Data and Curiosity: Strategies to Strengthen Patient Safety

00:00:01:03 - 00:00:22:12
Tom Haederle
Welcome to Advancing Health. Coming up, a look at the role of leaders, including hospital boards, in ensuring patient safety and connecting with the communities they serve. How can leaders prepare to meet these important goals? Where do we find the right people to help lead the way? And what investments can care providers make to address disparities in care? These are among the questions you'll hear more about.

00:00:22:17 - 00:00:40:08
Tom Haederle
Dr. Mindy Estes, former CEO of Saint Luke's Health System and former AHA board chair, is your host today. Her guest is Tori Bayless, CEO of Luminis Health and a member of a board of trustees. Now over to Doctor Estes.

00:00:40:10 - 00:01:13:11
Mindy Estes, M.D.
I'm Mindy Estes, and joining me is Tori Bayless, CEO of Luminis Health and a member of the board of trustees. Under Tori's leadership, Luminous Health has made significant investments to advance patient safety, improve quality of care, and address disparities in behavioral health. And let's just dive right in. You've spoken about the strength of your board and the passion and insights they bring to Luminis work to improve patient safety and connect with the communities your hospitals serve.

00:01:13:13 - 00:01:26:12
Mindy Estes, M.D.
What are the keys to selecting and preparing board members for this vital work? And then could you share an example of how a board member from outside health care has brought new insight to quality and patient safety?

00:01:26:16 - 00:01:50:15
Tori Bayless
Sure. Thank you so much for that question. So clearly we're governed by a board of trustees. They are all volunteers. They are incredibly passionate about the work that we do. And it's a self-perpetuating board. And then we do a lot of the heavy lifting in our committees. So one of those key committees is the board quality, Patient Safety and Workforce Committee.

00:01:50:17 - 00:02:11:24
Tori Bayless
Over the years, we've debated whether workforce should be broken out separately. And we really came to the conclusion that how we take care of our teams, how we staff, how we do the work every day with our team members is going to impact the patient experience, the clinical outcomes. So we couple quality and patient safety with workforce at a governing level.

00:02:11:26 - 00:02:34:16
Tori Bayless
And in terms of our trustees, they really are incredibly committed. They need to be passionate. They need to be committed to our values. When we think about trustees and who and where they hail from. Some of them have deep expertise in health care, but many of them do not. And we look to different sectors. We looked at education, the public school system, higher ed.

00:02:34:24 - 00:03:06:01
Tori Bayless
We've looked at military leaders and had trustees commit to us and bringing that expertise to us. We have people from the technology sector, from pharma, and dare I even say the payer community has engaged with us, whether that's at a governance committee level, board of trustees or one of our community advisory councils. So we've been very, very fortunate to have the level of engagement and expertise and we have a tempo of meeting with the Board of Trustees and the committees on a quarterly basis.

00:03:06:03 - 00:03:11:09
Tori Bayless
But we have a lot of points for interaction in between those formal quarterly meetings as well.

00:03:11:12 - 00:03:39:26
Mindy Estes, M.D.
Let's pivot to another question. You know, I think a few years ago, luminous noticed rising behavioral health issues in your community. And a lack of resources, which is something we see all across our nation. As a result, there were disparities in care, and you chose to invest in addressing these problems. Can you describe your approach to the issue and what has worked best?

00:03:39:28 - 00:04:01:27
Tori Bayless
So clearly, Mindy, as you well know, a top health care priority. And in so many of our communities across the country. So if you look at our community health needs assessment for the various counties we're serving, you know, we've got number one on that list has been mental health. The rise in the need. And we've made a pretty significant investment over the past five years.

00:04:01:28 - 00:04:25:21
Tori Bayless
Now, if you think about that time horizon, that was also the horizon of the global pandemic. And economic adversity and difficulty for hospitals and health systems. And when it's the top priority in your community health needs assessment, we had to find a way to move forward. And we did that with support and cooperation from the counties we're serving in terms of resources they could bring to bear as well.

00:04:25:24 - 00:04:48:22
Tori Bayless
So over the past five years, we opened a new mental health hospital in Annapolis. We built out a new behavioral health pavilion on our Lanham campus. We have also built upon three decades of experience in substance use disorders. But as we think about behavioral health, it's not enough to have, you know, just the intake unit in the E.R. or just the inpatient beds.

00:04:48:22 - 00:05:12:13
Tori Bayless
We've really tried to build a continuum. And when we looked in particular in the Prince George's County area, which is wraps around the DC Beltway, if you will, there were Signifi can gaps and not enough services. So we partnered with the county, and they were able to bring forward capital dollars that could accelerate our investment. We married up of course, our resources as well.

