Latest / Becker’s Healthcare - Clinical Leadership Podcast / Accelerating Quality and Access at Hackensack Meridian Health with Dr. Jose Azar

Transcript

Accelerating Quality and Access at Hackensack Meridian Health with Dr. Jose Azar · Becker’s Healthcare - Clinical Leadership Podcast

0:00
This is Laura Dierda with the Becker's Healthcare
0:02
podcast. I'm thrilled today to be join joined
0:04
by doctor Jose Azar, executive vice president and
0:07
chief quality and clinical service line officer as
0:10
well as professor of medicine at Hackensack Meridian
0:12
School of Medicine in the department of hematology
0:15
and oncology.
0:16
Doctor Azar, it's a pleasure to have you
0:17
on the podcast today.
0:18
Yes. A pleasure is mine, Laura. Thank you.
0:21
Absolutely. Now I'm excited to get into our
0:23
conversation. I know we're gonna be talking about
0:25
some really amazing things that you're doing there
0:27
at Hackensack Meridian Health,
0:29
connected to quality and patient safety and more.
0:31
But before we do, can you tell us
0:33
just a little bit more about yourself and
0:35
and the health system?
0:37
Yes. Absolutely. I am, as you mentioned, I'm
0:40
an oncologist by background. I've been, in the
0:43
quality and patient safety
0:45
arena for about
0:47
sixteen, seventeen years now,
0:50
and it's really a compliment to,
0:53
continuing the clinical work on a bigger scale,
0:55
and that's why I do that.
0:57
I've been with Hackensack Meridian Health for four
1:00
years since,
1:02
2022,
1:03
and it's been a really,
1:05
very rewarding,
1:07
ride.
1:08
So I'll tell you a little bit about
1:09
Hackensack Meridian Health. We are the biggest and,
1:12
most integrated
1:14
health system in New Jersey.
1:17
We have
1:18
18 hospitals,
1:19
500,
1:21
ambulatory care site locations,
1:23
40,000
1:25
amazing team members, and,
1:27
about 8,000,
1:29
physicians who are either
1:31
part of our medical group or affiliated,
1:34
with us.
1:36
So I get to work with all of
1:38
them, and that's,
1:39
that's a a truly deep honor for me.
1:43
That's amazing to hear. And, you know, what
1:44
an incredible organization. I know you've got a
1:46
huge size as well as influence in the
1:49
area. So it's exciting to see,
1:51
how you've been able to grow and develop
1:53
the,
1:54
department. Now I'm curious. Could you dig a
1:56
little bit deeper and tell us a bit
1:58
more about Hackesack Meridian Health's Agile Institute? What's
2:01
the mission, and how are you driving some
2:03
of the rapid quality improvement initiatives?
2:06
Yeah. Absolutely.
2:08
So we launched the Agile Institute,
2:10
two years ago.
2:12
And the reason we did that is because
2:16
in health care,
2:17
it can take sometimes up to seventeen years
2:20
to
2:21
implement
2:22
effectively
2:23
a, a new
2:25
discovery or a new,
2:27
treatment or a new health care solution.
2:29
And
2:31
to us, that's unacceptable. That's way too slow.
2:34
Health care needs to be transformed,
2:37
at a much faster rate. And at Hackensack
2:40
Meridian
2:41
Health, part of our mission and vision is
2:43
that transformation is in our DNA and innovation
2:46
is in our DNA. And
2:49
making health care
2:50
more accessible,
2:51
more affordable, and better for all patients
2:55
is definitely,
2:56
what we come to work to do every
2:58
day. And so in order to be able
3:00
to achieve that, we launched the Agile Institute,
3:03
which is
3:04
meant to,
3:07
support
3:08
our clinicians,
3:09
support our
3:11
clinical teams
3:12
in transforming health care and the way we
3:14
deliver care every day so that we can
3:17
better
3:18
serve patients
3:19
where they are and meet them
3:22
with their needs, whether in their communities, whether
3:24
they're in the ambulatory space, or whether they're
3:28
in our hospitals.
3:30
I'll tell you just,
3:32
in terms of its
3:34
foundation and and what it actually does.
