Leading Quality
Welcome to Leading Quality, the show that dives into the real-world stories and strategies of healthcare quality improvement leaders at all levels, from Frontline Champions to C-Suite Executives. Each episode uncovers how these dedicated professionals tackle complex topics in real healthcare environments. Discussion range from QI fundamentals, to leadership, technology, AI, and beyond. If you’re passionate about elevating patient care and want practical insights that go beyond the buzzwords, this podcast is for you. Tune in for inspirational conversations, innovative frameworks, and the behind-the-scenes details you won’t hear anywhere else, and discover how you, too, can lead quality improvement from wherever you stand in healthcare.
Leading Quality
From 1 to 4 CMS Stars: A Quality Transformation Journey
What transforms a one-star hospital into a four-star institution in just four years? The answer lies not in fancy technology or complex solutions, but in approaching problems with genuine humility and data-driven focus.
Dr. Kimiyoshi Kobayashi brings a refreshing perspective to healthcare quality leadership in this illuminating conversation. As Chief Medical Officer at UMass Memorial Medical Center, he shares the critical mindset shift that helped him lead a remarkable quality transformation: "I always tried to remember when approaching somebody to approach each problem with humility." This approach—starting with curiosity rather than assumptions—has proven more valuable than any technological solution.
The discussion delves into common misconceptions about capacity command centers, revealing that despite their NASA-like appearance with monitors and co-located services, their effectiveness depends entirely on answering fundamental organizational questions. "It doesn't matter how shiny the room is," Dr. Kobayashi explains, "if you don't have difficult discussions around how decisions will be made when there are winners and losers."
For physicians transitioning into quality leadership, Dr. Kobayashi offers hard-earned wisdom from his own mistakes. He describes how his medical training conditioned him to be "answer-oriented," while leadership requires focusing on process and collaboration. This insight resonates deeply for clinical leaders who must unlearn the habit of individual problem-solving to embrace collaborative improvement.
Looking toward healthcare's future, Dr. Kobayashi envisions AI transforming quality measurement by enabling more comprehensive monitoring across all procedures and settings. Yet he maintains that human judgment will remain essential: "While data might get easier to extract, someone still has to tell the story and understand where workflows need to change."
Subscribe to Leading Quality for more conversations with healthcare leaders who are transforming patient care through innovative approaches to quality improvement.
You know, I think one of the things I always tried to remember when I was approaching somebody was to approach each problem with humility and to try not to kind of bring my own biases to these conversations, to try to approach it with a learning mentality.
Speaker 2:Welcome to Leading Quality, the podcast spotlighting the people moving healthcare forward from the front lines to the C-suite. I'm your host, jason Meadows. I'm excited to welcome Dr Kimi Yoshi Kobayashi to the show.
Speaker 2:Kimi is one of those rare physicians who marries deep operational expertise with a genuine passion for improving patient care. As chief medical officer at UMass Memorial Medical Center, an 850-bed academic hospital in central Massachusetts academic hospital in central Massachusetts, he provides clinical leadership for safety, quality and capacity management, while overseeing hospital medicine, the EICU, employee health and palliative care. He also invests heavily in mentoring the next generation of physician leaders. When Kimmy joined UMass Memorial in 2019 as chief quality officer, he founded the Center for Quality and Safety and helped lead the hospital's transformation from one to four CMS stars in just four years, a shift that represents a real difference for patients and staff alike. His research focuses on handoff safety, hospital transfers and how capacity management impacts outcomes. Hospital transfers and how capacity management impacts outcomes.
Speaker 2:Before UMass Memorial, he held leadership roles in medical informatics, clinical operations and capacity management at Massachusetts General Hospital and Johns Hopkins Hospital. Nationally, he serves on the Vizient AMC Chief Quality Officers Network Steering Committee and the Society of Hospital Medicine's Quality and Patient Safety Committee. What I love about Kimi's story, and why I wanted him here, is that he's not just making improvements on paper. He's changing the day-to-day experience for patients and staff, and that's exactly the kind of leadership that we celebrate on this podcast. Kimmy, welcome to the podcast.
Speaker 1:Thanks, jason, it's a pleasure to be here.
Speaker 2:So, kimmy, I think, starting at the start, I'm just curious. We've known each other for a little while, but I don't know that I've gotten fully into your origin story and I'm wondering what got you into quality improvement and from their quality improvement, leadership.
