Latest / Becker’s Healthcare - Clinical Leadership Podcast / LeWanza Harris, MD, MPH, MBA, MS, Chief Quality Officer at Emory Healthcare

Transcript

LeWanza Harris, MD, MPH, MBA, MS, Chief Quality Officer at Emory Healthcare · Becker’s Healthcare - Clinical Leadership Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
• 0:14
  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - Hi. Welcome to the Becker's Healthcare podcast. My
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  - name is Paige Twenter, and I'm an editor
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  - here at Becker's Healthcare.
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  - I'm honored to be joined today by doctor
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  - Lowenza Harris, chief quality officer at Emory Healthcare.
• 1:02
  - Doctor Harris,
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  - I'd love for you to just briefly introduce
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  - yourself, your role in your organization.
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  - Sure. Thank you so much for having me,
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  - Paige. I really look forward to the conversation
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  - with you today.
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  - As you stated, I am the chief quality
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  - officer at Emory Healthcare,
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  - and
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  - September 30,
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  - will make
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  - two years for me. So it has been
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  - a wonderful journey and,
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  - leading the quality efforts across the system and
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  - working with those teams who are truly doing
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  - the work,
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  - at the bad side.
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  - And talking about,
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  - doing the work at the bedside,
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  - specifically, I'd like to talk about physician and
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  - physician engagement.
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  - Can you
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  - kinda offer
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  - a definition of physician engagement and quality and
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  - how that
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  - is different than just compliance?
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  - Sure.
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  - So
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  - when I think about engagement, engagement is when
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  - physicians treat quality as a part of their
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  - craft, not a report card that's handed to
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  - them. Compliance will ask the question, did you
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  - do the right thing?
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  - Engagement
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  - asks, is this the right thing for my
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  - patient, and how do we make it easier
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  - to do it every single time?
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  - The difference can show up in who owns
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  - the problem. A compliant physician would make sure
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  - that they are completing, like, the step one
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  - bundle
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  - because the order set demands it. An engaged
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  - physician asks why our sepsis mortality
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  - looks the way it does,
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  - questions the data,
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  - and helps redesign the workflow.
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  - Compliance gets you to the floor of the
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  - measure. Engagement is how you get past it.
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  - So I like to think of it like
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  - three different signals.
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  - Physicians
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  - really help choose what we measure. They challenge
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  - the data before we accept it,
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  - and they bring problems to us before we
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  - bring them to them.
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  - When we all... When all three are present,
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  - we are no longer managing compliance. We are
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  - building a shared practice of care. And, really,
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  - that's what we wanna do in order to
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  - have our physicians engaged.
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  - You mentioned the SEP one bundle. I know,
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  - Emery has
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  - really been performing really well with the SEP
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  - one
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  - bundle, not just with compliance,
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  - obviously, but I just enjoy the three signals,
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  - that you raised because it really goes to,
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  - like, active participation
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  - and continuous improvement,
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  - in
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  - quality care.
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  - For
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  - physician trust and quality data, what do you
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  - feel like earns
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  - earns it, and what do you feel
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  - like maybe sidesteps
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  - or loses
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  - trust?
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  - Yes. Trust really comes from transparency.
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  - Physicians trust data that they can take apart.
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  - That is they're gonna ask what are the
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  - definitions,
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  - the exclusions,
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  - risk adjustments come up all the time, and
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  - the patient level cases behind the number.
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  - So when a patient can pull up the
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  - chart behind a PSI event or a sepsis
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  - event
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  - and and agree or disagree with it, that's
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  - when the conversation starts and changes. So what
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  - truly
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  - earns trust is showing the case, not just
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  - the rate. So our mortality index means little
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  - until someone reviews the actual patients together.
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  - The second is admitting the limit saying that
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  - this measure
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  - over captures in your population,
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  - and here is how we are accounting for
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  - it, builds more credibility
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  - than defending every number. Thirdly, physician validation is
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  - important before you actually publish it. So having
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  - clinicians
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  - engaged and involved when they are reviewing attribution
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  - and documentation
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  - is important before you actually publish the dashboard
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  - or even bring it up in a leadership
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  - meeting.
