1 00:00:05,275 --> 00:00:07,325 - This is the Becker's Healthcare Podcast, created 2 00:00:07,325 --> 00:00:08,445 by the team of Becker's Healthcare, 3 00:00:08,605 --> 00:00:10,365 a multimedia company devoted to the people 4 00:00:10,385 --> 00:00:11,645 who power us healthcare. 5 00:00:11,955 --> 00:00:14,765 Four new 15 minute episodes are released daily containing 6 00:00:14,965 --> 00:00:16,725 industry news analysis and thought leadership. 7 00:00:16,725 --> 00:00:19,605 From powerful healthcare decision makers Support our show 8 00:00:19,745 --> 00:00:22,565 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,785 --> 00:00:24,045 or other platforms you use. 10 00:00:24,195 --> 00:00:26,005 It's a chance to tell us what you like about the show 11 00:00:26,065 --> 00:00:27,285 and act on your feedback. 12 00:00:27,285 --> 00:00:29,245 Thanks for listening. Now here's the episode. 13 00:00:30,435 --> 00:00:31,605 - Welcome everyone, 14 00:00:31,605 --> 00:00:33,525 to the Becker's Healthcare podcast series. 15 00:00:33,685 --> 00:00:34,965 I am Mariah Mohammed, writer 16 00:00:34,985 --> 00:00:36,645 and moderator with Becker's Healthcare, 17 00:00:37,065 --> 00:00:39,845 and I'm absolutely thrilled to have with me today Dr. 18 00:00:39,875 --> 00:00:43,205 Elizabeth Mort, former senior vice president of Quality 19 00:00:43,265 --> 00:00:45,205 and Safety at Mass General Hospital, 20 00:00:45,625 --> 00:00:47,445 and current primary care physician 21 00:00:47,545 --> 00:00:49,845 and associate professor of medicine 22 00:00:49,865 --> 00:00:52,485 and healthcare policy at Harvard Medical School. 23 00:00:52,545 --> 00:00:54,485 Doctor, it's very nice to have you on the podcast today. 24 00:00:54,505 --> 00:00:55,505 How are you? 25 00:00:56,315 --> 00:00:58,895 - I'm doing well, and thanks so much for having me, 26 00:00:58,895 --> 00:01:00,135 Mariah. I am thrilled to be here. 27 00:01:00,565 --> 00:01:02,055 - Yeah, of course. Um, 28 00:01:02,465 --> 00:01:04,495 today we will be discussing patient safety. 29 00:01:04,955 --> 00:01:07,855 So the first question I really wanted to ask you is, uh, 30 00:01:07,995 --> 00:01:10,655 you were one of the senior authors on the safety 31 00:01:10,995 --> 00:01:15,215 or in the Safe Care study published in January of 2023, uh, 32 00:01:15,355 --> 00:01:17,135 in the NEJM. 33 00:01:17,395 --> 00:01:19,295 Can you remind us of the headlines 34 00:01:19,315 --> 00:01:20,975 and comment on the current state 35 00:01:21,275 --> 00:01:23,015 of patient safety in the US now? 36 00:01:24,705 --> 00:01:27,505 - Absolutely. And let, uh, I'll give you the headlines. 37 00:01:27,505 --> 00:01:28,505 They're a bit sobering. 38 00:01:28,645 --> 00:01:31,065 Um, and I wanna start by saying that despite the fact 39 00:01:31,065 --> 00:01:33,905 that the headlines were sobering, I remain optimistic 40 00:01:34,095 --> 00:01:35,785 that there is a way forward. 41 00:01:36,705 --> 00:01:39,225 I do believe we need to raise the bar on performance. 42 00:01:39,225 --> 00:01:41,305 The headline suggests we have room to move there, 43 00:01:41,645 --> 00:01:44,265 and I also think we need to lower the bar on transparency 44 00:01:44,445 --> 00:01:46,545 to promote more learning and improvement. 45 00:01:47,125 --> 00:01:49,145 So the results of the study that you mentioned 46 00:01:49,145 --> 00:01:52,025 that were published in January, 2023 in the New England 47 00:01:52,025 --> 00:01:56,025 Journal, we looked at, uh, patients hospitalized in 11 48 00:01:56,535 --> 00:01:59,105 Harvard affiliated Massachusetts hospitals. 49 00:01:59,325 --> 00:02:01,625 And that was in 2018, so before the pandemic. 50 00:02:02,605 --> 00:02:05,385 And we found that adverse events occurred in a quarter 51 00:02:05,405 --> 00:02:06,745 of hospital admissions, 52 00:02:06,845 --> 00:02:09,825 and our reviewers deemed that 23% 53 00:02:09,845 --> 00:02:11,345 of those events were preventable. 