Quest for Quality Honorees on Challenges and the Impact of Equity on Care

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Tom Haederle
The famous humanitarian philosopher and physician, Dr. Albert Schweitzer, said: "A good example has twice the value of good advice." In health care's never ending journey towards better service for patients, good examples are especially valuable as teaching tools that demonstrate what is possible. Stick with us today as this podcast highlights three health organizations that are leading by example as winners of the American Hospital Association's 2023 Quest for Quality Prize.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications, the AHA Quest for Quality Prize honors hospitals and health systems committed to leadership and innovation in improving quality and advancing health. The 2023 winner was Mainline Health in Pennsylvania, Atlantic Health System in New Jersey and University of Chicago Medicine were finalists with Citation of Merit Awards.

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Tom Haederle
This year's three honorees were recognized at the AHA Leadership Summit in Seattle, and during that meeting, they sat down with us to talk about their achievements, reflect on the challenges they faced, and assess the real impact of equity on quality of care. Let's join them.

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Akin Demehin
Welcome to the AHA Advancing Health Podcast. My name is Akin Demehin and I'm senior director for Quality in Patient Safety Policy at the American Hospital Association. And I have the honor of sitting down with the three organizations that won The Quest for Quality Awards this year. First, let me ask our panelists to go around and introduce themselves, starting with Jack Lynch.

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Jack Lynch
My name is Jack Lynch, president and CEO at Mainline Health in Bryn Mawr, Pennsylvania.

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Stephen Weber
My name is Steven Weber, the health system CMO and executive vice president of the University of Chicago Medicine.

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Suja Mathew
Hi Akin. I'm Suja Mathew. I'm executive vice president and chief clinical officer of Atlantic Health System.

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Akin Demehin
Thank you. And first of all, congratulations on this award. It is truly a testament to your own organization's hard work and really an exemplar for the whole hospital field. So I want to spend some time doing this morning is talking to you about the process of applying for the award specifically, but starting more generally around your quality journey.

00;02;30;04 - 00;02;40;11
Akin Demehin
And I would really be interested if you all would reflect on one of the most challenging aspects of your quality journey in recent years and how you worked to overcome it.

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Suja Mathew
You know, Akin, I'll tell you that one of our most challenging aspects of our health care quality journey is one that we're going through right now. So if you'd allow me to talk about what we're doing about it and how we're addressing it while we're in the middle of it, and it's very closely tied in to what we're all experiencing around the country is the sequella of the pandemic.

00;03;06;04 - 00;03;47;13
Suja Mathew
So specifically, it's our workforce. And there's been a lot of conversation, of course, about the quantity of individuals in our workforce. What we're addressing and challenged by is what I'll just term as the quality, just to compare it to quantity, the quality of the workforce. Again, more specifically, we are seeing a young workforce enter our health system and into our hospitals, especially around the clinical fields that haven't had the same type of preparation during their education and training that historically those individuals have.

00;03;47;13 - 00;04;32;27
Suja Mathew
So we're seeing young doctors, young nurses, young pharmacists that trained during the pandemic, and that has meant that we have needed to come alongside those individuals and support them, frankly, in a way that wasn't necessary, certainly not enmasse in the past. So we have had to relook at our orientation programs, our preceptorship programs, our general oversight and support that we provide, again, for all of those clinical team members to ensure that what they may not have seen and or learned during their training, we're able to provide them elbow support and guide them through during their early years of working with us.

00;04;32;29 - 00;04;50;09
Stephen Weber
I might add on to that I suspect all of us will overlap in terms of some of those experiences and challenges. And so the good news is you can always learn from your colleagues and partners around the country. What I would emphasize is the very real impact that equity has around quality. Now, you can't be equitable without quality for all.

00;04;50;09 - 00;05;12;13
Stephen Weber
You can't deliver quality without equity. And so to that end, it's the realization of saying that as our ambitions grow and our desire for near-perfect care can't be obtained, when you have whole segments of your population community who are not being fully served. And so digging in and understanding that it's not only a necessity, it's an obligation for us to really figure that out.

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Stephen Weber
And so for us, it's been both a great challenge and a source of a lot of pride that we've started that journey. But like I think like all of us, we all still feel like we're closer at the beginning than to the end. And a lot of work still ahead.

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Jack Lynch
So I think those guys really hit a lot of the main topics. So let me answer the first part of the question and just say you've got to have great staff if you're going to apply. So I can't tell you a whole lot about the application process, but I can tell you what you've got to have is one) a commitment to quality saved in equity if you even want to consider looking at the application.