Speaker 1:Awesome. So I'll go way back. I'm originally from Boston, I'm a thoroughbred Northeasterner, I consider myself a New Englander, patriots fan, celtics fan, all that and you know, as I was going through my training and education, I was influenced partly by my family background. My parents are both PhD scientists. I tremendously respect what they accomplished in their research careers, advancing and contributing to basic science and mainly immunology. This was during the 80s and the boom of the biotech era and I thought that was very cool.
Speaker 1:I did a research experience during college. I quickly realized, while it was interesting, it really wasn't for me. I kind of liked the people experience, part of it, which is what led me ultimately to medicine. And as I was going through the educational process I realized that conceptually it was possible that you could improve patient outcomes by the way you deliver care just as much as a blockbuster cancer drug could. And that concept fundamentally is what still drives me today. It still is what keeps me interested in improving operations, improving quality, improving safety and has sort of been the, I think, thematic passion through my career.
Speaker 1:And so when I was a resident I was going through training at a time where quality improvement was really starting to take off and that was starting to percolate within training systems. This was pre the ACGME clear requirements and things like that and really enjoyed that concept because it melded really well with that concept of improving care and changing outcomes. And so I got involved there and started to do projects, even as a resident, that were very small in scale, and then wanted to do bigger and bigger projects that were very small in scale and then wanted to do bigger and bigger projects and ultimately I started to get interested in how to organizations change from point A to point B and that's what then drove my what I would call my leadership, growth and experience through my attending hood career after my training.
Speaker 2:Yeah, Thanks for that summary. I think a lot of people probably listening to this can relate to the enthusiasm that you built in understanding that operations can be as profound or even interesting as far as your time at Mass General is concerned. So I understand you were the director of inpatient medicine. You're also an epic physician champion and you have kind of an informatics background, or at least that's part of what's brought you into this moment. What were some of the early lessons or experiences that set the stage for your quality leadership that came after?
Speaker 1:I think one of the things that I learned early on in my career, thanks to mentors that I had, was to really take away from every experience that you've been given as much as you can. So you know, when I was going through my early career, I was really just interested in doing something, making a contribution, making change, learning, growing as a leader. And so when I came out of residency and was starting to develop my career as an attending and as a physician leader, I was really given the opportunity to participate in the EPIC deployment for Mass General, and at first I don't really think of myself as an informaticist, just to be clear but I think that the project was really instrumental in my career in development because it taught me a lot about workflows across both the inpatient and outpatient space, and I'm a hospitalist by clinical trade. So learning about outpatient care, pediatric care that was all stuff that I would not have been exposed to otherwise in my normal hospitalist day to day Taught me about rev cycle, taught me about data structures, quality reporting, and really gave me an opportunity to interact with a huge plethora of people, and I was also attracted by the fact that at the time it was being billed as one of the biggest changes that the organization had gone through in its history, which I think probably is true in terms of the overall impact it had in touching every caregiver's workflow in life. So I was really. That's how I got started in that realm.
Speaker 1:And after I had that experience, I had experience working with other leaders across the institution and healthcare system.
Speaker 1:That's when my chair at the time asked me to take on some operational responsibility working within the department, and I absolutely loved that role. It was great to interact and represent my department, but also, really, you know, one of my mentors at the time that I was starting that role told me hey, kimmy, if you're doing that role correctly, you're going to spend most of your time not with the people in your department but actually interacting with others outside of your department. And that's absolutely what happened. Is I love collaborating with other departments, trying to solve problems together, and that's what exposed me into issues such as capacity and boarding and working on alternative pathways to admission, and so I really liked how I was able to meld both my clinical experience that I was experiencing every day as a hospitalist caring for patients, my Epic experience, my experience with other leaders, and now solving different kinds of problems and with a little bit more operational responsibility. So that's. That was really how I would summarize my MGH experience.
Speaker 2:Yeah, I mean there's. There's so many kind of interesting themes in what you just said and you know, one of them is kind of the theme of being an outsider in a sense. You're a hospitalist by training but then working really cross-departmentally, and I think that some of us, when we try and tackle this work, notice how siloed our healthcare systems can be. I'm curious if you, as a hospitalist working with a lot of others who are not hospitalists, if you would consider that a relative strength, being the non-expert in the room when it came to, I don't know, pediatric oncology or, you know, orthopedic surgery or something else. Does that strike a chord with you at all?
