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Becker’s Healthcare Podcast
Stephen M. Langley, MD, Medical Director and Chief of Pediatric Cardiac Surgery at Driscoll Children’s Hospital
00:27:44
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- [00:02]
Athenahealth Representative
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth, see how simpler is healthier@athenahealth.com.
- [00:44]
Alan Condon
This is Alan Condon with the Becker's Healthcare Podcast and today I'm delighted to be joined by Dr. Stephen Langley, the Medical Director and Chief of Pediatric Cardiac Surgery at Driscoll Children's Hospital in Corpus Christi, Texas. Dr. Langley, a pleasure to have you make your debut appearance on the Beckers healthc podcast. For those of our listeners who might be as well acquainted with yourself, Driscoll Children's do you mind giving us a little bit more info about your background and your role?
- [01:14]
Dr. Stephen Langley
Yes, well, it's a pleasure to be here, Alan. Thank you for the invitation. As you said, my name is Stephen Langley. I'm a pediatric cardiac surgeon, originally from England where I did my training and moved to the states in 2020 gosh, 2007. And have been in the states for the past 18 years. And I worked in Oregon for eight years and then in Florida for five years in Tampa in Florida. And I've been the chief of Pediatric Cardiac surgery here in Corpus Christi and the director of our heart center since the end of 2019.
- [01:52]
Alan Condon
Fantastic. So I believe I moved here from Dublin 2014. So we've got seven years of me since you landed states and no doubt a 10 year decorative career since then before you landed at Driscoll Children's around six years ago. So I believe you said, I'd love to dive right in. In terms when we talk about Driscoll Children's obviously serves a vast and often underserved region in South Texas. Can you talk a little bit about some of the unique challenges that your team faces in delivering complex pediatric cardiac care in these rural communities, and how have you adapted to meet some of those needs?
- [02:31]
Dr. Stephen Langley
Absolutely. I think there are a variety of different challenges. As you mentioned, it's a very large and also very diverse geographical area in Texas. Many of our patients come from hours away. And just to put it in context, the size we have 32 counties in the area. It's about the size of South Carolina, so 34,000 square miles. And we look after predominantly indigent and Medicaid based patient population. There are a lot of Hispanic people, so we have language barriers going both ways. And this region was once and perhaps still is known as a medical desert because historically it's been very, very underserved. And have we adapted? What have we done to meet the needs of delivering such complex care as pediatric cardiac surgery to this patient population? Well, what we've done is go to the patients. We've expanded our care and coverage on the ground. Last year we opened the first ever freestanding children's hospital and the Rio Grande Valley. We have a special training center, the Driscoll Training Center. It's a brand new state of the art facility which has advanced simulation labs and allows hands on training to provide Driscoll healthcare staff with the skills that they need to look after the patients in the Rio Grande Valley. We have a number of quick care centres around our area in Corpus Christi, but also in other towns much further afield. Edinburgh, Macallan and Victoria, which is halfway between Corpus Christi and Houston. We have a number of specialty clinics and general clinics in the bigger cities in our area, including Brownsville, including Corpus Christi itself, including outside of Driscoll Children's Hospital we have El paso, Harlingen, Laredo, McAllen and again Victoria. And finally, I think one of the things that's very important is we have our own health plan and patients in Brownsville, in Corpus Christi, in Laredo, in Macallan and Victoria, all members of of that health plan.
- [04:41]
Alan Condon
So quite a bit of growth recently to you mentioned the first ever freestanding children's hospital in the Rio Grande Valley, multiple quick care urgent care centers in the region, specialty clinics around health plan as well. Quite a bit of growth in recent years there. Could you maybe share some insight into future growth over the next couple of years? Is that does that look like adding more physicians, more providers, potentially opening up more quick care clinics or how are you kind of pursuing more growth and access to care in the region?
- [05:11]
Dr. Stephen Langley
And the simple answer to that question is yes. So all of those things, you know, we are continuing to expand in the region so that patients can have the care that they need as near to home as possible. It's challenging, but we've been remarkably, I believe remarkably successful in the past few years in doing that. We want to continue with that strategy.
- [05:35]
Alan Condon
Yeah, I think no doubt it's such a spotlight on rural underserved areas. No doubt the types of regions, the types of patients that Driscoll Children's cares for many hospital leaders that I, that I spoke with recently in the podcast, really looking to replicate successful models in these rural underserved areas, similar to like what Drista has done. Could you share some lessons maybe from your approach? What do you think are the most transferable to other regions, other health systems who serve similar payer mixes, similar rural underserved regions and those types of communities?
