Podcast Summary

Becker’s Healthcare Podcast

Episode: Dr. Vladimir Manuel (Vice Chair of Clinical Affairs, Department of Family Medicine) & Scott Jahnke (Senior Director of Operations), UCLA Health
Date: November 23, 2025
Host: Laura Deardel

Episode Theme

This episode explores UCLA Health’s innovative application of improvement science to hospital operations, focusing on the development and evolution of their hospital command center. Dr. Vladimir Manuel and Scott Jahnke discuss how moving from reactive "firefighting" to proactive, data-driven decision-making has yielded measurable improvements in efficiency, patient care, and financial performance.

Key Discussion Points & Insights

1. Backgrounds and Roles

• Scott Jahnke:
  • Experience building command centers at Tampa General Hospital and UCLA Health.
  • Focus on operational efficiency and transformation of hospital operations.
• Dr. Vladimir Manuel:
  • Dual focus on operations and quality; instrumental in developing UCLA’s urgent care system to increase access and reduce unnecessary ER visits.
  • Shifted attention in recent years to hospital operations and improvement science, particularly around the command center.

2. Development and Evolution of the Command Center

[02:12] Scott Jahnke:

• Early command centers focused on monitoring and escalating issues—essentially acting as the "easy button" for crisis response.

• Realization: This approach created a "firefighting mentality," constantly reacting to emergent issues rather than solving root problems.

• Influenced by leaders in improvement science (Dr. Moira Inglis, Dr. Peter Margolis, Dr. Manuel), shifted to using real-time data to detect and address root causes, aiming to prevent issues instead of always escalating.

  "We really created a firefighting mentality... by escalating each individual case through the command center. We're always just chasing down and putting out fires."
  – Scott Jahnke [02:39]

3. Shifting the Focus: Effectiveness Over Efficiency

[03:55] Dr. Vladimir Manuel:

• Rather than focusing solely on traditional operational metrics (e.g., length of stay), UCLA re-examined the effectiveness of key clinical decision points.

• Example: Instead of only reducing a length of stay by 20–30%, consider avoiding unnecessary admissions entirely—a "100% reduction" for those cases.

  "We can reduce length of stay by 100% by not admitting the patient that doesn't need to be admitted..."
  – Dr. Vladimir Manuel [04:23]

• Improved staff decision-making, especially at points of transfer center interaction, can save hours or days and significantly reduce physician time spent on cases unlikely to result in admissions.

[04:46] Scott Jahnke:

• Prioritizing effective early decision-making leads to downstream efficiency and improves physician time allocation—a resource "most precious" for patient care.

4. Measurable Results and Culture Change

[05:53] Laura Deardel:

• Key Outcomes: 48% improvement in net margin via the transfer center in six months; projected 30% more in fiscal 2026.

[06:39] Scott Jahnke:

• Achievements realized by better upfront triage—ensuring the right patients were prioritized, thereby increasing the completion rate for transfers and reducing wasted referrals.
• Saving staff and physician time allows focus on patients who can benefit most, supporting both mission and financial goals.

[07:41] Dr. Vladimir Manuel:

• Moving "upstream"—proactively interrogating workflows and reviewing cases for ongoing learning.

• Building a "learning culture" that leverages properly visualized data to drive better, more thoughtful future decisions.

  "One of the methods ... is we look at cases and review and activate staff to be thoughtful about where the cases could have gone better. And that constant interrogation of the workflows... changes how people respond to future cases."
  – Dr. Vladimir Manuel [07:54]

• Small tests of change are annotated and tracked to ensure they demonstrably shift system stability.

5. Expanding Methodology & Data-Driven Improvement

[09:47] Scott Jahnke:

• Applying the command center approach to emergency department (ED) admission avoidance—an area with notable national challenges.

• Funnel charts reveal significant variation in physician admission rates; analysis shows a 4–5% reduction could eliminate ED boarding at UCLA’s quaternary campus.

  "We see that there is still big opportunity on reduction of our admissions to our quaternary campus. And ... a 4 to 5% reduction ... would effectively eliminate ED boarding..."
  – Scott Jahnke [10:27]

[11:06] Dr. Vladimir Manuel:

• The approach is adaptable across diverse operational pain points—whether over-admissions, reducing ED visits, avoiding readmissions, or managing back-transfers.

On Technology & AI:

• Emphasizes that technology alone is not a solution; systems must build a responsive learning culture before advanced analytics or AI can drive improvement.

  "...if you haven't set up this structure where you know how to respond to data ... then adding new ways to see data doesn't help drive improvement."
  – Dr. Vladimir Manuel [12:12]

6. Advice for Leaders Implementing Similar Strategies

[13:38] Scott Jahnke:

• Leaders should “see the system” with clarity, developing a systems-thinking mindset.

• Focus initially on understanding baseline performance and system stability before automating or introducing AI.

• Observe data over extended periods to judge impact rather than relying on isolated projects or quick wins.

  "You need to be able to see the system clearly. So even before you try to automate ... you need to understand where your system is at and where you want to be."
  – Scott Jahnke [13:48]

[15:07] Dr. Vladimir Manuel:

• Practical experience essential: “See one, do one, teach one.”

• Encourages leaders to visit organizations successfully implementing these approaches to understand the difference between superficial adoption and true operational integration.

  "If you haven't seen that switch from reacting to data … it really isn't operationalized..."
  – Dr. Vladimir Manuel [15:29]

Notable Quotes & Memorable Moments

• Scott Jahnke [02:39]:
  "We're always just chasing down and putting out fires."
• Dr. Vladimir Manuel [04:23]:
  "We can reduce length of stay by 100% by not admitting the patient that doesn't need to be admitted..."
• Dr. Vladimir Manuel [07:54]:
  "That constant interrogation of the workflows... changes how people respond to future cases."
• Scott Jahnke [10:27]:
  "A 4 to 5% reduction in our admission rate would effectively eliminate ED boarding at our quaternary campus."
• Dr. Vladimir Manuel [12:12]:
  "Adding new ways to see data doesn't help drive improvement" without the right culture for learning from that data.
• Scott Jahnke [13:48]:
  "See the system clearly...understand where your system is at and where you want to be."
• Dr. Vladimir Manuel [15:29]:
  "If you haven't seen that switch from reacting to data … it really isn't operationalized..."

Important Segment Timestamps

• Backgrounds and UCLA Health's Command Center Origins: [00:45]–[02:12]
• Command Center Evolution & Improvement Science: [02:12]–[03:55]
• Decision-Making Effectiveness vs. Efficiency: [03:55]–[05:53]
• Transfer Center Metrics & Results: [05:53]–[07:41]
• Creating a Learning System and Upstream Solutions: [07:41]–[09:19]
• Applying Methodology to System-Level Problems: [09:47]–[12:56]
• Advice for Healthcare Leaders: [13:38]–[16:04]

Conclusion

This episode spotlights UCLA Health’s transformation from reactive to proactive operations by leveraging improvement science, real-time data, and a learning culture. The leaders emphasize clarity in systems thinking, the importance of effective over merely efficient decision-making, and the foundational work necessary before layering on technology or AI. Their success offers replicable lessons for healthcare organizations everywhere, urging leaders to see, understand, and experience operational excellence firsthand.