Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Christopher Thomas, Vice President and Chief Quality Officer at Franciscan Missionaries of Our Lady Health System

Transcript

Dr. Christopher Thomas, Vice President and Chief Quality Officer at Franciscan Missionaries of Our Lady Health System · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  This is Alan Connan with the Becker's Healthcare
• 0:03
  Podcast. And today, I'm delighted to be joined
• 0:06
  by doctor Christopher Thomas, vice president and chief
• 0:09
  quality officer of Franciscan Missionaries of Our Lady
• 0:13
  Health System. That's a 10 hospital
• 0:15
  nonprofit health system headquartered
• 0:18
  in Baton Rouge, Louisiana.
• 0:20
  Doctor Thomas, pleasure to have you on the
• 0:22
  podcast with us today. Before we dive into
• 0:24
  our discussion, I'd love to just firstly hand
• 0:26
  the hand the floor over to you, hear
• 0:28
  a little bit more about your background and
• 0:30
  your role at the health system.
• 0:32
  Yeah. Happy to be on.
• 0:34
  I am a pulmonary and critical care physician
• 0:38
  by training.
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  Moved into that
• 0:41
  area because I was concerned and wanted to
• 0:44
  kinda investigate critical illness, and and that's how
• 0:47
  I ended up in sepsis.
• 0:49
  I grew up in a small town in
• 0:51
  West Virginia.
• 0:52
  And then when I joined our health system
• 0:54
  here, was afforded the opportunity to think about
• 0:57
  safety at scale
• 0:59
  and how we can improve the overall outcome
• 1:01
  of many patients. So,
• 1:03
  moved into the role of chief quality officer,
• 1:06
  after a stint as medical director of system
• 1:09
  quality and patient safety
• 1:10
  over the last three to four years.
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  That's been kind of a journey of moving
• 1:15
  from the research elements over to the application
• 1:18
  of evidence based medicine, which for us is
• 1:21
  quality and trying to bridge the gap in
• 1:23
  between
• 1:24
  a publication that says we should do
• 1:27
  a certain intervention for patients and then the
• 1:29
  time it takes us to get every patient
• 1:32
  within our health system to be able to
• 1:34
  realize those benefits.
• 1:37
  Got it. And I really appreciate the the
• 1:38
  brief kind of background and perspective there. And
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  I understand
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  big, big core part of your focus. Like
• 1:44
  you said, moving from that research to the
• 1:46
  application
• 1:47
  of evidence based medicine,
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  and I understand you you recently led a
• 1:51
  a landmark initiative that achieved
• 1:54
  a thirty nine percent reduction in sepsis
• 1:57
  mortality at the health system. I'm eager and
• 2:00
  excited to hear more about this significant achievement.
• 2:02
  So
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  to kick things off, could you begin by
• 2:05
  walking us through
• 2:07
  the moment that you realized that this was
• 2:09
  a critical issue that your health system needed
• 2:12
  to tackle?
• 2:13
  When we look at the major reasons patients
• 2:16
  come in the hospitals
• 2:18
  and when they leave hospitals, they don't return
• 2:21
  to the same level of function to their
• 2:24
  families. The disease that we become the most
• 2:26
  concerned with is sepsis.
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  So as we began to evaluate how do
• 2:30
  we think of all of the patients who
• 2:31
  are coming into our health system and what's
• 2:33
  the most impactful disease
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  that would get patients back to their dinner
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  tables and get them to living,
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  we decided this was the one. If you
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  ask me retrospectively whether that was a great
• 2:45
  decision, I would tell you,
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  I probably should have started in something that
• 2:49
  was easier.
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  But globally for us, when you,
• 2:53
  come off of the pandemic, what you're really
• 2:55
  trying to understand is patients have a risk
• 2:58
  to develop an infection.
• 2:59
  And then when they develop an infection, the
• 3:01
  body either responds appropriately
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  or it responds in an abnormal way and
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  and creates this area where all of the
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  organs respond to the presence of infection.
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  We were really interested in that the majority
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  of people who show up to the ER
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  have an infection.
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  And if they have an infection in that
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  group, who is going to be those who
• 3:22
  get really sick, and who are gonna be
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  those that we can say,
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  I think you're okay for right now and
• 3:27
  you can go home.
