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Becker’s Healthcare Podcast
Accelerating Quality and Access at Hackensack Meridian Health with Dr. Jose Azar
00:25:36
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- [00:00]
A
This is Laura Dardo with the Beckers Healthcare podcast. I'm thrilled today to be joined by Dr. Jose Azar, executive Vice President and Chief Quality and Clinical Service Line Officer, as well as professor of Medicine at Hackensack Meridian School of Medicine in the Department of hematology and oncology. Dr. Azar, it's a pleasure to have you on the podcast today.
- [00:19]
B
Yes, a pleasure is mine, Laura. Thank you.
- [00:21]
A
Absolutely. Now, I'm excited to get into our conversation. I know we're going to be talking about some really amazing things that you're doing there at Hackensack Meridian Health, connected to quality and patient safety and more. But before we do, can you tell us just a little bit more about yourself and in the health system?
- [00:37]
B
Yes, absolutely, I am. As you mentioned, I'm an oncologist by background. I've been in the quality and patient safety arena for about 16, 17 years now. And it's really a complement to continuing the clinical work on a bigger scale. And that's why I do that. I've been with Hackensack Meridian Health for four years, since 2022, and it's been a really very rewarding ride. So I'll tell you a little bit about Hackensack Meridian Health. We are the biggest and most integrated health system in New Jersey. We have 18 hospitals, 500ambulatory care site locations, 40,000amazing team members, and about 8,000 physicians who are either part of our medical group or affiliated with us. So I get to work with all of them. And that's, that's a truly deep honor for me.
- [01:43]
A
That's amazing to hear. And, you know, what an incredible organization. I know you've got a huge size as well as influence in the area, so it's exciting to see how you've been able to grow and develop the department. Now, I'm curious, could you dig a little bit deeper and tell us a bit more about Hackersack Meridian Health's Agile Institute? What's the mission and how are you driving some of the rapid quality improvement initiatives?
- [02:07]
B
Yeah, absolutely. So we launched the Agile Institute two years ago, and the reason we did that is because in healthcare, it can take sometimes up to 17 years to implement effectively a new discovery or a new treatment or a new healthcare solution. To us, that's unacceptable. That's way too slow. Healthcare needs to be transformed at a much faster rate. And at Hackensack Meridian Health, part of our mission and vision is that transformation is in our DNA and innovation is in our DNA and making healthcare more accessible, more affordable, and better for all. Patients is definitely what we come to work to do every day. And so in order to be able to achieve that, we launched the Agile Institute, which is meant to support our clinicians, support our clinical teams in transforming healthcare and the way we deliver care every day so that we can better serve patients where they are and meet them with their needs, whether in their communities, whether they're in the ambulatory space or whether they're in our hospitals. I'll tell you just in terms of its foundation and what it actually does, the Agile Institute is based on a transformation and implementation methodology that I developed with several of my colleagues. And basically the Agile Institute delivers three services. It trains people and changes culture so that we can adapt more of a startup mindset, not waiting for a perfect solution, but really testing a viable solution in real time and then iterating and keep improving it as much as we can. So that's the first mission, is to train and change the culture. The second is to provide and empower our bedside teams, our clinical teams, our leadership with the tools and the methods to effectively transform and implement a evidence based solutions in healthcare. What is proven to work should not take 17 years to be implemented, it should take a very short time. We should be able to adopt and drive that change very quickly. Then the third part is oftentimes we don't have proven solutions and we cannot be paralyzed with that. We need to innovate in real time and we need to empower our bedside teams to be able to do that. And we've created innovation units that allow us to test a solution very quickly and once we find that it works, we scale it as fast as possible.
- [05:20]
A
I love that. I think it's so fascinating to think about innovation, health care and now moving so quickly because traditionally health care has been a bit slower moving and for good reason. But you know, when you talk about this culture change and the shift that you're making at Hackensack Meridian Health, how do you do that? Because I think that's something that hangs up a lot of organizations and has been quite frankly a challenge to try to help clinicians and others understand that moving quickly is important in finding those areas where they can test different solutions in real time, figure things out. That's really going to be the right space to do that type of innovative work and then get used to moving more quickly than they ever had done before.
