Episode 74:
Stay Safe and Look Out for One Another
Kevin B. Mahoney, CEO, University of Pennsylvania Health System
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In this episode of Fireside Chat, we sit down with Kevin B. Mahoney, CEO, University of Pennsylvania Health System to talk about how healthcare systems impact the economies around them and the need for systems to lower costs in the future. We also discussed how the COVID crisis has reawakened the realization that public health is important to good personal health for many and it contributes to a healthy economy.

Kevin B. Mahoney is Chief Executive Officer of the University of Pennsylvania Health System (UPHS). He assumed this role on July 1, 2019. Beginning in 1996, Kevin’s leadership posts at Penn Medicine have included serving as Executive Vice President and Chief Administrative Officer of UPHS, Executive Vice Dean of the Perelman School Medicine, and Senior Vice President of UPHS. He also served as Executive Director of Phoenixville Hospital, as Executive Director and Chief Operating Officer for Clinical Care Associates, and as Director of Network Development.


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Kevin Mahoney 0:03
We want the city of Philadelphia’s economy to boom and to grow and, and we know that healthcare costs are cited by many of the businesses as a hindrance to their growth. So we are dedicated to reducing the cost of healthcare. And we put a full-court press on it all the time.

Gary Bisbee 0:20
That was Kevin Mahoney CEO University of Pennsylvania Health System speaking about the responsibility that he feels to Philadelphia businesses by controlling health system costs. I’m Gary Bisbee and this is Fireside Chat. Kevin described the University of Pennsylvania Health System and how it is unique because it’s owned by the university. As much as 60% of the health system’s bottom line goes to the medical school for research. He spoke about how the second COVID wave is different from the first in part because the velocity of COVID patients in and out of the hospital is much higher. I found Kevin’s discussion of leadership in a crisis to be powerful and compelling. Kevin spoke about how COVID has reawakened the realization that public health is important to good personal health for many and it contributes to a healthy economy. Let’s listen.

Kevin Mahoney 1:10
Public health in the United States needs to be reinvested in and Penn wants to play a part of that. So an example, we with the university, we just made a $100 million donation to the local school district to address asbestos and lead in school buildings. So it’s not COVID related, but I think it’s inspired by we need to get back to the basics of public health in this country and Penn wants to help lead that way.

Gary Bisbee 1:35
Kevin concluded that regardless of what government health program is legislated, health systems would be paid less in the future and he emphasized the importance of lowering costs as follows.

Kevin Mahoney 1:46
Regardless of what happens, we’re going to get paid less in the future. And we need to get our cost structure lower and lower and more efficient. And we’re going to do that by eliminating waste, eliminating infections, and outcomes that are negative because that’s where so much of the money goes.

Gary Bisbee 2:04
I’m delighted to welcome Kevin Mahoney to the microphone. Well good afternoon, Kevin, and welcome.

Kevin Mahoney 2:15
Thank you. I so appreciate the opportunity to spend some time with you.

Gary Bisbee 2:18
Well, we’re pleased to have you at this microphone. Let’s start by learning more about you and your fascinating background, and then we’ll go to the University of Pennsylvania Health System and dig into what’s changed due to COVID, and then wrap up with your views on leadership. You went to undergrad at Millersville University, got your MBA and Ph.D. at Temple, we’ll cover that later. But let me ask first, what was the story behind your becoming interested in healthcare?

