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The 2024 Quest for Quality Prize Honorees
The American Hospital Association’s Quest for Quality Prize recognizes exceptional health care leadership and innovation in improving quality and advancing health in America’s communities. In this conversation, leaders from the 2024 Quest for Quality winner, WellSpan Health, and finalists Carilion Clinic, Jefferson Health and MUSC Health, discuss their organizations' work in providing safe, patient- and family-centered care, and share how they partner with community organizations to keep quality health care accessible.
Transcript
Tom Haederle
ality prize, first awarded in: ::Tom Haederle
unications. The winner of the: ::Tom Haederle
invites you to apply for the: ::Akin Demehin
Welcome to the Advancing Health podcast. My name is Akin Demehin, senior director for quality and patient safety policy at the American Hospital Association. We're coming to you live from the AHA Leadership Summit in San Diego, and I have the privilege of having the opportunity to speak with the awardees for this year's AHA Quest for Quality prize. So I'm going to ask the awardees to introduce themselves very briefly before we dive into the conversation.
::Michael Seim, M.D.
Hi, I'm Mike Seim. I'm the senior vice president and chief quality officer for WellSpan health.
::Suzy Kraemer, M.D.
Hi there. I'm Suzy Kraemer. I'm a general internist, and I'm the vice president and chief quality officer at Carilion Clinic.
::Anthony Poole
Hey, I'm Anthony Poole. I'm the system director for quality assessment, performance improvement at the Medical University of South Carolina.
::Trish Henwood, M.D.
Good afternoon, Trish Henwood. I am executive vice president, chief clinical officer for Jefferson Health in the Philadelphia area.
::Akin Demehin
Great. First of all, congratulations to all four of your organizations for really providing an exemplar for the entire hospital and health system field around how to advance quality, safety and health equity. So we have a few questions for you about your approach to quality. The process of going through the award application, and so forth. So let's start with your quality journey.
::Akin Demehin
And Dr. Seim, I'll start with you. Could you tell us about one of the more challenging aspects of your quality and patient safety journey, and a little bit about how your organization overcame it.
::Michael Seim, M.D.
So like many organizations, we came together through a series of affiliations. And what that did was it brought us multiple different approaches to quality improvement and patient safety. So we felt it was really important to align our strategy early in the process. So for our health system, it started with our board of directors. So we really engaged our board of directors in helping us select lean management as our continuous improvement methodology.
::Michael Seim, M.D.
We began by actually setting measurable outcome goals at the board level to drive quality and safety, and to improve the overall health of our populations. We really focus on three key areas. We set the aspirational goal to be the safest health system to receive care, the safest health system to work for. And third, we really committed to decreasing disparities in life expectancy.
::Michael Seim, M.D.
So our board committed to that and committed to allowing us to perceive those bold visions, but having yearly accountability and measurable outcome goals to drive success. So we trained all 23,000 team members in lean management. We started doing methodology. We foresees to solve every problem to root and sharing broadly across the health system. So those were the guiding principles that led us on our journey.
::Suzy Kraemer, M.D.
Well, at Carilion Clinic, what I noticed when I came into my position about four years ago was my clinical observations as a position, I saw great care being provided, but those same great outcomes weren't being reflected in maybe some of the publicly reported programs. And it really caused me as a clinician to continue to observe, continue to understand and study what the gaps were.
::Suzy Kraemer, M.D.
And what I realized was that it was going to be essential to create a better structure for that great care to be realized and to make it more efficient, more effective. We really leaned into what we call a project economy. We expanded our team with project management and process improvement experts. And through that, we were able to support physicians and nurses working at the frontlines in their roles to achieve substantial and sustaining outcomes with the goals that define excellent care.
::Anthony Poole
At MUSC health, I think one of the things that I can echo what Doctor Seim said about integrating health systems - so over the past six years brought on several new health systems that have established cultures already. And so starting to meet early and often as a quality team and with our leadership about the things that we have hardwired and meeting with their existing quality structures about areas where we overlap and similarities, and also some things that are going to change as we become one health system.
