The top clinical officers at Allegheny Health Network, UW Health, and Houston Methodist have made physician well-being a primary focus.
With a nation-wide shortage of physicians worsening, physician well-being programs are essential for retention and recruitment.
Physician burnout remains a concern across the country, and it spiked during the coronavirus pandemic. In a 2021 survey of physicians conducted by the American Medical Association, Mayo Clinic, Stanford University School of Medicine, and the University of Colorado School of Medicine, 62.8% of physicians reported experiencing burnout symptoms, which was up from 38.2% the previous year.
Health systems and hospitals have launched a range of interventions to improve physician well-being. The efforts range from initiatives to address basic needs such as taking meal breaks to more advanced approaches including improving efficiency of practice such as support for coding and billing.
The following HealthLeaders stories show how three health systems are addressing the well-being of physicians and other staff members.
1.Allegheny Health Network wellness program is improving the well-being of clinicians and nurses: AHN's wellness program started by focusing on basic problems such as making sure staff were taking meal breaks and staying hydrated. Several well-being initiatives that the health system adopted during the coronavirus pandemic have become permanent such as a peer support program. More recent well-being initiatives at AHN include hiring a wellness officer for each institute on the medical staff and creating an advanced practice provider council.
2.UW Health is following best practices for physician well-being: The Madison, Wisc.-based health system is using Stanford Medicine's well-being survey and implementing the Stanford Medicine Model of Professional Fulfillment. UW Health's physician well-being programs focus on a culture of wellness, efficiency of practice, and personal resilience.
CCO Hoda Asmar says the health system improved sepsis care during the first two years by focusing on two processes, including early administration of antibiotics.
After committing to improve sepsis care in 2021, Providence has significantly reduced deaths over the past three years.
Sepsis is an extreme response to infection, and it can lead to tissue damage, organ failure, and death. At least 1.7 million Americans develop sepsis annually, and one third of patients who die in U.S. hospitals have sepsis during their hospitalization, according to the Centers for Disease Control and Prevention.
"Sepsis care is a key focus for us," says Hoda Asmar, MD, MBA, executive vice president and chief clinical officer at Providence. "We have made significant strides, and we will continue to make strides. This is something we are going to be working on for years to come, and we are saving lives."
Asmar says Providence focused on two processes during the first two years:
The health system has more than doubled use of a standardized order set for sepsis patients. The primary elements are blood work and tests used to diagnose sepsis, administration of antibiotics, intravenous fluid resuscitation, and management of hypotension. Providence now uses the order set for 76% of patients presenting with sepsis and hopes to raise that rate to 80%.
The health system is also setting a goal to have the first antibiotic administered within one hour of identifying a patient with sepsis. It’s currently meeting this goal for 77% of patients, with a target of 80%.
Asmar says those efforts helped reduce sepsis deaths from 2021 through 2023.
"Our end goal is to be at a rate better than expected mortality," she says. "The way we measure sepsis mortality is the ratio between observed mortality and expected mortality. The expected mortality comes from a benchmark based on the acuity of the patients we see. We want to be better than 1.0 on the sepsis mortality ratio of observed mortality and expected mortality."
In 2021, Providence ended the year with a sepsis mortality observed-to-expected ratio of 1.11. In 2022, that ratio was 1.04, and in 2023 the ratio was 0.90.
Last year, the health system saved an estimated 1,250 lives of sepsis patients, Asmar says.
Hoda Asmar, MD, MBA, is executive vice president and chief clinical officer at Providence. Photo courtesy of Providence.
New plans to save more lives
Asmar says Providence is now focusing on four more areas to improve sepsis care:
The health system is looking at gaps between its care performance and the Centers for Medicare & Medicaid Services' (CMS) sepsis bundle expectations, which include early antibiotic use, timing of blood cultures, fluid resuscitation, and management of hypotension.
Providence is looking at sepsis care through a health equity lens. Nationally, several patient populations experience worse sepsis outcomes than white patients, including Black patients and Hispanic patients. The health system wants to solve the unique challenges of vulnerable populations and is working on educational tools in languages other than English. A primary goal is to educate vulnerable populations about sepsis and sepsis care such as seeking care early.
The health system is also focusing on early intervention. The earlier that clinicians can identify sepsis and intervene, the fewer complications and deaths. Providence is focusing on key settings such as emergency departments and urgent care centers. One strategy involves using the EHR to monitor vital signs such as blood pressure, heart rate, and respiratory rate and give clinicians an early warning when sepsis is detected.
