EPISODE 93

The Intersection of Innovation and Compassion - Dr. Amy Compton-Phillips, Chief Clinical Officer at Providence Health

12-21-2020

Have you wondered what it was like for the doctors who treated the very first COVID-19 patients when so little was known about the disease? Well, you can find out directly from the source in this episode of Raise the Line. The initial cases were in Seattle where Dr. Amy Compton-Phillips works as the chief clinical officer at Providence Health, one of the nation’s largest health systems. In that role, she was deeply involved in quickly creating protocols to triage, test and treat the COVID patients who started to flow in. She was also involved in making masks for providers in the basement of the hospital as the crisis took hold. The COVID experience has deepened her commitment to make great healthcare available and affordable for everyone in the U.S., and in this insightful conversation with Shiv Gaglani, she shares many examples of the innovations Providence is employing to reach that goal.

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Hi, I'm Shiv Gaglani and today on Raise the Line, I'm really happy to be joined by Dr. Amy Compton-Phillips, who is the executive vice president and chief clinical officer at Providence Health. Providence is one of the nation's largest healthcare systems with 51 hospitals and more than 1,000 clinics in over seven states. She was also involved in treating some of the first patients with COVID-19 in the U.S. and is a medical analyst for CNN, so you may see her on that channel. So Amy, thanks so much for taking the time to be with us today.
 

DR. AMY COMPTON-PHILLIPS: Thanks so much for having me Shiv, I'm delighted to be here.
 

SHIV GAGLANI: You wear quite a few hats and I guess the first hat that we're curious about is how you actually decided to pursue a career in healthcare.
 

DR. AMY COMPTON-PHILLIPS: You know, I have a really super boring story because I never wanted to do anything other than be a doctor. And in fact, from the time I was kindergarten on, I always said I was going to go to medical school. There was a brief period of time, maybe in seventh grade, that I thought maybe I'd be a vet instead until I realized they had to put dogs to sleep. And I was like, "I'm not strong enough for that." So I went into medicine and kind of straight through on a straight and narrow path.
 

SHIV GAGLANI: And then how did you know that you wanted to go from being a full-time practicing clinician to now you're chief clinical officer at a major healthcare system? How did that shift happen to administration and leadership?
 

DR. AMY COMPTON-PHILLIPS: It happened slowly insidiously over time. So, I went straight from residency to work for Kaiser Permanente. I was there for 23 years and absolutely love Kaiser Permanente. One of the things that is true is that if you're mouthy and you have opinions there, they say, "Hey, maybe you should be in leadership. You have an opinion, well do something about it." And so Kaiser invested significantly in me to help grow my capacity to not only practice medicine but help lead in medical leadership. So, over time I went from being a frontline clinician as a full-time doctor to being a full-time administrator by the time I left as chief quality officer for the organization.

SHIV GAGLANI: Amazing. What are some of the proudest accomplishments you have both as chief quality officer at Kaiser and now at Providence as chief clinical officer?
 

DR. AMY COMPTON-PHILLIPS: Well, the accomplishment is really trying to think through how we navigate in a country where care is not universally accessible, where it is overpriced for many and inequitably distributed around the country. I'd say kind of my personal mission is to make great health and great care affordable and available for everyone in the U.S. So, my career trajectories and the things that I'm most proud of are really trying to live that mission.

With Kaiser Permanente, it was about “how do we make care ever better? How do we drive up the quality of care? How do we make not only care but health more accessible?” I worked diligently around our program to support the mission of that organization, which is very much focused on the same thing. While Kaiser Permanente had kind of figured out that route, when I came over to Providence it was “how do you work with the 97% of America who don't have Kaiser Permanente insurance to be able to provide that same thing? How do we actually make great health and great care affordable and available?” I’ve been working on both legs of that, the great health and the affordability side. It's doing things like making sure we have an understanding of where is care great, and where is it not, and what can we do to improve it? Where is care overly expensive without actually adding value and what can we do to improve that? Really setting up a system to help us know and have a mirror in front of us so we know what we can work on to continuously improve.
 