Kevin Mahoney 2:46
It’s a story that I repeat and I’ll go through it again because it is what drives me and motivates me. But I was a typical wayward teen, not quite sure what I wanted to do with my life. And I went to Millersville, as you mentioned, and I made the Dean’s List, but unfortunately, it was the dean telling me that 1.98 was not a sustainable grade point average and I needed to go home. And I went home and wasn’t really sure what I wanted to do. So I was working for a local landscape company. And it was the summer of 1978. And three things happened to me that year that shaped the rest of my journey and my career. The first was, I ran into a gentleman by the name of Bill Rouse who was a visionary developer in Philadelphia and he was breaking all the rules. And one of the rules was he was going to build offices out in the suburbs which was the antithesis of offices in the city and sleep in the suburbs. And he painted a vision that was compelling. And he taught me how to do it succinctly. And when you’re 18 years old listening to just a personality that just drove a vision that was so compelling, that taught me a lot about quickly painting visions for the future and how critical they were to inspiring people. The second thing is he told me that I should jump on this farm tractor and cut this field that he was going to have a ribbon-cutting for his suburban office park. And I laughed because I thought it was gonna be a big, big failure. But while I was cutting the field after about a week, I fell off the tractor under the tractor and the tractor drove over me. And I was severely injured and ended up in the hospital for a long time. And after multiple surgeries in the hospital, what I realized was, man, I loved the teamwork. I loved the environment – the confidence that people had that they could make me better and the deep caring that so many of the team, and it was remarkable, again, to be 18 years old and have every person that came through the door trying to help you get better and get back on your feet. And I just said, I need to work in a hospital. But as we mentioned earlier, we’ve already confirmed that I wasn’t the greatest student. So physics and chemistry and biology were beyond me. So being a doctor or a nurse wasn’t going to happen. So I took the easier path and I said, “I’m gonna become a CEO of the hospital” and I set out on my career path to make that happen. The third thing that happened that summer was I met my wife and we’ve been together since we were 18. And what God couldn’t do in a couple weeks in the hospital, he makes sure that Pam takes care of me every day. And when I’m making too big a deal about things, she’s always the first one to say, “What do the employees think? What are the patients thinking?” And she’s been my center. So 1978 was a big part of my life and getting my career started.

Gary Bisbee 5:29
For somebody not being a student, went on to get your MBA and your Ph.D. so obviously you found your way there. I wanted to ask, Kevin, most of your peers went to get an MHA, masters of health administration, you went to get your MBA. Can you share with us why that was?

Kevin Mahoney 5:48
Sure. Being from Philadelphia, I wanted to stay in Philadelphia. And at the time, again, in the early 80s, the Temple MBA was more of a calling card, perhaps better described as a union card. That was your minimum entry into a hospital administration job in Philadelphia. Bob Cathcart and others had MHAs from their programs, but a growing majority of the hospital leadership in Philadelphia at that time were getting their MBAs at Temple. So that seemed like the network that I wanted to be part of.

Gary Bisbee 6:19
What was the next step in terms of the Ph.D.? What was your thinking there?

Kevin Mahoney 6:23
I’ve always been a believer that you need to constantly learn. When I started Millersville, I was doing punch cards and by the time I was at Temple, I had an Apple IIe and how quickly the world was evolving. So it certainly taught me the speed of change we continue. So lifelong learning is important. The other thing that I think everybody has to find the way their mind works, but for me, often staring at a problem doesn’t allow me to solve it. It just frustrates me. And I have found over the years that if I trigger my mind to think about something else while I’m thinking about it, I’ll go back and figure out how to solve that problem. So I coach the kids’ baseball teams and I’d be sitting at third base, and I’d say, “That’s how I’m going to solve that problem with the facility.” Or I joined a local school board for ten years and while people were complaining about taxes, I’d be thinking about work and since my mind was distracted, I could solve that problem. The doctorate program at Temple was a similar thing, which was, it guaranteed that several times a year I was going to be sitting in the classroom thinking about something other than work. And what I find when I then leave is I’m refocusd, I’m reenergized, my mind’s clear and I can get back to the business at hand.

Gary Bisbee 7:35
How and when did you become involved in leadership? Did you know right from the beginning that that’s what you wanted to do?

Kevin Mahoney 7:42
I think it was by my family. It’s a large Irish Catholic family. Early on, I had to take care of my younger brothers and sisters. And God bless my parents. They did a wonderful job, but they needed help. And I enjoyed it. I enjoyed being the big brother. In Boy Scouts, I enjoyed being the leader of the troop. So I think I’ve always had a knack for leadership and the hard work that comes with it. It’s not always easy and it’s sometimes the subject of a fair amount of criticism, but I’ve always aspired to leadership positions.

Gary Bisbee 8:11
We’ll cover your thoughts about leadership in a crisis later, but just in terms, right now, what do you think makes a good leader?