Providence is also using the EHR to manage care for patients who are admitted to a hospital for a different diagnosis but show signs of sepsis or septic shock.
"This is an ongoing journey," Asmar says. "There is not just one goal. We want to decrease harm and save lives. We are proud of our achievement in 2023, and 2024 is trending in the right direction to be below expected sepsis mortality."
The health system has focused on catheter-associated urinary tract infection, central line-associated bloodstream infection, Clostridium difficile, methicillin-resistant Staphylococcus aureus, and colon and hysterectomy surgical site infections.
Indiana University Health (IU Health) has significantly reduced healthcare-associated infections through a series of initiatives over the past six years.
On a daily basis, 1 in 31 of hospitalized patients in the United States has at least one healthcare-associated infection, according to the Centers for Disease Control and Prevention. Healthcare-associated infections have several negative impacts, including increased length of stay, hospital readmissions, and morbidity and mortality.
Healthcare-associated infections are a key element of patient safety, which is a top concern for CMOs. Health system and hospital CMOs can learn from IU Health's success in reducing healthcare-associated infections.
Over the past six years, IU Health has focused on several healthcare-associated infections: catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA), and colon and hysterectomy surgical site infections.
Efforts to reduce these healthcare-associated infections at the health system have decreased these patient harms by nearly 50%, says Christopher Weaver, MD, MBA, senior vice president and chief clinical officer at IU Health.
"In 2017, we had more than 700 of these events. In 2023, we had 382 of these events," Weaver says.
According to Weaver, data and standardization have played key roles in IU Health's healthcare-associated infection initiatives.
"We have focused on good, clean, timely, and actionable data both in outcomes and processes. We have looked at data that shows how we are performing in care bundles," Weaver says. "We have also looked at our standardization of processes and supplies."
National benchmark data indicated IU Health could improve its healthcare-associated infection performance, Weaver explains.
"We looked at national benchmarks for these infections that gave us good data and recognition about the harm that these infections cause," Weaver says. "We were not performing at the level where we wanted to perform."
Christopher Weaver, MD, MBA, is senior vice president and chief clinical officer at IU Health. Photo courtesy of IU Health.
Healthcare-associated infection initiatives
To reduce CAUTIs, IU Health has focused on the care bundle for urinary tract catheters, educating staff on the insertion of catheters as well as the daily care for catheters, Weaver says.
"We started with standardizing the insertion kits—making sure that we had the same insertion kits across the health system, with all of the appropriate supplies in an easily used format," Weaver says. "When someone opens a kit, they have everything they need to insert a catheter."
For CAUTIs as well as CLABSIs, the health system has tried to limit the use of catheters whenever medically appropriate.
"We put a process in place for non-invasive urinary collection devices that avoided the use of invasive catheters. This effort had a tremendous impact in reducing CAUTI events across the health system," Weaver says. "We make sure we do not use urinary-tract and central-line catheters for the sake of convenience."
Daily chlorhexidine gluconate bathing has helped reduce CLABSI events, according to Weaver, adding patients or families were refusing the bathing, which decreased bathing percentages.
"We changed the language from saying it was a bath to saying it was a treatment, which has been more readily welcomed by the patients and just part of their standard care," Weaver says.
IU Health has strived to be more consistent in its efforts to reduce C. diff infections, Weaver says.
"We have standardized the testing of patients for C. diff. We have made sure patients have a positive indication for C. diff, so we are conducting better stewardship of patients who develop C. diff," Weaver says. "When we have a patient with C. diff, we optimize our isolation of the patient to limit the spread of the infection."
The health system has also bolstered efforts to promote hand hygiene and hand-washing among care team staff, which has helped decrease the spread of C. diff and MRSA, Weaver says.
"We also established a process for isolating patients with MRSA infection to drive those numbers down," Weaver says.
To reduce colon and hysterectomy surgical site infections, IU Health has looked "upstream" to focus on patients who are at high risk for a surgical site infection, Weaver says.
"We made sure patients were optimized before it was time for their surgery to decrease the likelihood of infection," Weaver says. "We evaluated patients who were at high risk for an infection and tried to get their medical issues under control. For example, we made sure we were managing diabetes and were giving nutritional supplements for patients at high risk."