SHIV GAGLANI:  It's pretty remarkable to see the way healthcare shifted even in the past few years. I was in medical school at Johns Hopkins and even during those few years, Hopkins was starting to consolidate and bring on a pediatric hospital in Tampa Bay, Florida and several other hospitals in the mid-Atlantic region. Providence has obviously been one of the largest players in the space and certainly the biggest provider in the Northwest U.S. I'd love to hear, during your time at Providence, how has that kind of consolidation played out both for the experience for your caregivers, the 120,000 caregivers under your purview, as well as for the patients?

DR. AMY COMPTON-PHILLIPS: Well, the really important thing is that we think big, and our vision statement for the organization is “health for a better world.” Like how do we contribute to health for a better world? But we have to act small. Our promise is that for patients, we'll know them, care for them and ease their way and I think it would be incredibly expensive for the country for every single hospital, every single medical office, every single urgent care to figure that out by themselves.

So, in the “thinking big” part, how do we actually develop seamless tools that allow us to transform care so that at the individual office level -- for every doctor and patient, for every nurse -- they actually have seamless and easy tools to be able to do their job? That's what Providence is trying to do, is to make those kinds of seamlessly integrated tools available for all so that it's easier to do your job locally in a way. The way we think about it is we exist at the intersection of innovation and compassion, that we have to be able to provide innovative tools at scale across our entire footprint, which means not everybody inventing it all at the same time independently, but rather deploying great interventions across our entire footprint while we enable that compassionate care that happens one-to-one individually. So that's the goal.
 

SHIV GAGLANI: I like that. I've never heard that combination of “intersection of innovation and compassion”. We've had a previous guest from Providence, Cyril Philip at Providence Ventures who talked about some of the exciting things you all are working on and the fact that this large health system has a whole team dedicated to identifying innovations that can hopefully free up the doctor or any caregiver to provide more one-on-one compassionate care. I think it's one of a few health systems that seems to be super innovative in that way. Are there specific innovations during your time at Providence that you're also kind of excited about? I've heard a bit about telemedicine. We've obviously met that moment with COVID -- and we're going to go into COVID in just a little bit -- but I'd love to hear from your perspective as a clinician turned hospital leader, what are some of those innovations that you think have really improved the clinician-patient relationship?


DR. AMY COMPTON-PHILLIPS: I think one of the big things is our use of data, that we are big believers in having data-driven care. We've been migrating our data assets to the Cloud and have been able to build tools in the Cloud and we think more data is better and that we can actually use those tools to invent back into patient care. So simple things like care gaps, and a lot of people now can identify care gaps. So, if you have a patient who is coming in for their sprained knee and you realize that they're overdue for their mammogram and oh, by the way, that cholesterol is higher that gets served up to the clinician in front of them. So that's one way for patients. And Oh, by the way, we're also building safety net tools that the thyroid test was done a month ago and it's not been followed up on. And oh, by the way, doc, bing, bing, bing in your overcrowded Inbox, here's something that was abnormal that is still outstanding. So we can use data for these very discrete things, but we're also using data for some things that are really cutting edge. Like I said, we have been thinking a lot about value-driven care and not necessarily from the contracting perspective, but how to actually drive care delivery. To understand if we are providing better outcomes at more affordable costs, we actually have set up a value-oriented architecture that looks at what are our outcomes and what are our costs?


Part of those outcomes are Patient Reported Outcomesm(PRO). In order to understand if we're making patients' lives better by treating them, we have to actually ask them, which means we need to clip PROs. So, we've set up a whole PRO infrastructure to be able to gather PROs and then feed that back to the doctors and the patients that they treat to use in shared decision making. So when you start thinking about what is the value that data can unlock, we've been making huge bets. I think there's a lot still to be done, but we've already come a huge way.