54 00:02:11,925 --> 00:02:14,385 Now, our results, uh, were not in isolation. 55 00:02:14,475 --> 00:02:16,905 There were similar to results reported by the office 56 00:02:16,925 --> 00:02:18,145 of the Inspector General. 57 00:02:18,765 --> 00:02:21,465 And that study was looking at the same year, 58 00:02:21,605 --> 00:02:24,385 the same performance year 2018 pre pandemic. 59 00:02:24,925 --> 00:02:27,385 And that study was looking at just Medicare patients. 60 00:02:28,095 --> 00:02:31,745 They found that a quarter of those patients experienced harm 61 00:02:31,745 --> 00:02:33,145 during their hospital stays. 62 00:02:33,565 --> 00:02:37,265 And physician reviewers in that study, judge that 43% 63 00:02:37,565 --> 00:02:39,505 of the adverse events were preventable. 64 00:02:39,505 --> 00:02:41,465 So a higher percentage 65 00:02:41,465 --> 00:02:44,225 of preventable events in an older population. 66 00:02:45,085 --> 00:02:48,945 And then the last study I'll just mention to describe sort 67 00:02:48,945 --> 00:02:53,185 of the state of affairs is that CMS leaders reported 68 00:02:53,215 --> 00:02:55,265 that in the early part of the pandemic, 69 00:02:55,405 --> 00:02:58,985 so now we're looking at 2020, uh, nationally, 70 00:02:59,135 --> 00:03:02,715 we had seen some slippage in our performance on common 71 00:03:02,935 --> 00:03:04,035 safety indicators, 72 00:03:04,345 --> 00:03:06,675 central line associated bloodstream infections, 73 00:03:07,275 --> 00:03:09,475 catheter associated UTIs, et cetera. 74 00:03:10,375 --> 00:03:15,115 So the news from 2018 and 2020 was sobering. 75 00:03:15,975 --> 00:03:18,515 And these headlines, I would say the headlines were out 76 00:03:18,515 --> 00:03:20,795 there, people listened, people in healthcare listened, 77 00:03:20,935 --> 00:03:21,995 and they were a gut punch. 78 00:03:22,105 --> 00:03:23,875 They were a gut punch for the industry. 79 00:03:24,415 --> 00:03:26,475 And I think what's going on now is people 80 00:03:26,495 --> 00:03:27,515 are digesting that. 81 00:03:27,515 --> 00:03:30,755 They're, they're meeting those, uh, headlines with a range 82 00:03:30,755 --> 00:03:32,915 of emotions from disappointment, frustration, 83 00:03:33,005 --> 00:03:34,075 shame, and even anger. 84 00:03:34,815 --> 00:03:38,235 But the good news is, is that people are moving on 85 00:03:38,535 --> 00:03:40,315 and moving toward action. 86 00:03:41,565 --> 00:03:42,975 - Yeah, absolutely. Thank you so much 87 00:03:42,995 --> 00:03:44,255 for sharing that information. 88 00:03:44,875 --> 00:03:46,815 Uh, are there any signs 89 00:03:46,845 --> 00:03:49,375 that the healthcare industry is acting on the message? 90 00:03:50,855 --> 00:03:52,335 - Absolutely. Um, there have been 91 00:03:52,335 --> 00:03:55,535 so many exciting things happening this year. 92 00:03:56,075 --> 00:03:59,615 Uh, the study that I mentioned came out in January of 2023, 93 00:04:00,195 --> 00:04:02,135 and through the years, uh, through the months 94 00:04:02,135 --> 00:04:03,815 of 2023, a lot's happened. 95 00:04:04,205 --> 00:04:07,175 Perhaps one of the most exciting things is the President's 96 00:04:07,175 --> 00:04:10,575 Council of Advisors on science and technology known as PCA. 97 00:04:10,965 --> 00:04:14,455 They put out a report late summer on the transformational 98 00:04:14,455 --> 00:04:15,815 effort on patient safety. 99 00:04:16,005 --> 00:04:17,455 Very exciting activities. 100 00:04:17,995 --> 00:04:19,615 Uh, CMS put out, uh, 101 00:04:19,615 --> 00:04:22,735 some guidance on governance and leadership. 102 00:04:23,475 --> 00:04:25,935 Um, governance and leadership arguably are 103 00:04:26,615 --> 00:04:30,215 critical in getting an organization focused on doing the 104 00:04:30,215 --> 00:04:32,495 right things, prioritizing the right things. 105 00:04:33,275 --> 00:04:34,935 The Joint Commission has also 106 00:04:35,215 --> 00:04:38,015 provided guidance on qapi, they call it, um, 107 00:04:38,385 --> 00:04:42,095 which is really looking at how we organize our institutions 108 00:04:42,435 --> 00:04:45,855 for constant improvement of care board to bedside. 