Even now, Eugene Washington still dons his white coat as he makes his regular rounds of Duke Health’s three hospitals spread across North Carolina, speaking to patients and staff.

It is a commitment he has maintained despite his busy schedule as Chancellor for Health Affairs at Duke University. “Being there, being reminded of what this great profession is all about at its core is really important,” said Washington, who is joined by chief quality officer for Duke Health, Dr Richard Shannon on his rounds of the wards and clinics under his care.

He chats with patients receiving treatment to find out how they are doing and if there are any areas for improvement. “I come back filled with this sense of obligation, but also this sense of purpose that is rooted in just having that direct contact with the people that we have been trained and charged with serving,” said Washington, who is also president and chief executive officer of the Duke University Health System. 

“I come back filled with this sense of obligation, but also this sense of purpose that is rooted in just having that direct contact with the people that we have been trained and charged with serving.”

Chancellor Washington

“We also meet with the clinicians and nurses to hear their inputs about the system, and how we can better support them,” added Shannon. These regular engagement sessions have been crucial in shaping what is now known as the Duke Quality System, an initiative spearheaded by Washington, which Shannon came onboard to help establish.

“We really changed the focus of the quality system by understanding how the work gets done and meeting with the people who do that work to get their inputs. The result is 20 percent fewer harms, and very high performance in terms of our clinical outcomes,” added Shannon.

The Duke Quality System is a key pillar that Washington introduced to provide better care for patients. After the system was successfully launched, all three Duke Health hospitals received top scores for hospital safety from The Leapfrog Group, an independent national non-profit organisation run by employers and other large purchasers of health benefits.

It is also symbolic of Washington’s efforts to transform Duke Health into a system focused on advancing the very notion of health, moving beyond traditional medical care into addressing other determinants of population health through a carefully planned roadmap marked by a series of strategic priorities.

For Washington, it is never only about just delivering care, but also making sure that even those with the least means can access it.

"It was not about me"

Washington grew up in the city of Houston, Texas, in a segregated community.

“I really was a child of the community. I was among a handful of individuals that everyone took great pride in paying a little extra attention to in terms of development, with the idea that we would go on to achieve positions in life, so we could better the lives of the people in our community,” he recalled.

His parents, too, impressed upon Washington and his siblings the importance of excelling in their pursuits, particularly when it came to education. “They instilled in me this idea that it was not about me. It was really about how I could prepare myself to be a more impactful servant,” said Washington.

“My father was a minister, so I grew up as we used to say in the South as a preacher’s kid,” added Washington. Home to him was a loving and supportive place where he always returned to family meals prepared by his mother.

Washington’s road to medicine was a culmination of events triggered by an early observation of the disparity in access to healthcare by Black Americans up and down the country.

With only a single medical provider serving multiple communities in the area at the time, people had to drive a long distance before they could get help at the clinic when someone in the family fell sick. “I grew up with the understanding that there was a dearth of medical providers in the community,” said Washington.

The full extent of this realisation would come later on in college when Washington, then a mathematics major, visited his friends. “I saw the impact that having an adequate number of providers in the communities made,” he added. It was a future he hoped to bring to people back home, and many others.

With that inspiration, Washington began his career in medicine and public health: “I wanted to be an ambassador between our community and a larger healthcare community to provide healthcare to those in need.” So he enrolled to study medicine at the University of California San Francisco.

A passion for community health

Even as a medical student, Washington found himself attuned to the wider needs of the people whom he saw in clinics. In particular, following a regular group of patients over months in longitudinal clinics during his rotations, he noticed the many underlying issues that influenced their health and ability to care for themselves and their family members.

Issues that could not be solved by medication alone.

“We kept seeing a group of asthmatics back at the clinic. And it was only later that we discovered that they were still going back into houses with dust and an environment that exacerbated the very underlying conditions that we were treating them for,” recalled Washington.

For these patients, medication was a temporary fix that relieved their symptoms. What was more important was for them to be in a healthier environment, explained Washington.

“So I saw early on the impact of working, whether it was with policy or whether it was with certain kind of studies that were community based, of being able to identify interventions that had broad reach in terms of their effect on individuals and larger populations,” he said.

Something had to change in the way people thought about health, and the way it was delivered—a mission he continues to advance today at Duke Health, starting from the moment Duke Medicine became Duke Health.

“This was not a re-branding exercise aimed at energising the face of an academic health system. It was, and is, a declaration that Duke is ready to lead a paradigm shift in how the medical community views and delivers health,” Washington was quoted saying in an article he wrote for The Rockefeller Foundation.

