Inside a Quest for Quality: How Safer Care Is Built at Scale

00:00:00:06 - 00:00:16:14
Tom Haederle
Welcome to Advancing Health. CommonSpirit Health is a 2025 finalist for the American Hospital Association's prestigious Quest for Quality Prize. Stay with us and learn more about its winning formula for advancing health.

00:00:16:16 - 00:00:54:13
Kristin Preihs
Hi everyone, I'm Kristin Preihs and welcome to our Quest for Quality episode, where we highlight leaders in health care who are transforming the field through innovation, quality, and patient centered care. Today, we are shining a spotlight on an organization making a big impact at scale. CommonSpirit health, the 2025 finalist of the AHA's Quest for Quality Prize. The prize itself is a prestigious award that highlights hospitals and health care systems doing incredible work in leadership and innovation for others to learn from. And most importantly, they are delivering safe, patient centered and family centered care, partnering with communities to improve patient and safety outcomes.

00:00:54:16 - 00:01:22:29
Kristin Preihs
So today joining us is Dr. Thomas McGinn, a senior executive vice president and chief physician executive at CommonSpirit Health. Tom oversees clinical activities across the system, leads clinical service lines including population health, quality based programings, and supports academic partnerships and research, and is a practicing internal medicine physician and nationally recognized researcher. He's advanced evidence based care across the spectrum, and we are so honored to have him here today.

00:01:23:03 - 00:01:24:00
Kristin Preihs
Welcome.

00:01:24:02 - 00:01:36:05
Thomas McGinn, M.D., MPH
Thank you so much for having me. It's just a real thrill to talk about, you know, the efforts of our team across all of CommonSpirit. We're very proud of the work that we do. So thank you for giving me the opportunity to talk about those efforts and having me here.

00:01:36:08 - 00:01:51:17
Kristin Preihs
Well, you are certainly a leader who I think many can learn from with what you've done at CommonSpirit. So let's start there. I know when I was fortunate to be able to see a little bit of what CommonSpirit has done on our Quest for Quality site visit, you demonstrated some significant leadership with you and your team.

00:01:51:22 - 00:01:56:22
Kristin Preihs
Can you talk a little bit about leadership and quality and patient safety and what that means for the realm of today?

00:01:56:24 - 00:02:16:01
Thomas McGinn, M.D., MPH
So we're a large distributed health system. We're in multiple states, just continuously. So it's a little bit interesting to do this, but I think at each level of our organization, whether it's in our markets or our hospitals, in our regions - at the national level, you know, quality, safety and highest standards have been adopted and are constantly talked about at

00:02:16:01 - 00:02:41:00
Thomas McGinn, M.D., MPH
every executive meeting, every local meeting. And I think when you visited us, you know, from the AHA - which by the way, was an amazing opportunity for us to really, you know, look at what we were doing, think about that thoroughly and actually have experts come in and reflect on our work. Just the process itself was so beneficial and our teams were just excited that they were being looked at, seen and recognized whether we won or not.

00:02:41:00 - 00:02:59:09
Thomas McGinn, M.D., MPH
So the process itself is amazing. I really want to thank the AHA for actually giving us that opportunity. But what was fun for us at that visit was we had our board members there. We were in a local hospital and we could see very clearly what the board was thinking and what the community level people were doing. It was connected.

00:02:59:12 - 00:03:16:06
Thomas McGinn, M.D., MPH
And when you were at a system of this size, that doesn't always happen. You know, we didn't rehearse. It was just the culture from A to Z, from national to market was talking about quality, safety and high standards, reducing variability. And it was it was very evident. It was very exciting for me to see.

00:03:16:14 - 00:03:35:24
Kristin Preihs
Well, I think that's an important piece to talk about and really lean into it at such a large system, how leadership is aligned and scaffolded across all of your different locations and sites. It's something that certainly came across loud and clear at our site visit. And one of the things that we were fortunate to talk about with you and your team was also the evolution of technology, including AI.

00:03:35:24 - 00:04:00:06
Kristin Preihs
But certainly beyond that and how the field has shifted and predictive analytics and technology enabled solutions that improve patient safety. And how, as a leader, you have to identify and lean into areas to engage in that work to improve the broader support of patients, but certainly also engage with the workforce as well. So can you talk a little bit about the evolution of CommonSpirit's technology and how that's had an impact on patient safety and quality?