The health system also made sure clinical staff were following care bundles for preoperative care, intraoperative care, and postoperative care. In addition, clinical staff focused on daily care of wounds after surgery, Weaver says.
Implementation tips
Weaver explains there is no "special trick" for avoiding these infections to take care of the problem and drive infection rates to near zero.
"In reality, much of the work involves conducting the basics of care and making sure all of our team members understand the importance of infection prevention," Weaver says.
As IU Health posted gains in some of its healthcare-associated infections, it was crucial to maintain those improvements before moving on to other initiatives, Weaver says.
"We were able to improve our performance on CAUTI, CLABSI, and C. diff, and it was important to keep that data in front of us to stay at an optimal level of performance," Weaver says. "Then we shifted our focus to more infections such as MRSA and colon and hysterectomy surgical site infections."
Sean Reinhardt says being successful in his new role includes admitting he does not have all the answers.
Humility is an essential quality for CMOs, the new CMO of Doylestown Health says.
Sean Reinhardt, MD, began his tenure on June 3 at the Doylestown, Penn.-based health system, which features Doylestown Hospital, a 247-bed community teaching hospital with more than 435 physicians in over 50 specialties. He has held several leadership positions at the hospital, including lead physician for the cardiology group, director of the medicine department, and president of the medical staff.
"You need to realize that you do not have all the answers, but there are people around you who probably do have the answers if you bring them in the loop," he says. "You need to lean on other people to help. You need to approach challenges humbly, and say, 'How can I make this better, and who can help me find the solution?'"
There are other qualities that can help a CMO succeed, Reinhardt says.
"It also helps to have a history with the organization, which helps you support the culture," he says. "You obviously must have people skills—you are not going to do well as a CMO if you can't work well with others. You must have good organizational skills because there is a lot thrown at you."
Sean Reinhardt, MD, is CMO of Doylestown Health. Photo courtesy of Doylestown Health.
At this early stage in holding the CMO role, Reinhardt says he has two primary priorities.
First, he wants to promote care quality at Doylestown Health.
"Quality is the center of everything we do," he says. "Nothing happens without good patient care."
"Our medical staff is robust and focuses on the quality of the doctors," he says. "We take very seriously any deviation from quality care, and deviations are investigated in a formal process and dealt with in a timely manner."
Reinhardt says quality is included in patient care metrics.
"Quality is reviewed regularly when we follow various metrics of performance, including door-to-balloon time for the cath lab and door-to-needle time for stroke," he says. "Everyone needs to be invested in improving quality."
Second, Reinhardt is playing a role in merger talks with Penn Medicine.
"Successfully completing that merger is a top clinical priority," he says. "If the merger goes through, success would be defined by maintaining our unique culture while garnering Penn Medicine's strengths and scale."
Reinhardt has clinical experience as a cardiologist, which he says helped prepare him to serve in the CMO role.
"As a specialty, cardiology has many different facets," he says. "There is noninvasive cardiology, which shares a lot of characteristics with primary care. There is interventional cardiology, which is much more procedural-based and involves interactions with surgeons, so I have a surgical background. Cardiology is a great place to develop experience and master the medical issues that come before a CMO."
Promoting patient safety
Reinhardt says he has three priorities when it comes to patient safety.
"My primary approaches to promoting patient safety are to make it the center of our culture, to make sure everyone knows it is essential to our culture, and to make it easy for people to report patient safety issues," he says. "We also need to address patient safety issues and to constantly re-evaluate how we are doing on patient safety. So, it is a continuous process, where you foster a culture of patient safety."
Like other hospitals, Doylestown Hospital has several metrics to evaluate performance on patient safety, such as hospital-acquired conditions, Reinhardt says. Patient safety is addressed at the highest levels of the organization, including a monthly Patient Safety Committee meeting.
Reinhardt says the health system makes an effort to avoid being punitive so that staff will feel more comfortable reporting patient safety issues.
"Everyone understands patient safety reporting is conducted so patients can receive better care," he says. "We all make mistakes. We all have bad days. Everyone knows that the patient safety reporting system is designed to have a teaching moment, where we can all learn."
Leading a medical staff
Reinhardt says his leadership style is focused on working together.
"Being collaborative is the only way to work with a medical staff," he says. "All physicians are very accomplished, and they are not going to be convinced by just saying, 'I told you so.' You must establish a collaborative environment, where physicians feel like solutions are developed with them at the table."
To do this, he says, a CMO must also be an effective intermediary.
