The Q&A: John Warner

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

John Warner is the CEO of UT Southwestern University Hospitals, overseeing multiple facilities including the newly opened William P. Clements Jr. University Hospital. He is also a professor in the Department of Internal Medicine – Cardiology. Warner is holder of the Jim and Norma Smith Distinguished Chair for Interventional Cardiology and the Audre and Bernard Rapoport Chair in Cardiovascular Research. He received his medical degree from Vanderbilt University and his MBA from the Physician Executive Program at the University of Tennessee. He completed residency training in internal medicine at UT Southwestern, where he served as chief resident, and fellowship training in cardiovascular disease and interventional cardiology at Duke University Medical Center. His research interests and publications have centered on acute coronary syndromes, adult congenital heart disease, and the risk factors for coronary artery plaque rupture and progression of atherosclerosis.

Editor's note: This interview has been edited for length and clarity.

Trib+Health: You were involved with planning Clements University Hospital from the start. What was the process of getting input from the medical staff and patients to make the hospital what it is?

John Warner: If asked about the things we did right, I always tell everyone that we did a lot of listening at the beginning.

Before we even started drawing or looking at what the hospital might actually look like, we convened a group of 12 planning groups, which included patients, nurses, housekeeping attendants, nutrition services, patients' families, every person who might be involved in either being a patient in the hospital, visiting the hospital or working at one.

We essentially divided those groups into different services and basically got input about what we thought the hospital should be, what kind of care we want to deliver there and what kind of work environment we wanted to have.

We also reached out and visited other hospitals to look at things that were considered best practices at other high-performing hospitals. For three months, the architects were there with us listening but they weren’t driving the process. We actually didn’t even let them speak in the meeting. We just went through the exercise of doing research, learning about best hospital practices and really determining what kind of care we wanted to provide in the building.

I really think that’s what drove our result, that listening process and discovery process that we began with for those first three months.

Trib+Health: Were there specific problems you wanted to tackle, or did changes arise throughout the process?

Warner: As a set of guiding principles going in, we wanted to first and foremost make sure that it was a hospital designed for patients. Many hospitals that you visit are more designed around staff efficiencies and movements, rather than the actual patient experience. That is the thing we put in the forefront. This should be a very different experience for patients and their families.

We also wanted to make sure that we incorporated research and education into the hospital. We are a large academic medical center. We train a number of caregivers, providers and physicians. So we wanted to make sure that the architecture supported that. Often that is a late add to the project. We didn’t want that.

We also wanted to make sure that we built in the ability to do meaningful clinical research, directly into the architecture of the building.

Those were very high priorities. Another thing is that flexibility is key. We know that health care delivery models are going to change. What we are doing as an in-patient might be an out-patient procedure in the future. We wanted to make sure the building was built to change and grow over time.

We were trying to build out a lot of structural flexibility, so that if we needed to turn an operating room into a heart catheterization lab, or something like that, it wouldn’t be an expensive or difficult proposition.

Trib+Health: The medical district in that area is pretty robust, so why send somebody to that hospital instead of another one in Dallas?

Warner: What I think we are best at is that team-based coordinated care of someone who has a very complicated medical problem. To do that you need very good technology, but you also need a cohesive team of people. That is what UT Southwestern is known for and proud of. But we are built to tackle any problem.

Trib+Health: Since the hospital has been open, have you seen what you expected?

Warner: I am very pleased. We have been much busier than we expected. We have been running between 85 and 90 percent capacity most days, so that was busier than we thought we would be right up front. That happened almost immediately. We have been very reassured that the support we are receiving from patients and their families has exceeded our expectations.

From the patient experience standpoint, we are very pleased. We really hoped the patients and their families would appreciate the building and like it. Our patient satisfaction rankings from the very beginning have been in the 90th percentile or above.

Trib+Health: You weren’t expecting such high numbers because it is a referral hospital? Or was it something else? 

Warner: Like most hospitals, we knew we would see more patients through the emergency department. We are a referral hospital, so a lot of our patients have seen other physicians and are being referred for a procedure or for a higher level of care, or clinical trial. 

I don’t know that we expected the building to be quite so full so quickly, but that has been reassuring. It suggests that we are serving the needs of this community.

Trib+Health: In planning, where was the balance between the technology and team needed for care and the patients' comfort?

Warner: We wanted the building to be supportive of the technology and to have the latest MRI scanners, CT scanners, state-of-the-art operating rooms, but we also wanted this to be a really personal experience. I think a lot of the experience of the patient has been around the design of the room. That includes making sure the patients have a lot of control over the room environment and to build an optimistic room that is bright, with natural light along with public spaces that are warm and have an inviting feel to them.

Being sick is a stressful experience so anything we can do to minimize that stress only enhances the patients' experience. But we also think it enhances healing. Healing is more than just technology. The spaces in the hospital should really promote wellness and healing. 

Trib+Health: What is the plan for growth at this hospital?

Warner: We have some shelled space that we had built. There is one patient care unit that is not built out on the top floor of the hospital. We wanted to reserve a little bit of space for us to get in and live in the place for a bit and realize the things we missed or might need. We are beginning to build out those spaces and we’ll have all the hospital completely unshelled by the end of this calendar year, to give us some room for growth.