Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Elizabeth Mort, Primary Care MD and Associate at Mass General Hospital

Transcript

Dr. Elizabeth Mort, Primary Care MD and Associate at Mass General Hospital · Becker’s Healthcare - Clinical Leadership Podcast

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  Thanks for listening. Now here's the episode.
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  - Welcome everyone,
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  to the Becker's Healthcare podcast series.
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  I am Mariah Mohammed, writer
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  and moderator with Becker's Healthcare,
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  and I'm absolutely thrilled to have with me today Dr.
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  Elizabeth Mort, former senior vice president of Quality
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  and Safety at Mass General Hospital,
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  and current primary care physician
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  and associate professor of medicine
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  and healthcare policy at Harvard Medical School.
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  Doctor, it's very nice to have you on the podcast today.
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  How are you?
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  - I'm doing well, and thanks so much for having me,
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  Mariah. I am thrilled to be here.
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  - Yeah, of course. Um,
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  today we will be discussing patient safety.
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  So the first question I really wanted to ask you is, uh,
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  you were one of the senior authors on the safety
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  or in the Safe Care study published in January of 2023, uh,
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  in the NEJM.
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  Can you remind us of the headlines
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  and comment on the current state
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  of patient safety in the US now?
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  - Absolutely. And let, uh, I'll give you the headlines.
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  They're a bit sobering.
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  Um, and I wanna start by saying that despite the fact
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  that the headlines were sobering, I remain optimistic
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  that there is a way forward.
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  I do believe we need to raise the bar on performance.
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  The headline suggests we have room to move there,
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  and I also think we need to lower the bar on transparency
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  to promote more learning and improvement.
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  So the results of the study that you mentioned
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  that were published in January, 2023 in the New England
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  Journal, we looked at, uh, patients hospitalized in 11
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  Harvard affiliated Massachusetts hospitals.
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  And that was in 2018, so before the pandemic.
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  And we found that adverse events occurred in a quarter
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  of hospital admissions,
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  and our reviewers deemed that 23%
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  of those events were preventable.
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  Now, our results, uh, were not in isolation.
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  There were similar to results reported by the office
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  of the Inspector General.
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  And that study was looking at the same year,
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  the same performance year 2018 pre pandemic.
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  And that study was looking at just Medicare patients.
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  They found that a quarter of those patients experienced harm
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  during their hospital stays.
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  And physician reviewers in that study, judge that 43%
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  of the adverse events were preventable.
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  So a higher percentage
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  of preventable events in an older population.
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  And then the last study I'll just mention to describe sort
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  of the state of affairs is that CMS leaders reported
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  that in the early part of the pandemic,
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  so now we're looking at 2020, uh, nationally,
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  we had seen some slippage in our performance on common
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  safety indicators,
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  central line associated bloodstream infections,
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  catheter associated UTIs, et cetera.
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  So the news from 2018 and 2020 was sobering.
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  And these headlines, I would say the headlines were out
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  there, people listened, people in healthcare listened,
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  and they were a gut punch.
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  They were a gut punch for the industry.
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  And I think what's going on now is people
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  are digesting that.
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  They're, they're meeting those, uh, headlines with a range
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  of emotions from disappointment, frustration,
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  shame, and even anger.
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  But the good news is, is that people are moving on
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  and moving toward action.
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  - Yeah, absolutely. Thank you so much
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  for sharing that information.
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  Uh, are there any signs
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  that the healthcare industry is acting on the message?
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  - Absolutely. Um, there have been
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  so many exciting things happening this year.
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  Uh, the study that I mentioned came out in January of 2023,
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  and through the years, uh, through the months
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  of 2023, a lot's happened.
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  Perhaps one of the most exciting things is the President's
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  Council of Advisors on science and technology known as PCA.
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  They put out a report late summer on the transformational
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  effort on patient safety.
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  Very exciting activities.
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  Uh, CMS put out, uh,
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  some guidance on governance and leadership.
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  Um, governance and leadership arguably are
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  critical in getting an organization focused on doing the
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  right things, prioritizing the right things.
