By Ralph W. Muller
As I near the end of my tenure as CEO of the Health System, I look back with great pride on all that we’ve accomplished together. All I need to do is look out the window to see the tangible evidence of the impact we’ve had. When I arrived at Penn on May 1, 2003, the view from the CEO’s office was very different. From the 21st floor of Penn Tower, I was not only a stone’s throw from the Hospital of the University of Pennsylvania, but also from the Philadelphia Civic Center site that then stood empty. And beyond my immediate view, our system was much smaller: three Philadelphia hospitals and one we owned at that time in Phoenixville, plus a small number of outpatient facilities and a network of physicians.
Today, our $8 billion enterprise employs over 40,000 people and includes six acute-care hospitals and state-of-the-art outpatient facilities in the city and throughout the region, as well as cutting-edge research towers. At the Civic Center site, a 20-year process of redevelopment has seen creation of a vast, interconnected clinical, research, and educational complex that has expanded the footprint of HUP and our neighbors and collaborators at Children’s Hospital of Philadelphia. Where Penn Tower once stood, our new inpatient Pavilion is rising.
In our country’s rapidly changing health care environment, the road has not always been smooth, and at times, hurdles have slowed our progress. But as I look back, there are some milestones along the way that showed we were always moving ahead in our pursuit of reimagining health care for the 21st century.
Here are five defining moments I believe shaped UPHS during my time as CEO.
2003: Arriving at Penn and Building Financial Strength
When I arrived at Penn, it was nationally distinguished as an academic medical center, but there was room for our clinical care programs to become more robust and patient-oriented. To accomplish this, we had to build financial strength. We started by designing an improved billing system and later implemented an innovative fiscal model known as “Funds Flow.” This approach shares resources throughout clinical areas and helps support our research and education missions. These moves led to stronger departments across the system, greater financial security, and eventually, it brought us more patients, as our reputation of delivering stellar care soared.
By 2008, our operating revenue had increased by over a $1 billion, and it only increased from there. “Funds Flow” now serves as a national model. Achieving this required not only financial acumen at the executive level among our Finance leadership team, but a shift in the way all of our clinical leaders worked in support of the larger whole. In the process, we laid the foundation for our ability to sustainably provide outstanding clinical care for our patients, to conduct cutting-edge research, and to support the training of future physicians.
2006: Establishing Penn Medicine Academy and Strengthening Staff and Patient Experience
The most significant investment we ever made wasn’t in a building or new technology. It’s our staff.
In 2006, our Human Resources team established the Penn Medicine Academy (PMA) to ensure that the staff, from the front lines of care to the executive suite, had a plentiful source of training and resources to help them develop new skills, stay abreast of changing policies and new clinical pathways, and become stronger leaders.
It’s clear that effort is helping our staff to rise and engage at the highest levels. The latest employee engagement survey in late 2017 showed that the percentage of engaged employees at Penn Medicine is well above the national average. In recent years, we have been named as one of America’s “Best Places to Work” and top 10 “Best Employers” by Forbes magazine, and HUP received the “2018 Workplace of the Year Award” from the Advisory Board.
But perhaps the most important impact from investing in staff is on our ability to deliver an excellent experience for patients, from the moment they’re greeted to the time they spend with physicians and nurses to when they walk out the door. Because of the “Penn Medicine Experience,” patient satisfaction scores have improved considerably. The likelihood a patient would recommend a Penn practice jumped from the 23rd percentile in 2013 to 86th last year! PMA has been a fundamental piece in the success of the Health System and well-being of our patients.
2008: Opening PCAM and Expanding Our Reach
For several years before I came to Penn, plans to build a new outpatient facility on the 14-acre Civic Center lot were being developed. Within my first month, the vision was officially set into motion. Five years later, the Perelman Center for Advanced Medicine (PCAM) opened and represented a pivotal moment in time for the Health System. The state-of-the-art building not only advanced patient-focused, complex care at Penn, but it also kicked off an expansion of clinical, research, and education space that has continued for more than a decade.
PCAM served as a prelude to the now-established service lines across the Health System that organize care by patient populations. Under one roof, clinical care became more cohesive and coordinated among departments. We doubled the size of our cancer program, and significantly built up cardiology, diabetes, gastrointestinal, neurological, and maternity care, among several other multidisciplinary services. The Roberts Proton Therapy Center was also the first of its kind and remains the largest in the world.
