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
What Does a Chief Quality Officer Actually Do?
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Episode Summary
What does the Chief Quality Officer role actually entail once you get past regulatory compliance and dashboards?
In this episode, Dr. Abraham Jacob draws on years as a system-level CQO to explain how quality leadership really works in practice: where to start, what to prioritize, and how culture, safety, and accountability interact over time. The conversation is grounded in lived experience, including successes, failures, and lessons learned during periods of workforce instability and change.
This episode is most useful for CQOs, CMOs, senior clinical leaders, and anyone building improvement capability at scale.
Core Ideas from the Conversation
- Patient safety is a leverage point
Reducing preventable harm creates alignment, urgency, and moral clarity in a way few other priorities do. - Quality assurance is necessary but insufficient
Meeting regulatory standards does not, by itself, produce better outcomes or learning systems. - Variation reveals system design problems
Unwarranted variation signals where workflows, standards, or training have failed the system. - Psychological safety enables performance, not comfort
Teams improve faster when speaking up is expected, acknowledged, and protected. - Turnover threatens reliability more than leaders expect
Standards erode quickly when onboarding, retraining, and reinforcement don’t keep pace. - The CQO role is shifting toward stewardship and value
Mature organizations expect CQOs to help lead system transformation, not just oversight.
Questions This Episode Raises for Leaders
- Where does your quality function spend most of its energy: assurance, improvement, or capability building?
- What forms of harm are still tolerated because they’ve become routine?
- How do new staff actually learn “how we do things here,” beyond policies?
- Where might turnover be quietly undoing prior improvement gains?
- When was the last time you publicly reinforced speaking up, especially when it was inconvenient?
Resources & References Mentioned
- “What Google Learned From Its Quest to Build the Perfect Team”
Charles Duhigg, New York Times Magazine
On psychological safety as the strongest predictor of team performance. - Institute for Healthcare Improvement (IHI)
Referenced as a formative influence on improvement science and leadership development. - IHI Chief Quality Officer Professional Development Program
A national program supporting CQOs in building system-level improvement capability. - High Reliability Organizations (HRO) in Healthcare
Principles focused on reducing harm and building reliable systems under pressure. - Intermountain Healthcare – Advanced Training Program
Cited as an early influence on variation reduction and outcomes-focused care. - Key Driver Diagrams
Discussed as a durable tool for linking strategy, drivers, and improvement work.
Continue the Conversation
You can connect with Dr. Abraham Jacob via email at akj@umn.edu or on LinkedIn.
Reflection and dialogue are central to improvement, so take a moment to notice where these ideas show up in your own system.
New episodes published every other Thursday at 7AM Eastern Time.
Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.
If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.
Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.
New episodes published every other Thursday at 7AM Eastern Time.
Credits:
Host, Writer, and Executive Producer
Jason Meadows, MD
Produced by
Thrive Healthcare Improvement
Edited by
Milan Milosavljevic
Why Patient Safety Persuades
SPEAKER_02The thing about patient safety is it's hard to find arguments against it, especially when you're pointing out harm that is preventable or harm that we can reduce. The one thing I'm most proud of is that our quality and safety team have uh a turnover rate of less than 1%. And uh we have some of the highest employee engagement scores in the system.
Meet Dr. Abraham Jacob
SPEAKER_00Welcome 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. Today's guest is Dr. Abraham Jacob, and I invited him on the show because he spent years thinking deeply and very publicly about what it actually means to be a chief quality officer. Abe's path into this work started the way it does for many of us as a frontline clinician. He trained in both internal medicine and pediatrics, helped start and build a MedPed's primary care practice, and later helped launch a hospitalist program. As his scope grew, so did the questions he was asking. Not just about individual clinical decisions, but about how systems perform, how standards get set, and how teams consistently deliver safe care. That trajectory led him to formal leadership. From 2012 to 2019, he served as chief medical officer of a children's hospital, where he led quality and patient safety efforts and helped implement a high reliability platform. Since 2019, he's been the chief quality officer at M Health Fairview, a 10 hospital system in Minnesota that includes an academic medical center and an academic children's hospital affiliated with the University of Minnesota. What makes Abe especially interesting for this conversation is that he hasn't just done the CQO role, he's also helped shape how others understand it. He's spoken frequently about the role at the IHI Forum, and since 2022, he's served as faculty for the IHI Chief Quality Officer Professional Development Program, which is actually where I first came to meet him. So he spent years both living the role and helping other CQOs make sense of it. In this conversation, we focus on the real life of a CQO, what the day-to-day work actually looks like, why patient safety is such a powerful starting point, how accountability and psychological safety coexist in practice, and how the role is evolving beyond quality assurance towards system transformation and value. We also talk about what future CQOs will need to know and be good at as healthcare continues to change. If you want a grounded, experience-based look at what the CQO role means today and where it's helping to steer healthcare in the future, this conversation delivers. Abe, welcome to the show.
