Episode Transcript
[00:00:01] Speaker A: Welcome to PG Pulse Press, Ganey's podcast on all Things healthcare, tech and human experience. In this podcast, we'll be joined by some of the best and brightest minds in the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
[00:00:22] Speaker B: I'm Tejal Gandhi, press Ganey's chief safety and transformation officer, and we're here on the floor of HX 24. Joining me today are two lifelong leaders in quality and safety, Sonya McClendon and Michelle Schreiber. Sonya McLennan is the chief of operational excellence at Northeast Georgia Health System, this year's recipient of our HRO foundation award. Sonia is an expert in disruptive innovations in healthcare delivery and a steadfast believer in making it easy to do the right thing and hard to do the wrong thing. Thank you for joining us today, Sonia.
[00:00:55] Speaker C: Thank you very much.
[00:00:57] Speaker B: Also with us is Michelle Schreiber, the deputy director of the center for Clinical Standards and Quality at CMS and the director of the Quality Measurement and Value based incentives group. She's a primary care physician by background, which is why we get along so well and has served in the C suite in several large systems. Thank you, Michelle, for joining us.
[00:01:18] Speaker D: Always a pleasure.
[00:01:19] Speaker B: Thank you. So I wanted to talk with you today about really how we embed high reliability in healthcare and accelerate our progress towards the optimal human experience, really often by leading with safety. And so, Michelle, I think I'll start with you. Given your perch at the national perspective, I'd love to hear about how CMS itself approaches safety and quality in healthcare.
[00:01:48] Speaker D: The approach at CMS around safety and quality is really anchored in the CMS National Quality strategy. That is our framework for quality and safety, and has become sort of a framework across the other federal agencies where we do partner together on quality and safety, AHRQ, CDC, FDA and others. But the CMS framework includes eight important pillars, equity, because we know that you can't have safety and quality without equity. Best outcomes, patient engagement, because having the patient voice in all of this and being patient centered is so fundamental. Safety, of course, the digital transformation resiliency, a very important topic, especially since COVID innovation 19 and alignment. And with those emphases across CMS, we work together across the agency on a weekly basis actually to align our objectives across the agency. As you know, CMS has a lot of levers actually to support not only quality, but patient safety, the conditions of participation, survey and certification, direct assistance through the quality improvement networks and of course, our many CMS quality measures that are used in over 27 CMS value based programs, which lead to public reporting as well as incentives and financial penalties in some cases.
[00:03:19] Speaker B: Great. Thank you. And what you just described, really like how these things are so connected between safety and patient engagement and equity. Sonia, that leads me to the question I wanted to ask you, which is, at Northeast Georgia, how have you really connected all of those elements together, really thinking about how enhancing safety, for example, contributes to ultimately that optimal human experience?
[00:03:45] Speaker C: Absolutely. And Michelle, I think you really set me up. Great. So thank you. You know, patients expect high quality and safe care, along with exceptional outcomes as a baseline when they enter any of our facilities, whether it's a traditional hospital or whether they're coming for outpatient services. So if we fail them, then we're already behind the eight ball when it comes to patient experience. So it is imperative that we create a framework for high quality and safety so that we can meet just the minimal expectations of our patients.
And we do that in a number of ways. A by, like you said in my introduction, we want to make it easy to do the right thing. We want to create processes for our caregivers, really for anyone that interacts with a patient through our high reliability operations. We do things like starting every meeting with safety, making sure that we have, you know, safety at the forefront of our minds in every interaction. We want to make sure that we test our processes to make sure that they work, and if they don't, that we test them again and figure out what's going to be optimal for our patients. We have error prevention tools when we mess up. We engage in cause analysis and really get to the apparent cause or the root cause of what happened. So I can go on and on. Tangella. So you have to tell me when to stop. But I think it's really creating that framework through high reliability and through a lean transformation to truly make it easy.
[00:05:27] Speaker B: And so, Michelle, we have organizations like Northeast Georgia that have really embraced high reliability and made incredible strides.
How do you think about the role of quality measurement and really incentives in promoting safety within healthcare organizations who maybe aren't as far along as in northeast Georgia?
[00:05:49] Speaker D: Well, first of all, congratulations on your award to your entire organization. That's really very exciting.
You know, quality measures are the way of highlighting what's good and of pointing out gap areas. You know, the famous saying, you can't improve, what you can't measure is, there's some truth to that, actually. And so that's why CMS uses measurement and works very hard, actually, on developing individual measures and uses them in the various value based programs, because in the end, what we're trying to do is drive value, obviously, you know, highest quality, best safety, best experience, but, of course, tempered by cost and efficiency.
