11 clinical quality leaders on fall priorities 

Hospital and health system quality leaders are focused on quality improvement measures ranging from improving access to care to workplace safety as they head into fall.

Becker's asked leaders what their quality improvement priorities are in the coming months. This compilation features guidance from 11 leaders at 11 systems who shared insights.

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

Dan Roth, MD. Executive Vice President and Chief Clinical Officer at Trinity Health (Livonia, Mich.): Trinity Health has a strong focus on improving access to care as the single biggest thing we can do to improve quality. Since the pandemic began, people have deferred care, leading to worsened quality measures and health outcomes. We are dedicated to reaching out and making care more accessible to people so we can partner on their health maintenance and chronic illnesses.

David Williams, MD. Chief Clinical Officer and Senior Vice President at UnityPoint Health (Des Moines, Iowa): Clinical effectiveness is our major quality and safety focus at UnityPoint Health. My partner on this effort is D’Andre Carpenter, our Chief Nursing Officer, which gives us a physician/nurse perspective that really elevates our efforts to improve both clinician efficiency and patient outcomes. Our approach is to create enterprise clinical departments that work across geographies. That’s key because it allows us to standardize processes, reduce variabilities, identify best strategies and support optimal care delivery across the entire system. That way, we can be sure our patients receive the same great care no matter which UnityPoint Health clinic or hospital they visit.

Hilary Babcock, MD. Vice President and Chief Quality Officer at BJC HealthCare (St. Louis): BJC HealthCare's mission is to deliver high-quality care to all of our patients and our community. Currently, we are working to stabilize our operations and quality improvement activities following recent COVID-19 surges. Like other health systems, our quality work was impacted by the pandemic as our staff provided clinical care to increased numbers of highly complex and critically ill patients.

Our overarching strategic goals are to perform in the top quartile in overall quality and patient experience, and significantly reduce the number of preventable harm events. The primary focus for the remainder of 2022 is to improve inpatient experience, reduce hospital acquired infections and lower the number of pressure injury events. We are also addressing workplace violence events against our staff and reducing other serious patient safety events.

To accomplish these goals, we are focused on implementing standard work for our front-line teams, training clinicians on key patient experience techniques, and developing data and analytics to identify opportunity areas and provide key insights into performance. We continue to investigate patient and employee safety events and identify key trends and interventions to reduce harm. We are also developing improved governance and resourcing models to help us achieve our quality goals.

Ihab Dorotta, MD. Chief of Quality and Patient Safety at Loma Linda (Calif.) University Health hospitals: We are focused on creating access for patients as they seek medical care with increased trust in the safety of our clinics and hospitals amid an ongoing public health emergency. We are seeing many patients with advanced stages of their disease and an urgent need for medical intervention. Our focus is to meet their need with increased clinic access, increasing emergency department capacity and adding additional operating rooms.

Ilseung Cho. MD. Chief Quality Officer at NYU Langone Health (New York City): While many factors help determine quality metrics, an important focus at NYU Langone Health is ensuring a single high standard of excellence in care for all patients across the entire system. To achieve this, NYU Langone remains committed to promoting healthcare equity and reducing disparities in care. We are dedicated to eliminating biases wherever we uncover them, whether they relate to race, ethnicity, sexual orientation or gender identity. To do this, we have implemented strategies including more comprehensive collection of race and ethnicity data and requiring that every clinical department work in close partnership with our Institute for Excellence in Health Equity on meaningful projects to address potential inequities of care. There is much work to be done, but collectively we have an obligation to our patients and our communities to address these issues.

Jeff Pothof, MD. Chief Quality Officer and Emergency Medicine Physician at UW Health (Madison, Wis.): The ability to synthesize a large amount of data from the electronic medical record is one of the most difficult aspects of a busy and complex care environment. There is an increasing body of evidence which suggests that automated monitoring tools have the potential to improve patient safety. Providing support to the clinicians by using predictive models can ensure that the clinicians are able to focus on patient care and still benefit from the vast amount of data available about their patients. UW Health is investing in using these tools to drive earlier recognition and response to clinical deterioration more than what was historically possible. We employ predictive modeling coupled with clinical decision support tools to provide clinicians with a clear picture of patients at risk for deterioration and to assist with guidance for next steps.