SHIV GAGLANI: That's fascinating. Patient Reported Outcomes particularly resonates. One of our other guests on Raise the Line was Mel Hall who ran Press Ganey for about 17 years. One of the most interesting things he told us on this interview was that when he started, about 10% or less of healthcare CEOs were compensated in part based on patient satisfaction and outcome metrics like that. But then by the time he left Press Ganey and scaled from 50 hospitals and health systems that were leveraging their tool to a couple thousand, over 90% of health system leaders were compensated in part based on patient voices, patient satisfaction. So that sounds like something you guys are doing at Providence, too.


DR. AMY COMPTON-PHILLIPS: We are, and I'd love to just tease apart that a little bit, because we also care a lot about patient satisfaction which is asking a patient, "How were we?" A Patient Reported Outcome is asking, "How are you?" People don't get their knee replaced because they want to stay in the hospital and tell us how they were treated. They get their knee replaced because they want to be able to walk up and down steps and play golf again. So, a patient reported outcome is saying, "How are you doing? How are you getting around again? Are you able to do your activities of daily living? Are you able to enjoy your life again?" I would say probably 5% of organizations are collecting patient reported outcomes. But I think in the future they will be the sine qua non of the highly effective care because that's really what matters. We measure patient satisfaction because we can, we're measuring PROs because we should.

SHIV GAGLANI: Thanks for clarifying that distinction. Because we know with HCAHPS scores and Press Ganey scores, there's some tension in the clinical community based on those, especially in certain specialties like psychiatry. I remember one of my professors at Hopkins is a psychiatrist and he was saying, "Look, the patient oftentimes is not satisfied when the psychiatrist says, 'no, you've got to take this medicine or you've got to quit taking heroin,' and things like that.” Like, satisfaction is not the right outcome, but PROs would be. Are they actually improved? And it sounds like the infrastructure you are putting in place for PROs will be very important for the bundled payment models. One of our guests coming up is Vivian Lee, who I'm sure you know, she ran University of Utah...


DR. AMY COMPTON-PHILLIPS:
She's a PRO fan as well, by the way.


SHIV GAGLANI:
Great. That's definitely something I think our audience, as they go into the clinical setting, should be paying attention to, is how organizations like Providence are implementing PROs and how that can become more ubiquitous the same way patient satisfaction became more ubiquitous.


DR. AMY COMPTON-PHILLIPS: Yeah, I think it's critical.


SHIV GAGLANI: So for this next question, let's go in a time machine to about seven months ago when the first cases of COVID were starting to be diagnosed. I would love to hear how Providence and you in particular adjusted to COVID and what are some of the lessons you've learned over the past seven months that may be useful looking forward to the next seven months as we enter this even more dangerous time with COVID and influenza?


DR. AMY COMPTON-PHILLIPS: Great question. You very likely know we had the first patient with COVID in the U.S., which was actually really good for us because first of all, that gave us a little bit of a head start...that we knew it was here, it was real, and we had to immediately activate our system to be able to respond. I'd say phase one is all about how do you respond? It got us thinking about “how are we going to triage test and treat patients that are influxing with a new disease?” And that got us thinking about, a”ll right, well, what do we do today that's different than 1918?” Well, today somebody gets a cough and shortness of breath, they go onto Google -- and we were thinking about this in February -- how do we answer the question, do I have COVID? If somebody Googles on that? So we started working very closely with our digital innovation group and with Microsoft and built a chat bot so that we could come up with answers so that people didn't have to call up phone lines that we were just imagining would be overwhelmed. We ended up building this chat bot with Microsoft. We said, "Hey, we want the world to use this. It's not just for us." So they actually turned it over to the CDC and now many millions of patients have been using that chat bot to be able to answer the question, do I have COVID? We also had that transferred directly with the branching logic and the chat bot, one of the answers could be, "Go immediately to a tele-health consultation” -- an express care virtual consultation in our lingo.