So across these multiple programs that we have, because we have value based programs for virtually every clinician in every facility in healthcare in the country, there's public reporting so that consumers can actually see the performance of their clinicians or their facilities that helps them choose when they're trying to make decisions around healthcare facilities. And I actually think that public reporting is one of the most important levers that we have. Patients are starting to look and they're starting to walk with their, you know, with their feet as much as they can. And then, of course, these programs are tied to incentives and or penalties.
I will admit the incentives and the penalties are relatively minimal in the big scheme of things. Nonetheless, they do capture the board's attention. They capture the attention of the people who work at these facilities, and they really have helped drive improvement. For example, look at some of the improvements in healthcare, acquired infections.
So it's really, we think these programs are very important in at least calling attention to these areas and providing the public with important information that they can use in their healthcare choices.
[00:07:47] Speaker B: And you mentioned boards, and leadership in boards is something you and I have talked about a lot in terms of how critical they are to really drive this work in their organizations. You know, Sonia, if you could tell us a bit about your leadership and board and what role they've had in the journey at Northeast Georgia.
[00:08:05] Speaker C: Oh, sure. I'm so glad you asked. Our strategy deployment starts at the board level, and they help set the direction for the system when it comes to all of our pillars. But we're speaking specifically about safety and quality, which is our first pillar, and it's the most important one. It drives everything else. And we are very transparent about how we are performing. They help us set that direction for how the whole organization will work for the next, not just year, but the next five years, where we want to be when it. As it relates to how we will perform a for our patients, who are the most important customers. Right. But we also have other ways that we benchmark against our CMS guidelines, against Leapfrog, all kinds of public reporting, which I agree, Michelle, that's really important. Transparency is so important to us, but our board is very engaged with us, and they're very well informed.
I'm very proud to say that our board cares more about safety and quality than they do about finances all day long, because they truly believe that if we get safety and quality right, that the finances will follow.
[00:09:12] Speaker D: Now I know why they won the award, too.
[00:09:15] Speaker B: Well, we've been talking about, you know, boards should spend more time on quality and safety than finance, because honestly, it's more complicated. And that's kind of a recommendation that has been put forth by many of us to say that boards really do need to have that attention on this work.
So, Michelle, when you look ahead, as you know, we've been doing this work for a long time.
There's leadership, clearly, and governance and other things that are very important, high reliability that needs to get embedded in. But as you look ahead, what trends or innovations do you foresee that are going to play a pivotal role in advancing safety and improving that overall human experience?
[00:09:58] Speaker D: Well, I think there are multiple things that have to be incorporated. So we talked about leadership and governance. I think things have to start there. We've spoken a bit about everybody in an organization has to be included in this, from the valet parkers to housekeeping, to the nurses and the pharmacists and the providers, the physicians, everybody has to be incorporated. Data and data systems, which I'll circle back to for a moment, because I think that that's really fundamentally important. And then, of course, engaging the patient, I think that is one of the key steps forward where we have to go, because we know that we don't always hear the voice of the patient. We don't always let them participate, for example, in the analysis of safety events. We don't always provide clear communication and resolution programs. We don't always give patients access to their information in a culturally and linguistically sensitive way either, so that they can understand it. So I think all of those components have to be there, but I do think that there are some new and very exciting things on the horizon. So the expansion of telehealth, for example, that happened in COVID, where you can really get care anywhere these days, the expansion of monitoring services at home, the whole concept of interoperable data so that you can track patients wherever they get their care, be it at the local pharmacy for their immunization or in a different hospital setting than the one that they normally get their health care. And then, of course, I think AI, so big machine learning, for example, generative AI, natural language processing, to look at our data in a very different way, to be predictive and proactive rather than reactive, to have early warning signs so that people can intervene quickly. I just think that there's so many wonderful things on the horizon, but we're going to have to temper that with some caution because we don't fully understand some of these things. Sometimes we need to be careful of those underlying algorithms. How are they being calculated? What's really going into them? So I think there's some great optimism tempered with a little bit of, you know, we better be careful.
[00:12:18] Speaker B: Well, you know, I think for those of us in safety particularly, it's, yes, we want to use these tools to improve safety, but also how do we make sure we are implementing, designing and implementing them safely? So there's this whole component which we learned with electronic health records, because electronic health records were going to solve everything. And then we realized, oh, there's unintended problems that happen as well. And so, you know, we just have to think through all of those. Sonia, what about you, in terms of thinking about kind of that trend or innovation that you foresee, it doesn't have to be just one that you foresee playing a pivotal role.
