Interview with Mr. Charles Kahn

President and CEO of the Federation of American Hospitals (FAH) and Founder of the FOH community.
“I hope that the various themes and work discussed in the meeting of the community will lead to innovations and other developments that will impact all healthcare systems.”

The Coronavirus has undoubtedly changed the world as we know it. How do you see the change? How is it reflected in the organization you manage?

Without question, the hospital and healthcare systems have been changed materially by COVID both in terms of the effect of the pandemic on operations and the way we treat patients from the time we began with shutdowns.

Hospitals were confronted with a very unique situation where the lion’s share of their elective activity had to be curtailed. That resulted in almost empty hospitals that had to prepare for surges – at least in some places. This was problematic because of supplies and the supply chain and even in terms of personnel.

The supply chain had broken down and that was unique and problematic. A lot of energy went into working with both the government and suppliers just to have the supply, and the stress on prepping institutions that weren’t made for the level of ICU use. Finally, the places that got the surge had to deal with all of the stress on care that comes with dealing with not just a contagious, but a very contagious disease – a disease that we’re learning how to treat. And there’s no silver bullet.

 Over the year, I think incredible amounts have been learned about how to treat COVID. Incredible amounts of energy have been invested in assuring the supply chain. I think the current stress remains on the individual caregivers. In the United States, the disease is becoming so prevalent that in a very short time it’s going to be very difficult to move caregivers from hospitals that have no or a few COVID patients to the places that are hotspots. So all that’s going on right now. And then the last part was post the shutdowns. Bringing hospitals back online was a difficult experience also.

There was an obvious economic and organizational effect on hospitals across the country that was completely unprecedented when local authorities shut hospitals down, and part of the shutdown came because of the lack of PPE, or the concerns about the lack of PPE and other supplies. And so the idea was to conserve the PPE and other supplies and also to prep for a surge, and the surge didn’t come in all parts of the United States.

That’s why the government had provide funding and assistance. The economics of running hospital systems is that they aren’t prepared to go from 90 or 100% occupancy down to 10 or 15%.

I think we’ll find that death rates are higher during some of these periods then normal trend probably due to non-COVID patients who were not getting care. In terms of elective surgery, there are many patients who are afraid to come to hospital. In one of our national systems, it’s the largest in the world, the HCA; their patient mix changed, and fewer seniors came in for treatment. They were actually able to get back to almost the same level of occupancy across their system then before COVID but, it was predominantly private patients under age 65. The over 65s didn’t return in the same numbers, and I think it was related to fear of COVID.

What problems do you expect global healthcare will be facing 10 years from now? How are you preparing for those problems today, in your organization?

Well, as I said, I represent many a number of systems, and they probably have a very different orientation in terms of looking at the future. I think it’s a little difficult to assess this kind of question.

You know, a community can be thinking about how it’s going to expand itself, and then all of a sudden it has a 500 year flood and it changes the whole question of where the community is going to grow and what’s appropriate. You know, you learned you either can’t build in flood plains, where you’d already been building big neighborhoods. And actually, what I’m describing, you could sort of take Houston, in the United States in Texas. They had a big hurricane a number of years ago. They had tremendous flooding which brought into question the growth pattern of the city, because they had built on floodplains. And, they built near dams. And the dams had broken. And so I sort of see global healthcare as follows –  we’ve had this pandemic, which is sort of equivalent to a great flood and I think it’s leading us to a period of little discontinuity in terms of what we might think of as the future of health care.

When you think globally, at first it’s just in a negative impact. Over the next 10 years, the pandemic has had a very negative impact on significant vaccination programs. What’s going to be the long term effect of that? It’s created a new disease, along COVID. And by the end of this, millions of people are going to have COVID. Does that add a whole set of new conditions that we’ll have to face? And then finally, it’s probably in most healthcare systems, but I think in the overall healthcare system in each country,  it has probably led to a real reevaluation of how many hospital beds you need, and what’s your orientation? And how ready do we need to be for future pandemics.

