Michael J. Duncan became President and CEO of Chester County Hospital and Health System on May 2nd . He has a long and productive career in management, having held executive level positions at large institutions including the University of Oklahoma, PacifiCare, Prudential and Temple University,  most recently serving as CEO and Executive Director of Columbia Doctors, a 1400 physician practice plan at Columbia University Medical Center. With his honest, inclusive open door policy he has already won many friends.
 
1. You have worked with physicians at Temple  and Columbia, both large teaching hospitals. Now you come to TCCH a non- teaching, comparatively small hospital. Will your approach as CEO here differ from your approach at those Hospitals?
 
As you point out, my recent experience has been at large academic medical centers as the CEO of the physician groups. The aspect of that I loved was spending so much time with physicians and trying to help them in any way I could to further the clinical mission. The challenge in any academic center is that there are multiple missions and the best intentioned leaders have a difficult time focusing relentlessly on the clinical mission. As I considered that challenge, it became clear to me that I wanted to be in a setting where I ran the hospital and had complete freedom to collaborate with the physicians to optimize the clinical mission.
 
2. Do you plan to keep TCCH an independent hospital and how will you keep it afloat in today’s economic environment?
 
Chester County Hospital’s long history as an independent hospital is important to the Board. Independence brings many advantages. While I am still learning, two advantages that are most obvious to me are the simplicity of the decision-making process and the freedom to keep the community’s interest utmost. Our intention is to execute on a strategic plan which enhances our ability to remain independent .
 
3. You have been known as a physician’s advocate. At TCCH how do you intend to continue that trend?
 
I am glad to hear you say I have a reputation as a physician’s advocate. I got my start in healthcare through the managed care industry. After a number of years there, I realized that my grasp of how the health care system really works was meager. I made an intentional shift in my career to lead large physician groups for the sole purpose of learning the health care system through the physician’s eyes. Now that I am responsible for the hospital, I would expect to continue on my path of learning. I would hope to broaden my view so that I am a clinician’s advocate – in other words I want to see how the system works to serve patients through the eyes of every caregiver. For example, beyond the 90+ one-on-one meetings I have had with physicians, I have rounded with nurses in many of the major units. The operating room staff has routinely hosted me to teach me what happens there. I take our mission seriously, so my job is to advocate for anyone who delivers on the mission.
 
4. In this era of intensivist and hospitalist the relationship between hospital based and private physicians should be symbiotic rather than antagonistic. What is your plan to keep the 300 physicians affiliated with TCCH involved and encourage them to continue to use the hospital?
 
A simple answer to this question will be difficult, but I will try. Over the past several decades, a variety of trends have led doctors and hospitals to conclude that taking care of patients in hospital is, in effect, a specialty unto itself. The average patient in the hospital today is much sicker than the average patient was 20 years ago. The complexity of the available interventions and the transition to electronic medical records has made the physician responsibilities in the hospital dramatically more complicated than they were 20 years ago.While a conscientious primary care physician can do all of this well, it takes so much time to do it right that most simply can’t give that much time to inpatient work. In the outpatient setting, the economics of the health care system drive the physician to the focus on productivity and throughput. While much of this is unfortunate, these are the market realities. At most hospitals, the admitting physicians have concluded that either it makes more sense for their business to stay in their office and see three or four more patients than to go to the hospital for one patient, or it makes sense to entrust the increasingly complex care of inpatients to a colleague specially trained in that discipline, or both. This is the first hospital I have been in 20 years which has primary care physicians coming in from their ambulatory practice to attend to their patients. There is much to be said for continuity of the relationship and the care for the historic model. Unless there is something unique in our setting, I would expect that these trends would continue and fewer physicians would choose to leave their office to come see the occasional inpatient. That being the case, we have at least two efforts underway to provide the support necessary to the referring physician community. First of all, we continue to grow our hospitalist program with an eye toward easy handoffs from the referring physician and good communication afterwards. The second effort is focusing on expanding our technology initiatives to take an extraordinary inpatient EMR and connect to the broader network of ambulatory systems. It is my hope that a physician anywhere in our community could gain access to all of the relevant information about one of their patients without having to come to the hospital.
 
5. In these times of great turmoil, SGRs, increasing cost and diminished reimbursements, how would you help the physicians cope with these issues?

I will give you a philosophical and then a practical answer to this question. Physicians are a discerning group and look to people they trust for advice and leadership. As such, I have an almost transcendent responsibility to always be trustworthy. Then, with that as a given, I believe the best thing I can do with physicians is be very clear about the challenges we face together and what I believe are the best general directions. A practical example of this is an effort currently underway regarding ambulatory electronic medical records. Every physician in the community knows they need to get on an electronic medical record. There are literally hundreds of choices of systems to buy. Some are technically brilliant but financially prohibitive. Some are affordable but have an undercapitalized company behind them and will almost certainly fail. The average physician’s office does not have the administrative talent to do an evaluation of electronic medical records. The hospital does have such IT professionals on staff, but they have been focused on inpatient electronic medical records. In my first month here, I asked to meet with the physicians’ office administrators to discuss this issue. Using their input combined with our IT professionals and some volunteer physician input, we are going through a mini-evaluation of a handful of systems. Soon we will make recommendations to the physician community. Rather than tell doctors which electronic medical record we think they should use, our intent is to give the good housekeeping seal of approval for maybe three or four electronic medical records. We are playing an active role in stimulating networking between different practice sites to learn from one another. I hope two things will come out of this exercise. First, we will have played an important role in helping doctors choose an electronic medical record in which they can have a fair amount of confidence that they will be able to meet “meaningful use” requirements and that other colleagues in the community will be on a similar platform. Secondly, if all the practices are on a handful of well functioning electronic medical records, we can build a hub so we facilitate communication between physicians and the hospital as well as among the physicians.
 
6. How do you feel your administration will differ from the previous administration?

Succeeding an icon is not for the faint of heart. Perry Pepper did an extraordinary job for more than three decades to build a high-quality low-cost delivery system whose sole goal is to serve the community. Perry and I meet on a regular basis at my request to review a wide range of issues. At this point, I would say the similarities of my administration will be much greater than the differences. I think Perry had the right strategies, so we will put all our energy into implementation. The culture is remarkable, so continued refinements will be in order but not wholesale change. Since I cannot tie a bow tie, you can count on one sartorial change.
 
7. TCCH is one of the main employers in the county and thus what happens here effects everybody who lives here. Do you have a final message for the physicians, the community and the citizens of Chester County?
 
What I believe the community will most notice is a growth spurt. I expect us to begin construction on the new wing within 60 days. We added robotic technology to the operating room last week. In the next few months we will complete a strategic facility master plan which will inform our next steps. Given that the community is the fastest growing in the state, I expect us to be one of the fastest-growing healthcare systems in the state.