

Other things that we did were we set up the testing sites for the county using a lot of volunteers, students, etc. It was often in very high temperatures, and I was very proud of my team. In the hospital, within about two months, we had set up 27 separate clinical trials in Tampa General Hospital — testing everything from Remdesivir to, most recently, a pediatric vaccine trial. So really extraordinary efforts made by our faculty there. The intensive care docs, the ID docs — sometimes they were working six weeks straight and never complaining. They’re truly the heroes of the story.

Another example was we set up a continuity clinic for the county. So anybody who tested positive would be followed with telehealth — with our physicians or sometimes our medical students. They may be called twice a day, and then we might triage them in the hospital, or just at home. And occasionally we would measure their level of oxygen saturation, their blood pressure, and their temperatures. We call that a CoCo clinic, the Covid Continuity Clinic. And that was literally thousands of patients who have been followed in that clinic.

So there’s a lot of different things that we did. Another example was setting up telehealth. We had talked about it for five years, and obviously this crisis forced our hands. And of course, we were also able to build for it for the first time. And so we were able to set that up in a week. We’ve now done over a hundred thousand telehealth visits. So, you know, I think nimbleness and the ability to be incredibly agile and respond very, very quickly were the hallmark so far of how we’ve dealt with this. This is a horrible pandemic, but I’m incredibly proud of all the folks at USF Health and Tampa General who responded so well to it and worked so hard and continue to work so hard.

Teamwork, Innovation, and Adaptability in Times of Crisis

DF: Do you feel as if telehealth is one of those things that is a fad or do you think it’s here to stay?

CL: Oh, I think it’s here to stay. Absolutely. I have been using it actually for consults, and initially was only for patients in Florida, but now I’ve consulted with patients in California, New York, and a couple of other states, too. So it’s really opened up our opportunities to provide care. And patients love it. We’ve had very high patient satisfaction rankings on our Press Ganey Survey for our telehealth setup.

DF: You just talked about the radiology department pitching in. Do you feel like everybody has pulled together during this time?

CL: Literally. I would be doing testing in these outdoor testing sites for the county and I’d be working with a physical therapist and students, and our administrators did all the clerical work at these county testing sites. It was sad that we were having to do it, but it was also kind of fun. In so many ways for health care, this has been our version of World War II. My father used to tell me these amazing stories about all the events that occurred to him during the Second World War. And, you know, sometimes there’d be almost a gleam in his eye. That was an exciting time for him and obviously a tragic time as well. This is very similar for health care. This is our version of that. And so a lot of the innovation that’s been generated has been generated because of the urgency of the situation and because so much was not known at the beginning and still not known today.

DF: Under your leadership, you were, it seems, adequately prepared. Do you ever have any issues acquiring ventilators or anything like that?

CL: Well, we had the advantage of a little bit of a delay here in Florida. So we saw what was happening in New York, in the Northeast, and we began to earnestly collect PPE. We even very quickly realized that we need to be able to sterilize it with UV light and gas sterilization of N-95 masks. We began stockpiling that. John Couris, the president of Tampa General, ordered 87 new ventilators. I thought it was crazy, but he was way ahead of the curve on that. We set up the ability to flex our ICU capacity there such that we never were overwhelmed. And we were one of the busiest centers in Florida because we were obviously an ordinary care center and we received very, very sick patients from all over the region. And I had quite a few patients on ECMO, etcetera, but we were able to keep our case fatality rate in the county and at Tampa General very low, among the lowest in the United States. And I think that part of it was that we were well-prepared. Part of it was that we were early in the game to administer dexamethasone, Remdesivir, convalescent plasma therapy, prone ventilation, etc. And we had happened to have been investing heavily in our infectious disease group. So timing was good. We had built significant ICU capacity and expertise and infectious disease expertise a couple of years before the pandemic hit. So it reinforces the adage that it’s lucky to be smart, but it’s smarter to be lucky.

DF: You’ve had to adapt to a large amount of change in such a short period of time. But in terms of changes, you’ve had a lot of change yourself at USF, haven’t you?

CL: We have. Change has become, I think, part of our DNA. It’s been a period of unprecedented advances for the medical school and for USF health. We’ve had a huge surge of applications. We’ve had our most competitive classes six years in a row. The curriculum has been revised and improved, and we had record-high USMLE scores. We have doubled our NIH-funded investigators. We’ve doubled our research brands, we tripled our clinical trial volume, and we’ve completely revamped our clinical practice over the last six years and developed much, much closer ties to our primary teaching hospitals. Those relationships with the hospital have in turn allowed us to expand our clinical practice at a much faster pace than we could have before, to implement EPIC and improved our revenue cycle, and recruit a lot of clinicians. One good thing about Covid is I haven’t had to go to any recruitment dinners. So I’ve lost a couple pounds, but it’s been an exciting period. And because of all that, we were well prepared for the ability to flex as much as we have during the Covid crisis.

Building Partnerships for a Better Level of Care

DF: You hold roles currently at USF and Tampa General Hospital. Tell us a little about that.

