Ensuring patient safety and healthcare quality is critical and should be a key focus of everyone in healthcare practice. This course provides healthcare practitioners and others with an introduction to the knowledge and skills needed to lead patient safety and quality improvement initiatives at the micro and macro levels. Participants will explore the foundations of health care quality and the science underlying patient safety and quality improvement, design and select effective health care measures, analyze patient safety problems and processes using tools such as human factors analysis, apply systematic approaches including the Plan-Do-Study-Act (PDSA) model to address quality improvement challenges, and learn strategies to lead a culture of change. The course takes a world view of patient safety and quality, linking participants to research and resources from the World Health Organization (WHO), the US Agency for Healthcare Research and Quality (AHRQ), the Joint Commission and other international organizations. Course highlights include personal stories, lessons learned from other industries and interviews with the President of the National Committee for Quality Assurance (NCQA) and other leaders in quality movement. About The George Washington University School of Nursing Ranked among the top nursing schools by U.S. News & World Report, the George Washington University School of Nursing educates and inspires nurses to provide high-quality, compassionate person-centered health care. The school develops leaders actively engaged in health promotion, patient advocacy and healthcare innovation, and prepares exceptional nurse educators who pursue quality and advance the profession. The School of Nursing is committed to improving the health and wellbeing of people and communities locally, nationally and globally. The school values lifelong learning and its students advance nursing practice, leadership and education as they make a difference in the world.
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Leading Healthcare Quality and Safety
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Quality and Safety Improvement Science
Welcome to Module 4! This week you'll learn how to identify quality improvement opportunities and apply the PDSA cycle to address them. We'll also discuss the importance and benefits of team-based approaches to quality improvement, and the value of Health Information Technologies (HIT) and other innovations in improving health care quality.
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Jean Johnson
Professor, GW School of Nursing and Executive Coach
Gregory Pawlson
Clinical Professor of Medicine and Adjunct Professor, GW School of Nursing and Executive Coach
I am very pleased to be talking with Dr. Jesse Pines today.
And Dr. Pines is an emergency room physician, board certified.
He's also the director and founder of the office of clinical practice innovation.
Which is a new office here at the George Washington University.
He is also a professor of emergency medicine in the school of medicine and
health sciences, as well as a professor in the Department of Health policy and
management in the Milken Institute School of Public Health.
Dr. Pines has had a very innovative, educational background.
He has gotten a Bachelor's Degree in the Biological Basis
of Behavior at the University of Pennsylvania.
He has also gotten a Master's degree in
Clinical Epidemiology from the University of Pennsylvania.
And he has also gotten his Medical Degree
as well as a Masters of Business Administration from Georgetown University.
He did his residency at the University of Virginia Medical Center and
he is the principle investigator of a project called Urgent Matters
that disseminates information about the best practices in emergency care.
And he's written over 200 articles and four books.
So I am very pleased to be talking with Dr. Jesse Pines.
And I would like to say that he's also a wonderful colleague.
>> Okay. Thanks for having me.
[LAUGH] >> So, Dr.
Pines, you have a unique background.
I mean, behavior in biology, and epidemiology, and medicine, and business.
And you're the Director of a new office of innovation.
Tell me a little bit about how you got from sort of
all of these background in expertise, to developing an office of innovation.
>> Sure. Well, let me start by saying and
describing what the Office for Clinical Practice Innovation does.
So we have several different aims.
So we do a lot of work in what's called health services research
where we use big data to look at
how different ways of delivering medical care as associated with outcomes.
We also work directly with the federal government at a number of projects
where we help the federal government primarily on contract related work.
And a number of different phases from the acute unscheduled care emergency care.
Also we have a very deep portfolio in post acute care now and
several faculty, we are working in that area.
We also do a lot of work in applied health policy around town.
So, >> Okay.
>> I came from Penn and I was on the faculty at Penn for about six years after
residency and was trained in epidemiology and bio-statistics there.
I moved down to DC in 2010 and
found that epidemiology and bio-statistics are important but
health policy is the thing that really sort to drive DC when it comes to health.
So I've gotten involved in several different groups around town
in the health policy area.
I spent a year at CMS and had to work with national quality for
them, and primarily what we're doing in OCPI now is focusing on
the latest greatest thing out there in health policy, which is payment reform and
how we can pay physicians and hospitals differently.
We also have a footprint in quality improvement at GW Hospital.
And also work directly with UHS,
which is the parent company of GW Hospital on several projects.
And then our final thing that we do is education.
We spend a lot of our time trying to educate the next generation.
