Gena Lawday, RN, BSN, Chief Quality Officer at UVA Community Health

Summary

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Becker’s Healthcare Podcast – Episode Summary

Guest: Gena Lawday, RN, BSN, Chief Quality Officer, UVA Community Health
Host: Erica Carbajal, Becker's Healthcare
Date: December 22, 2025
Main theme: The expanding role of standardization in care delivery, current quality and safety priority areas, AI-driven decision support risks, and considerations for outpatient quality monitoring in light of new CMS site neutral payment rules.

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Episode Overview

This episode features Gena Lawday, Chief Quality Officer at UVA Community Health, discussing key challenges and strategies in quality and safety for 2026. The conversation delves into the impact of CMS policy changes, the necessity of standardized care pathways, the risks and opportunities of AI in clinical decision-making, and the critical need for robust quality oversight as procedures move to outpatient settings. Gena emphasizes transparent data sharing, patient education, and working closely with both perioperative and post-acute care teams.

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Key Topics & Insights

1. Gena Lawday’s Role and UVA Community Health System (00:42 – 01:20)

• Gena oversees quality across three hospitals (Prince William, Haymarket, Culpepper) and over 50 medical groups.
  • "We have over 50 medical groups nowadays, so that is an aspect of business that the community health side is growing all the time." (00:58, Gena Lawday)

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2. 2026 Quality Priorities: CMS TEAM, Harm Reduction & Data Transparency (01:20 – 04:32)

Transitional Care and Harm Reduction

• Focus on success with CMS TEAM model, particularly managing post-acute transitions and overall perioperative patient risk reduction.
  • "We're always looking at ways we can reduce harm...I've been inspired to look at how we approach harm reduction at all phases in the patient care continuum." (01:50)
• Early patient education as a key fall prevention and safe discharge tool, starting even before surgery.
• Standardizing patient education across all care phases ensures consistency and effectiveness.

Data Transparency Initiatives

• Developing and publicly posting scorecards on performance metrics (e.g., SEP1 bundle compliance, sepsis outcomes).
• Including process and outcome measures alongside traditional compliance scores for staff visibility and engagement.
  • "We're also sharing now our sepsis mortality and sepsis readmission rates right alongside that SEP1 bundle compliance score." (03:36)
• Positive staff engagement and leadership involvement resulting from increased transparency.

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3. Partnerships with Post-Acute Providers & Rural Challenges (05:11 – 06:05)

• Enhanced collaboration with post-acute care providers, especially critical in rural settings like Culpepper, due to limited post-acute access.
  • "That's been an opportunity in all of the areas that we have hospitals...We've begun the process of making those care transitions a little more smooth." (05:15)
• Ongoing work to ease care transitions and ensure continuity outside the hospital, particularly under the new CMS TEAM program.

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4. Standardized Care Pathways: The ERAS Example (06:05 – 09:24)

Implementation of Enhanced Recovery After Surgery (ERAS)

• Broad rollout for joints, bowels, and soon hip fractures; rapid progress over the past six months.
• Addressing previous variability in protocols such as fluid management and normothermia by standardizing processes across the system.
  • "We had some pretty robust multimodal pain management...but some of our other elements like fluid management or antibiotic usage...were really dependent on individual provider's preference." (07:25)
• Anticipated benefits: reduced complications, shorter stays, decreased opioid use, enhanced predictability, and improved patient experience.
  • "We think it's just going to be impactful overall to improving length of stay, fewer post op complications...reduced opioid use...a smoother, more predictable recovery for patients." (08:05)
• Patient education is a central component, ensuring patients understand recovery expectations from the outset.

