How to improve a 5-star, straight-A system: 3 things to know

When Shlomit Schaal, MD, PhD, stepped into her role as executive vice president and chief physician executive of Houston Methodist, she wondered how she could improve a top-performing system.

"Quality and patient safety is not a destination, it's a continuous journey of improvement," Dr. Schaal told Becker's. "All of our hospitals are top performers in quality metrics, placing in the top five regionally and our main academic center was ranked number 12 by Vizient. We also have five stars from CMS and grade A rankings from LeapFrog in all our hospitals so when I came into this position, I wondered how I could improve it even more."

In the last year, she has overseen all the physician activities and quality and patient safety across eight hospitals. Although the system continues to rank highly across various measures, Dr. Schaal has focused on three ways to further improve quality and patient safety and physician wellness.

Leadership development: I strongly believe that people are not born leaders. Leaders are made and leaders have to continuously learn no matter what their role in the organization. You have to keep learning. You have to keep that open mindset of willingness to learn and to be a forever student. Leaders have the most influence on how their people are doing in morale, culture, performance, and everything else. To be the best leaders, we have to become unparalleled. In the last year, I have focused on leadership development programs for department chairs, for administrators, and for physicians. As we've seen from the Press Ganey engagement surveys, physician and employee engagement ties to the lead, so if you have a capable leader, engagement is high, and that is what we have seen.

Quality and patient safety: I started by listening and learning, trying to come without any prefixed ideas of how to get better. I asked every person I met three questions, "What do you do here? What's good here? And what could we do better?" Over three months, I asked these questions to hundreds of people and we found some common themes emerge. One was we don't communicate very well across our hospitals and they tend to act like silos. From that we're creating a better way to communicate strategy for quality and patient safety to the whole system through newsletters, podcasts and symposiums. We also learned that our structure for quality and patient safety was different at every hospital so there was an opportunity to standardize it. Lastly, we found an opportunity to convert all the great work we're doing into academic publications and grants. If we publish and spread what we are doing, others will learn from us and we from them.

Physician wellness: Post-pandemic, people's lives have changed, especially physicians. We need to focus on the wellness of physicians. If we have an engaged, happy provider, we will have superior patient care. The physicians need to be supported, so we started the Joy In Medicine Initiative, or JIMI. JIMI focuses on our primary care physicians first, who are our most vulnerable population. To help them, we focused on three key things: efficiency of practice and removing hindrances to physician time; a culture of wellness, especially among academic physicians, who may feel they have to produce like they are a commodity; and personal resilience to help individuals have a more positive outlook through life and create peer-to-peer support networks.

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