New Mass General Brigham CMO Shares Goals and Perspectives

Thomas Sequist has been promoted from chief patient experience and equity officer to serve as the health system's top physician executive.

Boston-based Mass General Brigham has appointed the health system's first chief medical officer.

Thomas Sequist, MD, MPH, was announced as the health system's CMO last month. He has been with the health system since 1999, when he started his residency at Brigham and Women's Hospital. He still practices as a primary care physician at the hospital, and before taking on the CMO role, Sequist served as chief patient experience and equity officer at Mass General Brigham.

Sequist recently spoke with HealthLeaders about a range of issues, including leadership at Mass General Brigham, patient experience, health equity, and patient safety. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: You are the first CMO at Mass General Brigham. What are your top goals in pioneering this new position?

Thomas Sequist: At a high level, the top goal that we have is to bring together the great minds that we have across our system to address some of the most pressing patient care concerns that we have in a way that we have not done in previous iterations of our organization. We want to all be driving toward a single purpose and a single set of strategies.

Diving down one layer deeper, our passion and our commitment across Mass General Brigham is going to be in the spaces of equity, patient experience, and maintaining our foundation of quality and safety. I hope that we are going to be able to substantially move the needle in the areas of equity and patient experience.

HL: What are your top goals in promoting patient safety?

Sequist: We want to maintain the ongoing excellence that we have in the hospital space, whether it is related to hospital-acquired infections or excellent outcomes related to acute myocardial infarction or congestive heart failure. We want to pioneer patient safety in spaces that are increasingly important; in particular, the ambulatory safety space.

As we move care more and more out of quaternary hospitals and into community hospitals, ambulatory centers, such as ambulatory surgical centers and medical offices, and home-based care programs, we need to parallel that movement with the development of important patient safety programs.

Ambulatory safety is a space where there is a ton of potential for us to make care even safer. It has different characteristics to it than the hospital space—it is much more episodic. A typical hospital stay is three or four days in a contained environment. Ambulatory care happens over time—it can happen over the course of months or even a year. It has many more providers and care team members involved, and much more degrees of freedom, which means it presents more challenges to patient safety. We are gearing up to address all of those challenges.

HL: What are your top goals in promoting community health equity?

Sequist: On community health equity, I separate that out between what we call health equity, which is related to the clinical delivery of care at our hospitals and offices, versus community health, which is related to a much broader concept of all of the neighborhoods we serve and how we improve their health status.

On the community health side, our top goal is to promote precision community health, which is using a data-driven approach to identifying the most pressing health concerns of a community and targeting our resources and interventions in partnership with community leaders to address those concerns. We are initially going to be focused on prevention of excess morbidity and mortality from substance use disorder and cardiovascular disease. Of course, we will not lose our attention to many of the other community health concerns, but we do want to have a targeted impact on those two areas.

On the health equity side, we have a platform called United Against Racism. This year and into the next year, our most pressing priority in the health equity space is continuing our journey of becoming an anti-racist organization. That journey takes many steps to accomplish from how we collect demographic information about our patients such as race, ethnicity, and language, to how we build out digital tools, to how we train our staff to deal with racism across our organization, to how we build care teams in primary care and staffing community health workers and social workers. We are taking a multifaceted approach to health equity, with the goal of achieving anti-racism across our organization.

HL: You have played a leadership role in the United Against Racism initiative. What have been the primary learnings from this program?

Sequist: We are about 15 months into the United Against Racism platform. Racism in healthcare is a large problem, so we are on a multi-year journey to try to have an impact.

So far, we have had an important impact in a few areas. For example, during the coronavirus pandemic, we and many others across the country noticed very early on that there was a digital access divide as telehealth stood up and people started doing video visits more regularly. We quickly noticed that many people in our Black and Latino populations were not able to access that technology and maintain their continuity of care.

We set aggressive goals to increase the enrollment rates of our Black and Latino patients into our electronic patient portal, which is the venue through which you do telehealth visits. Over the course of the past 18 months, we have seen aggressive increases in the rates of enrollment of our Black and Latino populations—more than 10 percentage point increases, which is a substantial increase in the number of patients who are now able to access the digital tools that we offer.

HL: What are your top goals in promoting patient experience?

Sequist: One of the things that we want to emphasize is that when our patients interact with our health system that they understand that they are not only going to be cared for but also cared about. It is the notion that we can provide excellent clinical delivery of care and at the same time we recognize there is much more to the patient experience. There is the care coordination. There is the empathy that we show to our patients. There is making sure that our patients have a comprehensive understanding of their care plans, so they can engage in their care in a meaningful way. We are dedicated to doing all of those things.

Another primary goal in our patient experience is going to be making sure that patients can both achieve the benefits of the scale of our health system and also not be overwhelmed by the scale of our system. That is a difficult balance to achieve. The benefit of the scale of our system is that we can treat every clinical problem of a patient—whether it is an advanced problem or a specialized problem. The diversity of the doctors, nurses, pharmacists, and staff that we have can treat a patient across the entire life span. However, with such a large and diverse system, we want patients to feel comfortable in navigating our system.

HL: How do you characterize your leadership style?

Sequist: There are a couple of things that drive me. The first is that I tend to lead through passion. I have been passionate about the things that I have been blessed to lead such as equity, community health, and quality.

The second thing about my leadership style is that I am impact-driven. The thing that matters to me the most is whether we are demonstrating that we are improving the lives of our patients and community members.

I also am someone who tends to thrive more as a leader in times of change.

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