3:38
The Agile Institute is based on
3:41
a transformation
3:42
and implementation
3:43
methodology
3:44
that,
3:46
we I developed with several of my colleagues.
3:49
And basically,
3:50
the Agile Institute delivers three services. It,
3:55
it trains people and changes culture,
3:58
so that we can adapt
4:00
a,
4:01
more of a startup
4:03
mindset.
4:04
Not waiting for a perfect solution, but really
4:07
testing a viable solution
4:10
in,
4:11
real time and then,
4:13
iterating and keep improving it,
4:16
as much as we can. So that's the
4:18
that's the first mission is to train and
4:20
change the culture.
4:22
The second is to provide and empower our,
4:26
bedside teams, our clinical teams, our
4:29
leadership with the tools
4:32
and the methods to effectively transform
4:35
and implement
4:36
a, evidence based solutions in health care.
4:39
So what is proven to work
4:42
should not take seventeen years to be implemented.
4:45
It should take
4:46
a very short time. We should,
4:48
be able to adopt
4:50
and drive that change very quickly. And then
4:52
the third part is
4:54
oftentimes, we don't have
4:56
proven solutions
4:57
and we cannot be paralyzed with that. We
4:59
need to innovate in real time and we
5:02
need to empower our bedside teams to be
5:04
able to do that. And we've created,
5:06
innovation units that allow us to test a,
5:11
a solution
5:12
very quickly. And once we find
5:15
that it works, we scale it as fast
5:17
as possible.
5:18
I
5:19
love that. I think it's so fascinating to
5:21
think about innovation, health care, and and now
5:24
moving so quickly because, traditionally,
5:26
health care has been a a bit slower
5:27
moving in for good reason. But, you know,
5:29
when when you talk about this culture change
5:31
and the shift that you're making in Hackensack
5:33
Meridian Health,
5:35
how do you do that? Because I think
5:36
that's something that hangs up a lot of
5:38
organizations and has been quite frankly a challenge
5:41
to try to, help clinicians and others understand
5:45
that moving quickly is important in finding those
5:47
areas where they can,
5:49
test different solutions in in real time,
5:52
figure things out that's really gonna be the
5:54
right space to do that type of innovative
5:56
work and then get used to moving more
5:58
quickly than they ever had done before?
6:01
Yeah. So
6:02
we do it with every single one of
6:04
our team members, and I think that's really
6:06
the key element that
6:09
innovation cannot be something we do on the
6:11
side. Transformation cannot be something we do on
6:14
the side. It should be
6:15
and and it is our mission and our
6:17
vision, and it is in our DNA.
6:20
And I think that that's where it starts.
6:23
Also,
6:25
our CEO,
6:27
mister Garrett,
6:28
and our leadership team
6:30
is very committed to innovation and transformation.
6:33
And I think that is
6:35
so critical that the leadership
6:38
is absolutely committed to supporting
6:41
innovation
6:42
in a very,
6:43
agile and adaptive way. Right? We we are
6:46
not afraid to make tough decisions.
6:49
We're not afraid to
6:51
test something
6:53
and figure out whether it works or not.
6:54
And we're not afraid to say, you know
6:56
what? There's a better way and a newer
6:58
way to do it. Let's figure out how
7:00
to,
7:01
spread it across
7:03
all of our hospitals or all of our
7:05
sites. And so that would be the the
7:08
second element.
7:10
And I think the, the third part in
7:12
terms of how we do it is we've
7:14
created a culture
7:16
that
7:18
fosters
7:19
innovative thinking,
7:21
that fosters psychological
7:22
safety so that
7:24
anybody
7:25
feels
7:26
comfortable to step up and say, hey, I
7:28
have a new idea, and they feel heard.
7:31
But
7:32
also, hey. I'm concerned
7:34
this may not be working.
7:36
And,
7:37
we take a pause and we listen to
7:38
that. And I think that's really critical. Because
7:40
otherwise, if you're trying
7:42
to transform
7:44
too quickly,
7:46
you could be reckless if you don't listen
7:48
to
7:49
the people who are actually doing the work
7:51
and allowing them to weigh in and and
7:54
and,
7:55
and direct your strategies
7:57
in a way that makes them effective.
