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Becker’s Healthcare Podcast
Dr. Peggy Duggan, Executive Vice President Chief Physician Executive Chief Medical Officer, Tampa General Hospital
00:23:03
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right, click. Looking forward to hosting you in Chicago.
- [00:33]
B
This is Laura Deardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Dr. Peggy Duggan, executive Vice President, Chief Physician Executive and Chief Medical Officer at Tampa General Hospital. Dr. Duggan, it's a pleasure to have you on the podcast today.
- [00:47]
C
Pleasure to be here.
- [00:48]
B
Fantastic. Well, I'm excited for our discussion because I know Tampa General is really on the cutting edge of a lot of things happening in healthcare today and some particularly really fascinating things in just serving the pat more inpatient experience. And so I'm looking forward to digging in. But before we do, can you tell us a little bit more about yourself in Tampa General Hospital?
- [01:08]
C
Oh, sure. Happy to. So as you stated, I'm the chief physician executive at Tampa General and Tampa General is a large academic health system in the central part of Florida. So we are we the anchor is really our academic medical center which is in Tampa, but we are a six hospital system. We have three community hospitals north of us that came into the system about two and a half years ago. We manage a hospital on the other coast, a true rural hospital. And then we just made an agreement to take on desoto Hospital to the south of us. So another true rural hospital. So we are really working both in the large academic medical space, but also providing care to the rural citizens of the city of Florida. In addition to that, we have about 150ambulatory sites and that covers pretty much anything a patient could need, urgent care, imaging, ambulatory clinics, specialty clinics. So really a wide range of care can be really received at Tampa General Hospital in many environments basically to provide care to patients in their communities at the level of care we provide at the amc. For myself, I am here. I've been here about five years this month. So January is my fifth year anniversary here at Tampa General as the chief physician executive. I came from Boston where I did most of my training and most of my work had been at the Brigham Women's Hospital. I was there for about 22 years as a academic breast surgeon and as a physician leader in their system. But coming to Tampa has been a lot of fun. We get a lot of things done here at Tampa General and it's, you know, we are innovative, as you said, and on the cutting edge of a lot of activity in the health care space. So it's been a great five years.
- [03:02]
B
That's amazing to hear and, you know, really, really fantastic to think about and understand a little bit more of Tampa General's growth as well. Now, in looking at the last year or so, what was the most important initiative that you led? What did you do and what were the results?
- [03:16]
C
Yeah, so for me personally, and it's really a two year journey for this mission, but my biggest, I'd say and most impactful project was a full redesign of our critical care delivered at Tampa General and across the system. So at the academic medical center, we have about 210 critical care beds, so the size of a pretty typical community hospital. We have in critical care beds. So a big project, lots of specialty units, lots of different ways people were providing care. So what we set about doing is really creating a series of standards so that we were simplifying and standardizing care across units based on specialty, but also staffing, bringing in more critical care providers as both MDs and apps to be the support for the nursing crew that takes care of the patients day in and day out. And so by doing that, we've really created an as ICU center of excellence. It's been incredibly empowering to the teams and incredibly impactful to our patients. And I can just give you a few statistics, but we've had a significant drop in central line infections, so about half of what we had in FY26 and same for urinary tract infections, two things that really plague critical care patients. So had significant improvement. But what's most compelling for us is our mortality. So our ICUs, we compare ourselves, when we think about where does Tampa General sit in the world of hospitals, we compare ourselves to the other large academic medical centers. When you look at our ICU mortality, we are in the 9th percentile in the large academic medical group that shares their data with the Vizient database. So really impressive work that the teams have done and really has driven great outcomes for our patients. It's been a joy to watch. We really just got it started and then the team we built ran with it and it's just been a joy to watch them drive those improvements. In addition to that, we've done a housewide safety work, just really working on the safety and quality of care for our patients. Tampa General's primary goal is delivering the highest quality care. And for doing that, engaging, really. All of the teams, when I say all, I mean everybody. Like our finance team's engaged and our IT team is engaged in this work because we all come to work to care for patients every day. We've moved our ranking in that Vizient academic cohort to the 24th percentile in the country. We're talking about all the large academic medical centers, the Mass Generals, the Vanderbilts, the Stanford. We feel really good about the work we've done and how we've driven and shown the quality of the work and the care we provide at Tampa General while caring for some of the sickest patients, certainly in our. In our state.