We've got a track in the medical school, where we've got in the second year
of the track over 20 medical students who are interested in practice innovation and
entrepreneurship.
>> Terrific, and
you are a practicing physician in addition to all of what you just described?
>> Yes, I have a 5 o'clock shift that I gotta get to tonight.
>> [LAUGH] >> [LAUGH]
>> You actually see patients.
>> Yes.
>> Really helps to inform the work you do, and
being in DC That is a really good match for policy.
>> Yes.
>> So, tell me how you see innovation really driving,
improving quality of care and patient safety.
>> Sure, well, so with the Affordable Care Act of 2010, there were
many new policies that are being put in place right now.
That are moving payment from general fee-for-service payment.
Where you go to the doctor and the hospital or
the doctor's office gets a fixed amount of money for that, to other ways of
paying doctors that involve concepts such as habitation, bundled payments.
A lot of different flavors of payment models
where really the focus is less on volume and more on value.
So, really what's necessary is trying to come up with
models that really improve value in medical care delivery in this country, and
we're currently undergoing a transformation right now.
Where new models are being tested, implemented, and
really our version of innovation is really being on the cutting edge of those models.
And trying to understand what works best.
>> Thank you.
Because clearly, the payment system in the U.S.
has not helped or supported to move Poly Improvement forward because
people got paid the same whether they provided good care or bad care, really.
>> Right, well really, the quality measurement enterprise has been around for
a while where Where organizations measure
specific elements of medical care, such as processes or outcomes, and
post that information as a way to be really a driver of quality improvement.
Really what's different this time around is that that quality and quality
improvement is being tied to payment, which is really waking everyone up.
>> Yes. It is waking people up.
I understand certainly from many colleagues that one of
the areas that they're focusing on is patient experience of care.
And, being in the emergency room, patient experience of care is really important.
Can you talk a little bit about some of the projects or
lessons learned from urgent matters, >> Sure.
>> That have sort of improved care in the emergency room?
>> Sure, so one of the major reasons that people are unhappy when
they come to the emergency department is that they've got to wait a long time.
>> And they're hurting and they're sick.
[LAUGH] >> They're hurting, they're in pain,
they're having their crisis and they have to wait for a long time.
What we've been trying to do with urgent matters, and urgent matters is actually
a program that predated me here at GW, it's been around since 2002, is to figure
out some of the best ways to improve flow through the emergency department.
Through testing new interventions, trying to get the decision maker
to the patient earlier so that the waiting time is shorter, trying to focus on
efficiency within the emergency department to make sure that things happen smoothly.
And one of the major things that is actually the hardest part is the back end,
which is the interface with the hospital.
Where often, people will wait for long periods and
board in the Emergency Department which tends to sort of back everything up.
There are a lot of best-practices at each one of those levels.
And our role is really to
get the word out about how Hospitals can address that in meaningful ways.
>> That's, I think, really important.
And I know having been a customer [LAUGH] of the I would say actually
that GW seems to be implementing some of the things that you have been finding.
>> Mm-hm.
>> And recommending.
So, tell me how, I mean being the Director of the Office of
Clinical Practice Innovation, how do you get your colleagues
to recognize and adapt innovation?
Because we know that it changes hard.
>> Yes, so there are multiple levels.
So I think, first coming up with innovated projects
is really sort a central focus of what we do.
And then secondarily, how do you translate this innovation into clinical practice?
And it's honestly sort of two very separate but, overlapping concepts.
So, my approach is really to be very multi-disciplinary and
pretty much everything, every project that I work on has
people from multiple disciplines who are working together with their own word view.
Bringing their own world view and their own deep knowledge to the table.
And the combination of people with different fundamental knowledge
attacking a problem is so much more impactful than people with
similar knowledge trying to figure out a system.
And I'm going to give you an example, so, when I was at Penn,
I was doing a lot of publication early on on crowding in the emergency department,
and I was asked to do a review for
a paper that was actually in a completely different discipline.
It was from the Journal of Operations Management,
which is an engineering journal.
>> Yeah.
>> And I read the title of the paper and
it said, proving crowding in the emergency department, and flow, and simulation, and
I said, well, I know a little bit about crowding and flow.
So I agreed to review the paper, and I started reading the paper and
the first four sections were completely opaque to me.
It was all mathematical proofs and
simulation and Greek terms and I had no idea what they were talking about.
And I got to the fifth section.
And the fifth section was their model of an emergency department.
And in their model of an emergency department,
they basically treated an emergency department like a McDonald's.