8:00
Got it. That makes a lot of sense.
8:02
And, you know, I really appreciate that, kind
8:04
of additional context because I know the leadership
8:07
team often will have one idea and maybe
8:09
the frontline teams,
8:11
have another. And so having that type of
8:13
communication
8:14
and and balance between how you're looking at
8:16
innovative thinking, building it into the culture, and
8:18
then, you know, making sure that there is
8:20
that feedback,
8:22
between the two sides, it seems like it's
8:24
really critical.
8:25
Now I know that, the health system recently
8:28
received a five star,
8:30
rating from CMS and which is incredible. And
8:33
congratulations.
8:34
Could you talk a little bit about the
8:35
transformational changes that took place in order to
8:37
achieve this honor, and how did the team
8:40
work together cross functionally to make it happen
8:42
in such a short period of time?
8:44
Yeah. Absolutely.
8:46
But just to to,
8:48
be very accurate,
8:50
we have our flagship hospital, Hackensack University Medical
8:54
Center, is a five star hospital,
8:57
with,
8:58
you know, in the CMS ratings.
9:01
But all our hospitals now are three stars
9:03
or four stars and above. So,
9:07
that's, that's truly a transformation.
9:09
In the past
9:11
five years,
9:12
we have gone from
9:15
all our hospitals being great
9:18
to now we're moving our hospitals to being
9:21
all outstanding. And I'm I'm very, very excited
9:25
and very proud of all our our teams
9:27
because this really requires
9:29
each leader and each,
9:32
team member to be dedicated to excellence. And
9:36
that's what, that's what we fostered.
9:38
We fostered a culture where everybody is committed
9:41
to excellence,
9:43
and that's really what has helped
9:46
accelerate the transformation.
9:48
The other part to this is, we've partnered
9:51
very closely with our hospital leadership
9:54
across the entire network.
9:57
And,
9:58
we identified
9:59
and kept our focus on what are the
10:02
few things we can do that will have
10:04
the most impact.
10:05
And that's what we,
10:07
focused our attention on.
10:09
And then,
10:10
what we did is we kind of, we
10:13
empowered and unleashed the power of our,
10:15
bedside teams. So
10:17
we really
10:18
directed the teams to where the biggest opportunities
10:22
are and where we need to focus,
10:24
But then we also allow them to
10:27
come up with the solutions
10:29
and test those solutions. And once the solution
10:32
is working,
10:34
help disseminate it as fast as,
10:36
fast as possible.
10:38
We also are very mindful that health care
10:41
is
10:42
a business of people taking care of people.
10:45
And unless we have solution that are
10:49
designed by the people who are doing the
10:50
work
10:51
and that that are making their work easier
10:55
and more effective every day,
10:58
health care becomes too rigid and too slow.
11:00
And it loses its essence, which is
11:04
the the kindness, the caring,
11:07
the humane side of it. And that's what
11:09
we always anchor our solutions in.
11:12
We don't take solutions off the shelf
11:15
and try to force them.
11:18
We actually
11:20
partner with our team members to figure out
11:22
solutions that work
11:24
in real time in the real world.
11:27
That's helpful to understand. And, you know, I
11:29
I love how you're talking about making sure
11:31
that you're not forcing
11:33
those, solutions, but, you know, thinking of this
11:36
as a partnership and and making sure that,
11:39
you're able to go back and forth with
11:41
those bedside teams and and really taking the
11:43
heart everything that they're trying to do and,
11:46
their perspective on how these changes are going.
11:49
And, you know, I am curious,
11:51
when you look at the the idea of
11:53
taking care of people and being at the
11:54
bedside, is there any, example that you can
11:57
provide us of the change that you made
11:59
based on some of these,
12:01
different innovative,
12:03
innovation pushes that you've been doing or something
12:06
you've done at the suggestion of of a
12:07
bedtime bedside team member?