Kevin Mahoney 8:20
I think it is, back to where I started, I think it requires that you’re able to communicate a vision and confidence because people follow leaders that they believe in. And if you’re just out, we’ve got to make budget or man, things are really bad right now, that’s not the inspiration that people are looking for. So I think the first is, paint a vision. Do that by telling stories. Have confidence in yourself and hire confident people. And then, perhaps the most important part about being a leader is the ability to listen at all levels of the organization and then connect the dots. Because when the housekeeper’s telling you about the number of patients coming through our COVID census right now, that qualitative data may be very helpful to solving some of our planning issues. So if you listen, you get a lot of nuggets along the way that you can, again, connect the dots together. Then lastly, you need to know why you’re doing it. And leading for leadership’s sake doesn’t work for me. But leading, as we do with Penn, we talk about our mission is to advance science and to disseminate knowledge and take care of patients. And we live that mission every day. And as a leader, it’s important for me to make sure that I’m communicating to people why we’re here and why we’re doing it.

Gary Bisbee 9:47
So you’ve spent over 25 years at the University of Pennsylvania. What about Penn kept you there throughout that period of time?

Kevin Mahoney 9:52
I didn’t set out thinking I would be here as long as I have. What’s kept me, I think, is several things. One is a deep history of making a difference in the world that the university has done and I love being part of that. Second is the group of talent that has been amassed here, I find just remarkable. And we talked about COVID just briefly, but the two vaccines that are coming out first, the Pfizer and the Moderna vaccines are built upon technology that was developed at the University of Pennsylvania. And it’s wonderful that we have the vaccine. It’s so cool to me that I can walk down the hallway and pass Dr. Drew Weissman who helped invent it. And it motivates me to work harder because the next person I pass in all the way, maybe 20 years from now, they’ll be the person that eliminated dementia from the world or came up with a way to regrow limbs or things like that. So that amassing of the talent and being able to hang out with that talent, really, I find motivational. And then the last thing, and I know it’s unique to Penn, but we’re one of the few health systems where the university actually owns the health system. As you know, and as my colleagues know, most of the time the health system is separate and there’s a contractual relationship between the university and the health system. So we are fully integrated. That means 60% of our bottom line goes to support the research mission at the School of Medicine. So it allows me to tell all of the employees at Penn that you’re not just a hospital worker, you’re also a cancer researcher because when you do your job right, the money goes over and we cure cancer and we prevent cardiac disease. So that integrated organization I think is unique and it inspires me to stay.

Gary Bisbee 11:30
Let’s build on those comments and shift to the University of Pennsylvania Health System. Will you please describe the University of Pennsylvania Health System for us Kevin?

Kevin Mahoney 11:39
We are about six hospitals. Our hospitals tend to be quite large. So the Hospital University of Pennsylvania and Penn Presbyterian are on the US News and World Report Honor Roll and have been for decades. They’re both teaching hospitals. And then as we spread out, we include Pennsylvania Hospital, the nation’s first hospital. So again, my love of history, to be able to go down to Pennsy and realize that 265 years ago our country was just being formed and they knew they needed a hospital and the first one was built in Philadelphia. And then you go up to Princeton, you go out to Lancaster, so we spread the large geography. Size isn’t as important to us as quality. So the hospitals that we’ve acquired and integrated were leaders in their market and stand on their own. But together we’re stronger but individually they’re just spectacular as well. We have a large homecare division. And I continue to tell everybody, and I think it’s important to anybody listening, despite being one of the nation’s most advanced hospital systems, 65% of our revenue comes from the outpatient side. So we continue to grow ever larger hospital campuses without beds throughout the region, you know, roughly 150 to 200,000 square feet with every service from radiation, oncology, to chemotherapy. But back to my integration, you can get at those suburban sites, the latest clinical trials because we’re hooked on one electronic medical record to the researchers downtown. So I would describe it as a vibrant, growing, and health system that’s trying to meet the patient in their environment, which as we know, is increasingly virtual. So we have hospitals, we have ambulatory, we have connected health, we have home care, and we continue to perform well, even despite COVID, we’ve done well financially and continue to do so.

Gary Bisbee 13:35
Thinking about your role, how do you define the CEO role at Penn?

