How to 'engineer' for patient safety: 5 questions with CHI CMO Dr. Robert Weil

When it comes to patient safety, everyone in the health system plays a part — whether one is a clinician, administrator or another staff worker. That's why Robert Weil, MD, senior vice president and CMO of Englewood, Colo.-based Catholic Health Initiatives, says it's imperative to create and sustain a culture of leadership and accountability when setting strategy to improve patient safety.

Dr. Weil, who was appointed to his current role in September, is a neurosurgeon by training. Prior to joining CHI, Dr. Weil served in several roles at Danville, Pa.-based Geisinger Health System, including chief medical executive in northeastern Pennsylvania, associate chief scientific officer for clinical and translational research for the system and as medical director of care support services, the system's enterprise supply chain and pharmacy division.

With a strong focus on quality, safety and care delivery, Dr. Weil is tasked with providing strategic clinical and cultural leadership to ensure CHI's hospitals and other healthcare facilities— which span 17 states — provide high-quality, cost-effective and patient-centered care.

Dr. Weil took the time to answer Becker's five questions.

Note: Responses have been lightly edited for length and clarity.

Q: What made you want to be a physician and what attracted you to neurosurgery?rob weil

Dr. Weil: My interest in medicine came from a combination of things. First I had teachers, siblings and parents who encouraged my curiosity about biology and the natural world. Even though I was healthy growing up, I encountered several physicians who impressed me. They made me feel I was the focus of their attention and they had my best interests at heart. Additionally, my religious upbringing taught me service to others is an ethical and moral imperative. Medicine was a way to merge these interests.

Q: What do you believe the biggest patient safety issue is?

RW: When I think of safety there is not one isolated concern but a bigger issue of ensuring the outcomes that we're trying to achieve are ones the entire organization is engineered to solve. At the design level, healthcare organizations need to create programs of quality by design and safety on purpose. They must work to achieve effective outcomes by intention and activate patients in a shared decision making model.

This is a global issue — not just an issue for CHI. There is a need to design, create and sustain systems of care in which quality outcomes are achieved through shared responsibility and shared risk so that each member of the healthcare organization, no matter how far removed from the patient they are, knows how they personally contribute to the outcomes of patients and safety of the environment. These outcomes need to be meaningful, durable and measurable. It's a long journey but it's one I enjoy being a part of.

Q: What is CHI doing to address this need? 

RW: At the global level, we have a variety of programs that are similar to those at many other health systems, which combine safety with quality, outcomes and the patient experience. But far more important than one initiative or a suite of programs is creating a culture of leadership and accountability for the organization. One of the things that attracted me to CHI was the clear imperative that Kevin Lofton [CEO of CHI] places on what CHI calls its "Living our Mission Measures."

The first of these measures and one that we stress is service to the poor and vulnerable. I think every patient who comes to us is, in some way, vulnerable. To me this means this imperative reaches every patient. After that measure, there are quantitative metrics on quality, safety, patient experience and caregiver activation and safety. These measures all precede measures of interest to operations or finance. It's clear that all of the executives and managers throughout the organization need to lead by example and work hard to sustain this part of our mission.

Q: As congressional Republicans work on an ACA replacement plan, are there any elements of the law that you hope will be preserved? Are there any particular changes you'd like to see made? 

RW: Given the uncertainty of the first few weeks of the new administration, I suspect anyone who claims clairvoyance will rapidly recognize how feeble their power is in that regard. Certainly there are many important aspects of the ACA that resonate with CHI and its mission, such as caring for the poor and vulnerable; improving the health of communities through the expansion of insurance to millions of Americans; coverage of people with pre-existing conditions; and the reduction or elimination of the ceilings on healthcare coverage. The ACA also provides coverage of many preventive medicine services that didn't exist before and extends coverage of young adults on their parents' health plan until age 26.

When it comes to a replacement plan, I think it's important to figure out ways to reduce duplicative and unnecessary reporting and regulatory burdens when they add little or no value to the care being delivered. Just as we in healthcare are striving to reduce needless variation in care that doesn't add value or is harmful, CMS and nongovernmental bodies should limit the measures and reporting to a minimum number of quantitative, accurate, precise and reliable metrics that matter for patients.

Q: Despite the uncertainty of the future of the U.S. healthcare system, what do you find most rewarding about working in healthcare? What are you most optimistic about?

RW: I am quite optimistic that committed organizations such as ours, whether alone or in partnership with other like-minded systems, can realize our goals. We need to develop healthcare ecosystems that sustain our ability to adapt, learn and evolve; to provide wholly integrated, top-quality population level health, wellness and prevention; as well as acute, catastrophic, chronic and long-term care within a single transactional healthcare system. And while the healthcare system strives to reach zero defects, it does so reproducibly and over time, thereby reducing the burden of disease, disability, suffering and expense for our patients, their communities and our society.

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