109 00:04:46,595 --> 00:04:49,135 And the joint commission's also put out incredibly important 110 00:04:49,725 --> 00:04:52,975 information and guidance on equity, sustainability 111 00:04:53,075 --> 00:04:55,255 and an increased focus on outcomes. 112 00:04:56,115 --> 00:04:59,775 The A-H-A-A-H-R-Q are both putting out important efforts 113 00:05:00,355 --> 00:05:03,575 to work on learning organizations, collaboratives 114 00:05:03,575 --> 00:05:04,695 to advance performance. 115 00:05:05,435 --> 00:05:08,895 And as we speak, uh, the CMS is, uh, 116 00:05:08,895 --> 00:05:11,175 looking at measures under consideration. 117 00:05:11,435 --> 00:05:14,255 Um, and there's an exciting measure being reviewed 118 00:05:14,255 --> 00:05:17,215 to look at patient safety, uh, there as well. 119 00:05:17,835 --> 00:05:20,095 Of course, organizations like IHI 120 00:05:20,155 --> 00:05:21,935 and the National Patient Safety Foundation, 121 00:05:21,935 --> 00:05:24,775 who've been leaders in this area for decades, continue 122 00:05:25,155 --> 00:05:28,415 to sound, sound the alarm, and get the playbooks out 123 00:05:28,475 --> 00:05:31,455 and support organizations in this important journey. 124 00:05:32,075 --> 00:05:36,295 So there are many, many signs from high leverage, 125 00:05:36,645 --> 00:05:39,815 influential organizations, many signs that 126 00:05:40,565 --> 00:05:42,695 they hear the message, they get the message, 127 00:05:43,235 --> 00:05:46,855 and there are playbooks out there, the challenges now, how 128 00:05:46,975 --> 00:05:48,695 to get the playbooks in the right hands 129 00:05:48,995 --> 00:05:52,815 and get everyone focused on organizing their agendas, 130 00:05:52,815 --> 00:05:54,695 their goals, and getting the work done. 131 00:05:56,695 --> 00:05:58,505 - That's wonderful. Thank you so much for, 132 00:05:58,805 --> 00:06:00,145 you know, sharing that. 133 00:06:00,605 --> 00:06:03,585 Um, kind of moving to recommendations for action. 134 00:06:04,005 --> 00:06:05,465 Is there anything that you can think of 135 00:06:05,465 --> 00:06:06,585 that the boards can do 136 00:06:08,055 --> 00:06:09,055 - Well? 137 00:06:09,055 --> 00:06:12,265 Absolutely. And some of the, uh, recommendations, uh, 138 00:06:12,265 --> 00:06:14,865 coming out of these important national organizations 139 00:06:14,865 --> 00:06:18,705 that I just mentioned are focused exactly at the boards. 140 00:06:19,445 --> 00:06:22,185 Uh, boards vary tremendously in the type 141 00:06:22,185 --> 00:06:25,305 of healthcare organization they are governing. 142 00:06:25,965 --> 00:06:30,385 Um, however, they have incredible influence on 143 00:06:30,385 --> 00:06:32,745 what the organization, uh, is doing, 144 00:06:32,845 --> 00:06:34,985 how they're prioritizing, how they're investing, 145 00:06:34,985 --> 00:06:36,985 what they're holding themselves accountable for. 146 00:06:37,725 --> 00:06:40,265 Um, and you know, what they say, it starts at the top, 147 00:06:40,725 --> 00:06:42,705 and that's true with, uh, patient safety. 148 00:06:43,445 --> 00:06:46,745 So, um, the, the word out is certainly out there 149 00:06:46,855 --> 00:06:50,385 that boards need to improve their, uh, competency, 150 00:06:50,385 --> 00:06:53,665 their understanding of patient safety and quality. 151 00:06:54,325 --> 00:06:56,625 Um, and there's lots of playbooks out there as well. 152 00:06:56,845 --> 00:06:58,785 But basically, boards need to be educated. 153 00:06:59,245 --> 00:07:01,025 We need to have the right people on the boards. 