"As the CMO, I am here to act as an interface between the administration and the clinical staff," he says. "When someone brings me a problem or challenge, my first reaction is how can I help them fix the issue, whether it is an administrator with a question about the medical staff or vice versa. I am the link between the two sides. I need to be able to speak both languages, so there is communication between the administration and the medical staff."
The hospital wants clinicians to know quickly when scans show unexpected or emergent results.
Massachusetts General Hospital has launched an innovative patient safety initiative to promote the timely communication of radiographic results.
Patient safety is a top priority for CMOs. Patient safety concerns at health systems and hospitals include healthcare-associated conditions such as infections and medical errors.
"As CMO, I believe there is no higher priority than patient safety and the culture we build around it," says William Curry, MD, CMO of Massachusetts General Hospital, Massachusetts General Physicians' Organization, and Mass Eye and Ear.
Massachusetts General Hospital, which is a part of the Mass General Brigham health system, recently established a policy and process for the acknowledgment of clinically significant radiographic results, Curry says.
"A well-known issue in patient safety internationally is communicating results of scans to the appropriate responding clinician and closing the loop so you know that the responding clinician knows about critical or unexpected results," Curry says.
For example, a doctor may have a patient in the office on a Friday and be worried about pneumonia. A chest X-ray or CT scan is ordered for Saturday morning. While there may be pneumonia identified on that scan, there may also be something else identified such as a pulmonary embolism, which is an emergency.
Massachusetts General Hospital is setting up a system that is resilient to confirm that the ordering clinician or whomever is covering for that clinician gets results promptly. Subsequently, one of the clinicians can carry out the right action for the patient.
Massachusetts General Hospital has created the technology infrastructure for radiologists to reach out and get closed-loop responses from clinicians whether the situation is emergent or important, Curry adds.
"We also require Epic-based documentation of the receipt of scans by the responding clinician within 30 minutes to two weeks, depending on the urgency of the scenario and the need to protect the patient," Curry says. "Once the ordering clinician acknowledges receipt of a scan, the next step is to make sure the appropriate action is taken and documented."
According to Curry, there should be no patients who have had an image with an urgent, critical, or surprising result where the entire loop between acknowledgment of receipt of the scan and appropriate clinical follow-up is not carried out and documented.
"This is an exciting initiative, and it takes some of the burden off providers who worry about what they are missing," Curry says. "The goal is to make a system for managing images that is more resilient than anything we have done before."
William Curry, MD, is CMO of Massachusetts General Hospital, Massachusetts General Physicians' Organization, and Mass Eye and Ear. Photo courtesy of Mass General Brigham.
Promoting a culture of safety
Massachusetts General Hospital's patient safety philosophy is to be relentlessly patient-oriented, according to Curry.
"We want to create patient safety systems that are resilient to make sure that we are putting our providers in the best position to use their knowledge and their skills to deliver the safest possible care," Curry says. "The key for us is to be relentlessly focused on every step of the patient journey to create the systems that prevent safety events from occurring."
Curry and other hospital leaders are constantly showing that patient safety is a priority.
"We consistently message about patient safety and put it first in our communications," Curry says. "We open every meeting with an assessment of patient safety. We review patient safety events at the institution as broadly as we possibly can—we are responsive to every patient safety event. We almost beg for reporting—there is no amount of patient safety event reporting that is too much."
The health system uses RLDatix's RL6 patient safety reporting platform.
"We share patient safety reporting throughout Mass General Brigham," Curry says. "We can learn from each other in an immediate way. If there is a safety event that occurs at Massachusetts General Hospital, the other hospitals in our health system can learn from our analysis of the event in real time."
There are as many as 27,000 patient safety events reported at Massachusetts General Hospital annually. "We revel in the high number of safety events that are reported," Curry says.
Patient safety partner
RLDatix recently announced the creation of the RLDatix Safety Institute, and Curry hopes the vendor partner will help Massachusetts General Hospital improve patient safety performance.
"I hope the RLDatix Safety Institute can help us address the known and the unknown issues in patient safety," Curry says. "We learn from a volume of events, and we learn from each other. There is no single patient safety issue in particular that I am hoping to learn about from the safety institute—I am eager to see what kind of data they generate."
Millie offers midwife-led care to patients with low-risk or moderate-risk pregnancies.
Millie, a maternal care clinic based in Berkeley, Calif., features a midwife-led care model with doulas also providing support to patients.
