What healthcare leaders need to know now
Tejal Gandhi: Push for quality, safety needs to come from boards
By furstgroup | July 24 th, 2015 | Lucien Leape Institute, patient safety, physicians, Blog, boards, Brigham and Women's Hospital, CEO, chief quality and safety officer, directors, National Patient Safety Foundation, Partners Healthcare, Tejal Gandhi MD MPH CPPS, culture, quality | Add A Comment
One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.
The patient-safety movement has made slow and steady progress in the U.S. healthcare industry. But to achieve a faster pace of change, Tejal Gandhi, MD, MPH, CPPS, says change needs to come from the top of each organization – and that means above the CEO.
"We talk about CEOs and leadership in terms of patient safety, but I think the involvement of governance and boards is a major gap we're overlooking," says Gandhi, president and CEO of the National Patient Safety Foundation. "Most boards don't know much about quality and safety. They tend to leave that to the clinicians and aren't necessarily demanding better performance in this area."
The move away from fee-for-service payment in healthcare makes this even more critical, she adds.
"If you start to pay for value, part of the value is quality and safety," Gandhi says. "Boards are going to have to become more knowledgeable, and they will; they are smart people and will ask the right questions. Workplace safety is a big issue in every industry. The directors will need to demand more and even think about CEO incentives being tied to safety and quality."
Gandhi, who served as chief quality and safety officer at Partners Healthcare and executive director of safety and quality at Brigham and Women's Hospital before joining NPSF, believes most healthcare CEOs want to improve safety but get overwhelmed about where and how to begin.
"I think CEOs want to create the right culture – they know a culture of safety is important – but how to actually do it is where the challenge is."
One key element of NPSF is its respected think tank, the Lucian Leape Institute, named after the Harvard physician and researcher regarded as one of the pioneers of the patient-safety movement. At the institute's retreat last February, Gandhi said the leaders came to the conclusion that they needed to sharpen their focus on helping healthcare CEOs.
"For the last five years, we've been focusing on what we call the transforming concepts, the big issues that we need to see change to really make advancements in safety – issues like patient engagement, transparency and reforming medical education," she says.
"At the retreat, we asked, 'Where are we struggling, and what theme ran across all five of the reports we released on the major issues?' The theme was culture."
Back when the seminal "To Err Is Human" report on medical harm was published in 1999, little was written about culture in the healthcare environment. Today, notes Gandhi, culture can be measured and stakeholders sometimes insist that organizations do just that. Going forward, the Leape Institute plans to get down to brass tacks to help CEOs create safer systems.
"We can't just say, 'Go change your culture,' " Gandhi says. "We need to give people things that are much more tactical. And I come from an operational, tactical background so I like the fact that we're going to create a playbook that says, 'Here are the concrete steps you can take as a CEO to start down this path.' "
As a relatively young CEO who has been on the job for two years, Gandhi has great empathy for leaders. She says her own learning curve was steep and that getting up to speed on issues ranging from finance to human resources to even real estate "was like drinking through a fire hose for the first six months. There's a different level of stress when you're the leader, so that's taken some time to get used to. But what makes this job fun is the learning."
Key to any discussion of quality and safety in a healthcare setting are the doctors, and Gandhi, a board-certified internist, worked in clinical care for many years.
She is hopeful that the transition to value-based care will allow mid-level providers to participate more in patient care and allow physicians to get back to having significant conversations with their patients. Primary care physicians, she said, sometimes have a tough time even visiting their patients in the hospital because they're seeing an overwhelming number of patients in clinic on any given day.
"The primary care physician is the person who can advocate for the goals and values of the patient when interfacing with the rest of the healthcare system," she says. "I've seen payment models where the primary care doctor gets reimbursed for going to the hospital and seeing a patient. It's very important."
While patients can and should partner with physicians on decision-making and with organizations by being welcomed onto quality improvement committees, Gandhi says the predominant responsibility for patient safety should be with the caregivers.
"The whole 'ask-me-if-I-washed-my-hands' thing drives me a little crazy because the patient shouldn't have to ask – that's on us," she says. "But we do need their advocacy, making sure patients feel comfortable asking questions, that they agree with and understand their plan of care and that their voice is part of creating that plan."