Kevin Mahoney 13:40
I identify and be able to communicate what our vision is. And then second, identifying and finding talent to execute that vision. The old adage, “Execution operation beats strategy for lunch,” for sure is true at Penn Medicine. And we won’t fill a position until we’ve identified the right people. And we have a very robust, we do it through what we call the Penn Medicine Academy. So in addition, last year, we spent about $25 million in college tuition for employees to get advanced degrees and to continue to move forward. In addition to that, we have a large leadership development program through the Penn Medicine Academy. And we use the adage, “We’ll teach on Saturday what they can use on Monday.” So how to make a presentation, how to do XL spread, real tools that you need, so leadership development. So my role, set the strategy, communicate that strategy, and hire the talent that can execute it.

Gary Bisbee 14:38
You mentioned that the Health System is owned by the university. So in effect, is the University board your board or how does that work?

Kevin Mahoney 14:49
The trustees of the University of Pennsylvania is our board. They have a subsidiary board just like the Wharton School has a board of directors. And Penn Medicine we have a governance committee, but its authority is relegated from the trustees.

Gary Bisbee 15:04
Thinking about your priorities maybe have been modified somewhat because of COVID, we’ll cover COVID a little bit later. But thinking about your priorities, how would you describe your top several priorities for those of us outside Penn?

Kevin Mahoney 15:19
I think our number one priority as an academic medical center is to advance science. So as a learning healthcare system, we have one of the largest biobanks. And it costs money to hire people to get consent forms from people when they’re giving blood downstairs to make a donation to the biobank. But when we’re able to compile that data, we can advance science. So we want to be a learning healthcare system. That is data science, the biobank, collecting the genetic material so, again, we can figure out cures because the best way to eliminate the healthcare spend is to come up with cures for diseases that plague us. So that’s our number one priority. Our second priority is that patients get an empathetic experience. Nobody wants to come to a hospital healthcare so we spend a lot of money teaching and training around the patient experience. And then I think the other area that we continue to try to focus on is, we want the city of Philadelphia’s economy to boom and to grow. And, and we know that healthcare costs are cited by many of the businesses as a hindrance to their growth. So we are dedicated to reducing the cost of healthcare and we put a full court press on it all the time. So it’s not just price times volume anymore, as you know, but how can we come up with coordinated care? How can we come up with alternative delivery sites that truly drive down the cost of delivering care?

Gary Bisbee 16:55
You mentioned earlier that quality was more important than size, but do you see any future acquisitions or mergers in Penn’s strategy?

Kevin Mahoney 17:05
The answer is yes. If the right partners are interested in our model. Our model is not for everybody. So the tight integration, the dedication to science. But we would welcome the partners that fit into that mold. I think we just saw today that the University of Pittsburgh Medical Center sold their home infusion business for $400 million. I think much of our future growth, though, is in the ambulatory side, the connected health side, being able to deliver care, hospital at home is going to be our future much more so than more bricks and mortar facilities. A recent example would be, just to the west of our main hospital is Mercy Hospital of Philadelphia, historic Philadelphia institution. And we partnered with the community when they announced that they were closing their inpatient services. We partnered with the community to recreate that as a healthy village. I should mention that, despite our size, and again, so much of our money comes from the outpatient side, we can deliver most of the services that people need in their community without having to come to the hospital setting. So those types of partnerships, I think you’re going to see more than hospital acquisitions. They’re way too many patient beds in the Philadelphia region to start with. So I think you’re going to see downsizing more than you’re going to see hospitals merging and acquiring. We need to work on what’s the new delivery mechanism for the next century.

Gary Bisbee 18:33
For sure. And your point about over-bedding is true to most major urban areas in the country. Kevin, let’s turn to the COVID crisis. Looking back nine months ago, what’s been the major impact of COVID on Penn?