12:10
Yes. I'm gonna give you two examples,
12:13
that that really illustrate how we've
12:17
done a centralized
12:18
direction setting and strategy setting, but also
12:22
a decentralized,
12:24
bottom up type of solution finding
12:27
and,
12:30
performance improvement. So,
12:32
let me start by saying
12:35
we had to create
12:36
a structure that supports that.
12:39
So,
12:40
over the past several years,
12:42
we've always intended and wanted to,
12:46
hear from our team members, from our clinicians,
12:48
from our bedside
12:50
physicians, etcetera.
12:52
And
12:52
to be able to do that effectively,
12:55
we created,
12:56
what we're calling specialty collaboratives.
13:00
These are,
13:01
basically
13:03
groups of physicians
13:05
who,
13:05
are led by physicians
13:07
and they
13:09
we
13:10
we hand them problems and challenges we're facing.
13:13
And
13:13
they give us solutions, and they work with
13:16
us on implementing those solutions.
13:18
We organize those collaboratives by specialty because physicians
13:22
really
13:23
aggregate around their their specialty and what they
13:27
do on a day to day basis. So
13:29
we have a collaborative for internal medicine. We
13:31
have a collaborative for general surgery. We have
13:34
a collaborative for,
13:36
neurosurgery
13:37
or orthopedic surgery or neurology,
13:40
oncology,
13:41
cardiology,
13:42
pulmonology,
13:43
etcetera.
13:44
So,
13:45
these are physicians
13:47
in those specialties that come together on a
13:49
regular basis
13:51
to help us solve problems.
13:53
And we designed it in a very representative
13:55
way. So
13:57
every hospital sends us two physicians,
14:01
and
14:02
they send us one physician who is,
14:06
by specialty, basically. Two physicians, one that
14:09
is employed
14:10
and one that is, independent physician. Because
14:14
we love our physicians the same way, and
14:16
we value all our physicians the same way.
14:19
And we want to partner with all of
14:21
our physicians, whether they're independent or employed,
14:25
because they all bring,
14:27
tremendous value to problem solving and to improving
14:31
care at the bedside. So,
14:34
the way we designed it was similar to
14:36
the way, the senate is designed. Right? All
14:39
our hospitals are equally represented. And that was
14:42
very purposeful because
14:44
we care as much about our smallest hospitals
14:47
as our biggest hospitals and most complicated hospitals
14:51
because every single patient matters.
14:54
And from that perspective,
14:56
every clinician matters
14:58
in being able to bring, solutions. So that
15:01
specialty collaborative
15:03
model that is a representation
15:06
for all the hospitals equally,
15:09
for all of our clinicians equally, by specialty,
15:12
has helped us
15:13
be so granular in our problem solving. Right?
15:16
When we talk about,
15:18
improving care for patients with, let's say, congestive
15:22
heart failure,
15:23
we,
15:25
depend on our cardiologist to help us find
15:27
solutions.
15:29
We don't just bring a solution that's canned.
15:32
And that brings me to the second,
15:34
part of your question. So how did we
15:36
find solutions?
15:38
We listen to our physicians. Like, for example,
15:42
when when we were trying to improve,
15:44
readmissions and care for surgical patients,
15:48
our surgeons
15:50
brought up a a,
15:52
a new concept
15:53
that they wanted to pay attention to the
15:56
most vulnerable patient population
15:58
that they take care of, which is patients
16:01
who are older than 65 or 70.
16:03
And so
16:04
they wanted to,
16:07
establish a geriatric
16:09
surgery verification
16:10
certification. So, basically,
16:12
being certified that we provide
16:15
best evidence care to,
16:17
patients who are older than 65.
16:20
And the partnership was wonderful because they came
16:23
up with the idea. They knew what the
16:25
standards should be, but then we empowered them
16:28
with tools
16:29
and,
16:31
methodologies through the Agile Institute
16:33
to be able to
16:35
implement very quickly, test change very rapidly,
16:38
design those solutions in a way that,
16:41
makes sense to people,
16:43
and work,
16:45
in the real world
16:46
and are human centric.