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5. Under-Discussed Quality/Safety Issue: AI Algorithmic Drift (09:36 – 12:15)

• Gena highlights the subtle risk of algorithmic drift in AI-driven clinical decision support, especially as populations shift or documentation practices evolve.
  • "The one safety issue that I think organizations...deserves a lot more attention is the potential of algorithmic drift in clinical decision support tools." (09:44)
• Continuous AI validation and oversight are lacking in many organizations as AI becomes more embedded in care.
  • "Unlike medications or equipment, most organizations may not have a defined owner for ongoing AI monitoring...As AI becomes more embedded...it'll become more important to ensure adequate and the right oversight." (10:45–11:11)
• Absence of proactive monitoring can lead to gradual, unnoticed degradation in decision support reliability, with potential for patient harm.
• Strong call for defined governance, early detection of drift, and ongoing validation to keep AI tools "safe and trustworthy." (11:20)

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6. Outpatient Quality Oversight Amidst CMS Site Neutral Payment Rule (12:15 – 16:47)

• CMS's expansion of site-neutral payments and phase-out of the inpatient-only list is pushing more complex procedures to outpatient environments.
• Emphasis on robust standards for patient selection, screening, and pre-procedural optimization (including frailty and cardiac clearance assessments).
  • "Setting clear standards for which procedures can safely be done outside the hospital...clear screening to ensure the patient is truly appropriate for outpatient care." (13:06)
• Importance of standardizing discharge protocols, ensuring staff competency, and equipping outpatient sites to handle potential emergencies.
• Integration of outpatient sites under central quality/reporting structures to maintain oversight and accountability.
• Leveraging technology for remote monitoring and automating follow-up to quickly identify and address complications.
  • "Organizations are going to want to look into the possibility of remote monitoring those remote follow up checks on patients..." (14:54)
• Relentless focus on patient education so individuals understand self-care, monitoring, and when to seek help post-procedure.
  • "You can never say enough about excellent education for patients...the patient education aspect cannot be emphasized enough." (15:45)

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Notable Quotes & Memorable Moments

• On standardizing performance transparency:
  • "I'm really pleased with the conversation that it spurred...I think it's really helped increase the visibility of our performance in these metrics." (04:13, Gena Lawday)
• On the risks of unmonitored clinical AI:
  • "The degradation can be subtle. Clinicians won't necessarily see a clear failure, just a gradual decline in reliability that can lead to missed deterioration or unnecessary workups..." (10:08)
• On the shift to outpatient care:
  • "Data sharing and reporting is also going to be super important in this new reality...making sure that you're doing those course corrections as things bubble up..." (14:27)
• On patient education in all settings:
  • "Patients need to understand, you know, what their course looks like, when they need to be concerned, if it deviates." (15:19)

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Timestamps for Key Segments

• 00:42 – 01:20: Gena Lawday’s scope as Chief Quality Officer
• 01:20 – 04:32: 2026 priorities: CMS TEAM, harm reduction, and transparency
• 05:11 – 06:05: Building relationships with post-acute providers
• 06:05 – 09:24: Standardizing care with ERAS pathways
• 09:36 – 12:15: AI algorithmic drift as an emerging safety risk
• 12:15 – 16:47: Site-neutral payment, outpatient shift, and quality oversight

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Conclusion

Gena Lawday underscores the necessity of proactive, standardized approaches across the care continuum—spanning from pre-op education, harm prevention, and transparent quality metrics, to AI governance and rigorous outpatient oversight in the face of policy shifts. Patient education and data-driven transparency emerge as recurrent, foundational threads throughout the conversation.

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Transcript

[A]

Hi everyone. You're listening to Becker's Clinical Leadership Podcast. I'm Erica Carbajal with Becker's Hospital Review. And thank you so much for tuning into this episode. Today I'm joined by Gina Laude, Chief Quality Officer at UVA Community Health. We'll be discussing the growing role that standardization plays in care delivery today, quality and safety issues that she has her eye on right now, and what CMS's recent rule expanding site neutral payment means for outpatient quality and safety monitoring. Gina, welcome, welcome. We're so happy to have you on. Great.

[B]

Thank you for having me, Erika.

[A]

Yeah, well, do you want to start by just sharing a little bit about the scope of your work and your role as Chief Quality Officer?