- [06:09]
Dr. Stephen Langley
Absolutely. I think there are kind of two ways I would answer that question because I think many of the things that we have done are, can be replicated wherever you are, and I'll expand on that in a little bit. And then there are other things that I think specifically relate to our predominant patient population, our predominant rural situation and population. So what would I do anywhere? What would I recommend anywhere? I would say two things. Firstly, put programmatic elements in place. I'll talk about that. And then recruit and retain the right people. So you can't have one without the other. You can't suddenly be successful if you just have one of those two things or the other. So what programmatic elements are in place for anybody or should you put in place? Well, you need a rigorous quality process. We talk about quality a lot, we're always hearing about it, but it's got to be rigorous. We but way beyond what people accept as a quality process. And it is, which is the standard morbidity and mortality meeting or a clinical quality improvement meeting that every hospital, every department within the hospital has. But in addition to that, that isn't even. It's important, but it doesn't make you any different from anybody else. You've got to do more for quality than that. We have a dedicated quality committee we met this morning. We meet for an hour every Friday and discuss in a much more granular way our data opportunities for improvement, what we could have done differently. On top of that, and in an even more granular level, we have developed what we call a Discover team. Discover stands for something. It stands for a deep investigation into serious cardiac or vascular events. And we always, within 24 hours, if something happens to a patient, the patient has a cardiac arrest, if there's a drug error, if there are any of these things that happen in any cardiac centre, we don't just wait for a few weeks to discuss it or say, oh, well, this happened for that reason, let's move on. We discuss it with a, with a select group of people and immediately put things in place to address, if we can, what should be done differently. These changes are made real Time for immediate benefit of our patients and their families. We have a culture of improvement. Improvement is a continuum, it's a journey. There's no destination to improvement. We don't like to say we've arrived. I mean, far from it. We are pursuing perfection. And that is our goal, I think in terms of recruiting people. We have aimed to recruit creative, resourceful, mission driven and kind hearted talent and people who are happy to hold themselves and other people's accountable. It's really important to have a supportive, supportive of one another, an administration that supports the physicians and a drama free mission aligned environment and to have, as I alluded to a few minutes ago, this constant pursuit of perfection. That's the culture that we have in the heart center and that's what anybody could do wherever they are, at any organization in the world. In a rural underserved area where it's not possible for patients to come to us, we go to them. We have a fleet of planes. We have six planes. Driscoll has six planes that literally crisscross our region daily, bringing specialists to rural clinics and some rural hospitals to see patients near their home. And we need this, we need this network of specialty centers and quick care facilities because of the large service area. And when we go there, we strive to provide the same quality of care, regardless of the distance, regardless of whether we've had to drive five hours or fly two hours to get there. And we've created a regional infrastructure that allows us to deliver that.
- [10:30]
Alan Condon
Yeah, I mean, fascinating. You hear health systems so often talking about the catch all term meet patients where they are, but that doesn't necessarily really focus on a fleet of six planes flying to different parts of the state or further afield to literally meet patients where they are, provide that care. Could you talk maybe one bit deeper about how that works essentially in terms of bringing those providers to the patients? And is there any kind of future plans for that fleet, that initiative?
- [11:01]
Dr. Stephen Langley
So every day one or two, sometimes three planes leave Corpus Christi with 10, 12 providers, physicians, nurse practitioners, physician assistants, to go and see patients near their home. In one of our quick care facilities, in one of our specialty clinics, they go and see the patients. They. And it's very difficult for many of these patients to travel to us. And we're very fortunate to have built the network that we have and to have the resources to be able to go to their local area to meet them. It's very well scripted. We have a tremendous flight team. And this happens on a regular basis. This is not an occasional thing. This happens every Day.
- [11:48]
Alan Condon
Yeah. Fascinating to hear the kind of the efforts that you and your team are going to, to really, really carry out this top quality care where it's needed. You talked the first part of your answer there. You touched a little bit on the workforce, which kind of ties nicely into my next question here. No secret to yourself, me, many of our listeners, in terms of the ubiquitous challenges we see in terms of the workforce, particularly arguably more acutely in rural areas. Can you talk a little bit how you build and sustain that high performing surgical and clinical team in such a demanding specialty like pediatric cardiology?