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  The Joint Commission has also
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  provided guidance on qapi, they call it, um,
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  which is really looking at how we organize our institutions
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  for constant improvement of care board to bedside.
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  And the joint commission's also put out incredibly important
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  information and guidance on equity, sustainability
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  and an increased focus on outcomes.
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  The A-H-A-A-H-R-Q are both putting out important efforts
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  to work on learning organizations, collaboratives
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  to advance performance.
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  And as we speak, uh, the CMS is, uh,
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  looking at measures under consideration.
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  Um, and there's an exciting measure being reviewed
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  to look at patient safety, uh, there as well.
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  Of course, organizations like IHI
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  and the National Patient Safety Foundation,
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  who've been leaders in this area for decades, continue
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  to sound, sound the alarm, and get the playbooks out
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  and support organizations in this important journey.
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  So there are many, many signs from high leverage,
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  influential organizations, many signs that
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  they hear the message, they get the message,
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  and there are playbooks out there, the challenges now, how
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  to get the playbooks in the right hands
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  and get everyone focused on organizing their agendas,
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  their goals, and getting the work done.
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  - That's wonderful. Thank you so much for,
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  you know, sharing that.
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  Um, kind of moving to recommendations for action.
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  Is there anything that you can think of
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  that the boards can do
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  - Well?
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  Absolutely. And some of the, uh, recommendations, uh,
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  coming out of these important national organizations
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  that I just mentioned are focused exactly at the boards.
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  Uh, boards vary tremendously in the type
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  of healthcare organization they are governing.
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  Um, however, they have incredible influence on
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  what the organization, uh, is doing,
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  how they're prioritizing, how they're investing,
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  what they're holding themselves accountable for.
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  Um, and you know, what they say, it starts at the top,
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  and that's true with, uh, patient safety.
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  So, um, the, the word out is certainly out there
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  that boards need to improve their, uh, competency,
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  their understanding of patient safety and quality.
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  Um, and there's lots of playbooks out there as well.
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  But basically, boards need to be educated.
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  We need to have the right people on the boards.
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  They need to understand what their job is, they need
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  to understand what the issues are.
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  And, um, once that happens, then they can be in a position
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  to help do their job, which is
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  to govern the organization's operations
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  and ensure that a healthcare organization is doing
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  what it's there to do,
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  which is give every single patient the opportunity
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  to have the best healthcare outcomes for them.
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  And that includes safe care.
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  So board activation, board education, board alignment
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  and board activity is really, really important.
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  It starts at the top.
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  - Yeah, I completely, completely agree.
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  It definitely starts at the top.
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  Um, but kind of moving down the ladder, what about c-Suite
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  and, uh, senior leaders?
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  - Yeah, so important, Mariah.
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  You know, I think we're do, we've heard a lot
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  of conversation over the years
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  and it's been, um, amplified this year, uh, for sure.
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  Uh, but I do think the board needs the c-suite, um,
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  to be at the ready, um, to help them understand
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  what the issues are for quality, for safety, for equity,
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  for disparities, all these important issues.
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  So the C-Suite really also needs to be activated as well,
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  and they are key key players.
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  So, you know, since the Institute of Medicine report in,
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  at the turn of the century, we've seen
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  functions develop in the C-suite, quality
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  and safety functions.
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  And that's great because now we have infrastructure,
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  we have reporting, we have all sorts
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  of improvement activities,
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  we have high reliability approaches, lots
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  of different tactics
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  and strategies, um, for advancing healthcare quality,
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  I think it's time that we sort
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  of play ball across the c-suite
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  and ensure that every single
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  c-suite leader understands what her
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  or his accountability is for quality and patient safety.
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  So the quality leader,
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  and sometimes there's a separate quality leader.
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  Sometimes the quality leader is embedded in a Chief Medical
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  officer role, or chief nursing officer role,
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  or chief operating officer role.
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  But each one of those c-suite leaders, including HR
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  and others, has an accountability
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  for improving patient safety that needs to be articulated.
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  That playbook needs to be written with, uh, more, uh,
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  intention and clarity.