Our nearly 300 programs, services, and clinics at PCAM are steps away from adjoining facilities that have grown up on the old Civic Center site during the past decade: the Smilow Translational Research Center, the Jordan Medical Education Center, and the South Pavilion labs and clinical areas. All together, this integrated facility strengthens the opportunity for all of our faculty, staff, and trainees to pursue our missions collaboratively.
Our regional outpatient footprint also increased, as we put up new facilities in Bucks County, Valley Forge and other suburbs. Today there are now two dozen throughout the region. This unprecedented growth signified where health care was heading: outside of the hospital and into communities. We would later grow our Health System to include a total of six outstanding acute-care hospitals and systems spanning the region, from Chester County Hospital (2013) to Lancaster General Health (2015) to Princeton HealthCare (2018). Each of these facilities has brought its own strengths to Penn Medicine, including nursing Magnet status. Each has seen investments and growth to better care for patients and extend our integrated reach from central Pennsylvania to central New Jersey.
2010: Health Care Reform
Former President Barack Obama signed the Affordable Care Act (ACA) into law in 2010, widening health coverage to tens of millions of more Americans, including almost one million people living in the greater Philadelphia region. Because greater access and an emphasis on high-value care and technology aligned with our mission to better serve our patients and communities, I worked with the Association of American Medical Colleges, the American Hospital Association, and the Obama administration to support the landmark law.
Expanded coverage also meant more patients for us, particularly those in need of complex care in areas such as cancer and cardiovascular disease. The addition of PCAM and new facilities at Penn Presbyterian and Pennsylvania Hospital prepared us for that influx of patients and their needs in the years after it passed, but we also knew that better coordinated care would have to play a role to improve access and keep costs down.
A big part of health care reform included a push for improved digital technologies and electronic health records (EHR) systems, which have become a cornerstone of our success. Even before the ACA, our Information Services team was making major strides to advance our EHRs in the outpatient and inpatient settings. Together, the technology and coordination of care help us deliver higher value care for different patient populations.
Today and Tomorrow: The Pavilion and the Future of Health Care
The completion of the Pavilion in 2021 will cap off a decade of planning and represent the largest capital investment in UPHS history, at $1.5 billion. It’s also the first inpatient addition to the University City campus in over 25 years — and it’s being built for the latest advances in medicine, as well as for change.
Of all our building projects, the Pavilion is the most innovative in both design and the building itself. That started with the PennFIRST team — a diverse group of architects, designers, construction experts, executives, and clinical staff — that, by working together as one, has increased efficiency and streamlined overall decision making. It continued with that team’s collaboration with the Academy to use a 30,000-foot, full-scale mockup of an inpatient floor, to test the design and make changes based on staff feedback from simulated scenarios.
When all of the pieces come together, the 17-story, 1.5-million-square-foot facility will house 500 private patient rooms and 47 operating rooms to deliver complex care in heart and vascular medicine and surgery, neurology and neurosurgery, and cancer by designing adaptable, larger patient and hybrid operating rooms, among other features.
The Pavilion is both a byproduct of everything before it, and a vision of what’s to come.
To get here, and to get to where we’re going next, we’ve needed every piece of the puzzle. We grew financially stronger. Implemented and strengthened practice-changing service lines and programs. Trained and hired more staff. Focused on excellent outpatient services connected by one records system. Designed better EHRs and other digital technologies. And along the way, we continued to integrate our clinical system’s growth with our skyrocketing research enterprise and our premier medical school.
Outside my office window these last months, I’ve watched the Pavilion rise and take shape on the very site where I sat when I first began my tenure as CEO. Soon, I’ll be proud to depart from Penn Medicine at a moment that signifies both the growth we’ve seen and the potential still waiting to be realized in one of the most advanced and innovative health systems in the world. I have no doubt every part of our system, in Philadelphia and across our region from Lancaster to Chester County to Princeton, Penn Medicine will continue set a new standard for delivering health care — thanks to the extraordinary work that all of our staff are doing, and continue to do each day. I am so grateful for all that you do and all that we have achieved together. It has been a tremendous privilege to lead this great organization.