Taking Healthcare by Storm: Industry Insights with Gayle Michelle Olano Hurt

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Gayle Michelle Olano Hurt, MPA, CPHQ, PMC, Vice President of Patient Safety and Quality Operations at the District of Columbia Hospital Association (DCHA). 

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-110124-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical Director Dr.

Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello, everyone, and welcome to another episode of Taking Healthcare by Storm.

I am Dr.

Jean Storm, the Medical Director at Quality Insights.

Today, we are going to be talking about one of my favorite subjects, which is patient safety, among other things.

I am thrilled to have Gayle Michelle Olano Hurt, MPA, CPHQ PMC with us today.

She is the Vice President of Patient Safety and Quality Operations at the DC Hospital Association, and she is at the forefront of improving healthcare standards and patient outcomes with extensive experience overseeing patient safety initiatives, data analytics, and collaborative efforts among healthcare leaders.

She brings invaluable insights into the evolving landscape of healthcare quality.

I am so excited to learn and highlight her experience, discuss the challenges and innovations in patient safety, and explore the role of technology, including AI, of course.

We always have to talk about AI a little bit in shaping the future of healthcare.

Gayle, thank you so much for joining us today.

I'm happy to be here.

Great.

So we're just going to jump in.

What inspired you to pursue a career in patient safety and healthcare quality?

And how did you end up in your current role at the DC Hospital Association?

It's funny.

I think throughout my life, I've always been interested in the helping professions, but I also had a lot of math and data and logic in my background.

And I actually started out in behavioral health research and I'm dating myself a little bit.

But it was right around the time patient safety and quality started to really become a critical component of what hospitals and health systems were doing.

And they needed people who understood data and on some level understood how data could potentially help with quality improvement and patient safety.

And so I really ended up in patient safety and quality simply because I think I had on some level the right skills at the right time.

I was given the opportunity to work nationally advising hundreds of hospitals across the country after my initial work.

And through part of that, I was able to serve on committees and become involved in not only the work of implementing patient safety and quality improvement and organizations, but advocacy and understanding the bigger picture of how value-based purchasing may work and how the ideal and reality don't always meet when it comes to those kinds of things.

And was really fortunate that the District of Columbia Hospital Association offered me an opportunity to marry all of those things that I was able to gain through my experiences and interested in doing, but at a local level.

A journey to get here, I'm super excited to be here.

I will say, I think it's very rare to find an individual who understands, really understands the importance of data in healthcare quality.

So you're definitely a rare breed.

So can you share some of the key responsibilities you oversee as Vice President of Patient Safety and Quality Operations?

So what does a typical day look like for you?

Yeah, sure.

So under my purview, are various quality collaboratives, which include patient safety components, depending on the collaborative and the data piece of the organization.

This could range from maternal health, perinatal quality collaborative work.

We do a lot of opioid response work, work in the technology side on health information exchange and any other number of topics.

Typically, I start my day with a huddle with the team.

That's something that I borrowed from Lien.

And we do a quick touch point.

And then a lot of what I'm doing is trying to work with the team to design interactive meetings to facilitate and foster quality improvement.

I'm trying to make sure that as we're running these collaboratives and hospitals are working together, that there's some form and function to it that keeps true to Weather's Lean or Plan to Study Act methodologies, that they're keeping true to the methodologies and we have some interactive mechanisms to ensure that we're actually having people learn by doing, not just talking at them.

That involves identifying evidence-based practices and innovations every day.

I'm on the lookout for those kinds of things, guiding our teams and creating resources, sometimes working with the collaboratives to create resources.

A lot of at the VP level, the role is strategizing on how to approach problems and how to move things forward in a way that takes into mind the bigger picture.

Certainly, as you talked about data, some of that's reviewing data to make sure we understand the current state, what causes might be progress, and on some level teaching people how to use data when it comes to doing this quality improvement work.

From the advocacy perspective, depending on a day, I may be serving on a local board or committee or national board or committee around some of this work in terms of improving measures and improving quality and safety when it comes to healthcare.

I would love to learn more about how the association utilizes data analytics to improve patient safety and health care quality.

Can you provide an example of a recent data-driven initiative?

Sure.

I think I'll take one from the maternal health space.

We manage the district's perinatal quality collaborative.

And in all of our collaborative work, we're typically looking at data that we have available or trying to identify where possible existing sources to spare burden, if not existing sources working with the hospitals and health systems that are members to identify how to gather and report data, to make sure we're helping them understand where they are and what their progress looks like.

And in particular, in the maternal health space, one example of this is we were implementing the hypertension patient safety bundle from the Alliance for Innovation on maternal health.

And one of the metrics there is around timely treatment.

