Episode 21 : Quality, Safety, and Patient Experience:

SCTS_Barbara Pelletreau: Audio automatically transcribed by Sonix

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Intro/Outro:
Welcome to the Smart Care Team Spotlight, presented by Care.ai, the Smart Care Facility platform company and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CNO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm delighted today to have a special guest on the Smart Care Team Spotlight, Barbara Pelletreau. Barbara was formerly the patient safety officer at CommonSpirit Health, one of the largest nonprofit healthcare systems, where she was responsible for regulatory readiness, medication safety, management of controlled substances, reduction of hospital-acquired conditions, voluntary events reporting, and loss control prevention. Under her leadership, CANDOR, which stands for Communications and Optimal Resolution and Just Culture, were implemented system-wide. Barbara also led system-wide employee safety efforts, resulting in the reduction of worker's compensation costs at the University of California Office of the president. Barbara is known for her strategic and collaborative leadership and implementer of transformative and large-scale initiatives, patient-centric results, adoption of innovative technology solutions, and investment in her team and colleagues. Barbara continues her passion for safety by serving on advisory boards for innovative companies, chairing policy committees promoting candor, and mentoring future healthcare leaders. Welcome, Barb. It's great to have you with us today.

Barbara Pelletreau:
Nice to be here, Molly.

Molly McCarthy:
So many conversations on this particular podcast to date have described the significant challenges facing our caregivers, really with a focus on how we can build smart care teams and smart hospitals by reimagining our current models of care with new technology. But another important dimension for us to consider is the imperative to focus on quality, safety, and regulatory compliance in an era where we all are compelled to achieve more with less. So this leads me to my first question, Barb. And before we really dive into more potentials around technology and patient safety, I would love for you to share with our listeners more about your most recent role, including perhaps, the scope and scale of the requirements, mandates, and elective priorities that achieve quality and Patient Safety Officer is responsible for implementing and then also accountable to oversee.

Barbara Pelletreau:
That's a broad question. First of all, my previous role with what, over 23 states and 140 hospitals and let alone the many hundred sites of care. So primarily, people often ask, what does a Patient Safety Officer do? And I often break it down into buckets categories, and again it's not siloed, they all work together and across the spectrum. But we certainly have medication safety, you have regulatory compliance, you also have the high-reliability organization putting those skills into place. You also have the voluntary events reporting system; how that information is used, certainly working with root cause analysis, how to do good root cause analysis. Also, just public reporting of harm events. And then on top of that, we also have innovation. How can you make it easier to do it right for those at the bedside, those that deliver care, those that are at small community hospitals. So in my role in the department, we were what, I'd stay here to serve. Our goal is to support those on the front lines and those leaders to get it right and bringing innovation and bringing the most, the latest and greatest, because it's not the flavor of the day, but it's what works, what's proven, what's evidence-based, and then how do you spread that for adoption? The last thing I'll just say on this, Molly, is we all know, especially in healthcare, it takes 17 years for something to be adopted. So a personal goal is, can we adopt this a bit sooner? Because when we do, patients are going to benefit and so will those that provide the care.

Molly McCarthy:
I think that's a really good point, especially since technology is so rapidly changing, and those innovations will definitely come and go over the course of a 17-year period. So I hear you; I think you make a good point, though, of your role and others in this particular role is, how can you make, how can you utilize innovation to make what caregivers do on the front lines easier and really work to the top of their license? So that's fantastic. And to your point, not just taking what's the latest and greatest, because we know there's so many different options and point solutions on the market, so many different buzzwords of the month. For example, generative AI has been all the buzz this year, but really, ones that have been proven and directly shown evidence. So that's great. My next question is a little bit deeper, it's two parts. I'm going to ask the first part and allow you to answer because sometimes it's just easier like that, but related. And you talked about this a little bit, but I would love to hear how closely correlated are a hospital's financial outcomes to high quality and riot reliability.

