Latest / Becker’s Healthcare - Clinical Leadership Podcast / Reducing Clinical Variation to Improve Patient Outcomes with Dr. Harpreet Pall

Transcript

Reducing Clinical Variation to Improve Patient Outcomes with Dr. Harpreet Pall · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  The most important health care decisions don't happen
• 0:05
  in isolation.
• 0:06
  They happen when leaders come together.
• 0:08
  Becker's sixteenth annual meeting brings together more than
• 0:11
  3,500
• 0:12
  hospital and health system executives this April in
• 0:15
  Chicago.
• 0:16
  With 800 speakers from Ascension, Cleveland Clinic, CommonSpirit
• 0:20
  and more, the conversations get real. Leaders will
• 0:23
  share how their scenario planning for policy shifts,
• 0:26
  breaking through value based care barriers and building
• 0:28
  clinical teams that translate new ideas into real
• 0:31
  world care.
• 0:32
  Join top decision makers in the room April
• 0:35
  13 through the sixteenth.
• 0:37
  For the agenda and event details, visit beckers
• 0:40
  hospital review dot com and click on the
• 0:42
  events tab in the upper right.
• 0:45
  This is Laura Dirdle with the Becker's Healthcare
• 0:47
  podcast. I'm thrilled today to be joined by
• 0:49
  doctor Harpreet Paul, chief medical officer at Hackensack
• 0:52
  Meridian Jersey Shore University Medical Center and k
• 0:55
  Hovnanian
• 0:55
  Children's Hospital, as well as professor of pediatrics
• 0:58
  at Hackensack Meridian School of Medicine. Doctor Paul,
• 1:01
  it's a pleasure to have you on the
• 1:01
  podcast today.
• 1:03
  It's such a pleasure to be here with
• 1:04
  you, Laura. Thank you. Absolutely. Now I'm excited
• 1:07
  for our conversation. I know we'll talk a
• 1:09
  little bit about some of the cool things
• 1:10
  that you've been doing over the last year
• 1:12
  or so as well as your perspective on
• 1:14
  the future. But before we dive in, can
• 1:17
  you tell us a little bit more about
• 1:19
  yourself and your organization? Absolutely. I'll tell you
• 1:22
  first a little bit about Jersey Shore University
• 1:24
  Medical Center. We're a large academic medical center
• 1:27
  in New Jersey. We're located in Neptune, New
• 1:29
  Jersey, and we're one of the
• 1:32
  academic hospitals within, Hackensack Meridian Health.
• 1:36
  We've got a diverse patient population in Monmouth
• 1:38
  and Ocean Counties, and we're also a referral
• 1:41
  center for complex care.
• 1:43
  So we're a level one trauma center for
• 1:46
  both adults and children.
• 1:48
  We've got advanced cardiac care, oncology,
• 1:51
  neuroscience,
• 1:52
  and, children's hospital as well, Cajobanian Children's Hospital.
• 1:57
  In my role
• 1:58
  as CMO,
• 2:00
  it it's really at the intersection of,
• 2:03
  leadership for our physicians,
• 2:05
  clinical quality,
• 2:07
  hospital operations. A lot of my time is
• 2:09
  spent working with our clinical teams to
• 2:13
  really look at how care is delivered across
• 2:15
  the hospital and across the continuum
• 2:18
  and see how we might be able to
• 2:20
  enhance that from
• 2:22
  patient safety and outcomes to
• 2:26
  performance and innovation.
• 2:28
  I'm also a practicing pediatric gastroenterologist,
• 2:31
  and I'm also,
• 2:33
  very much engaged in our academic activities at
• 2:36
  our medical school. So I'm,
• 2:39
  remaining closely connected to both our clinical and
• 2:42
  academic missions.
• 2:44
  That's amazing to hear. And, you know, really
• 2:45
  cool to understand where you're positioned in the
• 2:47
  community and how you're, really continuing to serve
• 2:50
  them well. Now can you tell me about
• 2:52
  the most important initiatives that you led in
• 2:54
  the last year? What did you do and
• 2:55
  what were the results?
