Collaboration between the faculty and a hospital = great responsibility + gigantic opportunity!
He has the experience of university hospitals in financial full health and in financial trouble. Hospitals with extremely strong and very weak company culture, and hospitals, which had enough stuff and lack of staff. He has the experience of both extremes and can live with them, although the situations are incomparable. He believes that the pinnacle of the art of management is to give an impression that everything works on its own and the manager is not needed for anything. That is David Feltl, the new director of the General University Hospital (VFN), with whom we spoke shortly after he assumed his post. And present at the interview was also our dean, Aleksi Šedo.
About ten years ago, you said that you have experienced obstacles rather than opportunities in Prague, and that is why you left for Ostrava. But now, a chance in Prague seems to have come.
D. Feltl: Clearly! My initial career in Prague seemed to be over and done with and I had a feeling I am not moving anywhere. When I then received an offer from the University Hospital in Ostrava, I did not hesitate. I stayed there for eleven years and it was a contrast to what I had experienced in Prague. I must say it was a great time of my life, I loved it and always will.
A. Šedo: I think David made great progress from being the ‘son of nobody’ to a self-made man. And that is how it should be.
Why did you apply to the tender for a position of director of the General University Hospital?
D. Feltl: I am a fighter and went for it with a vision of winning the position and moving the hospital significantly further because I think there is a lot of work to be done here.
In what areas?
D. Feltl: In fact, in all areas. The hospital still has a good reputation among the patients, and I think for many employees, especially doctors, it is still prestigious to work here. Nevertheless, the current situation, especially when it comes to finances, is tragic. If something is not done soon, the General University Hospital will not be able to invest in people, technologies, or development. It will start resembling a museum not only by its age but also by inner exhaustion.
A. Šedo: It is a certain advantage that David comes from our faculty. And it is positive that from the very beginning he realises that one of the reasons why the General University Hospital has a good reputation is due to its people, professionals, medical teams, and it is important to hold on to them. From my point of view, it is of critical importance that the faculty and hospital help one another, not drag each other down.
So the task number one is to improve the financial situation of the General University Hospital?
D. Feltl: It is task number one, two, three, four, five, six, seven, eight, … We need to focus on this throughout this year. It will involve some fundamental changes which will affect us all and will hurt, but I must use my mandate to make them happen. I would love to say that we will build here Kaplicky’s Octopus or a science museum with virtual reality, but for something like that, we will have to wait for about ten years.
By the way, do you like the name General University Hospital?
D. Feltl: I do, and I take it as a fact. And you know why? Because I am conservative and see every change as a change for the worse. On the other hand, I do not like the hospital’s visual presentation, and I will change it.
A. Šedo: The General University Hospital is a well-known brand, but the name is perhaps not the best.
D. Feltl: And what would be better?
A. Šedo: For instance the First Faculty Hospital! :)
Do you believe you will have support from the hospital and from the Ministry of Health?
D. Feltl: I hope that from the ministry I will, at least to start with. There were eight candidates, twenty-one members of the committee, I got twelve votes, so the mandate is not weak, and that is a kind of bonus to start with. Nevertheless, it would be naïve to rely on it. And as for the hospital? It is like in any organisation: 20% people are of key importance, 70% regular, and 10% bad. The task of a good manager is to identify the fifth of key employees who are pushing the hospital forwards and to 80% of the work, get them on one’s side, and couch them.
A. Šedo: It helps the management on both sides to get to know the employees in their different roles, both as physicians and as teachers. It helps in assembling teams and in predicting what can be expected of them, their strengths and weaknesses.
D. Feltl: There is nothing one can do about it, when two companies are engaged in running one place, it is a large obligation, a risk, but also a gigantic opportunity that can be fulfilling and fun. It is all about setting up the collaboration.
A. Šedo: In any case, if one loses, the other does as well. One must focus on cooperation, including financial one.
D. Feltl: Certainly. In the long run, we are ‘condemned’ to making it a win-win situation.
Is it difficult to harmonise the needs of healthcare and school in one place?
A. Šedo: It is a bit of burden for the hospital, another craft on top of anything else, but it is co-financed by the faculty. On the part of the General University Hospital, we would need some help in building awareness that teaching should not take second place. Feedback from students tells us what is happening at the various clinics and departments and it is clear that the situation is not everywhere the same…
D. Feltl: … and once again one can see that either everything works or nothing does. There are clinics where they treat patients well, they teach well, patients and students are happy, and then there are clinics that simply do not work. There is no place where they provide fantastic treatment but keep students behind closed doors. This is clearly up to the top management of the clinic or department in question.
What does it take to lead an institution that involves many different professions and in fact many managers, heads of the individual clinics and departments?
D. Feltl: For me, the absolute priority are PhD students. Extremely important people, who are young and highly motivated. We share them. They are the reservoir of future lecturers, professors, heads of clinics, or outstanding scientists. Moreover, since the beginning of their professional career, they move in a shared company culture. I find that extremely important. So if there is, from the perspective of human resources, one group of people in the hospital with whom one should work, it is the postgraduates.
A. Šedo: This goes both ways. We have a long-term collaboration with the General University Hospital on an MD/PhD programme. This programme enables financing these people both from the faculty’s budget and the hospital budget. One can see that hospital departments which pay too little attention to postgraduates start to lag behind, do not develop properly, it is hard for them to find the right people for the leading positions, etc.