00:04:00:09 - 00:04:19:05
Thomas McGinn, M.D., MPH
You know, you said all the right things. I think that technology is a double-edged sword. You could jump too quick, the new shiny item, you know what's happening. And when you're this large, you have to be a little bit cautious what you're going to adopt and then disseminate. So we have a very, well-organized governance structure that has everything from legal to finance to clinical.

00:04:19:07 - 00:04:42:07
Thomas McGinn, M.D., MPH
As we adopt, particularly the AI space, it's happening so rapidly. We have weekly meetings as we look at different things coming at us. And of course, as you can imagine, everybody approaches us to say, hey, we've got the best solution for you. And having that ability to do that rapid cycle is critically important. We think about this in the lens of is this back office, front office, is this clinical decision making?

00:04:42:07 - 00:05:01:06
Thomas McGinn, M.D., MPH
Is it prognostic indicators? And depending on what pocket we put it in, we have a different level of scrutiny or evidence that we demand before we actually start even piloting something. So you've got to be eager but cautious at the same time. And that's kind of the trick. So I'm happy to meet people, hear their ideas. But then we do quick notes,

00:05:01:06 - 00:05:02:12
Thomas McGinn, M.D., MPH
we call them.

00:05:02:14 - 00:05:25:22
Kristin Preihs
I love your note on eager but cautious. And I think that's incredibly important for technology and equally for innovation, as I think patenting work is looking differently across the field as, of course, technology, but also really thinking about how you in a culture that continues to evolve so quickly, also allow for a culture of innovation, of spreading of ideas from the front line, from the board to the bedside.

00:05:25:29 - 00:05:55:19
Kristin Preihs
So can you also - you're kind of using and leaning into that phrase, just think about how you create an infrastructure of innovation and how then you scaffold that across the data, resources and technology that you guys all have in place. Because I believe when I was on site, I notated that there was 17 different EHRs feeding into your central quality measure repository, which is significant from a management and an incredibly impressive based on the clinical results that we all seen.

00:05:55:24 - 00:06:04:04
Kristin Preihs
Because you guys have a strong system, I think for others to learn from, for how you idiate and also lean into opportunities to innovate.

00:06:04:06 - 00:06:19:25
Thomas McGinn, M.D., MPH
We have a little bit of a mantra where we're all going to do the same process, we're going to adopt the same technology and we're going to use the same KPIs. So if you think about that process, technology, KPIs, if you're all thinking now, it takes a while to get there. But as we move forward, that's our goal.

00:06:19:27 - 00:06:42:18
Thomas McGinn, M.D., MPH
And if you're on the same process, the same technology, measuring the same KPIs, you can quickly and efficiently adopt new best practices and disseminate those. But if you're on different processes and have different technologies and you're all measuring things in different ways, that is a very difficult position to be in. So that is sort of our North Star. You know, this issue of the EHRs

00:06:42:18 - 00:07:01:20
Thomas McGinn, M.D., MPH
and we have 17 and I really thank my IT colleagues because we are rolling out one EHR. Every six months, we're kind of reducing that variability and the fragmentation of our data. However, at the same time, we have to win today and be excellent today, even though it's going to be 2 to 3 year roadmap. And that's all the hard work that you just talked about.

00:07:01:20 - 00:07:27:15
Thomas McGinn, M.D., MPH
The data normalization, the proper use of dashboards, which really to me means clinicians are in the moment thinking about what that dashboard should look like to help them. We often get dashboards, we're like, this doesn't help me. So how are the clinicians iterating on those dashboards? I've never had a dashboard that was done. I mean, if you're really working with a dashboard, there's a back and forth with the clinical frontlines about how it's being used, what's not being used.

00:07:27:18 - 00:07:41:11
Thomas McGinn, M.D., MPH
So it's a lot of hard work. The first win makes the second win easier and the third one even easier. You know, that normalization process gets a little bit easier every time you do it. And then hopefully on the back end we're reducing the amount of EMRs we're doing so it even gets easier.

00:07:41:13 - 00:08:04:11
Kristin Preihs
And I think what you're describing also really lends into the broader environment you've all built around creating a culture of continuous improvement. That you identify something, you try it, you iterate, you learn what happened, and you continue the cycle from there. And we all certainly felt that while we were on site that folks were interested able, based on data to try new things and to identify different solutions.

