Healthcare doesn’t run on technology alone—it runs on people who show up every day to bring order to complexity, calm to crisis, and humanity to a system that often feels overwhelming. In this episode of Success in Chaos, we sit down with David Facchini, Director of Radiology and Biomedical Imaging at Yale New Haven Hospital, to explore what it truly means to lead from the front lines.
David’s journey—from patient transporter to executive—shapes a leadership philosophy grounded in trust, humility, and connection. He speaks openly about the importance of sitting with staff, listening deeply, and leading “like you’re talking to your cousin at a Christmas party.” In a world full of alarms, alerts, backlogs, and burnout, his approach is a reminder that people are the most powerful lever for reliability.
We dive into one of healthcare’s most persistent systemic failures: incidental findings that never receive follow-up. Through a heartbreaking case that inspired Inflo Health’s founding mission, the episode illustrates why “doing the right thing” requires more than individual heroics. It demands culture change, coordinated processes, and technology that reduces—not adds to—clinician burden.
David shares how Yale spent years building its own follow-up program, why cultural buy-in mattered as much as technical workflows, and how transparency, authenticity, and ROI all shape quality improvement at scale.
The Front-Lines of Chaos isn’t just a conversation—it’s a call to rethink how we lead, how we support clinicians, and how we prevent patients from falling through the cracks. Because in the chaos of modern healthcare, connection is still our most reliable compass.
Episode Chapter Guide:
04:02 Understanding Incidental Findings in Healthcare
10:11 Building a Quality Improvement Program
15:42 The Role of Culture in Healthcare Initiatives
20:43 David’s Journey from Technologist to Executive
24:43 Inspiration and Leadership in Healthcare
David’s Resource Recommendations
Full Transcript
AI-generated transcript. Accuracy may vary; please excuse any transcription errors.
David Facchini (00:00)
Leaders here, my mentors that have promoted me over the years, they sit and talk with me like a normal person, like I’m talking to my cousin at a Christmas party. Honestly, that’s one of the things that’s most important—connecting with your direct reports, with the staff. It makes people trust you. It makes people want to work with you, not for you. They want to work with you, they want to make things better. So you have to have that passion, but unless they trust you, it doesn’t always work out.
Angela Adams, RN (00:39)
Hello and welcome to Success in Chaos, a healthcare podcast where each episode is dedicated to unlocking success amid the constantly changing environment and uncertainty of healthcare. I’m Angela Adams, the CEO of Inflo Health.
Kandice Garcia, RN (00:55)
And I’m Kandice Garcia, owner of Tungsten QI Partners and Quality Improvement Director of the American College of Radiology Learning Network. Today we are very excited. We have a guest, David Facchini, who is the Director of Radiology and Biomedical Imaging at Yale New Haven Hospital. With a background in technology and a passion for improving care, David brings a problem-solving mindset to one of the nation’s leading academic medical centers.
David is known for developing technology-enabled quality improvement solutions that strengthen patient safety, streamline communication, and support better outcomes. At Yale, he has helped launch a radiology communication command center that transformed how critical results and follow-ups are managed, improving reliability while reducing risk.
David is widely recognized for understanding the complex intersection of technology, patient outcomes, and ethics in modern healthcare. His work continues to shape how health systems use innovation to deliver safer, more accountable care. Now, I got the privilege of meeting David, gosh, about 10 years ago through the Radiology Improvement Summit at Stanford. I think at that time we were both just quality managers in radiology, and it has been such a privilege to watch David grow through his career at Yale.
Welcome, David. Thank you for joining us today.
David Facchini (02:12)
Yes, thank you for having me.
Kandice Garcia, RN (02:15)
All right. Well, we like to start every podcast by letting our audience get to know a little bit about you. So we’re going to start with two truths and a lie. You can try and trick us, but we’re pretty good guessers.
David Facchini (02:30)
So I have some good ones for you guys. When I was five years old, I had a picture of me taken at Kmart. It was one of those stock photos that comes in a Christmas frame. Another one: I’m an avid pickleball player and I’ve participated in semi-professional events in the Northeast. And my other one is I am a landscaping enthusiast who spends a lot of time working on my equipment and my property and my spirit.