00;05;43;14 - 00;06;03;25
Jack Lynch
But I would encourage people to apply and get in the process and learn from it. And so given the greatness that is out there, I was absolutely shocked that we were identified as a recipient because I know how many people are doing great stuff, but like Stephen said, you can't have quality and safety if you don't have equity.

00;06;03;28 - 00;06;19;25
Jack Lynch
And unfortunately we don't have buy in across this country yet. That equity is something that I would argue as part of the three legs of the stool. You know, when I went in this business, I didn't get up in the morning and look in the mirror and said, make sure everything is safe and high quality for people that look like me.

00;06;19;28 - 00;06;39;06
Jack Lynch
I took on an obligation that said, as Stephen indicated, we have a responsibility, an obligation to the entire community of different people that we serve, and not only the ones we serve, but the ones who aren't coming to us because we don't serve them well. We have an obligation to be there for them, to see them where they are.

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Jack Lynch
I joined Mainline Health 18 years ago and the board chairman at the time said to me in the interview process, Jack, we want to be the safest hospital in America. And I said to him, Would you be satisfied with being one of the safest? And I said that because I didn't want to be suggesting that we couldn't be.

00;06;56;29 - 00;07;23;14
Jack Lynch
But there's nothing proprietary about any of the work we do in safety, quality and equity. So we shamelessly steal and we share everything we do with our competitors and with people across the country. For us getting better and to help them get better. I think part of the other part of the journey is we used to all talk about patient safety and quality and then Ebola hit and we realized, oh my God, we've really got to pay a lot of attention to the safety of our employees.

00;07;23;14 - 00;07;46;25
Jack Lynch
And we did back on the needle days when needle sticks were big and back injuries. But Ebola, I think, really struck us. We remove the word patient from our board committee and called it the 
Safety and Quality Committee. And a number of years ago, we decided to add the word equity. So safety, quality and equity to that mission of the board's oversight.

00;07;46;27 - 00;08;04;26
Jack Lynch
And so moving on with suggesting that there are very similar issues, the one that scares me the most is complacency. And we've been on this journey for a very, very long time, and all of us come to work in a hospital and don't think twice about it. Our patients come to work and they're nervous the minute they walk through the door.

00;08;04;29 - 00;08;13;26
Jack Lynch
Our staff get used to what it's like to work in a hospital. And I think when we become complacent as an organization, bad stuff happens.

00;08;13;28 - 00;08;36;04
Akin Demehin
I think that's an incredibly important point and it really touches on an issue that is so intimately tied to advancing quality, safety and equity, and that is keeping the workforce engaged. I know, Dr. Matthew, you've talked about the efforts underway in Atlantic Health System around addressing workforce challenges. Maybe starting with you, Dr. Webber, and then asking all of you to weigh in here.

00;08;36;06 - 00;08;43;20
Akin Demehin
And what are some of the ways you've used to keep your staff engaged, motivated and to fight against the complacency that Jack alluded to?

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Stephen Weber
Well, it's interesting that occurs to me that as I'm very, very proud to be honored with this recognition, but it puts us in a unique risk for added complacency. Right? I'm always struck that by, I think any objective measure, You know, we're close to achieving the standard that Jack's board believed challenged him with the being among the safest places.

00;09;03;22 - 00;09;29;05
Stephen Weber
Yet we always like to remind our teams that it's still not safe. And I think that is essential for people to have a tenacious desire to become even safer. It's great to be the safest hospital, but you need to go even beyond to challenge the whole industry to get to be safer. I think that jumping off from what Dr. Matthew said a few moments ago, what's the engagement with the staff in a very authentic way and to remember that they understand where we have the opportunities.

00;09;29;05 - 00;09;46;01
Stephen Weber
Granted, I'm surrounded by great health system leaders at the meeting and in the association, but at the same time to the teams who are on the front line, understand they're seeing every day what's happening and not all of them are going to be black belt certified. Not all of them are going to have PhDs and human factors, but at the same time they understand what the risks are.

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Stephen Weber
And I think one of the key ways of engaging folks is to listen to them and to engage them in the process in a way that's authentic. It's got to go beyond town hall meetings. It's got to be really predicated on the notion saying, we trust you and you're going to help us close that gap. That's always going to exist for all of our organizations.

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Suja Mathew
We've also really leaned into the need for reporting across the enterprise, encouraging individuals to report it in a culture that provides safety to them, psychological safety to them, to be preoccupied with failure in such a way that, again, like like Dr. Webber said, folks who are on the front lines directly caring for patients and even, you know, in those supportive roles, they see opportunities and we need them to be able to speak up around those near misses, those missed opportunities, because they're going to see things that we couldn't possibly see ourselves.