SPEAKER_01Just to start, I wanted to uh give I wondered if you could give listeners a brief overview of your career path leading from you know being a frontline clinician and eventually becoming a chief quality officer.
Career Path From MedPeds To Leadership
SPEAKER_02Yeah, I mean I I think I uh, you know, after I finished residency, there were six of us in my residency program. So I was MedPede's internal medicine and pediatrics, you know, four-year program. And uh we were talking to each other, I think it was during our uh last year of residency, and said, Hey, you know, what would you think about starting a primary care practice, a medpeeds practice? There none really had existed in Minneapolis, St. Paul or in Minnesota. And so really started um the six of us started interviewing various health systems in the metro and um identified a system that was ready to take us. And, you know, we really kind of created the model um that we wanted in terms of having learners with us and admitting both pediatric and internal medicine patients. And so I started uh in primary care. That was my foundation. I did that for seven years. Through that, became I was medical director of our clinic after about a year or two. And I really credit that because I there were two of us when we started the practice that wanted to work part-time. So in working part-time, um, really gave me the space to think kind of big picture about what I was doing, what we were doing, um, and just loved it. I I never had a sense that I was burning out or was sick of it. I just loved uh just having, again, that free space in my mind to think about what we were doing and how do we do it better. I guess those are my early phases of improvement, if you will. And so I expanded, you know, I knew I could take care of patients individually, patients and families. And then I started thinking about okay, how do we do this as a collective group practice of six people, six of us? We started, you know, growing and hiring people. And it was also the early phase of converting to electronic health records. And so now we were having electronic data and registries and uh just loved, loved that idea and doing more of that. And we we drove some significant improvement work. Um, and then, you know, from primary care was kind of recruited or asked to come back to the university to start a PEETES hospitals program, and that was back in 2005 and thought long and hard about that. But I kind of liked the idea of kind of building something from scratch, and uh really did that from 2005 to 2012. And again, through that work, got even more into improvement um science, if you will, and variation reduction essentially. Did some more training out at Intermountain Health, you know, through their advanced training program, and then uh decided I needed to kind of speak the uh love language of finance and did the uh Masters of Healthcare Administration here through our School of Public Health. And then shortly after that, stepped into the chief medical officer role, which was newly created at our children's hospital. And then again, that was for seven years, and now I'm into my sixth year of being chief quality officer across our health system.
SPEAKER_01What a journey. And uh and thanks for that recap. Um yeah, so then tell me a little more about what you know sparked your interest in in quality and safety specifically, because it sounds like this was a bit of a gradual process, but were there particular mentors or particular projects that kind of led you in this path?
SPEAKER_02Yeah, you know, I think um I was just naturally interested in thinking about um improving kind of, you know, it's all based in improving outcomes for our patients, you know, not just the patients I'm taking care of in front of me, but how do we do this collectively, you know, have a much larger impact across the region or the community we were serving than, you know, at the hospital across all the patients we admitted. How could we, you know, make sure that for the the really hard work we are putting in every day to take care of patients, that at the end of the day we could show, like, yeah, we do a pretty good job in terms of outcomes. Like that, I think that was just that's always been kind of an internal motivation, I think, for any of us that go into medicine. And uh, you know, we don't do it to just kind of punch the time card and do our shift, you know, like we we want to feel like we're uh doing right by our patients. And for me, it was about how do we collectively, because I I knew that I was really dependent on the the you know, medical assistant, the nurse, the pharmacist, the restorative therapist, you know, the entire team of people, the registration, uh registrar, um, to kind of get information right so that we could, as a team, take care of the best care of this patient. And so I love that idea of um working as a team uh to deliver good outcomes. And um, that has always, I think, been a part of what has driven me and and why I've kind of always migrated towards doing improvement. Now I've had really, I've been really blessed to have really good mentors around me, people who kind of, I guess, recognize that, you know, passion I had for improvement and time I would put into it, and they'd tap me on the shoulder to do some, whether it was a leadership development thing or you know, you should go to this conference. In fact, one of my early mentors uh recommended I go to an early IHI conferences in the early 2000s, and I remember seeing Don Berwick get up there and do a keynote. I think this was the Office of Clinical Redesign. It was when they used to have an ambulatory improvement uh conference every spring, and uh just came back with my pants on fire, like, yes, this is what we have to do. And so uh I don't know. I just felt really energized. I've always felt energized by the idea of improving uh improving outcomes.