154 00:07:01,175 --> 00:07:03,465 They need to understand what their job is, they need 155 00:07:03,465 --> 00:07:04,785 to understand what the issues are. 156 00:07:05,525 --> 00:07:08,945 And, um, once that happens, then they can be in a position 157 00:07:08,965 --> 00:07:10,665 to help do their job, which is 158 00:07:10,665 --> 00:07:13,985 to govern the organization's operations 159 00:07:14,525 --> 00:07:17,585 and ensure that a healthcare organization is doing 160 00:07:17,585 --> 00:07:18,585 what it's there to do, 161 00:07:18,995 --> 00:07:21,705 which is give every single patient the opportunity 162 00:07:21,705 --> 00:07:24,465 to have the best healthcare outcomes for them. 163 00:07:24,925 --> 00:07:26,825 And that includes safe care. 164 00:07:27,405 --> 00:07:31,585 So board activation, board education, board alignment 165 00:07:32,205 --> 00:07:34,825 and board activity is really, really important. 166 00:07:35,245 --> 00:07:36,245 It starts at the top. 167 00:07:39,305 --> 00:07:41,155 - Yeah, I completely, completely agree. 168 00:07:41,155 --> 00:07:42,355 It definitely starts at the top. 169 00:07:42,855 --> 00:07:45,595 Um, but kind of moving down the ladder, what about c-Suite 170 00:07:45,615 --> 00:07:46,915 and, uh, senior leaders? 171 00:07:47,825 --> 00:07:49,635 - Yeah, so important, Mariah. 172 00:07:49,735 --> 00:07:51,555 You know, I think we're do, we've heard a lot 173 00:07:51,555 --> 00:07:53,395 of conversation over the years 174 00:07:53,695 --> 00:07:57,875 and it's been, um, amplified this year, uh, for sure. 175 00:07:58,535 --> 00:08:02,315 Uh, but I do think the board needs the c-suite, um, 176 00:08:02,855 --> 00:08:07,635 to be at the ready, um, to help them understand 177 00:08:07,635 --> 00:08:10,275 what the issues are for quality, for safety, for equity, 178 00:08:10,335 --> 00:08:12,315 for disparities, all these important issues. 179 00:08:12,895 --> 00:08:15,835 So the C-Suite really also needs to be activated as well, 180 00:08:16,415 --> 00:08:18,035 and they are key key players. 181 00:08:18,655 --> 00:08:21,675 So, you know, since the Institute of Medicine report in, 182 00:08:21,775 --> 00:08:23,755 at the turn of the century, we've seen 183 00:08:24,755 --> 00:08:26,875 functions develop in the C-suite, quality 184 00:08:26,935 --> 00:08:28,075 and safety functions. 185 00:08:28,335 --> 00:08:31,115 And that's great because now we have infrastructure, 186 00:08:31,175 --> 00:08:33,715 we have reporting, we have all sorts 187 00:08:33,715 --> 00:08:35,075 of improvement activities, 188 00:08:35,075 --> 00:08:37,235 we have high reliability approaches, lots 189 00:08:37,235 --> 00:08:38,275 of different tactics 190 00:08:38,655 --> 00:08:42,315 and strategies, um, for advancing healthcare quality, 191 00:08:43,345 --> 00:08:44,745 I think it's time that we sort 192 00:08:44,745 --> 00:08:46,585 of play ball across the c-suite 193 00:08:46,685 --> 00:08:48,905 and ensure that every single 194 00:08:49,735 --> 00:08:52,905 c-suite leader understands what her 195 00:08:53,005 --> 00:08:57,685 or his accountability is for quality and patient safety. 196 00:08:58,505 --> 00:09:00,245 So the quality leader, 197 00:09:00,785 --> 00:09:02,845 and sometimes there's a separate quality leader. 198 00:09:02,845 --> 00:09:06,165 Sometimes the quality leader is embedded in a Chief Medical 199 00:09:06,195 --> 00:09:08,925 officer role, or chief nursing officer role, 200 00:09:09,145 --> 00:09:10,645 or chief operating officer role. 201 00:09:11,065 --> 00:09:14,725 But each one of those c-suite leaders, including HR 202 00:09:14,725 --> 00:09:16,975 and others, has an accountability 203 00:09:16,995 --> 00:09:20,055 for improving patient safety that needs to be articulated. 204 00:09:20,285 --> 00:09:23,615 That playbook needs to be written with, uh, more, uh, 205 00:09:23,615 --> 00:09:25,415 intention and clarity. 206 00:09:26,075 --> 00:09:29,655 And I think that will go a long way towards taking 207 00:09:29,805 --> 00:09:31,615 what the board is expecting 208 00:09:32,595 --> 00:09:35,015 and making sure that every single person 209 00:09:35,155 --> 00:09:38,575 who has a responsibility for hiring, managing, delivering, 210 00:09:39,125 --> 00:09:41,775 improving care, understands what he 211 00:09:41,795 --> 00:09:44,255 or she can do to advance that. 212 00:09:44,655 --> 00:09:46,575 I think we need to do some more work in the c-suite. 