That was how we went from in 2019, we did 70,000 telehealth visits in Providence. We were doing 70,000 a week in April. So we scaled up instantly in our telehealth capacity and still have that. The other thing that we stood up was the capacity to triage patients through drive through testing, which everybody has now. But when we started up, the only other people that we'd heard about doing it were in South Korea. So our triage, test and treat patients was very rapidly scaled in addition to the ability for us to move people, products and places. We put together a pandemic playbook. We had our supply chain escalated at the worst of the worst in the spring. When we were running out of masks, we had a colleague go over to Joanne's Fabric and bring home every bit of medical sheeting and Mylar that they had and we started making masks in our basement like many did. 

But again, we were a little ahead. We were about a week ahead of the rest of the country so I think we were one of the first. The news found out about that and came in and that's how I ended up on CNN, was from making masks in the basement because we were desperate knowing that our docs were going to go in and take care of patients and our nurses were going to go in and take care of patients whether they had a mask or not. And we needed them not to do that. We needed them to have protection. We couldn't stand that they weren't going to have protection. A local furniture manufacturer heard about it and it ended up turning into the 100 million mask campaign, which we turned over to the American Hospital Association.  Now, by the way, they have exceeded 100 million masks in local manufacturing, which has been pretty amazing. 

So that was in the “react” phase. But then by May we said, "we can't only treat COVID. We know that COVID is not the only problem that happens here.” We had seen about a 30% drop in heart attacks and strokes, and we don't think COVID treats heart attacks and strokes so we knew that people were having them and they were afraid to come back in. In the “recover” phase, we said, "we've got to get people the treatment for heart attacks and strokes and cancer and arthritis and all the other things that are still ongoing." And so we started rapidly scaling up our ability to care for everybody else with COVID, not instead of COVID, which is what we were doing initially.

The best way we can measure it is volumes. We're almost back to parity with volumes at the moment. That's likely to change with this new surge, which means that we're probably taking care of people's underlying health needs in addition to COVID right now. But the big thing I think that’s critical is the third phase. So, we have react, recover, and the third phase is “renew.” We really do think that pandemics often form tipping points. We're going to be talking about the before COVID, during COVID, after COVID world, and what is the world that we want to live in after COVID and how do we reimagine the healthcare system? We are not going back to having a telehealth-free infrastructure. So how is telehealth going to move knowledge, not people, in the future?


How are we going to make sure we get care to where people are rather than requiring people to come where care is? So that's going to be the future. We are not going back to the data-free way that we built healthcare up. So how do we make sure we're embedding the tools that big data allows for machine learning, artificial intelligence, predictive analytics into the future infrastructure? How do we ensure that we can create seamless care that crosses venues where knowledge moves with people, so that they're not having to be their own project managers when they get a complex condition? That really is the work that we're structuring right now, in this very friable time when healthcare is unmoored from its foundations -- what can we do to make sure that when it settles back down again, it settles into an ever- better configuration?


SHIV GAGLANI: That's the first time I've heard that framework of “react, recover and renew.” Honestly, when you first said renew, I was wondering if you were going to go into the physician or clinician burnout space, because I know some of your 120,000 caregivers have been non-stop. And now it's another rush and maybe the worst one coming over the coming months and I'm sure that you all have plans and ways to get more caregivers in the fight, or renew them. I'd love to hear your thoughts on that, especially given that our audience are primarily comprised of current and future health healthcare professionals.


DR. AMY COMPTON-PHILLIPS: It's such an important point. I think our caregivers have just been feeling whipped. And by the way, we use the term caregivers for everybody that works at Providence, because we believe that our EVS workers (the “janitors”), or IT workers who are working night and day to make sure that the EMR is up and running and we can stand-up drive through test centers, and that our supply chain people that literally have driven across mountain ranges to make sure that one facility doesn't run out of gowns so they take them from one to another in the middle of the night, like when things were really awful – so they're all caregivers, and they've all been working nonstop in addition to the nurses and the doctors and the MAs and the respiratory therapists.

