UnityPoint Health CMO Says Simplicity Drives High Quality Care

Focusing on too many quality measures is counterproductive, this CMO says.

Simplifying the metrics is the key to success in UnityPoint Health's quality program, according to the health system's CMO.

Gregory Johnson, MD, became UnityPoint’s CMO in July 2024. Prior to joining UnityPoint, he held several clinical leadership positions, including CEO of hospital medicine and chief health equity and diversity officer at Sound Physicians, a physician-founded multispecialty group based in Tacoma, Washington.

To promote high quality care, Johnson says, UnityPoint has gone from focusing on more than 140 quality measures to concentrating on 26 metrics.

"One of the things that we recognized for our overall quality program is getting away from a focus on many metrics because so many people were getting thrown various metrics at various times," he says. "By keeping it simple, reporting it consistently, and having structures such as market performance reviews and service line clinical reviews, in each of those cases everybody is focused on the same items so that we can row in the same direction."

Johnson says the two dozen quality measures that UnityPoint is focusing on are similar to the top quality metrics at other health systems. These include length of stay, mortality, hospital-acquired infections, and hospital-acquired conditions.

Readmissions are also a crucial quality measure, he says.

"One of the biggest areas that we recognized to function as an integrated health system was to take a step back and look at readmissions," he says. "A lot of people roll their eyes at readmissions and say it is a financial metric. For us, we spend a lot of time focusing on readmissions for our acute care space, but we also look at UnityPoint at Home for preventable hospitalizations as well as our UnityPoint Clinic in terms of looking at transitional care management visits."

Johnson says readmissions have a significant impact on patient experience.

"To create an exceptional experience for our patients, we do not want them coming back to us unnecessarily," he says. "We have reconfigured ourselves to intentionally focus on the steps we have to take to deliver an exceptional experience. We want to help our patients avoid unnecessary hospitalization."

UnityPoint has seen a 9.6% absolute reduction in its observed-to-expected ratio of readmissions within the first few months of rolling out readmission initiatives.

Gregory Johnson, MD, is CMO of UnityPoint Health. Photo courtesy of UnityPoint Health.

Promoting patient safety

Structural elements are essential to boosting patient safety, according to Johnson.

"Recently, we have focused on making sure that when we discuss a culture of patient safety, that it pervades every level of the organization," he says. "We have highlighted and simplified what we had in terms of reporting for patient safety concerns. We recognize that when we support just culture, it avoids blame and focuses on the best outcomes. We want people to increase their reporting."

Structural elements include what is happening at the bedside and at the health system and local board level, Johnson says.

"We want about 20% of what our boards are discussing to be around patient safety and how they can engage in terms of being notified of serious safety events as well as getting these events resolved," he says.

Another structural element is the use of "respect huddles," according to Johnson.

"These huddles occur at every level of the organization on a daily basis," he says. "Last year, about 17,000 respect huddles occurred across the health system. Ultimately, these huddles highlight areas of safety, whether there are concerns or great catches that we identify."

Johnson says UnityPoint is also fostering a culture of patient safety.

"It can't be a sign that we put up," he says. "It must pervade everything that we do."

"Ultimately, we want zero harm to come to our patients, and it takes a level of rigor in terms of daily interactions with the staff to achieve the zero-harm goal," he says.

Crisis management

Johnson was involved in a successful crisis management effort last year after Hurricane Helene inflicted severe damage on a medical-grade fluid manufacturing plant in North Carolina, which led to a nationwide shortage of IV and sterile fluids.

When the health system was notified that there would be a 60% reduction in the supply of IV and sterile fluids across the country, executives activated incident command protocols within 24 hours. They assessed their supply of IV and sterile fluids and convened an ad-hoc committee of 60 physicians, advanced practitioners, nurses, and other clinical team members led by Johnson and the chief nursing officer.

"Once we were able to articulate the concerns that we had about conserving fluid, then each group went back and did their homework," Johnson says. "They identified where we could conserve fluids and the process for notifying bedside team members of what was going on. Ultimately, that led to more than 140 clinical interventions that were applied."

With UnityPoint now in the recovery phase, Johnson says the health system rose to the challenge and made permanent changes to how it uses IV and sterile fluids.

"Almost 70% of the clinical interventions we developed have been accepted as the new standard at UnityPoint," he says. "Most importantly, we never turned a single patient away in terms of procedures, including surgeries that needed to be performed during the peak of the national emergency."

The shortage has had a lasting impact on operational considerations at UnityPoint, according to Johnson.

"We are setting a new bar for what our approach is not only in terms of understanding what a clinically integrated supply chain looks like, but also how we involve our clinicians in terms of operational decision making," he says.