Kandice Garcia, RN (02:56)
Hmmmm.
David Facchini (02:59)
Trying to stump you guys.
Angela Adams, RN (03:01)
I don’t know that you have a lot of spare time, but I can actually see you being a competitive pickleball player. I don’t know that you have a lot of time to spend in the yard.
Kandice Garcia, RN (03:06)
That’s what I was going to say—like, when?
Angela Adams, RN (03:19)
Kandice?
Kandice Garcia, RN (03:20)
Yeah, I was going to say the same thing. I was like, that sounds lovely. That’s like my dream too—to be out in the garden. But yeah, we’re going to say that’s the lie.
David Facchini (03:29)
No, I am not an avid pickleball player. I actually stink at pickleball. That was my lie.
Kandice Garcia, RN (03:30)
Yeah. Ha ha!
Angela Adams, RN (03:36)
Man, so you are a yard enthusiast and you’re in a Kmart frame.
David Facchini (03:42)
Yeah, yeah, my parents still have the picture hanging over their mantle.
Angela Adams, RN (03:47)
That’s amazing. You were the stock picture. That’s so good. What a claim to fame, David. I mean, from Kmart frame to Yale—what a trajectory.
David Facchini (03:50)
Yeah.
Kandice Garcia, RN (03:59)
Hahaha!
Angela Adams, RN (04:02)
So, really great to have you, and I’m so glad I got to meet you this year at the ACR Quality Conference. I think what we would love to do, if you’re open to it, is start with a legal case and get your thoughts. With your expertise and what you’ve built at Yale around incidental follow-up and detection management—you kind of built it all before tech was really even in the space.
So I want to get your perspective. I’m going to tell the story, and then we just want to ask you some questions around this—like, who’s responsible, what are the ethics behind this, and how did you build out your program with all of this in mind?
So: a 50-year-old patient goes to the emergency room with severe abdominal pain. They’re trying to figure out what’s going on. They end up doing a CT of the chest and abdomen. They realize she has acute appendicitis. They obviously need to take her to the operating room pretty much emergently. They set all that up. She goes through surgery, recovery, all of it.
Ten months later, she goes for her regularly scheduled mammogram. They find out she has a lesion. But when they look back, they realize that lesion was actually present and reported in the emergency department 10 months ago. The radiologist clearly called out a breast lesion, malignancy, ASAP follow-up—and it just completely falls through the cracks.
So now you’ve got a radiologist who may or may not work for the whole system, right, because we’ve got that going on with the radiology shortage. You’ve got the emergency room physician who obviously did the right thing for the emergency. You’ve got the hospitalist staff and the surgical staff that covered the patient while she was in the hospital. Then you’ve got the primary care physician somewhere in there who never got notified that she was there.
So where does the responsibility for all of this fall in the hospital, and how do you go about unwinding this?
David Facchini (06:34)
I mean, this unfortunately is—I’m going to be a little blunt here—but this is a standard case that we see in papers and in articles around the country. I’m speaking from the imaging space, but this is healthcare right now when it comes to complex incidental findings.
The responsibility, honestly—and this is how we sold programs here and built things here—is on everybody. Yes, it lies with the patient. Yes, it lies with the provider. But patients are busy in their personal lives. Patients don’t understand the results. Providers are busy.
It’s honestly the healthcare industry’s responsibility because we went through cases like that here. I’ve read papers of similar cases, and I think people and the media like to place blame on somebody, but it’s a part of our healthcare system that’s broken. So it’s important for programs to develop to tackle this.
For our program here, it’s health-system-wide, it’s service-line-wide. We took ownership because we felt passionate about it for radiology and our team, but it’s everybody. And it does fall on the patient as well, but the patient has responsibility only up to a point because they don’t understand what an incidental finding is.
Kandice Garcia, RN (07:52)
Yeah. Yeah.