- [12:27]
Dr. Stephen Langley
Yes, it's certainly not easy, but it is doable with a clear strategy and a clear approach. What we've done is first, define the goal, the end goal of what you hope to achieve and where you want to go. If you don't do that, I don't think you're going to be able to build the team of people that you need. Five years ago, we had a vision for the Driscoll Heart center, what it could be and a goal of making it a reality. And that was our goal five years ago. And without that, almost nothing of what we've achieved I think would have been possible. Secondly, it's very important to inspire people around you to share your vision and work towards it together. You can't do it on your own. You can't do it with two or three people. Everybody needs to be involved, so important that the existing team feels valued and feels part of the growth and the whole momentum of the institution. And you have to recruit a special kind of talent, people that want to be part of creating and building an organization or building an institution that possibly forever is going to change the level of care in the region. Driscoll Children's Hospital and Driscoll Heart center especially. It's such an exciting, I think it's an exciting place to join because it empowers people to be part of that fast trajectory of growth for the heart center. And it's a place where every, when people interview here, I say, you can make a difference. Every single person coming to Driscoll Heart center at the moment can help. They can singularly make a difference to patients that have not been looked after and have been in, in this way until now. Now, to some people, that's a risk. And I've met a number of people, they said, no, no, I, I'm going to go to this established place. So that's, that's wonderful. You know, everybody should go where they're happy, but for other people, it's just totally exhilarating. And they, they can't wait to come and, and work with us. I think establishing a firm culture within your organization and we have that at Driscoll is the way to sustain the team and to continue to build. And at Driscoll, we talk about something called the Driscoll way. And that's the way we do things at Driscoll. And it's a culture I'll define it as. It's difficult, never seen it written down. It's just kind of a feeling in a way we behave. But it's defined by a nimble collaboration between the administration and the clinical team. I think there's very shrewd resourcefulness of the hospital administration and within the clinical areas, what I would describe as a relentless pursuit of perfection in all clinical areas.
- [15:27]
Alan Condon
The pursuit of perfectionism that's popped off kind of time and time again during this conversation. And hear a little bit more about the culture of your clinical teams and the team more broadly. Also, on the administrative side, I wanted to talk a little bit about how does that culturally informed family centered care. I know that's such a core principle, a core tenet of Driscoll Children's. Can you talk a little bit about how that culturally informed family centered care, what does that look like in practice? Can you walk me through it? And then how does that ultimately affect outcomes for children and families, the patients?
- [16:02]
Dr. Stephen Langley
So, yes, that is a core principle at Driscoll and I believe it. It certainly affects outcomes and it's a concept of what I would probably put together in what I call best care, the best care for the patient, which includes everything related to the care. It starts from the moment family walks in the doors at Driscoll throughout their hospital stay and continues to post surgery considerations for their families so that children can thrive throughout all stages of their lives after leaving Driscoll. And I think sometimes there's an emphasis on superior surgical technical skills and outcomes related to the way an operation is done. And that's important. But it's only the beginning. And as we've mentioned, many of these families are far from home. And a family far from home needs to feel at home. And so we help, we help them with that. We have a wonderful Ronald McDonald partnership. This gives the abilities to families to create their own small community within themselves, supported by staff. We like to understand and anticipate what I think are unique needs of our patients and our patient population. As we said, we have a very large Hispanic population. Make every effort to weave cultural considerations into our community. Outreach into our education, and definitely into our clinical care as well. And all these elements come together in a really wonderful way when we send home healthy patients. And what I would like to say is healthy families. And one of the things that we are known for is our quick recovery time after cardiac surgery. This short length of stay is, I believe, a testament to our best care model. Only when every stage of the patient's and their families experience is given the highest degree of attention and empathy and excellence are we able to send a child home early and healthy.
- [18:05]
Alan Condon
Dr. Landley, it's fascinating to hear insight into the cardiology program, Driscoll Children's more broadly, some of the growth in your region, just how much of an onus you put on the patient experience, the culture of your team. We've touched on quite a lot here. But I guess looking ahead, when you think about the future of Driscoll Children's, what are you most excited about?