Kevin Mahoney 18:49
Charles Dickens in the Tale of Two Cities, “It’s been the worst of times and the best of times.” And we mourn the families that have lost loved ones and the pain that the country is going through and the like. But in terms of a team, I am so proud of the way everyone came together across our system. And we would have critical care doctors at the main campus drive an hour and ten minutes to get up to Princeton to help them. The early days when we were learning that putting people on ventilators was not necessarily the best thing to do, our team would go to their, you know, their colleagues and reach out and help them out. So that teamwork was incredible. I tell everybody that back in the late 90s the University of Pennsylvania Health System we lost $200 million one year and we lost $300 million in two years. And out of that crisis came, what I believe, is one of the most fiscally disciplined health systems you’ll ever come across. But it was born out of that crisis. I think out of the COVID crisis, you’re going to see the University of Pennsylvania Health System, people will look back and say that’s when we integrated clinically across the six campuses as opposed to everybody operating in clinical operations pretty much on our own. We’ve traded pathways, we’ve worked together so closely on personal protective equipment. The last impact that I think it had, and only time will tell if this is true, we stepped up in the very early days and we made a commitment to our employees that there would be no layoffs, that people would not miss a paycheck. So we set up emergency funds, we paid people, even if we didn’t have hours for them, and we avoided layoffs. And I think that has just made us more of a family and more tightly aligned with the special things that take place here. And then the very last thing that I think we learned is public health in the United States needs to be reinvested in and Penn wants to play a part of that. So an example we, with the university, we just made a $100 million donation to the local school district to address asbestos and lead in school buildings. That’s not COVID related, but I think it’s inspired by, we need to get back to the basics of public health in this country and Penn wants to help lead that way.

Gary Bisbee 21:11
Well good for you. I think if COVID showed us anything, it’s that public health is part of the economic security of this country. Thinking about the surge, first wave was in the spring/late spring. Are you in a second surge yet?

Kevin Mahoney 21:27
It’s a great question. And the statisticians tell me that wave is not a technical term that it was made up by a commentator, but it describes adequately what we’re going through. So we had our high watermark back in the middle of April, across our six hospitals, we had 424 inpatient was our high watermark. And we’re at almost 75% of the way back to that number. So it is rapidly increasing back to the April timeframe. What’s different this time is, initially people stayed, the length of stay was quite long. We weren’t 100% certain on the right techniques and treatments to use. We were calling our colleagues in New York, calling our colleagues in Italy to find out. What’s happening now is the velocity, the in and outs of the hospital are much higher. So we will admit 56 patients yesterday and we discharged I believe 35. So we increased our daily census by 21. But it’s not what you think, which is again, they added 21 patients, we added 56 and we discharged. So the in and out, and the fatigue that causes on the staff is real. So this second wave is certainly different than the first one in terms of how much better we are at treating the patients. And again, as I described the velocity in and out of the hospital. The other thing that we quickly set up, we’ve treated as many patients through our home care group. We have an app we call COVID Watch which does remote monitoring of patients. And we discovered that when patients escalate bad in the course, they need to get to the hospital in a hurry. And on the other hand, if you’re not in that escalation period, staying out of the hospital is probably good for you and your family since you’re not bringing in, in and out of the germs. So just in a period of days, our team’s set up an app, that again, does remote pulse oximetry and watches the people at home. So we’ve had as many people treated and managed through our home care group as we have on the inpatient side.

Gary Bisbee 23:30
The COVID crisis has elevated our view of health disparities, certainly. How do you think about that, Kevin?

Kevin Mahoney 23:37
I have apologized to the community and to my co-workers. I came from a generation where we thought we had licked civil rights. I took my family to the Pettus Bridge, we’ve walked through Selma, and we’ve been to DC and the Civil Rights Museum. But until George Floyd, I had convinced myself that things were better than they were. And Penn Medicine, at the end of May, we had a series of town halls. We’ve committed to making a difference in health equities is the lane that we can make our fastest advances. An example, and I think this is a demonstration of leadership, 600 of our top employees, myself included, have a variable compensation plan based upon making a budget, making quality outcomes, employee satisfaction, patient satisfaction. This year we added two metrics that are directly related to health equities. One is reducing morbidity and mortality amongst black and brown patients. And second is increasing colorectal screening amongst the black population. And that’s not the doctors in family medicine have to do it, or the doctors in OB. The entire management team has their compensation at risk on making improvements in those metrics. So you’re going to see more of us not just tackling health disparities, but coming up with novel ways to reduce it. We started a social impact fund with Wharton. The health system funded $5 million and we want to identify companies that can help with homelessness, helping with getting jobs after you’ve been incarcerated, to help with diabetes and management, and things like that, food insecurity. And doing that together in partnership with Wharton, I think we’ll be able to start to make an impact.

