10 executives on quality improvements amid COVID-19

The demands of the COVID-19 pandemic have pushed quality leaders to seek innovative solutions to not only maintain but reinvigorate quality improvement efforts — especially as the most recent surge from the omicron variant has waned

This compilation features guidance from leaders at 10 systems who shared insights with Becker's via email.

Question: What advice do you have for healthcare leaders looking to reinvigorate quality improvement efforts amid the pandemic? 

Editor's note: Responses were lightly edited for clarity and length.

Shereef Elnahal, MD. Former President and CEO of University Hospital (Newark, N.J.): I've heard a lot of leaders say that because of issues around staffing and morale, that it's hard to focus as much on quality improvement and lean transformations like the ones we've instituted. And I think we have a counterexample here in our hospital where, by virtue of engaging people through our quality improvement efforts, we are actually improving morale, because people feel like they have agency, they feel like they're a more central part of the mission. And so it's not just the imperative to improve quality and safety, which is the most important reason to do it for our patients. But it can be a tool to better engage your employees and improve morale in and of itself. Editor's note: This interview was conducted before Dr. Elnahal left his role at University Hospital. 

Peter Silver, MD. Chief Quality Officer of Northwell Health (New Hyde Park, N.Y.): As significant as the pandemic has been throughout our society, our patients still rely on us to provide the best care possible, whether we're talking about inpatients or ambulatory. It's our obligation not to get distracted by the pandemic, as easy as that might be. And to really continue to focus on the quality of care that we give. Focus, focus. We can't take our eyes off the road. It's so easy to get distracted with COVID-19. It's had such an impact on our communities and on our teams. We have to continue to focus on quality. Our patients demand it, and it's their right. Editor's note: This interview was conducted on Jan. 11.

Leslie Jurecko, MD. Chief Safety, Quality and Experience Officer of Cleveland Clinic: Caregivers have given their all over the past two years of this pandemic. To help keep our teams focused on quality improvement, I would advise leaders to not ask caregivers to "care more." Asking them to do more is insensitive. Instead, focus on the broken systems and processes that surround our caregivers, which is much more respectful and likely to succeed.  If healthcare learned anything over the last two years, it is that our processes are not ​as hardwired as originally thought.  Let us not repeat the same design, but instead work across organizations globally to learn how reliability and excellence are achieved and share widely with all. Our patients deserve this. 

Clay Dunagan, MD. Chief Clinical Officer of BJC HealthCare (St. Louis): The stress of COVID-19 really challenged standard work, and we have seen significant drift in processes. Our emphasis is going to be on getting back to the basics of reliable, consistent application of known quality and patient safety practices.

Firas Zabaneh. Director of System Infection Prevention and Control at Houston Methodist: The last two years have been very difficult, but this crisis has given us the opportunity to very closely examine intricate vulnerabilities in infection prevention programs. It is no secret that many leading organizations have seen significant increases in healthcare-associated infections. Many have struggled to maintain staffing and adjust workflows to address pandemic response in addition to all other priorities for preventing infections. Some organizations completely shifted infection control resources to optimize pandemic response surges and found it difficult to pivot back to routine practices during low community transmission periods. Now is the time to rethink traditional infection prevention practices. At Houston Methodist, we are in the process of creating a formal training and mentorship curriculum in collaboration with our academic institute. The goal is to address all vulnerabilities in the system and provide continuous infection control support for all of our hospitals. This will allow us to expand and/or contract as necessary. Additional full-time employees are not always the answer, especially when hospitals are shorthanded.

Saul Weingart, MD. President of Rhode Island Hospital and Hasbro Children's Hospital (Providence, R.I.): The pandemic itself invigorated quality improvement efforts. We learned to work better and smarter under the demands of the COVID-19 response, enhancing infection control practices, accelerating telemedicine, and developing human-centered approaches to supporting patients and staff members dealing with loneliness and burnout. We implemented daily and real-time methods to track what had been monthly metrics and to detect early signals of problems that needed to be addressed. As we move into a quiescent phase of the pandemic, we look forward to rebooting a more strategic and less time-constrained review of quality data, project priorities and improvement initiatives while maintaining the ability to move decisively when that is needed. 