- [18:29]
Dr. Stephen Langley
I can't think of a single one thing, but there are so many things that I'm excited about for the future. And I was talking with somebody the other day and I said, well, today, you know, currently Driscoll Children's Heart center is, is the best pediatric cardiac care institution that you've never heard of. And that's about to change, I think, because word's getting out we now have the fastest growing heart center in the United States, having tripled our surgical volume in the past five years. We've just unveiled a significant heart center expansion, in fact, $100 million investment to expand the heart center, which enables us to enhance the pediatric care for children across South Texas at and beyond. This expansion adds 50,000 square feet of dedicated cardiac care space, including two new, wonderful state of the art operating rooms, two advanced cardiac catheterization laboratories, and a 35 bed dedicated cardiac intensive care unit. So I'm excited about creating, I'm excited about creating many things. So if we have time, I'll talk about a few of them. So mobile ECMO capabilities. ECMO stands for extracorporeal membrane oxygenation. It's a machine that supports the heart and the lungs in critically ill patients. Patients needing this, needing ecmo, normally need to be transferred in a critical state to a distant hospital to be placed on ecmo. But with mobile ecmo, we can now, and we are now equipped to travel to them to put the patient on ECMO in their own, in their own local hospital. Very excited about that. I'm really excited about a single ventricle center that we have established. It, you know, we want to expand our heart center as a beacon for children requiring the highest risk surgeries. These are what we call stat 5 patients. They're the highest risk patients. And many patients in this group only have one ventricle, one pumping chamber. Alan, you have two pumping chambers in your heart. I have two in my heart. And many patients who have a STAT 5 operation undergo an operation called the Norwood procedure. And those patients only have one pumping chamber. According to the Society of Thoracic Surgeons Congenital Heart Database, Driscoll center is one of the elite programs in North America for looking after these patients. In fact, it's only one of five programs in the nation of about over 100 that have outcomes that are statistically better than the rest of the country. And not only is the survival for these stat 5 patients remarkably high, but we have a much shorter length of stay following this operation, the Norwood procedure. So the average length of stay here after the Norwood procedure is 19 days, compared to 59 days for the rest of the nation. So we're excited, and some would even say, wow, you guys have a moral responsibility to expand care for those high risk patients way outside your service area, way outside of South Texas. I'm excited because we're going to do that. I'm excited that we're going to introduce more subspecialty services. So as our volume continues to grow, it's going to allow development of specialized care within pediatric cardiology and cardiac surgery, including, for example, a potential heart transplant program and just more comprehensive care for our patients. I am really excited about treating more patients with down syndrome. I have a really deep affection for children with down syndrome in their families. I love those kids. There's one operation that many of those children need. They're born with a condition called an avsd, an atrioventricular septal defect that's common if you have down syndrome. I've spent a large part of my career focusing on that operation, thinking about how to do it, trying to pursue perfection technically in that operation. Because if you can create a perfect heart for a patient with an avsd, I don't think that's possible. But as near perfect as possible, you reduce the need for, or really reduce the need or possibly eliminate the need for further surgeries if you have an excellent initial technical repair. I really believe kids, individuals with down syndrome, deserve the same level of perfect care as you, as me, as any human being. And this certainly can challenge some historical disparities in treatment, but I think it's achievable. I'm excited about the way that the success of Driscoll Heart center allows us to support other areas within pediatric care. You know, we're very fortunate in cardiac care. We're relatively well reimbursed compared to other specialties. And our growth allows the heart center and our organization to support care in less reimbursed areas of pediatrics. And I would say, finally, I'm excited about working at Driscoll for as long as. As long as they'll have me. And it's certainly my intention to personally see this mission through for the long term.
- [23:52]
Alan Condon
Yeah, I think. Fantastic. I think your passion for, for not just cardiac care, but care more broadly certainly comes across a lot of exciting things. It sounds like certainly in the pipeline when you think about the expansion of, of the heart center. The best cardiac heart center you've never heard of, I believe you said. But that's about to change. Last question, Dr. Lanley, if you're hearing me before I let you go, it's something that you've spoken to quite a bit. It's just the lengths that Driscoll Children's will go to making sure that the patients and indeed their families feel at home. Such an emphasis, it seems, on the patient experience and hospitality. I read a recent book in New York Times bestseller called Unreasonable Hospitality, spoken with the CEO of University Hospitals in Cleveland, Dr. Cliff McGarrian, who spoke to just how important arguably now than ever, hospitality patient experience is in today's healthcare landscape, particularly in areas that are rural, that are underserved. Before I let you go, could you maybe just a word on that in terms of how important the patient experience, the hospitality component is, particularly in your.
- [25:02]
Dr. Stephen Langley
In your line of work, it's incredibly important. I mean, just think about anything you do in your life, whether you're going to the store, whether you're going to watch a game, whether you're listening to music. You want an experience that is made for you and is done well. Everybody wants that. And healthcare may be one of the last areas that we experience in our life that has may be cottoned onto this. Yes. Marketing in and advertising in. As I was mentioning, clothes and music and so on. They want to give you an incredible experience and we all want that. And I think it's incredibly important to put yourself into the mind and the vision and the view that a patient and their family have and to walk into the hospital as a care provider and think, what would it be like if I were a patient? What could be done better? What would make me feel more at home? It's a terribly difficult situation. Many of these patients coming into the hospital, they're given sometimes for the first time a very scary diagnosis. For them, anything that we can do to, anything that I can do individually to help them feel more at home, more at ease, safer, and in a caring environment is incredibly important. And we strive for that every day.
- [26:37]
Alan Condon
Certainly, certainly comes across and everything we've spoken about so far. Dr. Lanley, so greatly appreciate the work that you and your team do. I so greatly appreciate you taking the time out of your busy schedule to have a chat with us today. Thank you so much.
- [26:50]
Dr. Stephen Langley
It's a pleasure. Thank you.
- [26:54]
Athenahealth Representative
At athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions Reduce administrative burdens, streamline billing and payment payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com.