He knew that for this paradigm shift to occur, he needed to get others onboard. “It has always been my aim to collaborate with others to address the pressing needs of the most vulnerable people around us and be unwavering in that commitment,” he said.

So Washington put his plan into motion, starting at Duke. “We leveraged assets here at Duke and more broadly at the University, but also at Duke Health to partner with communities to drive big improvements in some of the big areas, particularly socioeconomic determinants of health,” he said.

His proudest moments include the establishment of a population health management office within the Duke University Health System and a department of population health sciences in the School of Medicine, which focuses on understanding the impact of factors such as food, housing and transportation on health.

Leading with people in mind

To Washington, these successes were due to the people at Duke Health who made the difference in implementing this vision. So everywhere he went, he made it a point to thank and honour them.

“He was just very very respectful of the people that do the work,” said Shannon, who noted how Washington would always listen intently to what the team was presenting during their visits before giving his comments.

And as much as Washington valued their contributions, equally important to him was their welfare. So, he introduced a string of initiatives that led the Duke University Health System to be ranked among the Best Large Employers in a list by Forbes.

Washington’s concern for people stood out strongly during the pandemic. “In the early days of the pandemic, the Chancellor would come to me, and we would go to the floors and our purpose would be to make sure that all our team members had the equipment they needed to care for COVID patients,” recalled Shannon.

By tapping the quality framework that had been established just before the pandemic, the team developed a sustainable system which ensured that the supply chain bringing the equipment to patient care areas was intact even when they were faced with an onslaught of COVID cases. The system could also be adapted to cope with subsequent surges when other variants struck, helping everyone in Duke Health to weather the storm. “With this system, we made sure that every nurse and every doctor always had adequate protective equipment,” said Shannon.

That was just one of the many aspects that Washington had to tackle as he steered the health system through the evolving situation created by the pandemic.

“With the rapid mobilisation of our research, education, patient care and community health missions to equitably treat thousands of COVID-19 patients and safeguard public health locally and globally, Duke Health demonstrated remarkable capability and unity of purpose for all to see,” said Duke University President Vincent Price in an interview with Duke Today.

For Washington, what kept him going during the pandemic was the dedication of his team: “It’s inspiring to see so many other dedicated people give so much, even at a time when we didn’t exactly know what was causing COVID, or how contagious it was. Yet I just saw colleagues push through the fear and be there for their patients, so that was motivating and inspiring to me.”

There were also other lessons to be learned: “What COVID brought into focus was to have humanity in what we do, and how important it is to work together and collaborate.”

Forming lasting partnerships to impact healthcare

Espousing the importance of collaboration and his firm belief in empowering people to generate innovative new solutions, one of the priorities that Washington focused on right from the start of his tenure at Duke Health was to move beyond Duke to strengthen its partnerships abroad.

“Being able to draw on the diversity of perspectives and expertise that are brought to bear when you work across institutions and regions drives innovation. And that innovation can even take place in the form of the education that we provide,” added Washington.

Citing the Duke-NUS success story, he said at the signing ceremony for Duke-NUS’ Phase IV Agreement: “Our enduring partnership is creating innovative pedagogy that is transforming medical education and greatly amplifying the impact that our learners have in our respective countries and around the world.”

It is a cause that he is particularly passionate about, and one that he often lends his strategic insights to while serving as a member of the Duke-NUS Governing Board.

But Washington does more than just engage with faculty and board members when he visits Duke-NUS. He also meets students at the School’s graduation ceremonies.

“I’ve been to the graduations we’ve had in person and what really stands out is the students. I interact with them, and it just makes me proud to know that we are part of providing something special to a group of individuals who I know are going to do special things in the world,” he said.

This June will be Washington’s last time attending Duke-NUS’ graduation ceremony as chancellor. His wife, Marie, will mark this bittersweet moment with him as he looks forward to spending more time with his family, including the latest addition to the family, a granddaughter.

Reflecting on their shared time at Duke, the couple feel nothing but fondness. “Thank you for so graciously welcoming us into the Duke family, for the enduring friendships we now enjoy and for the trove of endearing memories we will take with us,” said Marie Washington in a video to the Duke Health community.

As Washington prepares to step down on 30 June 2023, he feels that now is the right time for the institutional renewal.

“I feel extremely fortunate to have been part of the progress that we made. But importantly, I’m proud of the position we’re in and the slope that we are on to doing even more. I feel great about having been a part of this journey that we’ve been on, and I want to express my heartfelt gratitude to our Duke-NUS extended family. ”

Chancellor Washington