Latest / Becker’s Healthcare 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 Podcast

• 0:02
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  - upper right.
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  - Hi, everyone, and welcome to the Becker's Healthcare
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  - Clinical Leadership podcast. I'm Mackenzie Bean, associate vice
• 0:57
  - president and managing editor of Becker's
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  - Hospital Review.
• 1:01
  - Today, I'm very excited for our conversation with
• 1:03
  - Doctor. Luanza Harris, who is the chief quality
• 1:06
  - officer of Emory Healthcare.
• 1:08
  - Doctor. Harris, thanks for joining us on the
• 1:10
  - podcast. How are you doing?
• 1:12
  - I'm doing well. Thank you for the invitation.
• 1:15
  - Yeah. It's such a pleasure to have you
• 1:17
  - on again. And just in general, a pleasure,
• 1:20
  - anytime I get to reconnect with you, whether
• 1:22
  - on-site at a conference or virtually.
• 1:25
  - But for those of our podcast
• 1:28
  - listeners who aren't as familiar with your work,
• 1:29
  - can you just start off sharing a little
• 1:31
  - bit more about yourself and your role at
• 1:33
  - Emory?
• 1:35
  - Yes.
• 1:36
  - As you noted, I am the chief quality
• 1:39
  - officer at Emory Healthcare,
• 1:41
  - which means I have
• 1:44
  - ultimate
• 1:45
  - oversight
• 1:46
  - and provide strategic direction
• 1:48
  - over
• 1:49
  - our quality improvement programs, regulatory
• 1:52
  - programs
• 1:53
  - throughout the entire system.
• 1:56
  - Wonderful.
• 1:57
  - So let's
• 1:59
  - dive in deeper. Today, we're gonna talk a
• 2:01
  - lot about the work that you've been doing
• 2:03
  - around
• 2:03
  - sepsis and some of the impressive results that
• 2:06
  - you've seen, but
• 2:07
  - let's let's walk it back and start at
• 2:09
  - the beginning.
• 2:10
  - When you get to Emory, you're looking at
• 2:12
  - the system's own sepsis data.
• 2:14
  - What did you find? What was the starting
• 2:16
  - point?
• 2:17
  - Yeah.
• 2:18
  - So, you know,
• 2:20
  - looking at the data, what we found was
• 2:22
  - that the performance was inconsistent
• 2:24
  - and in places low.
• 2:26
  - Early on, some of the measurements were in
• 2:29
  - the teens.
• 2:30
  - So looking at our June
• 2:32
  - 2025
• 2:33
  - baseline,
• 2:34
  - data show that the real problem was not
• 2:36
  - a single failing hospital, but enormous spread.
• 2:40
  - One site was at eighty five percent, another
• 2:43
  - at thirty percent within the same system,
• 2:46
  - same medical record, and the same policies.
• 2:50
  - Alerts were underused or ineffective. Clinicians were deferring
• 2:54
  - the pop ups because too many of them
• 2:56
  - were wrong.
• 2:58
  - Blood culture collection was delayed. Fluid assessment was
• 3:01
  - manual. Screening tools were misaligned with the pace
• 3:05
  - of an emergency department.
• 3:07
  - And frequently, sepsis was recognized by a clinician
• 3:10
  - before the alert fired, which tells you the
• 3:13
  - technology was trailing trailing
• 3:16
  - the clinical judgment,
• 3:17
  - not supporting it.
• 3:20
  - Got it. So you're seeing that variation. You're
• 3:23
  - seeing the trailing clinical judgment.
• 3:25
  - Once you
• 3:27
  - recognize these observations,
• 3:29
  - what was the next step there in terms
• 3:32
  - of calling it out with your teams and
• 3:33
  - really, like, talking about those numbers in a
• 3:36
  - way where no one felt like they were
• 3:38
  - blamed or in trouble for it, but you
• 3:40
  - had that transparency of, hey. Here's where we're
• 3:42
  - at, and we need to improve.
• 3:44
  - Yeah. The the framing was really about the
• 3:46
  - variation
• 3:47
  - is a system signal, not a scorecard on
• 3:51
  - the individuals themselves.
