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Becker’s Healthcare Podcast
Driving Surgical Efficiency and Culture Change with Dr. Paula Ferrada
00:21:16
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- [00:00]
A
This is Scott Becker with the Becker's Healthcare podcast. I am thrilled today to be joined by an absolutely brilliant physician leader. But we're joined today by Dr. Paula Farada and Dr. Farada is the Department of Surgery Chair at inova Fairfax Hospital. Dr. Farada, we'll talk today about operational efficiency, about a number of the tools that you're using, how you're approaching things and a lot more. But before we do that, can you take a moment and tell us about yourself and a bit about your work and your background?
- [00:36]
B
Thank you. Thank you so much, Scott. Thank you for having me. I'm really excited about this episode. I am a trauma surgeon by training and I'm the chair of Surgery, Nova Fairfax. We are 920 licensed bed hospital with about 60 operating rooms that we oversee is a large high acuity health care system in Northern Virginia, Inova Health. We serve a population of 3.2 million people. We manage a significant volume of complex surgical care. My work sits at the intersection of clinical care, surgeon engagement and operational leadership, ensuring that our teams can deliver timely, high quality care to our patients. I am personally particularly passionate about helping surgeons engage with innovations and this includes also AI tools, also to improve access for our patients, increase operating room efficiency in patients outcomes, which is our mission as healers. Over the past year I have been closely involved in supporting our systems transformation for operating room access and utilization along our preparative teams and also partners with Lean Task as well.
- [01:44]
A
It's simply remarkable. And you've had this fascinating background from University of Miami to your residency at Harvard to a couple different fellowships. Talk a bit about some of your background and how it's prepared you for what you're doing today. And one, we've got a stepdaughter that's at University of Miami Medical School. So we relate to that. Two were big fans of Harvard. Tell us about those experiences, about fellowships and more.
- [02:08]
B
Oh, thank you for the opportunity to tell my story. I think looking back, everything that I had to go through prepare me to be here right now. I believe, I mean my dream job is a good fit. I'm happy every day. I was born in Colombia, South America and I didn't know that I was going to end up in the United States. My dad was a very well known surgeon where I grew up in Cali, Colombia. My mom was a chief nurse. So I didn't plan to come to the United States, but I ended up coming after my medical school training. And in medical school I did mostly trauma because Cali, Colombia at the time was if you were a surgeon or a physician, you were taking care of trauma patients. That's why I think trauma chose me rather than the other way around. I came as a foreign graduate to University of Miami where I did some research. I did preliminary couple of preliminary years. Then I did my residency at the Bethel Deaconess in one of the major Harvard teaching hospitals. I learned a lot. I learned, I learned a lot. Not only surgical part, but I learned a lot about leadership. Now retrospectively, you know, leadership is not taught in medical school or in residency, but retrospectively. I learned a lot from the beginning, just trying to immerse myself in the American culture, understand how systems here work differently. And because I didn't take any of that for granted, it was a steep learning curve for me, which I am grateful for. Then I went to Pittsburgh and did my critical care fellowship. Then I went to shock trauma and I was their first acute care surgery fellow. Then I moved to Virginia Commonwealth University in Richmond where I spent 11 years. I went from assistant to associate to professor director of the intensive care unit and the fellowship. I came to Inova in 2021 as division system chief for trauma. I took over preoperative services in 2024 for Fairfax Hospital and, and then I took over as chair of the Department of surgery in 2025. But it has been a great, professionally, it has been a great journey for me, I can tell you, because I love, I know about and what we stand for and the culture that we have built. I am very excited, I have always been very excited of being a surgeon and treating patients. Now that I discover that I am actually good at what I do in terms of leadership and helping people in transformation and changing culture. And it is, it is so motivating to me. I read something about leadership every day. I show up to work every day, super happy. I love where I'm at right now. I think not only the job, but the institution is a good fit. We're a good fit for each other.
- [04:46]
A
It's fantastic. And INOVA is a fantastic system, I think. Dr. Jones is still the CEO of Inova, Stephen Jones, and a fantastic leader. Just fantastic. And so a great system, a great mid sized system where you could still really be close to leadership, really be close to people and, and your community. So literally a fantastic system. We love it. Talk about the perioperative team over time. The perioperative team at NOVA has talked about, you know, different challenges everybody faces or block under utilization scheduling bottlenecks, limited access to the data you need for leaders that are Navigating these types of pressures, blocks that got to be used better, better scheduling, getting the right data. Can you put those challenges in context? What's the real problem if systems don't address these? What happens if systems don't address some of these problems?