- [06:18]
B
Absolutely. That's fascinating to hear. And, you know, I think a really powerful example of how you can, you know, get initiatives started, kind of create the vision of what you're looking for, and then let your teams really take the lead on making sure they're successful and then continue to grow and iterate on them. And I think, especially when you look at quality patient safety initiatives, metrics, and moving the needle there, what do you think has been really the biggest, I guess, thing that your teams have been able to do and accomplish and overcome in order to create some of these results that are truly magnificent?
- [06:56]
C
Yeah, I think a couple of things. Building a lot of infrastructure, so resourcing, right. Things that needed to be built so that that patients were getting the most efficient and effective care. And I'll give a very simple example. We built out a new peripheral IV team. That does not sound like a big important project, but what it's done is a number of things. So that new team places all the peripheral IVs in the building for patients who are not in our critical care units. Those nurses place those. It's decreased the infection rate, honestly, the mrsa, the really resistant bug rate that spreads from patients in the building, it's decreased that significantly. And it's given our nurses, our bedside nurses, time back with their patients so that they can really spend the time providing nursing care and the support that patients need. So simple. Sometimes it's simple things or things that wouldn't seem like a big needle mover. But when you build the infrastructure and then you let the teams really go after the work, that's a huge benefit. The other thing we do a lot of here is look at our data, right? And so we look where we're challenged and we analyze that data and look for the why of that data. So dig really deep into why something is sitting where it Is like, you know, we've done a ton of work on length of stay. Why were we sitting where we were and then going after? Well, how do you remove those barriers for the teams? Because the team wants to do the right work. Everybody comes to work to deliver great care, but sometimes there's barriers for them that as leaders, our job is to identify those and really tick them off so that they can. The teams can be more effective.
- [08:42]
B
That makes a lot of sense. Thank you so much for digging a little bit deeper there. Now, looking ahead, what are some of your big priorities as well as headwinds you're focused on for 2026?
- [08:52]
C
Yeah. So a couple of big priorities are things that are in motion. But we really want to scale and drive. So a huge opportunity for us. And we have one of the largest programs in the country, but we still want to continue to grow. It is our hospital at home program. So we have a group of patients who are inpatient level of care, but are cared for in their home by our nurses, by our advanced practice providers and our physicians. We designed that program with our Chief Innovation Officer, Dr. Peter Chang. That program has really allowed us to take some of our lower acuity patients from our ED or from our inpatient unit and bring them home receiving the same level of care they receive in the hospital. That's a huge win for everybody. The patients love it. They're home with their family. The teams love caring for patients in their home environment. And I think one of the things we've seen as a side effect of that is when you're in someone's home, you can see some of the reasons why they either return to the hospital, maybe their dietary habits or some of their other activities. You can see it and you can make an intervention. That population of patients has the lowest readmission rate in our system because of that ability to see outside the hospital walls. What are some of the challenges our patients are facing? I think our other big initiative really to scale is this idea of moving to. What can we move to? Ambulatory. So we have a. I'd say a nascent project that's really in growth, but we call it, think ambulatory first. And that's led by one of our associate Chief Medical Officers, Dr. Asa Ochsner. And that work is really driving the patients who can be taken care of in an ambulatory space to an ambulatory clinic. And if we just take a second to explain the why of that, you know, if you're an emergency medicine physician or a hospitalist, you have a Lot of responsibility to make sure the patient gets what they need. Even if it could be done outpatient. You can't just send them to get that outpatient care without making sure that really happens and that there's follow up. So what we've done is create an environment where the providers know that the patient is going to get what they need. Very consistently we built it with them, which is one of the, I think keys to the success is really building it with the teams that are going to be using a resource and it's really taken off. And the other thing I'll say is that we've needed this for a long time and I think probably most hospital systems do. And that's what really drove its success. Like we were meeting the needs of our emergency medicine physicians. They don't want to admit patients, they don't have to, but they do want to make sure the patients get what they need. So we created that for them. And it's really taken a lot of patients who would be admitted out of the hospital and allow those beds to be available for sicker and more complex patients, which is really what certainly at our academic hospital is why we're here.