• 3:53
  - And so the high performance sites were treated
• 3:55
  - as a source of practice to spread,
• 3:58
  - not as a stick to beat the others
• 4:01
  - with. Transparency
• 4:02
  - really
• 4:03
  - came paired with support
• 4:06
  - alongside,
• 4:07
  - coaching and with the data that they may
• 4:10
  - have seen.
• 4:13
  - And can you talk a little bit more
• 4:14
  - about that coaching? What did that look like?
• 4:18
  - Well, we had dashboards that we can actually
• 4:21
  - see the results,
• 4:23
  - as they were happening
• 4:25
  - as quickly as possible.
• 4:28
  - And to be able to you know, with
• 4:29
  - our sepsis program
• 4:31
  - managers, we were able to provide
• 4:34
  - feedback directly
• 4:36
  - to the frontline
• 4:38
  - staff and clinicians.
• 4:40
  - This was really helpful
• 4:41
  - in changing
• 4:42
  - behavior, changing culture, and
• 4:45
  - how we may, set out to carry out
• 4:48
  - our improvements.
• 4:50
  - Mhmm. We all know culture is such a
• 4:52
  - big piece of the puzzle. Yeah. And a
• 4:54
  - lot of systems
• 4:55
  - do respond to quality gaps immediately with more
• 4:59
  - training as the
• 5:00
  - first step, but you decided to start somewhere
• 5:03
  - else if I'm correct. So can you talk
• 5:05
  - through that and why?
• 5:07
  - Yeah. So edu well, we realized that education
• 5:10
  - alone does not survive a shift change.
• 5:13
  - If the workflow is broken, trained people fall
• 5:17
  - inside
• 5:18
  - of it. So the initiative was framed as
• 5:20
  - a governance and workflow reliability challenge. That is,
• 5:24
  - who owns this?
• 5:25
  - What is the target? What happens when the
• 5:27
  - target is missed? And how does anyone
• 5:30
  - find out in time to act. So a
• 5:33
  - system wide sepsis steering committee was,
• 5:36
  - set up to set enterprise targets, escalation
• 5:40
  - pathways, and role based accountability.
• 5:43
  - And,
• 5:44
  - a unit level sepsis Diane was ran in
• 5:48
  - a a very structured matter to look at
• 5:51
  - cases.
• 5:52
  - So the local engine underneath the enterprise structure
• 5:56
  - really worked.
• 5:58
  - That makes a ton of sense. I know,
• 6:01
  - you know, executive sponsorship is something that comes
• 6:03
  - up
• 6:04
  - a lot when you're thinking through,
• 6:07
  - improvement efforts like this and,
• 6:09
  - governance strategies.
• 6:11
  - But I think it's not something that's always,
• 6:13
  - like, clearly
• 6:14
  - defined. So can you talk through what that
• 6:16
  - looked like the in this effort? What did
• 6:18
  - it really mean in practice here?
• 6:20
  - Yeah. So all of our quality
• 6:23
  - priorities
• 6:24
  - have an executive sponsor assigned to it, and
• 6:26
  - really, their role is to make sure
• 6:29
  - that they are listening to those teams. They
• 6:32
  - meet with the two process owners monthly
• 6:36
  - to understand what barriers,
• 6:38
  - are present and to remove those barriers and
• 6:41
  - as well to to facilitate any progress.
• 6:45
  - So admit that,
• 6:48
  - a standing form, you know, where these leaders
• 6:51
  - could come
• 6:52
  - to look at the performance and not just
• 6:54
  - receive a report about it.
• 6:57
  - And,
• 6:57
  - it also helped
• 7:00
  - to unblock any decision making that was help
• 7:03
  - happen at that time.
• 7:05
  - So that may have been, how do we
• 7:07
  - build decisions in the electronic record?
• 7:10
  - How do we,
• 7:11
  - help to help our staff around competing priorities?
• 7:15
  - And how do we handle ownership disputes that
• 7:18
  - may exist between departments?
• 7:20
  - And so this was very important
• 7:23
  - for our progress
• 7:25
  - and the success that we were ultimately able
• 7:28
  - to see.
• 7:31
  - You mentioned,
• 7:32
  - you know, some
• 7:34
  - of the ownership disputes are really pointing to
• 7:36
  - all the different stakeholders that are involved with
• 7:38
  - an effort like this, which is quite a
• 7:39
  - few. And I think it's interesting.