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Suja Mathew
So that's been a really important way that we've encouraged and engaged our staff. We also celebrate our team members. You know, our team members are phenomenal and we've been able to create very luckily, an environment that continuously acknowledges the great work that they do every day that may not necessarily be heroic in, as some would say, but there's a heroism in coming in every day performing these tasks regularly, reliably and safely, every single day.

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Suja Mathew
And we choose many opportunities. We seize those opportunities to bring attention to that.

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Jack Lynch
You know, again, very similar. You know, one of the things we started to talk about because we were doing a pretty good job, Press Ganey scores were pretty good, and I was convinced that the only way we're going to get ourselves focused to take it to the next level was to think about that patient as us or our family member.

00;11;41;10 - 00;11;58;29
Jack Lynch
And I jokingly have said, and not your mother in law, but we all love our mother in laws. But really, what if that is your kid? What if that is your spouse? What if that is your partner? And I don't think that some of the things that we're inherently willing to accept - and I'm thinking mostly about wait times -  we would accept if it was one of our family members.

00;11;59;01 - 00;12;20;16
Jack Lynch
The other challenge that we face and maybe other industries do too, but you know, it's not like we're building and getting better and getting better and getting better and it can't slip back. We start over with every single encounter with every single patient. So if you identify the patient correctly in ED, 5 minutes later, if you take the wrong patient to the operating room.

00;12;20;16 - 00;12;44;17
Jack Lynch
So it's a really, really complex industry. We really underscore that everybody matters. And I think this is a problem in America today. And depending on where you are and as you'll find from this podcast, I'm not shy about talking about controversy. I don't understand how people can't embrace the commitment to the work that needs to be done to eliminate disparities of care.

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Jack Lynch
We all need to accept that every one of us deserves a level of care that the white Jack Lynch gets, not because he's the CEO, but that's just because that's the level of care.

00;13;22;16 - 00;13;41;07
Jack Lynch
You're going to listen to me. I think we got to be committed to lifelong learning. I think you got to stratify the data.

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Jack Lynch
I had an aha moment. I asked a colleague that was a COO, black colleague. I said, Do you think your CEO believes there's disparity of care and you're E.D.? He said, "no." I said, Do you believe there's disparity of care in your E.D.? He said, "yes."

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Jack Lynch
And when it started getting pointed out to us on a daily basis, we did something about it. And I think unless you see the stratification of your safety, quality data by race, ethnicity, gender, gender, orientation, age, zip, code payer, you don't know you have a problem. I loved your comment about celebrate. You know, high performing organizations can get in a rut of only focusing on the errors or the near misses because we want to do better.

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Jack Lynch
You have to celebrate the ones that are great. And the truth is, I'm not a black male. Whatever. 99.9, something of the percent of people that our people touch do great. But if you're that family member or that patient of that small, small percentage that didn't do so well and it was preventable. It's a crisis.

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Akin Demehin
Absolutely. I'm going to switch gears to the award itself and the process for applying for it. And I know that there are organizations that are doing a lot of great work on quality patient safety and equity who may be at that point where they want to seek national recognition like the Quest for Quality Award. I would be curious to hear your reflections on what you see as the value of this particular award.

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Akin Demehin
What made your organization make the decision to apply for it and what did you learn from that process?

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Jack Lynch
I have a unique situation. I happen to be a sitting board member of the American Hospital Association. And so I learned about the fact that we had applied after we had applied, because one) we empower our folks to do what they do. I think our team that focuses on this 24/7 really believed they had a good story to share.

00;15;42;06 - 00;16;09;15
Jack Lynch
And I was concerned that as a board member, is that something that's going to get in the way? And unfortunately it doesn't. And I was not involved in any of the site visits or any of the discussions about who was going to get the award. But what I would encourage folks to do is whether you are completely convinced that you're going to be the award winner for us, whether it's Baldrige, whether it's other recognition programs, it's not the award that you get to take home, although it is a pretty cool award.

00;16;09;18 - 00;16;29;16
Jack Lynch
It's the process that you go through that you know, is going to result in better care. You know is going to result in more engagement with your staff. You know is going to result in more of your people at your organization, understanding what you're doing and buying into it. So I think the reason to apply is not to win.

00;16;29;20 - 00;16;33;06
Jack Lynch
The reason to apply is the process will make you better.