UW Health is piloting the latest version of our clinical deterioration program on a subset of care units, with a focus on notification to front-line clinicians about at-risk patients identified by a predictive model.  We will be evaluating the program based on model performance, process measures and patient outcomes. We will employ a continued process improvement method to ensure we are identifying the right patients and that any tools we build informs the care plan from our clinicians' perspective, rather than adding to noise. We will also look to see how the program will impact the number and duration of unplanned ICU visits as well as rapid responses and length of stay. Current feedback has been positive with our mixed service general care units appreciating the extra support for such a wide variety of patient types. We have identified some early trends that would indicate an impact from the program on the pilot units and are hopeful those will prove out over time as we continue to collect data. Future directions for the program include the spread across all clinical areas at UW Health including our pediatric and ICU units, as well as leveraging our remote clinical care nursing team to provide an extra layer of support for the front-line clinicians.

Jeffrey Boord, MD. Chief Quality and Safety Officer at Parkview Health (Fort Wayne, Ind.):  Similar to other health systems across the country, Parkview Health is committed to improving workforce safety and well-being. Though these are not new issues, the entire healthcare industry is seeing an increase in the frequency and severity of workplace violence and employee and provider burnout.

To support our co-workers’ physical safety and mental wellness, Parkview has spread our de-escalation training program systemwide, and we are expanding our hospital behavioral emergency response teams. We are also working closely with our public safety team and employee assistance program to ensure proper follow-up and collect detailed data on workplace safety incidents for reporting and performance improvement.

A second area of focus is hospital-acquired pressure injuries among critically ill patients. Nearly all hospitals in the United States saw an increase in hospital-acquired pressure injuries among critically ill COVID-19 patients during the pandemic. Parkview is taking the lessons we learned to improve our prevention and mitigation efforts.

Jose Azar, MD. Executive Vice President and Chief Quality Officer at Hackensack Meridian Health (Edison, N.J.): Hackensack Meridian Health is focused on both hospitalwide measures for improvement and disease-specific measures per hospital. We've been making inroads on measures such as mortality and [hospital-acquired infections] and we're looking to continue our momentum. Hackensack Meridian Health is also launching a networkwide clinical care redesign that will look at the entire continuum of care at all levels to continue setting the standard for quality, accessible and integrated healthcare for patients in New Jersey and beyond.

Peter Silver, MD. Senior Vice President, Chief Quality Officer and Associate Chief Medical Officer at Northwell Health (New Hyde Park, N.Y.): As chief quality officer for Northwell Health, my focus is never on just one quality improvement measure — there are several for this autumn. One is to continue to decrease our hospital-acquired conditions to our 2019 rate — the best they have ever been. Making our hospitals safe for our patients is always a top priority. Of equal importance is the full incorporation of diversity, inclusion and health equity into the fabric of all that we do at Northwell, including all measures of quality improvement. As an example, in our multifaceted effort to reduce maternal mortality, we are particularly focused on reducing Black maternal mortality, which includes efforts to improve access to quality pre- and post-natal care in all of our communities. Another focus is our ongoing effort to standardize our delivery of care through the creation and spread of standardized care guidelines, with a goal of reducing variability, improving outcomes and decreasing the expense of no-/low-value care.

Rick Shannon, MD. Senior Vice President and Chief Quality Officer at Duke Health (Durham, N.C.): Our lead quality initiative is to redesign clinical care delivery in the wake of staffing challenges focused on non-value-added tasks which nurses are asked to do. 

Our lead safety initiative is workplace safety for team members focusing on reducing workplace violence.

We cannot create a remarkable patient experience without a remarkable team member experience.

Sonya Pease, MD. Chief Quality, Safety and Patient Experience Officer at Cleveland Clinic Florida (Weston, Fla.): Cleveland Clinic Florida is focusing on growing our culture of safety. A strong safety culture is the backbone of all improvement activities and incorporates every caregiver, while spanning all workflows.

Becoming safer is not just about processes and systems. It's about culture and the living, breathing team that creates and sustains that culture. We are investing in our people because safety is an organizational and an individual commitment that demands deliberate interventions just like any other quality measure.

We will be going into Q4 by training our leaders on the science of safety. Leaders will be trained on high reliability behaviors and skills needed to foster safe practices for both clinical and nonclinical teams. We will continue training all caregivers on high reliability safety practices in 2023 and ingraining this into our onboarding and annual competencies going forward. By reducing re-work, building more resilient teams, and developing more efficient workflows based on the safety science of high reliability, we will continue to drive how we as an organization, as leaders and as caregivers prevent harm. 

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