• 7:42
  - You brought clinical documentation
• 7:44
  - improvement and quality staff really into frontline operations,
• 7:47
  - which is a more unusual pairing.
• 7:49
  - What did that unlock for you all?
• 7:52
  - It unlocked that documentation
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  - is not
• 7:55
  - clerical work and sepsis. It did helped us
• 7:58
  - to determine whether
• 7:59
  - the care that happened is visible in the
• 8:02
  - record at all. So
• 8:04
  - a patient can receive a flawless care and
• 8:07
  - still fail the measure because the note lacked
• 8:09
  - one phrase, and that gap was real and
• 8:12
  - it was fixable.
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  - So what we did was we brought our
• 8:15
  - clinical documentation
• 8:17
  - integrity
• 8:18
  - team, CDI,
• 8:19
  - and quality together
• 8:22
  - alongside
• 8:22
  - clinicians to reduce preventable failures
• 8:25
  - and to clarify how organ dysfunction and rule
• 8:28
  - outs get captured.
• 8:32
  - I know part of this work was also
• 8:34
  - consolidating
• 8:35
  - order sets. You had about seven,
• 8:37
  - then standardize that into one. Yes. How how
• 8:41
  - does the system end up with seven? I
• 8:43
  - imagine, you know, other systems are likely in
• 8:46
  - the same boat now or have
• 8:48
  - been. Yeah. This is not through carelessness.
• 8:51
  - This is this happens throughout time.
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  - So each what we found was each was
• 8:56
  - built for real local need by a real
• 8:59
  - team for a real setting.
• 9:02
  - So, cumulatively,
• 9:03
  - they became
• 9:04
  - a reason
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  - for variation
• 9:07
  - and a source of misbundle
• 9:09
  - elements. You think about it, it's
• 9:11
  - which one do we actually use, and what
• 9:14
  - you're doing is you are contributing to the
• 9:17
  - variation that exists because
• 9:19
  - the clinician can decide
• 9:22
  - which one they're gonna focus on, and they
• 9:24
  - may not have all the necessary bundle elements
• 9:27
  - embedded in them.
• 9:29
  - So the replacement
• 9:30
  - is one umbrella order set with with setting
• 9:33
  - specific versions for the emergency department, which, you
• 9:37
  - know, that's where we tend to see sepsis
• 9:40
  - first
• 9:41
  - for inpatient units and the rapid response team.
• 9:44
  - So standard is where it it needs to
• 9:48
  - be in that particular setting,
• 9:51
  - and that really helps to,
• 9:53
  - codify what the local team should be doing.
• 9:58
  - And can you talk a little bit more
• 10:00
  - about
• 10:01
  - the technology piece, specifically,
• 10:03
  - how you built all of this in Epic
• 10:05
  - or what you really built to make this
• 10:06
  - happen?
• 10:07
  - Sure.
• 10:08
  - So there were several tools that we,
• 10:12
  - leveraged within Epic.
• 10:14
  - A sepsis
• 10:15
  - timer that tracked time sensitive bundle elements.
• 10:19
  - There was a sepsis navigator
• 10:21
  - given a single view of the bundle progress,
• 10:24
  - and there was a documentation
• 10:26
  - for a documentation tool for the nursing workflows
• 10:30
  - and a predictive model for early detection,
• 10:32
  - as well as automated timers for the lactate
• 10:35
  - and antibiotics, and then a fluid
• 10:38
  - re assessment form.
• 10:40
  - So
• 10:41
  - deliberately,
• 10:42
  - we constrained everything to the epic foundation tools.
• 10:46
  - There was no custom development.
• 10:49
  - That was the scope decision made upfront and
• 10:51
  - held to. And then the alert refinement and
• 10:54
  - duplication order reduction was treated as first class
• 10:57
  - work, not cleanup. So reducing noise was an
• 11:01
  - important was as important as adding, the right
• 11:04
  - signal.
• 11:05
  - Mhmm. Then you really have everything. Everyone's
• 11:08
  - looking at the same thing and speaking the
• 11:11
  - same language.
• 11:12
  - Exactly.
• 11:14
  - I know part of this work also was
• 11:16
  - aligning the sepsis documentation with patient safety indicators.
• 11:21
  - Why do these two have to be solved
• 11:23
  - together, and how has that work been going?
• 11:26
  - Yeah. Step one,
• 11:28
  - covers all encounters.
