Q&A with Dr. Damian P. “Pat” Alagia

MD-UPDATE Editor Jennifer Newton talks with KentuckyOne Health Chief Physician Executive Damian P. “Pat” Alagia, III, MD.

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MD-UPDATE: Tell us a little about yourself.

ALAGIA: I am a native Kentuckian born on the Fort Campbell army base –my father was JAG corp – and then grew up in Louisville. After graduating from St. X, I attended Georgetown University in Washington, DC, for both undergraduate and medical school. I had the good fortune to work under the direction and guidance of Dr. Hiram Polk for three years as a general surgery resident before deciding to transfer to Georgetown to complete my residency training in OB/GYN. After my training was finished, I started a private practice in Washington, DC, which grew into a group practice. During the early years of the practice, I was able to finish an MBA in finance at Johns Hopkins University in Maryland.

I was very fortunate to grow up in a close family with great parents and siblings. I married a wonderful woman, and we have three children of our own.

Describe the complexities of the job as Chief Physician Executive.

First and foremost, we focus on our patients, potentially three-and-a-half million people in the Commonwealth. We have more than 15,000 physicians, nurses, medical, and administrative support staff working to integrate the deeply rooted and proud cultural heritages of the UofL academic health system with the Jewish and Catholic health care systems into one organization. Even though we are in transition as an organization, and like others, are constantly managing changing funding sources in the new world of health care, we are working hard to provide the highest level of care to the people of our communities.

At the end of the day it comes down to focusing on the patient, communicating with our physicians and encouraging all staff members and providers to contribute in a meaningful way.

What are your priorities?

Quality, safety, and service are our top priorities, followed by physician engagement and physician leadership. Doctors need to feel that they have a voice in the system. The physician enterprise, known as KentuckyOne Health Medical Group, must provide an exceptional experience for both the patient and the physician. We also need to integrate the hospital practice, the ambulatory practice, and the Center for Innovation and Research (CIRI) into the vision of providing the highest quality of care to our patients.

Every day is exciting and surprising and challenging. It is wonderful to see the determination and commitment among the doctors and all the stakeholders to get this right, in the face of changing business and health care delivery models.

Talk about quality, safety, and service. Those concepts are buzzwords. What do they mean in practice?

Quality, safety, and service comprise a cultural mindset. In the past, if there was a problem, we might have thought the problem was caused by one or two bad apples on the team. There was a “gotcha” mentality that created tension and mistrust. The new way of thinking focuses on the processes or the context surrounding a situation in which there was a bad or less-than-desired outcome. Instead of asking “Who let that happen?” we ask, “How did that happen?”

We’ve established a culture of accountability, not a culture of blame; and we listen. Then we solve problems as a team. That’s what great teams do.

When you work in a hospital, instead of assuming it’s a safe and stable environment where nothing can go wrong and nothing bad can happen, you have to realize that it is a highly complex, highly functioning but inherently unstable environment. People are seriously ill and we often have to act quickly with limited or incomplete amounts of information. We have set up mechanisms to ensure accurate, appropriate care despite the pace of our work and the acuity of our patients. Our ability to successfully manage this complexity while providing a safe environment for our patients distinguishes KentuckyOne from the rest.

Quality, safety, and service are not just events or just a bunch of boxes we check off. It’s how we think about the quality, safety, and service that we’re delivering every day that defines the culture we are creating.

What do you see in the next two-to-three years at KentuckyOne?

We’re here to stay. We’re here to be great. The future of the health care model is still unclear. We know that in the future hospital admissions and lengths of stay will go down, while outpatient care will go up. Only the really sick will be admitted into the hospital and will be cared for by the full complement of hospital resources.

Growth will be in the acute setting caring for the very sick and in the ambulatory setting with physician-led teams of extenders, physician assistants, and nurse practitioners. We’ll become much better at chronic disease management because it’s the right thing to do and we’ll be incentivized to do so.

Our focus will be on keeping people out of the hospital. We will change the paradigm, and that is really exciting.

Tell us about the 24-hour Anywhere Care. Where did that idea come from and how is it working?

It was an idea that came from CHI. The question was asked, “How can we serve a larger patient population who does not have immediate access to a primary care doctor without using our emergency rooms or ambulatory care centers?” Anywhere Care was the answer. It’s no surprise that younger people are adopting it more quickly than the rest of us. They’re more comfortable with digital media. We do track the number of calls being made to the service, and the numbers are increasing steadily every month. I’m a little surprised by how quickly it’s been adopted, but happy with the results. You have to constantly be trying different and innovative things – knowing that some of your efforts will not be successful– if you are going be competitive, relevant, and sustainable in the marketplace.

You’ve been here since September 2013, talk about merging three different health care systems.

It comes down to communication, transparency, and trust. It takes time to create a culture where all three are present and embedded. As long as we remember that “It’s not about us, it’s about the people of the Commonwealth,” we’ll be ok. We need to keep focused on the vision and the purpose of the work we are doing and keep building trust.

What do doctors need to know about KentuckyOne?

We are working to make KentuckyOne the best place for physicians to practice. We must give them the authority, the venue, and the resources to excel in the work they are trained to do. If we, in any way, marginalize or diminish the physician’s voice, then the system falls apart. When physicians lead, we win.

We’re finding a balance and creating alignment; the physician’s interest is focused on taking care of the patients and the business interests support them in this endeavor. It goes back to keeping our focus on our mission: to bring wellness, healing, and hope to all.

Is KentuckyOne in a practice acquisition mode?

We are always looking for great physicians and great practices committed to providing the highest level of quality and service to patients and their families.

Are there any misconceptions in the marketplace that you want to address?

We are absolutely here to stay. As a group of physicians, nurses, support staff, pharmacists, technicians, chefs, and administrators, we don’t commit to something this big if we don’t believe in our hearts that we can make a difference. We’re a young company, merging three legacy systems from across the state. That takes time. If there is any misperception out there that I need to address, it is that KentuckyOne is committed to our mission, our patients, and our clinicians. We’re here to stay.

You have some interesting siblings and family relatives, I hear?

They’re all interesting. My brother is a major record producer. He produced the first Dave Mathews Band CD and won a Grammy with John Mayer. I have three wonderful and successful sisters, and a father-in-law who was a Navy test pilot and the first head of the FAA. My sister-in- law is the Queen of Jordan. As I said at the beginning of our discussion, I am very fortunate, and of course, very grateful.

WE’RE HERE TO STAY. WE’RE HERE TO BE GREAT. THE FUTURE OF THE HEALTH CARE MODEL IS STILL UNCLEAR. WE KNOW THAT IN THE FUTURE HOSPITAL ADMISSIONS AND LENGTHS OF STAY WILL GO DOWN, WHILE OUTPATIENT CARE WILL GO UP. ONLY THE REALLY SICK WILL BE ADMITTED INTO THE HOSPITAL AND WILL BE CARED FOR BY THE FULL COMPLEMENT OF HOSPITAL RESOURCES.