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  And I think that will go a long way towards taking
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  what the board is expecting
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  and making sure that every single person
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  who has a responsibility for hiring, managing, delivering,
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  improving care, understands what he
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  or she can do to advance that.
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  I think we need to do some more work in the c-suite.
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  I think we need to do some more work in the
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  c-suite critical group.
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  - Yeah, definitely critical group.
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  And I know the C-suite is always, you know, uh, trying
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  to figure out what positions
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  and titles are needed at this very moment.
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  Um, if we can change, uh, the group a bit.
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  What about the frontline caregivers, doctors, apps, nurses,
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  technicians and staff, anyone
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  who really touches a PA patient, do you have any recommend,
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  uh, recommendations for action there?
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  - Oh, yes, of course.
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  Anybody who touches a patient has a role
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  and they have a job description, they were hired
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  to do something specific.
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  And I would like to see that in every single description
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  of a role, in every single job description, it's super clear
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  to that individual what their role is
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  in making care better and in their orientation
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  and in their management, and in their annual reviews
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  and reward that they are rewarded for advancing
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  not just their piece, but they understand
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  how their piece advances the goal
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  of the organization, right?
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  The goal of the organization is to deliver healthcare
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  and give every patient the opportunity
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  to get the best outcome for him or her.
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  Right. So, you know, there's a story that I, I mean,
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  I remember this story for, for, from decades ago,
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  but I've been telling it more lately
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  because I think a lot of, uh, younger folks have,
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  haven't heard the story,
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  but it's the story of President Kennedy's 1962 visit
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  to the NASA Space Center,
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  and he noticed sort
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  of an environmental health worker carrying a broom working
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  on, uh, his shift.
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  And, uh, president Kennedy interrupted his tour
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  and walked over to the man
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  and said, hi, I am Jack Kennedy, what are you doing?
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  And the individual said, well, Mr.
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  President, I'm helping put a man on the moon.
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  So that's more or less the story, uh, that people talk about
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  to illustrate how each individual has something to do,
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  and that individual understand how it relates
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  to the organization's mission.
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  So, you know, if we could get the board and the C-suite
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  and the managers organized around what the goal
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  of the organization is, what its mission, what its reason
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  for being is, and then understand each individual's role
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  and responsibility all the way down to those people
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  who touch the patient, a doctor an a PPA nurse,
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  a technician, a medical assistant,
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  and they understand, oh, we're here to improve outcomes
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  and my job is X, Y, or Z.
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  That's very doable.
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  And I think with that kind of an alignment
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  of every single person around, I mean,
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  could you imagine a better, a better mission
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  of an organization now, help help people get well,
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  to help people enjoy their lives.
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  And I think that's cultural work,
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  but it's also some, you know, nuts and bolts
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  and some tactical work
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  around job descriptions and management.
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  But I, I do think that it's all doable,
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  and I think we need to do some more work there as well.
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  And I think it will be work, work well worth doing.
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  - Yeah, absolutely. I completely agree there.
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  How important would you say culture is in this
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  entire situation? Does it really matter?
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  - Oh, gosh, yes. Mariah, you know,
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  culture's kind of the wraparound.
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  So you know, you go the board to the bedside
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  and then watch the wraparound milieu.
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  What is business as usual in that organization?
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  And when I visit organizations, I look for certain things
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  that are kind of cultural cues as to
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  how the organization is working.
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  You can watch things in the hallway,
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  you can watch things in the patient care unit
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  or the operating room, or the ambulatory center
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  or the waiting rooms, and you can kind of get a sense for
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  what the culture is like in the organization.
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  So, uh, it's a complicated topic,
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  and yet it's so foundational.
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  And, um, I think when it comes to culture,
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  and when it comes to patient safety,
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  what you wanna see in an organization is
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  that people are habitually doing those behaviors
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  that promote patient safety.
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  And clinically, I mean, these are the things
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  that we talk about with the National Patient Safety
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  Goals and the Joint Commission.
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  Are people doing timeout before procedures every time?
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  Are people using hand hygiene
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  every time they're supposed to?
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  Are they using closed loop communication?
