Hi, everyone. You're listening to Becker's clinical leadership
podcast.
I'm Erica Carbajal with Becker's hospital review. And
thank you so much for tuning into this
episode
Today, I'm joined by Gina Lade, Chief Quality
Officer at UVA Community Health.
We'll be discussing the growing role that standardization
plays in care delivery today, quality and safety
issues that she has her eye on right
now, and what CMS's
recent rule expanding site neutral payments means for
outpatient quality and safety monitoring.
Gina, welcome, welcome. We're so happy to have
you on.
Great. Thank you for having me, Erica.
Yeah. Well, do you wanna start by just
sharing a little bit about the scope of
your work and your role as chief quality
officer?
Sure. Yeah. So I'm chief quality officer over
the UVA Community Health Hospitals, which, includes three
hospitals,
two in Northern Virginia, which includes
Prince William Medical Center in Manassas,
as well as Haymarket Medical Center, which is
located in Haymarket.
And then lastly, one down in Culpeper, which
is, of course, Culpeper Medical Center. As well
as that we have over 50,
medical groups nowadays.
So that is an aspect of business that
the community health side is growing all the
time.
Gina, do you wanna start by sharing
what your top priority is heading into 2026?
Hard to believe we're wrapping up the year
already, but what do you anticipate
will demand the majority of your focus as
chief quality officer in the next year here?
Sure. I mean, that's a really good question.
And, obviously, you know, with the year winding
down, something I've been thinking about a lot.
I have a couple priorities in 2026.
Of course,
I mean, I'd be remiss if I didn't
mention CMS team.
With the rollout of CMS team. We've been
looking at not only how we can manage
our
manage these post acute transitions will be important
to success with that program
but also more holistically on how we can
reduce risk to our overall perioperative patients.
This is obviously not a new approach. We're
always looking at ways we can reduce harm.
But it just happened to be a happy
accident for me that I have two members
of our perioperative team and our CMS team
steering committee,
which have inspired me to look at how
we approach harm reduction at all phases in
the patient care continuum.
You know, for example,
how can we restart
the process of reducing risk for all falls
in pre op?
Research has shown that patient education is one
of the most impactful interventions to reduce patient
falls.
So we're looking at, you know, can we
start the education in pre op? Can we
coordinate with the post op in inpatient
units to ensure that the message is the
same throughout the patient journey.
One of the other ways we're doing this
is we're looking at the discharge teaching that
we provide through the same lens.
We're starting
discharge teaching with the pre periopt team and
we're making sure that aligns with the
inpatient teams to make sure that we have
a standardized approach to patient education all the
way through.
The other thing I'm really looking at is
data transparency.
One of the things that my team has
been looking at is we've been developing scorecards
that show our performance in key public reported
metrics.
The intent is that these scorecards are gonna
be shared widely with both staff and visitors
in our hallways.
But we've also decided that in addition to
sharing,
the actual
key metric point. But we're gonna actually be
sharing the corresponding outcome and process measures so
that staff can see how they are impacting
that measure
as well as the impact of these measures
on patient outcomes.
So to give an example,
along our SEP-one bundle compliance, which I think
is a very normal thing to
post, we're also sharing now our sepsis mortality
and sepsis readmission rates right alongside
that SEP-one bundle compliance score.
Also alongside our CAUTI and CLABSI rates, we're
also sharing our standardized utilization rates in our
bundle maintenance compliance rates.
So we've only been sharing these a couple
months but I'm really pleased with the conversation
that it spurred. You know, we've gotten the
CNO has been really heavily involved in
pushing back and giving us feedback on
how how these metrics are reported and presented.
And I think it's really
it's really helped increase the visibility of our
performance in these,
in these, metrics.
Yeah. So interesting, Gina. I'm glad you mentioned
CMS teams model. Been such a big area
of of coverage and things that quality leaders
are really focused on right now.
And
and you mentioned just
education with patient discharges
and and fall prevention, kind of getting that
that started earlier in the process and,
kind of
having this model
raise the the importance of that even further.
Are you working as well, like, more closely
with post acute
providers or long term care facilities
to support those transitions as well?
We are. That's,
that's been an opportunity in all of the
areas that we have hospitals,
just because of the areas where our hospitals
are located. You know, we have, for example,
Culpeper. Culpeper is quite a rural hospital. So
we have limited access to post acute providers
out there.
But this has really been
motivational
to
help think outside the box a little bit
on how we look at our post acute
providers.
So we have begun the process of, you
know,
making those care transitions a little more smooth,
trying to get in place good relationships with
our post acute providers.