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  - And then lastly, consistency. So the same definitions
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  - every month from one source of truth so
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  - people are not arguing over
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  - whose spreadsheet is right.
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  - On the other side, what fails is surprise
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  - data.
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  - So unblinded
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  - ranking showing in a large meeting before the
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  - physician has seen them, that produces defensiveness,
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  - not improvement.
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  - Secondly, attribution that doesn't match reality.
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  - If I had a dollar every time attribution
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  - came up, I would be a very wealthy
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  - woman. So when assigning an outcome to the
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  - discharging
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  - physician when the harm happened
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  - three handoffs earlier or somewhere else, that's not
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  - gonna help you in garnering trust. And then
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  - late... Lastly,
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  - chasing documentation
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  - instead of outcomes.
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  - When a metric improves because coding changed,
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  - physicians notice.
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  - It tells them the work is about the
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  - score, and it cost us credibility
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  - for the next initiative.
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  - The barriers to trust is
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  - surprise
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  - data, like, right before
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  - presenting it, and that's that can, like, you
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  - know, prompt
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  - defensiveness,
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  - attribution, or, like, responsibility
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  - Mhmm. To a specific person that doesn't, you
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  - know, make sense, doesn't really
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  - apply. And then
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  - chasing documentation instead of
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  - care or kinda, like, showcasing to physicians, like,
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  - yes. The numbers,
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  - like, are tracking our progress, but
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  - progress is in the delivery of care to
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  - patients. Right. I mean Friday every day. Yeah.
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  - Correct. Physicians, they care about the outcome like
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  - we all do. We want our patients to
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  - be safe. We wanna make sure that there
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  - is
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  - excellent,
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  - care delivery
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  - and that the outcomes
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  - reflect
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  - what we're
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  - trying to achieve, which is excellent. So
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  - when you're speaking to a physician,
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  - it's not just, okay, you need to document
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  - this properly
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  - in order for us to see
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  - this particular move in the needle. It's how
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  - are we connecting it to the patients,
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  - and connecting their care to the patients. That's
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  - what's important, and that helps with building trust.
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  - Mhmm. What is your response to,
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  - you know, those physicians or other clinicians who
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  - kinda see quality initiatives as
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  - administrative
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  - burdens rather than patient care?
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  - Well, first, I tell them
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  - they are sometimes right.
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  - I mean, it can be an administrative burden.
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  - I mean, we we have to make sure
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  - that we put ourselves in their shoes.
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  - We are asking them to do one more
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  - thing,
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  - when their focus rightfully so is on providing
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  - care for the patients.
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  - Some measures reward documentation more than care and
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  - pretending otherwise ends the conversation.
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  - So acknowledging that openly is what earns the
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  - right to talk about the rest.
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  - Then I bring it back to the patient.
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  - Behind every sepsis bundle is a family waiting
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  - to hear whether their mother will come home.
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  - Behind every CLABSI is a patient
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  - who came in for one problem
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  - and left with another.
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  - So when we start with the patient's story
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  - rather than the measure specification,
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  - most physicians recognize
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  - the work as their own. So my commitment
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  - in in return is to earn the ask.
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  - Remove before we add. If we introduce a
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  - new requirement, we look for one to retire.
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  - Build it into the workflow. We need to
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  - make it very easy for the physician.
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  - The right action should be the easiest action
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  - in the EHR, not an extra click or
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  - a separate form.
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  - Show the return. This is where data
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  - transparency is important. So share those outcomes back
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  - with the teams doing the work, including the
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  - patients who benefited.
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  - And then lastly, separate regulatory
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  - from meaningful. Be honest about
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  - which work exists because a payer requires it
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  - and which is... Exists because it changes outcomes
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  - and design each accordingly. So if an initiative
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  - cannot explain how it helps a patient,
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  - it should not survive our review.
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  - I love your comment of, like, they are
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  - sometimes
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  - right. Yes. And and just, like, acknowledging, like,
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  - yes. This is gonna add
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  - time. Like, this is administrative
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  - burden,
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  - and
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  - this is the outcome we're hoping to achieve.
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  - Exactly. Yeah.
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  - On that note about kind
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  - of perspectives between
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  - c suite and frontline
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  - physicians,
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  - what do you feel like
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  - the c suite usually gets wrong about physicians?