Speaker 1:You know, I think one of the things I always tried to remember when I was approaching somebody let's say during my Epic role about changing a workflow from homegrown IS systems to Epic was to approach each problem with humility, right that everybody that I was talking to had very good intentions, wanted to take great care of their patients and cared a lot about outcomes and quality and safety, and to try not to kind of bring my own biases to these conversations, to try to approach it with a learning mentality, and I think that really helped me in my future quality leadership roles. Because you know, we're often we're going to go into a situation when we're trying to solve a quality problem, where we're trying to understand maybe the signal is that the quality isn't as good as it could be or there was a safety issue, and so you know, rather than coming in and saying like there was a problem here, I think I learned early on in my career lessons about how to approach situations where you don't assume the worst in people. Right, to a certain extent, you know people might approach these conversations with some sense of defensiveness to begin with anyway. So it doesn't help for you to come in and kind of say, hey, there was a problem, right, and I really tried to.
Speaker 1:I learned that lesson over and over when I was doing the Epic thing where you know you have to start with inquiry. You have to start with tell me about how you do X procedure. Right, if we're going to talk about X procedures quality being off, let's talk about that procedure Like what is it that you do? Tell me about it. Tell me about, because I might start to hear things at that part in the discussion that completely changes my view about what might be going on. And I've had plenty of experiences, particularly in quality, where we start talking about a problem and I all of a sudden realize, oh, this might actually be just a pure data problem, just by some of the things that I learned. And so I think that was really key and really helpful in how I approach problems now.
Speaker 2:Yeah, I love the idea of leading with humility. I think that's a that's a really key theme that that I've experienced as well. So thanks for sharing that. If that is you know. What you're describing is you know kind of the zoomed in approach, in the sense that you might be getting down to the nitty gritty of of how a procedure works or how a particular process works? I'd like to zoom out for a minute and actually talk about your experiences at the Johns Hopkins Capacity Command Center, which is an example I think that a lot of the healthcare world looks to. They've had great success with that command center. It may even be the first of its kind, if I'm not mistaken, but certainly among the first. I guess. For our audience, who may have different levels of familiarity with that, can you explain what a command center is and why it's important?
Speaker 1:Absolutely. You know capacity command centers over the past I would say probably five to 10 years have really evolved and now I think we're at a stage where you can access in the literature, for example, more standard papers, documents about what a command center is. You know, fundamentally, I think, about command centers as doing a couple things ultimately for health systems and, frankly, most command centers that I've seen or interacted with have been slightly different. None of them are exactly the same, but I think some of the central functions that they're trying to do is really act as a hub for either one institution or multiple institutions or institutions, hospitals and outpatient areas. I think, too, they're trying to co-locate some services that have commonality and synergy across them, services that have commonality and synergy across them, and I think they also are ultimately trying to act as a decision point for an institution, whether that be a single hospital, a health system with multiple institutions as a decision point to adjudicate. You know situations where we need to make a decision that's for the better good of the patient and the health system, and the reason why, in a system where you don't have a command center, why that might be a little bit more difficult, is that you're transacting those decision points just unilaterally, kind of in a one-on-one-on-one situation. But if you have a command center, you can kind of take into consideration all of everyone's interests and try to make the best decision possible. So I think that that's really to me what a command center is.
Speaker 1:Now, what services you put into the command center? Do you include, for example, transport services yes or no? Do you include a clinical expediter role yes or no? Those are some of the sort of the nitty gritty and again things look different. But ultimately I think that's really what a command center is founded on a foundation of data and insight. Increasingly now, command centers are hubs of advanced analytics using AI and machine learning and predictive tools, and I think certainly we will see, as we see, consolidation in the healthcare market and we have larger and larger health systems, I think it's only natural that command centers will just grow and not shrink. That's my prediction.
Speaker 2:What would you say to hospitals that are working hard to manage patient flow but they see command centers as an additional investment that they can't afford? And secondarily, what would you imagine to be the minimum size or the minimum set of features that you might need to make a command center work?