In what areas would you like to deepen or change the collaboration between the two institutions?
D. Feltl: From my point of view, there is no fundamental problem here, but everything can be done better and more intensively, be it in science, coordination of investments, development programmes, large projects …
A. Šedo: I would say we should work on qualitatively improving the interconnection and discussion between the leading representatives of both institutions. Not only among the top managers, where this can be done relatively simply, but also between the vice deans and the deputy heads, so that they function as direct partners. It will then be of crucial importance to create a certain culture at the individual clinics and departments, in order to stop, as soon as possible, any animosity towards the other partner. If this is set up right, it increases the potential of joint programmes and projects, which in the past we did not do as much as we could. That is a loss and a pity. I would also like to improve the mental attitude of the clinicians, scientists, and teachers. To make them proud of being part of the faculty and the hospital, to boost their positive self-confidence.
D. Feltl: I saw this in the USA, where this pride was fascinating and to us, Central Europeans, almost funny. On the other hand, it is in fact something worth striving for. A feeling of togetherness and company culture, that is something we still seem to lack.
You both do oncology, albeit each from a different angle. Why this area of medicine?
D. Feltl: In oncology, there are no malingerers, everyone is mortally ill, and that is a challenge. I have decided I wanted to do this area of medicine in my third year of studies and I would choose it again. At that time, we were taught that we could successfully treat about 30% of people. Now it is about 40 to 45% across the population, in some kinds of tumours more, in other kinds much less.
A. Šedo: From an experimental perspective, what fascinates me about malignant states is the similarity between biological and social principles. When mechanisms of communication and regulation do not function, it is a road to hell. Communication of the various components of oncological diseases, communication between the tumour and the patient, the way the tumour mercilessly grooms its victim in order to feel good in his body, that is the focus of our Centre of Tumour Ecology focuses on. We know there are ways of intervening in these processes to increase the success rate of oncological treatment above 45%.
What do you think about oncology in Prague?
A. Šedo: One should say that we are both involved in that…
D. Feltl: … yes, and I woud say there is space for improvement. This year, reaccreditations should be carried out at the Department of Oncology (KOC), where the General University Hospital collaborates with Na Bulovce Hospital and Thomayer Hospital. We shall see how we manage to meet the demands of the re-audit; we do not know the criteria yet. But the oncological programme is very important to us and we want to be on the top, be it in haematooncology or oncology of solid tumours.
How are you going to divide your time between management and clinical work?
D. Feltl: This year, it is going to be 95 to 5%, but if all goes as planned, next year it may be 75 to 25%.
A. Šedo: If all goes well, you may end up having even less time : )
D. Feltl: I certainly do not want to leave medicine altogether because I still enjoy it, but part of the reason I went into the management of the General University hospital is because in my area of specialisation, I fulfilled my ambitions and I do not feel too bad about having to set it aside for a while.
What kind of outcomes would make you happy by the time you are leaving the leading positions?
D. Feltl: It is easier for Aleksi because his term is set, but as for myself, I would like to leave the General University Hospital in a better shape than I found it in.
A. Šedo: Americans say, ‘He failed but failed better than his predecessor’ : )
D. Feltl: Thanks for the compliment :)
A little more about Professor MUDr. David Feltl, Ph.D.
David Fetl graduated from the 1st Faculty of Medicine of the Charles University in 1994. Five years later, he finished his specialisation in radiation oncology, and last year, he was appointed professor of oncology. During his professional career, he worked as assistant physician in the Na Bulovce Hospital, head of radiotherapy department in Královské Vinohrady University Hospital, and as head of the Oncology Clinic of the University Hospital in Ostrava, which he also headed for three years instead of Svatopluk Němeček, then minister of health. Since 2017, he was head of the Oncology Centre of the General University Hospital in Prague.
Are you a proud graduate of the 1st Faculty of Medicine of the Charles University?
Sure! When the minister introduced me to my post, I told him that I remember my first underground trip to my first class and still can recall that feeling. I find it interesting, almost surreal, that now I stand here in front of the department heads and some of my former teachers as their boss.
What do you like best about your work and what do you like the least?
What I like the least is paperwork and all the admin. And what I like best are people who do not need to be directed but rather just coached. What I mean is people who come up with ideas and have lots of energy which I can take and just direct and advise them rather than having to regulate, forbid, or criticise.
Is there still something that can surprise you?
Always. Any time. Every day.
What lifts your mood?
Sport, food, beer, wine, and FC Liverpool.
How do you relax?
I have so many interests I do not have enough time for them all. I love ‘hardcore’ travel to ‘strange’ countries, mostly with a backpack, plane ticket, and the first night. This way, we went with my family to Tajikistan and travelled through Kashmir or travelled through Bosnia and Herzegovina just with a tent. This year, we are planning to take the trans-Siberian railway through Russia. I also enjoy cooking, I find it soothing. And then I also like modern, twentieth century architecture.
Do you think that as a patient, you would feel comfortable in the Czech healthcare system?
It depends on the disease and the hospital or doctor’s office.
How do you care for your health?
I am fairly good at that. I do a lot of sports: I run long tracks and bike on a road bike. I am somewhat addicted to the endorphins produced during sports so when something hurts and I cannot move, I am terribly tetchy. Twice a month I also go to a physiotherapist and have a full-body massage. Physically, I feel very well.