• 2:57
  Well, one of the,
• 2:58
  areas that we've had a focus on is
• 3:02
  clinical variation
• 3:03
  across the hospital. And the goal has been
• 3:06
  straightforward,
• 3:08
  ensuring that the patients we serve get the
• 3:11
  consistent right care at the right time in
• 3:14
  the right setting
• 3:15
  while we're focusing on reducing that unnecessary
• 3:19
  variation. And as you know, sometimes when you
• 3:21
  have that variability,
• 3:22
  that can drive longer
• 3:24
  hospital stays,
• 3:26
  higher costs, and lead to,
• 3:28
  inconsistent outcomes.
• 3:30
  So what we did, as one of our
• 3:32
  focus areas is
• 3:34
  ensure that
• 3:35
  the multidisciplinary
• 3:37
  teams
• 3:38
  across the service lines that we have
• 3:40
  are really drilling into areas like readmissions,
• 3:44
  efficiency of our discharge processes,
• 3:47
  care pathways for some of our high risk
• 3:49
  conditions like heart failure or
• 3:52
  COPD and pneumonia.
• 3:54
  An example
• 3:56
  that really highlights some of this work is
• 3:58
  how we've looked at our multidisciplinary
• 4:00
  rounds that take place on a daily basis
• 4:03
  and
• 4:04
  see what the opportunities were for redesigning them.
• 4:09
  Historically,
• 4:11
  in healthcare, sometimes these Multidisciplinary
• 4:14
  Rounds or MDR Rounds
• 4:16
  can become somewhat of a reporting exercise.
• 4:19
  So our team's focused on redesigning the process
• 4:22
  so that the attending physician leads the discussion
• 4:26
  and the entire care team aligns
• 4:29
  around a clearly defined expected discharge date.
• 4:32
  And when that happens consistently,
• 4:35
  you know, that leads to better coordination
• 4:37
  across the clinical teams and case management.
• 4:41
  It can lead to improved
• 4:43
  flow of patients,
• 4:44
  avoiding unnecessary
• 4:45
  delays,
• 4:46
  and really, very importantly, gives patients and families
• 4:49
  better expectations about their care journey.
• 4:52
  Sounds kind of, simple, but when implemented well,
• 4:54
  it can have a very significant impact. So,
• 4:58
  you know, it's that that clinical variation
• 5:01
  reduction isn't about isn't
• 5:04
  about
• 5:05
  restricting physicians and clinical teams. It's really about
• 5:08
  making sure that every patient gets the best
• 5:10
  evidence based care every time.
• 5:13
  I love that. I I think it's such
• 5:14
  an important distinction because understanding that and having
• 5:17
  that why out there, I can imagine, it
• 5:18
  really helped the teams get behind the changes
• 5:20
  you were trying to make and see a
• 5:22
  better and more efficient process for caring for
• 5:24
  patients and their outcomes. And, you know, I'm
• 5:26
  curious when you're going through all of that,
• 5:28
  what type of,
• 5:30
  change management did it take to do that
• 5:31
  with the teams? Who was involved? And how
• 5:33
  did you really get to the place where
• 5:35
  you're seeing the results that you were hoping
• 5:36
  for?
• 5:38
  Yeah. It's, you know, it it it it's
• 5:40
  really ensuring that the teams have a
• 5:44
  a voice and that they're engaged in the
• 5:46
  process. I think that with especially around complex
• 5:50
  change like this, these are not simple,
• 5:52
  interventions that we're,
• 5:55
  trying to deploy. We we've got, at a
• 5:57
  large scale, a lot of
• 5:59
  change and progress that needs to happen to
• 6:02
  deal with the complexity and the acuity of
• 6:04
  the patients that we're serving.
• 6:06
  So I think the most important part of
• 6:08
  this is ensuring that the teams are engaged
• 6:11
  in the process,
• 6:13
  that we take their ideas and we incorporate
• 6:15
  them into the planning that we have.
• 6:18
  And that leads to them being bought into
• 6:21
  the process and owning it as well. So
• 6:23
  I think that that's really the key
• 6:25
  that we take the multiple perspectives, that three
• 6:28
  sixty view of the issues that we're dealing
• 6:31
  with, which are very complex issues.
