Quality 101: University of Utah Health

00:00:01:01 - 00:00:30:06
Tom Haederle
Welcome to Advancing Health. Quality and patient safety are the twin engines driving the mission of every hospital and health system, and both clinicians and board members have an important role to play in achieving these goals. Coming up in today's podcast, we hear from two experts from University of Utah Health about some of the best ways to help board members understand the critical role they play in making sure that quality and safety are always foremost in the patient experience.

00:00:30:09 - 00:00:53:15
Nikhil Baviskar
Hi, I'm Nikhil Baviskar program manager, trustee services here at the American Hospital Association. Today I'll be discussing the critical role the board plays in quality and safety. With me are Dr. Kencee Graves, who is the interim chief medical quality officer at University of Utah Health and is an associate professor of internal medicine, where she practices as a hospitalist and palliative medicine physician.

00:00:53:18 - 00:01:16:24
Nikhil Baviskar
Also with us today is David Calling, who has served on the University of Utah Hospitals and Clinics Board since 2016 and is currently vice chair and co-chair of the board Quality and Safety Committee. Dr. Graves, I'd like to start with you. You recently presented to the board at University of Utah Health on quality and patient safety, an extremely important topic now and always for board members.

00:01:16:29 - 00:01:19:18
Nikhil Baviskar
Can you give us an outline of that presentation?

00:01:19:20 - 00:01:51:22
Kencee K. Graves, M.D.
Thanks for having us. And I think this is a really important topic. So when I gave this presentation to our board, I was new in this role. And what I learned was people around me, our board, our staff, people did not really understand the nuts and bolts of quality and the details. And so one of the things I offered to do was a quality 101 session. And my intent in doing that was to make sure that the group I would be working with and I were starting on the same page, so we both knew kind of what was going on in the landscape of quality.

00:01:51:25 - 00:02:10:18
Kencee K. Graves, M.D.
So the content of my presentation really came from the questions I was being asked in my first few months in this role. And that is, what is quality? What is safety? How they are different. So what sets those apart? What are these ranking systems all about? Why do we do that? What are accreditation bodies, why do we do that?

00:02:10:20 - 00:02:22:05
Kencee K. Graves, M.D.
And then, what is a quality structure? So what are you responsible [for]? Who works for you, that kind of stuff. And so really that's what my outline was, was just the basics, what I consider the basics in quality.

00:02:22:07 - 00:02:38:29
Nikhil Baviskar
I think it's great that you, you did something where everyone starts at a level playing field. That sounds like a really wonderful way. I know that not everyone has the opportunity to do so, but definitely a good way to get everyone on the same page. Can you give us the response that you received from the board members to that presentation?

00:02:39:01 - 00:02:57:20
Kencee K. Graves, M.D.
Yeah, I do want to call out - when I started, I actually had really good support from our board members. And they told me that this is something that they wanted. And so I felt like I had an open invitation because Dave and our CEO said, hey, we really think people could use something like this. Would you be open for it?

00:02:57:20 - 00:03:15:20
Kencee K. Graves, M.D.
So they gave me the time. Many of them had been to the AHA and we used an AHA podcast by Jamie Orlikoff to kind of set the tone for that session. And so people went in with a really curious mindset. I actually did a Google survey after I gave the talk to make sure people learned and felt like it was valuable.

00:03:15:22 - 00:03:35:21
Kencee K. Graves, M.D.
The feedback I got were that people felt like they knew more about quality after this session than they did before. They loved hearing about what we did at the U. They really felt strongly about supporting quality and supporting our leadership and driving toward high quality care, and they wanted to know how they could be more involved.

00:03:35:23 - 00:03:44:27
Nikhil Baviskar
So, David, question for you as one of the University of Utah Health board members, what was your reaction to this presentation?

00:03:45:00 - 00:04:03:12
David Colling
Yeah, Nikhil, what I would say is a couple of things, a few things that Kencee mentioned. But also remember, community board members typically are not clinicians, they're not health care employees, so this is a bit of a foreign environment for them. And that's part of the point, right. To have community board members get, you know, to offer a different perspective.

00:04:03:14 - 00:04:22:09
David Colling
But what can happen is, as a board member, you can get pretty overwhelmed pretty quickly with whether it's the acronyms, the accreditation, you know, all the different things Kencee trained on can be pretty overwhelming for community board members. So, I thought it was excellent. And once again, I want to reiterate, it was really a 101. Kencee

00:04:22:09 - 00:04:40:02
David Colling
didn't take any for granted, whether it was an acronym or a word, something need to be defined. It was really quite effective in the way that she approached it. You know, the other thing I think is it helped us continue to elevate quality and safety, you know, as a really important topic for the board. Right? So this is not a sideline.

00:04:40:09 - 00:04:55:17
David Colling
This is a really, really important really the driving force behind the board. You know, maybe besides finance and some other things, you know, a really important piece of piece of the work that we do. So I think there's a couple of things, that I reacted to. And frankly, I've been a board member for, as you mentioned, almost ten years.