[B]

Sure, yeah. So I'm chief Quality Officer over the UVA Community Health Hospitals, which includes three hospitals, two in Northern Virginia, which includes Prince William Medical center in Manassas, as well as Haymarket Medical center, which is located in Haymarket, and then lastly one down in Culpepper, which is of course Culpepper Medical Center. As well as that we have over 50 medical groups nowadays, so that is an aspect of business that the community health side is growing all the time.

[A]

Gina, do you want to start by sharing what your top priority is heading into 2026? Hard to believe we're wrapping up the year already. But what do you anticipate will the majority of your focus as Chief Quality Officer in the next year here?

[B]

Sure. I mean, that's a really good question. And obviously, you know, with the year winding down, something I've been thinking about a lot. I have a couple priorities in 2026, of course. I mean, I'd be remiss if I didn't mention CMS team. With the rollout of CMS team, we've been looking at not only how we can manage our manage these post acute transitions will be important to success with that program, but also more holistically on how we can reduce risk to our overall perioperative patients. This is obviously not a new approach. We're always looking at ways we can reduce harm. But it just happened to be a happy accident for me that I have two members of our periop team and our CMS team steering committee, which have inspired me to look at how we approach harm reduction at all phases in the patient care continuum. You know, for example, how can we restart the process of reducing risk for all falls? In pre op research has shown that patient education is one of the most impactful interventions to reduce patient falls. So we're looking at, you know, can we start that education in pre op? Can we coordinate with the post op and inpatient units to ensure that the message is the same throughout the patient journey? One of the other ways we're doing this is we're looking at the discharge teaching that we provide through the same lens. We're starting discharge teaching with the pre periop team and we're making sure that aligns with the inpatient teams to make sure that we have a standardized approach to patient education all the way through. The other thing I'm really looking at is data transparency. One of the things that my team has been looking at is we've been developing scorecards that show our performance in key publicly reported metrics. The intent is that these scorecards are going to be shared widely with both staff and visitors in our hallways. But we've also decided that in addition to sharing the actual key metric point, but we're going to actually be sharing the corresponding outcome and process measures so that staff can see how they are impacting that measure as well as the impact of these measures on patient outcomes. So to give an example along our SEP1 bundle compliance, which I think is a very normal thing to post, we're also sharing now our sepsis mortality and sepsis readmission rates right alongside that SEP1 bundle compliance score. Also alongside our CAUTI and CLABSI rates, we're also sharing our standardized utilization rates and our bundle maintenance compliance rates. So we've only been sharing these a couple months, but I'm really pleased with the conversation that it spurred. You know, we've gotten the CNO who's been really heavily involved in, you know, pushing back and giving us feedback on how these metrics are reported and presented. And I think it's really, it's really helped increase the visibility of our performance in these, in these metrics.

[A]

Yeah, so interesting. Gina, I'm glad you mentioned CMS teams model been such a big area of coverage and things that quality leaders are really focused on right now. And you mentioned just education with patient discharges and fall prevention. Kind of getting that started earlier in the process and kind of having this model raise the importance of that even further. Are you working as well, like more closely with post acute providers or long term care facilities to support those transitions as well?

[B]

We are. That's been an opportunity in all of the areas that we have hospitals, just because of the areas where our hospitals are located. We have, for example, Culpepper. Culpepper is quite a rural hospital. So we have limited access to post post acute providers out there. But this has really been motivational to help think outside the box a little bit on how we look at our post acute providers. So we have begun the process of, you know, making those care transitions a little more smooth, trying to get in place, good relationships with our post acute providers. And it's probably something that we're going to be working on more as we go through year one of team. But it's definitely shown us a huge opportunity in our care transitions.

[A]

Yeah, certainly. Gina, I want to turn to standardized care as well. I think clinical leaders increasingly over the past year have pointed to standardized care pathways as a lever for both improving patient outcomes but also enhancing operational efficiency. But this, you know, there's so much work that goes behind being able to do this effectively. So could you share an example perhaps where implementing a standardized care pathway helps drive improvements in patient care? Yeah.

