Ballad's clinical chief embraces 'big, hairy' goals

During the COVID-19 pandemic, hospital quality and safety scores dropped. Amit Vashist, MD, is working to rapidly fix this issue at Johnson City, Tenn.-based Ballad Health.

Dr. Vashist, Ballad's senior vice president and chief clinical officer, helped set up the Center for Clinical Transformation and Outcomes Optimization, which launched in 2022. He said the project's goal was to move away from "incremental and bite-sized improvements to exponential, what we call big, hairy, audacious goals."

The system's 20 hospitals each have different goals for clinical safety since some locations experienced more hospital-acquired infections and patient falls than others. 

The benchmarks are ambitious, he said, but predictive analytics have strengthened insights into when a clinical process might break. 

"Healthcare, traditionally, we are laggards. The pace of improvement in healthcare leaves much to be desired," he said, adding that healthcare should have high standards similar to the nuclear power and airline industries.

He said statuses, such as Joint Commission certifications and other accreditations, can make hospitals feel "good enough" — which, for Ballad, is not great enough.

Another strategy Dr. Vashist mentioned was tiered safety huddles, which are composed of four layers: morning huddles between night and day nurses sharing safety concerns, which then boils those issues up through hospital leadership, then to regional leaders, and finally to corporate tiered safety huddles at 9:45 a.m.

Other departments, including IT, pharmacy and infection prevention, have safety huddles where issues are "bubbled and escalated" to top leaders, Dr. Vashist said.

When Ballad began making blueprints for tiered safety huddles, logistical problems appeared, such as calendar overlaps and other priorities. Those issues whittled away as the system reminded all teams of its top priority. 

"Our guiding principle was Ballad Health has to be a zero harm, top decile health system; we have to be a highly reliable organization in everything," Dr. Vashist said. "If we have those underlying guiding principles, we find a way to make that happen. The message from the top leadership, including our CEO, was very clear that morning time has to be safety first and safety last."


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