And when we looked at the initial data that was reported into the Hospital Association from the Hospitals, timely treatment in keeping with the metric, which looked at how frequently blood pressure is taken and then what and when medication is on board, based on what the results of that measurement is, was about 20 percent give or take.

And we really worked then with the hospitals, collectively and individually, to say, what's going into this number?

As they dung into root causes, it was really two main things.

One was making sure policies and procedures and training were up to date on what the current evidence-based practice was, but the other was actually a data component.

Understanding where data captured in the electronic record may not have been accurately reflected in the reports because of the way the reports they were pulling were built or how people were documenting.

And most of the organizations ended up doing sort of two cycles of improvement, if you will.

One, making sure that the data was accurate and the other actually doing improvement work on implementing timely treatment.

And within two quarters, I want to say it was, they had went from 20 percent to over 90 percent, and have been able to sustain that for several quarters since that time.

In fact, I think we're moving on four or five at this point.

And that performance, not only did they go from below the national benchmark to above it, but they've sustained above that national benchmark in terms of performance.

And I don't think we would have been able to make that progress had we not had that data available to start getting people to ask questions.

When they looked at the 20 percent, a lot of them were like, that just can't be.

And that was part of what led to, let's dig into it to try to find the root causes.

And the first root cause was the accuracy of the data.

And then the second round was actually implementing the improvement in a way that allowed for essentially, if you think, processes to default on so that they could get to a point of sustainability.

And we have other examples of that throughout our work.

And as in process improvement, we have examples of things that we tried that we were like, okay, that didn't quite work.

Let's try something else.

But in all of those, if you don't have the information, you need to figure out if what you're trying from an improvement perspective works.

You really just bloundering.

You have to really dig into it to truly understand what's happening.

And we are typically most successful when we are able to have some data to give us that true north, if you will, about what we're aiming for and to give us some sense of how we're progressing on that.

I was going to say, I think that's remarkable with that example, to make that amount of change in six months.

We know all the improvement in health care takes time.

So I just want to stress to everyone who's listening, like that's remarkable.

I'll admit that's one of my favorite examples because the group that we work with there really cares and really works hard to make improvement.

Certainly, most of our activities, it's unusual that you'd have that much success in that quick a time and maintain, but they did.

Part of the reason I'm in this work, every once in a while, you run into an example like that and you're like, wow, we made a difference.

What are the biggest challenges, in your opinion, in patient safety today?

The side question from that, how have these challenges changed since the pandemic ended?

Good question, especially comparing it to the pandemic, because I don't know, on some level, life changed, right?

It's never quite gone back to where we were pre.

I would say one big challenge, and this has been throughout, this isn't new, although perhaps exacerbated by staffing shortages and burnout and those kinds of things is everyone is so busy.

And thinking through how to incorporate quality improvement, patient safety related initiatives into the work that we do every day, including that data component, which can be burdensome if it's not designed right or not thought through is tough.

And I think always a challenge.

I think certainly from a patient safety perspective, we're progressing when it comes to incorporating some of the human factors design techniques that certainly started pre-COVID.

And in some instances, likely helped where people were able to maintain gains in patient safety through the pandemic.

I think we have a ways to go there.

I still think we could do a better job of incorporating those techniques.

I think the analogy people use most frequently is you used to have to turn your car lights on and off and now they automatically go on and off for you.

And to the extent when it comes to patient safety in particular, we can think through how we incorporate those mechanisms is really where I think we're going to make groundbreaking difference.

I do think there's an increased, at least as we're seeing in the district and what I'm hearing nationally and focus on equity.

Certainly that was there on some level historically, but has certainly got renewed interest.

And I think is actually going to be a really key factor in moving things forward.

Changing how we think about what we're looking at, to look at disparities and understand.

It's not just about improvement, but it's about understanding how particular safety or quality initiative may impact various populations, and whether something might need to be done differently to address that.

And as you mentioned, AI.

When I think that these days weaves throughout but for good reason, I think it's got tremendous potential for the future.

I don't think you can talk about AI these days without talking about equity, quite frankly.

But I do think that's going to be a game changer if we do it right and we figure it out.

I think it has great potential to make a difference.

Yeah, I would agree.

And I think it's really interesting that equity AI piece.

Maybe we'll get to that a little later.

But I wanted to talk about the various committees that you lead, like the Quality Collaborative and the Behavioral Health Collaborative.

How do these groups work together to enhance patient outcomes?

It's a great question.

We are typically, because we have line of sight as the association leaders, have line of sight into what all the different committees are doing or interested in doing.

We have line of sight into what's going on at the national level, at the local level, and to a large degree, because we're out there doing the advocacy and leveraging those relationships to understand what might come next, we're always looking for alignment across committees and with various activities that might help bolster or might present a barrier when it comes to doing improvement.

