The Exec: How CMOs Can Successfully Promote High Quality Care

Providing high quality care is a team effort, according to this new CMO.

The most important factor in promoting high quality is making sure every staff member is focused on that goal, according to the new CMO at Allegheny General Hospital.

Saad Mahmood, DO, MBA, became CMO of the Allegheny Health Network academic medical center last month. His previous leadership experience includes serving as associate CMO of the hospital.

Providing high quality care is a team effort, according to Mahmood.

"At a large hospital such as Allegheny General Hospital, you have multiple important players in achieving high quality, including specialists, hospitalists, emergency room staff, and ancillary services staff," Mahmood says.

Ensuring high quality at an academic medical center is more complicated than it is at a community hospital, Mahmood explains.

"At Allegheny General Hospital, we provide a range of services such as transplants, trauma, and neurosurgical procedures," Mahmood says. "When you have a broad range of individuals providing care, you must make sure that everyone is interfacing in a way that orients all staff members to the primary goals, including patient safety, quality, and length of stay management."

At Allegheny General Hospital, ensuring high performance on quality includes assessing trends and reviewing individual cases, according to Mahmood.

"If we are trending in the wrong direction, we immediately put into place meetings to discuss the change in performance and look at individual patient cases," Mahmood says. "If there is a case that needs to be reviewed, we have our peer review committee examine the case."

There are two primary elements for successful quality improvement initiatives, Mahmood explains.

"First, a quality improvement process should start with getting everybody on the same page," Mahmood says. "Second, you need to work with individual staff members and teams to develop a clear and concise process that can be followed easily."

A hospital should monitor key performance indicators to boost quality, Mahmood explains.

"You need to monitor hospital-acquired infection rates such as catheter-associated urinary tract infections and central line-associated blood stream infections," Mahmood says. "You need to monitor hospital falls with harm. You need to monitor cases involving mortality to make sure you did everything you could to provide the patient with the best possible care."

Saad Mahmood, DO, MBA, is CMO of Allegheny General Hospital. Photo courtesy of Allegheny Health Network.

Reducing Length of Stay

Many factors are at play when a hospital seeks to reduce length of stay, and clinical leaders and care teams need to focus on the factors they can control, according to Mahmood.

"For example, if you can improve turnaround time on testing such as MRIs and echocardiograms, you can improve the progression of care," Mahmood says.

Case management and social work teams can help reduce length of stay by optimizing the transition of patients from the hospital setting to post-acute care settings such as skilled nursing facilities, Mahmood explains.

"You must make sure you identify patients who may require post-acute care as early as possible because you can talk with the patient and the family about not being able to go home after a hospitalization," Mahmood says. "This also makes it possible to make an earlier request for post-acute care from an insurance company and to have earlier discussions with post-acute care facilities about securing a bed."

Efforts to reduce length of stay should never put patient safety at risk, according to Mahmood.

"When we talk about reducing length of stay at Allegheny General Hospital, we talk about improving our processes to reduce length of stay," Mahmood says. "We do not want to discharge patients earlier than they are ready to be discharged based on the determination of their physicians."

Harnessing data is crucial to help a hospital improve processes that reduce length of stay, Mahmood explains.

"The important data points to monitor to reduce length of stay include diagnostic imaging time and when blood draws are being conducted," Mahmood says. "The earlier the phlebotomy team can conduct blood draws, the earlier you can get the results from the hospital's laboratory, which can facilitate a patient's discharge."

Boosting Patient Experience

A CMO and care teams must make intentional efforts to provide a positive patient experience, because nobody wants to be in a hospital, nobody wants to be in an emergency room, and nobody wants to be lying in a bed for days, weeks, or months, Mahmood explains.

When you think about patient experience, you want patients to be as comfortable and informed as possible, Mahmood says, adding communication is essential to achieve a good patient experience.

"You may have long wait times in your emergency department, and there are limited opportunities to address that challenge," Mahmood says. "You may have a patient ready for discharge for a couple of days, but you can't get a skilled nursing facility authorization. What you can do is make sure you communicate with patients clearly about unfortunate situations."

For example, Mahmood says an emergency department physician can communicate with a patient that there has been a delay in getting the results of a CT scan.

"That can make a difference to a patient in terms of their experience," Mahmood says. "The patient knows that someone is listening to them and someone is paying attention to a delay in care."

To ensure that care teams are communicating effectively with patients, Allegheny General Hospitals closely monitors patient experience scores, including patient communication with doctors and staff.

"When we see these scores going in the wrong direction, we have a patient experience team that can provide education to care teams," Mahmood says.