00:04:55:19 - 00:05:03:13
David Colling
And I learned a lot. So what does that tell you? Right. So I think it's good for existing board members and new board members.

00:05:03:16 - 00:05:14:01
Kencee K. Graves, M.D.
I think it was a really important launching point for the CMS structural measure that requires patient safety to be part of board meetings. That would have been difficult if we had not done already the Quality 101 session.

00:05:14:03 - 00:05:35:29
Nikhil Baviskar
Thank you for mentioning that. What you're referring to as quapi, we're seeing a lot of folks, other boards that are realizing this is something that has to be integral to the planning process and the strategic planning process. David, I wanted to ask you, a follow up on that. So as the co-chair of the Board Quality and Safety Committee, you said you learned a lot.

00:05:36:01 - 00:05:46:01
Nikhil Baviskar
Do you do you feel like Kencee's presentation sort of set maybe an agenda or help you and your other co-chair plan going forward?

00:05:46:04 - 00:06:02:13
David Colling
Yeah. I mean, again, it gave such a good foundation, and I liked what Kencee said about us all being on the same page. So I do, I think it's set an excellent foundation for the committee moving forward. Got us all kind of in the same spot, whether you'd been there for ten years like myself or whether you're a brand new community board member.

00:06:02:15 - 00:06:19:22
David Colling
You know, the other thing I thought it was nice to, you know, we had it wasn't just board members. It was the clinical and health care staff there as well. I think it's important for them to listen to the dialog, understand that should help them understand kind of that knowledge gap, whether it's quality and safety or whether it's other, you know, board activities.

00:06:19:22 - 00:06:32:15
David Colling
You know, the community board members do need to be constantly reminded of definitions and things that come naturally to clinicians and health care workers, that that we need to continue to, to bridge that knowledge gap. So, yeah, absolutely.

00:06:32:17 - 00:06:43:01
Nikhil Baviskar
So as you know, this podcast will be listened to, by other board members. David, can you give some nuggets of wisdom or some advice to other board members that may be listening?

00:06:43:04 - 00:07:04:06
David Colling
Yeah for sure. So again, going to reiterate 101 basics. You know, don't take anything for granted. Don't make any assumptions. Assume that you're starting with everyone that knows very little about, you know, not necessary quality and safety, but certainly quality and safety in the context of the health care environment. I'd highly recommend making it interactive, almost a Q&A ongoing, right?

00:07:04:06 - 00:07:23:12
David Colling
So in other words, and I think we did that, you know, we never have enough time in our board activities. We probably could even have allotted more time. But as opposed to a report out on a presentation with Q&A at the end, and we did some of this, I would argue we could have even done more with this kind of back and forth discussion with the community board members asking further questions.

00:07:23:16 - 00:07:41:15
David Colling
Kencee being able to elaborate a little bit more, potentially even the health care folks and clinicians in the room adding a little bit of color. And we did some of that but I would encourage that. And once again, I would make sure that you include all certainly all community board members, regardless of tenure. You know, there might be the occasional one that feels like they know it.

00:07:41:15 - 00:08:01:11
David Colling
I'd be amazed if, if a community board member, no matter how long you've been serving didn't learn something from the presentation. And once again, I would say the entire board should be included, that dialog is healthy and I think creates good understanding amongst all parties. And you know, Kencee, you mentioned the podcast that that we kind of did a pre-work.

00:08:01:12 - 00:08:20:28
David Colling
You know, we asked everybody to listen to Jamie's podcast, and I want to say that was about a 30 minute give or take podcast, excellent foundation to reinforce the importance of quality and safety, right? So before we go into the 101 and the teaching piece, get everybody on the same page of the importance of it and the role it plays with the board.

00:08:20:28 - 00:08:29:10
David Colling
So I thought that was excellent. You know, I'll call it pre-work and everyone should kind of be required to listen to that I think prior to the actual presentation itself.

00:08:29:12 - 00:08:46:16
Kencee K. Graves, M.D.
I'm really glad you called out some of the interactive stuff and the keep it fun. I don't know if there's any chief quality officers listening, I do think that's an important piece. And so a couple things that I did that I thought worked really, really well. Survey questions after sections of my presentation. So I would talk about patient safety.

00:08:46:16 - 00:09:04:11
Kencee K. Graves, M.D.
And then I would ask people what it is. And then I would give them four multiple choice questions. Put one in there that was funny. And that kind of thing kept people really engaged. I also put together a laminated front-and-back about what ranking system that we use at the University of Utah, and explained every section of that.

00:09:04:14 - 00:09:23:11
Kencee K. Graves, M.D.
I went through my office and introduced people and talk about what they did, and that's the kind of stuff that people loved. They loved getting to know who their leaders are, and they really liked the human part. And I think that's critical because we're here for humans, right? Like quality care is for humans. And so that was kind of my undertone.