• 11:31
  - PSI
• 11:32
  - thirteen,
• 11:33
  - postoperative
• 11:34
  - sepsis covers a subset of elective surgical cases.
• 11:39
  - They overlap.
• 11:40
  - So, coding drives which patients land in each
• 11:43
  - measure.
• 11:44
  - Step one performance then depends on the care
• 11:47
  - timeline,
• 11:48
  - whereas PSI 13 is heavily coding driven.
• 11:52
  - So solving them separately means asking the same
• 11:55
  - clinician to satisfy
• 11:57
  - two different sets of expectations
• 11:59
  - from the same note.
• 12:01
  - So a cross, functional forum that is using
• 12:05
  - sepsis program managers, the CDI team,
• 12:09
  - quality, abstractors, surgical quality, and physician leadership
• 12:13
  - now work together in order to improve sepsis
• 12:16
  - overall.
• 12:18
  - So we've been
• 12:19
  - talking a lot about
• 12:21
  - what exactly you did, but I wanna make
• 12:23
  - sure we have some time to talk through
• 12:25
  - the results that you've seen so far.
• 12:28
  - Can you share any numbers or progress?
• 12:31
  - Yeah. I mean, system wide compliance went roughly,
• 12:34
  - from thirty two percent in March
• 12:37
  - 2025
• 12:39
  - to looking at the recent,
• 12:41
  - numbers.
• 12:43
  - We will see that all of our systems
• 12:45
  - will be over,
• 12:47
  - 60% or close to 60%.
• 12:50
  - And if you recall, the national average for
• 12:54
  - step one bundle compliance is 63%.
• 12:58
  - Mhmm. So this is tremendous,
• 13:01
  - the fact that we've been able to do
• 13:02
  - this. We started this initiative
• 13:05
  - in October of last year, and to be
• 13:08
  - able to accomplish it within a year
• 13:11
  - really speaks
• 13:12
  - to the the way
• 13:14
  - that we have,
• 13:16
  - redesigned
• 13:17
  - our systems and our processes and the work
• 13:20
  - that the frontline team has done.
• 13:23
  - So we know that we are going to
• 13:25
  - exceed our fiscal year,
• 13:28
  - system wide goal, which was to be at
• 13:30
  - 43%.
• 13:32
  - And, again, it's a testament
• 13:34
  - to our,
• 13:36
  - to the work that's been done by the
• 13:37
  - teams.
• 13:38
  - Yeah. I mean, very, very
• 13:40
  - impressive results and so much to be proud
• 13:42
  - of. Curious beyond the number,
• 13:45
  - what else have you seen change, whether that's
• 13:49
  - culturally, operationally,
• 13:51
  - that you would also consider a win?
• 13:53
  - Yeah. I think it's really
• 13:56
  - how we are leveraging technology within our electronic
• 14:00
  - medical record. You know, the tool has or
• 14:03
  - the tools have already always existed.
• 14:06
  - It's how are we thinking very differently
• 14:09
  - in our approach.
• 14:11
  - Also, what has changed is the collaborations
• 14:14
  - have really strengthened. I mean, Emory Healthcare
• 14:17
  - has a strong history of, you know, delivering
• 14:22
  - excellent care
• 14:23
  - and providing,
• 14:25
  - great quality work.
• 14:27
  - But
• 14:29
  - doing this work has helped us to partner
• 14:31
  - even more so outside of what we may
• 14:34
  - have considered. I mean, bringing together,
• 14:37
  - when we're looking at the SEP one bundle,
• 14:39
  - our surgical quality team and pairing them with
• 14:43
  - the work we're doing with sepsis. So you
• 14:45
  - have PSI and sepsis working together, and then
• 14:47
  - the using the CDI team. So I do
• 14:50
  - think that there has been a cultural shift
• 14:53
  - in terms of how do we work together,
• 14:56
  - how do we leverage technology,
• 14:58
  - and this is what we want to continue
• 15:00
  - every single day as we our goal is
• 15:03
  - to provide the best care for our patients.
• 15:06
  - Mhmm.
• 15:07
  - That combination really is so, so powerful. And
• 15:10
  - you mentioned this work continuing.
• 15:13
  - I think that's a can be a common
• 15:14
  - challenge for
• 15:15
  - quality leaders as maintaining that progress and momentum
• 15:18
  - with quality improvement efforts.
