Swedish Health’s interim CEO Guy Hudson spoke with The Seattle Times on Friday about issues raised in a Times investigation and where Swedish is headed next.
Swedish Health’s interim CEO says he is working to rectify a leadership breakdown that failed to address widespread staff concerns about the organization’s shifting culture.
In an interview with The Seattle Times, Dr. Guy Hudson acknowledged that caregivers felt there had been lapses in patient care, but said he wasn’t in a position to say whether specific concerns were founded. He has ordered an external review of Swedish’s “safety structure and processes.”
Hudson is also pushing Swedish to adopt new ways of compensating physicians based in part on quality metrics, he said. And he apologized to medical staffers, saying Swedish leaders hadn’t acted quickly enough on their concerns.
“It’s a new day at Swedish,” Hudson said Friday. “It’s my job to address our internal leadership issues and restore trust amongst our caregivers and community.”
A SEATTLE TIMES SPECIAL REPORT
THE O.R. FACTORY | High volume, big dollars, rising tension at Swedish's Cherry Hill hospital
- State regulators investigating Swedish
- Swedish CEO Tony Armada resigns
- Top Swedish neurosurgeon resigns
- Interim CEO: 'It's a new day at Swedish'
- U.S. Attorney’s Office launches investigation
- Providence CEO Rod Hochman apologizes
Hudson spoke about a month after a Seattle Times investigation exposed a range of internal concerns that surfaced during a dramatic growth in the number of surgeries and billings at Swedish’s renowned neurosurgery facility. Since then, Swedish CEO Tony Armada has resigned, as has the Swedish Neuroscience Institute’s top surgeon, Dr. Johnny Delashaw. The state has also launched an investigation into the practices of Swedish-Cherry Hill, the campus where the neuroscience team is based.
Staffers had expressed particular concern that Delashaw’s practices had put patient care at risk and that he had established a culture of intimidation that quashed dissent and prevented concerns from being addressed.
Hudson, who was appointed to the job less than three weeks ago, said that in a series of staff forums since then, he has heard from many Swedish staff members who felt intimidation had been a problem. He said the failure to listen more thoroughly to caregivers in the past had undermined the organization’s culture and led to communication and trust problems.
“People are angry. They are upset,” Hudson said. “It doesn’t seem like we’re the Swedish that we know and love — or knew.”
Hudson said Delashaw is a highly skilled surgeon who is technically proficient and had the ability to recruit talented peers. He said that in recent months, Swedish leaders had worked with Delashaw to give some of his management duties to others. He characterized Delashaw’s decision to leave the organization as “amicable.” Asked if Delashaw received a financial payout to leave, Hudson said he couldn’t discuss that.
Hudson said there are no specific reviews examining Delashaw’s cases, but that the organization is studying issues at the Swedish campus “to make sure that everything’s great.” Asked whether the internal concerns about patient care and complications were accurate, Hudson said anytime someone has concerns, “we do an investigation and take those seriously.” He wasn’t involved in those past reviews, but said he could report back later regarding the results.
As part of the broader external review of safety processes that Hudson has ordered, Swedish is soliciting proposals from two leading health-care-improvement organizations. Hudson is also in the process of hiring a new chief medical officer, who Hudson said will lead “new quality and safety initiatives throughout the organization.”
Surgeons at the neuroscience institute worked under contracts incentivizing high workloads, paying them more money for handling more procedures and more steps in each procedure. Hudson said Swedish is shifting toward paying doctors for the value they provide, so that various quality metrics will comprise a significant portion of their pay.
“In my opinion, we can’t move fast enough,” Hudson said.
Some staff members have expressed concern that Delashaw and other high-volume surgeons managed their caseloads by booking concurrent surgeries — taking place in multiple operating rooms at the same time — and relying on fellows to handle much of the work. Hudson said he wouldn’t describe them as “concurrent” surgeries that run at the same time. He said they were more like “overlapping” surgeries, noting that the organization’s internal system won’t allow staff to schedule a doctor’s cases to begin at the same time.
Hudson said a surgeon had discretion on how to overlap the cases, but the policy — similar to Medicare rules — is that the surgeon must be there for the “critical” portions of each case.
Five years ago, Swedish became part of the larger Providence Health organization that has now grown to encompass 50 hospitals in seven states. The Times described in its investigation how Providence CEO Rod Hochman, who was the Swedish CEO before the organizations’ merger, had played a role in Delashaw’s promotion to a leadership position despite the concerns of other Swedish doctors.
Delashaw had initially been hired to work for Providence — not paid by Swedish — but was placed at Swedish-Cherry Hill. He quickly emerged as the highest-volume brain or spine surgeon in the state, handling 661 inpatient cases totaling more than $86 million in billed charges for the hospital in his first 16 months. Hudson said Delashaw later reported to then-CEO Armada.
Hochman has declined interview requests, and Swedish staffers in recent days have expressed frustration that Hochman hasn’t made any comments or taken responsibility for his role. Hudson noted that Hochman was previously at Swedish, and said Hochman not only lives in the community but cares a lot about Swedish.
Hudson said they are looking at ways to improve the Providence-Swedish affiliation but said keeping the organizations together is best for Swedish.
“Swedish could not survive on its own without an affiliation,” Hudson said.
Hudson said Swedish still operates with independence and that Swedish leaders will be the ones making decisions for the organization. He plans to continue listening to the concerns of Swedish caregivers and working to rebuild trust with them.
“We have to acknowledge where we’ve been. And we have to own it — right? — the stories you’ve heard and the people you’ve talked with,” Hudson said. “But we also have to recognize that we have to move forward to make sure that this does not happen again.”
For more on our discussion with Dr. Hudson, we invite readers to join our investigative newsletter, where we will be sharing excerpts from the interview.