Daniel Roth, MD. Executive Vice President and Chief Clinical Officer of Trinity Health (Livonia, Mich.): One aspect of quality improvement that became integral during the pandemic was the need for accessible and results-driven data and analytics. The COVID-19 pandemic has challenged Trinity Health and other health systems to use data and technology in ways we never have before, and we have been able to leverage our existing and emerging technology to improve care, interact with and empower patients in new ways (for example, virtual care) and integrate systems to provide efficient processes (for example, Epic, our electronic health records system). 

George Ralls, MD. Senior Vice President and Chief Medical Officer of Orlando (Fla.) Health: The COVID-19 pandemic brought an unprecedented level of uncertainty and presented some of the greatest challenges we've witnessed in the healthcare sector for generations. From a quality and safety perspective, it's important to acknowledge the level of disruption the pandemic has levied on our team members, providers and business partners. Despite aggressive efforts to avoid compromising quality practices and safety standards, the immense pressure placed on healthcare providers and organizations alike has undoubtedly impacted outcomes due to resource deficiencies and reshuffling of priorities. 

We've all improved our ability to manage through the pandemic chaos, but patient outcomes may remain at risk related to workforce instability and an attrition of knowledge due to high turnover rates. What was a highly reliable environment in the pre-pandemic era may now be at greater risk of avoidable errors, clinical breaches and gaps in protocol adherence. 

Although data will always dominate when looking for opportunities, turning direct attention to the teams caring for patients will go a long way. Hearing directly from them will not only help us learn more quickly of gaps that would otherwise lag in outcomes data, but it also engages the main link in quality outcomes — those providing the care. Giving the bedside providers the platform to speak on behalf of their patients is an important restorative opportunity for them as well. In doing so, clinical leaders play a key role in helping team members reframe their mindsets away from simply surviving, to aggressively pursuing excellence as we move beyond the pandemic response. 

James Moses, MD. Senior Vice President of Quality, Safety and Patient Experience at Spectrum Health West Michigan (Grand Rapids): As a core strategy to aiding in recovery of improvement and high-reliability culture across healthcare organizations coming out of COVID, quality improvement should be considered a primary strategic lever to be prioritized. Not just in improving care processes that may have deteriorated due to the pandemic as standard work became less so, but also as an evolving win-win in addressing staff burnout and depression. Ensuring quality improvement gets local and is focused on improving workflow processes to generate efficiencies that will make the daily grind staff experience that much lighter and more manageable is an important first step in getting quality improvement culture back to where it needs to be. We do have a long road ahead in this recovery. But I strongly believe quality improvement with active participation by staff tied to outcomes and process improvements that are relevant to their work environment is the key to success moving forward. 

Deepa Kumaraiah, MD. Chief Medical Officer at NewYork-Presbyterian (New York City): At NewYork-Presbyterian, delivering high-quality patient care is at the center of all the decisions we make. As the medical community emerges from one of the worst healthcare events in recent history, one thing is clear: We are in an age where patients expect personalized care that is accessible and convenient. To that end, healthcare institutions should continue to offer a hybrid approach to delivering care — making it available in person and virtually so that patients can get access to wellness and clinical services face-to-face or from the comfort of their homes. 

To further reinvigorate quality improvement efforts amid the pandemic, we must address burnout. Our healthcare workforce is exhausted, and it is incumbent upon healthcare leaders to find ways to prioritize teams' mental health and well-being, whether through more flexible scheduling options (using telehealth as a modality to not only meet patient needs but also provider flexibility) or even something as simple as capping meetings (as an example: no 30 minute meetings — maximum 25 minutes) to give people downtime to think, reflect and process.

Finally, as we reemerge from the last two years, it is necessary for healthcare leaders to bring people back to the mission. Reminding everyone how much care means to a patient and their families at the worst time in their lives, and how our actions can make that terrible time better and safer. We need to move from having a multitude of quality initiatives to a few key ones and at every turn make real-life patient scenarios the center of how we turn "initiatives" into collective efforts to do what we hold most sacred — delivering high-quality, reliable, and empathetic care to our patients and families.


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