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  So in taking care of our communities that
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  we're privileged to serve, it was the disease
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  that
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  came to our our forefront and said, if
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  we're gonna be really good
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  for our hospitals in Louisiana and Mississippi,
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  we need to be really good at this
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  disease, and that's kind of when we first
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  started to look at it. From a personal
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  journey,
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  I actually experienced this with my father.
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  And so it's always been a personal,
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  evaluation
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  of, hey. He had a routine procedure. He
• 3:58
  got an infection, and then he became critically
• 4:00
  ill. And so I began to think before
• 4:03
  I ever joined our health system, what would
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  that be like if it wasn't my dad,
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  but it was someone else's family? And could
• 4:10
  I be confident as the quality officer for
• 4:12
  us that every single time, every single patient
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  would get the same approach and get the
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  same results that he was fortunate to have
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  when I was in medical school?
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  I'm curious to just follow-up. And out of
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  those patients that present to the emergency department,
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  can you talk us a little bit about
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  how you identify
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  those patients with infections that were going to
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  be really sick and and needed to be
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  treated and stayed perhaps in the hospital, and
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  those patients who presented in the ED with
• 4:42
  an infection but were perhaps healthy and strong
• 4:45
  enough to fight that infection and maybe return
• 4:47
  home.
• 4:48
  Yeah. This is a fantastic question and one
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  that's really critical across The United States. There
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  are many diseases
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  where we're very clear
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  the severity of illness related to the test
• 5:00
  that we have. So,
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  for example, if you come in with chest
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  pain and you have a very specific change
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  on your EKG,
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  something that we call a ST elevation myocardial
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  infarction, we take you immediately to the cath
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  lab. And we know that the patients who
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  do not have that specific change
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  won't have a severity of an illness as
• 5:21
  that patient. We know that in stroke care
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  that when you come in and we get
• 5:25
  a CAT scan and we see a blockage
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  in a vessel in your brain, that we
• 5:29
  need to be able in our comprehensive stroke
• 5:31
  centers to go and get that clot out.
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  For us in sepsis up to about three
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  years ago when we began this journey,
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  what I would tell you is we just
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  were forced to assume
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  that everyone
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  who had an infection was at risk to
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  develop,
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  an abnormal response and get markedly sicker. And
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  so we, by definition,
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  overtreated
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  all the patients. So you brought up a
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  really great point. That meant that there were
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  people who we watched in the hospital
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  who probably were able to go home and
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  then on the other side of it, you
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  had to be perfect
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  in your assessment of who were the ones
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  that were gonna get sick. And it was
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  less elite than our
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  management of things like trauma and heart attack
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  and stroke. It just didn't meet the same
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  standard of where we were trying to go
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  from an excellence perspective.
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  So that was the very first question we
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  looked at is, what do we need? How
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  do we create a structure
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  that takes those patients who, as you described,
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  some could go home and some are gonna
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  get really sick, and how do we figure
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  out who is who? And that led us
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  to both the research and then implementation
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  of a new diagnostic test,
• 6:43
  that was developed. It's brought by a company
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  called CytoVAIL and Intelycep. And so it was
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  a key feature for us in creating this
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  pathway
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  to being able to pick out the right
• 6:53
  patient at the right time as opposed to
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  all of the patients getting everything.
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  Got it. And that makes a ton of
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  sense. It was kind of the first question
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  that's sprung into my mind when I when
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  I was reading about this study and this
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  this significant achievement on your part and by
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  the everyone at your team with the health
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  system. Ties right into my next question, which
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  I wanted to to pry on. What were
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  the biggest gaps in sepsis triage and management
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  that you identified early in the process, particularly,
• 7:21
  like we said, in the emergency department?
• 7:24
  Yeah. I think we didn't use our talent
• 7:26
  well, to be honest, and this is a
• 7:29
  a challenge across The United States. We had
• 7:32
  experts in being able to suspect people of
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  having infections. That was our nurse triage team.
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  We weren't using them and giving them tools
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  in a way that could be repeatable in
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  every single time.