- [06:02]
B
Yeah, so we do it with every single one of our team members. And I think that's really the key element, that innovation cannot be something we do on the Side, transformation cannot be something we do on the side. It should be. And it is our mission and our vision, and it is in our DNA. And I think that that's where it starts. Also, our CEO, Mr. Garrett, and our leadership team is very committed to innovation and transformation. And I think that is so critical that the leadership is absolutely committed to supporting innovation in a very agile and adaptive way. Right. We are not afraid to make tough decisions. We're not afraid to test something and figure out whether it works or not. And we're not afraid to say, you know what, there's a better way and a newer way to do it. Let's figure out how to spread it across all of our hospitals or all of our sites. And so that would be the second element, and I think the third part in terms of how we do it is we've created a culture that fosters innovative thinking, that fosters psychological safety, so that anybody feels comfortable to step up and say, hey, I have a new idea, and they feel heard. But also, hey, I'm concerned this may not be working. And we take a pause and we listen to that. And I think that's really critical because otherwise, if you're trying to transform too quickly, you could be reckless if you don't listen to the people who are actually doing the work and allowing them to weigh in and direct your strategies in a way that makes them effective.
- [08:01]
A
Got it. That makes a lot of sense. And I really appreciate that kind of additional context because I know the leadership team often will have one idea and maybe the frontline teams have another. And so having that type of communication and balance between how you're looking at innovative thinking, building it into the culture, and then, you know, making sure that there is that feedback between the two sides, it seems like, is really critical. Now I know that the health system recently received a five star rating from cms, which is incredible, and congratulations. Could you talk a little bit about the transformational changes that took place in order to achieve this honor and how did the team work together cross functionally to make it happen in such a short period of time?
- [08:45]
B
Yeah, absolutely. But just to be very accurate, we have our flagship hospital, Hackensack University Medical center is a five star hospital with, you know, in the CMS ratings, but all our hospitals now are three stars or four stars and above. So that's truly a transformation. In the past five years, we have gone from all our hospitals being great to now we're moving our hospitals to being all outstanding. And I'm very, very excited and very proud of all our teams, because this really requires each leader and each team member to be dedicated to excellence. And that's what we fostered. We fostered a culture where everybody is committed to excellence. That's really what has helped accelerate the transformation. The other part to this is we've partnered very closely with our hospital leadership across the entire network and we identified and kept our focus on what are the few things we can do that will have the most impact. And that's what we focused our attention on. And then what we did is we kind of, we empowered and unleashed the power of our bedside teams. So we really directed the teams to where the biggest opportunities are and where we need to focus. But then we also allowed them to come up with the solutions and test those solutions. And once the solution is working, help disseminate it as fast as possible. We also are very mindful that healthcare is a business of people taking care of people. And unless we have solutions that are designed by the people who are doing the work and that are making their work easier and more effective every day, healthcare becomes too rigid and too slow and it loses its essence, which is the kindness, the caring, the humane side of it. And that's what we always anchor our solutions in. We don't take solutions off the shelf and try to force them. We actually partner with our team members to figure out solutions that work in real time in the real world.
- [11:27]
A
That's helpful to understand. And I love how you were talking about making sure that you're not forcing those solutions, but thinking of this as a partnership and making sure that you're able to go back and forth with those bedside teams and really taking to heart everything that they're trying to do and their perspective on how these changes are going. And I'm curious, when you look at the idea of taking care of people and being at the bedside, there any example that you can provide us of a change that you made based on some of these different innovative and innovation pushes that you've been doing or something you've done at the suggestion of a bedside team member?