• 6:33
  They're not
• 6:34
  silos. Healthcare is one care model
• 6:37
  and,
• 6:38
  you know, making sure that the nurses, the
• 6:41
  doctors, the case managers, dietitians, and pharmacists, all
• 6:45
  the
• 6:46
  frontline teams who have a a voice in
• 6:49
  this, who have a stake in the outcomes,
• 6:51
  have a seat at the table and are
• 6:52
  able to contribute
• 6:54
  and give their perspectives so that ultimately we
• 6:56
  can come up with the best model and
• 6:58
  the best approach
• 7:00
  to deliver the the
• 7:02
  amazing outcomes that our teams deliver on.
• 7:05
  That's fantastic to hear. Thank you so much
• 7:07
  for digging a bit deeper there. Now I'm
• 7:09
  curious. I'm looking ahead to 2026. What are
• 7:11
  some of the, big headwinds as well as
• 7:14
  opportunities that you're looking at? What are your
• 7:16
  priorities heading into the next few months or
• 7:18
  so?
• 7:19
  Laura, there's a a few key,
• 7:22
  priorities. So,
• 7:24
  the first is really
• 7:25
  continuing to focus on the throughput and the
• 7:30
  patient flow
• 7:31
  while we're maintaining the highest standards of quality
• 7:34
  and safety.
• 7:35
  We we already know that hospitals across the
• 7:37
  country are facing capacity challenges, and addressing that
• 7:42
  requires a really tight coordination
• 7:44
  across the emergency
• 7:46
  departments, our inpatient
• 7:47
  care teams, and also the post acute transition.
• 7:50
  So
• 7:51
  that is, definitely gonna continue to be a
• 7:54
  major focus.
• 7:56
  I'd say another
• 7:57
  priority is continuing to expand the
• 8:01
  care delivery beyond the traditional
• 8:04
  hospital walls,
• 8:06
  and programs like hospital at home,
• 8:09
  virtual or remote monitoring,
• 8:12
  and some of our digital care platforms
• 8:14
  are gonna allow us to deliver high quality
• 8:17
  care while improving access and experience. So
• 8:21
  that trend I think is gonna continue and
• 8:24
  that's an area for our focus as well.
• 8:27
  I'd say a third is in physician and
• 8:30
  clinician engagement.
• 8:32
  None of these initiatives succeed
• 8:35
  unless those frontline teams feel a strong sense
• 8:38
  of ownership in improving,
• 8:40
  how that care is delivered. And a big
• 8:42
  part of my role as the CMO
• 8:45
  is creating a structure where these clinical teams
• 8:48
  help lead these efforts,
• 8:50
  rather than feel that,
• 8:52
  our initiatives are simply being imposed on them,
• 8:55
  and we touched on that before. So,
• 8:57
  you know, all of this is in the
• 8:58
  backdrop of the headwinds that are,
• 9:01
  that many health systems are facing across the
• 9:04
  country.
• 9:05
  Workforce shortages,
• 9:07
  regulatory complexity,
• 9:09
  financial pressures,
• 9:11
  that all come with caring for these increasingly
• 9:14
  complex,
• 9:15
  patients. So,
• 9:16
  you know, to to sum it up that
• 9:18
  I I I think that health care leaders
• 9:20
  today have to think beyond the walls of
• 9:22
  the hospital, and the real
• 9:24
  opportunity is designing a system of care that
• 9:27
  meets patients where they truly are.
• 9:30
  Got it. That's so helpful to understand and,
• 9:32
  you know, really interesting to hear all of
• 9:34
  those different aspects we're intertwined together.
• 9:37
  What do you think the hardest thing you'll
• 9:38
  have to do in the coming year will
• 9:39
  be?
• 9:40
  Well, it it's it's also where the biggest
• 9:43
  opportunity is. So the hardest part of health
• 9:45
  care leadership right now is leading meaningful change
• 9:48
  in a very complex environment.
• 9:51
  Hospitals are very sophisticated.