Speaker 1:One of the most important lessons that I was fortunate enough to learn at the Hopkins Command Center was the notion that while they did have a very cool NASA-looking room with a bunch of computers and monitors everywhere, we had this cool wall of monitors, for example one of the most important things is to remember that what really matters is not so much the material appearance of the command center, it's actually how is the command center functions actually going to get accomplished? And what I mean by that is, I think so much there's oftentimes a discussion of if we just co-locate these services and put them in a shiny bunker with a bunch of computers and data, that all of our problems will just dissolve and go away and our length of stay will go down by 1.5 days, and that our readmission rates will get cut in half and our aura holds will disappear and that it'll be nirvana. But what I think that approach fails to recognize is that the fundamental effectiveness of a command center depends on some of the key questions and guiding principles that you have to answer generally to create an effective command center. So by that I mean that conceptually, when we worked in a more of a classic single hospital style, you know, ultimately, the institution can make the decision of what it prioritizes, in what order, but when you go and you try to solve problems like where can I place a patient across our five hospitals, it becomes more complicated.
Speaker 1:The decision-making process now incorporates five different major stakeholders instead of just one, and so if you don't have difficult discussions, for instance, around how are we going to manage the finances of transfers between our hospitals, or how, at the end of the day, when we resolve a disagreement, how are we going to make those decisions, which inherently means that we're going to have losers and winners. If we don't have those kinds of foundational principles laid out, it doesn't matter how shiny the room and how many monitors and computers and people you have co-located, it's really not going to work. And so I think that a lot of the discussion and focus at times is around the cool technology, ai, machine learning, predictive learning aspect of things, but what I think folks need to focus on actually more is some of those principles, some of those decision-making points, conflict resolution and because really what you're talking about is how do we act as a?
Speaker 1:system and I think that's a question that, fundamentally, a lot of institutions are grappling with right now is how do we act as a system, how do we organize ourselves as a system and this could be for quality or capacity, really and I think that the key questions are in solving those rather than focusing on the product. The product design will flow from whatever you organize.
Speaker 2:Yeah, it reminds me very much of what a lot of the older QI literature about the evolution of Toyota and other companies in different industries that have succeeded in this kind of quality improvement journey, which is when implementing technology, we want to deeply understand the workflow, deeply understand the, as you say, the principles or the problems that are actually being solved, because it can be awfully tempting to think that a new technology will be a panacea when in fact we haven't done the hard work of understanding how our hospital is structured, who is there, who organizes and interacts with whom.
Speaker 2:So yeah, I really I appreciate that perspective. You know this may also overlap with your command center experience, but maybe not too. I'm curious you are now at UMass Memorial now for about six years, I think, and you were a big, big part of this transition from one to four CMS stars, which is a really remarkable achievement. And I wonder if you can give me a sort of first 100 days playbook idea of what is the initial thinking in making that transition, and obviously it takes a lot more than a hundred days, but I'm curious what that kind of playbook looks like in your mind now having gone through it.
Speaker 1:Yeah, it was, it was, it was. It's probably one of the things that I'm most proud of so far in my career of being able to achieve. You know, personally as a leader, I was really excited about taking on the role of chief quality officer, to be given the opportunity to solve problems like this. How do you transform an organization, whether it be quality or otherwise, and move it from one you know one position to the other? So, in terms of the first 100 days, you know I'll talk about what I felt early on. One of the first things I felt when I got to the organization and trying to again back to some of the principles we talked about, what is the problem? And you know, when I stepped onto the wards as a practicing hospitalist at UMass Memorial Medical Center, I immediately realized that the one out of five CMS stars was not a reflection of the quality of care that was actually getting delivered, and so part of my hypothesis early on was that we're sort of not getting credit for the quality of care that we are providing and that approach starts to take or that lens starts to take you down a certain avenue of inquiry that I began, which is making sure that our data was aligned, that was clean and correct and validated, making sure that we had good alignment organizationally amongst frontline caregivers as well as the most senior executives, on what we're trying to achieve. On quality and looking at how did we ensure or improve on a quality issue as it's identified. You know, oftentimes I heard earlier on when I got to the institution that quality had been very much a flavor of the month issue. So you know, this month we're focused on hospital-acquired conditions, but next month we're worried about infections. Well, last month you were worried about hospital-acquired conditions. What happened to that? Oh, no, no, we're talking about infections this month. Right, and in that environment you can't sustain progress.