And it's it's probably
something that we're going to be working on
more as we go through year one of
team.
But it's it's definitely
shown us a huge opportunity in our care
transitions.
Yeah. Certainly.
Gina, I want to turn to
standardized care as well. I think clinical leaders
increasingly over the past year have
pointed to standardized care pathways as a lever
for both improving patient outcomes, but also enhancing
operational efficiency.
But this you know, there's so much work
that goes behind
being able to
do this effectively. So could you share an
example perhaps where implementing a standardized care pathway
helps drive improvements in patient care?
Yeah. So one of the ones we've been
working on and we're in early days, but,
one care pathway that we've put a lot
of emphasis on is actually implementing
an enhanced recovery after surgery or surgery also
known as ERAS.
We're probably playing a little bit of catch
up on this one, but we've made a
lot of strides in the past six months
to get our ERAS programs up and running.
And we've kind of gone all in on
this. We're
implementing it for joints, rip and lining for
bowels, and we're gonna be implementing it for
hip fractures as well very soon.
So I'd say we've done a lot of
work in the past six months to go
from, you know, zero to 60
before developing our ERAS pathways. We had some
elements of the protocols that were implemented. For
example, we had some pretty robust
multimodal pain management, early mobilization
processes. We're working with PT and those were
getting to be in place. But some of
our other elements like, you know, fluid management
or antibiotic usage or maintenance of normothermia
nutrition,
those were all really dependent on individual providers
preference or we didn't have a standardized process
in place, for example, in normothermia.
So this is something that we feel is
gonna be impactful. You know, we're you kind
of tied a little bit in with team.
We think it's gonna be impactful to that.
We think it's, you know, just gonna be
just impactful overall to improving, you know, length
of stay, fewer post .com locations, you know,
especially like ilias and things like that.
Reduced opioid use always huge priority for all
healthcare organizations.
But also will help with a smoother more
predictable recovery for patients. And a big element
of this is patient education.
Making sure that our patients are
aware of what they can expect at every
point in their care,
you know, and starting that early with things
like joint camp and things like that. So
I think,
it's it's probably the most important one we've
been working at and we're hoping that this
will be
a bit of a,
you know, a break in the dam for
all of the other,
important care pathways we'll need to
implement to truly get to where we want
where we're reducing variation in our care and
we're having a consistent product all the time.
Yeah. Sure. And I I imagine that the
ERAS pathways will go a long way too
in in patient experience just to your point
about giving patients a really firm understanding of
of what to expect in terms of the
recovery process.
Exactly. Exactly.
And we've our early early
turnout, you know, we've shown that,
people tend to like the the,
increase in education and the expectations around pain
management. I think that's gonna be a really
big one is that people understand, you know,
you can have some pain.
How we're gonna here's how we're gonna deal
with it on the other side.
Yeah. Certainly.
Well, Gina, what is one quality or safety
issue that you believe deserves
perhaps some more attention across the health care
industry right now and why?
So what I've been thinking a lot about,
just with, you know, how much
AI has
infiltrated
every part
of of health care and, you know, even
society.
You know, I mean, you can't go about
forty minutes without hearing something about, you know,
AI and how it's gonna be changing
things. But the one safety issue that I
think, organizations
and,
you know, vendors, everyone needs to be prepared
for and deserves a lot more attention is
is the potential of algorithm drift in clinical
decision support tools.
You know, more health care shift
systems are shifting to AI tools for things
like sepsis alerts and triage
and image prioritization and risk scoring. And these
models have the the chance or the risk
of losing accuracy as patient population shift
or documentations have habits change or adapt to,
you know, the
infiltration of AI into,
you know, our care how we give care.
I think the dangerous part of that is
the degradation
could be subtle.
Clinicians won't necessarily see a clear failure.
Just a gradual decline in reliability that can
lead to, you know, misdeterioration or unnecessary workups.
You know, the things that we are trying
to avoid, we're trying to increase efficiencies,
with AI.
And the other thing is is is something
that's all seeping on my mind a lot
is that, you know, unlike medications or equipments,
most organizations
may not have a defined owner for ongoing
AI monitoring,
you know, with maybe in quality. You know,
we we've dealt with some kind of Perry
AI tool Perry
AI tools.
And so I've I've seen this firsthand and
I think that there might be an element
of learning the best government structure for it.
As AI becomes more embedded in care, I
think it'll become more important to ensure adequate,
and the right oversight
continuously be validating the performance of the AI
products,
have a plate have a process in place
to detect drift early and make sure that
the tools stay safe and are trustworthy.