SPEAKER_01So you find yourself now in the the title of of a chief for the role of chief quality officer, and I think that what that is is might not be as obvious to um to the average listener uh as you know, a chief operating officer or chief medical officer, that uh these are titles that we're much more accustomed to hearing. We can kind of wrap our brains more easily around what the job entails. But I wanted to dive a little bit into what it is to be a chief quality officer. And uh I wonder if you can kind of share what your job, what your experience of being a CQO is on a day-to-day basis.
Defining The CQO’s Core Mandate
SPEAKER_02Yeah, so I I guess I I think of it uh in terms of, you know, the a couple different frameworks. You know, one is there's just a base level of quality assurance, right? Like, and that that's usually in a regulatory frame. Like these are the minimal things you have to do to kind of demonstrate that, you know, you should stay in business. And so um that is just quality control or quality assurance, right? Like if you don't get that right, it's really hard to do improvement. You just have to, you know, make sure you're doing that and doing that really well. Then there's okay, you've you've you're you you've satisfied whatever regulators or organizations around you that you can, you know, stay in business and just in terms of you provide basic quality care. Then the real interesting work, I think, comes at improvement. Like, how do you get better? Like, what is how can we deliver better and better outcomes? And for me, in many ways, that is in sits in the foundation of patient safety. Like, um, I think of this in terms of let's there's all there's like a million things you could improve, right? Like uh, we get asked every day for help to improve all kinds of stuff. And for me, you need a place to start. And for me, it's always been about just reducing harm. Let's just start with reducing harm and focus on reducing harm. And uh, I bet you'll find a lot of improvement uh in those spaces. And sure, and sure enough, we have. And so we've um, you know, when I started uh both when I was chief medical officer and now as chief quality officer for the system, um, that's always just been the foundation. Like those are just table stakes. We are gonna get up every day and we're gonna figure out how to reduce harm. And that's, you know, and really focused on preventable harm. And then, you know, beyond that, there's just um, I think the work of clinical variation reduction. So there's lots of things we do where you find there's just, wow, there's a, you know, 10 or 100 different ways we do this same clinical process. Can we imagine creating some guidelines, you know, some uh recommendations around uh standardizing the approach to delivering a baby, to managing an ear infection, to managing pneumonia, to, you know, having an ECMO patient, right? Or solid organ transplant, or it just goes on and on and on. And so we have a core area in just reducing, you know, uh variation. And then I think the next or the another level is how do we can kind of continue to educate and train all the operations people we support in the science of improvement and patient safety, right? High reliability. And so this is about teaching people how to fish. So they're not always calling someone from my team about doing a local improvement effort on their local unit, OR, or clinic. Like they, we want them to be able to do this, have agency and ownership and you know, good education and training about how to do this. So we've we've you know done um, I think every good quality shop should have some efforts around educating and training not only the people around them, but even your own people. So we've created, you know, pathways, even in our quality and safety team, about how do you become better at leveraging the electronic health record to pull data out yourself instead of always calling our data analytics team, right? How do we make sure that our team is advancing in terms of you know, greenbelt, you know, yellow belt, black belt training? Like we encourage that, and that's a part of their kind of improvement as a as a professional. We're also have done some work in education and training around looking at disparities. You know, how do we get different, uh do um subgroup analysis based on, you know, race, ethnicity, insured, not insured, you know, male, female um language, all of it, right? So we can understand where the biggest opportunities to close gaps in care are. So I don't know, I don't know if that might have been a little rambling, but again, I think it starts, you know, quality assurance or quality control, patient safety and just harm reduction, doing clinic, good clinical variation reduction, having a system around that. And then, you know, how do you educate and train everyone around you, including your team? Uh, if you have kind of those fundamentals,
Safety As The Foundation For Improvement
SPEAKER_02then you can pretty much tackle anything, right? Like you can, um, then it's just a matter of identifying what your priorities are as a system and getting after it with kind of the foundation you've you've built.
SPEAKER_01Yeah. I mean, digging into that a little bit, you mentioned, and I've heard this this before, kind of focus on patient safety is both an easy sell and a great place to find ways to improve. It sounds like, by the way you said it, you have some some good war stories of of uh successes in in patient safety.
SPEAKER_02Well, you know, the the the the thing about patient safety is I have found, and you've probably found this too, is it's hard to find arguments against it, right? Like especially when you're pointing out harm that is preventable or harm that we can reduce. That I find that easier to get people engaged in the work uh to kind of do better. And there's a myriad of patient stories you can tell that are uh heartbreaking and really uh provide a compelling reason to change. And so I, you know, again, I think all of us are calling to medicine, whether you're a nurse, pharmacist, you know, RT, clinician, um, is that you're gonna do no harm. And I think focusing on patient safety, particularly reducing preventable harm, is easy to sell. So for me, it's maybe it's a it's uh a lazy way out and that I don't want to deal with all the change management and everything else. Like safety is an easy sell. Like that it doesn't uh it's it's for me, it's easy to walk into a room of respected uh leaders and say, yeah, we harmed this patient. What are we gonna do about it? You know, like it's it's uh gets it's that's an easy story to tell and to gather some momentum around.