00:05:12:14 - 00:05:38:04
Tori Bayless
We basically renovated what had been a former nursing home building on our campus, basically gutted it, took it down to the studs and built it back up as a behavioral health comprehensive program where we have walk in services, urgent care services. And, you know, it was a screaming need. And, you know, you know, well, sometimes the reimbursement for behavioral health services is not where it needs to be.

00:05:38:04 - 00:06:00:20
Tori Bayless
It's not always valued the same way some other health care services are, whether that's by commercial payers or even our government payers. So we continue to have that dialog to say, let's really put the dollars behind where the greatest need is in the community. So it's a work in progress for sure. We're certainly proud of the work that we've done to open up these additional resources.

00:06:00:22 - 00:06:11:13
Tori Bayless
And it's a journey, but very, very proud of the team and having that full continuum of services rather than just one slice of the behavioral health continuum.

00:06:11:15 - 00:06:31:28
Mindy Estes, M.D.
Where you point out that the continuum is important, and also that behavioral health is a part of all, if not all, many of the chronic diseases that we deal with. So addressing behavioral health issues not only is good in its own right, but really helps in our mission to provide the highest quality, safest care that we possibly can.

00:06:32:01 - 00:06:57:18
Mindy Estes, M.D.
You've made significant investments in developing analytics to guide decisions and track improvement, and we all know that what we measure is where we see improvement and accountability. What types of analytics have been most useful? How do you leverage the information? And can you give an example of where data analytics really has provided what was perhaps an unexpected opportunity?

00:06:57:25 - 00:07:17:26
Tori Bayless
That's a great question, Mindy. You know, I think organizations around the issues of quality and safety, you have to have enough courage to ask the questions, and you've got to be able to back it up with the data. So we've built a central data analytics team. And they are really we've been working in partnership with our clinical leaders across all of the different service lines.

00:07:17:26 - 00:07:43:00
Tori Bayless
So if I look to my lead for maternal and child health services, she has done an incredible job of delving into the data and recognizing disparities in our C-section rates, for example. And you have to study the data to know where to potentially put your interventions. Similarly, our orthopedic team has looked very carefully at surgical outcomes. They've looked at pain management.

00:07:43:03 - 00:08:07:29
Tori Bayless
Our opioid task force has looked at the data in great detail on the primary care side, we're really looking at not just the outcomes that we see, but how do we really get upstream to the issues of prevention and detection and screenings? So we looked at the data on our diabetic populations and how are we meeting the thresholds defined by ourselves defined by payers, defined by NCUA.

00:08:08:02 - 00:08:32:21
Tori Bayless
We also look at our colorectal cancer screening, breast cancer screening, lung cancer screening. And there are times where we've seen disparities we're finding and this shouldn't surprise us given the broad literature that's out there nationally. But some of our detection rates among some populations, more vulnerable population, underserved communities, their cancers are more advanced at the time they're detected.

00:08:32:23 - 00:08:56:06
Tori Bayless
We looked at data across patient experience. We looked at data across ID, wait times. So there are so many ways that we're delving into this. But I started with the example in maternal child health, and we looked at the data again in C-section disparities. And that multi-discipline generic team, through a number of different interventions, were able to reduce the disparity over a five year period.

00:08:56:13 - 00:09:10:18
Tori Bayless
It was from a 12% down to 7%. So more work to go. But it was a very focused work. And over many months and years, time to try to get those results demonstrated.

00:09:10:20 - 00:09:43:25
Mindy Estes, M.D.
You know, just a couple of thoughts come to mind. You know, the courage to ask the question is step one. And I think all of us have been surprised when we'd ask a question. Our answer would have been, absolutely not. This doesn't happen in my organization. But then when you find out that it does, then the multidistrict linear nature of a team that both has leadership but also grassroots folks where the work actually is occurring, I think is a key to really making forward progress and progress quickly.

00:09:44:01 - 00:10:07:12
Mindy Estes, M.D.
And you point out it was a five year journey, you know, and that journey continues. It's one of those things that strikes me the minute you take your foot off the gas, it slows down. So congratulations to you all. We appreciate the examples and the structure that you've shared. I wanted to just pivot a touch and talk about mentorship.

00:10:07:15 - 00:10:21:04
Mindy Estes, M.D.
What advice do you have for seasoned leaders considering a mentorship role for recent graduates? How does all of this come about? Do you identify people? Do mentors fall in your lap? Is it is it deliberate?