Speaker 1:So the other key thing that we did early on was to identify what were the top things that we needed to improve. So you know, you might look at the full slate of quality outcomes and say we want to improve on all of them, but really pushing ourselves to say no, no, no, like what are the most important things that we need to work on, and then committing to a multi-year improvement process, cause, as we all know, you can, in the short term, improve any of these quality outcomes pretty quickly with a lot of effort. But the real trick is can you sustain the improvement? And if you want to improve on any of these externally reported quality rating systems, you really need sustained outcomes, because the measurement periods are often more than a year and also they lag behind by a couple of years, and so you need to be aiming for sustained results, and that's what we're always sustaining for in a good QI sense. Right is that? Final S is that sustainment.
Speaker 1:And I also sort of knew that, based on the way that data is structured and reported, that what we needed to aim for was not just incremental improvement, because that's what everybody in your peer group is doing, and so you know, as we know, in quality, each year our peer benchmarks are generally improving on any given metric. So what we needed to do was sort of, you know, stepwise function improvement, not just incremental improvement. And the only way that I thought we could do this is to basically look to the highest achievers in every one of these domains and then understand what are they doing? And then ask ourselves why can't we do that today? And that's a really different muscle than most academic medical centers that I've been a part of are used to. Most academic medical centers don't move with that kind of quick muscle.
Speaker 1:But that was a challenge that I wanted to put in front of others is to say these are the people who are doing the best on any particular issue and they're doing it this way. Why can't we do it that way also? And that helped to really cut through a lot of things. Like well, kimmy, you know we've always done it that way before, so you know we got to keep doing it that way. It helped to cut through issues. Like you know, we don't think we can do it because generally people don't want to say that they're aiming to be third best, right, generally, you know, most people, particularly physicians, I find you know they want to be the best and so when you tell them that this is what the best is doing, they, it's hard for them to say, well, I want to be like that.
Speaker 2:So I think that that really helped me mentor others in leadership or those who might aspire to be leaders in the future. I'm curious what are maybe some mistakes that you made along the way that were really valuable teachers? Maybe lessons that you'd convey to people that you mentor?
Speaker 1:Boy, there's a lot of mistakes that I can think of. You know, one of the mistakes that I talk about a lot when I'm talking with others is the fact that the one of the biggest blunders I still consider that I've made in my career happened like within the first year that I was out of training and it's and there's something about that first major mistake that really catches your attention and sticks with you year over year over year. And really what that mistake boiled down to was that I thought that I had this great idea, that the idea itself was great, but I so fell short on stakeholder engagement and generating buy-in and understanding others' perspectives that it was a complete fail. It didn't actually matter. In that instance I realized it didn't actually matter how good my ideas were when I totally fail at engaging others and including them in the conversation. And so in that instance again, one of my really early projects that I was trying to champion it never went anywhere. It got killed almost immediately and never saw the light of day.
Speaker 1:I still think it was a pretty good idea, and so I try to really, and I'm going to focus a little bit on physician leaders.
Speaker 1:I'm a little biased to that, being a physician.
Speaker 1:But I think sometimes, you know, there's such, there's so much focus on in our training as a physician about getting the diagnosis right, getting the correct medication for that disease, getting the right surgery for that injury, that I think we become very solution focused and that works against us often when we're now put in a leadership role where it's not, most of the time it's not about the idea, and in fact your job as a leader is not so much idea generation but it's about generating buy-in and support and fostering a sense of collaboration.
Speaker 1:And so I think that I talk about that a lot and I try to pay attention to that myself a lot, because I recognize that I've spent my entire sort of upbringing and training to be so answer oriented, that to really remind myself always like it's about the process, it's not about the solution. You know, I've really tried to say like now, the best solution is the one we come up with as a team. It's not the smartest answer or the most pure, perfect answer, and so I think that's a real important lesson that, um, I felt directly, uh, that my mentors have taught me and that I try to pass on to others.
Speaker 2:Yeah, I mean again that theme of of humility that you mentioned before coming through and uh, yeah, it's, I've I've had those projects. Uh, I've seen those projects, uh been a you know, a bystander, bystander watching it as it unfolds, so I can really relate to that. You had a paper published this year in April entitled Navigating the Pathway to Quality Leadership Perspectives from Contemporary Quality Executives. There's a lot of good in there. It's a great read. I recommend it to the audience. But I was curious about one particular question. Essentially, you surveyed nationwide a bunch of self-identified quality leaders and one of the things that was overwhelmingly agreed as a critical skill by those surveyed was about 92.6%, I believe, agreed strongly that data and storytelling were essential features for a, or essential skills for a quality leader. I'm wondering how much you know we, as you've kind of alluded to there, we focus on the data. We focus on getting the right answers. How much has data and storytelling been important to your journey and are there any specific examples where that combination was important for you?