A report published earlier this month by The Commonwealth Fund provides insights into the U.S. maternal mortality crisis. The report found that the United States has a higher maternal mortality rate than 13 other high-income countries. The report shows that the United States and Canada have the lowest supply of midwives and obstetrician-gynecologists among the high-income countries, and OB/GYNs outnumber midwives in the United States, Canada, and Korea.
Millie's model of care features collaboration and innovation, says Amy Kane, MD, medical director at the maternal care clinic.
"The model involves midwifery care with the support of a trained doula," she says. "Our doulas play the role of a support person in collaboration with the team. Our doulas provide prenatal and postpartum support, but they are not present at a birth."
Millie works in collaboration with physicians whenever patients have conditions that make them high risk, Kane says.
"We do not provide direct physician care, but we have strong relationships with the maternal-fetal medicine groups in the community, private OB/GYN groups in the community, and hospitalists who provide OB/GYN care," she says. "So, our midwives always have the support that they need, and our patients always have the support they need. If a patient develops a high-risk pregnancy, our midwives can hand them off directly to a physician for their care."
For most pregnancies, the most important Millie team member is the midwife, Kane says.
"The patient has a midwife who sees the patient throughout their pregnancy and the postpartum period," she says. "Most patients have the same midwife for all of their visits, but patients also get the opportunity to see other midwives on the team. Midwife visits are both in-person and virtual."
Tech support is one of the innovative elements of Millie's care model.
"One of the special things about Millie is the educational resources on our app," Kane says. "Even when you have longer prenatal visits like we do, there is never enough time to teach patients as much as they need to know. So, providing educational resources is critical. It is hard to get the right information—the Internet is vast, and it is hard for patients to find reliable sources of information."
Millie has an effective care model because the clinic is setting up a situation where patients are cared for by clinical professionals who are appropriate for the level of care that the patients need, says Mark Simon, MD, MMM, CMO at Ob Hospitalist Group.
"They have midwives involved to deliver care for low-risk patients and medium-risk patients," he says. "They can make an OB/GYN available for high-risk patients and any surgical interventions. They have the doulas engaged from a support perspective, which makes a lot of sense."
The Commonwealth Fund report indicates the importance of midwives in maternal care, Simon says.
"An interesting finding of the report is that the United States is one of the countries that has the lowest supply of midwives," he says. "If you look at how we have obstetrical care providers in this country, we are heavily physician focused. A country like Norway, which has one of the lowest maternal mortality rates, has essentially the same number of obstetricians per live births as the United States, but they have 15 more midwives per 1,000 births."
Midwives should play a larger role in U.S. maternal care, Simon says.
"I am a physician, and physicians provide great care in obstetrics, but physicians are not the be all and end all in maternity care," he says. "Clearly, the numbers indicate that we need more clinicians such as midwives providing maternity care in this country to help address maternal mortality and morbidity. Midwives are part of the solution, and they should be adopted more frequently than they are today. Hopefully, we are moving in that direction."
A higher reliance on midwives in maternal care would help address a shortage of obstetricians in the United States, Simon says.
"We just do not have enough physicians practicing obstetrics in this country," he says. "It takes a long time to train physicians, and relying on obstetricians alone is not the most effective way to deal with our maternal mortality and morbidity crisis. A better model is to have physicians working in concert with midwives."
Generating results
Data indicates Millie's model of care is driving good clinical outcomes.
The C-section rate among Millie's low-risk, first-time mothers is 21.7% compared to the national rate of 26.3%
Millie's patients have a low preterm birth occurrence rate at 3.01% compared to the national rate of 10.49%
Millie's patients experience a low birthweight rate at 3.66% compared to the national rate of 8.52%
Compared to OB/GYN-led clinics, Millie has a lower cost of care, according to Anu Sharma, MS, Millie CEO and founder.
"Clinical studies and the experience of peer nations has shown that midwifery-led care leads to fewer C-sections and other interventions for low-to-moderate risk pregnancies," she says. "Midwifery-led care is also less expensive than OB-led care in terms of staffing costs."
Millie excels at early detection and management of risk, which lowers costs, Sharma says.
"In addition to C-sections, other drivers of cost are related to poor management of care and late detection of risks," she says. "These result in readmissions, preterm births, NICU stays, and unnecessary emergency room usage."
As OhioHealth came out of the coronavirus pandemic, its quality and safety team decided there was a need to do an entire reset across the health system.