Profiles in Leadership: Top 25 Minority Executives The undercover exec: Wright Lassiter III scoped out his hospital before he took the job, then forged a bond with his board to stage a remarkable turn
By furstgroup | September 11 th, 2012 | board, Furst Group, Healthcare, executive, Minority Executives, Modern Healthcare, patient safety, Alameda County Medical Center, Blog, CEO, directors, leadership, Top 25, Wright Lassiter III, quality, trustee | Add A Comment
One in a series of profiles of Modern Healthcare's Top 25 Minority Executives in Healthcare (sponsored by Furst Group)
Back in 2005, before Wright Lassiter III interviewed for the position of CEO at the then-beleaguered Alameda County Medical Center in Oakland, Calif., he decided to see for himself if there were some signals of hope in an institution that had seen 10 CEOs crash and burn in the previous 11 years.
"I flew in the afternoon before and grabbed a taxi over to the hospital," he says. "I was in street clothes; I wasn't in a suit. No one knew who I was. I walked into the ER waiting room and then walked the hallways. I wanted to get a sense of how the staff functioned; to see if people might help you find your way."
What he found surprised him, especially for an organization with such a troubled recent past. Everyone he encountered was consistently courteous and helpful to him as a visitor, and to patients.
"There wasn't one interaction that was negative," Lassiter remembers. "The people doing the work in the trenches serving the community were doing the best they could."
That, Lassiter says, gave him some hope that the health system could be turned around with the right moves. It also helped persuade him to give up a solid, comfortable position at JPS Health Network in the Dallas-Fort Worth area where he was senior vice president of operations.
Fast-forward a few years and the work that Lassiter has accomplished earned him a glowing write-up in Fast Company magazine, a spotlight that brought him national attention as well as some good-natured ribbing from his peers, he adds.
But to Lassiter, none of it would have happened without the backing of his board of trustees, a source of strength that is sometimes overlooked in the business world, he says.
"Two board members who served on the search committee that selected me are a large part of the reason why I considered the job in the first place," Lassiter says. "They were instrumental in the turnaround. I think it's important for CEOs to partner with their boards to drive change."
It was the board's backing that enabled him, he says, to press forward with an aggressive plan to reduce errors and champion quality and patient safety.
"I generally take my board members to health care conferences to help them understand the nuances of what's being presented," he says. "But I purposely did not go with my vice chair when he attended an IHI conference on quality because I didn't want to influence him. He went with our chief medical officer instead. When he came back, he told me, 'OK, Wright, I get it. I am scared out of my mind, but we have to do this.' "
The leaders at Alameda County Medical Center presented a plan for "harm reduction" and, in 18 months, reduced incidents of harm by 48.5 percent across the system.
"People get uncomfortable with the word 'harm,' but the board agreed that it was the correct word to use. The groundbreaking report "To err is human" found that harm was happening in hospitals and we were willing to acknowledge that a problem existed," Lassiter says bluntly. "Our work drew glowing comments from the Joint Commission and Donald Berwick, a member of the original committee that published the report on errors. That's what happens when you educate a board well and then engage them."
Healthcare and leadership are part of Lassiter's heritage. His mother is a nurse, and his father is chancellor of the Dallas County Community College District. What he's learned from them, and from his career, is that a critical factor in leadership is simply courage, like the move he made in accepting the Alameda position. "That doesn't mean blind courage," he notes, "or taking risks that are inappropriate. But when the lights are off and you don't know what's around the corner, you have to lead with courage."
Closely aligned with courage, he says, are transparent communication and flexibility. "Communication is especially important with the medical staff," Lassiter notes. "You tell them, 'Here is our plan, and we will keep communicating with you all the way through this process.' " It's a reason why he still takes part in new employee orientations, he says.
Flexibility is based in honesty, Lassiter says. "You have to do your planning with flexibility. You can plan so that you have a baseline for your actions as an organization, but you have to be willing to be flexible if conditions change."
And as conditions change within the healthcare industry itself, he says, building a leadership team requires flexible people. "Healthcare is a relationship business, and I'm always looking for folks who can foster, build and maintain strong relationships. It takes perseverance too. You can't be dissuaded easily by problems or challenges."
At Alameda, the challenges have been formidable, but Lassiter and his team have stepped up to the task, stopping seven-figure financial losses and building a new facility while dealing with all the issues that come with being a safety-net hospital.
"When I talk to our people, I say, 'Think of your loved ones and put their faces on the patients and families you're caring for.' When you approach your work with this in mind, you will do all you can to provide excellent service."
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