213 00:09:46,735 --> 00:09:48,215 I think we need to do some more work in the 214 00:09:48,215 --> 00:09:49,855 c-suite critical group. 215 00:09:51,145 --> 00:09:52,715 - Yeah, definitely critical group. 216 00:09:52,935 --> 00:09:56,635 And I know the C-suite is always, you know, uh, trying 217 00:09:56,635 --> 00:09:57,915 to figure out what positions 218 00:09:57,915 --> 00:09:59,755 and titles are needed at this very moment. 219 00:10:00,375 --> 00:10:03,435 Um, if we can change, uh, the group a bit. 220 00:10:03,465 --> 00:10:08,075 What about the frontline caregivers, doctors, apps, nurses, 221 00:10:08,145 --> 00:10:10,195 technicians and staff, anyone 222 00:10:10,195 --> 00:10:13,115 who really touches a PA patient, do you have any recommend, 223 00:10:13,135 --> 00:10:14,755 uh, recommendations for action there? 224 00:10:15,815 --> 00:10:16,995 - Oh, yes, of course. 225 00:10:17,865 --> 00:10:20,875 Anybody who touches a patient has a role 226 00:10:21,175 --> 00:10:22,955 and they have a job description, they were hired 227 00:10:22,955 --> 00:10:23,955 to do something specific. 228 00:10:24,455 --> 00:10:28,155 And I would like to see that in every single description 229 00:10:28,155 --> 00:10:31,875 of a role, in every single job description, it's super clear 230 00:10:32,175 --> 00:10:35,835 to that individual what their role is 231 00:10:36,495 --> 00:10:40,315 in making care better and in their orientation 232 00:10:40,615 --> 00:10:43,755 and in their management, and in their annual reviews 233 00:10:43,855 --> 00:10:47,735 and reward that they are rewarded for advancing 234 00:10:48,555 --> 00:10:50,335 not just their piece, but they understand 235 00:10:50,395 --> 00:10:52,295 how their piece advances the goal 236 00:10:52,295 --> 00:10:53,935 of the organization, right? 237 00:10:53,995 --> 00:10:56,335 The goal of the organization is to deliver healthcare 238 00:10:56,715 --> 00:10:58,455 and give every patient the opportunity 239 00:10:58,475 --> 00:11:00,535 to get the best outcome for him or her. 240 00:11:00,535 --> 00:11:04,375 Right. So, you know, there's a story that I, I mean, 241 00:11:04,455 --> 00:11:07,055 I remember this story for, for, from decades ago, 242 00:11:07,475 --> 00:11:09,015 but I've been telling it more lately 243 00:11:09,015 --> 00:11:12,295 because I think a lot of, uh, younger folks have, 244 00:11:12,325 --> 00:11:13,455 haven't heard the story, 245 00:11:14,115 --> 00:11:17,695 but it's the story of President Kennedy's 1962 visit 246 00:11:17,755 --> 00:11:19,055 to the NASA Space Center, 247 00:11:19,835 --> 00:11:20,855 and he noticed sort 248 00:11:20,855 --> 00:11:23,735 of an environmental health worker carrying a broom working 249 00:11:23,835 --> 00:11:25,615 on, uh, his shift. 250 00:11:26,635 --> 00:11:29,135 And, uh, president Kennedy interrupted his tour 251 00:11:29,135 --> 00:11:30,295 and walked over to the man 252 00:11:30,295 --> 00:11:32,575 and said, hi, I am Jack Kennedy, what are you doing? 253 00:11:33,435 --> 00:11:35,095 And the individual said, well, Mr. 254 00:11:35,095 --> 00:11:38,055 President, I'm helping put a man on the moon. 255 00:11:38,835 --> 00:11:42,695 So that's more or less the story, uh, that people talk about 256 00:11:42,915 --> 00:11:47,735 to illustrate how each individual has something to do, 257 00:11:48,515 --> 00:11:51,375 and that individual understand how it relates 258 00:11:51,395 --> 00:11:53,325 to the organization's mission. 