OhioHealth has made becoming a high-reliability organization a top priority for the 16-hospital health system.
High reliability was pioneered in the aviation and nuclear energy industries. At health systems, hospitals, and physician practices, it includes focusing on patient safety and limiting medical errors.
OhioHealth launched its high-reliability effort a year ago, saysTeresa Caulin-Glaser, MD, senior vice president and chief clinical officer of the health system.
"As we came out of the coronavirus pandemic, our quality and safety team decided that we needed to do an entire reset across the health system," she says. "The goal was to get everybody back into understanding what we needed to be focusing on and working together across the health system to create a high-reliability organization."
At health systems, the foundation of high reliability is safety, but becoming a high-reliability organization generates widespread benefits, Caulin-Glaser says.
"When you focus on safety, you are automatically improving your quality," she says. "You are automatically improving your service to the patient. You are improving the culture of the organization to be safety-first. Financially, you gain a benefit because you do not have unnecessary hospital readmissions, long lengths of stay, or errors that are costly for the organization and the patients."
Teresa Caulin-Glaser, MD, is senior vice president and chief clinical officer of OhioHealth. Photo courtesy of OhioHealth.
Taking the first step
Driving high reliability at a health system starts with education, Caulin-Glaser says.
"The messaging and importance of this initiative came from Steve Markovich, our president and CEO," she says. "His message was: Everybody is training. If you were an executive, you were training. If you were working in accounting, you were training. Everyone in the organization was training on universal skills for high reliability."
OhioHealth has been training employees on several universal skills:
S.T.A.R.: Employees are encouraged to stop, think, assess, and react.
Make a 50-second connection: Caregivers are encouraged to make a connection with their patients in the beginning of a clinical interaction. For example, a provider can ask how the patient is feeling and about family members. The goal is to know important things about the patient and focus attention on the patient.
Speak up: Staff members have been trained to validate and verify everything they do that touches patients. For example, if a caregiver is administering medication, they are expected to validate and verify that they have the right patient, the right medication, the right timing of administration, and the right dose. In an operating room, if a surgeon asks for an instrument and a nurse is not sure that they heard the request clearly, the nurse is expected to stop and ask a clarifying question to make sure the right instrument is provided.
Communicate clearly: For example, if a patient is in the emergency room, then is transferred to a medical floor in the hospital with direction to receive 325 mg of aspirin, the nurse receiving the patient should ask whether the patient needs 325 mg of aspirin. The nurse is repeating the direction and asking the emergency room staff to verify the prescribed medication.
Practice empathy: Team members should make empathetic statements such as, "I hear you are not feeling well today, and you had a bad night with little sleep." All employees should listen to patients' concerns and acknowledge them.
Caulin-Glaser says the education program is working.
"About 90% of the leaders across OhioHealth have received high-reliability training," she says. "Our goal is to have 70% of our associates—more than 15,000 people—trained by the end of this month. We want to have 100% of our associates trained by the end of September. High reliability is part of our onboarding training."
The value of reporting systems
OhioHealth has established a daily tiered huddle process to report on four kinds of events: patient safety incidents, workplace injuries, workplace violence, and anything that needs to be escalated to senior leadership.
Tier 1 huddles are conducted with frontline healthcare workers.
Tier 2 huddles feature frontline leaders, who try to resolve issues that arise in the Tier 1 huddles.
Tier 3 huddles address issues that are escalated from Tier 2 huddles, with managers and directors in attendance.
Tier 4 huddles handle issues escalated from Tier 3 huddles, with hospital presidents and their leadership committees in attendance.
Tier 5 huddles are held at noon and address the most serious and repetitive issues reported by the other tiers, and participants include the chief clinical officer, president and CEO, chief operating officer, chief nursing executive, chief information officer, and the vice president of quality and safety.
"Our tiered huddles have helped us to find out what is happening in the health system and to proactively address issues," Caulin-Glaser says. "We are having fewer repetitive issues, and we are getting ahead of issues."
OhioHealth also has an online platform for staff members to report patient safety events. The platform is easy to access and use, Caulin-Glaser says. Over the past year, the health system has experienced a 30% increase in patient safety event reporting.
Safety teams review all safety event reports, and there is a review process for any safety events that are considered serious, Caulin-Glaser says.
"If there are events that we feel need a deep dive, we conduct a root cause analysis that is sent to senior leaders, who determine what we have learned and what actions are going to be put in place," she says.