Barbara Pelletreau:
Well, that is a great question and certainly could be discussed for hours. But I think when you look at quality, safety, patient experience, and you get those three right on all cylinders, not just in 1 or 2 categories, but across the board, and it's more than just what we're reporting or measuring through CMS, but you look at the ongoing application of the evidence-based practices, whether it's by nurses, by doctors, by the laboratory, whatever it is that defines high quality and safest care, and of course, with kindness for the patient experience and respect for those that are using our services. It is absolutely, in my opinion, a direct correlation with your financials, and here's why. When you get it right for quality and safety and patient experience, first of all, that's the business we're in. If we can't do that, why are we in business? The next step for that, though, we got to do it well in many areas and in many disciplines, and that takes good leadership. And when you get that right, and I find you have the physicians working with the leaders with nursing and the other professions, and then it builds a reputation. And when you get that reputation, and you sustain it and nurture it and keep staying current with what I'll call simply evidence-based practices in a nice work setting for kindness with patients, you know, what your financials are going to follow. And I've also seen where certainly leaders are changed and you have the potential, but you have the wrong leadership. But you get the right leaders in all three are firing on all cylinders, and you get that reputation, and it certainly drives your bottom line.

Molly McCarthy:
Yeah, I like that, what you said. Why are we even in this business if we can't deliver a quality, safety, and patient experience? 100% agree with you. The second part of that question, and you touched on this a little bit, but one, I would love for you to share any examples that you've done during your tenure in that role, and then obviously, consequences of falling short of that and then obviously benefits of improving.

Barbara Pelletreau:
Okay. Well, let me break that down a little bit. For example, most of our system that where I worked was made up of small hospitals, community hospitals, and we had some large ones, but for the most part, healthcare is delivered through the small community hospital. And in order to do that, certainly, you have to get the right information together to be able to get it to your colleagues and partner in how it delivers it, care. With that also comes interaction with the medical record. That's our documentation on how we deliver care. And we, I can't believe that there's hospitals still on paper these days, but there was at one point, not everybody was on board. But now, with everybody on, using some type of electronic medical record, we really need to make it work for us. So we're not just educating. When I started in this business a long time ago, I remember everything was about education. In fact, it was an education department. It wasn't a quality department. It was everybody. Well, we need to educate. And how many times do we sit in training and educate, and we still need the education. However, I think education maybe gets us to a 60% confidence level. We got to go beyond that because education we know just does not work in and of itself, but complementary net medical record to be able to drive the highest quality, the evidence-based work and help those front line work get it right. So any kind of technology that is consistent and makes sense for the front lines definitely can achieve that. So I can think of several examples. So I'm going to give you two. So one is small community hospital near big city but not in a big city. I don't know has maybe a little over 100 beds, maybe 150 beds. And they weren't doing well on all of their quality measures and harm, and boy, seemed like regulatory was showing up regularly and, after events, because certainly in states, I think there's 22, 25 states where there's public reporting, so there's certain things that happen that you must report, and that usually brings out your Department of Health Services, and that represents CMS. Anyway, after a few events like that and now getting in the right leader, right leaders, usually I think of the triad, I think of the president, the Chief Nursing Officer, and the CMO. If those three are on the same page, they can drive change along with the chief of staff, of course. But anyway, so with that did not have great outcomes when it came to the hospital acquired infections. Many hospitals now have gone, you know, well over a year, two-three years without hospital-acquired infection, especially central line, and yet there they had them. So again, when they start applying the evidence-based practices, they got the right leadership in, they got it down to the front line, and they had a multidimensional approach. They're now well over, and there are other quality, and they are A-rated in Leapfrog, and there are many other outcomes that are publicly reported, and they've gone quite a period of time without a HAC, a hospital-acquired condition. Another example is a hospital that did fairly well in their measures, whether there's quality, safety, but let's just say their dashboard for how we're delivering healthcare and what we're publicly reporting. And then, there's other criteria also that they thought were important that they added in, so it wasn't just limited to CMS public reporting. Anyway, with that, they were doing very well. They had safety coaches in the units, they had regular safety huddles, they had a very integrated team with the doctors and with their Chief Medical Officer, with their quality, with their safety leader, and really helped that the president and others were all about the bottom, not the bottom line, but the bottom line of safety and quality that would drive the bottom line. And they were just consistently getting great outcomes publicly as well as one of their key measures was Leapfrog and being able to look at Leapfrog as well as their star ratings with CMS. So that was a couple of their measures, and then they had deeper measures inside. But with that, again, their financials followed, and I just think that it's a win-win-win. It's a win for the patient, it's a win for the quality, and the care, the evidence-based practices, and it's a win for the bottom line, and to me, that's good healthcare.