16:49
And we were able to do this,
16:51
implement
16:52
and get the certification within a ten week
16:54
period of time. And that was a really
16:57
exciting,
16:59
you know, I I even get excited now
17:01
two years later,
17:03
and in terms of just thinking about how
17:05
quickly we were able to implement something,
17:08
that was
17:10
based on a direction that we set from
17:12
the network, which is, you know,
17:15
improving
17:16
certain outcomes,
17:17
a solution that came from the bedside and
17:19
from our, surgeons and our clinicians,
17:22
and then a method
17:24
that really helped bring it all together in
17:26
a very rapid implementation way. And that has
17:28
led to,
17:30
really great results. So you mentioned that
17:33
all our hospitals are three stars, four stars,
17:36
or five stars,
17:37
and that tells me we're
17:40
among the best in the country and definitely,
17:43
you know, the the best system in in,
17:46
in New Jersey
17:47
because of
17:49
that type of partnership
17:51
and effective,
17:53
implementation of best best practices.
17:56
Absolutely. And that's amazing. You know? And I
17:59
I really appreciate you digging that one level
18:01
level deeper because,
18:02
you know, that implementation side of it truly
18:05
is a a huge unlock and and being
18:06
able to see success there and moving quickly,
18:09
is critical.
18:10
Now looking into 2026, where do you see
18:12
some of the big priorities or headwinds that
18:14
you're focused on right now?
18:16
Yes. You know, with with all the improvements
18:19
that we've made, I feel very confident that
18:22
we're providing outstanding care
18:25
for every patient that we take care of.
18:28
The
18:29
challenge and the headwind that we're facing is
18:31
that
18:32
not every patient can access our care.
18:35
And I think access to health care and
18:38
access to high quality care
18:40
is a very, very important responsibility for all
18:43
of us.
18:44
It doesn't matter if I have the best
18:46
care in the world and only a few
18:48
people can access it.
18:50
My communities
18:52
and
18:53
the,
18:54
the communities that we serve, the communities we
18:57
live in,
18:58
the people that we're supposed to help
19:01
are gonna suffer if they can't access the
19:04
outstanding care that we have. And so this
19:06
is where we're putting a lot of our
19:08
focus in 2026
19:10
and beyond, is to think about designing our
19:14
care models,
19:16
meaning organizing the way we deliver care
19:19
in a way that allows for very rapid
19:21
access.
19:23
Same day access,
19:25
same week access,
19:26
and no more than, you know, access within
19:29
two weeks to a highly subspecialized
19:30
service. That's what we're really aiming towards.
19:34
We want to be able to see you
19:35
when you need to be seen,
19:37
and we we need need to be able
19:39
to rethink the way we organize ourselves
19:42
so that we can meet that expectation and
19:45
that responsibility, honestly, that we have to
19:47
our patients and our communities.
19:50
I think that access question is critical and,
19:53
you know, looking into these innovative solutions and
19:56
the things, you know, that you've been doing,
19:58
on the culture side to be transformational.
20:00
It seems to set yourself up,
20:02
for success in, you know, troubleshooting some of
20:04
those challenges, which, you know, are industry wide.
20:07
I'm curious. What do you think the hardest
20:09
thing you'll have to do in the coming
20:10
year will be?
20:12
You know, designing the care models and rethinking
20:15
the way we
20:16
we organize ourselves is gonna be difficult because
20:20
let's face it. I lead change and change
20:23
is kind of, you know, my job and
20:25
my responsibility.
20:26
I don't like change. I have to change,
20:29
but I don't like change. And I think
20:31
winning the hearts and minds of our clinicians,
20:34
and engaging them very early on so that
20:38
they are part of the change and the
20:39
change is not happening to them, So that
20:42
they are designing those care models and they
20:44
are helping
20:45
us figure out how to best meet those
20:48
access standards
20:49
rather than doing it to them. We wanna
20:52
do it with them.
20:53
And we also wanna engage
20:55
our patients in our communities to understand
20:59
what are they expecting of us and what
21:00
do they need from us,
21:02
so that we can factor that into our
21:04
care model design. I would say that's our
21:06
biggest challenge, but also to me, that's our
21:09
biggest exciting opportunity.
21:11
Figuring out how to do that and how
21:13
to do it quickly
21:15
is gonna be really,
21:17
challenging, but also really, really exciting and very
21:20
meaningful.