Angela Adams, RN (07:55)
Yeah, interestingly enough—and I’ll just finish that case—that was a good friend of mine. Her name was Jill, and it’s the whole reason we started Inflo Health. She ended up never even knowing about the lesion. She was another nurse.
If one person would have mentioned one thing to somebody in her family—even if they had just said verbally, “Hey, not right now, but make sure that you go get follow-up on this breast lesion”—it would have been done.
She ended up having metastatic breast cancer at that point, and it had traveled to her brain. She struggled through like a year and a half of hardcore treatments and therapies, and unfortunately she passed away in 2021. But that’s the mission. That’s the why behind everything that we do.
I don’t feel like it’s fair to the clinicians. We’re expecting them to be heroes every day, to catch things like this, rather than putting tools and technology and process in their hands to make sure this doesn’t happen. Because I can tell you this: any clinician who gets pulled into a room to talk about an RCA on a patient like this, they’re broken. They’re brokenhearted that this happened.
Kandice Garcia, RN (09:02)
Yeah. Thank you.
Angela Adams, RN (09:22)
Yeah, that’s… yeah.
Kandice Garcia, RN (09:26)
Yeah, I think that’s based on the foundation that we all—healthcare workers—we go to work to do a good job. We go to work to care for our patients. And actually, it’s because of these healthcare workers that more patients are not harmed, because we rely on our staff to pull those strings together, to fill those holes and fill those gaps.
But this one—especially with incidental findings—it is a known gap. It is a known issue and it is incredibly difficult to solve. I want to know, David, when you got started in this area so many years ago, how did you convince your organization that this was a problem? How did you get people behind you? Because this takes the entire organization’s effort to make happen.
David Facchini (10:11)
Yeah, we started the conversations and the planning in 2017–2018. So pre-COVID. Vendors didn’t really exist in this space. There were some vendors that existed, but no one had a great comprehensive plan.
We got a grant and used a system called Montage. We studied, with NLP, 200 randomized exams where our radiologists had said a follow-up was needed. We quantified how many of those patients actually got their imaging after, and how many never did and then went to another organization. From some of our research teams at the university, it was like 58.7% of the patients didn’t get what they needed.
So we had a system—we called it critical and incidental results in radiology. We were fortunate to have technology, but there was no follow-up mechanism besides, of course, our providers, who did a great job. We took a stance and said to the organization, “We want to take this, and we also want to be the service line that helps everybody else close the loop.”
If there’s an incidental finding, then we want to follow it right through to a patient letter saying, “Hey, we tried to contact you; you never had imaging. This is our last attempt.” We wanted to follow it right through to the patient, saying, “Let us help you.”
To do that, we built a business case. Everybody knows in this healthcare environment, with what’s going on in the country, people are resource-constrained, capital-constrained. The only way I thought we would be successful was to show an ROI. Healthcare is about quality and outcomes, but it’s also about at least breaking even, if not generating revenue to invest back into the healthcare system and equipment.
So I constructed a business plan that required FTE resources and technology resources, but it had an ROI, which is one of the most important things when you’re spending six and seven figures on resources for a program like this.
Kandice Garcia, RN (12:20)
Yeah.
Angela Adams, RN (12:28)
Yeah, you hear that—”no margin, no mission” and all of that. And it’s true. We have to be good fiduciaries of the money that we do have in order to run the quality that we want to run in healthcare. That’s just the kind of sad state of it.
David Facchini (12:31)
Yeah. And I get in trouble all the time here because I’m asking for millions of dollars in equipment and more staff—more MRIs, more CT. I need, you know, 10, 30, 50 million dollars to refresh equipment. So we need to be conscious of that as an organization. I needed to bring that business case to them saying, “This is important, but also I can bring these scans back, scan the patients, and help them—and it’s going to be good for our organization as well.”
Angela Adams, RN (12:47)
Yeah.
Kandice Garcia, RN (13:01)
Yeah, you know, I think in quality we have so much desire to do the right thing. We want to fix things to do the right thing. And this is one of those special projects where, when you do the right thing, it also supports the business. That is a special project and a special initiative for an organization.