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  So that was the first step. The second
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  step is we needed to listen to our
• 7:46
  teams who said, hey. There are
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  procedures that we wanna do to patients to
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  help them, and then there are procedures we're
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  doing the patients that don't help them. That
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  was something called blood cultures. So we listened
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  to our phlebotomy team and our nurses to
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  kind of start a process that started with
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  the nurses and then nurse initiated or set,
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  and then develop a set of labs that
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  told us who was at high risk and
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  who was not. And that new addition in
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  that triage is that's where the Intelycep test
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  for us became super helpful. It allowed us
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  to change to look at the patients and
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  say, you are very sick, and we're gonna
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  come give you as much treatment early as
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  possible. And then it allowed us to look
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  at the patients
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  where it was very clear over ninety seven
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  to ninety eight percent of the time, they
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  were not gonna progress to this threatening thing
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  that we call sepsis and allow us to
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  treat them in an individual manner, personalized still,
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  but not expose them to all of the
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  testing and all of the procedures that are
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  necessary when the patients are really critically ill.
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  So,
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  the take home from that is triage had
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  to be optimized,
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  and then we had to have a pathway
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  where we could get to something that told
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  us you're gonna get sick or you're not,
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  and then allow our teams of just elite,
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  emergency department physicians
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  who they're gonna go to the first and
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  get to the amount of treatment that's necessary
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  in terms of antibiotics
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  and then evaluating them and having a good
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  conversation with their families about how concerned we
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  are about them.
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  Curious if you could just talk one bit
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  more about
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  rallying at at the talent,
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  the staff, the clinicians at your organization,
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  kind of what you did specifically differently in
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  terms of the tools you provided them, the
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  resources, perhaps the education to really kinda really
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  help secure that buy in and drive towards
• 9:33
  these results?
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  Yeah. We have a phenomenal performance improvement team,
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  here at Our Lady of Lake Health and
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  as part of the system. And the first
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  thing we did was took the voice of
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  those,
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  team members who said, we wanna get several
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  things correct.
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  We wanna make sure that we get into
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  the waiting room and pull out patients who
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  are sick, who may not look really sick.
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  We wanna make sure that we have this
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  correct recognition of the patients who do have
• 10:00
  sepsis.
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  We wanna make sure that the patients were
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  taken care of,
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  stay in the hospital for a very short
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  period of time or shorter compared to others.
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  We wanna make sure that they are able
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  to survive.
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  And then
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  the teams also told us a really interesting
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  concept that's critical to this is they also
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  said,
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  we also wanna look at the patients who
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  before we thought were septic but are really
• 10:22
  sick and who aren't septic. And we wanna
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  have a pathway where we can pivot off
• 10:27
  of them. So we call this people process
• 10:29
  and pivot. We took the talent of the
• 10:31
  people. That's the ER, the phlebotomist, the pharmacist,
• 10:34
  our performance improvement team. We put them in
• 10:36
  a room every week,
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  and we looked at every single result over
• 10:40
  an entire year and continued to iteratively improve
• 10:44
  the process that we were creating. We let
• 10:47
  them tell us what was working and what
• 10:49
  wasn't working, and so we could get to,
• 10:51
  like, a final really good structure that you
• 10:53
  see in those results of the reduction in
• 10:56
  in mortality relative by thirty nine percent,
• 10:59
  a length of stay reduction of point seven
• 11:01
  six.
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  But more specifically, when you put those people
• 11:05
  together in a room in performance improvement,
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  they then begin to drive the change
• 11:11
  related to other things surrounding the disease. And
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  so what we learned is that they were
• 11:15
  much more comfortable in having the conversation about
• 11:18
  sepsis with the patients. They were able to
• 11:20
  enhance
• 11:21
  the conversation about risk with the patients.
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  And so the biggest part about this is
• 11:27
  the ability to implement a really novel diagnostic,
• 11:30
  but at the same time, kind of
• 11:33
  estimate the talent of your internal team,
• 11:36
  recognize when they're really supremely talented, and then
• 11:39
  put them into a process and a structure
• 11:41
  where they can show that talent. And that's
• 11:43
  what we've been able to do, not only
• 11:45
  for where the first pilot location in The
• 11:48
  United States was of this process, our Lady
• 11:50
  of the Lake Regional Medical Center in Baton
• 11:52
  Rouge, but now in the rest of our
• 11:55
  health system to repeat and replicate that kind
• 11:58
  of process. And so it's been really rewarding.