- [05:40]
B
I love how you're phrasing it, because it's not only the challenges that we see is the challenges that we don't see. The unspoken truth that percolates between phrases and teams that if we don't address, then we can never really incorporate change. I think the challenge was for preparative services and our team. It was not not only about the news, opening room time. It's about the disconnect between perceiver scarcity and actual access. And, you know, making sure that surgeons don't feel that they're blocked from scheduling because they're very protective of their block times. And. But at the same time, keeping the patient in the center when scheduling is fragmented and data is hard to access, it creates a really downstream impact to delay care. Longer hospital stays, frustrating clinicians. And if you have a frustrated surgeon, you also have a frustrated nurse and a frustrated team. Right. It translates into inefficient use of highly valuable or resources or operating room time for those that work in operating in this space, in preparative space, you know that that's like precious real state. These issues also drive cultural friction, and culture actually eats a strategy for breakfast. In my book, surgeons felt the need to protect block time, which limits flexibility and collaboration across the system. And if this is left unaddressed and health care systems are essentially leaving capacity and patient access on the table while simultaneously increasing burnout across teams. I think that what we did very well was changing the culture from this is my operating room time, this is my patient, to this is our operating room time, these are our patients. Because amplifying that view and making people realize that again, it's not a scarcity problem, everybody will eventually find time and creating trust in between team members.
- [07:42]
A
But your point is so well taken aside from frustration of surgeons that don't get the time they want, nurses are irritated because now they're working overtime because they're sort of somebody's not used their block as well as it could. So now you've left that time open and you're scheduling later to get patients in. Patients are frustrated too, because if they're not getting scheduled, when they get scheduled, not only do they end up, they end up ultimately sometimes looking elsewhere too. Their surgery gets done at a different institution with different surgeons, even if it's not the best thing to do because you haven't addressed those problems, talk a little bit about you've made great improvement and moved the needle really well on surgical volume, utilization and culture. What's the most impactful data insight you've gained through your partnership with Lean Toss? I know that Lean Toss is sort of the leader in predictive analytics and or efficiency also in fusion centers. What's some of the best data that you've gained through the Lean Toss ANOVA partnership?
- [08:38]
B
Well, Scott, I gotta tell you that our partnership with Lean Toss was transformational. I think one of the most impactful insights for us is realizing how misaligned our block release timing was with actual scheduling behavior. We had operating room time, but it wasn't accessible early enough to be used. And then using IQ for operating rooms, we use data driven recommendations to better align the outer release datelines and how advanced the cases are actually scheduled, which unblocked meaningful capacity across the system. And when we did, the impact was significant. We saw about 20% increase in release operating room time in nearly half of the time backfill, along with measurable gains in primetime utilization. And so the statistics are, and this is, I hope you're sitting down because I believe that this is amazing. Also I'm bragging about, I know a lot, so sorry, but we have 46% release field rates across operating rooms and endoscopy. And if you look only out of the or is 51% turning open time into book cases.
- [09:45]
A
That's amazing. That's just to give, just to give people sense of that. That means 40, 50% of the time that would have gone unused then gets used. And in the old days, a surgeon might have felt like they just owned that block. So nobody's touching that time. So that's where you have to change the culture too, because you get, you get great clarity on culture and also the data to know it's not being usefully. That four hour block or the two hour block or whatever block it is. And we could fill some in that way. And everybody's happy. The other surgeons are happy. Even that surgeon's happier because now they're busier. The nurses. Nothing worse than nurses sitting around. It might sound good, but it's horrible for culture. And if patients can't get in, they're just very frustrated. And everybody's frustrated 100%.
- [10:28]
B
And then we grew the case volume by 8% in endo and 13% for open time requesters. And we increased prime time utilization by 3%, which is great, because this helps us with efficiency during the core business hours. More importantly, I think that it showed us relatively small dating form changes, that when you release time, you can fundamentally improve access for surgeons, which means access for patients increase throughput and ultimately get patients treated sooner and people and the team home earlier too. Right.