00:09:23:11 - 00:09:24:29
Kencee K. Graves, M.D.
I'm glad David picked up on it.

00:09:25:01 - 00:09:42:16
David Colling
And Nikhil, I'll just add one more comment to that. Yeah, the structure within the organization where quality and safety fits, the different roles. Again, something I kind of knew but didn't know in that level of detail. There's quite a bit more to the quality and safety than many would imagine. So I thought that was know really well done.

00:09:42:16 - 00:09:58:17
David Colling
You know, Kencee, I don't know if I've mentioned it to you, but I think that presentation it's interesting is I went back and reviewed it. That almost needs to be kind of a continuous piece of reference material. I almost feel like I want to make it a little less of a PowerPoint and more of a reference piece. So there's an assignment for you.

00:09:58:17 - 00:10:16:07
David Colling
But, you know, because it is so well done. It should be a continuous reference, you know, that's almost in your little in your toolbox as a community board member, because this is how busy we as committee board members are. You know, we've got our day jobs and we get so focused. So that presentation, which was extremely effective was only a few months ago.

00:10:16:09 - 00:10:30:20
David Colling
But when I reviewed it, you know, even prior to this, discussion, I was like, oh yeah, I need to, you know, keep remembering this kind of thing. So I'm going to be referring back to that pretty regularly. So that might be another piece of advice, you know, use it as an ongoing resource for the for the board.

00:10:30:22 - 00:10:48:28
Kencee K. Graves, M.D.
That's really good advice. And I want to go back to a point you made earlier where our accreditation partner is, that Det Norske Veritas or DNV. They were on site at the end of January. And so I reported that out to the board in February, and I included what DNV stands for and what it means and what they gave us citations on.

00:10:48:28 - 00:11:07:27
Kencee K. Graves, M.D.
And I used graphics to demonstrate kind of each bucket. And I did have people that have worked at the University of Utah in leadership for more than a decade come up and tell me, thank you for doing that, because I think quality is such an alphabet soup that for those of us who work in it, it's easy to forget that it doesn't mean a lot to anybody else.

00:11:07:27 - 00:11:16:23
Kencee K. Graves, M.D.
And so I would just say, I think it's really, really important to continue to revisit those abbreviations that may not land well without an introduction.

00:11:16:25 - 00:11:35:05
David Colling
And Kencee, I would say that the entire clinical or healthcare environment, health care environment is a big alphabet soup. If I had one advice for, you know, the clinical and health care staff, beyond quality and safety, there are acronyms and short you know, wordings used for things that just don't come natural to community board members.

00:11:35:05 - 00:11:38:06
David Colling
So I think that's a good reminder beyond quality and safety as well.

00:11:38:08 - 00:11:59:03
Kencee K. Graves, M.D.
Yeah, I've spent a lot of time talking about what I think chief quality officers should do. But I'll tell you what I think has been valuable to me as interim chief quality officer with a board. The board members ask really good questions. And for me, that is my check on. Am I explaining something well? What does an average patient hear and think and see?

00:11:59:03 - 00:12:17:24
Kencee K. Graves, M.D.
And how do they perceive us through the media? And what does the community say? And that is incredibly valuable because there are not a lot of spaces in my life where I hear that because I work in health care, I work around other doctors and nurses and the community board is my window to what the rest of the world sees when they see our health system.

00:12:17:27 - 00:12:37:28
Nikhil Baviskar
That's very helpful. As you said, the board should reflect the community and that's really important. You know, Kencee or Doctor Graves, I'll ask you just one more thing. For the board members listening, I already asked this to David, but what do you think that the board member should take away when it comes to, you know, working on quality, understanding it and learning about it?

00:12:38:01 - 00:13:01:02
Kencee K. Graves, M.D.
Part of that is, is what I said in that ask questions, stay engaged. And so if you see something or hear something that doesn't make sense, ask about it. The other thing that our board has asked me to do, which I found very, very helpful, is if I bring them a problem they've also asked me to report on who is responsible for it, what is the fix and when do I report back?

00:13:01:05 - 00:13:23:29
Kencee K. Graves, M.D.
And that cadence has kept me giving them information that is meaningful. And then also they've learned to trust the information I bring them. It keeps me honest and keeps a closed loop communication. So I think that's been really good. I do think it's possible to skim over things, and I would just say, I think board members can and should ask really really good questions.

00:13:24:01 - 00:13:35:08
Nikhil Baviskar
Well, thank you both so much for your time. This has been an awesome discussion and we really do hope that you know, your quality journey just continues getting better from here on out. So thank you again.

00:13:35:11 - 00:13:36:04
David Colling
Thank you.

00:13:36:07 - 00:13:38:16
Kencee K. Graves, M.D.
Thank you for having us.

00:13:38:19 - 00:13:47:00
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.