NorthShore's quality chief on the 2 most important safety issues to fix in healthcare

October marks the three-year anniversary of Lakshmi Halasyamani, MD, stepping into her role as chief quality and transformation officer at Evanston, Ill.-based NorthShore University HealthSystem.

Here, Dr. Halasyamani reflects on her proudest moment in the past three years, the ongoing challenges in her role and the two patient safety issues she'd fix overnight.

Editor's note: Responses have been lightly edited for style and clarity.

Question: What safety or quality initiative are you most excited about right now?

Dr. Lakshmi Halasyamani: There are two initiatives I'm most excited about now. One focuses on identifying patients in real time who are at high risk for death or readmission. The goal is to organize their care proactively across the continuum, meaning from the time they come into our emergency department to 90 days post-discharge. We've really engaged care providers across the team and continuum to provide a more integrated, connected experience for patients and their families.

The second effort is focused on engaging front-line providers in improving evidence-based practice. We're trying to make sure that what we do for patients and families is providing value, while also eliminating inefficiencies that might make providers' work less fulfilling. Sometimes we create this false dichotomy where we think the only choices are making things better for patients or creating work that is meaningful and sustainable for providers. We really need to be able to do both.

Q: What is the No. 1 challenge you are facing in your role, and how are you tackling it?

LH: Healthcare in general is very wedded to the status quo. It's very hard for us to embrace new ideas and new thinking. We want to make sure that whatever we do works the first time we do it. Achieving a culture where everyone is much more open to trying new things and adapting as necessary is a challenge. I think the way to solve this is to ask people to participate. Oftentimes, when you ask someone to try something, they'll say OK if they know they aren't signing up forever. It's like getting your children to try broccoli. You're not asking them to eat the whole plate, you just want them to take one bite. Using that approach makes it so much easier to gain staff participation because they are not agreeing to something indefinitely; they're just agreeing to try it. It's also important to provide ways for people to share feedback on how it's going and what we might need to change for something to continue to improve and evolve. 

The second challenge is being more data-driven in the decisions we make. Rather than using the last anecdote to drive what we do next time, how do we use our systems and information as evidence to guide our choices so they become a lot more sustainable and impactful? We are working on providing data and feedback transparently with employees. I think sharing how the organization is doing, outlining the problems we're trying to solve, and giving people a view into why it's important is incredibly helpful.

Q: What has been your proudest moment as NorthShore's chief quality and transformation officer?

LH: My proudest moment is witnessing folks across the organization begin to own the problems we're trying to solve and be excited about developing and implementing solutions. This is not something that can be done by one person. What you really want to see over time is how the front-line care providers are engaged in the work and see this as part of what they do every day. I've been here for three years as of October, and seeing that evolution has been incredibly rewarding for me. 

Q: If you could fix one patient safety issue overnight, what would it be?

LH: I would want to fix the distractions that make providers be less present in the moment. Oftentimes, we're not fully taking in all the information we have in front of us. We're not integrating it in a way that gives us the best decisions. Sometimes that is because we get interrupted. Sometimes it's because we are distracted by something else. Providers need to have clarity of thought in those moments so they can fully understand the information in front of them, whether that is presented by another provider, in the patient record or directly from the patient.

In addition to having that presence of mind, I would also want people to feel like it is safe for them to speak up or raise any questions or concerns they may have in an environment that is really focused on trying to get to the best decision. To me, it's a blend of both having the presence to understand the information, but also as you're synthesizing it, being able to very openly speak up about potential concerns. Those two things together are the most important safety issues to fix.

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