SPEAKER_01Are there initiatives you remember from patient safety that you've you've found that you know you had some real success with that you're that you're proud of?
SPEAKER_02Ooh, uh so I'm when I when I say I'm proud, I'm not proud of myself as much as I am of our team and our uh the system um in responding in the way they have. So over the things, I guess, that are you know, we've had kind of six-year lows and central line associated bloodstream infections and catheter-associated urinary tract infections and C diff, the basic stuff, we've had a you know, 40% reduction in surgical site infections, um, or observed to expected mortality has gone from consistently above one to now consistently, you know, uh between 0.6 and 0.7. This, the our ambulatory care composite, I think by the end of this year we'll have 10 or 12 measures that are of our 20 that we track that are you know above the 75th percentile. So this takes a ton of hard work and uh alignment and doing again, focusing on the foundation of all the things, you know, I just talked about. And, you know, we've had a reduction in preventable harm. So we we track serious safety events in our system. And the way we measure that, we've had, you know, the last couple of years, year over year reductions, which is which is great. Um and so that all of that success really builds a lot of kind of momentum and morale around, you know, the net, what's next, right? Like the next thing that's gonna be harder to sell. Now, I've I've certainly had my share of failures um as well, and um learned from that. I would I would say, Jason, the the thing that I wish I would have known, you know, when I started this job would have been the I guess I I uh did not anticipate the impact that turnover would have on our performance as a system. So we did such hard work to establish these standards of care, you know, these care pathways. We go through the pandemic, and you know, as we all know, we had an exodus of quite seasoned nurses, restorate therapists, pharmacists, where we lost a lot of that institutional knowledge because they retired or decided to do other jobs. We had an influx of brand new, you know, nurses, restorate therapists, pharmacists, clinicians who frankly just didn't know the standards. And what we saw was that, you know, because of the urgency to onboard and get them, you know, in our ORs and our ICUs and clinics, I think we lost some of that, the stability of the system because people just didn't know the standards. And so I think uh going forward, I have a much deeper respect for the need to appropriately onboard, you know, educate and train and retrain and retrain to kind of what your standards are.
Results, Setbacks, And Workforce Turnover
SPEAKER_02If you don't manage that thoughtfully, um, you will have a decline in your performance. And so uh, you know, we experience that. Now I think it's we're back on track and it's more stable. But I, you know, again, the question I always ask our teams, like, what do we learn from that? Like, how are we going to make sure we prevent this from happening again? And so that's been, I think, uh significant learning. But, you know, in terms of your original question, like what am I, you know, the one thing I'm most proud of is that our quality and safety team, which has probably around 160 to 170 people in my part of the system, have uh a turnover rate of less than 1%. And uh we have some of the highest employee engagement scores in the system. Um, of all the metrics I look at that I'm most proud of as a leader, that's it. Because I I know that means that our teams feel like they're being developed and nourished, you know, in terms of their professional development. They, if if they leave, I encourage them to leave if it's going to a higher role or higher leadership position. That's what we are here for. I want, you know, we want to build leaders. And and I I want to make sure that our team feels connected to each other and they feel like they can come to work and feel like they're getting meaning at the end of the day. They could be doing a million other things. And I feel like it's our job as leaders is to make sure um they're feeling fulfilled in terms of uh finding meaningful work, that that we're answering kind of their their call to medicine and finding kind of a deeper sense of purpose. And, you know, quality and safety is kind of an easier sell than uh many other things, you know, uh that we can do in the world. So Uh but to answer your question, you know, original question that like that's probably these the metric I'm most proud of is just the impact this has had on our teams.
SPEAKER_01Yeah, that's great. You've spoken a lot at leadership forums, like at the IHI forum.
Building Engaged, Low-Turnover Quality Teams
SPEAKER_01Uh, from your perspective, I'm I'm curious what distinguishes kind of effective leadership or what defines good quality leadership from your point of view.