Speaker 1:Yeah, the project was really interesting. We were trying to get a current snapshot of those who are in quality leadership and I think it was kind of an interesting time that we did it, because quality has really matured over the past 20 years and I think it's gone from a conceptual topic to one where it's almost normal to have folks who are chief quality officers and VPs of quality and directors of quality and whatnot. That's almost nobody blinks an eye anymore that that's a normal key function within an organization. So we were trying to understand, you know, who are these people that are currently in the role? Kind of what, what do they do? What is their skill set? Kind of what do they do? What is their skill set? Ultimately, I kind of hope that it would be a little bit of an informative piece too to folks who aspire to be in quality leadership roles so that they can kind of understand what are the things that are important for them to get there.
Speaker 1:And, as you mentioned, you know data and storytelling I think is one of the most critical things.
Speaker 1:You know as quality folks you and I, we do that all the time and I think is one of the most critical things we you know, as quality folks, you and I, we do that all the time and I think sometimes, while we can get over focused on data and quality, I do think that the rigor that it forces is a good one, and that's that.
Speaker 1:Let's start with what the data is telling us. You know, for instance, when early in our quality journey at UMass Memorial Medical Center, I would hear about problems being solved with solutions and they were not seeing results. And when we dug deeper into the cases, into the data, and we did things like Pareto charts, we realized that we were working on solutions that were not aimed at the majority of the issues that were driving the problem. And so sure, we could work on that solution all you wanted, but it's never going to move the dial to actually, you know, work in the problem. So I think that's those are some examples of where data really helps cut through a lot of noise. And you know even it could be that maybe they were working on that project because the most senior person on the team insisted that that's what they should work on.
Speaker 1:Or maybe they were working on that project because it's the most politically easy thing to work on.
Speaker 1:It doesn't ruffle feathers, it's easy to do, nobody's upset by it, we don't, nobody has to really make a lot of change, and so I think that data can sort of force some of those difficult conversations. And but again, I think you know we touched on this a little bit earlier too when I bring data as a quality leader to others, I generally like to sort of have an idea of what I think the data, what story the data is telling me. But I actually try not to disclose that early on, right, because those are stories that I've formed with my limited understanding and my biases. And again, to try to approach it from a position of curiosity and learning and to say this is what the data is showing us, how do you interpret this expert and then see if it resonates with how I've been looking at the data or not. Um, and I think that's that's so much of how we drive change as a quality leader. That's how much, uh, that's how much you know we can.
Speaker 1:we can do our work and figure out how we get people on the same page to work on quality projects, uh, or safety initiatives, um together, and so I I was not surprised at all that that came out as a key theme and a key trait.
Speaker 2:Yeah, and you know we talked a little bit about how this work contrasts with medical school and residency in terms of you know, a lot of these leadership skills maybe all of them are not explicitly taught and I wonder, just like there's a proliferation of roles like VP of quality and chief quality officer, there's been a proliferation of other post-secondary education options master's degree in quality and safety and that type of thing and that makes me wonder whether those programs I also know you took your MBA and there may have been this. This may have been part of the curriculum there, but but I'm curious if, if there is, you know, does this work and you identifying these critical traits, does that? Does that evolve into a quality leadership curriculum or a leadership curriculum more broadly?
Speaker 1:leadership curriculum or a leadership curriculum more broadly, as I think about. You know what is the pathway to a quality leader, and actually even in one of the papers that we were just talking about regarding the current quality leadership landscape, you know a lot of people did have advanced degrees and secondary degrees I'll call them and I think that that's a reflection of a couple of things. I think one quality has become, to a certain extent, a fairly specialized skill set and knowledge. There's a decent amount of content, or you know hard skills that I'll call them that you probably do need to be familiar with now being in a quality leadership role. So I think that quality development programs can be helpful in that, in making sure that you have the requisite content, knowledge, for example. I think it's pretty hard to be in a quality leadership role without understanding the fundamentals of quality improvement. I think that's like a very concrete example of one where you know that's a content that you just need to acquire, and then I think the other thing that you know that's a content that you just need to acquire. And then I think the other thing that you know quality development programs can be helpful for two more is the soft skills and the networking. So the soft skills you know, certainly if you didn't receive training on leadership, organizational behavior, change management, those kinds of things. Usually, now, you know, quality training programs have some element of that incorporated. We have, for instance, at UMS Memorial Health, we have an internal quality development program particularly aimed at clinicians that incorporates leadership training and leadership themes along with teaching them lean methodology. So I think you know you can get those soft skills.