00;16;33;09 - 00;17;06;18
Stephen Weber
And I think that's a great observation. I think go back each of you talk a little bit about celebrating folks, and a big motivation for our leadership group was we wanted to apply on behalf of the folks in our front line who do the work where we're cognizant as we talk about the meeting previously. But the sense among frontline providers about having gone from this kind of heroic status at the peak of the pandemic to maybe not to becoming abused, although that's another challenge for another podcast, but actually to really celebrate and to acknowledge the work they do every day that it didn't take a pandemic to define these folks as heroes.

00;17;06;18 - 00;17;26;02
Stephen Weber
They were heroes before the pandemic turned, and they still are now. The process I think that was really interesting. Because one of the key tenants from our organizational point of view around improvement is the idea of mindfulness and whether it's a physician in her practice or a nurse at the bedside to be thinking about what do I do, does it make sense and can I do it better.

00;17;26;09 - 00;17;42;21
Stephen Weber
The pandemic didn't give us a lot of chance for reflection, right? But as we came out of it, the process of the application allowed us to look at the different program, practices, people and reflect on what had made them great. We do root cause analysis, right? But we do root cause analysis around as Jack as I think said, I think said harm events and near misses.

00;17;42;25 - 00;18;01;05
Stephen Weber
This was like doing a root cause about what works. And we found ourselves now, since the submission and before we heard the notification of being recognized, of taking that saying, what lessons can we learn from some of those pieces we shared with the site visitors and how can that be applied to our next prominent next challenge? So it's been incredibly impactful.

00;18;01;05 - 00;18;11;10
Stephen Weber
And I think going back to an earlier topic, it's given us the means to fight that complacency. So I can't say enough about it. I really would encourage anyone listening that it's a great, great exercise to undertake.

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Suja Mathew
Yeah, our path was a bit different than the others, perhaps. We made a very late decision to go ahead and throw in an application. One of my peers mentioned that this was an opportunity and were like, Yeah, sure, my team can put this together. Sure enough, it was just a few days before the deadline, so we really worked around the clock to put together a good strong application for it.

00;18;35;29 - 00;19;01;04
Suja Mathew
It was largely because we had a sense that there was something to report. We have no expectation that we would be recognized. So this is gleeful, right? It's wonderful to be so. But we felt like it was an opportunity for us to again, put on paper, collect our thoughts, collect the individuals around the work that had been done, and really make it an edifying experience.

00;19;01;04 - 00;19;28;10
Suja Mathew
And it absolutely has been that. I will tell you that even before we were announced as a recognition winner, we gained so much value from that process. Specifically from the site visit itself. It also brought myself and members of particularly the chair of our Board Quality Committee together to work together in a way that I'm extremely grateful for.

00;19;28;13 - 00;19;48;17
Suja Mathew
It was an opportunity for us to gather across the system, bring together leaders showing off their very best that they had to offer is wonderful. And so, don't do it because you necessarily would only do it to win it. Do it because the process itself, it's a win.

00;19;48;20 - 00;20;11;13
Jack Lynch
It's almost an audit of what you think is going on. And I think all of us probably in any of these processes of being recognized for or reaching achievement, learn things about their organization that they wouldn't have known. And I don't mean the CEO, but people in the organization learn things about the organization that they thought were one way.

00;20;11;16 - 00;20;37;12
Jack Lynch
And it turns out they were another. Or for systems like ours, three places are doing it one way. And as a part of this process, you realized there was another piece of the organization that hadn't adopted the new way of doing it. And so that's another benefit. I think that it really helps you hold yourself accountable because when you put that application in, you better be able to defend a site visit that says, I saw what you told me I was likely going to see.

00;20;37;14 - 00;21;09;05
Suja Mathew
And I'll just add one more point. This process of sitting side by side with other honorees and having the conversations that we've had over the last 24 hours, getting to know one another's work again has been hugely beneficial. We all do good work. We do it in different ways and we have different focuses. So it's been an opportunity for Atlantic to learn from the University of Chicago, to learn from Mainline, and that by itself has been enormously valuable.

00;21;09;08 - 00;21;10;02
Stephen Weber
Well said.

00;21;10;05 - 00;21;18;22
Akin Demehin
All right, I think we are about out of time. Again, let me congratulate your three organizations on your honor this year, and thank you all for listening.

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Jack Lynch
Thank you. Thanks for giving us the opportunity.

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Tom Haederle
Applications for the 2024 AHA Quest for Quality Prize are due September 29. Learn more at A-H-A.org