Expected improvements
OhioHealth has lofty expectations for the impact of its high-reliability initiative.
"Our quality will improve, and we have already seen quality gains," Caulin-Glaser says. "We have been working on high-reliability skills to reduce the mortality rate in our hospitals, and we have seen that number improve. We expect to decrease unnecessary infections such as central line infections and catheter infections. We are expecting to see a reduction in surgical site infections because staff are being more careful."
The health system is expecting to see gains in patient satisfaction, Caulin-Glaser says. They’re hoping that patients will report that they were heard in the hospital and that all members of their team understood the care plan, she says.
In addition to reducing hospital readmissions, length of stay, and costly errors, OhioHealth is expected to reap other financial benefits from its high-reliability initiative, Caulin-Glaser says.
"By establishing high reliability in our outpatient clinics, we hope to be treating patients proactively, so they do not require hospitalization, which should reduce expenses for the patients as well as the organization," she says. "If we become known as a high-reliability organization, it should drive more patient volume to the organization, which will increase revenue."
The hospital has not had a central line-associated bloodstream infection or a catheter-associated urinary tract infection in the past eight months.
AdventHealth Celebration hospital has made gains by doubling its infection prevention and control (IPC) staff.
Infections including healthcare-associated infections are a major concern at hospitals. Healthcare-associated infections include central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs).
The Centers for Medicare and Medicaid Services (CMS) penalize hospitals that report high rates of healthcare-associated infections through the Hospital-Acquired Condition Reduction Program. In 2021, CMS penalized nearly 800 hospitals for healthcare-associated infections, with about $254 million in lost revenue.
AdventHealth Celebration has increased the hospital's IPC staff from 2.0 to 4.8 full-time equivalents. There have been several benefits from increasing the IPC staff, says Alric Simmonds, MD, vice president and CMO of AdventHealth Celebration and chief health equity officer for AdventHealth.
"First, increasing the IPC staff allowed them to have more of a proactive presence in the operating rooms, on the inpatient floors, and the ICUs," he says. "Second, it allowed them to be able to integrate more with our physicians. Third, it allowed them to have a more proactive understanding and thorough analysis of infection prevention challenges as well as the opportunity to conduct more education about the importance of infection prevention."
Since AdventHealth Celebration's IPC staff was doubled, all hospital-acquired infections have been low compared to national benchmarks, Simmonds says. "We have gone eight months without a CAUTI or CLABSI," he says.
A powerful business case can be made for having robust IPC staffing, Simmonds says.
"Under our guardianship, patients have the expectation that they will have an excellent outcome without complications such as infections," he says. "From a revenue standpoint, there are penalties from CMS for infections. There can also be erosion of the CMS five-star rating for hospitals, which affects our marketing. In addition, hospital-acquired infections can impact our Leapfrog patient safety score."
There also is a "material impact" from hospital-acquired infections, Simmonds says. "If you have an infection, you need to provide additional care such as antibiotics and wound care. So, having an effective IPC staff decreases the cost of care," he says.
One of the initiatives that has been launched by AdventHealth Celebration's enlarged IPC staff is a CAUTI Bootcamp.
"We train staff on how a CAUTI arises," Simmonds says. "The bootcamp addresses how we can remove catheters in a timely manner. The training includes sterile technique, the proper cleansing of the perineum, proper glove utilization, and proper insertion and maintenance of catheters."
Guiding the hospital's clinical staff on appropriately reducing catheterization of patients is a crucial element of the CAUTI Bootcamp, Simmonds says. "We need to seize on opportunities to not have an indwelling catheter for a patient," he says.
The bolstered IPC staff at AdventHealth Celebration is having a far-reaching impact on the hospital, Simmonds says.
"They can be ever-present," he says. "They are part of our leadership team. They are a member of our Patient Safety and Quality Committee. They are driving metrics. They help shape the culture of safety and high reliability from a hygiene and infection-prevention standpoint. They are a clinical arm that is tactically deployed to address infection concerns, and they get in front of infection concerns so that patient harm is prevented. They are additive to the clinical outcomes that we achieve at our hospital."
Virtual care has become a widespread and effective area of medicine, says David Vega, MD, MBA, senior vice president and CMO at WellSpan.