Speaker 1:And then, third is the networking piece, and networking, I think when I was in medical school, almost had a negative connotation. You know people think of it as somewhat maybe subversive or slimy or something, but it's really not that. First of all, you know, people like us get to connect and connect with each other and learn about each other and all the common problems that we face. And so that's one fun aspect. But the other really important aspect is when, when I was early in my journey here at UMS Memorial Medical Center, I talked a lot about incorporating best practice. Well, I can't incorporate best practice if I don't have folks I can reach out to and ask for help and learn from.
Speaker 1:And so that's the other part that networking can really help with and, I think, one of the really special things about the quality community, as I've gotten to know folks, is one of the common traits that everybody has is they're very open to sharing and there's not this competitive sense of well, I've figured it out so I'm not going to share it with you. I've never seen that within the quality community and that's one of my most favorite things. And so this willingness to share, this willingness to share is the other part, that, the other reason why that networking part is so important. So you know, I think, in general, jason, you know I would say it's helpful to you know, have a quality development program or to go through one, and then at some point, if you're aspiring to lead quality, you will in one way or other have to pick up those three major domains of hard skills, soft skills and kind of that network.
Speaker 2:Yeah, I agree we need to do a rebrand on the word networking, because I felt the same aversion to it early in my career and you know we we talk so much in in the quality world about kind of expanding our collaborative circles. You know something along those lines of it, just. You know networking, but by a different, by a different brand, and certainly the themes that you're touching on with the projects you've worked on and and and same with me are you know all about engaging and partnering with people. You know across domains, across expertise silos, and I think the paper that you were referring to a minute ago was the one also published this year Demographic Profile and Oversight Duties of today's healthcare quality leaders. Can you tell me a little bit about the, the key findings from that Cause? I think this may also speak to an equity lens that has gotten a lot more, a lot more press in in the quality improvement world.
Speaker 1:Absolutely. You know, just like other survey-based studies are, results were obviously subject to reporting bias and the results that we reported were based on the folks who decided to return our survey. But With that limitation being acknowledged, what was fascinating was the preponderance of women in the cohort and the vast majority of them were white. We saw a very skewed representation of Black and Latino and other underrepresented in medicine races and they tended to be all fairly what I would call probably mid to mid-advanced career folks and mostly in clinical roles of either nurse, physician, pharmacist, those kinds of things.
Speaker 1:And probably, you know, when we take a step back, it's maybe not that big a surprise. You know, as we were just talking about, it takes a little bit of knowledge and experience to have the requisite skills to be a quality leader, so that takes a little bit of time to acquire. It definitely helps as a quality leader to have what I call clinical credibility, meaning that you have experience either directly providing care in one way, shape or form or participating in the care environment, because you can interpret and understand how data is coming at you and what that might really mean. So maybe that's not surprising, but I think the racial and gender disparities, which were much bigger than you would have expected, just based on statistics of either other leadership types within medicine or within the general workforce, are definitely something that generated pause and more questions in my mind. Something that generated pause and more questions in my mind. Frankly, I don't really know why we saw what we saw, so I think we just need to kind of look at that more.
Speaker 2:Yeah, I think not enough people are looking at that and I really appreciate how that has also kind of you know, entered into your work and you know, as we're looking ahead from where we are now hoping that equity is a bigger and bigger part of the picture. Where do you see the quality landscape in healthcare going?