259 00:11:54,385 --> 00:11:57,765 So, you know, if we could get the board and the C-suite 260 00:11:57,785 --> 00:12:01,645 and the managers organized around what the goal 261 00:12:01,645 --> 00:12:04,525 of the organization is, what its mission, what its reason 262 00:12:04,585 --> 00:12:07,845 for being is, and then understand each individual's role 263 00:12:07,845 --> 00:12:10,925 and responsibility all the way down to those people 264 00:12:11,145 --> 00:12:14,365 who touch the patient, a doctor an a PPA nurse, 265 00:12:15,005 --> 00:12:16,565 a technician, a medical assistant, 266 00:12:17,105 --> 00:12:19,565 and they understand, oh, we're here to improve outcomes 267 00:12:19,665 --> 00:12:22,085 and my job is X, Y, or Z. 268 00:12:22,935 --> 00:12:24,075 That's very doable. 269 00:12:24,455 --> 00:12:26,475 And I think with that kind of an alignment 270 00:12:26,775 --> 00:12:29,755 of every single person around, I mean, 271 00:12:29,765 --> 00:12:32,275 could you imagine a better, a better mission 272 00:12:32,295 --> 00:12:34,835 of an organization now, help help people get well, 273 00:12:35,095 --> 00:12:36,515 to help people enjoy their lives. 274 00:12:37,375 --> 00:12:38,835 And I think that's cultural work, 275 00:12:38,935 --> 00:12:41,115 but it's also some, you know, nuts and bolts 276 00:12:41,115 --> 00:12:42,235 and some tactical work 277 00:12:42,235 --> 00:12:44,075 around job descriptions and management. 278 00:12:44,615 --> 00:12:47,035 But I, I do think that it's all doable, 279 00:12:47,655 --> 00:12:50,035 and I think we need to do some more work there as well. 280 00:12:51,415 --> 00:12:54,075 And I think it will be work, work well worth doing. 281 00:12:56,575 --> 00:12:58,545 - Yeah, absolutely. I completely agree there. 282 00:12:59,165 --> 00:13:01,505 How important would you say culture is in this 283 00:13:01,505 --> 00:13:03,545 entire situation? Does it really matter? 284 00:13:04,045 --> 00:13:05,545 - Oh, gosh, yes. Mariah, you know, 285 00:13:05,545 --> 00:13:06,905 culture's kind of the wraparound. 286 00:13:07,445 --> 00:13:09,345 So you know, you go the board to the bedside 287 00:13:09,525 --> 00:13:11,825 and then watch the wraparound milieu. 288 00:13:11,855 --> 00:13:14,905 What is business as usual in that organization? 289 00:13:15,285 --> 00:13:17,945 And when I visit organizations, I look for certain things 290 00:13:17,945 --> 00:13:20,265 that are kind of cultural cues as to 291 00:13:20,265 --> 00:13:21,745 how the organization is working. 292 00:13:22,285 --> 00:13:23,745 You can watch things in the hallway, 293 00:13:23,885 --> 00:13:25,625 you can watch things in the patient care unit 294 00:13:25,625 --> 00:13:27,905 or the operating room, or the ambulatory center 295 00:13:28,245 --> 00:13:31,465 or the waiting rooms, and you can kind of get a sense for 296 00:13:31,465 --> 00:13:33,385 what the culture is like in the organization. 297 00:13:34,125 --> 00:13:36,185 So, uh, it's a complicated topic, 298 00:13:36,365 --> 00:13:37,865 and yet it's so foundational. 299 00:13:38,485 --> 00:13:40,625 And, um, I think when it comes to culture, 300 00:13:40,765 --> 00:13:42,225 and when it comes to patient safety, 301 00:13:42,815 --> 00:13:45,705 what you wanna see in an organization is 302 00:13:45,705 --> 00:13:49,825 that people are habitually doing those behaviors 303 00:13:50,095 --> 00:13:52,105 that promote patient safety. 304 00:13:52,895 --> 00:13:54,755 And clinically, I mean, these are the things 305 00:13:54,755 --> 00:13:57,155 that we talk about with the National Patient Safety 306 00:13:57,155 --> 00:13:58,435 Goals and the Joint Commission. 307 00:13:59,055 --> 00:14:01,875 Are people doing timeout before procedures every time? 308 00:14:02,615 --> 00:14:04,155 Are people using hand hygiene 309 00:14:04,285 --> 00:14:05,515 every time they're supposed to? 310 00:14:06,095 --> 00:14:08,275 Are they using closed loop communication? 311 00:14:08,895 --> 00:14:11,395 So there are things that we know should be done 312 00:14:11,815 --> 00:14:13,155 to promote patient safety. 313 00:14:13,735 --> 00:14:15,115 And many of those things are habits. 314 00:14:16,015 --> 00:14:17,875 And you can walk around and you can observe 315 00:14:17,875 --> 00:14:19,475 and you can talk to people, and you can get a sense, 316 00:14:19,475 --> 00:14:21,075 you can also measure safety culture. 