- [12:11]
B
Yes. I'm going to give you two examples that really illustrate how we've done a centralized direction setting and strategy setting, but also a decentralized bottom up type of solution finding and performance improvement. Let me start by saying we had to create a structure that supports that. Over the past several years, we've always intended and wanted to hear from our team members, from our clinicians, from our bedside physicians, et cetera. And to be able to do that effectively, we created what we're calling specialty collaboratives. These are basically groups of physicians who are led by physicians, and we hand them problems and challenges we're facing, and they give us solutions and they work with us on implementing those solutions. We organize those collaboratives by specialty because physicians really aggregate around their, their specialty and what they do on a day to day basis. So we have a collaborative for internal medicine, we have a collaborative for general surgery, we have a collaborative for neurosurgery or orthopedic surgery, or neurology, oncology, cardiology, pulmonology, et cetera. So these are physicians in those specialties that come together on a regular basis to help us solve problems. And we designed it in a very representative way. So every hospital sends us two physicians and they send us one physician who is by specialty, basically two physicians, one that is employed and one that is independent physician, because we love our physicians the same way and we value all our physicians the same way. And we want to partner with all of our physicians, whether they're independent or employed, because they all bring tremendous value to problem solving and to improving care at the bedside. So the way we designed it was similar to the way the Senate is designed, right? All our hospitals are equally represented, and that was very purposeful because we care as much about our smallest hospitals as our biggest hospitals and most complicated hospitals. Because every single patient matters from that perspective. Every clinician matters in being able to bring solutions. That specialty collaborative model that is a representation for all the hospitals equally, for all of our clinicians equally by specialty, has helped us be so granular in our problem solving. When we talk about improving care for patients with, let's say, congestive heart failure, we depend on our cardiologists to help us find solutions. We don't just bring a solution that's canned. That brings me to the second part of your question. How did we find solutions? We listen to our physicians. Like, for example, when we were trying to improve readmissions and care for surgical patients, our surgeons brought up a new concept that they wanted to pay attention to the most vulnerable patient population that they take care of, which is patients who are older than 65 or 70. And so they wanted to establish a geriatric surgery verification certification, basically being certified that we provide best evidence care to patients who are older than 65. The partnership was wonderful because they came up with the idea, they knew what the standards should be. But then we empowered them with tools and methodologies through the Agile Institute to be able to implement very quickly, test change very rapidly, design those solutions in A way that makes sense to people and work in the real world, in our human centric. And we were able to do this, implement and get the certification within a 10 week period of time. And that was a really exciting. You know, I even get excited now, two years later, in terms of just thinking about how quickly we were able to implement something that was based on a direction that we set from the network, which is, you know, improving certain outcomes, a solution that came from the bedside and from our surgeons and our clinicians, and then a method that really helped bring it all together in a very rapid implementation way. And that has led to really great results. So you mentioned that all our hospitals are three stars, four stars or five stars. And that tells me we're among the best in the country and definitely, you know, the, the best system in, in, in New Jersey because of that type of partnership and effective implementation of best, best practices.
- [17:57]
A
Absolutely. That's amazing. You know, and I really appreciate you digging that one level deeper because, you know, that implementation side of it truly is a huge unlock and being able to see success there and moving quickly is critical. Now, looking into 2026, where do you see some of the big priorities or headwinds that you're focused on right now?
- [18:17]
B
Yes, you know, with, with all the improvements that we've made, I feel very confident that we're providing outstanding care for every patient that we take care of. The challenge and the headwind that we're facing is that not every patient can access our care. I think access to health care and access to high quality care is a very, very important responsibility for all of us. It doesn't matter if I have the best care in the world and only a few people can access it. My communities and the communities that we serve, the communities we live in, the people that we're supposed to help are going to suffer if they can't access the outstanding care that we have. And so this is where we're putting a lot of our focus in 2026 and beyond, is to think about designing our care models, meaning organizing the way we deliver care in a way that allows for very rapid access, same day access, same week access, and no more than access within two weeks to a highly subspecialized service. That's what we're really aiming towards. We want to be able to see you when you need to be seen. And we need to be able to rethink the way we organize ourselves so that we can meet that expectation and that responsibility honestly that we have to our patients and our communities.