For example, when I think about behavioral health component, they did some recent work on sharing some best practices around environment when it came to safety and trying to understand what is your nurse's station and your rooms look like across the different hospitals to learn from one another.

Not traditional PDSA, cycle quality improvement, but working together to understand how they might better address some of the environmental safety related concerns when it came to behavioral health.

And connecting that to our quality collaborative, where we have a lot of our folks from the hospitals and health systems that are experts when it comes to regulations around that work and understanding what would be required and how you might actually move something like that forward within an organization where we're critical.

So we look for alignment.

We've aligned some of our work when it comes to looking at long acting medications in the behavioral health space with some of the activities that managed care organizations and Medicaid are looking at when it comes to ensuring after the patient leaves the hospital that they're able to maintain the medication and maintain the progress that they gained when they were in the hospital.

Now we have some new long acting medication options available and those took the form of more traditional PDSA cycle activities, but leverage the relationships that we're able to pull together to try to make it more than just hospitals looking within their four walls.

Yeah, I know that the Patient Safety and Quality Summit is a significant event for the Association, which I honestly thought that sounded very fun event.

So what are some key takeaways or themes that emerge from this summit every year?

What's interesting to think across years, we typically find innovations.

There's always a few innovative activities or ideas that hospitals are working on that we're able to identify and share.

It's not just the hospital quality teams that are doing this work, even though it's a patient safety conference.

In fact, this year we've pulled health innovation into it because it just, it seems like when you're looking at patient safety and quality to make a big difference, a lot of times you're also talking about innovation.

One of the ones I'm excited about hearing and sharing this year is a simulation work, where oftentimes hospitals or health systems will simulate something that may happen, such as a hemorrhage or something, and really focus on how are the multidisciplinary teams communicating with one another.

Is the blood in the right place?

Can you get to it?

Is everything in the cart that you need in the car, those kinds of things.

And this simulation actually took it to another level and said, let's run that, but let's look at trauma.

And let's look at trauma from the perspective of what the patient is experiencing and the trauma that they may have on board when they come in and from the perspective of how is this impacting staff in terms of the trauma that they're experiencing.

If you went into the ED, you didn't necessarily go into the ED today thinking that this particular issue may come up.

And they did the simulation, but within that simulation, they did pre-work around how we process trauma and how trauma can impact how we interact.

And then their debriefing included, you're not just your typical questions that you might see in a sort of technical debriefing, but questions about interactions and how those interactions might be changed, improved, etc.

And that is fairly innovative and really exciting work I'm looking forward to hearing about.

And we get everything from patient experience to somebody looking at catheter-associated UTIs and doing quality improvement on that.

Because of the way we have this structured, it's a very broad clinical set of topics, but the theme that runs through it is, what are you doing to improve quality and patient safety?

How do you leverage the tools and techniques to do that?

And where in that activity may you have identified innovation?

And that to me makes the meeting just super exciting.

Yeah, very exciting.

And I would say just for that simulation, just to bring together the shared experience around a very challenging, difficult medical situation, I think is just really leading edge.

It really is.

You're involved with physician leaders and chief nursing officers.

How do you see the leadership evolving in health care, particularly in relation to quality and safety?

I think, and I'll say we're moving into a phase, although we've been moving into it for a while, where sort of everyone is responsible for quality and safety.

And if we don't continue that flow, where, you know, from leaders to line level, people understand their role in quality and patient safety and have some basic competencies to do that, I think will stagnate a bit.

To me, I see that C-suite level as supporting, supporting the line level staff and having time to do quality and patient safety work and feeling safe to report when they see things and easing burden where possible, but also doing quality improvement on some level.

Our chief nursing officers a couple of years ago picked up a quality improvement initiative on their own.

They wanted to develop model policies and education with district forensic nurse examiner program to make sure that they were identifying potential domestic violence, sexual violence victims in the emergency departments, and that everyone was clear on how to get those individuals to specialized care.

And you'll work together with district groups to develop that model policy, come up with a toolkit to implement it and do training.

And so in that sense, they were doing the quality improvement.

But I think there's also a role on that level in supporting others doing that work.

It's not just the Quality Patient Safety Office, director, coordinator doing it.

You really need the folks that are involved in the activity, actually doing that quality improvement work.

Yeah, I would agree.

Everybody's job.

So what advice would you give to healthcare professionals who are passionate about improving patient safety and quality in their own organization?

I think one big thing is taking the initiative on some level to build up your competencies, whether it's talking to those patient safety folks at your organization, taking opportunities where they come, looking at talking to their leaders, like their chief nursing officer or chief medical officer, to understand where they could play a role.

And it can be small.

You'll probably hear me repeat this again somewhere else, I suspect.

But it doesn't have to be big.