SPEAKER_02You know, assuming uh leaders have a base level of competency in terms of understanding um strategy and driving strategy, I think, you know, really good, effective leadership, also the ones that I've, you know, either, again, have been uh fortunate enough to have mentors around me uh that I've really learned a lot from and uh feel like, wow, that's a he or she is a great leader. Uh and the things that kind of pop out in my mind are one, their authenticity. Like uh there are just not pretenses about them. They are, you know, honest and truthful, and they will um they will speak truth to power when it's difficult, especially when it's difficult. One, I think they all are two, I think they also have a certain amount of emotional intelligence, like they just know how to read the room and how to um
Authenticity, EQ, And Psychological Safety
SPEAKER_02kind of connect with their leaders and their people, and also know when, you know, uh when they need to kind of slow down in terms of the pace of change. Those two things I think are really hard to not replace. You know, in other words, if you're not authentic and you don't have some degree of emotional intelligence, I think you can only get so far. I mean, I think you can be a good leader. I just don't know how sustainable it is. And I um, yeah, I I just would hope that any one of a member of my team could feel like they could text me and reach out to me. And, you know, that we we've established significant levels of psychological safety across, you know, not only my team, but the the teams we support. So if I had to say three things authenticity, emotional intelligence, building psychological safety. Like you can't show me a leader that a really good leader that doesn't demonstrate kind of those three domains pretty well.
SPEAKER_01Aaron Powell I'd like to dive into to one of those that you that you mentioned, because I think there's a natural tension for quality leaders who are expected to drive accountability while fostering psychological safety. And I'm curious how you navigate that tension.
SPEAKER_02Yeah, I think this is you ask, I think, the most important question. So being fair and uh holding our teams accountable, uh yet creating high levels of psychological safety. And so there's different ways to measure psychological safety. Uh, you know, um, and there's been a lot of writing about this uh over the last decade or so. But uh there's an important article that came out, I think 2017 in the New York Times magazine about the Google study, you know, where they they looked at um the factors that drove their most high performing teams. And lo and behold, levels of psychological safety was the most important thing. And so they looked at that, they dove into that. Like, how could we scale this, you know, across all our leaders? And it's hard, it's really hard to do because you have to be able to nurture some sense, like in a room or in a group, that people feel safe to speak up when they disagree or find, you know, have questions about the direction, you know, the team is going in. And it's okay to have those conversations and not, you know, for me as a leader, not to be get defensive about it, to be always in the state of inquiring more about like, tell me more about how you feel that way. I want to understand more. And, you know, once that individual has made has made their you know argument or their explanation, you know, we can just say, you know what, I heard you. Um, I just I feel like in my gut, like, you know, or based on other data, I still think this is the way we need to go. Are you okay with that? And if yes, I, you know, I disagree or think, you know, at least I've uh we as leaders, we have,
Balancing Accountability With Safety
SPEAKER_02you know, understood all, you know, all sides, you know, of the issue. And so I remember early on and when I was medical director of that primary care clinic I told you about, I had one of my partners who uh just it was like what I would call chewing gristle, like just complaining about everything, right? And um it can be really frustrating as a you know, as a leader or trying to drive direction when you have someone who's constantly like, well, you know, well, you know, but I uh as one mentor told me, you know, like you know, you need to use those individuals as little birdies in your ear about you know what you're not you know thinking about. And so that reframing for me was really, really helpful uh in terms of uh saying, okay, instead of that person being a bother or a pain in my butt, I'm gonna really seek that person out to make sure I understand what I might be, you know, I'm not missing something here about this plan. Um, and so now having said that, those people can still be a pain in the butt, but I do appreciate when people feel like and I, you know, the the other thing I think as a leader um is to kind of acknowledge when someone does speak up, you know, like and it's a simple thing to do, right? And I don't, if you're a clinician and you uh get called to a rapid response team, that ends up being kind of not much, right? The patient's okay, you gave some fluids, the patient responded, didn't have to transfer the ICU. I think making a point as a clinical team to say thank you to the nurse or to whoever called that rapid response team, like, thank you for your concern. We'd much rather know about this than not. I I think it's devastating for that team to come and say, why did you call this RRT? This patient's fine, right? Like that, there's nothing that suppresses people speaking up than our response to things like that. And I, and even as a leader in a meeting, you know, I I was uh we had a large, you know, gathering our kind of our yearly gathering of our entire quality and safety team. There were probably about 80 people in the room and there were 70 some online, you know, uh watching virtually because they're remote. And uh at the beginning, as as I was speaking, and I was speaking really eloquently, I gotta tell you, like I was just, you know, uh knocking it out of the park. Someone, you know, had the courage to kind of say, Hey, Abe, you know, um, just so you know, we can't hear you. Like you, when you walk away from the computer, because I was walking around the room, and I said, uh, if you wouldn't mind, could you tell me who who said that? And it was a uh a woman who I know on our team. And I said, now she just demonstrated psychological safety. And I want to thank her for role modeling that for all of us. So, you know, she's in this virtual room of 70 people, a physical room of 80. It'd be really easy to just not say anything and go through an hour of me kind of going in and out and not getting much out of that. But instead, she had the courage, you know, I call it courage, to speak up and say, hey, hey, you know, just so you know we can't hear you. I mean, and so we adjust it and uh and then people could finally hear me. And so I think it's important for us for leaders to affirm any knowledge when you see it happening, because it happens quite a bit. Uh I don't think we probably acknowledge it as much as we should as leaders.
