New SSM Exec's Vision: Quality and Safety More Than Metrics

SSM Health's new chief quality officer values performance improvement and a high-reliability approach.

The first-ever chief quality officer at SSM Health has set a lofty goal for the health system.

"My vision is to have the highest quality healthcare of anywhere in the country within the next five years by any measure. All of the models are different; so, if you want to score well on those, you have to do well in virtually everything," says Alexander Garza, MD, MPH, who became chief quality officer in January.

The health system features 24 hospitals and 9,900 clinicians.

Laura Kaiser, who has served as president and CEO of the St. Louis, Missouri­–based health system since May 2017, is committed to quality and patient safety. Kaiser's decision to hire a chief quality officer for the whole health system demonstrates that commitment, Garza says.

HealthLeaders spoke recently with Garza. Following is a lightly edited transcript of that conversation.

HL: What are the primary quality challenges at SSM?

Garza: There are five areas we are focusing on this year. Sepsis mortality is one. It's a very expensive condition to treat, so there is a financial reason for addressing it.

We are engaged in two infection prevention initiatives. One for central line-associated blood infections and the other for catheter-associated urinary tract infections. By and large, these are infections that are within our control.

The fourth focus is readmission reduction. This metric applies to the whole health system—it measures how well we are organized in moving patients from acute care, to postacute, to ambulatory, and how good we are at recognizing risk for readmission.

The fifth focus is opioid reduction and dealing with our opioid epidemic. We are addressing it through multiple phases of care—the emergency department, inpatient, ambulatory, and our behavioral health and additional services.

HL: At a national scale, what are some of the most significant quality challenges?

Garza: What I get concerned about is people being too metric-focused when we are talking about quality. The performance metrics are part of quality, but there's also the patient experience and how well you are doing performance improvement as an organization. We teach our clinicians to do good healthcare work, but we don't train them as well to do performance improvement.

From our health system's point of view, I would rather [that] people focus on how to look at quality and how to do performance improvement. That would do much more good for us than focusing on a percentage or comparing us to a benchmark.

Quality is an umbrella term that includes more than metrics—infection prevention, regulatory issues, and safety.

My vision is moving our clinicians and our staff away from meeting specific metrics to thinking more from a high-reliability organization point of view. The goal is to be perceptive of what is going on around you, then making sure you can prevent errors that come up while adhering to best practices.

HL: Give an example of the high-reliability approach.

Garza: One of our Oklahoma facilities came up with a tracking system to make sure they were eliminating all of the risks associated with catheter-associated urinary infection. They bought into performance improvement.

It wasn't me coming down and saying, "You have to prevent urinary tract infections." The staff recognized the infections were not good for our patients. They developed a performance improvement system to treat our patients best, lower the risk, and improve performance all at the same time.

HL: Two decades after publication of "To Err is Human," patient safety remains an area of concern such as the estimated 400,000 deaths annually linked to medical errors. Why does patient safety remain a vexing problem?

Garza: Healthcare has not reached a tipping point where patient safety is the No. 1 priority. We talk about it a lot, and we have made good strides, but we haven't reached [that] point yet. You see it in other industries, when they step back and say change is needed.

Part of it is generational—as new physicians, new nurses, and new physician assistants come onboard, they will be graduating from programs that have an increased emphasis on quality. A new attitude is being built into them as professionals.

Making safety a front-and-center issue is a multi-level process.

There are obvious things like making sure we are doing surgery on the right side. You also need to identify the right safety policies, implement those policies, and hold people accountable. You always ask for two forms of identification from patients; you mark the surgical side; you have timeouts in the OR—these are all parts of those policies.

Senior leadership needs to show that they have bought into this as well. They need to make safety one of their priorities. When the executives at the system, regional, or hospital level promote safety, it helps change the culture.

HL: How do you engage physicians to participate in quality initiatives?

Garza: Whether they deserve it or not, physicians can get the reputation of not being participatory, but I think they do want to participate. It's all in how we get them to the table and how we engage them. We need to show that it is worthwhile to participate.

There are simple things like setting up meeting times that are convenient and asking for their opinion on how things could work. For example, as part of our patient safety surgical checklist we were talking about spine surgery and surgery on the wrong level of the spine. Adding [spine level] to the surgical checklist seemed like an easy answer to me. I sent the proposal to our orthopedists, and I got three emails and three phone calls on why it wasn't a good idea.

It was great. When I spoke with them, they thought they had a better approach. So, I had three different orthopedic spine surgeons from three different regions of our system coming together to work on this.

It showed [physicians] do think about these things seriously, and we need to give them the opportunity to solve problems.