• 15:21
  - Can you talk through how you were thinking
• 15:23
  - about that? How do you ensure this momentum
• 15:25
  - is building versus sort of sliding backwards?
• 15:29
  - Yeah. So
• 15:30
  - sustainment
• 15:32
  - was treated as its own phase within its
• 15:34
  - own work, not as something that is
• 15:38
  - outside
• 15:39
  - of the initiative itself. So
• 15:41
  - ongoing, there's monthly performance reviews with site leads,
• 15:45
  - there's structured case review.
• 15:48
  - We're looking at, you know, the real time
• 15:51
  - dashboards,
• 15:52
  - any overdue
• 15:53
  - task rosters, and as well as looking at
• 15:57
  - unit level
• 15:58
  - scorecards.
• 15:59
  - So, the measure of success
• 16:01
  - shifted from did we implement it to
• 16:05
  - does it hold on
• 16:07
  - a night shift in
• 16:09
  - August?
• 16:10
  - So we wanna make sure that the sustainment,
• 16:15
  - plan is embedded in the work that we're
• 16:18
  - doing every single day and that it carries
• 16:21
  - on.
• 16:23
  - Regardless of what the shift or what the
• 16:25
  - time of the year is you see that
• 16:27
  - sustainment?
• 16:28
  - Yes. And regardless of what clinical setting. So
• 16:31
  - whether or not the patient is coming through
• 16:33
  - the emergency department
• 16:35
  - or inpatient
• 16:37
  - or is in the the, you know, one
• 16:39
  - of the ICUs,
• 16:41
  - this we are doing the same thing,
• 16:43
  - and it's embedded into our everyday standard work.
• 16:47
  - Mhmm. That makes a lot of sense.
• 16:50
  - I wanna
• 16:52
  - leave our discussion with,
• 16:54
  - a key takeaway for listeners. Perhaps it's a
• 16:56
  - quality leader at a smaller system who doesn't
• 16:59
  - have maybe the same resources as Emory or,
• 17:02
  - another system at an academic medical center. But
• 17:05
  - I'm curious, what what is the big lesson
• 17:08
  - or takeaway that you would leave audience members
• 17:10
  - with
• 17:11
  - about this initiative?
• 17:13
  - Yeah. I would say to start with the
• 17:16
  - variation,
• 17:17
  - not the average.
• 17:19
  - The spread tells you where the design is
• 17:21
  - failing,
• 17:23
  - secondly, decide who owns it before you build
• 17:26
  - anything,
• 17:28
  - third, consolidate
• 17:29
  - order sets. It costs political capital, and it
• 17:33
  - returns
• 17:35
  - reliability.
• 17:37
  - Bring documentation and coding people in at the
• 17:40
  - start. We found this to be successful not
• 17:43
  - only within our sepsis efforts, but also other
• 17:46
  - efforts efforts as well. And in doing so,
• 17:49
  - you don't want to wait until when the
• 17:51
  - results
• 17:52
  - are not, you know, going in a direction
• 17:53
  - that you want it to go into.
• 17:55
  - And then lastly, make the data local and
• 17:58
  - visible,
• 17:59
  - then close the loop by fixing what it
• 18:01
  - shows.
• 18:02
  - It is important
• 18:04
  - that staff and the clinicians, frontline staff and
• 18:07
  - clinicians,
• 18:08
  - feel like they own the process, that they
• 18:12
  - own the work themselves. That is
• 18:15
  - so important.
• 18:17
  - And,
• 18:18
  - you know, whenever we can do that, that's
• 18:21
  - exactly what we want to
• 18:24
  - focus on. So, those things are incredibly
• 18:28
  - important.
• 18:30
  - So having a shared sense of ownership
• 18:32
  - is what really helped us to also move
• 18:36
  - the needle.
• 18:38
  - Well, Doctor. Harris, I so appreciate you giving
• 18:41
  - us such a rich and thorough,
• 18:45
  - walkthrough of the work that you've been doing
• 18:47
  - in sepsis. I'm excited to see how this
• 18:49
  - work continues, and it's clear that Emery is
• 18:51
  - so lucky to have you and your expertise.
• 18:54
  - So thank you so much for joining us
• 18:55
  - on the podcast today.
• 18:57
  - Thank you for having me.