SPEAKER_01Yeah, well said. And the uh the article you alluded to earlier was uh what Google learned from its quest to build the perfect team. And I'll uh I'll put that in the show notes for you, as you said, from the New York Times magazine uh written by Charles Duhig. So I'm just putting that as a note here, so I'll uh include it in our show notes. And uh, you know, I can imagine that, you know, before you had a leadership title, you had experiences of leading maybe with informal authority. Uh and you might see this on your teams now, people who who have a lesser title um but who are showing themselves to be, you know, leaders standing out amongst amongst the group. What have you learned about kind of that informal leadership?
SPEAKER_02I I think those are probably the most important roles of leadership in any system. People who uh have informal roles or seen as leaders on their team because of their high degree of, you know, skill sets, just the way they, you know, handle people. I there's any number of people that are just flying through my mind right now of people who don't have formal, formal leadership roles. But man, I look to them and reach out to them all the time just to get their insight or input because I know they're respected. They have uh they're very thoughtful about you know the work they do. So I, you know, um I try, you know, I I try to hold those people up as much as I can just to kind of continue to affirm and encourage them because I think they have it, it's just a matter of time before they uh, if they want it, they'll they'll be asked to to be in a form a formal leadership role. And so, you know, again, you you see it in uh on any unit or microsystem. Yeah, uh, you can just go go ask, you know, anyone in who works in there, like, you know, who are your informal leaders or who do you really respect around here? And you can quickly find out who they are. So I I just think um it's really important that we're thoughtful and again intentional about acknowledging those people, holding them up and thinking about how we mentor them into more, you know, formal leadership roles. I mean, that that's kind of that is the heart of quality improvement is you have someone who's willing to take the initiative to help drive change, even though they're not given a formal leadership role to do that. They just they they are internally motivated to get to a better, you know, a better system or better uh outcomes. And they often lead that just by voice or by modeling it.
SPEAKER_01How has the the role of chief quality officer changed
The Power Of Informal Leaders
SPEAKER_01since you stepped into it in 2019?
SPEAKER_02You know, I I think my so my perspective on this I uh is that initially a lot of CQO roles were probably thought of as more as a quality control or quality assurance thing. Like just can you help us stay in business or avoid, you know, financial penalties or getting into big trouble with our regulators. But I think the more mature organizations really rely on their chief quality, you know, their quality operations to drive significant improvement and to help think about um how you transform the organization in that improvement, right? So it's it goes way beyond just quality assurance or control, but how do you drive significant, you know, system transformation to get to you know different levels of care delivery and outcomes than what you experienced before? So um that those levels of transformation um are really um, I think about how you really leverage the experience of patients and families in terms of touch points with our system. I think it's thinking about the financial um implications of what we do, how do we drive significant value, whether that's through value-based care arrangements, shifting models of global payments of care, you know, like we're seeing uh with CMS uh here in the US. Again, getting to this idea that we are significant
How The CQO Role Is Evolving
SPEAKER_02stewards of uh the healthcare dollar, and we should, we should be able to drive better value than we currently do uh based on you know the outcomes we get. Um so I think I think that's that's how the chief quality officer role is shifting, continues to shift. And there's kind of other, you know, the chief quality officer, I think many executive leaders have to think about just the dynamics of what's happening in their environment. So here in Minnesota, you know, we have a uh a different uh pace of an aging population than other parts of the country. And so, how do you really get the system prepared and organized and make sure you're able to manage what is a different variable than you might have, say, in the southern United States or other parts of the country? So I think there's a lot of different things. I think the chief quality officer really has to kind of have their eyes and ears out uh just to understand how you kind of prepare the system for various levels of transformation.
SPEAKER_01Yeah, and and as the CQO, I think there's a lot of different hats and a lot of different types of work that you're being thrust into kind of all the time. If you were designing a CQO role from scratch today, what would you intentionally do differently?