CL: Right. Tampa General has been our premier teaching hospital since the founding of the medical school. Our first class graduated in 1974. But as with a lot of new medical schools, the relationship was not always harmonious, and it could be stormy. And over the last six years, it’s improved so much that we’ve now been able to negotiate a new affiliation agreement, which will create a single clinical platform and allow us to access Tampa General’s capital and to be able to create a common infrastructure for revenue cycle access. HR, IT, etc. while maintaining the independence of the faculty. They still get their checks from the University of South Florida, but allow us to be able to expand even faster than we have been already and to really develop outstanding quaternary care, critical service lines, and also to be able expand our accountable care organization, build primary care, and actually provide better service to our referring docs, so that we can be sure that we can see their patients more quickly and get back to them more quickly and so forth. So that’s been a really exciting action, but very complicated. We’re a state university. They’re a private, not-for-profit hospital. So it took about two years to work through all the details of that new, much tighter affiliation. And we had to get approval from not only our boards of trustees, but also from the equivalent of our board of regents in Florida. It’s called the State University System Board of Governors. So we were able to work very well with everyone, and a lot of lawyers and come up with a really sound plan that allowed us to do all the things we needed to do from an academic standpoint, but gave us new resources to continue our pace of expansion.

DF: I think there’s a lot other organizations around the country can learn from this. I mean, I would expect that from this relationship we’ll be able to deliver a better level of care.

CL: I think that’s true. The old adage is, if you’ve seen one academic medical center, you’ve seen one academic medical center. And certainly we had our own constraints. We had to protect a whole variety of different endpoints. For example, a state university can’t pledge credit to a private concern. So we had to build a structure that avoided that constitutional issue. We want to protect sovereign immunity. We wanted to be able to make sure we didn’t have any antitrust issues. So all those things got constructed into the agreement in a way that afforded many protections but allowed us the flexibility to do what we needed to do to go to this next stage of our relationship, and to gain the kind of capital and the ability to take a little more risk than a standalone practice within a university could take. So we think we think it’s a really good agreement and we think that it probably would be a good model for other public medical schools that are closely affiliated with a large tertiary care hospital.

Looking to the Future of Healthcare

DF: And again, obviously, you’ve led such a large amount of change thus far. What does the future hold? What does it look like?

CL: When I think back on the last six years, it is a bit of a blur. We have to implement all this so we have a lot more to do. We’ve moved up on our U.S. News rankings considerably since I got here. We were languishing around 80 for many years and we’ve moved up to 47. We’re second in the state on the heels of our great colleagues at the University of Florida. But we really want to continue that pace of ascent. And we’re not a slave to the survey, but we do think it serves to organize and measure what we’re trying to do to advance health care in Florida, and to try to advance our teaching programs and our research programs. So it’s a little bit of a motivator for everybody. And Tampa General is equally interested in moving up in their U.S. News rankings. We’re top in the state now, I think, in three areas: cardiology and cardiac surgery, G.I., and orthopedics. So we’d like to be top in the state and all the categories. So lots of work to do.

DF: But being top in the state wasn’t always the case when you got there, right? You had to do a lot on the patient side of things as well. These scores didn’t just miraculously happen overnight.

CL: So, I said pretty early on that we were in the customer service business and our customers were our students and our patients. And we think our students are doing great. So give ourselves an A minus for that, maybe an A. And for our patients, we were keenly interested in being able to assure that not only we were giving them great outcomes and high value for their care, but that they were really satisfied. And we hadn’t measured patient satisfaction for a decade before I came. And we implemented our Press Ganey surveys in the last quarter of 2015. And most of the metrics on that survey have increased either three or four fold. So in many areas we’re the 70th or 80th percentile. And that’s taken a lot of work: customer service training for our staff and a lot of work with our physicians to improve their communication skills. Although they are great docs and, we had to work on that, and it’s paid off. In quality, we were very proud that our first macro score from CMBS was 100. We’re very proud of the level of quality at both USF Health and Tampa General. Tampa General had its own quality journey that we’ve been hopefully an integral part of. And I know that John Couris is equally proud of what they’ve accomplished in terms of the leapfrog in their scores and so forth.

Advice for Other CEOs

DF: I’ve got one more question for you. I’d like to ask. There are a lot of CEOs and leaders who follow this podcast. And if you could give them advice today, what would you tell them?

CL: Well, I probably don’t need to tell them anything because they probably know it all already! But, I think that one of the keys to our success has been that this is really all driven by the consensus that we really worked hard at creating a vision in all of our mission areas, in our education and training area, research area, and our clinical area. And we really built a strong consensus around that — not just among the leaders and the chairs, the departments and the administrators, but among the rank-and-file, the staff, etc. We have lots of town halls. I make rounds in every unit. John Couris literally walks every corner of his hospitals. I remember making rounds with him and he started talking to one of the housekeepers and seemed to know more about her family than I could possibly know. And I said, “John, you know, you’re amazing. You really are.” And he said, “Nope, that’s what leaders do”. And hopefully, we do the same on the practice side and in the medical school. We laid off no one during the height of the crisis, and we were able to spring back such that our volumes are actually higher than our pre-Covid volumes in terms of in-person visits. And of course, we’ve added telehealth, which is a bonus. But our surgeries are also ahead of our peak overtime. So not having to lay off anybody and being poised, ready to spring into action really made a huge difference. And having a great partner like Tampa General was one of the keys to doing that. And I know that with Moffitt the story is almost identical. They’re just amazingly agile in their responses. And we’re proud to have them as part of our family as well.

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