Tell me: you went about building this on your own. This was before the tech, before we had a lot of vendors in this space. How did you go about doing that? Did you specifically build it? How did you find the expertise? I hear a lot of organizations even now saying, “I think we can do this ourselves. Let’s not go with a third-party vendor; let’s just build it ourselves.” How did you do that?
David Facchini (13:57)
Yeah, we engaged our EMR vendor. At the time, we hadn’t been approached by any outside vendors that actually specialized in this. So we engaged our EMR vendor and built a custom program, but it needed intensive FTE resources.
I think in the current state we run about 10 FTEs with leadership—there’s leadership in the center—and we run 24/7 coverage, because this group also does critical results as well as incidentals. We built it with our EMR vendor; they built a queue and a trackable program. In our EMR, you can message internal providers, send alerts, have them sign off. It was all homegrown EMR build that cost a lot of money. We hired consultants, and it cost a lot of FTE resource time as well.
That’s how we did it. In 2018, 2019, this kind of solution didn’t really exist the way it does now.
Kandice Garcia, RN (14:57)
Yeah. And how long did that take—from when you started this project and started getting everybody together? Was that six months?
David Facchini (15:05)
To build—to build the program in general—I think it was like four years.
In 2017–2018 we started doing the research. We didn’t go live until after COVID, and COVID probably stalled it. But I think it was about four years from when I sat with our team and said, “Let’s do this.” And I had great partners—Kandice knows Dr. Jay Bahadur here, he was our vice chair of quality. Everybody supported it. So from 2017 to around 2021–2022, somewhere in that timeframe. So it was like four years. Crazy.
Kandice Garcia, RN (15:27)
Mm-hmm. Wow. That is crazy.
Angela Adams, RN (15:42)
Let’s talk a little bit about culture—culture of change and everything that you need around a quality initiative. I’m sure you’ve spent countless hours here. Technology can do a lot, but culture can kill a lot of things.
So, from what you’ve learned from your clinicians, your IT, your projects, your quality initiatives—what part do you feel culture plays in all of this?
David Facchini (16:17)
Culture is huge. I still get messages from providers—our team does—that say, “You’re bothering me too much,” because we send multiple reminders until something is closed, right? So the culture has shifted here, but that old culture still exists. We have so many providers in our system.
We’re going down the road of a project now—I think I talked about it at the ACR conference in San Diego—around judicious MRI and CT ordering for inpatients that don’t need to be done as inpatients, and maybe don’t need to be done at all. It’s a huge culture shift.
In radiology in general, we don’t want to question physicians’ practice. But there comes a point where we need to try to spread our resources farther. We have such high demand for MR, CT, and nuclear medicine. So culture is huge. There’s a culture shift needed in many things in healthcare.
For incidental findings, you need to change your culture all the way up to your CFO—for the resources—and your CMO saying, “We’re going to tackle this. We have to do this.”
Kandice Garcia, RN (17:30)
When you talk about that culture shift, did that come from the front line? Did that come from middle management? Did you get a new C-level leader that shifted things? How did that shift start to take place and grow?
David Facchini (17:52)
Yeah, that’s a good question. We had Jay’s support—Jay is our vice chair of quality. We had our chairman in radiology supporting it. I think it took a lot of pushing.
We had a new executive director hired for the whole health system. His name is Dan Alexa. He came in and looked at it with me. I think they had a program similar to this in his previous organization. So with Dan coming in, Jay and our chair helping push, and cases coming up—because there are cases that come up often in healthcare—we looked at them and said, “We can’t let this happen here.”
So it was a mixture of new leadership and persistent pushing—pushing the vice president of regulatory, because there are regulatory implications, and pushing on the financial implications. I think it took persistence and pushing, mixed with having great leaders in radiology who supported us right through the whole process to the end.
Angela Adams, RN (18:56)
So you’re now in 2025. You built a manual process, but if you are coaching someone today—a director of quality or a director of radiology for a health system—how would you guide them? They’re trying to start a new program. With all of your knowledge and experience, and given we’re in a totally different technological space now, where do you send them?