"If you had asked me just a few years ago, I would have said virtual care is best for those patients who have minimal physical complaints that need to be evaluated," he says. "For example, the use of virtual care for mental health concerns grew very rapidly, while virtual health in the non-behavioral health space lagged behind. Then COVID hit. In our organization, we went from about a few hundred virtual visits per year to a few hundred virtual visits per day within just a couple of weeks."
When it comes to virtual care, necessity is the mother of invention, Vega says.
"For a subset of the population, virtual care quickly solved the problem of providing care in the ambulatory space and limiting possible exposure to COVID," he says. "Since then, both providers and consumers have learned that a great deal of care can be delivered safely and effectively virtually. This includes care for both acute illnesses and chronic conditions."
Virtual care is not appropriate or possible for all healthcare interactions, Vega says.
"Virtual care has limitations related to physical exams or procedures when needed. Acute emergencies such as heart attacks and severe injuries still need immediate, in-person attention," he says. "There is also diagnostic testing like blood tests and imaging studies that obviously cannot be performed virtually; although the overall management of a patient may involve virtual care. In addition, there are very complex diagnoses that may require in-person evaluation."
In addition, some patients face barriers that make using virtual care difficult, Vega says.
"On the consumer side, there are people who do not have access to the needed technology for virtual visits, or they may lack the digital literacy to use telehealth options effectively," he says. "There are also some individuals who have visual or hearing impediments that may make virtual care difficult to use."
In the podcast, Vega also focuses on how virtual care is being used at WellSpan:
How a partnership with Concert Health has created a collaborative care model that is increasing access to mental health services in the primary care setting
How working with KeyCare has increased the number of virtual visits that are available at WellSpan
How the health system is working with Artisight to help nurses in the inpatient setting
How WellSpan is conducting remote patient monitoring with virtual nursing
University of Texas Health Science Center at San Antonio and University College at the University of Texas at San Antonio are offering an MD/MS in artificial intelligence dual degree.
Two Texas-based schools are the first educational institutions to offer an MD/MS in artificial intelligence dual degree.
The dual degree is being offered by University of Texas Health Science Center at San Antonio and University College at the University of Texas at San Antonio. Planning for the dual degree program began in 2018, and the program launched in 2022.
Leaders at the schools saw the increasing importance of AI in healthcare when they started planning for the dual degree program, says Ronald Rodriguez, MD, PhD, director of the MD/MS in AI program and professor of medical education at the University of Texas Health Science Center at San Antonio.
"In 2018, there was a recognition that data science and data analytics were going to become increasingly important in the healthcare workforce," he says. "In the health sciences realm, we were increasingly aware that machine learning and artificial intelligence techniques were becoming more used in the basic sciences. We predicted that there was going to be an explosion of AI in the health sciences and healthcare. We wanted to be at the beginning of this development."
"A physician trained in AI brings a unique skill set that enhances traditional medical practice," Fink says. "By leveraging a formal AI education, they can help us create ways to improve diagnostic accuracy, personalize treatment plans, streamline operations, and contribute to groundbreaking medical research. Additionally, there are emerging areas for AI integration that are not yet fully known and have potential to impact our patients and organizations to an even greater degree. The integration of AI into healthcare represents a significant step toward more efficient, effective, and patient-centered care."
Fink says he would "certainly" be in favor of hiring a doctor who graduated from the MD/MS in AI dual degree program.
Teaching doctors about AI
There are three pathways through which students can apply to the dual degree program: computer science, data analytics, and robotics, Rodriguez says.
"Most of our students are going through the data analytics pathway," he says. "We have been recommending students follow the data analytics pathway because it does not require as much theory in computer science. Data analytics is more of a practical and applied-education approach."
The core elements of the MS in AI degree include understanding how to implement the tools of artificial intelligence, Rodriguez says.
"Those tools include machine learning, neural networks, deep learning, convolutional neural networks, and natural language processing," he says. "All of these tools are essentially the toolbox to be able to create the artificial intelligence applications that are being used in healthcare right now."
Teaching doctors about AI should put more physicians in leadership roles in the development of the technology, Rodriguez says.
"For the most part, development of these technologies has been done through computer scientists and data analysts as opposed to being developed by physicians," he says. "By having physicians drive development of the technology, we can ensure that it is focused on patient-centered care and health outcomes in a way that is not driven necessarily by business interests such as profits."
Teresa Caulin-Glaser, MD, is senior vice president and chief clinical officer of OhioHealth. Photo courtesy of OhioHealth.
