B (3:16)

Well, I think that's an important piece to talk about and really lean into at such a large system, how leadership is aligned and scaffolded across all of your different locations and sites. It's something that certainly came across loud and clear at our site visit. And one of the things that we were fortunate to talk about with you and your team was also the evolution of technology, including AI, but certainly beyond that and how the field has shifted in predictive analytics and in technology enabled solutions that improve patient safety and how as a leader you have to identify and lean into areas to engage in that work to improve the broader support of patients, but certainly also engage with the workforce as well. So can you talk a little bit about the evolution of common spirits technology and how that's had an impact on patient safety and quality?

C (4:00)

You said all the right things. I think that technology is a double edged sword. You could jump too quick, you could the new shiny item, you know what's happening and when you're this large, you have to be a little bit cautious what you're going to adopt and then disseminate. So we have a very well organized governance structure that has everything from legal to finance to clinical. As we adopt particularly the AI space, it's happening so rapidly. We have weekly meetings as we look at different things coming at us. And of course, as you can imagine, everybody approaches us to say, hey, we've got the best solution for you. And having that ability to do that rapid cycle is critically important. We think about this in the lens of is this back office front office, is this clinical decision making, is it prognostic indicators? And depending on what bucket we put it in, we have a different level of scrutiny or evidence that we demand before we actually start even piloting something. So you've got to be eager but cautious at the same time. And that's Kind of the trick. So I'm happy to meet people, hear their ideas, but then we do quick nos we call them.

B (5:02)

I love your note on eager but cautious. And I think that's incredibly important for technology and equally for innovation as I think patenting work is looking differently across the field as of course technology, but also really thinking about how you, in a culture that continues to evolve so quickly, also allow for a culture of innovation, of spreading of ideas from the front line from the board to the bedside. So can you also you kind of using and leaning into that phrase, just think about how you create an infrastructure of innovation and how then you scaffold that across the data, resources and technology that you guys all have in place. Because I believe when I was on site I notated that there was 17 different EHRs feeding into your central quality measure repository, which is significant from a management and incredibly impressive based on the clinical results that we all seen. Because you guys have a strong system, I think for others to learn from, for how you ideate and also lean into opportunities to innovate.

C (6:04)

We have a little bit of a mantra where we're all going to do the same process, we're going to adopt the same technology and we're going to use the same KPIs. So if you think about that process technology, KPIs, if you're all thinking now, it takes a while to get there, but as we move forward, that's our goal. And if you're on the same process, the same technology, measuring the same KPIs, you can quickly and efficiently adopt new best practices and disseminate those. But if you're on different processes and have different technologies and you're all measuring things in different ways, that is a very difficult position to be in. So that is sort of our North Star, you know, this issue of the EHRs and we have 17. And I really thank my IT colleagues because we are rolling out one EHR. So every every six months, we're kind of reducing that variability in fragmentation of our data. However, at the same time, we have to win today and be excellent today, even though it's going to be two to three year roadmap. And that's all the hard work that you just talked about, the data normalization, the proper use of dashboards, which really to me means clinicians are in the moment thinking about what that dashboard should look like to help them. We often get dashboards, we're like, this doesn't help me. So how are the clinicians and iterating on those dashboards there's never been. I've never had a dashboard that was done. I mean, if you're really working with the dashboard, there's a back and forth with the clinical front lines about how it's being used, what's not being used. So it's a lot of hard work. The first win makes the second win easier and the third win even easier. You know, that normalization process gets a little bit easier every time you do it. And then hopefully on the back end, we're reducing the amount of EMRs we're doing, so it even gets easier.

B (7:41)

And I think what you're describing also really lends into the broader environment you've all built around creating a culture of continuous improvement and that you identify something, you try it, you iterate, you learn what happened, and you continue the cycle from there. And we all certainly felt that while we were on site, that folks were interested, able, based on data, to try new things and to identify different solutions. Can you also talk about, again, based on your size, how that culture of continuous improvement, in addition to identifying and making improvements across dashboards, really lent to the culture that is very evident at common spirit of continuous quality improvement and using data to inform improvements for culture.

C (8:21)

One good example that pops to mind is the RPA process that we have on screening for cancer. And this again, same process, Same technology, same KPIs. A group in the Pacific Northwest, we have five regions. We're looking at the big three cancers, breast, colon and lung cancer screening, and how constant changes were happening in the screening guidelines. So some were age, genetics, family history, all these things were changing. And a busy primary care provider was having a hard time. So these bots actually scrubbed the charts, previsit and look for the different risk factors and hand up to the primary care provider. Would you like to send this screening colonoscopy, this mammogram? And we just saw a huge lift in our colon, particularly in colonoscopy, which is one of the more difficult areas to break into. So we got together and we decided, okay, this is best practice. How do we now take that from actually, it was an epic environment to a Cerner environment, to other environments. And now we're rolling that out across the entire health system. And that just gets all of our people so excited, right? Because we're sharing best practices, we're learning from each other, and we're saving lives in a real, real, concrete, measurable way. And once you get a win like that, the next one is like, okay, let's do it again. The hard work of data normalization technology shifts, people kind of push through those things and get excited.

B (9:44)

I certainly agree and it's such a good example for the field to learn from on technically process and people where to start and how to continue to scale up your quality management system from there. Your organization is so incredible and I think there's so many facets that the realm of quality can learn from in the field. Then as you went through the site visit, as you mentioned and prepared for the Quest for Quality award, I'd love to hear from you advice you have for future leaders in the field, future organizations as they consider or are just beginning their own quest towards excellence on what you might recommend as they continue that journey.

C (10:19)

I would strongly encourage, no matter where you are in your journey, to think about participating in this process because I think the process onto itself is a learning curve for everybody and it enables you to get feedback from AHA and from other experts around the country. And actually some of the feedback is like, honestly, some of our PDF was like, wow, I didn't know we were that good. Which is really nice to have, right? Someone said, you know, you're pretty good and we're like, oh, I didn't know we were that good. And obviously then you get feedback on where you could, you can make some improvements and some changes. And I think that process is invaluable because how often do you get an objective and what's the downside of participating is very little. Right? It's not like a rating agency or you know, it's not US news, but it's really looking at you and trying to help you get better and smarter.

B (11:11)

Thank you so much Tom. It's been fantastic having you and hearing your perspective on leading quality, on safety and certainly on innovation at Common Spirit. The work you and your teams are doing, from improving patient safety outcomes to implementing system wide solutions, is nothing short of remarkable. Truly, it's been energizing to hear how from leadership to technology to data to continuous quality improvement, you all are a good point to reference as excellence and for others to pick up the phone and learn a little bit more. And if the Quest for Quality prize is on your radar, check out the AHA website or the show Notes to learn how your organization could be recognized for its impact. So on behalf of aha, I just want to say thank you for taking the time on this podcast. Thank you for applying for and being awarded the Quest for Quality as a runner up and we can't wait to hear more from you in the future.

C (12:01)

Again, I want to thank you for letting me have the opportunity to talk about my amazing team and all the frontline workers, our nurses, all the staff across all of common spirit. Hats off to them for jumping on board and really tackling this as one common spirit, as one big health system.

A (12:18)

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