Molly McCarthy:
Yeah, that's critical, obviously, and really working towards the quintuple aim. And I'll put that fifth piece in of health equity. Appreciate those examples, and I love what you described as the triad of successful leadership, including the president, the chief nursing officer, the chief medical officer, to drive that change within an organization and drive that culture and that multi-pronged approach. Specifically, you describe the central line infections, and that's pretty amazing over 1300 days without. So appreciate that. Do you have any other thoughts around consequences of falling short other than the obvious financial or just from a culture perspective?

Barbara Pelletreau:
Certainly, culture plays a huge piece. We can say we need better culture, but it's our actions that get us better culture. So what are the very specifics and what's the plan for improving our culture, and what do we need, and how will we measure it? I'll add in another dimension for safety, and certainly using the latest and greatest and proven technology, is that your claims should also follow your lawsuits. And sometimes safety, patient safety lives in its world and doesn't connect with those that are managing the claims. And they're kind of often put into another little room, and you often hear, well, we can't talk about it, it's litigated. Somebody's going to be talking, have to talk about it so that it doesn't impact another patient. And when you impact patients, you're impacting those that care for patients. So with that you're, if you do all of this correctly, you should also not see your lawsuits and your claims, and that is depending on your size. And most healthcare isn't self-insured, that's a huge contribution to the bottom line. So I'd like to challenge the safety officers, the leadership, that you should be doing safety and you shouldn't be also seeing positive results on your claim side of the house, and then again, contributes to your bottom line. As for culture, certainly, when many hospitals participate in Leapfrog and do surveys of culture of safety, it used to be that you had your culture of safety survey, and then you had your employee safety survey. And, I don't know, a few years ago, I approached Leapfrog and said, we got to combine these. You cannot have the poor person that's managing a unit have two different sets of surveys, two different sets of measures. We got to combine these, and thankfully, Leapfrog agreed that, yes, you can combine them. And so now, I think quite a few organizations have combined their culture of safety questions in with their employee survey questions. And with that, certainly, having your different domains or grouping of questions and knowing exactly where to focus. And that's a great opportunity to take those results and sit with the teams at their safety huddles to say, give me some feedback. What else do we need to know to improve this? And here's the things we're doing really, really well and what contributes to that. But having those conversations at that front line is critical because you will find out exactly what people think and feel and how they perceive. And even if it's not quote, unquote right, or close, then that's your opportunity to get more information and partner for a better culture. Because over and over, when these adverse events happen, you'll find that the culture was a problem. So why wait? Let's use these survey results and dig deeper, and come up with the plan. The last point I'll say about this, Molly, is the thought of transparency. When I started doing this, I don't know, public reporting in the state of California began, oh gosh, I think it was July 1st, 2007. And I know that because right before that, about six months before, they created a patient safety officer position. And with that, over 40 hospitals learned very quickly that there's a lot of things that go on that are now going to be public. And I just don't think we're ever going to see the change until we figure out how to get past transparency and or move forward with transparency, but get past this whole, well, we can't talk about it. We got to learn from it, because certainly those that are taking care of our patients know what's happening, and they must think we're living in the sky or in the sand or wherever you're it's. But you definitely need to have that information out so we can do better. And I think my last comment is healthcare providers, you and I know, show up and want to do what's right, but they need information and they need direction, and we need to make it easy for them.