317 00:14:21,075 --> 00:14:22,475 They're tools out there now 318 00:14:22,985 --> 00:14:25,075 that increasingly healthcare organizations are 319 00:14:25,075 --> 00:14:26,235 using to help drive that. 320 00:14:26,695 --> 00:14:29,355 But ultimately, it sort of circles back to what we started 321 00:14:29,385 --> 00:14:30,915 with, which is governance. 322 00:14:31,665 --> 00:14:35,595 What is the board really, um, governing and overseeing? 323 00:14:35,825 --> 00:14:37,275 What is the c-suite talking about? 324 00:14:37,275 --> 00:14:38,515 What is the c-suite doing? 325 00:14:38,975 --> 00:14:41,675 How are they hiring folks, organizing, managing, 326 00:14:41,905 --> 00:14:43,275 operating, rewarding? 327 00:14:43,935 --> 00:14:47,195 So a, a culture is key. It's absolutely key. 328 00:14:47,495 --> 00:14:50,435 And I believe that a focus on safety culture, 329 00:14:50,755 --> 00:14:53,485 a focus on workforce safety, a focus on just culture. 330 00:14:54,185 --> 00:14:55,805 Uh, these are words that have meaning. 331 00:14:56,145 --> 00:14:57,805 We won't have the time to go into them, 332 00:14:57,985 --> 00:15:01,885 but, um, without a focus on workforce safety, 333 00:15:01,915 --> 00:15:05,045 without a focus on just culture, without a focus on reward 334 00:15:05,045 --> 00:15:06,365 and recognition for the right things, 335 00:15:07,065 --> 00:15:09,125 we won't get the most out of our organizations. 336 00:15:09,585 --> 00:15:12,685 And that would be a shame if we don't start working on 337 00:15:12,685 --> 00:15:16,365 that now and continuing to develop great models 338 00:15:16,705 --> 00:15:18,645 for safe cultures in our organizations. 339 00:15:20,625 --> 00:15:22,995 - Yeah, definitely. I completely understand 340 00:15:22,995 --> 00:15:24,235 what you're talking about there. 341 00:15:24,495 --> 00:15:26,755 Doctor, before I let you go, the last thing I wanted 342 00:15:26,755 --> 00:15:29,995 to ask you very quickly is, do you have anything 343 00:15:29,995 --> 00:15:31,515 to say about ai? 344 00:15:31,725 --> 00:15:33,875 Where can these new tools kind 345 00:15:33,875 --> 00:15:35,555 of help us in this entire situation? 346 00:15:36,545 --> 00:15:41,275 - Well, AI for sure is giving everybody, um, great optimism. 347 00:15:41,815 --> 00:15:44,835 And I think pretty much everyone has experienced AI in 348 00:15:44,835 --> 00:15:47,555 healthcare in one way or another already. 349 00:15:48,215 --> 00:15:51,075 And what I'm seeing is, uh, excitement 350 00:15:51,135 --> 00:15:52,595 and even I would say joy. 351 00:15:53,295 --> 00:15:56,275 Um, I went to a session where there was a debate 352 00:15:56,275 --> 00:15:58,555 between an expert and an AI tool, 353 00:15:58,895 --> 00:16:00,595 and they were trying to make a diagnosis 354 00:16:01,295 --> 00:16:03,355 and, um, it was, it was so fun. 355 00:16:03,695 --> 00:16:07,875 Uh, actually the expert, uh, got it first, uh, 356 00:16:07,935 --> 00:16:09,515 but the AI tool was pretty good. 357 00:16:10,015 --> 00:16:12,995 And, uh, that gives, I think, people great optimism that, 358 00:16:13,455 --> 00:16:16,515 um, as smart as providers are, doctors, nurses, apps, 359 00:16:16,765 --> 00:16:19,515 other folks, as much as we can keep in our brains, 360 00:16:19,675 --> 00:16:22,075 I think there's gonna be an opportunity for those brains 361 00:16:22,075 --> 00:16:25,395 to be complimented with AI tools that will, you know, 362 00:16:25,395 --> 00:16:28,755 reduce diagnostic error potentially, and make care safer. 363 00:16:29,305 --> 00:16:31,675 Another, another example that really has, uh, 364 00:16:31,825 --> 00:16:34,795 I've seen people get so excited and we need excitement. 365 00:16:34,815 --> 00:16:37,915 We need joy. We need people to wanna love to go to work 366 00:16:37,915 --> 00:16:39,795 and feel like they're working at the top of their license. 