[B]

So one of the ones we've been working on, and we're in early days, but one care pathway that we've put a lot of emphasis on is actually implementing an enhanced recovery after surgery, also known as eras. We're probably playing a little bit of catch up on this one, but we've made a lot of strides in the past six months to get our ERAS programs up and running. And we've kind of gone all in on this. We're implementing it for joints, we're implementing for bowels, and we're going to be implementing it for hip fractures as well very soon. So I'd say we've done a lot of work in the past six months to go from, you know, zero to 60. Before developing our ERAS pathways, we had some elements of the protocols that were implemented. For example, we had some pretty robust multimodal pain management and early mobilization processes. We're working with PT and those were getting to be in place. But some of our other elements like fluid management or antibiotic usage or maintenance of normothermia, nutrition, those were all really dependent on individual providers preference or we didn't have a standardized process in place, for example, like normal Thermia. This is something that we feel is going to be impactful. You know, you kind of tied a little bit in with team. We think it's going to be impactful to that, but we think it's just going to be just impactful overall to improving length of stay, fewer post op complications, especially like ileus and things like that. Reduced opioid use, always a huge priority for all health care organizations, but also will help with a smoother, more predictable recovery for patients. And a big element of this is patient education, making sure that our patients are aware of what they can expect at every point in their career, you know, and starting that early with things like joint camp and things like that. So I think it's. It's probably the most important one we've been working at. And we're hoping that this will be a bit of a, you know, a break in the dam for all of the other important care pathways we'll need to implement to truly get to where we want, where we're reducing variation in our care and we're having a consistent product all the time.

[A]

Yeah, sure. And I imagine that the ERAS pathways will go a long way too, in patient experience. Just to your point about giving patients a really firm understanding of what to expect in terms of the recovery process.

[B]

Exactly, exactly. Early turnouts have shown that people tend to like the increase in education and the expectations around pain management. I think that's going to be a really big one, is that people understand, you know, you're going to have some pain. Here's how we're going to. Here's how we're going to deal with it on the other side.

[A]

Yeah, certainly. Well, Gina, what is one quality or safety issue that you believe deserves perhaps some more attention across the health care industry right now? And why.

[B]

So what I've been thinking a lot about just with, you know, how much AI has infiltrated every part of healthcare and even society. I mean, you can't go about 40 minutes without hearing something about AI and how it's going to be changing things. But the one safety issue that I think organizations and vendors, everyone needs to be prepared for and deserves a lot more attention, is the potential of algorithmic drift in clinical decision support tools. You know, more healthcare systems are shifting to AI tools for things like sepsis alerts and triage and AIM into prioritization and risk scoring. And these models have the chance or the risk of losing accuracy as patient population shift or documentation habits change or adapt to the infiltration of AI into our care, how we give care. I think the dangerous part of that is the degradation can be subtle. Clinicians won't necessarily see a clear failure, just a gradual decline in reliability that can lead to, you know, missed deterioration or unnecessary workups. You know, the things that we are trying to avoid, we're trying to increase efficiencies with AI. And the other thing is, is something that's also been on my mind a lot is that, you know, unlike medications or equipments, most organizations may not have a defined Owner for ongoing AI monitoring. You know, with me being in quality, you know, we, we've dealt with some kind of peri AI tool, pari AI tools. And so I've, I've seen this firsthand and I think that there might be an element of learning the best governance structure for it. As AI becomes more embedded in care, I think it'll become more important to ensure adequate and the right oversight continuously be validating the performance of the AI products, have a process in place to detect drift early and make sure that the tools stay safe and are trustworthy.

[A]

Yeah, that is a really great one around clinical decision support tools, one that hasn't, I haven't heard a ton about. I think you raise a really interesting point there, Gina. I wanted. Yeah, sorry, go ahead.