• 12:01
  Fantastic. The the three p's, people, process, and
• 12:04
  pivot. Love that.
• 12:06
  Obviously, the results really speak for themselves. I
• 12:09
  mean, hats off to to you and the
• 12:11
  fantastic team around you.
• 12:14
  What are the next steps? And in terms
• 12:16
  of driving even further, even more substantial results
• 12:19
  results around sepsis, how are you looking to
• 12:21
  continue the great work that you're doing across
• 12:23
  the health system?
• 12:25
  Yeah. I think this just comes back to
• 12:26
  listening to the team. So here's what they've
• 12:28
  told us. Before we started this process versus
• 12:31
  after, the after process for every a hundred
• 12:34
  and ten patients we put through this structure,
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  we save one life.
• 12:39
  For every patient,
• 12:41
  comparatively
• 12:42
  from before and after who comes up with
• 12:45
  a high risk test,
• 12:47
  we save it takes about 24 of those
• 12:50
  tests. So the number needed to treat based
• 12:53
  on that high risk result is twenty four.
• 12:56
  So we're taking those numbers and we're saying
• 12:59
  where else in this journey of the pathway
• 13:02
  of the sepsis patient
• 13:04
  can we help further improve the care? So
• 13:07
  we're now looking at how our antibiotic use
• 13:11
  and which antibiotics that we're using, how can
• 13:13
  we optimize that. Meaning, if you don't need
• 13:16
  a very broad antibiotic, let's not give it
• 13:19
  to you. Let's be very specific and tailored.
• 13:22
  We're also beginning to look at, well, what
• 13:24
  who are those patients that we think we're
• 13:27
  gonna need to admit to the hospital, but
• 13:28
  the next twenty four hours to thirty six
• 13:31
  hours is gonna dictate to us whether you're
• 13:33
  gonna potentially get sicker or whether you're gonna
• 13:35
  get to go home. So we're focusing in
• 13:38
  on them. That's for us a process that
• 13:40
  we call rescuing the patient. So recognizing the
• 13:43
  disease and making sure that if they were
• 13:45
  gonna get sicker, we have to think about
• 13:47
  the rescue.
• 13:48
  And then
• 13:49
  on the last part, this is also about
• 13:52
  adding other data to this this new novel
• 13:55
  way to look at sepsis. So if I
• 13:57
  have my dad who would have come in
• 14:00
  and he talks to our emergency department team
• 14:03
  and they triage him, and then he gets
• 14:05
  the test and the test says he's high
• 14:07
  risk. And then as we think about him
• 14:09
  being high risk,
• 14:10
  what are the other things that we need
• 14:13
  to do for him to ensure that he
• 14:15
  gets to go home? And so adding things
• 14:18
  like a structured mobility program because we know
• 14:21
  sepsis patients get weaker which we have. And
• 14:23
  let's then look about what his needs are
• 14:25
  gonna be two and three days later so
• 14:28
  that when he's discharged, we wanna make sure
• 14:30
  that he understands the disease he had and
• 14:32
  that he sees his primary care physician
• 14:34
  within the next seven days.
• 14:36
  So really thinking about this holistically,
• 14:39
  this process looked about the inpatient
• 14:42
  ability to triage and identify a sepsis patient.
• 14:45
  And now as you take a step back,
• 14:48
  what we've begun to really think is we're
• 14:51
  world class in the results and recognition, and
• 14:53
  we're world class in the results of treatment,
• 14:56
  but we'd like to be world class
• 14:58
  in preventing you from ever needing to come
• 15:00
  into the hospital. And then if you had
• 15:03
  to, if it was unfortunate enough that you
• 15:05
  get infection and you get sepsis,
• 15:08
  what are we doing on the backside that's
• 15:10
  really meaningful in the same results that we've
• 15:12
  seen here?