::Anthony Poole
Another thing is, in the post-pandemic world, really a lot of changes in leadership, from nursing to different clinical skill set to operational. And so how are we continuing to keep things hardwired that ten years ago were very hard wired into a health system? Now we're having to do a lot more training early and often and keep those things top of mind.
::Trish Henwood, M.D.
Similarly for Jefferson, I think in piggybacking on the comments from my colleagues, we came together from a series of mergers over a period of time. And really over the last four years, we've focused on creating a unified platform for the work that we're doing in quality safety, patient experience, health equity and population health. And we've put internal branding to that.
::Trish Henwood, M.D.
We call that the on-point program. And that's really what we look at as our clinical operating system for how we focus on unifying the organization around the goals that we have in these areas. Again, goals that we work with our board in terms of coming up with the top priorities for the organization and thinking about how we can put the resources and the focus of the entire organization into that space, and really think about how we can redesign or design systems, depending on where we have processes in place to help support our people in delivering the best care possible for our patients and for our community.
::Akin Demehin
Dr. Henwood, your comment really leads us into our second topic of conversation, and that really is engaging the workforce in this critically important quality, safety and health equity work. And one of the things we often hear from our members is just how critical the role of trust is in the success of those programs. And I think what stood out to the award selection committee about your organizations this year is every unit they visited, they saw, wow, the level of trust in the organization and its process for addressing quality issues is so high.
::Akin Demehin
So I wonder if each of you could tell us a little bit about your approach to building that trust among your workforce? What did it take to get there?
::Michael Seim, M.D.
So at WellSpan, it really started with the pandemic, and we were hit very hard throughout the pandemic, and we actually had to really concentrate on how we can work with and engage our team members. And part of that was actually listening. So we held many listening sessions to understand accountability and just culture and true empathy for our team members.
::Michael Seim, M.D.
So we worked really hard to build that culture where people understood it wasn't punitive. And that actually I talked about this a little bit earlier, but we rebranded our whole patient reporting. Our major shift was changing from a reactive process to really engaging our teams to be proactive in trying to identify errors before they hit my patient. So moving from a safety first to a safety two organization and then moving from a leading root cause analysis to success analysis and really actually celebrating when people identify a problem before it ever happens.
::Michael Seim, M.D.
So really moving to changing from like a reporting process to making everyone own safety and putting it as first priority in their organization. So we really doubled in on being the safest health system to receive care and then to work at. So we really wanted to balance for us the importance of team member safety along with patient safety, because you can't have one without the other.
::Michael Seim, M.D.
So really trying to have our team members see that we're committed to their well-being as well as the care they provide our patients. And I think that went a long way to building trust.
::Suzy Kraemer, M.D.
Well, I think you're going to continue to hear really similar approaches. I will say that that trust was already there long before I came to Carilion Clinic. And so I was in the role of only having to continue to build on that trust and prove to the team members that these weren't metrics we were chasing, but these were lives that we were improving - both our team members well-being in the workplace, as well as the outcomes for our patients.
::Suzy Kraemer, M.D.
And you do that by pausing and celebrating the wins, by ensuring that you're kind and empathetic in your approaches. As a leader, my job is to remove barriers and to again permit those teams to excel at being so patient-centered. And now they can also achieve those outcomes that are the critical measures of how we measure success in health care.
::Anthony Poole
At MUSC Health, quality trust starts at day one. When they come for orientation, they're not just watching videos of the CEO talking about the culture and things. They're really seeing it. They're hearing from chief quality officers and other key quality and safety leaders. So not only the CQO's, but the leader for our patient family advisory council or patient safety officer or risk management leaders.
::Anthony Poole
And then when they get out of orientation and they get on their units, they're seeing leaders being present. They're seeing quality and safety rounds happening in each of the units, ambulatory, inpatient, and really eliciting open ended feedback from our care team members, making sure that everyone understands that their voice matters and really counts toward the changes that we're trying to implement.
::Anthony Poole
You get a lot of information from your employees in those first 90 days. You know, are the things that we're preaching at orientation - are we seeing them when you get out onto the units? And as we've shared already, just really creating a just culture where reporting is encouraged and we learn from opportunities and it's really collaborative and multidisciplinary.