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  - And then vice versa of
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  - what do you feel like physicians get wrong
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  - about the c suite?
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  - I know this is, like, very kinda generalized.
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  - So Yeah. No. So I think each side
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  - tends to underestimate
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  - how much the other cares about patients.
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  - Most of the friction I see comes from
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  - that assumption, not for real disagreements about goals.
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  - What the c suite gets wrong about physicians
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  - physicians is treating physicians time is unlimited.
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  - Every committee, every module, every meeting comes out
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  - at a time with patients or family.
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  - Secondly, reading pushback as obstruction. Physicians are trained
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  - to question evidence, and that skepticism
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  - is an asset in our quality work. We
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  - wanna hear their voice because they are the
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  - ones who are at the front line, and
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  - they understand the process better than we do
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  - because these are subject matter experts.
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  - And then lastly, assuming a directive
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  - creates engagement.
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  - Physician engage when they have real influence over
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  - the decision,
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  - not after it has been made.
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  - What physicians get at their home about the
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  - c suite
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  - is, number one, assuming decisions
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  - are about money.
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  - Financial stability is what keeps the doors open,
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  - staff employed, and services available to the community.
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  - Secondly, underestimating
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  - the constraints.
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  - Regulatory requirements, payer contracts, and system wide trade
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  - offs rarely show up in the version of
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  - a decision that reaches the front line. And
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  - then lastly,
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  - opting out of the table.
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  - When physicians decline
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  - leadership roles and governance work, decisions still get
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  - made just without their perspective.
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  - So my role as a physician in the
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  - c suite is to translate
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  - in both directions.
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  - The goal is a shared language
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  - built around the patient
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  - where leaders understand the realities of practice and
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  - physicians understand the the realities of running a
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  - health system.
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  - Now we're coming up on time. Is there
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  - anything we haven't touched on yet that you
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  - think it'd be remiss that we didn't discuss?
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  - We need to talk about,
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  - you know, possible
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  - physician resistance.
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  - So what what should we do
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  - if we're trying to roll out a particular
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  - initiative or want their participation?
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  - You know, if there is resistance,
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  - how should we approach it? And I think
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  - that we have to make sure that we're
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  - listening going back to what I was saying
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  - earlier,
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  - in terms of if physicians feel that there
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  - is an an administrative
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  - burden, we have to acknowledge the reality.
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  - So I like to listen before I present
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  - anything. And my my first move is to
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  - go to them on their unit. I do
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  - rounds. And so it's important for me
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  - to make sure that I am going to
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  - the gimba. I'm seeing what's going on. I'm
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  - listening to the teams.
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  - So going to the unit, going to their
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  - meetings, and asking them what gets in the
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  - way of the care that they want to
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  - give.
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  - And I think we need to look at
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  - resistance in a different way. Resistance is usually
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  - information.
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  - It may mean that the data is wrong,
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  - the attribution is unfair,
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  - the workflow is broken, or the past initiative
• 13:34
  - burned them out. You know, I've heard several
• 13:37
  - times, you know, when we're trying to implement
• 13:38
  - an initiative, we've done this before, and it
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  - didn't work, but it doesn't mean that we
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  - don't look at the same challenge that we've
• 13:45
  - had for years and think of a different
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  - way to handle it. I would rather learn
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  - that
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  - in a conversation than in a stalled project,
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  - meaning that we need to know
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  - well in advance
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  - what are the reasons why people may be
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  - hesitant or resistant or apprehensive
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  - in participating.
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  - So leadership rounding has taught me that people
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  - tell you exactly what is wrong when they
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  - believe that you came to actually hear it.
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  - Mhmm.
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  - Asking questions and
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  - fully,
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  - like, actively listening rather than just going into
• 14:21
  - a kinda PR spiel of why it's amazing
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  - and why they should, you know, jump on
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  - it. Yes. Yeah. Yes.
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  - Absolutely.
• 14:31
  - Well, thank you so much, doctor Harris, for
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  - joining us today and sharing your perspective and
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  - thoughts. I really, really appreciate it. Thank you,
• 14:38
  - Paige, and thank you, Becker's Health. I really
• 14:40
  - appreciate the opportunity.