- [19:51]
A
I think that access question is critical. And looking into these innovative solutions and the things that you've been doing on the culture side to be transformational, it seems to set yourself up for success in troubleshooting some of those challenges, which are industry wide. I'm curious, what do you think the hardest thing you'll have to do in the coming year will be?
- [20:13]
B
Designing the care models and rethinking the way we organize ourselves is going to be difficult because, let's face it, I lead change, and change is my job and my responsibility. I don't like change. I have to change, but I don't like change. I think winning the hearts and minds of our clinicians and engaging them very early on so that they are part of the change and the change is not happening to them, so that they are designing those care models and they are helping us figure out how to best meet those access standards. Rather than doing it to them, we want to do it with them. We also want to engage our patients in our communities to understand what are they expecting of us and what do they need from us so that we can factor that into our care model design. I would say that's our biggest challenge, but also to me, that's our biggest exciting opportunity. Figuring out how to do that and how to do it quickly is going to be really challenging, but also really, really exciting and very meaningful. I also think that with all the AI technology and all the advances in artificial intelligence, I think we're going to be able to also accelerate our ability to imagine and execute on a new and better future where access becomes an engaging term rather than a frustrating term.
- [21:45]
A
Absolutely. That would be, you know, an amazing transformation to see. And when you look at access, when you look at technology, how does that show up for Hackensack Meridian Health? What are the ways that you are leveraging or plan to leverage technology to expand some of those access points?
- [22:02]
B
Well, I think we need to meet people where they are, and I think technology helps us do that in a couple different ways. One and most StraightForward is using AI agents to help interact with patients on demand when they need to be interacted with. We're already using AI agents to help us with scheduling, to help us with navigating patients through our system. So we want to expand on that. That digital interaction is really critical. The other way is leveraging AI technology to better understand our gaps, our opportunities, and really model, to better model our care in a way that is responsive to our patients. So being able to use technology for better analytics and for better testing of change in A virtual way that allows us to figure out and and modify before we implement is is going to be really critical. So both in the interface with patients, but also on the back end in the analytics and in the predictive modeling. Got it.
- [23:24]
A
That's helpful to understand. Now, before we wrap up here, where do you see some of the best opportunities for organizational growth?
- [23:31]
B
Well, I'm going to build on access because if we have an engaging and timely access for every patient, we can meet them where they are, we can navigate their journey and their experience through our health system to give them access to the best care that we already deliver. I think that's going to lead to tremendous growth in our ability to serve our communities and our patients. I think the other area of growth is not necessarily in terms of business growth, but really in terms of our capabilities growth. Very, very soon we're all going to have to face a very real change in our day to day life. We're either going to be enabled by AI or we're going to be, you know, pushed to the side by AI. And at Hackensack Meridian Health, because we are absolutely committed to innovation and to transformation. We're embracing AI as a technology that's going to enable and empower our workforce and our team members to be the best caregivers they can ever be, to be able to achieve things that they've dreamt of in terms of interacting with patients and being able to serve patients better. And that, to me, is really exciting.
- [25:00]
A
I love it. Dr. Azar, thank you so much for joining us on the podcast today. This has been such a fun conversation, so informational and inspiring to hear about what you've been doing at Hackensack Meridian Health. And you know, I look forward to connecting with you again soon.
- [25:13]
B
Yeah, thank you very much. Thanks for taking the time.
- [25:16]
A
Absolutely. And you know, I'm excited to see you as well at our annual meeting coming up in April. I know you'll be a speaker on one of our panels and it'll be a truly great opportunity to connect and talk further on some of these things that we've mentioned today. So looking forward to that.
- [25:30]
B
Yeah, I'm looking forward to that as well.