- [11:03]
A
Which is a huge part of everything. People get part of their life back. They don't burn out as much. I mean, there's so many things that cause friction points, cause burnout out, but people regularly have it. To be at the office or at the hospital or wherever they're at longer than they have to be when they know it can be fixed and improved is so frustrating. And people want to get home and have a chance to decompress, see their family or whatever they do, whatever they want to do to get a chance to also take care of themselves. Besides being in the operating room. Talk a little bit about how surgeons you're a data driven surgeon leader. Technology has been a meaningful part of the journey here. Was it hard for surgeons to swallow using data, making changes? How was it received and how did their attitudes, interactions with the new system change over time as you got better and better at rolling this out and making impactful changes on volumes, usage of time and more?
- [11:59]
B
So the answer is, was that a hard pill to swallow? Absolutely yes. Nobody likes change. People say that they like change until they're the ones who have to change. Right. So like many organizations, we saw initial skepticism, especially about earlier block release policies, which felt like a loss of control really for surgeons and for their teams. What made the difference was pairing the technology with a strong clinical leadership and a clear message. This is about improving patient access. This is about the patient, put the patient in the center. It's not about taking time away over time as the surgeons experience these change and increased access to operating room time and fewer scheduling barriers. And I think that what made it so much better is that trust grew, like trust between our administrators, between the surgeon teams, nurses and anesthesiologists all together, trusting each other that we're doing the right thing for the patient. When you have that trust, then you'll see slowly. I'm not saying this is going to be like this, but slowly you're going to see that behavior shift. And when there's a real cultural transformation from is my block time right, my precious? To a more team based approach and mindset is operating in room time to serve the patients. Not only one patient, all the patients. The mission of inova, each patient, each time, each touch, every time, then actually it changed when releasing time was viewed as helping colleagues and helping your patients across the system. Then all of a sudden, once people understand the why, it's a lot easier to be part of that change instead of, instead of resisting it.
- [13:36]
A
And that's really an evolution because so many surgeons at least traditionally viewed it as that's my time and that is sacred. And one of the reasons I operate at this hospital is because I get that time. And so having that, giving that, allowing them still to have some control of their schedule, their time, but finding ways to share that efficiently where it doesn't get in the way of how they do business, where they don't just glob out of that time, but they use it well, they're still really well taken care of, your surgeons, but at the same time you're opening up some room for cases and for people and viewing it more as a team game. Is that a fair statement?
- [14:09]
B
That's a fair statement. You're absolutely correct.
- [14:12]
A
Thank you. Talk about as you look forward, what do you see as the most compelling opportunities to build on what you've established with Lean Toss, to build on what you've done with perioperative and also just the ors in general. And what is getting this right look like as you continue to scale it? How many hospitals does INOVA have now?
- [14:31]
B
Five hospitals.
- [14:32]
A
Five hospitals. One of the great mid sized systems in the country. Really high operating, really high quality, just fantastic. So what does it look like to do this at scale across the INOVA system and what's the most compelling challenge next?
- [14:45]
B
So I just want to be clear. The Lean task is a system wide initiative. However, I see where you're coming from. I do believe that the biggest opportunity is continuing to scale this model across service lines, embedding data driven decision making to everyday operations. The getting it right at scales means aligning technology, leadership and clinical engagement. So access becomes seamless. Not something that surgeons have to fight for. Right? And also there's an opportunity to expand. And we use these insights not only for scheduling, but for broader preoperative optimization and system wide flow. From my perspective, personally, I think that success at scales means surgeons trusting the system, trusting that we're going to help to get the timely patient care and fully utilizing the resources that we already have.
- [15:36]
A
Right. But it really is that trust with surgeons and growth, trust and growth and having them stay excited even as they change some of their patterns, but constantly in that trust to know they're still going to be really well taken care of. And the Patients are going to be really well taken care of as well as your teammates.
- [15:54]
B
Yeah, exactly. And then I think that once you have that team mentality, nobody's here to play. Gotcha. We all want the same thing. Whatever hat or title or that you're wearing that day, we all want the same thing. We want to serve the patient to the best of our ability.