• 15:14
  Sometimes we think meaning is just,
• 15:17
  checking a box to do something. What our
• 15:19
  teams are pushing us to do is if
• 15:21
  we do something, I wanna make sure that
• 15:23
  it helps
• 15:24
  someone's mother, brother,
• 15:26
  you know, sister, father. And so, really just
• 15:29
  a congratulations
• 15:30
  to the team to continue to push us
• 15:32
  in what we do because I think many
• 15:34
  places would stop at this level of success
• 15:37
  in terms of length of stay and mortality.
• 15:39
  But they're pushing us now to new areas,
• 15:42
  thinking about if we're a community,
• 15:45
  if their family members show up to our
• 15:47
  ER and they bring them in. They wanna
• 15:49
  make sure that we're we're doing the same
• 15:51
  for every member of the community we would
• 15:52
  do with their family. So they keep telling
• 15:54
  us new pieces of this kinda learning health
• 15:56
  pathway that we need to get better with.
• 15:59
  Yeah. I mean, fantastic,
• 16:01
  story, fantastic results. So greatly appreciate
• 16:05
  and so greatly respect,
• 16:07
  the work that you and your your fantastic
• 16:08
  clinical teams are doing across the board.
• 16:11
  Last question, doctor Thomas, before I let you
• 16:14
  go, I think for any other clinical leaders
• 16:16
  listening to the podcast, physician leaders, teams at
• 16:19
  hospitals, health centers across the country
• 16:22
  looking to achieve similar success in terms of
• 16:25
  improving sepsis care across their organizations,
• 16:28
  is there one or two maybe key pieces
• 16:30
  of advice that you give them?
• 16:32
  Yeah. I think,
• 16:34
  number one is,
• 16:35
  your teams and their talent are critical. Use
• 16:38
  them.
• 16:40
  Listen to their feedback.
• 16:42
  Go to where they do their work
• 16:45
  and get their ideas.
• 16:47
  That for us was revolutionary.
• 16:49
  It changed us from an old way of
• 16:51
  thinking to a new way of thinking. After
• 16:53
  you get their opinion,
• 16:54
  be willing to do things that are innovative
• 16:57
  that others would say,
• 16:59
  has not been done before,
• 17:01
  like like we have and find partners who
• 17:04
  are willing to do it differently. Our partner
• 17:06
  here,
• 17:07
  was a a company that makes this test
• 17:09
  called Intelycep.
• 17:11
  We were brave enough, I think, from our
• 17:13
  team to say we wanna use a novel
• 17:16
  diagnostic be better. And so for other health
• 17:18
  system leaders, my recommendation is,
• 17:21
  sometimes the courage is in changing something that
• 17:24
  was already working to try to get to
• 17:26
  Elite.
• 17:27
  And then with the way technology is developing,
• 17:30
  be willing to seek out new personalized kind
• 17:33
  of tests. This test that we use,
• 17:36
  looks at the actual
• 17:38
  biology
• 17:39
  of the individual patient you're looking at, which
• 17:41
  is a revolutionary
• 17:42
  change from just an aggregate
• 17:44
  of vitals and maybe a little bit of
• 17:47
  history.
• 17:47
  So for health system leaders, be willing to
• 17:49
  take what you do really, really now and
• 17:51
  go to a version two point o
• 17:54
  or do that thing that we call the
• 17:56
  pivot. Pivot with your people and your process
• 17:58
  and add something in that you think is
• 18:01
  gonna have really good patient centered goals.
• 18:04
  And then be willing to tell your teams
• 18:06
  what is and is not working
• 18:08
  because you can essentially
• 18:10
  supersize your results, and I think you can
• 18:13
  escalate
• 18:14
  and accelerate
• 18:15
  the process of improvement
• 18:17
  over a shorter timeline. And that's what we're
• 18:19
  here to do from a health care perspective.
• 18:22
  I think some fantastic
• 18:23
  words of wisdom, key takeaways, and advice for
• 18:26
  any of our clinical leaders here as we
• 18:28
  round out our discussion.
• 18:29
  Doctor Thomas, so greatly appreciate you taking the
• 18:32
  time out of your busy schedule. Really, really
• 18:34
  enjoyed this conversation, and I look forward to
• 18:36
  connecting with you again down the line.
• 18:38
  Absolutely. Thank you so much for having me.