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New Duke Hospital president Thomas Owens discusses future, issues facing hospital

In Dec. 2017, Thomas Owens was appointed president of Duke University Hospital, replacing the outgoing president Kevin Sowers. Owens has held titles such as vice president for medical affairs and chief medical officer for the Duke University Health System. He is also an associate professor of medicine and pediatrics at the Duke University School of Medicine. The Chronicle sat down with Owens to talk about his new role and the future of Duke University Hospital. This interview has been edited for length and clarity. 

The Chronicle: What do you hope to accomplish during your time as president? 

Thomas Owens: I'm really honored and so privileged to be serving in this role as university hospital president and to be assuming the role at a time when our hospital and our team are really doing phenomenally well. The hospital is not broken, the team does not need to be fixed. What we really need to do is we need to support the talented individuals we have to deliver the bold vision that we've created for Duke Health and for our Duke University Hospital—to deliver outstanding care, to continue to train future providers and leaders in healthcare and to help navigate these complicated times in healthcare. My goal is to, again, spend this initial time really listening to the team, understanding what works, identifying challenges and then helping create solutions so that we can continue to be successful and to be leaders locally, regionally and nationally in healthcare.

TC: What are your most important duties as president of DUH?

TO: The first thing to say is that we have a wonderful university hospital that takes phenomenal care of patients and families and delivers great service, not only to the Triangle, but to the region and nationally. It’s a team of very talented individuals that work everyday, so first and foremost, my job and my goal is to support that team and help them continue to deliver outstanding care, discover new breakthroughs in care and make them available to patients near and far. My first goals are to take time to really engage with and listen to the team—understand what's working well and understand where we can spend more time and energy to deliver even better care.

TC: Could you talk about what you value most in terms of healthcare?

TO: We’ve really been rallying around this idea now of the quadruple aim—to focus on outstanding outcomes, quality of care, with access and convenience. Care being available and local where possible, that is efficient, and being good stewards of our resources as we deliver this care. The last area of focus—it’s really been highlighted over the last couple of years—is to think about our healthcare team, recognizing that lack of resilience and burnout have become increasing issues in healthcare. It’s focusing on those three aspects of care delivery, with the fourth being the health and well-being of our team. 

TC: Could you explain how the hospital has been focusing on these values? 

TO: Some years back, we focused our values and as a team really identified that our core values—caring for our patients, their loved ones and each other—really resonated with us. We’ve been using that approach when we make decisions about who we hire so that they have that same set of values. We use that approach when managing performance and also for setting our strategic plan. Being even more sensitive and aware of the health and well-being of our team, who work so hard every day, has been something relatively new in healthcare, something that’s been recognized nationally over the past couple of years. 

The work that’s happening right now to help identify the challenges our team faces every day is through the annual assessment, the culture pulse survey, to help people provide feedback to us about the environment in which they work and the team and leadership that works with them. This helps us understand how to improve that environment, do their job better and feel a greater sense of well-being and resilience as they do it. The other thing we’ve done is that we have and will continue spending a lot of time working with our talented managers and administrative leadership to help them be even more effective in that role, which is certainly a hallmark of organizations that have a workforce that is very resilient and feels very healthy—having an engaged and effective leadership.

TC: What do you think are the biggest issues facing Duke Hospital right now?

TO: We’re fortunate that we live and work in a growing market, so the demand for services is very high, so we have real challenges around access and capacity right now. Most days we don't have the capacity, bed spaces or care space that we need to care for all the patients who want to come to Duke, so one of our first challenges is to continue to grow and be available to the patients who need us. We have plans to add to our facility with a new bed tower, which is under construction. However, that will take three to four years to be fully operational. In the interim time, we need to figure out how to use the space we have most efficiently and most effectively to meet our patients' goals. 

A second challenge is we have been a national leader in quality and safety, and we want to continue to be, so we have to challenge ourselves to be even more innovative and creative in the approach we take to raise the bar internally and push ourselves on quality. I think the third is around the well-being and resilience of our workforce. First, as we grow, one of our goals is to educate and train tomorrow's healthcare providers, and I mean nurses and doctors and other front-line caregivers. That leaves the last of the greatest challenges we face, which is the change in the healthcare landscape. Some of that comes out of legislative activity or changes in the healthcare insurance market—both commercial and federal—and we need to be able to respond to those changes to help deliver great care for patients and families.

TC: Are there any other plans to increase accessibility and capacity of the hospital?

TO: As a health system, we’re also adding additional capacity with a new bed tower at Duke Raleigh Hospital and are working on plans to continue to operate, renovate and expand services at Duke Regional Hospital. Again, we're fortunate that our overall market is growing and the demand for services across Duke Health has been strong, so we want to create access and be available for care. We’re also working to help bring care closer to home for patients and families around the Triangle with new ambulatory facilities and specialty clinics, many of which have opened already, and many of which are under construction and planning to open in the next two to three years around the region.

TC: How do you think the repealing of the individual healthcare mandate will affect the hospital?

TO: That's a great question. We are all anxious to see what effect that will have on enrollment in insurance. The Affordable Care Act had a very positive effect to reduce the number of uninsured individuals in North Carolina and the country in general. Our hope is that many healthcare consumers will continue to enroll and have access to care through an exchange insurance plan. I think in the first year, the enrollment here in North Carolina is down just a little bit, but still fairly strong, and we’ll have to watch very carefully to see if consumers make different decisions about enrolling in health insurance. 

We know in general when folks decide not to have insurance, it reduces their access to care, and they tend to delay care for chronic conditions or what is perceived as non life-threatening conditions. So, we see more folks with out-of-control disease, and morbidity and disability associated with that, and that's something we certainly don't want to see in our community. We need to continue to work to help encourage communities to make good decisions about health insurance and then have good access to care.

TC: Is Duke Hospital collaborating with any community partners at the moment?

TO: The hospital and the health system certainly work very closely with other community healthcare partners locally in Durham County and other regions. We recognize that health and healthcare are very local, meaning they're dependent on good care in local communities, but health and health outcomes are really largely driven by the environment, by psychosocial factors, by the overall environment in which people live and work. So, our goal is to enhance the health of our community, and I mean that broadly, but certainly speaking about Durham and our local community. 

To be successful there, we need to have broad and deep partnerships with public health, with the Department of Health, with our state leaders. We recognize really strong partnerships with the county of Durham and other health facilities in Durham, with the community health center and other community health services that deliver care. We certainly want to continue to grow and strengthen those partnerships because it is critical in enriching the health of our community.

TC: Is the hospital taking efforts to move toward patient-centered and value-based care?

TO: Yes, we absolutely are, and we have been focused on that transition for several years through efforts to fundamentally redesign and enhance the way we deliver care to always—first and foremost—improve outcomes of care, quality and patient experience, and to focus on affordability and the overall cost of care. We've participated in a number of programs that have helped us lead thinking about not only care redesign but engaging in different ways that we are paid to help reinforce value. We’ve participated in several [Centers for Medicare & Medicaid Services] demonstration projects and innovation projects. We learned a lot from that, which help us continue to evolve and enhance the way we deliver care to folks. We are also really working with our teams because this is new for many providers and physicians, so we are doing a lot of work educating our team how reimbursement and management has changed.


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