Molly McCarthy:
I love all those. I especially love the transparency piece that's so key moving forward and continuous improvement. Quite frankly, if you're not acknowledging it and doing that root cause analysis, how can you make changes? My next question, really, maybe reflecting on your last few years within your role. I would love to hear your thoughts on just when you look at the market with so many health systems today and really over the past few years, struggling to find staff to keep their beds open for care for patients, how have you seen the role of the quality and safety team changing, perhaps like thinking about through COVID and then post-COVID? And just with the workforce shortages in the market today across many disciplines, not just nursing.

Barbara Pelletreau:
Yeah, boy, it's quite a challenging time recovering from COVID and less in the workforce. And then I think the saddest part is I think there's not enough in the pike that are coming out of nursing anyway and to be able to meet our needs. So with that, being an optimist, I think this is the opportunity to step back and say, wow, how are we going to get there? What works, and what do we need to change? Maybe we need to not keep adding on in healthcare. Maybe we need to go back and redesign a path forward. And I happened to, I don't know, at one point in my career, receive the Innovation Award for one of the top innovators. And I think that came about because there's certain technology that is really going to help us get it right, and we need to be able to get that implemented as quickly as possible without certainly without errors and problems in itself, and show that it works and get that to our front lines. I also think, as I've looked at the last few years, is there's a lot of innovation going on out there, my goodness... Just to check with the innovation officers, they're being hit left and right with new startups, etc., but what it's done for me is it made me think, you've got to find partners that are not single solution. You need to find a partner that will grow because, of course, the technology is integrated with that medical record, it's integrated with other systems that are already embedded in healthcare that are working. So you can't just keep laying things on top. One, it's costly to integrate, two, it takes time, and on top of that, it's hard to sustain. So looking for innovation that solves multiple problems is actually, I think, really a key strategy for a large companies or even small companies to hook their wagon to and look for those right partners that are going to grow with them and solve many problems, not just single solution.

Molly McCarthy:
Yeah, a great point. I think that partnership between the tech industry, healthcare, the clinicians is so important because we know, and I know, and our listeners know it's not going to be solved by one entity. It's really that partnership and working together to make that change. I also just echo your point around single solutions, I think I've talked to many technologists and CIOs, etc. CTOs, over my time, and they really want to move away from single-point solutions more towards platforms. A couple more questions. So appreciate your time here. And you mentioned this a little bit in one of your answers previously, but would love your perspective on different organizations around quality and safety, for example, like the Joint Commission, Leapfrog, IHI, which is the Institute for Healthcare Improvement, and others within that area. Just in terms of how has their thinking and guidance changed over the past few years? If you think about, obviously, with COVID and then the economic and operational realities that health systems are facing today.