[00:12:52] Speaker C: Well, Michelle had a great answer, but in addition to that, I think we are moving into a space where we are seeing patients not in their episodes of care or even in their care in one health system, but really as, as whole people and even beyond, well, their medical care. But all the other social determinants of care that we have been talking about, do they suffer from insufficient housing or insufficient food or not enough, insufficient work? So how can we interact with, and healthcare can't fix all of that, but how do we interact with all the other entities that may interact with that patient? How do we get to know that patient as a whole person? And how can we bring technology into the mix to help paint a picture of that patient and their family? And how do they get to participate, as Michelle was saying, in that care of their whole life? And I think that technology will be able to help us with that. In addition, as Michelle was saying, how do we leverage all of our different AI predictive analytics? How can we help maybe predict who might be most at risk for all kinds of different disease states or at risk for homelessness, or not being able to get to their appointment, as we heard earlier today? So I think there's so much good that is coming. Yes, there is risk, and we need to be able to be prepared, too. But I think healthcare is the most exciting place that we can be.
[00:14:26] Speaker D: I just want to pick up on one of your comments, if I may. I think what's coming forward in technology is very exciting.
But in the end, healthcare is human. It is about the human experience. It is about the relationships. It is about the trust. And I think more and more as we link the human experience with safety, I think that actually is the sweet.
[00:14:50] Speaker B: Spot, if I agree. Right. And I think how can technology take away the burdens and tasks that have caused us to move away from that human experience component? And, you know, we know that, you know, many of these frictions that are experienced by both patients and by the folks working in healthcare take away from that one on one interaction, which is where the real gold is, right, in healthcare. Sonia, I love what you said, too, about kind of the whole patient journey and the whole person as well, and really painting that fuller picture. And I think technology and some of these analytic tools will help us really kind of listen everywhere to all of these components across an entire journey, but then make sense of it, because otherwise we're just overwhelmed with massive amounts of data. So doing that, but then being able to kind of find the insight amongst all of that listening.
So, one more question that I have for both of you.
So how do you think? I'll start, Sonya, I'll start with you. How can healthcare systems continue to evolve toward becoming true hros? And particularly, I'd like for you to talk about your experience with high reliability and how you've embedded it such that it is not only a safety thing.
[00:16:11] Speaker C: So for us at Northeast Georgia, we implemented our high reliability work in conjunction with, with our lean transformation. And along with that, it was really about people development at the same time. So it was never about just one thing. We integrated all of these systems together and always in service of our patients and families. It was never about trying to be more profitable or even necessarily about just trying to get to your CMS metrics, although we certainly respect them. Michelle. It was always about a better patient experience, patient experience, a higher quality patient experience. We never lost sight of who we're really here to serve. And I think that is what is helping us to continuously improve. We're not there yet. We are not at zero harm. Our patients don't all give it, you know, they're not always happy. We don't always get it right. And I think that's why it's a journey that we are on. And it's not just one person. You know, it takes the people who are at the pointy end of the spear, who are caring for that patient, who register them when they come in or answer the phone all the way to our fantastic CEO, Carol Burrell. So it takes every single one of us being focused on being better tomorrow than we are today.
[00:17:33] Speaker D: I think all of your points are absolutely correct. What I find exciting about high reliability is how everybody in the organization contributes and how their roles are interrelated. And the more people understand that, I think the more that they get engaged. So the person parking the car has a role in safety. The housekeeper absolutely has a role in safety. And with everybody engaged and starting to talk to each other and coming up with creative ideas, it's really very exciting. And quite honestly, it engages the workforce.
They're looking at the patient every day. They have some of the best ideas for how we can carry out safety. So when their voices are heard through things like daily safety huddles, where people are talking about issues or escalating them with cascading huddles, I think it's really very exciting. You know, the military and the Veterans Administration hospital system has really done a lot of work around high reliability. And as we know, this whole concept started in industry, right? Industry has done a lot with high reliability. I learned most of my high reliability actually from one of the big three auto companies in Detroit. You guys both know that I spent a lot of time there and lived there.
They understand this. It is data driven. It permeates their entire organization. And it's very exciting when that happens. And I think it is very exciting when it happens in healthcare as well.
[00:19:06] Speaker B: I agree. And to your point, in healthcare, we do have a lot of hierarchies and power, distance and so forth. And high reliability organizing can give a language that can be a common language for everybody, which I think is incredibly valuable. And also this point about engagement, I think is critical.
We know that when the workforce believes the organization cares about safety, believes that when they speak up, things will improve about safety, etcetera, they are more engaged. And we know a more engaged workforce delivers higher, stronger patient experience and other outcomes. So these things are so interconnected. But that high reliability piece can be such a great chassis to build on.
So I want to thank both of you. Really appreciate you joining us here at HX 24 on the floor here at our conference. It's pretty crowded here.
There's a lot of activity going on. So we appreciate you giving us your time to have this conversation about high reliability and safety. So thank you.
[00:20:14] Speaker D: Thank you. And congratulations to your system also. Thank you, Michelle, thank you for hosting us.
[00:20:19] Speaker A: Course, that's a wrap. Thank you for joining us today, and special thanks to our guests for sharing their time and insights. Stay tuned for our next episode, which will be released soon. In the meantime, visit our website where you'll find more information on the human experience and a lot more.
