Critical care pulmonologist uses Physician MBA to develop new devices and best practices during global pandemic

Hospital intensive care units and respiratory services have been ground zero for the most serious COVID-19 cases. That’s where you’ll find Rajat Kapoor, MD, MBA’18, a critical care pulmonologist and medical director for Respiratory Care Services at Indiana University Health’s Academic Health Center in downtown Indianapolis.

“I’ve pretty much been in the thick of it ever since the first surge,” he says.

As COVID-19 arrived in Indianapolis in spring 2020, bringing an influx of cases and stretching resources, Dr. Kapoor relied upon conflict resolution skills gained from years in ICUs. He also applied operations lessons gained from the Physician MBA Program at the Kelley School of Business.

“Most of the facilities impacted by COVID-19 nationwide were running low on ventilators and respiratory supplies, so as the medical director for the whole downtown area, I began applying some of the lessons I gained from supply chain lectures at Kelley,” says Dr. Kapoor. “I was able to work with our chief operating officer, and I understood the terminology and language. When you can communicate with leadership through shared language, you’re not only taken more seriously, but you also receive more authentic and critical answers than if you are a physician without this knowledge.”

When you can communicate with leadership through shared language, you’re not only taken more seriously, but you also receive more authentic and critical answers than if you are a physician without this knowledge.”

 

As the surge in cases began to ebb, Dr. Kapoor’s team prepared for the next wave. Several small companies pitched hospitals new ventilator substitutes to treat patients with severe cases of COVID-19. Drawing upon his Physician MBA courses in innovation and ventures, Dr. Kapoor collaborated on a crisis-mode protocol that allows two patients to use one ventilator. With ventilators in short supply, it’s a tool of last resort that was employed during the first wave in New York City.

“I worked with one of our fellows to create a prototype to prepare us for the next surge. We collaborated with the Purdue School of Engineering and Technology at IUPUI and IU Health’s 3D printers to create the prototype that would double 50 ventilators, allowing us to treat approximately 100 patients,” he says. “I provided the medical point of view. One of our fellows is a critical care physician with an engineering background, so he brought in the engineering touch. And we had the School of Engineering and Technology’s expertise in circuitry. Combining the three brains, we accomplished this in about two months.”

While it’s a device Dr. Kapoor and his colleagues hope they won’t need, he’s confident it can be used safely. The pandemic has forced many physicians to pivot their practices to treat patients effectively, and Dr. Kapoor says the greatest takeaway from the Physician MBA is a change in perspective.

“The biggest thing Kelley helped me to do is to widen my horizon. Prior to this degree, I don’t think I could’ve thought outside of the box,” he says. “I could never have foreseen myself co-developing a ventilator share. It’s the horizon that Kelley helped us create.”

The biggest thing Kelley helped me to do is to widen my horizon. Prior to this degree, I don’t think I could’ve thought outside of the box.”

 

Originally from India, Dr. Kapoor enrolled in the Physician MBA Program to gain a better perspective on the business of U.S. healthcare and to widen his approach to medicine. During his residency, Dr. Kapoor worked at a private hospital system, a VA system and a Christian health system with three very different approaches. Dr. Kapoor was also earning greater administrative and leadership roles. He wanted to fill in the gaps of his knowledge and gain greater conflict resolution and negotiation skills.

“When you’re leading human capital, you need to learn how to lead a team,” he says. “I use my conflict resolution skills from Kelley every day — probably several times a day. It’s those ideas that help you on a regular, real-world, decision-making basis that have been the biggest win.”

Dr. Kapoor says the courses on leadership have also endured. Even during the pandemic, he reads books on leadership and revisits learnings on how to engage and communicate effectively with his team members.

“I think that’s been a big learning curve. Kelley helps you widen your horizon, and you just keep building on it,” he says. “An MBA is a one-time event, but if you gain the right direction, you are going to build on it throughout your life. Kelley gave me a great starting point.”

If you gain the right direction, you are going to build on it throughout your life. Kelley gave me a great starting point.”

 

During the 21-month MBA program, physicians apply their new operations skills to solve a process improvement challenge at their practice or health system. Dr. Kapoor had suspected that the practice of “geographical cohorting” of intensivists within ICUs would help improve team member communications and, thus, patient outcomes. By assigning a critical care physician to one ICU to manage patients — instead of having to cover three ICUs — Dr. Kapoor expected patient care, care team communications and physician burnout would improve.

“I wrote out the full project and submitted it to our leadership at IU Health in January 2018. We went live in September that year and completed our quality improvement analysis a year later in October 2019,” says Dr. Kapoor.

“In that year, our data showed a very significant improvement in ICU quality markers across the board. Not only were we able to actually implement this major change, but our patient outcomes were significantly better. Communications improved, which led to better patient, caregiver and nursing satisfaction and more time available to teach residents. We looked at surrogate markers of physician burnout, and those also improved.”

Dr. Kapoor’s research was published in Critical Care Explorations, a journal of the Society of Critical Care Medicine (SCCM), and tweeted by the SCCM’s president. The findings by Dr. Kapoor and his colleagues showed that geographical cohorting improves coordination of care, physician workflow and critical care quality metrics in very large ICUs. Outcomes included:

• Significant reduction in the incidences of  C. diff infection, hospital-acquired pressure injury, central line-associated bloodstream infection and catheter-associated urinary tract infection.
• Healthcare providers perceived an optimal use of their time with fewer interruptions and an improved coordination of care through geographical rounding.

“I didn’t expect so much to come out of this project, but when we went back and looked at quality markers and interviewed physicians, the outcomes were significant,” says Dr. Kapoor. “Even using the Qualtrics survey tools I learned in the program were helpful in this project. It’s not just the big things you gain from the MBA, but also these smaller things you learn that improve your life in general.”

As he manages his team through additional waves of the COVID-19 pandemic, Dr. Kapoor feels better prepared to lead his team and improve the care for his patients. He also discusses with his colleagues the value of being a physician MBA.

“I told a colleague who’s starting the program next year: Don’t go in with a predetermined mind. Enroll, learn, graduate and see what you can do with it,” he says. “I’ve had non-clinical leadership roles come my way, but I want to remain a clinician. With the Kelley Physician MBA, you’ll be able to do what you want to do, but in a much better manner.”