367 00:16:40,335 --> 00:16:42,835 And that's these ambient listening tools. 368 00:16:43,655 --> 00:16:47,035 Um, ambient listening isn't a AI alone, um, 369 00:16:47,095 --> 00:16:48,475 but AI can enhance it. 370 00:16:48,475 --> 00:16:51,755 And essentially, you know, you can be in a, in a, in a, 371 00:16:51,755 --> 00:16:52,795 in a room with a patient 372 00:16:53,255 --> 00:16:55,395 and the AI listening tool can capture 373 00:16:55,395 --> 00:16:56,675 what you're saying and write your note. 374 00:16:57,095 --> 00:16:59,995 And I've seen, um, providers, I've never experienced 375 00:16:59,995 --> 00:17:03,155 that personally, but I have friends who have, 376 00:17:03,775 --> 00:17:07,155 and they are giddy with excitement about the promise 377 00:17:07,255 --> 00:17:09,435 of these tools, which is, you know, 378 00:17:09,435 --> 00:17:12,075 what we really wanna do is get people inspired to, 379 00:17:12,175 --> 00:17:13,995 to join in healthcare organizations. 380 00:17:14,535 --> 00:17:18,035 Um, I can't imagine sort of a, a, a more fulfilling mission, 381 00:17:18,775 --> 00:17:21,795 um, and a career, uh, to join in healthcare 382 00:17:21,855 --> 00:17:22,915 and be a caregiver. 383 00:17:23,375 --> 00:17:27,075 Um, and I think AI gives us all promise that, uh, 384 00:17:27,125 --> 00:17:29,035 it'll make it a little bit easier, uh, 385 00:17:29,175 --> 00:17:31,595 to do the very best job that we can 386 00:17:31,895 --> 00:17:33,235 and that our patients deserve. 387 00:17:33,615 --> 00:17:35,595 So I'll just end, I wanna thank you very much 388 00:17:35,655 --> 00:17:36,875 for having me today. 389 00:17:37,775 --> 00:17:41,115 But, um, you know, despite the sobering news, um, 390 00:17:42,095 --> 00:17:43,915 I'm optimistic that there is a way forward. 391 00:17:44,115 --> 00:17:45,995 I think we need to raise the bar on performance 392 00:17:45,995 --> 00:17:49,525 and lower the bar on transparency and get our C-suites 393 00:17:49,525 --> 00:17:51,485 and our boards and all the way board to bedside, 394 00:17:51,485 --> 00:17:53,845 everybody aligned and organized. 395 00:17:53,905 --> 00:17:58,285 And I do believe the action in the past year from incredibly 396 00:17:58,285 --> 00:18:02,125 important national high leverage organizations will help us 397 00:18:02,125 --> 00:18:05,885 advance that, uh, work and with, uh, with some speed. 398 00:18:06,265 --> 00:18:08,205 We shouldn't be competing on patient safety. 399 00:18:08,215 --> 00:18:10,485 We're all in this together, and I'm optimistic 400 00:18:10,485 --> 00:18:12,605 that we'll get there and we'll get there soon. 401 00:18:15,065 --> 00:18:16,625 - Absolutely. I completely agree. 402 00:18:16,675 --> 00:18:18,785 Thank you so much for those final thoughts, doctor. 403 00:18:19,135 --> 00:18:20,665 There's definitely been an amazing 404 00:18:20,765 --> 00:18:22,185 and informative discussion today. 405 00:18:22,205 --> 00:18:23,545 So again, I wanna thank you so much 406 00:18:23,545 --> 00:18:24,905 for coming on Becker's Healthcare, 407 00:18:25,245 --> 00:18:27,225 and I look forward to connecting with you again soon. 408 00:18:27,755 --> 00:18:29,135 - Thanks so much for having me. 409 00:18:32,245 --> 00:18:34,815 - It's so important for leaders at the top of organizations 410 00:18:34,835 --> 00:18:37,335 to keep learning, stay sharp, grow their networks 411 00:18:37,675 --> 00:18:40,175 to help our audience better do this in a more simplified, 412 00:18:40,175 --> 00:18:41,735 personalized, and meaningful way. 413 00:18:42,295 --> 00:18:44,695 Becker's Healthcare has launched my BHC, 414 00:18:45,325 --> 00:18:47,415 it's your trusted Becker's healthcare experience 415 00:18:47,415 --> 00:18:49,615 and more with content, connections, events 416 00:18:49,635 --> 00:18:52,455 and learning opportunities, join the community free 417 00:18:52,455 --> 00:18:57,255 of charge@www.my dot becker's hospital review.com 418 00:18:57,395 --> 00:18:58,215 and we'll see you there.