- [11:54]
B
That's amazing to hear and I think it's really helpful to understand that why behind the ambulatory focus and shift because so often I think that's lost within the dynamics of making such a big change. But really understanding that it seems like has helped propel and accelerate some of the movement action at Tampa General.
- [12:14]
C
It sure has. And as far as thinking about headwinds, which are big for 2026. Right. I think our biggest headwind is uncertainty. And so it's just hard right now to know where all is going to land, particularly as it comes to payers. Right. So we're here working very hard to make sure our patients get the highest quality care, which I'm very. I'm a very close partner with our chief financial officer and we both agree, like when you provide the right care, it's usually also, from an economics perspective, more efficient and really benefits the business. But the uncertainty is going to be a challenge for us. And being focused on fiscal responsibility this year is going to be very important as we lean into the coming years. I think that's again true for all health systems. We've all been challenged, especially after the pandemic. Things have shifted dramatically in how care is delivered. And I think we're, you know, we're just. It's a wait and see for many of us to see how the payers are going to react and how we're going to move forward. So the uncertainty can be challenging. But I think for us, we always look for the opportunity in that. And we've got a number of big initiatives going on to really drive cost management so that we can be in the best position possible for any changes that come. And I do think those changes will roll out over the next couple of years. But this year for me, it feels like just the headwind is uncertainty is going to be with us. And keeping focus while there's a lot of uncertainty will be the challenge for the leadership team. Keeping our teams focused and not distracted by that uncertainty.
- [14:04]
B
That's such a great point. I mean, you can't control exactly what the uncertainty is going to bring or what payers might do in policy shifts. But to have that kind of reaction, the messaging to the team is really critical. How do you communicate some of these things to the teams when, you know, you're looking at fiscal responsibility, trying to understand efficiency in cost cutting, while at the same time, you know, continuing to keep them focused on the patient care side? What does that look like? Or how are you rolling out some of these initiatives that you mentioned to really make sure that you're doing the best you can to push these initiatives forward?
- [14:42]
C
Yeah, so I think a lot of it we do by partnering. Again, like I said, our chief financial officer of course, is driving the work to improve efficiency from a cost containment perspective. But efficiency is quality and we spend a lot of time on that. Right. Inefficient care is not high quality care for patients. And so he and I are great, again, great partners. We share the work on our length of stay initiatives. And then I think for the teams, they see the chief physician executive and the chief financial officer aligned, that's really helpful. If myself and Mark Runyon, who is our chief financial officer, were not aligned, it would be really hard for the teams to be focused. So it's deliberate work. He and I work together on how we bring initiatives forward and how they're talked about. We co sponsor a lot so that again, people see us at the table together. We learn from each other. He and I've learned a lot from my CFO and he's learned a lot from me about how we can really help propel the teams because nothing gets done. We can make all the initiatives we want, but nothing actually gets done if the team doesn't get behind it. People can do a lot of lip service to an activity or they can get behind it and get after it. At Tampa General, that's one of the things I've been most impressed in my time here. People really get after the work we want to achieve, we just make it easy for them to see that quality of care is more efficient, is also more cost effective. We tie all of that so that the care teams identify it as we need to do this for, you know, myriad of reasons. In addition, of course, and John, of course, our president is a great communicator. We talk a lot about how we can't provide the care we want if we can't make a margin. Right. This doesn't work. And so even as an, particularly as a not for profit, we're really putting it all back into the community and the business. We have to have a margin in order to be successful with quality. It doesn't work any other way.
- [16:52]
B
That's really, really inspiring and helpful to understand. And I think, you know, especially given, as you mentioned, some of the potential challenges that are ahead. A great way to look at things and, you know, working aligned with, between the chief physician, executive and CFO too is just really inspiring to see. Now, I wanted to ask, what do you think the hardest thing you'll have to do in the coming year will be?