00:10:21:07 - 00:10:41:19
Tori Bayless
And I think think for all of us, you know, if we can have mentors, we're going to grow and develop. And that's at every stage of our careers. Even if you're sitting in a role as a chief executive or president of an organization. So to have mentors has always been impactful for my career, but also to be a mentor and mentor and can occur at so many different levels.

00:10:41:25 - 00:11:20:01
Tori Bayless
We've had programs within Luminous Health where we've identified what we'll call our hypo luminary leaders, our high potential leaders, and we've invested in them. But then we also expect them to give back and serve as mentors for others in the organization. At the administrative fellowship level. That's actually how I began my career 30 ish years ago, where I did an administrative fellowship coming out of graduate school, and I found it to be an incredible way to jumpstart a career, get broad exposure to an organization at a very senior level so that through the rest of your career, as you're progressing and growing, you always have that broad view of an organization.

00:11:20:02 - 00:11:46:04
Tori Bayless
So I think I'm in my 14th year of sponsoring administrative fellowships. I'm not the only mentor or preceptor. We have our hospital presidents and other members of executive leadership. We spend considerable time with our fellows. And I think about the generations in the workforce today. And you think about at least four generations in the workforce. And I do firmly believe that the greatest talent exists in every generation.

00:11:46:10 - 00:12:06:13
Tori Bayless
And it's not like the knowledge I can impart to you only, and that it's a one way street there. But to be open and candid and available to any questions these fellows want to ask. And believe me, I'm learning from them. And I don't mean just, you know, how do I save a PDF file or work figure out how to do a zoom poll or things like that?

00:12:06:16 - 00:12:08:04
Mindy Estes, M.D.
What's useful?

00:12:08:06 - 00:12:29:03
Tori Bayless
It's very useful. But they're coming out of these incredible programs, up programs across the country. They've got the latest and greatest research and the professors, what they're hearing and learning in their didactic training, and try to help them translate that in where they can have an impact. And they're not just sitting back as a sponge, observing and learning.

00:12:29:03 - 00:12:49:21
Tori Bayless
They can jump into projects and contribute in a pretty significant way in that fellowship. Yea, and selfishly, I do like to retain them. That's not a guarantee after the fellowship, but we have retained several throughout their careers and those who move on to other organizations. We follow them and track their career progress and remain accessible to them.

00:12:49:24 - 00:13:09:05
Mindy Estes, M.D.
You know, I think we are in health care, lifelong learners and mentorship and having mentees is part of that because you certainly are learning, and it is a two way stream. And something you said, I think is really important as we wrap up this thought in conversation is that, you know, I think we have an obligation to give back.

00:13:09:08 - 00:13:46:20
Mindy Estes, M.D.
Many of us have been very fortunate to have mentors throughout our career, sometimes unlikely mentors, but mentors who have made a great impact. And as you move into senior leadership and later in your career, I really do think it is a given or a privilege to be able to give back and to serve as a mentor. So thank you for sharing how that program works and how you expand to all of your leadership team, because, you know, half of what we do is being able to pick up the phone and talk to somebody and say, how have you tackled this?

00:13:46:23 - 00:13:55:27
Mindy Estes, M.D.
Or this is what I'm thinking. Help me think about the unintended consequences of an action. So thank you for sharing that.

00:13:56:00 - 00:14:18:12
Tori Bayless
Two things. One, that Mindy mentioned, I really value in all of our leaders and particularly young leaders and early careers is their curiosity and inquisitiveness. And I've tried to keep that with me through my career as well. But you're always learning, right? But that and it made me think of your other remark about the data question that we were talking about earlier.

00:14:18:14 - 00:14:42:14
Tori Bayless
And to have the courage to try to get to the right answer and understand where you're starting from. It's that curiosity that comes in and, you know, it's the Ted Lasso video where he talks about be curious, not judgmental. It's a great video clip that I've used in some training, but you can be curious. And even if it's in data that's telling a story that may not be that flattering.

00:14:42:17 - 00:14:57:24
Tori Bayless
We want to be able to really be honest with ourselves and have enough humility to dig in. But that curiosity, I think it's an important thing for all of us. Like as talented and sophisticated as our team members are, there's always room to learn and willing to grow.

00:14:57:27 - 00:15:21:26
Mindy Estes, M.D.
Well said. You know, on that note, I'm going to thank you for sharing your valuable insights and experiences today. You know, our discussion really has not only emphasized the importance of leadership and driving patients safety and equitable care, but just highlighted how innovative strategies and board leadership can transform health care delivery.

00:15:21:28 - 00:15:30:09
Tom Haederle
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