SPEAKER_02Ooh, that's a good question. So I I do so I oversee um patient safety and employee safety. I think the two are linked, and I do think a chief quality officer should oversee both. That's not true in many organizations. I just think you know, you can have safe patient care if
Designing A Modern CQO Portfolio
SPEAKER_02you don't have safe staff, uh staff that feel safe. I also think regulatory is an important piece, and so I think overseeing regulatory to make sure you've got the quality assurance or control piece down. I also think having you know capacity and being resourced to drive education and training around improvement science and high reliability science is also really important. I think there's also a key role that chief quality officer should be playing in the value-based care, population health side of things, right? So that's just in terms of driving the value side of the equation. So those would be the, I think, the most significant areas that I think a current CQO should really be thinking about. And, you know, in many organizations, the oversight of those may fall under different parts of the organization. For example, patient experience in our system has a separate uh leader. But I'm talking to them all the time because I just think part of what we do in quality is really critical to patient experience. And that if we don't think about patient experience, uh then we're not delivering good quality. So I think there's a lot of it, uh, you know, codependency with various functions in the organization. Um, and so it's just uh I think for our chief quality officer, just knowing, you know, when to kind of reach out to those colleagues or partners, stakeholders and and driving, you know, high quality work.
SPEAKER_01And you've you've been an instrumental part of and one of the core faculty for the the IHI's CQL Professional Development Program for a while now. How many years have you been doing that?
SPEAKER_02Uh let's see, I think I stepped into that in 22, if I'm not mistaken. Maybe it was 21. It was 21 or 22. But yeah, it's one of the you know joys of my career is to be a part of that program, mostly because I get to meet people like you, Jason, and other kind of thought leaders in quality and safety. Um, and we get to think about inviting really uh remarkable leaders in uh quality
Lessons From IHI’s CQO Program
SPEAKER_02and safety to kind of speak to the group. And again, just hear kind of how people are thinking about the work. Um, I think it's been really valuable. So I've really enjoyed that. I I think it's um uh, as you know, it's been really important for leaders in quality to be connected to each other, to have kind of a family, if you will, of of uh of quality and safety leaders kind of around the country, not only to see them at you know various meetings, but also just to think through like how are you thinking about the exact same problem I'm dealing with, you know, in my part of the country. And so that I think has been again, I'm really grateful to have had that opportunity and um experience with IHI.
SPEAKER_01And what what's most surprised you about about your experience with that uh those three or four cohorts that you've been through?
SPEAKER_02I'm always amazed that everyone wants to learn more about what your org structure is, even though we always say, like, you know, no org structure is the same, but it, you know, it depends on your system. But it's a it's a pretty uh predictably reliable question. Like, hey, can people share you know, physios of their various org structures? Um I'm also been surprised at how stable the key driver diagram has been. Um, and you know, that forms kind of the basis of the development. You know, every year we looked at, you know, changing it or trying to change it. And we're gonna look at it and like, yeah, I don't know if there's much I would change it. You know, like it still ends up being about right, you know. And I give David Williams, who uh was one of the original faculty of the C code development program and helped develop the key driver diagram, a lot of credit for this. I mean, I think they they put a lot of thought into that, and it is, I think, held up pretty well. Um, now there may be different points of emphasis in that key driver for various people, depending on where you are, you know, as a leader or as a system. But generally, those are still, I think, the right things to pay attention to. So, and yeah, I guess the other thing I I guess I've been pleasantly surprised at is just how great, you know, the year over year group uh the cohort has been, like just uh as individuals, as leaders. It's just been so fun to get to know uh know know them uh over the last couple of years.
SPEAKER_01That's great. I'm glad I asked that question. I did not expect org structures to be the uh the leading answer there.
SPEAKER_02Yeah, who doesn't want to see someone else's org structure, right? Uh and I think again, I think it's a demonstration of maybe the psychological safety we've built in the uh as a group of CQOs or uh quality leaders, I should say, is that people feel comfortable enough to ask for that kind of information, right? And yeah, you know, I've been willing to share it. You know, it's like, well, you know, I I don't know if you'll make much out of this, uh, but you know, stick with it, what do with it what you want. Yeah, no, it it it really is a testament to that and creating these psychologically safe spaces where uh you can ask the question that might seem silly or my guess is you know, the the the reason people we find people asking about it a lot is because there aren't great uh benchmarks about how to resource quality and and safety, right? I mean, there's some reasonable benchmarks for employee occupational health, depending on the size of your organization, for infection
Advice For Aspiring CQOs
SPEAKER_02control, but not so much for quality and safety, because everyone's definition of who's on your quality and safety team is just a little bit different, right? For some people, they have practice education nurses, other people have CDI, other people have, you know, patient experience, other people have, you know, system science, you know, system engineers. Uh it's just a little bit all over the map. And so I think that's probably the basis by which people want to look at org charts is they're trying to understand what's the appropriate level of resourcing uh to do, you know, this really important work. And I don't have a great answer for that.