Gary Bisbee 25:26
Let’s turn for a minute to what many are calling the new normal. What fundamental changes that may have already been underway have been accelerated by COVID?

Kevin Mahoney 25:38
My colleague Morrow, Ian over at the Wharton School has published a book, it’s called 2030. And one of the things that he talks about is the acceleration of trends. And he and I have spent a lot of time talking about COVID. So telemedicine was not invented in April when COVID hit Philadelphia. Telemedicine is something that we’ve been working on for a decade, but man, it accelerated overnight. We went from, you know, a couple hundred telemedicine visits at the first week of March to 400,000 by the end of April. Work-life balance is something we’ve talked about for years, but it is just been to the forefront, health inequity. So I think COVID it’s not necessarily a new normal, it’s an acceleration of trends that were underway before. The use of data science and artificial intelligence to predict who needs to be in the hospital and not, we’ve spent a lot of time working on that, trying to figure out which COVID patients need the ventilator in the ICU. So that acceleration of trends, I think we’ll look back and we’ll remember with sadness, the pain the country went through. But I think as the next decade unfolds, we’re going to see this dark year as a time when so many things that we had talked about turned into action and turned into small actions that led to larger actions and to a better healthcare system than we had before.

Gary Bisbee 27:05
Home care and hospital at home are good ideas. Are they practically possible under the current payment models, Kevin?

Kevin Mahoney 27:14
That is a phenomenally astute question. Because it worked at Penn, it may not work for everybody. What works for us is, we took, during the COVID crisis, six chemotherapy regimens, drugs that we were providing both inpatient and outpatient, we moved them into the home environment because we didn’t want the patients coming into the hospital and we were under orders to cancel non essential services. We are now treating those patients and they stayed at home. An example, one is called Epoch, E-P-O-C-H. And that used to be administered in an inpatient bed. We’re now doing it at home. We lose money doing that at home. Where we’re doing okay is we have so many patients that want Penn medicine level care that we’re able to backfill those inpatient days that were lost with other inpatients. But for most hospitals that don’t have that ability to backfill, moving things to the outpatient or to home, you’re going to lose money. So we need to work aggressively with Aetna, with the Blue Cross Association, with others, to recognize, Medicare, that you can’t just change payment mechanisms. Because if I move it out of the hospital, it’s a 100% rate cut for us. All the savings go right now to the managed care plans. And we need to have federal ways to share that. Medicare just announced their hospital-at-home pilots and I know they’re working towards it. But, again, we need a different payment mechanism or a hospital at home will never work. The other thing that could happen is non-hospital providers, Amazon and the like, will come in and do the work at home and leave the hospitals with, you care of 24/7, you take care of New Year’s Eve, you take care of the weekends. And that’s not a financially sustainable model if you only have the tough part to balance out if you’re following me. So I think as healthcare leaders, the nonprofit world needs to figure out together with the managed care companies and Medicare, how we can come up with a payment system that works on hospital and home.

Gary Bisbee 29:19
Yeah, I mean, you’re totally right. We’re definitely not going to see Amazon or Google operating emergency rooms, are we?

Kevin Mahoney 29:25
No. But if all you are operating is an emergency room, you know you’ll be broke pretty fast.

Gary Bisbee 29:30
One other quick question and then let’s turn to leadership in a crisis and that is, do you think that Medicaid will in essence become the healthcare floor in this country?

Kevin Mahoney 29:42
I’m not sure. Again, I think we’re at one of those inflection points. We’ve talked about Medicare-for-All, we’ve talked about Medicaid expansion, and I would be lying if I had a prediction as to which way all this was going to go. The one thing I keep telling everybody at Penn is regardless of what happens, we’re going to get paid less in the future. And we need to get our cost structure lower and lower and more efficient. And we’re going to do that by eliminating waste, eliminating infections, and outcomes that are negative because that’s where so much of the money goes. But the rules can be changed so easily anymore. Used to be, you’d go through Congress and you’d have a wrestling match, and you could talk to your local Senators. Now, so much is done by executive order that we need to be prepared. If site neutrality goes away on your hospital-based clinics, we can moan about it, or we can get our costs and lower. And that’s the focus that we’ve been taking on.