Barbara Pelletreau:
Well, let me pick off some of the top ones and spend a few minutes, a few sentences on each of those, certainly starting with the Joint Commission, all of our hospitals, or I think probably 95% of them were had joint Commission surveys. And with that, they've had new leadership in the last few years, and certainly, they've put and put patients over paper. And I know through the years overseeing regulatory, a lot of hospitals spend a lot of time preparing for the test, if you will, and then you've got a three-year gap as long as nothing terrible comes along, and then you brush it off and get ready again, I'm not sure anybody outside of healthcare would ever agree that's a good process. I think many in healthcare agree that's not a great process, but I think with their new leadership, they're definitely trying to figure out what regulatory requirements make sense, what standards make sense, and what we can retire, if you will, so we can get down to what matters. The next one that I will mention certainly is IHI. Boy, they've been a leader for a long time, and I think they were the one of the first ones I looked to and went through my patient safety fellowship with when I started in, working in defining patient safety, and they're international, and I think they've just taken so much of the work that we've done in the United States and have spread it to those that do not have IHIs or structure in place and, and made a difference around the world for them. So a lot of respect for the work that they've done and continue to do and especially their investment in boards; certainly, we all know we got strong boards we're going to have better outcomes and better again, under the leadership category. My favorite, I'll have to say, is Leapfrog. I've watched them evolve, and I watched these to be more bicoastal because they were started from companies that were fed up with healthcare. And as the company said, we got to get out of this fee-for-service, to manage care, etc., and Leapfrog and Leah Binder moved forward with Leapfrog and watched them to where it was a lot of process and reporting and no validation to where now they actually validate what you say, and 50% of it is outcomes and nothing you can control. What you can control getting there, you're going to pull the data. It's not what you answer on paper, and then 50% and roughly on process. So I find their structure, I personally really have a lot of respect for, they pull together experts in different categories. I know they've started one with technology innovation, and they've brought in experts and people to listen to for that. So they don't pretend to know it all, but they go out and find the right people, to help provide guidance for them. They also celebrate, love it when hospitals get A's in their reports just came out the last few days. And so, with that, let's celebrate people that have done well. Let's acknowledge them and help them share with others that haven't done so well what needs to change. So with that, I definitely think there's one other one I'm involved with, which I'll mention because I, very passionate about this work. The medical errors is the third leading cause of death, and the only reason you don't see it is because there's not a second place to put on a death certificate why, or what happened, or where, or... So third leading cause of death, heart cancer, and now medical errors. And this just seems to come out over and over David Bates's study last January that published over Harvard System came up with all the harm that had happened. So it just keeps getting validated over and over. The University of Washington has been a big leader in CANDOR, and just a few years ago it was top. AHRQ did a toolkit on it, so anybody can follow the toolkit and start implementing how to manage these adverse events, how to not defend, deny, delay, but how to talk and give information and make it so it doesn't happen to another patient. And the University of Washington, under their collaborative for Accountability and Improvement, has done a lot of work in leadership, along with IHI in Adriana Labs, a tool in Wendy's company, and have led 25 hospitals to up their skills and their tools and their leadership for managing medical errors and preventing medical errors. So anyway, I think it's all going in the right direction. Certainly, 15, 10, 15 years ago, a lot of this was not in place except for IHI and certainly the Joint Commission. But you read about it a lot more now, you see it in Becker's, you see it in the news, on some of the proven tactics that need to happen at every single hospital to manage and prevent these errors.

Molly McCarthy:
Yeah, I'm going to pick on Leapfrog just because you mentioned their tech and innovation component, which obviously is so critical moving forward. We talked earlier about the electronic medical records and electronic documentation. So when you think about evolving technologies like virtual and patient care, ambient monitoring, AI, what are your thoughts around the best use cases for immediate impact without using your lens of a quality, safety, and regulatory compliance?