• 9:53
  We've got thousands of people working together from
• 9:56
  physicians and nurses, administrators
• 9:59
  to support teams.
• 10:01
  So when we're talking about quality and performance
• 10:04
  improvement,
• 10:05
  we really need alignment across all of these
• 10:08
  different groups.
• 10:09
  And for me the hardest work, but also
• 10:11
  the most important, is building consensus
• 10:14
  around
• 10:15
  some of these operational changes like standardizing care
• 10:18
  pathways,
• 10:19
  looking at our discharge processes,
• 10:22
  and implementing new care models.
• 10:24
  And that requires trust, it requires us to
• 10:26
  be transparent with our teams, and also strong
• 10:29
  clinical leadership.
• 10:31
  But when that alignment happens, it's like magic.
• 10:34
  The impact on the patients that we serve
• 10:36
  and the culture that we have can be
• 10:38
  absolutely fantastic.
• 10:40
  I love that. And I think especially thinking
• 10:42
  about how leadership can truly, you know, transform
• 10:46
  with some of these,
• 10:47
  transparency
• 10:48
  and and and really being clear about how
• 10:50
  they're going about things and what will make
• 10:53
  a big difference, for them in the future
• 10:55
  is key. Now before we wrap up here,
• 10:57
  I wanted to ask about growth too. Where
• 10:59
  do you see some of the best opportunities
• 11:00
  for growth?
• 11:02
  There's a,
• 11:04
  a few
• 11:05
  key areas. The first is
• 11:08
  continuing to expand access to highly specialized care.
• 11:11
  For us as a
• 11:13
  destination academic medical center, we're continuing to grow
• 11:17
  programs in
• 11:19
  advanced cardiac care, in our children's hospital,
• 11:22
  neuroscience,
• 11:23
  oncology,
• 11:24
  and complex surgery.
• 11:27
  Patients are increasingly
• 11:29
  seeking out centers of excellence for these complex
• 11:32
  conditions and having that multi disciplinary
• 11:34
  team,
• 11:36
  is really important. So those Centres of Excellence
• 11:38
  is definitely one area.
• 11:41
  Another,
• 11:42
  major opportunity is looking at how care is
• 11:46
  delivered and whether there's opportunities to redesign that.
• 11:49
  You know, patients are expecting health care to
• 11:51
  be
• 11:52
  accessible, to be coordinated, and more so now
• 11:56
  digitally enabled as well. And,
• 11:59
  these programs, these innovations like remote monitoring, hospital
• 12:03
  from home, virtual specialty care allows us to
• 12:06
  touch more patients and manage chronic disease more
• 12:10
  effectively.
• 12:11
  The third major opportunity,
• 12:14
  is the ambulatory expansion.
• 12:16
  You know, that is really
• 12:18
  a critical part of our
• 12:20
  strategy as care shifts to the ambulatory
• 12:23
  setting.
• 12:25
  And and I think at the end of
• 12:26
  the day, the organizations
• 12:29
  that really combine strong clinical programs with innovation
• 12:33
  and how care is delivered are gonna be
• 12:35
  positioned really well for the future.
• 12:38
  That's amazing to hear, and I'd agree. I
• 12:39
  mean, it's so much is happening within how
• 12:42
  you're looking at care. The ambulatory space is
• 12:44
  making a a big impact right now. So
• 12:47
  I love that focus and drive it and
• 12:48
  seeing growth potential there. Doctor Paul, thank you
• 12:51
  so much for joining us on the podcast
• 12:52
  today. This has been such a fun conversation,
• 12:55
  really to truly get behind some of the
• 12:56
  things that have really made you successful,
• 12:59
  in how you're thinking about the next steps.
• 13:01
  So, thank you for your time today, and
• 13:03
  I look forward to
• 13:05
  seeing you as well at our annual meeting.
• 13:05
  I know you'll be speaking on a panel,
• 13:07
  coming up here in a couple of weeks
• 13:08
  in April. So excited to catch up there.
• 13:11
  Thank you so much, Laura. It's been a
• 13:12
  lot of fun, and I'm excited to to
• 13:14
  be at the meeting and to meet you
• 13:16
  as well.