David Facchini (19:29)
Yeah, I mean, we ourselves are exploring vendors in this space. I think: don’t reinvent the wheel.
People need to look at their resources—what’s your budget, do you have an ROI? But I think investing in and using a vendor, because of all the NLP and AI that exists now, is the way to go if you need to build quickly, or if you have litigation cases or something that has prompted you to act.
The FTEs are still important because in our program we make physical phone calls; we connect with patients. You can do that through a platform as well. But I think it’s a mixture. Vendors in this space are really expanding their technology, so I think it’s a huge way to go.
Angela Adams, RN (20:18)
Yeah. So tell me a little bit about—usually we do this at the very beginning—but I know a bit about your background and I think it’s so cool that you went from technologist all the way to the top today. Talk to us a little bit about that, and maybe inspire a few people. We’ve got technologists listening and we’ve got leadership listening. I think you have a really cool, inspiring story.
David Facchini (20:43)
Yeah, it helps so much in this industry to be a frontline clinical employee. I actually started as a transporter before I was even in radiology school. So I was a transporter, and then I went to school and worked in radiology as a technologist. I loved that job. I’ve always had a passion for speaking with patients and that interaction.
I think that translates all the way up to this role as an executive. I still try to stay grounded and be with our staff at least once or twice a week, because we have so much going on in the industry in general, and here we’re so big. I think there are about 56 facilities—56 cost centers—that I’m responsible for. I try to get out there and see the staff.
It translates into the work because I can sit with a technologist in the ER here—which is a massive Level One trauma center, one of the biggest in the country—and say, “I worked here. I know. I’ve been involved.” So when we have initiatives, like gaining efficiencies with staffing issues, I can sit with them and I think it helps.
One of my godfathers actually said to me—he was an administrator, a superintendent—and he used to say to his teachers, “I sat where you are. I know what you have to deal with. You’ve never sat where I am. So trust me: I was one of you. Now I need to make decisions at a different level.”
Kandice Garcia, RN (22:14)
Yeah. Yeah.
Angela Adams, RN (22:16)
I love that. I feel like some of my favorite leaders in my career have been people who have worked all the way through a system. Some of my favorite CEOs, just like you, started in transport or somewhere in the hospital, where they know from the bottom up the experience of the health system. It just makes you a different kind of leader.
Kandice Garcia, RN (22:43)
Yeah, you know, I think it also touches on some of these other conversations we’ve had with leaders across healthcare. The success they have is based on relationship and connection and humility, and a real understanding and empathy for one another. And it sounds like that is the kind of leader you are as well, David.
Angela Adams, RN (23:06)
Yeah. We’ve talked to a lot of leaders. I keep saying authenticity in leadership is one of the number one things they count as a skill set and a competency you have to have today. Would you agree with that? Is there anything you would add to that list as far as core competencies of leadership today in hospitals?
David Facchini (23:32)
No, I think you hit it. The one thing I try to tell all of our people, especially being a younger executive, is you have to be transparent. I know people always say that and it sounds corny, but you have to be transparent. You have to be a normal person. Go and sit with them and talk about your kids, their kids.
To me, that’s what my leadership style is. My leaders here—my mentors who have promoted me over the years—they sit and talk with me like a normal person, like I’m talking to my cousin at a Christmas party. Honestly, that’s one of the most important things: connecting with your direct reports and with the staff. It makes people trust you. It makes people want to work with you, not for you. They want to work with you; they want to make things better. You have to have that passion, but unless they trust you, it doesn’t always work out.
Angela Adams, RN (24:29)
That’s amazing. I love that. Kandice, what do we think—book recommendations?
Kandice Garcia, RN (24:36)
You know, yeah, I’d like to know: what should we read? What should we learn?
David Facchini (24:43)
Yeah, I actually have a few things even beyond books, because I feel like when I give book recommendations, they’re always nerdy data books that people don’t know.
Angela Adams, RN (24:50)
We will read them.