Something that we did early on -- and it's gotten a huge uptake, over 10% of our people have used the service, it sounds ridiculous, but again, in the react phase particularly, really important -- is we put a “stress-o-meter” on our intranet site. That's just the little happy face at level zero and really frowny face at level 10, and where are you on the stress-o-meter? Then we have services that we offer to people depending on where they are and it can be anything from as simple as here's some great reading material on how to manage stress, and here's a link to a mindfulness appointment, to tele-spiritual health -- which believe it or not is our number one thing that people choose, people have just had crisis of the spirit in this -- to tele-behavioral health. We have a behavioral health concierge service on-demand. Rather than giving you a phone number or a list of counselors, we offer people cognitive behavioral therapy on demand.  Our “No One Cares Alone” program has peer group support and we go all the way up through suicide hotlines.

Having an infrastructure to help staff dealing with the stress in the moment has been essential. But now we're also working on how do we build resilience? There's the concept of post-traumatic stress, which everybody knows about, but how do we turn that into post-traumatic growth? Our entire team of caregiver support and mental health support has been working on what's the pathway to get to post traumatic growth, because it's hard and it's going to get harder before it gets better.


SHIV GAGLANI: I love two of the things in particular that you said that I really want to highlight. One is this concept of being antifragile. There's an author Nicholas Nassim Taleb, who maybe you know of or have read, who popularized the term Black Swan. But he also has another book called Antifragile, which basically makes the point that there are things that, when they get hit or they get dropped, they break…that's obviously fragile. Things that get dropped and don't break, that's resilience. And then things that become stronger when they get hit...that's antifragile. The way you've described how Providence has adapted definitely sounds a bit like antifragility.


DR. AMY COMPTON-PHILLIPS: Yeah, I hadn't used that term, but the metaphor that I've been using is, it's like metal. The more you pound it, the more you bend it, the more you hit it, the more you heat it, the stronger it gets.


SHIV GAGLANI:  That's great. I mean, it's exactly the same concept. The second thing I want to highlight is very similar to a famous story of how when JFK went touring the Houston NASA facility, he asked the janitor there what did the janitor do? And the janitor said, "I'm helping send a man to the moon." And so similarly, your 120,000 caregivers, it's totally, exactly the right way to look at it and I'm glad that you made that clear. I know we're coming up on time. So my last question for you, given your leadership and clinical background as somebody who trained in healthcare is, what advice would you give to our audience of current and future healthcare professionals in terms of meeting the moment of COVID and beyond?


DR. AMY COMPTON-PHILLIPS: So there's a couple things. If you think really deeply about what you want to accomplish -- like I said earlier, my personal mission is to make great health and great care affordable and available for all -- but it took me a while to come up with that. But if you know where you want to go, there's 1,000 paths to get there. And so what can you do to continuously think about how do I get closer to that? Because it might feel sideways from what you're doing today. Like why would I read about anthropology and quarks, but I don't know, because how is that going to influence my future? And so by thinking about the end game and thinking about the myriad paths you have to get there, I think it opens up possibilities. I mentor a lot of younger people and I definitely advocate for continuing to be curious, continuing to learn and continuing to think about the myriad ways you can accomplish your goals.

SHIV GAGLANI: I think that's wonderful advice and very consistent with some of the people we've had on this podcast, including the person who runs the AAMC, Association of American Medical Colleges, who was a philosophy major before he became a physician. So with that, Dr. Compton-Phillips, thanks so much for taking the time to be with us today.


DR. AMY COMPTON-PHILLIPS: I really appreciate you having me. It was a pleasure.


SHIV GAGLANI: I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to flatten the curve and Raise the Line since we're all in this together. Take care.