- [16:10]
A
Thank you. Take a second. I'm going to ask you another question in a second about final thoughts and so forth. Before I do that, one of our daughters just visited the country of Colombia. What is a place in Colombia that they can't miss, that they shouldn't have missed when they went there? What's the most beautiful place? And she loved it. She said it was just fantastic. Her trip to Columbia. She was there for 10 days. Tell us a little bit about what you can't miss in Colombia.
- [16:36]
B
So Cartagena is beautiful. And anywhere that you're going to read about Colombia, you're going to read about Cartagena. It's amazing. And everybody that goes to Colombia should see it is very touristic. So if you're gonna go take a boat and go to Rosario Islands, less touristic and also gorgeous. And I think for those of you that maybe are want to do less touristic things and more cultural, the area of the coffee axis that includes Medellin is very safe right now. And it's beautiful. And you have rivers that are like the seven colors of the. Of the rainbow. You have a lot of nature. I'm not sure people know this, but Colombia is the most biodiverse country in the world. And we have two oceans and we have the Amazonic river below and the Orinoco river to the left. So, as you can tell, I love my country. So, yes, I would definitely recommend those two places for people that want to travel.
- [17:35]
A
Fantastic. So I feel we've closed some of those loops on Columbia and also the University of Miami Med School, as well as your fellowships and Harvard residency. Amazing, amazing career. What have you not talked about with the listeners? I mean, you've gone on this great, great journey with Inova and Wingtas and have had fantastic success with it. So congratulations on the work that you've done together to sort of really improve throughput and improve culture and get just better data, too. What have we not talked about? Is there anything else, Dr. Farrada, that we should share with the audience?
- [18:11]
B
Well, thank you, Scott. This is what I would say, and I will leave the listeners with this technology alone did not fix our problem. People that know how to Use it did. But all of us collaborating together is what changed the issue. Right. The tools gave us visibility, but what changed everything was trust. Trust between surgeons, trusting the data. Trust that the system was being designed for patients, not against clinicians. Right. There's a difference. That shift is harder than any implementation. And as I said before, I truly believe that culture eats a strategy for breakfast, or culture needs to be your strategy because it asks people to let go of control, to work differently with each other, to believe that collaboration will serve them better than protection. That. That scarcity mindset, that only happens when leadership is consistent, transparent, and willing to stay in the work long enough for people to see the results. At the end of the day, this is not about operating rooms or block time. It's about access. It's about a patient waiting to have surgery or a patient. They don't care how your schedule is structured, really. They just care that they have appropriate, safe surgery when they need it. I think if we keep that, if we keep the patient in the center as the north star of our decisions, everything becomes a little bit more clear. Technology is not your enemy. AI is not going to replace you. But trust me, people that know how to manage AI will replace you if you don't learn it. I think we need to continue to use technology as an infrastructure, not as an enemy or as a solution on its own, either. To build system that people trust, not systems that only uses slogans. Right? We have to leave and breathe what we do and never lose sight in why these works matters. Because when we get it right, we not only improve efficiency, we give time back to our patients.
- [20:05]
A
I mean, it really is this great mix of culture, technology, leadership, you know, and what you're trying to accomplish. I mean, really, all those things. But if you don't have the culture, right, people trying to learn and lean into what they're doing and retaining a great team and great leadership, nothing else works. I mean, you've got to have that culture and the people part. Right?
- [20:24]
B
Don't you 100% agree? It's all about people. And I think it starts seeing technology as a tool, like, be less afraid of it, dive into it 100%.
- [20:35]
A
And I love your point about leadership. Has to stick with it, not just for the idea phase, but actually through the implementation phase, to get through the rocky parts, and people start to see the benefits to it, then it can really start to work for the long run. I love that point as well.
- [20:50]
B
Awesome. Well, it's great to meet you, Scott.
- [20:52]
A
Dr. Farada, a total pleasure. Thank you for joining us in the Becker's Healthcare podcast. And thank you to Wingtas for helping share Dr. Farada with us today on this podcast. Just brilliant, Dr. Farada, Chief of surgery at Inova Fairfax. Inova is one of the greatest great systems in the country. Fantastic leadership. Thank you so much for joining us today.
- [21:12]
B
My pleasure.