Kandice Garcia, RN (24:52)
Don’t look behind me here.
David Facchini (24:55)
So one of the things that’s really interesting—very recently at one of our leadership kickoffs, there was the CEO of Not Impossible Labs. His name is Mick Ebeling. I’m not sure if you guys have heard of him, but he came and spoke. Sometimes you need motivation beyond healthcare.
He gave a motivational talk; it was one of the most inspiring things. The organization is called Not Impossible Labs. On the website he has all the stories. I think they’ve written papers, they’ve been published by the New York Times, but it’s all about motivation. They take problems from different countries and make prosthetic arms; they make vibration devices for people who are deaf so they can feel music. It’s amazing. So I would definitely recommend checking that out.
Kandice Garcia, RN (25:46)
Mm-hmm.
Angela Adams, RN (25:48)
I love that—something different. Sometimes, at the end of a tough week, we just need motivation. We need something to listen to and think, “There’s hope here.”
David Facchini (25:55)
Yeah.
Kandice Garcia, RN (25:59)
Yeah. Actually, I think that’s the thing we… go ahead.
David Facchini (26:00)
And then, putting on my… yeah, go ahead.
Kandice Garcia, RN (26:04)
I think that’s what we all need in healthcare right now. It’s a tough place to be. There are lots of patients, lots of care to provide, and there’s not enough staff. I think when we have hope through the darkest times, that’s when we can find the light and the path forward that serves us all.
David Facchini (26:07)
Yeah. And honestly, the other thing is giving a plug to Kandice’s crew—Dr. David Larson, who you guys had on. Whether he knows it or not, he’s one of the people I strive to be like.
All of the programs that team has out there—the RIGHT program, it’s on YouTube—anyone in healthcare, not even just radiology, can benefit. Jay and I here, for the last 10 years—we met Kandice and David and the team 10-plus years ago in Palo Alto—and we have only grown because of groups like that.
People like David Larson—he’s so passionate and he’s so humble, but he’s funny, like we talked about with leadership style. So just giving a plug: if you haven’t checked out their resources, like the RIGHT program, it guides you in the healthcare world for quality and safety. I honestly can’t say enough about that crew.
Kandice Garcia, RN (27:21)
Oh, thank you. You know, we do it with you all. We all love Dr. Larson.
Angela Adams, RN (27:22)
We are all big fans.
David Facchini (27:26)
Yeah, I know everyone loves him.
Angela Adams, RN (27:34)
At the ACR QI Conference, that final speech—tears were streaming down my face. I wanted to stand up. I looked around me at the end of his speech and people were speechless. They were just like, “Yes—he said all of the words about the future of radiology.” I wanted everybody to listen to that speech. I was like, “Did anybody record that? Anybody?”
Kandice Garcia, RN (27:41)
Yes!
David Facchini (27:47)
Yeah.
Kandice Garcia, RN (27:57)
Yeah.
David Facchini (28:00)
Yeah, I know.
Kandice Garcia, RN (28:00)
He does it all the time. He just has a way about him. But we all benefit from it. Like David said, we’ve been together in radiology quality for the last decade. There’s kind of a core group of us who are just pushing forward and trying to make change across the nation.
It’s such a privilege to be at the ACR Learning Network right now, where we get to bring these organizations together and collaborate, and we get to problem-solve together. That was Dr. Larson’s vision, and we’re all kind of a product of that. It’s just wonderful to be a part of.
Well, thank you so much for being here, David. It was lovely speaking with you, and we’d love to keep up with you and what you’re working on in the future as well. We’ll have to have you back.
Angela Adams, RN (28:47)
Thanks, David. Good to see you.
Kandice Garcia, RN (28:47)
All right.
David Facchini (28:49)
Thank you both.
Kandice Garcia, RN (28:51)
And thank you for joining us on Success in Chaos. Please be sure to like, follow, and share today’s episode on Spotify, Apple Podcasts, YouTube, or wherever you get your podcasts—and a special thank you to the Inflo Health team for their production support.