Yeah. That is a really great one around
clinical decision support tools, one that hasn't I
haven't heard a ton about. I think you
raise a really interesting point there.
Jeanne, I wanted yeah. Sorry. Go ahead. I'm
sorry. No. I was just gonna say I
was like, yeah. It's it's just, you know,
ever since,
you know, I've been talking to a number
of vendors around, for example, like, you know,
sepsis
tools and things like that. And that's the
question that I keep having is, you know,
if if AR AI at some point time
is potentially referencing AI, you know,
is is that a risk?
Oh, thanks for sharing that. Wanted to talk
just a little bit about a recent policy
as well. Obviously, CMS has passed a rule
expanding site neutral payments and phasing out the
inpatient
only list, another signal that we're seeing more
complex
procedures moving into outpatient settings.
And this just got me thinking, you know,
what this means for quality and safety monitoring
in the outpatient setting as more care is
moving there. So
what kinds of standards,
structures, or innovations do you believe are needed
to ensure there is robust oversight as more
care moves outside the four walls of the
hospitals? How should systems be thinking about evolving
their approach to quality and safety monitoring in
outpatient settings?
Yeah. I think this is such a great
question, and it really touches on, in my
view, you know,
every aspect of hospital care in a way.
You know, is as CMS is pushing these
procedures into outpatient
settings,
I think health systems need to be thinking
more proactively about the patients. You know, success
is going to be about
setting clear standards for which procedures can safely
be done outside the hospital.
I think very importantly, clear screening to ensure
the patient is truly appropriate for outpatient care,
having really good processes in place to make
sure
that, you know,
we understand
the risks of, you know, all of the
the comorbidities are coming with these patients if
they're being taken care of in that setting.
And that and we do have a a
roadmap for this. You know, this is something
that we've done in in other realms of
hospital
care.
But this also means that we have to
have a mature pre procedure optimization process such
as, you know, we're doing those frailty assessments,
getting cardiac clearance,
as well as having standardized
discharge
and observation requirements.
Again, it always comes back to,
you know, reducing variation in care.
It also means that organizations will have to
be a bit more mindful of these outpatient
care sites and ensure that we have the
right staffing, the right training for the staff,
because they potentially be doing, you know,
procedures have traditionally been done in hospitals,
equipment and rescue capabilities to make sure that
the staff understand,
you know, how to rescue.
Hospital leaders will also want to be sure
the facilities are well integrated into your bigger
quality structure.
Make sure that they have the same levels
of reporting and accountability to senior leadership and
the governing board. And that the oversight is
comparable to that inside the hospitals.
Data sharing reporting is also going to be
you know, super important in this new reality.
Things like tracking,
unplanned transfers, complications,
38 risk admission sites. So you're making sure
that you're doing those course corrections,
as
things bubble up, you know, as as tries
that we might, we're not able to always
see all of the wrenches that was thrown
into machines sometimes.
Technology is probably gonna be super important with
this shift.
I mean, Organizations are going to want to
look into the possibility of remote monitoring
those remote follow-up
checks on patients,
things like potentially having more automated follow-up calls
to check-in on patients and having a really
good algorithm on what gets kinda kicked back
to a nurse or a provider during those
follow-up calls.
And, you know, that because of the fact
that patients will be leaving
so quickly after the procedure,
I think you can never say enough
about excellent education
patients. Patients need to understand,
you know, we talked about this in ERAS.
They need to understand what the course looks
like,
when they need to be concerned,
if it deviates,
if you're trying to keep, you know, patients
out of unnecessary
ED visits, you know, that's a metric that
we look at a lot.
You'll want to make sure that they understand,
you know, what truly is a complication and
what is something that's expected to happen.
So I think the big takeaway for me
is that organizations with one on one good
on be proactive here and be thinking about
this stuff,
on ongoing basis,
making sure their teams are ready for this
change, making sure they're aware of this change,
making sure most of all that their patients
ready for this change.
I think that, the patient education aspect,
you know, again, cannot be emphasized enough.
Yeah. Absolutely. We touched on there's so many
considerations. Right? I mean, comprehensive screening, staff training,
equipment,
so much for leaders to start thinking about
and making sure that all these mechanisms are
are up to par for these site of
care shifts.
Well, Gina, thank you so much for joining
me on the podcast today. It was truly
a pleasure to have you on to talk
about a number of different things, and I'm
sure we will be in touch again.
Yeah. Thank you so much. Thanks again for
having me, and it was it's always a
pleasure to talk to you. Yeah. Absolutely. Thanks,
everyone.