Gary Bisbee 30:38
A couple of questions on leadership in a crisis. This has just been a terrific interview, Kevin, much appreciate it. So, what are the most important characteristics of a leader during a crisis?

Kevin Mahoney 30:49
I think it’s to constantly communicate two things. Reminding people why we’re here, which is to take care of our patients. And second, reminding everybody that we’re also here to take care of each other. So when the crisis developed, I rolled out the three P’s and an I we talked about. First was, we’re going to protect our patients and we’re going to make sure that they had the best possible outcomes, although it was a new disease. We weren’t quite sure, but we wanted to make sure we were protecting our patients. Second was, we’re going to protect our employees, so the no layoff pledge, no missed paycheck, that you’re going to get personal protective equipment that you need, I think was critical. Third was, we had to protect our finances. And we went about doing that through taking out a larger line of credit so that we maintained our cash liquidity. We did a lot of maneuvers financially to make sure that we were protecting ourselves for the future. And then the last, the I was, how to innovate your way forward, because the only way we were going to get out of this mess was through innovation. And I saw people that hadn’t worked together before just pulling together. And we developed what we call Penn Cobalt in nine days. And it’s more or less open table for behavioral health services that we made available to our employees. And about half of our employees have visited the website. It’s been remarkable in that if you need to talk something through, you get to talk to the right person. If that means a licensed social worker, we get that set up. If it means a clinical psychologist, we get that set up. If it means a coach, we get that set up. If it means you need a psychiatrist because you’re having suicidal ideations, we get that set up right away. So the innovation that that took to put together, I think was forged in our ethos of protecting each other. I think the most important thing of leadership, again, is remind people why you exist. In our case, it is taking care of patients, leadership in a crisis. And second, there has to be an unwavering belief by everybody in the organization that I cared about them and I wanted to make sure that they were safe, that their families were safe, and that we were doing everything we could to protect them and their families.

Gary Bisbee 33:07
Well said. Final question. How has the COVID crisis changed you, Kevin, as a leader and as a family member?

Kevin Mahoney 33:15
That is a question I actually haven’t thought about. As a leader, I think it’s reinforced, again, my instincts that if you take care of your workforce, if you care about your workforce, they’ll run through walls for you. I think that’s why people went into healthcare. And it’s not just the people in the emergency room. We have a revenue cycle, completely remote. And so March and our days in AR are actually lower now than they were when we went into the crisis. And I, we’ve done that, again, by Zoom, by Microsoft Teams, by communication, daily communication out to everybody conveying how important it is that they remember that they’re part of the family and part of Penn Medicine. So, I think my takeaway in leadership, it reinforced the instincts I had, which was talent and your employees and your physicians are your most important asset and you need to make sure that they’re not forgotten during the crisis. At home, over the last year, sadly, I lost my brother. Last night I lost my 55 year old first cousin Amy who I loved so dearly. And it’s just a reminder of how fragile life is and how unimportant titles and offices are. And how critical it is, again, as a family member that you make sure that you don’t just cursory, “How are you doing?” but, you know, have a deep conversation with your spouse or with your children about how they’re doing and mean it. And same thing with my work family. Everybody’s hidden behind a mask, but I can see through their eyes, you know, how they’re doing. And when I say, “How are you doing?” I need to mean it and I need to listen to what they have to tell me. I think the last year has reminded me the fragility of life and how important it is that we be kind to each other and that we stick together because it’s difficult for so many families.

Gary Bisbee 35:10
Well again, well said, Kevin. And by the way, condolences on Amy and your brother. We very much appreciate the time today. It’s just been a terrific interview and we look forward to having the opportunity to follow up with an interview in the future.

Kevin Mahoney 35:25
For everybody out there, thanks for listening and stay safe and look out for one another.

Gary Bisbee 35:31
Fireside Chat with Gary Bisbee is a Health Management Academy podcast produced by Think Medium. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review Fireside Chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we’ve found that podcasts are known through word of mouth and we appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capitol in Washington, DC, where we explore the strategies of leading health systems through conversations with CEOs and other interesting leaders. For questions and suggestions about Fireside Chat contact me through our website firesidechatpodcast.com or gary@thinkmedium.com. Thanks for listening.