MetroHealth's Dr. Brook Watts on getting to the next generation of quality

Brook Watts, MD, chief quality officer at MetroHealth, has been overseeing the health system's experience initiatives for a year. Here, she discusses provider burnout, missteps made in measuring healthcare quality and why it's important to acknowledge the lived reality of patients.

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

Question: What is your proudest moment/achievement overseeing patient experience for MetroHealth?

Dr. Brook Watts: For us, the proudest moment has been figuring out patient experience wasn't something separate than quality and safety. So, we have been working toward realizing that the perspective that patients provide can give us a great lens and voice to help to improve the overall care that we provide.

One of my favorite moments is engaging the patient and family advisory group as it regards quality and safety. Our patient and family advisory council meets monthly, and we have several hundred volunteers that participate in more than 30 committees throughout the hospital.

Q: What is the biggest threat to provider experience today? How do you think it can be tackled? image002

BW: We're all pretty aware of the challenges we have with burnout, which is now being reframed as moral injury. It's pretty clear that one of the greatest reasons for that has been the separation of provider experience from patient experience. And we know that healthcare is a service that comes from the interactions of individuals, the system, science-informed practice and a provider. Together, those multiple streams produce healthcare.

That is recent work from Dr. Paul Batalden with the Institute for Healthcare Improvement. I don't know if you've seen that beautiful visual of the braided cords of the patient, the system, the science-informed practice and the healthcare provider co-producing healthcare as a service. I think it's really powerful because it speaks to burnout and moral injury.

We measured healthcare from one dimension. We measured it as though it were a product. [It was] very outcomes-focused. By doing that, we separated the process and the relationship of the providers, the system, the evidence and the patient from each other.

And that's the opportunity, and that's how we are going to address provider experience. You can't address patient experience without addressing provider experience and vice versa because we produce healthcare from the patient, the system, science-informed practice and the provider. They're all together.

Q: How is MetroHealth planning to take patient experience to the next level in next few years?

BW: I think we're really working to acknowledge relationships, true relationships — trust, respect, kindness, empathy, truth-seeking — are necessary between patients and providers to really create action. To do that, we are starting to think more and more about that lived reality of our patients. And really acknowledging that in healthcare one size doesn't fit all.

A simplistic way [that we are integrating social determinants of health into care at MetroHealth] is screening patients, [and asking] are things like housing or access to food impacting your ability to care for yourself?

There was a recent [Journal of the American Medical Association] study that shows that when patients were provided with food, they took their diabetes medications more often,Why would that be? Well, it's because if you have to choose between buying your food and buying your medications, which do you pick? Food. So when patients were given food, they actually had more income to be able to buy their medications and their diabetes numbers got better.

We actually have a setup where we can write prescriptions for patients with chronic diseases to be able to go and get food. So healthy food is part of their chronic disease management.

Q: In what ways do you think your role will change over the next five years? What excites you most, and what worries you most?

BW: What's most exciting is that I really think we can do this: We can get to the next generation of quality that really acknowledges that quality, safety and experience — and that's both provider experience and patient experience — are the same thing.

I'm a general internist. I see my colleagues, and there is so much burnout. They are good people who want to take good care of patients, but a lot of things we've done in the system are getting in the way. And I believe fully that the cure for that, the way forward, is this next generation of quality, where we really think about healthcare as a service co-production.

If there is any part of all this that makes me sad is that we have been pushing standards of measurement that really have caused an artificial separation between the experience of providers, the experience of patients by sort of narrowing it down to just one dimension. The reality is that isn't healthcare. It got us in a bad situation, but I think there is a way out.

More articles on patient engagement:
Helping patients feel whole: Q&A with AdventHealth CXO Pam Guler
Lurie Children's nurse raises funds to donate gaming devices to patients
It's not all about the patient, Vidant Health CXO says 

 

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