00:08:04:14 - 00:08:21:12
Kristin Preihs
Can you also talk about, again, based on your size, how that culture of continuous improvement, in addition to identifying and making improvements across dashboards, really went to the culture that is very evident at CommonSpirit of continuous quality improvement and using data to inform improvements for culture.

00:08:21:15 - 00:08:45:00
Thomas McGinn, M.D., MPH
One good example that pops to mind is the RPA process that we have on screening for cancer. And this again, same process, same technology, same KPIs. A group in the Pacific Northwest. We have five regions. We're looking at the big three cancers: breast, colon and lung cancer screening and how constant changes were happening in the screening guidelines.

00:08:45:05 - 00:09:12:19
Thomas McGinn, M.D., MPH
So some were age, genetics, family history, all these things were changing. And a busy, you know, primary care provider was having a hard time. These bots actually scrub the charts pre-visit and look for the different risk factors and hand up to the primary care provider. Would you like to send this screening colonoscopy, this mammogram? And we just saw a huge lift in our calling, particularly in colonoscopy which is one of the more difficult areas to kind of break into.

00:09:12:21 - 00:09:34:01
Thomas McGinn, M.D., MPH
So we got together and we decided, okay, this is best practice. How do we now take that from...actually, it was an Epic environment to a Cerner environment to other environments. And now we're rolling that out across the entire health system and that just gets all of our people so excited, right? Because we're sharing best practices, we're learning from each other and we're saving lives, you know, in a real, real, concrete, measurable way.

00:09:34:04 - 00:09:44:09
Thomas McGinn, M.D., MPH
And once you get a win like that, the next one is like, okay, let's do it again. The hard work of data normalization, technology shifts, people kind of push through those things and get excited.

00:09:44:12 - 00:10:02:02
Kristin Preihs
Certainly agree. And it's such a good example for the field to learn from. Technically process and people where to start and how to continue to scale up your quality management system from there. Your organization is so incredible, and I think there's so many facets that the realm of quality can learn from in the field.

00:10:02:03 - 00:10:19:07
Kristin Preihs
And as you went through the site visit, as you mentioned, and prepared for the Quest for Quality award, I'd love to hear from you advice you have for future leaders in the field, future organizations, as they consider or are just beginning their own quest towards excellence on what you might recommend as they continue that journey.

00:10:19:09 - 00:10:44:23
Thomas McGinn, M.D., MPH
I would strongly encourage, no matter where you are in your journey, to think about participating in this process, because I think the process onto itself is a learning curve for everybody. And it enables you to get feedback from AHA and from other experts around the country. And actually some of the feedback is like, honestly, some of our feedback, I was like, wow, I don't know, were that good, which is really nice to have, right?

00:10:44:23 - 00:11:02:02
Thomas McGinn, M.D., MPH
Someone said, you know, you're pretty good. And we're like, oh, I didn't know we were that good. And obviously then you get feedback on where you could you can make some improvements and some changes. And I think that process is invaluable. Because how often do you get an objective. And what's the downside of participating? It's very little,

00:11:02:02 - 00:11:11:19
Thomas McGinn, M.D., MPH
right? It's not like a rating agency or you know, it's not US news, but it's really looking at you and trying to trying to help you get better and smarter.

00:11:11:21 - 00:11:42:18
Kristin Preihs
Thank you so much, Tom. It's been fantastic having you and hearing your perspective on leading quality and safety, and certainly on innovation at CommonSpirit. The work you and your teams are doing from improving patient safety outcomes to implementing system wide solutions is nothing short of remarkable. Truly, it's been energizing to hear how from leadership to technology to data to continuous quality improvement, you all are a good point to reference as excellence and for others to pick up the phone and learn a little bit more.

00:11:42:20 - 00:12:01:04
Kristin Preihs
And if the quest for quality prize is on your radar, check out the AHA website or the show notes to learn how your organization could be recognized for its impact. On behalf of AHA, I just want to say thank you for taking the time on this podcast. Thank you for applying for and being awarded the Quest for Quality as a runner up, and we can't wait to hear more from you in the future.

00:12:01:06 - 00:12:18:23
Thomas McGinn, M.D., MPH
Again, I want to thank you for, you know, letting me have the opportunity to talk about my amazing team and all the frontline workers, our nurses, all the staff across all of CommonSpirit, you know, hats off to them for jumping on board and really tackling this as one CommonSpirit, as one big health system.

00:12:18:26 - 00:12:27:06
Tom Haederle
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