::Anthony Poole
So whether you are a member of the EBS staff or you're a nursing unit leader, we want to make sure that you understand reporting is not punitive, but really encouraging that making your voice heard and counts.
::Trish Henwood, M.D.
Just to add on to my colleague's comments, I think that we similarly at Jefferson Health have that foundational focus and safety, believing that we need to have that and the safety for our patients and again, the safety for our staff. We have a lot of focus on our great catch program and making sure that our teams know that we want to hear about opportunities to fix the system.
::Trish Henwood, M.D.
We have a system safety huddle process where we take that information from those great catches and opportunities to fix the system and do that rapidly, and then bring that back to the frontline. So that helps us build the rapport and the understanding that we're asking our team members to take time to let us know when there's opportunities to improve the system, but that we're also focus on improving the system so they can focus on delivering the safest, highest quality care.
::Trish Henwood, M.D.
The clinician well-being considerations are also quite significant for us in thinking about how we can make sure that we're demonstrating the value to all of our stakeholders in the health care ecosystem. So knowing that we're supporting our clinicians, again in optimizing the system, how they work in the EHR, where we can reduce best practice alerts instead of add them, for example, so that we can make sure that they can focus on delivering care for our patients and community.
::Akin Demehin
Terrific. We are all gathered because you all are awardees of our Quest for Quality Prize. And so I was wondering if you could reflect a little bit on the process of applying for that award. What was the value of going through the award process to your organization, and did you learn anything about your organization in going through that process?
::Michael Seim, M.D.
I think any time you give your team the opportunity to reflect on the work they're doing, it actually inspires them to work to a common goal. So what was really important to me and my team as we were looking at that is how are we integrated into our communities? So, who are a key community partners? How are they helping us drive quality and what programs do we excel in, and then what are our opportunities, even still, to figure out how we can make health care more accessible, affordable?
::Michael Seim, M.D.
And really, it was an opportunity to sit back and reflect. And we used it as part of our annual planning process too for our group, to say this is where we see ourselves excelling, and this is where we have an opportunity even to go deeper into a topic. So I would just encourage everyone to fill out either the AHA Roadmap for Health Equity or to look at the Quest for Quality prize, because it really does give you the opportunity to assess how your program is doing in all of these key areas of health care.
::Suzy Kraemer, M.D.
Absolutely, Michael. The application is an assessment tool. And in addition to reflecting, you can I mean, all of us has had to design a strategy to be able to achieve these outcomes. And so to see it objectively in front of you, the areas where you're clearly excelling and where you still have room to improve was very, very helpful.
::Suzy Kraemer, M.D.
And then during the site visit, to have the opportunity to be in the room where all these teams came together. And for many of the aspects, I don't have oversight on the community health team, but it also inspired new ideas of how we're going to be working together for additional initiatives to serve our patients in their communities. And again, it was more than just what you've already achieved.
::Suzy Kraemer, M.D.
It helped us build frameworks and really substantial goals for where we went ahead in the future.
::Anthony Poole
So the great thing about the application process is it, as my colleagues have shared, it causes all to come together and really look at all the work that we're doing. As busy leaders, we don't take the time to really look in the mirror. You know, we all are in the weeds and on the grind of our day-to-day, the things that we're directly responsible for.
::Anthony Poole
So MUSC, when we came together and we looked at what is the QUAI structure look like, what does our safety structure look like, our health equity approach, patient family Advisory Council? It was great because we had to put all that together into one document and really gave us an opportunity to look and say, wow, the collective body of work is really, really impactful, and just being recognized for it on the national level is such an accomplishment to the work that collaboratively the teams have been able to do.
::Suzy Kraemer, M.D.
And then, if I could add, it was also very validating. We all know that performance in these publicly reported programs - I mean it's a currency of success. And to be recognized for this journey validated the investment, the restructuring, the accountability conversations, all the cheerleading, and it provided us even more momentum as we continue to look at the future.
::Trish Henwood, M.D.