Also, the accelerated work on the vaccine and on the treatments may be propelling a use of monoclonal antibodies and other science that could have all kinds of effects on speeding up treatments that were being developed but go way beyond COVID itself. So, I see us at this juncture. We hit a discontinuity, and I think it’s harder to make judgments about where we’re going, because I think we’re going to have a lot of reevaluation.

What is the value that drives you in your professional life? How is this value reflected in everyday life and important activities?

I’m on the policy side of things, so I would say that my work is driven by two themes. One theme is on the healthcare delivery side – how can we foster a system that’s going to be best for patients? The second; how can we foster an environment through policy to enable healthcare systems to do the best they can for their patients. That’s what drives my professional life and that’s why I’m involved in the sort of the rules of the road and the economics of healthcare delivery, mostly as it affects hospitals. That’s where the value of my organization is reflected.

Your collaboration with Dr. Eyal Zimlichman gave birth to the FOH community. What is the purpose of the community? Why was it important for you to establish it?

Well, I think if we look across the world there are many healthcare systems that generally get it right in terms of not just providing state-of-the-art medicine for their patients, but organizing that delivery and serving their communities. In a sense they are state-of-the-art across all aspects of healthcare delivery; not just the research and the training and the provision of care, but, all those things, digital and, and otherwise, that constitute what world healthcare delivery is today. And they are all in different systems – the financing systems, the regulatory systems, in each of those countries is unique. Most countries have some kind of national health system, but they really vary. But what I think is important is that, regardless of how each country defines the rules of the road and the financing of their systems, that there’s great commonality between what these health systems do.

I think the purpose of the community is to bring together those people who are at the forefront, at the state-of-the-art, who are innovators. And take all those things that are common across healthcare delivery, regardless of the setting and country, and bring those ideas together because much can be applied globally. So the idea is to tie people together who have common purpose and take the innovation and new ideas and mature them and figure out ways to diffuse the knowledge that comes from all these different systems.

The FOH community is a global community that plans to meet online once a quarter. Was it planned this way in the first place, or did the plans change as a result of Coronavirus?

Obviously Coronavirus had a material effect on our efforts. People like to get together physically, and that’s how humans best communicate. So the idea was to bring people together from around the world, to share their thinking, to share their experiences and share knowledge and develop and provide the possibility for the development of new knowledge that could be shared from working together. Clearly, we have now been forced to the internet to communicate. But in some ways, maybe we should look at this as an opportunity, because one of the themes that I think is going to be very important going forward is not just how we congregate for a summit, but how do we build an ongoing organization that allows for sharing and development and innovation and new ideas. So I think that moving online because of Coronavirus will hopefully accelerate our activity, because everyone is becoming so used to working online and communicating online. It isn’t perfect, because physical presence is always the best, but you also can’t run a summit every quarter, you can only run a summit periodically. And I think going online will allow us to build out the ongoing efforts that Eyal and I had envisioned in the development of this community.

How do you expect the community to look 10 years from now? What would you consider its success?

First I would consider it a success if it just continued to exist, because just the communication of people and the linkages that come from getting together have real meaning. And those relationships that develop go beyond the community. Leaders stay in touch and find other ways of using those relationships because all of a sudden there’s a new resource open to them they may not have known about previously, because there isn’t necessarily between hospital systems across the globe the kind of communication that is good for all of us.Particularly if you’re running a healthcare system, you tend to be domestically oriented. And this pulls people together. So that’s one aspect of it.

Second, whether it’s in artificial intelligence or in the other state-of-the-art tools, healthcare delivery, and organization; I would hope that over the next 10 years that there will be achievements.  Just to give one example, I know one of our members started an AI department at their institution because of what came out of the summit. And that’s just a small example. I hope that the various themes and work discussed at all levels of the community will lead to innovations and other kinds of developments that will impact all healthcare systems.

Tell us about yourself, something no one knows. A hobby perhaps.

My passions are travel and photography. I especially like traveling in Israel, where I find I have a real affinity with the land and its people. Similarly, being able to combine my love of photography with the diverse scenery in Israel – from the blues of the sea to the varying shades of the desert – and everything in between, allows me to indulge my two passions simultaneously.