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  So there are things that we know should be done
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  to promote patient safety.
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  And many of those things are habits.
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  And you can walk around and you can observe
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  and you can talk to people, and you can get a sense,
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  you can also measure safety culture.
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  They're tools out there now
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  that increasingly healthcare organizations are
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  using to help drive that.
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  But ultimately, it sort of circles back to what we started
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  with, which is governance.
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  What is the board really, um, governing and overseeing?
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  What is the c-suite talking about?
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  What is the c-suite doing?
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  How are they hiring folks, organizing, managing,
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  operating, rewarding?
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  So a, a culture is key. It's absolutely key.
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  And I believe that a focus on safety culture,
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  a focus on workforce safety, a focus on just culture.
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  Uh, these are words that have meaning.
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  We won't have the time to go into them,
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  but, um, without a focus on workforce safety,
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  without a focus on just culture, without a focus on reward
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  and recognition for the right things,
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  we won't get the most out of our organizations.
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  And that would be a shame if we don't start working on
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  that now and continuing to develop great models
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  for safe cultures in our organizations.
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  - Yeah, definitely. I completely understand
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  what you're talking about there.
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  Doctor, before I let you go, the last thing I wanted
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  to ask you very quickly is, do you have anything
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  to say about ai?
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  Where can these new tools kind
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  of help us in this entire situation?
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  - Well, AI for sure is giving everybody, um, great optimism.
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  And I think pretty much everyone has experienced AI in
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  healthcare in one way or another already.
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  And what I'm seeing is, uh, excitement
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  and even I would say joy.
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  Um, I went to a session where there was a debate
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  between an expert and an AI tool,
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  and they were trying to make a diagnosis
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  and, um, it was, it was so fun.
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  Uh, actually the expert, uh, got it first, uh,
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  but the AI tool was pretty good.
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  And, uh, that gives, I think, people great optimism that,
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  um, as smart as providers are, doctors, nurses, apps,
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  other folks, as much as we can keep in our brains,
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  I think there's gonna be an opportunity for those brains
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  to be complimented with AI tools that will, you know,
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  reduce diagnostic error potentially, and make care safer.
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  Another, another example that really has, uh,
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  I've seen people get so excited and we need excitement.
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  We need joy. We need people to wanna love to go to work
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  and feel like they're working at the top of their license.
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  And that's these ambient listening tools.
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  Um, ambient listening isn't a AI alone, um,
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  but AI can enhance it.
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  And essentially, you know, you can be in a, in a, in a,
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  in a room with a patient
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  and the AI listening tool can capture
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  what you're saying and write your note.
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  And I've seen, um, providers, I've never experienced
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  that personally, but I have friends who have,
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  and they are giddy with excitement about the promise
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  of these tools, which is, you know,
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  what we really wanna do is get people inspired to,
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  to join in healthcare organizations.
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  Um, I can't imagine sort of a, a, a more fulfilling mission,
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  um, and a career, uh, to join in healthcare
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  and be a caregiver.
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  Um, and I think AI gives us all promise that, uh,
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  it'll make it a little bit easier, uh,
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  to do the very best job that we can
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  and that our patients deserve.
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  So I'll just end, I wanna thank you very much
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  for having me today.
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  But, um, you know, despite the sobering news, um,
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  I'm optimistic that there is a way forward.
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  I think we need to raise the bar on performance
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  and lower the bar on transparency and get our C-suites
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  and our boards and all the way board to bedside,
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  everybody aligned and organized.
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  And I do believe the action in the past year from incredibly
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  important national high leverage organizations will help us
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  advance that, uh, work and with, uh, with some speed.
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  We shouldn't be competing on patient safety.
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  We're all in this together, and I'm optimistic
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  that we'll get there and we'll get there soon.
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  - Absolutely. I completely agree.
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  Thank you so much for those final thoughts, doctor.
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  There's definitely been an amazing
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  and informative discussion today.
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  So again, I wanna thank you so much
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  for coming on Becker's Healthcare,
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  and I look forward to connecting with you again soon.
• 18:27
  - Thanks so much for having me.
• 18:32
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