It can be a small step in taking a moment to have that more empathetic conversation or to check your biases at the door in a conscious way to make sure you're hearing appropriately.

Or it could be something a little bit bigger in identifying an issue and bringing it up the line and advocating for a team to be formed or some change to happen around that.

And some of those things take courage.

On some level, they shouldn't.

But I think that they do.

You come to your work, you do your work every day.

And depending on the environment that you're in, you may or may not have those opportunities without asking.

But I think it's incumbent on us all to really try to help make those changes.

I think they can help improve outcomes, but also help the quality of life for those with still over in care.

I'm so excited that you mentioned bias, because not many people talk about bias in healthcare quality, and not many people talk about bias in healthcare in general.

And I think it plays such a role and it's not often examined.

So I think in letting healthcare professionals know, you need to examine your own bias.

It's wonderful advice, really great advice.

So I hinted that we're gonna be talking about AIs.

How do you see artificial intelligence playing a role in enhancing patient safety and quality in healthcare?

And are there any specific applications or tools that you find particularly promising?

Because I'll tell you what, I go back and forth between being very excited about AI in healthcare and then being very scared about AI in healthcare.

So I would love to hear if you find any tools that you feel are promising.

I don't know that I have specific tools to recommend per se, but I would echo your excited and trepidatious comment there.

I think AI has tremendous potential to improve diagnostic excellence as an example.

I feel like that's an area where we have great opportunity to reduce costs and improve outcomes and AI could certainly really help with that.

Particularly, I suppose, on some level, the smarter we get, the more complex things become.

And it can be extremely difficult when you've got a complex case sitting in front of you for people to think through all the options.

So I see it as tremendously helpful in providing an aid to clinical folks.

I think there's potential for it to improve electronic health record interactions and documentation.

It's funny, I dated myself already.

I'll go ahead and continue that theme.

I think about when we were first implementing electronic records and everybody thought it was going to be like the panacea that was going to cure all, maybe exaggerating a little bit.

But the number of clicks we have to take and the complexity around which it's designed when it comes to documenting in a record, and whether or not the record actually helps facilitate the activity of providing care, I think has fallen short a little bit of expectations.

I think with AI, we have some opportunity to take a stab at making some groundbreaking change there.

I think if you build in, think about building in, I mentioned when it comes to patient safety, those human factors, components, where can AI help us in building in some of those protective factors, I think there's tremendous potential there.

What concerns me, I think, most about it is the privacy transparency components and making sure we're balancing those things appropriately, but also the nature of the beast as it were is that we're building it on the knowledge that we have, and to bring equity back into the conversation, if the knowledge that we have was built on tenets and lessons that are not equitable, we're really going to have to work consciously to make sure we're not perpetuating that or exacerbating it.

That's where I think my biggest fear comes into play, is that we build a model, AI builds a model on a faulty model, and instead of accelerating good things, accelerates bad things.

Yeah, I totally agree.

I'm going to say I'll date myself as well.

I learned in my training, I was doing my charting, all my documentation of my physical exams and diagnoses on paper.

So I was pre-EHR.

Good old days.

So the last question, I'm excited to hear your answer to this question.

I ask almost all my guests, if you are in charge of healthcare in the United States, what is the first thing that you would do?

I would pursue, continue to pursue payment reform.

And if it was easy to be done already, I acknowledge that's incredibly difficult, and it's an activity that many people, much smarter than I are attempting to do.

But the way that payment is structured currently, just doesn't fit the way we need to deliver care in order to get the best outcomes.

If I think about that diagnostic excellence example, I had this aha moment a few years ago.

People have been talking about improving diagnostic accuracy and delays in diagnostics.

And the third or fourth acquaintance or friend that had a delay in care and diagnosis for a number of reasons, if you think about that Swiss cheese model, the way that payment and how payment is structured exacerbated every one of those examples.

And I had this aha moment where I just thought, even if I take that one thing, if we continue on the way we are, we're going to make progress, but it's going to be slow.

And I've, we need to make some innovative, controversial moves there.

And as we've seen so far, we're going to stumble along the way.

We certainly have stumbled a few times already, but I feel like that's critical to tackle and to continue attempting, or we're just never going to get quite where we want to be when it comes to trying to achieve quite bluntly zero harm.

When it comes to patient safety, I feel like that's the real driving factor that we've got to figure out how to address.

I agree 100%.

Gayle Hurt, this has been fascinating.

I've learned a lot.

Thank you so much for joining us today.

Thank you for inviting me.

It's been great speaking with you.

Thank you for tuning in to Taking Healthcare by Storm, Industry Insights, with Quality Insights Medical Director, Dr.

Jean Storm.

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So until next time, stay curious, stay compassionate, and keep Taking Healthcare by Storm.