As chief executive of Holy Cross Providence Medical Center in Mission Hills, Dr. Bernie Klein spearheads one of the largest hospitals in the Valley region. The hospital had net patient revenue of $494 million last year, ranking first on the Business Journal’s list of hospitals. Klein worked as an internal medicine doctor for more than 17 years in various Valley region hospitals before deciding to take an administrative role to grow his impact. After obtaining his MBA from Emory University, he went full time into administrative medicine in 2004. “When you’re practicing medicine, you’re dealing with one patient at a time,” he said. “When you impact the system, you might be able to affect the care of hundreds and thousands of patients over time.” Question: How has diabetes affected your hospital? Answer: Diabetes is an epidemic and more and more patients are showing up at the hospital with elevated blood sugars. The medical literature has shown that it is extremely important to control a patient’s blood sugar while hospitalized. An elevated blood sugar may lead to increased infections and poor wound healing. However, patients in the hospital setting are also at risk for hypoglycemia, or low blood sugar, due to decreased caloric intake. How have you responded? Utilizing real time data, we have been piloting a program focused on ensuring our patients maintain an appropriate blood sugar level throughout hospitalization. As a consequence of the pilot, the patients have shown improved sugar control with few episodes of low blood sugar, and a shorter length of stay. What’s next? Within the next 12 months we hope to become joint commission certified around diabetes care. The certification says that we’ve met standards around care of the diabetic patient. The second certification is in patient blood management. It’s using blood appropriately so that we get the best outcome while minimizing the risk to the patient. What’s really exciting is when we are able to provide better quality at a lower cost. That to me is what we’re going to continue to need to do if we’re going to be successful. What changes are happening in the health care industry? We’re sharing information better with each other. We are doing a better job of focusing on the key areas of harm and prevention. We’re starting to shift towards paying for outcomes rather than paying for procedures and I think that bodes well for patients. Why did you decide to become an administrator? When I first started working at Kaiser, in nine months, I had over 1,600 patients assigned to me. Patients were very frustrated and I was frustrated. When we looked into it, we found out that my name was in the computer three different ways. So, I wrote a letter to management saying I can’t provide the type of care I’d like to, and here are the issues. And by the way, here are some things I would recommend we do to make it better for your physicians in the future. They not only listened to me, but actually put me in charge of the first-year doctors the following year. And that’s when I realized, “Wow, I could impact the whole system and I really like it.” That’s when I started to pursue administrative medicine and get an MBA. What are the challenges for caregivers? People always want us to make them feel better. But sometimes medicine is not the right thing to do. Sometimes when we intervene medically we can make things worse. It’s trying to get the patient to understand that. For example, an antibiotic is not going to fix a virus. Sometimes there are risks with antibiotics because people can develop a reaction. You have to explain that this (healing) is going to take more time but it’s the right thing to do. What kind of innovation do you see in hospitals? It’s an automated global trigger tool, where we can look at every single patient record within seconds and determine if there’s going to be potential harm. And then we are able to intercede and try to prevent harm from happening. Now, you’ve got to understand some harms are preventable and some aren’t. If I give you an antibiotic you’ve never had before and you break into a rash, you’ve been harmed but there’s no way to know that would have happened ahead of time. Preventable harm is when we knew you had an allergy to that antibiotic and I prescribe a cousin of that antibiotic because we did not know your history. With this, what’s exciting is getting more effective at preventing harm. What keeps you up at night? We’re seeing more patients and our reimbursements are dropping. And so how do we continue to provide highly reliable, highly satisfied, and high-quality care at a lower cost when your income is going down? How do we guarantee results and continue to improve? That’s probably our biggest challenge, not just for me but for all chief execs.