And I said, well, I know that I can't tell you whether any of these Greek symbols and
all that stuff is right.
But I can tell you that, that's not right.
So as a result of that, giving feedback to that paper, since that time,
this was about 2007, my approach to academic medicine, or academics
in general is, to work with people who have fundamentally different world views.
At that time, I went across campus to the Wharton School to an operations
management professor, a guy named Christian Terwiesch,
who we worked together, we had shared some graduate shared PhD student.
We did some very sort of fundamental work at looking at bringing a clinical
person's lens onto what the folks in the engineering school were doing
with simulation models.
And in the end, we made actually a very useful simulation model of the hospital
at Penn that was used for several academic projects.
So, and really the approach to innovation is that overlap and
I've taken that same philosophy to a lot of the work that I do today.
So now, I worked on a project recently with a sociologist,
a guy who's in health sciences to build a conceptual model for
acute unscheduled care.
This is for the US Government through a contract vehicle.
And what I found is that, my view of the world and
guy's view of the world as a sociologist were completely different.
But again putting us together, we were really able to make some
big steps forward by doing something sort of right on the edge of both disciplines.
So that's really our approach to innovation is to bring together
multidisciplinary people in either law, health economics,
sociology, engineering and to try to answer some of those questions.
>> Mm-hm.
In fact, I think you're making a really important point because I
think that many of us in healthcare, define inter-professional,
inter-disciplinary as people in different health disciplines working together.
And the examples that you gave is working with engineering,
working with sociologists, and so people in very different disciplines
that we don't necessarily think about in healthcare can bring expertise
that's really useful because the projects that you just described are fabulous.
>> Absolutely.
So the example with Guy's project was bring in the concept of what's called
concept mapping, which was a method
in sociology that's used to bring ideas together and
bring ideas to a new project, where basically it's a way to get feedback.
And in this case, it was about our model of acute and scheduled care.
We got formal feedback.
We went back with panel and
the process of bringing in these novel methods into healthcare is
really sort of can make great leaps and bounds
beyond anything that a guy can do on his own or anything that I can do on my own.
>> Yeah.
Wow, those are amazing projects actually.
So, if you were to step back and
sort of give some a view of how can we all be more innovative?
I mean, because our health system isn't going to improve unless all of us,
look at how we could do things better, and yet
that has been a bit of a challenge.
>> So, I think there are a couple of comments about innovation in general.
So first, when you say you're the chairman of the innovation department, it
can rub other people the wrong way because it means what I'm doing is innovative and
what other people are doing is not innovative which is absolutely not true.
But in order to be innovative,
I think what we need to do is to bring people together.
And to figure out the common goals.
And what tends to happen in healthcare is that groups,
even within the hospital or within the emergency department or
within a particular unit of the hospital or outside the hospital,
tend to be working independently in their own silo and
don't communicate well with the outside world.
Really the innovation is about bringing groups of people who are,
they have the same common goal which is to provide good medical care and
to treat people well and to make people better.
And making sure that everyone is on the same page.
What the federal government is trying to do is change payment models that sort of
makes everyone be on the same page when it comes to common goals.
But I think innovation is about bringing people together and not necessarily
reinventing what anyone's doing but to figure out where the overlap is.
And where common goals can be important, common goals that are important
can be measured, and that people can be held accountable for those goals.
>> Excellent.
Wow.
If you had one thing to kind of say to the people who are participating in
this course, about innovation and how it relates to quality and safety.
What would that be?
>> One thing.
So, I would say to be open.
I think being open to hearing a lot of other people's views on the world,
particularly when somebody else has a fundamental
viewpoint that is sort of different from yours.
To listen and then really try to integrate that into what you're doing.
So, I took my
last business school classes in the late 90s and this is actually before
a lot of the innovation in entrepreneurship science changed.
Basically back in 2004, a guy name Steven Blank out of Stanford came
up with this whole new way to basically do what's called Customer Discovery,
which is the process of asking people not necessarily about,
this is our product, will you use it?
But we really try to figure out what the needs are.
And that process of sort of iterating on the front end
when it comes to innovative projects, being willing to pivot.
So if you're not getting it right, knowing when you need to pivot, and
trying to get it right through a iterative way with a multidisciplinary team.
I think that's really the secret, and you think about clinical quality improvement,
you think about customer discovery, it's all basically the same thing.
It's about coming together, looking at problems, and
continuously collecting new data and trying to change your product or
whatever it is to meet the needs of people.
>> Thank you, Dr. Pines this has been very informative and I really thank you.
>> Great, well thanks for having me.
>> Yes.
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