Speaker 1:Well, I think I'd be remiss to not at least start with the word AI in talking about the future of anything. But I do think that, you know, increasingly it's an attractive proposition or vision to think that we can measure quality in a more scalable way. I think the amount of resources that we put in, not just in the United States but frankly, globally, and just measuring quality is astounding. And if you add on top of that the amount of resources it takes to do data and analytics and maintain that and all the servers and all these other things, it's a tremendous amount of resource investment. So I think if we can lighten that load and, you know, thinking about the concept of like working to the top of our license, really reserve the human capital for the improvement, the cognitive, the interpretation parts, I think that's a real attractive concept concept. I worry, as all of our quality nerds do, about automation and metrics and numerator denominator and gaming the system and all of these things, but theoretically we should, over the long term, be able to get to a much more manageable system that's, I would say, automatically captured and reported. And the other part of that is that if we can do that at scale meaning you know there's so many areas where surgical site infection is a good example. For instance, you know, I'm not aware that there's a lot of institutions that can do surgical site infection monitoring on every single procedure that they do and then stratify by surgery, stratify by provider, stratify by team, stratify by time of day location all those things that that's not usually easily done. And that's because most of the time to do surgical, true surgical site infection reporting, most of the time to do true surgical site infection reporting, you need somebody looking through the cases or just querying the electronic health record for diagnoses, and things like that is often not enough, and so the promise that things like AI will transform that and enable you to get a much more holistic picture of a problem is very, very attractive. So I certainly think that that's going to be a way of the future, but I think what won't change is, you know, some of the things that we talked about before, like, while the data might get a lot more easier to kind of extract, someone's gonna have to tell the story right. Someone's still gonna have to do the work of trying to understand where a workflow might need to change, understand where the challenges are that are occurring, and I think for that, you know, there's going to be no substitute for human connection and leadership. So I think that will probably be an area, and then I think we're going to have to create this is kind of like a systems on systems kind of thing, but, like you know, ways of monitoring our automated systems to make sure that they're not running awry right. And so, you know, thinking about how do you measure safety in the world of AI is an important concept. And then, clearly, you know, I think the settings in which we deliver care is diversifying increasingly outpatient, increasingly in the home environment.
Speaker 1:I don't really see that shifting. I do think that there will always be patients who have super complicated medical needs that require some what I'll call hospital-like building, medical needs that require some what I'll call hospital-like building. But no doubt more of the care is getting pushed out outside of the walls of a traditional hospital or clinic and trying to understand safety in that realm is much more complicated. The nice thing about a hospital is you sort of have a captive audience, and in the olden days when we used to keep people for 21 days, 28 days, regularly for normal admission, you had a lot of control. You saw them day in and day out. You had a lot of control, but now if, let's say, you're delivering care virtually or in the home setting, there's a lot more things you don't control. And how do you account for that in monitoring safety? And I think those are some really cool questions we have yet to answer.
Speaker 2:Yeah, I wasn't going to ask the AI question directly, but I got the answer and I hear you. It makes one wonder too, where there's so much talk about AI democratizing, for example, coding right, so software engineering becomes more amenable to just natural language input with hard coding outputs. It makes you know one of the bottlenecks, I think, that we face in quality work you know to some extent, no matter where you are, even if you're in a very well-resourced place is that there's only so many people with the right expertise to do quality work, and it certainly makes you wonder whether that might also be a catalyzing force for democratizing this work to people with less expertise, with maybe fewer minutes in their day to devote to this. That's you know. It's kind of definitely makes me think that that's, you know, the future direction we're heading in. So, as we're wrapping up for listeners who'd like to follow your work or invite you to run a workshop or give a talk, where should they go?
Speaker 1:Well, definitely folks can email me or reach out to me through LinkedIn. That's probably the easiest way. I'm not the most active on X or other venues. I probably should be a little bit more social media savvy, but I'm not that way. But certainly folks can reach out to me through venues like LinkedIn and you know I'm still kind of old school in this way. But I do look forward to, you know, connecting with colleagues through things like conferences and such still. So, hopefully, you know, look forward to making many more connections. Networking there's that word, there's that dirty word networking, things like conferences.
Speaker 2:Will you be at the IHI annual forum this year?
Speaker 1:I'm not sure yet. I haven't decided on that yet. I have to plan out my conference. What is it? The conference tour? I have to still do that.
Speaker 2:Very good Well, Dr Kimiyoshi Komeishi, thank you so much for sharing your insights on command centers, on capacity management, on leadership and the future of QI. I really appreciate you joining me here for Leading Quality and, if you enjoyed the episode, please follow Leading Quality in your favorite podcast app and leave us a review. It really helps others find the show. Until next time, stay curious and keep leading quality. Thanks for listening to Leading Quality. I'm Jason Meadows and I'm glad you joined me for today's conversation. If you enjoyed this episode, follow the show on your favorite podcast app and share it with a colleague who cares about improving healthcare.