21:21
I also think that
21:23
with all the
21:24
AI technology and all the advances in artificial
21:28
intelligence,
21:28
I think we're gonna be able to also
21:30
accelerate our ability to
21:33
imagine and execute on a
21:36
new and better future where access becomes
21:40
an engaging,
21:42
term rather than a frustrating term.
21:45
Absolutely. That that would be, you know, an
21:47
amazing transformation to see. And when you look
21:49
at access, when you look at technology,
21:52
how does that show up for Hackensack Meridian
21:54
Health? What are the ways that you are
21:56
leveraging or or plan to leverage technology to
21:58
expand some of those access points?
22:01
Well, I think we need to meet people
22:04
where they are. And I think technology
22:06
helps
22:07
us do that in a couple different ways.
22:09
One,
22:10
you know, and most straightforward is,
22:13
using
22:14
AI agents to help interact with patients
22:18
on demand when they need to be interacted
22:20
with. And we're already using AI agents to
22:23
help us with,
22:25
scheduling, to help us,
22:28
with navigating patients through our system.
22:31
So we wanna expand on that.
22:33
That digital interaction is is really critical.
22:37
The other way is,
22:39
leveraging
22:39
AI technology
22:41
to better
22:42
understand
22:44
our gaps, our opportunities,
22:46
and really model
22:48
to better model our our care in a
22:50
way that is,
22:52
responsive to our patients. So being able to
22:55
use technology for better analytics
22:58
and for better
22:59
testing of change
23:01
in a virtual way that allows us to
23:04
figure out
23:05
and,
23:06
and modify,
23:08
before we implement
23:10
is, is gonna be really critical.
23:13
So both in the interface with patients, but
23:15
also on the back end,
23:17
in the analytics,
23:20
and in the,
23:21
predictive modeling.
23:23
Got it. That's helpful to understand. Now before
23:26
we wrap up here, where do you see
23:27
some of the best opportunities for organizational growth?
23:31
Well,
23:31
I'm gonna build on access because if we
23:35
have an engaging
23:37
and timely access for every patient, we can
23:40
meet them where they are.
23:41
We can navigate
23:43
their journey and their experience through our health
23:46
system
23:47
to give them access to the best care
23:49
that we already deliver.
23:51
I think that's gonna
23:53
lead to tremendous growth,
23:55
in our,
23:57
ability to serve our communities and our patients.
24:00
I think the other area of growth,
24:02
is not necessarily in terms of business growth,
24:05
but really
24:07
in terms of our capabilities
24:08
growth.
24:10
Very, very soon,
24:12
we're all gonna have to face a very
24:15
real
24:16
change in our,
24:17
day to day life. We're either gonna be
24:20
enabled by AI or we're gonna be, you
24:24
know, pushed to the side by AI.
24:26
And at Hackensack Meridian Health, because we are
24:30
absolutely committed to innovation
24:33
and to transformation,
24:35
we're embracing AI as a a technology that's
24:39
gonna enable and empower our workforce
24:41
and our, team members
24:44
to
24:45
be the best caregivers they can ever be,
24:47
to be able to achieve things that they've
24:49
dreamt of in terms of interacting with patients
24:52
and,
24:54
being able to serve patients better.
24:56
And that to me is really exciting.
25:00
I love it. Doctor Azar, thank you so
25:01
much for joining us on the podcast today.
25:03
This has been such a fun conversation, so
25:05
informational and inspiring to hear about what you've
25:08
been doing at Hackensack Meridian Health. And, you
25:10
know, I look forward to connecting with you
25:11
again soon. Yeah. Thank you very much. Thanks
25:14
for taking the time.
25:16
Absolutely. And, you know, I am excited to
25:18
see you as well at our annual meeting
25:19
coming up in April. I know you'll be
25:20
a speaker on one of our panels, and
25:22
it'll be a truly great opportunity to connect
25:24
it and, talk further on some of these
25:26
things that we've mentioned today. So looking forward
25:28
to that too. To that. Yeah. I'm looking
25:30
forward to that as well.