[B]

I'm sorry. No, I was just gonna say, I was like. Yeah, it's just, you know, ever since, you know, I've been talking to a number of vendors around, for example, like, you know, sepsis tools and things like that, and that's the question that I keep having is, you know, if AR AI at some point in time is potentially referencing AI, you know, is that a risk?

[A]

Well, thanks for sharing that. Wanted to talk just a little bit about a recent policy as well. Obviously CMS has passed a rule expanding site neutral payments and phasing out the inpatient only list. Another signal that we're seeing more complex procedures moving into outpatient settings. And this just got me thinking, you know, what this means for quality and safety monitoring in the outpatient setting as more care is moving there. So what kinds of standards, structures or innovations do you believe are needed to ensure there is robust oversight as more care moves outside the four walls of the hospitals? How should systems be thinking about evolving their approach to quality and safety monitoring in outpatient settings?

[B]

Yeah, I think this is such a great question and it really touches on, in my view, every aspect of hospital care. In a way, as CMS is pushing these procedures into outpatient settings, I think health systems need to be thinking more proactively about the patients success is going to be about setting clear standards for which procedures can safely be done outside the hospital. I think very importantly, clear screening to ensure the patient is truly appropriate for outpatient care. Having really good processes in place to make sure that we understand the risks of all of the comorbidities that are coming with these patients if they're being taken care of in that setting. And we do have a roadmap for this. This is something that we've done in other realms of hospital Care. But this also means that we have to have a mature pre procedure optimization process such as, you know, doing those frailty assessments, getting cardiac clearance, as well as having standardized discharge and observation requirements. Again, it always comes back to, you know, reducing variation in care. It also means that organizations will have to be a bit more mindful of these outpatient care sites, ensure that we have the right staffing, right training for the staff, because they potentially be doing, you know, procedures have traditionally been done in hospitals equipment and rescue capabilities to make sure that the staff understand, you know, how to rescue. Hospital leaders will also want to be sure the facilities are well integrated into your bigger quality structure, make sure that they have the same levels of reporting and accountability to senior leadership in the governing board and that the oversight is comparable to that inside the hospitals. Data sharing reporting is also going to be super important in this new reality. Things like tracking unplanned transfers and complications, 30 day readmission sites, making sure that you're doing those course corrections as things bubble up, you know, as try as though we might, we're not able to always see all of the wrenches that get thrown into machines sometimes. Technology is probably going to be super important with this shift. Organizations are going to want to look into the possibility of remote monitoring those remote follow up checks on patients. Things like potentially having more automated follow up calls to check in on patients and having a really good algorithm on what gets kind of kicked back to a nurse or a provider during those follow up calls. And you know, because of the fact that patients will be leaving so quickly after the procedure. I think you can never say enough about excellent education for patients. Patients need to understand, you know, we talked about this in eras. They need to understand what their course looks like when they need to be concerned, if it deviates. If you're trying to keep, you know, patients out of unnecessary ED visits, you know, that's a metric that we look at a lot. You'll want to make sure that they understand, you know, what truly is a complication and what is something that's expected to happen. So I think the big takeaway for me is that organizations are going to want to be proactive here and be thinking about this stuff on an ongoing basis, making sure their teams are ready for this change, making sure they're aware of this change, and making sure most of all that their patients are ready for this change. I think that the patient education aspect, you know, again, cannot be emphasized enough.

[A]

Yeah, absolutely. We touched on, there's so many considerations, right? I mean, comprehensive screening, staff training, equipment. So much for leaders to start thinking about and making sure that all these mechanisms are, are up to par for these site of care shifts. Well, Gina, thank you so much for joining me on the podcast today. It was truly a pleasure to have you on to talk about a number of different things and I'm sure we will be in touch again.

[B]

Yeah, thank you so much. Thanks again for having me. And it was, it's always a pleasure to talk to you.

[A]

Yeah, absolutely. Thanks everyone.