SPEAKER_01What advice would you give to people listening who aspire to do uh a CQO type role?
SPEAKER_02So uh what I would say is uh just uh this is uh uh one of my mentors told me this early on. Uh this is maybe 20 years ago now. You know, he said, you know, just do improvement work, you know, um just go improve stuff in the spaces you're leading, or could be and so I've always remembered that. And um it's I still to this day, I just think, okay, what can we make better today? Like what what do we need to, you know, because we, you know, as especially as clinicians, you see all kinds of defects in the system. There's a lot of variation going on. And so uh just standardizing any number of workflows or clinical processes is an improvement, and you will get, you know, to a better place. And so there, there, there's uh so much.
Why Quality Work Still Inspires
SPEAKER_02Experience and so much learning from just doing kind of improvement and having, you know, understanding what change management takes, learning about other people or how other people work, understanding workflows better, you know, what are the human factors involved in this particular process. I think for people who are really looking to do more quality, I would encourage them to just uh go in your whatever sphere of influence you're in right now, go go do improvement work. You'll learn immensely from that, um, more than going in to get another degree. I would just, you know, have that lived experience of doing improvement. It'll give you so much credibility and knowledge in terms of what comes next.
SPEAKER_01Yeah, well said. There's you've spoken about this before, and we've all kind of lived through um the challenges of COVID, the burnout epidemic that we continue to live through. Yeah. What gives you hope about the the future of quality and and safety in healthcare?
SPEAKER_02The thing that gives me hope is that, you know, as quality leaders, I I I think we serve as kind of the true north or the compass for all the organizations we work in. And it's our job to kind of point to, you know, the direction of where the system should be going and be anchored in in terms of delivering really good outcomes. I also think it's really important that we create uh again those levels of psychological safety for again our teams uh and not just your quality and safety team, but the teams you support. You know, how do you build uh connection? How do you keep, you know, think about keeping your staff safe, both physically and psychologically? I just think this is deeply important because then that allows to do all kinds of remarkable things in terms of helping, you know, all the hundreds and thousands and millions of people that have chosen healthcare as their profession to get give them kind of a deeper sense of purpose, you know, that allows them to kind of grow and to uh kind of hopefully get to some sense of an answer to why they chose, you know, this career. And so I just there aren't many jobs that you know you can wake up to and feel like you're in true service, you know, to someone else and get paid reasonably well to do that. You know, I mean it's it's uh and I know there's a lot of people that complain that we don't get paid enough, you know, but but when you look at what we do and all the sacrifices we make, it's really in service to uh to patients and families and to each other, right? To uh to do that better. And so uh I think it's really inherent on us to help people do that. And that's the thing that gives me hope. It's like, okay, that's a that's a pretty cool thing. It's a privilege to get to um help people and uh get healthier and get them back to function.
SPEAKER_01And and that's a great place, I think, to to round out our conversation today, um, which I really appreciate you coming and joining me today. For listeners who uh want to connect with you or follow your work, what's the best place for them to do that?
SPEAKER_02Yeah, they can my email is in the public domain, akj at umn.edu. Um the feel free to uh send me a note and uh would be happy to connect with uh with them um and thinking through with them where they're at on their journey. And I I again have benefited and uh been blessed by so many people who've done that for me. And part of my uh commitment is to kind of carry that forward and uh continue to do that for other people and really, really enjoy doing that.
SPEAKER_01Very good. And we can can we link to your uh your LinkedIn profile as well?
unknownYeah.
SPEAKER_02Yeah, well, I forget about LinkedIn. I do I'm not obviously uh don't dive into that a ton, but I I will check into it often. So if you want to message me on LinkedIn, that that'd be great.
SPEAKER_01Fair enough. Well, uh Dr. Abraham and Jacob, uh, Abe, thank you so much. I appreciate your time. I was really great to hear about your journey as a you know frontline MedPed clinician up to CQO and and all of the great things that that entails for now and into the future. So thanks so much.
SPEAKER_02Yeah, thanks for having me, Jason. It's uh and thanks for what you do in terms of telling these stories. I think it's it's great, and uh in many ways, you're providing a great service for all of us. So thanks for what you do.
SPEAKER_01Yeah, thank you so much.
Connect With Abe And Closing
SPEAKER_00Thanks so much for listening to today's episode of Leading Quality. If you enjoyed the show, please take a moment to like, subscribe, and share it with someone who might find it useful. You can find all our episodes at leadingquality.budsprout.com or in your favorite podcast app. The show was written and hosted by me, Jason Meadows, edited by Milan Milostavievich, and produced by Thrive Healthcare Improvement. See you next time.
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