Barbara Pelletreau:
Well, certainly looking at how we redesign patient rooms and how healthcare is delivered in the room to the patients. So I'll get a little hospital-centric for a moment with that. Certainly, we're all fighting to get those nurses that we don't have enough of. So we've got to think differently to help the nurses that we have to want to stay in practice, and also nurses that might be leaving practice but could still be incredibly valuable. So as the virtual nurse, now, I'm just going to step back a second, Molly, and say, this reminds me, I'm really going to date myself here, but it reminds me of the 80s when the word wellness came out, and in healthcare, you remember that was that's going way back. But you couldn't even get a blood pressure, you couldn't even get a lipid panel percent body fat in that unless you went through your doctor. And so in the 80s, all of a sudden, right, everybody says, oh, we got to do wellness. And the doctors and people are saying, what's wellness? Well, I feel like we are in the, back in the 80s, but now defining artificial intelligence in healthcare, because certainly any day you read Becker's or any other Modern Healthcare, you start seeing the word of AI or virtual nursing, and then you start talking to nurse leaders. What does that mean? Here, we're doing this, and here we're doing that, and we've got a bigger plan. So it really has a huge realm that needs to get to be defined. And I always say when someone mentions those words, my first question is, how do you define it and what are you doing, and what's your long-term plan? Because then you find out much sooner where they are, where they plan to go and how they're currently defining it for their company, their location. So with that, there's many immediate and, I don't know, low-hanging fruit that can be picked up. Certainly, the falls, as we know, can really change someone's life when they start getting over 60, and there's that fall, oftentimes within a year or two. It's not a good scene, and it's the beginning of going down the wrong path, if you will. So, certainly, preventing falls is key. Pressure ulcers is another area. If somebody, when they leave the hospital, and they've gotten this great care, it definitely don't want them spending the next six, nine months recovering from pressure ulcers, from lying and positioning, etc., so anything to help with that. Medication reconciliation, I just heard a terrible story of someone who's just lost their daughter to medication reconciliation, the lack of, and the medical record was not current, and they gave them all the drugs that they were no longer taking and ended up sadly killing this young lady. And so medical reconciliation is just poor, it should be at the very, well, they all should, but this one is, we got to get this right to know what medications currently, plus what they've taken in the past. Some other area certainly is safety. We talk about safety for the nurse, those that are in the room caring for patients, certainly in the emergency room. So being able to use artificial intelligence and technology for safety is another key one. So I named a few of them, but I think the key is that's just the tip of the iceberg. In one area, somebody say, May I, may I have this issue? How can this technology help? And again, I'll go back to what I said before. Partnering with the right people that can help solve the problems is equally as important as having the right technology.

Molly McCarthy:
Right, no, I think what you started off saying there was, how do you define, I don't know, virtual nursing? I always ask people when I talked about virtual health many years ago, how do you define it? It's going to differ really where place to place. And then, to your point, what problem are you trying to solve? We can't lose sight of the underlying problem or workflow because we don't want to just attach technology to attach technology. We really need to be specific, so appreciate those examples, and to your point, they are low-hanging fruit. To wrap it up today, unfortunately, we have to close out here, but would love for you to share with our listeners, who typically are Chief Nursing officers, Chief Nursing Informatics officers, and hopefully now some Patient Safety and Quality officers. But would love your thoughts around what, if you could leave our listeners today with one piece of important advice as it relates to the responsibility of being tireless advocates for their patients, what would that be?

Barbara Pelletreau:
Well, I'm going to describe it as be bold, be brave. What that means is that often, in healthcare, we each create our own solutions. Each you have something proven, you have something that's working, it's in the medical journals, it's all over, and yet we look and say, that's nice, but what are we going to do here? So I say, be bold, be brave. Look outside of your own domain, your own hospital healthcare setting, and say, what are others doing and what are they doing? Well, and get out of your comfort zone. So that goes into be bold, be brave. The next part is you're probably not going to be doing this yourself. Developing your own technology sounds great in the beginning, and you get approval for all the money and the board support and everybody, but it's not sustainable. You must find partners that do this work and do it better and work with other healthcare settings so you can benefit from what their problems are, what their solutions are, that then automatically are transferable to your solutions. So I would say after be bold, be brave, looking outside is to find that right partner, that right platform, and it's not just technology, it's about the aptitude for them to grow and deliver services and partners. I think for me, I've always, throughout my career, looked at what the solution or what solution a company is bringing, but what brings them in the door for me is the long-term partnership. What are their values? Where are they going, and how can I benefit from all their other clients to help me on what I may not know?

Molly McCarthy:
I love that! Be bold, be brave, look outside of your own domain, and that partnership is key, and it really goes beyond just the technology but inclusion of that, the people, the process, the platform. So thank you so much for all of your insights today. Certainly appreciate your time and look forward to seeing you in person, hopefully soon.

Barbara Pelletreau:
Thank you, Molly. It's been a joy.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight. For best practices in AI and ambient intelligence, and ways your organization can help lead the era of smart care teams, visit us at VirtualNursing.com, and for information on the leading Smart Care Facility platform, visit Care.ai.

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