Just to build upon that, I fully agree that it was very validating and then also galvanizing process for the teams, both in putting together the application and having the Quest for Quality team come to the site visit. I think it really helped us at Jefferson reflect on how we are truly focused on being a learning organization and truly focused on continuous improvement, and that we know there's always opportunities to continue to improve, but the unifying platform that we have with the on point program and pulling together all of these different teams that contributed to the comprehensive application that we pulled together, I think does help us exemplify that
::Trish Henwood, M.D.
our focus on quality and safety, health equity, patient experience, as our top strategic priorities are indeed the focus of the entire team. It's not the office of the chief quality or chief clinical officer, but was really the entire organization coming together for the application and for the site visit. And I think really exemplifying that that's how we do the work on the daily, that it's really an all organization focus on quality and safety.
::Akin Demehin
Terrific. So we have a couple minutes left together, and I'm just going to open this question up to anyone who wants to answer. As you reflect on your really extraordinary work on quality and patient safety, do you have any sort of parting wisdom for folks out there who are looking to maybe take their quality and safety efforts to the next level?
::Akin Demehin
What advice might you have for them?
::Michael Seim, M.D.
I'll give the advice to making sure you have a clear objective in your program. So ours is all in about improving life expectancy. So everything we do, we measure based on that. So we use actuarial tables and other things to help us measure success. So examples would be, we committed to being at or above the 90th percentile for all populations,
::Michael Seim, M.D.
we calculate out, that's over: ::Michael Seim, M.D.
So we've mapped our entire market to understand where people don't live as long. So that's our North Star. In every program we're doing, we're measuring the how can we help increase the number of years of life saved and decrease the number of preventable deaths?
::Suzy Kraemer, M.D.
I don't think I could have said it any better than that. Always keeping the message patient-centered and translating what a mortality index improvement means in real lives, whether the by week, by month, by quarter. That was a consistent message, but also from a strategy standpoint, as we all know, there's multiple opportunities where improvement can be focused. And it requires the leadership to determine where to deploy a finite amount of resource.
::Suzy Kraemer, M.D.
And we always had the saying in our team meetings, you know, focus on everything, accomplish nothing. And we had to remain very, very focused, very strategic so that we could make the games turn it into our day to day operations and approach to quality and safety. And then we could expand our skill set, expand our focus to continue to achieve outcomes at a faster pace
::Suzy Kraemer, M.D.
had we focused on everything at once.
::Trish Henwood, M.D.
I think that's a key consideration in the quality space. We know that there are hundreds of metrics and innumerable programs that govern us from the standpoint of publicly reported programs, government programs. But the prioritization that you just heard from my colleagues is definitely been key for us in thinking about making sure that we're focused on what matters most, making sure that our entire team knows what matters most, making sure that we're thinking about how we create environment in the health care ecosystem where everyone can thrive, and understanding all those different stakeholders' perspectives on those key priority areas.
::Trish Henwood, M.D.
So while focusing in, we're looking at things then more holistically and how we can design those. So I think overall the theme of prioritization and the structure to be able to deliver that.
::Anthony Poole
One thing I always say in quality leadership is don't be afraid to set audacious goals. You know, if we can't be the quality leaders who are really raising the bar and the expectations then no one else in the organization is going to going to jump on board with it. So being able to set those audacious goals and then also just networking. AHA is a great opportunity,
::Anthony Poole
I've really enjoyed a few days here. I'm learning and collaborating with other health systems who are doing things in ways that are different than yours. And this morning at breakfast, I sat with a nursing leader who I was telling about our multidisciplinary team that we have in the QAPI belt. So myself being a physician assistant, I've got nurses on my team.
::Anthony Poole
We have pharmacists do what they're mph, we have a physical therapist, everybody creating different viewpoints and stuff. Whereas in some systems its very nursing focused and leadership quality, it's quality. Oh, it goes to nursing and stuff. So really talking with other leaders in health systems that are doing the things that you hope to do and just having that humility to say, okay, how can I learn from and develop best practices based off of what other leaders are doing?
::Akin Demehin
I know we're just scratching the surface of the incredible work you all are doing, but thank you for taking the time to take us inside your quality journey a little bit. Congratulations to all of your organizations again for your extraordinary work, and thank you for listening.
::Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.