- [17:16]
C
Yeah, so I think the hardest thing is one of the things actually our president, CEO speaks about a lot and that's care coord. Care coordination, of course, is really what the patients need us to do to make sure their journey really works for them and they're getting what they need. Like a lot of academic health systems, we do a lot of care coordination, but some of it is in, I'd say siloed or service line specific or focused. So those we've identified, those teams are doing great work in that episode of care. They're really helping the patient during an episode where they need that help and they need certain things. Like oncology is different than heart and vascular is different than neuro. Right. Neurology. But what the patient does is they cross all of our silos in their care. They're receiving care in the outpatient setting at our hospital, in our community hospitals across to the east Coast. And we need to align coordination with the patient journey. That's not going to be an easy thing to do. I think it's a required thing to do. But we're starting an initiative this year where we're really going to take a couple of our leaders again, our chief transformation officer, ambulatory officers and one of our associate CMOs, and they're going to really look at how do we Tie all the coordinating we do to what the patient's whole needs are. It's going to move a lot of people's cheese around. That's never easy, but I think if we keep focusing on what's the need of the patient, that will come along. I think that's probably going to be our biggest challenge. But it's a great one to tackle and we have the right team to do it.
- [19:02]
B
Absolutely. I love that. And, you know, looking at the people, of course, having the team in place and understanding the mission is critical, but then I can imagine, is there technology involved? How are you really thinking about the transformational side of this?
- [19:15]
C
Yeah. And that's why the Chief Transformation Officer, P. Cheng, is such a critical partner in all of this. Because for the team to be successful across silos, we need tools for them that speak to each other. Right. And so that will from a strategic and a tools perspective, that's a key component and why we need someone like him part of that work. Because the. The care teams know what they're trying to get to the patient or for the patient. But how do we communicate across and not duplicate efforts for some patients and provide less to other patients? How do we spread that out? How do we use tools like AI to support that so that we can take what we have and amplify it across more patients as well?
- [20:02]
B
That makes a lot of sense. It was really exciting to see how you're able to integrate those types of tools and technology and data into the broader initiatives that are making patient care as well as the patient experience a lot better. One last question for you. Where do you see some of the best opportunities for organizational growth moving forward?
- [20:22]
C
Yeah, for me, I spend a lot of time thinking about, again, growing that hospital at home platform so that we can take care of patients in their home and then create beds for patients who need to be at the amc. We are actually also at one of our community hospitals creating a similar hospital at home program. Again, decanting patients from the inpatient setting and giving them their care in their home. That's creating inpatient beds without building a building that is really impactful. Then the shift as much to ambulatory as possible. That includes our ASCs and our ambulatory think ambulatory force first platform. Those get up and really moving quickly. That creates capacity in our AMC that will allow us to care for more sick and complex patients. We also have a major initiative we're kicking off in January on efficiency and looking at where can we be more efficient on the inpatient side so that we can again more effectively deliver care to patients. And, and when we do that, and I say this all the time, when we more effectively and efficiently get the care the patient needs to them, they naturally leave the facility earlier and sooner and get back to their families. So we're kicking off a major initiative. And again, this is one of the areas where myself and the CFO are co sponsoring this work to bring it across the finish line and get really up and moving some more opportunities for our patients to get what they need in a more efficient fashion. I think the other opportunity for us with growth is really the use of AI in all of this. So we use AI pretty extensively at Tempe General and that's going to drive some of our efficiency work both on the inpatient side and the ambulatory side. Being able to see and identify what patients needs are and also taking some of the more menial tasks that team members do in like really digging through charts and having AI do that for us so they can be out with patients or with the nursing team supporting them and getting care to the patients more effectively. So we've seen some great improvements with our AI efforts as well.
- [22:36]
B
I love that. Dr. Duggan, thank you so much for joining us on the podcast today. This has been such an amazing conversation. We've covered so much ground and really cool to see the transformation happening at Tampa General. I'm looking forward to seeing you in April as well at our annual meeting. I know you'll be speaking on a lot of these themes and continuing to share, you know, more behind the scenes of what you're doing at Tampa General, so I'm looking forward to seeing you there.
- [22:58]
C
It's been my pleasure. Thanks, Laura. And I'm looking forward to it as well.