September 11, 2025 • 49 mins
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.
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Episode Transcript
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Speaker 1 (00:00):
You know, I think one of the things I always tried to
remember when I was approachingsomebody was to approach each
problem with humility and to trynot to kind of bring my own
biases to these conversations,to try to approach it with a
learning mentality.
Speaker 2 (00:23):
Welcome to Leading Quality, the podcast
spotlighting the people movinghealthcare forward from the
front lines to the C-suite.
I'm your host, jason Meadows.
I'm excited to welcome Dr KimiYoshi Kobayashi to the show.
(00:46):
Kimi is one of those rarephysicians who marries deep
operational expertise with agenuine passion for improving
patient care.
As chief medical officer atUMass Memorial Medical Center,
an 850-bed academic hospital incentral Massachusetts academic
hospital in centralMassachusetts, he provides
clinical leadership for safety,quality and capacity management,
(01:07):
while overseeing hospitalmedicine, the EICU, employee
health and palliative care.
He also invests heavily inmentoring the next generation of
physician leaders.
When Kimmy joined UMassMemorial in 2019 as chief
quality officer, he founded theCenter for Quality and Safety
and helped lead the hospital'stransformation from one to four
(01:31):
CMS stars in just four years, ashift that represents a real
difference for patients andstaff alike.
His research focuses on handoffsafety, hospital transfers and
how capacity management impactsoutcomes.
Hospital transfers and howcapacity management impacts
outcomes.
Before UMass Memorial, he heldleadership roles in medical
(01:54):
informatics, clinical operationsand capacity management at
Massachusetts General Hospitaland Johns Hopkins Hospital.
Nationally, he serves on theVizient AMC Chief Quality
Officers Network SteeringCommittee and the Society of
Hospital Medicine's Quality andPatient Safety Committee.
What I love about Kimi's story,and why I wanted him here, is
(02:15):
that he's not just makingimprovements on paper.
He's changing the day-to-dayexperience for patients and
staff, and that's exactly thekind of leadership that we
celebrate on this podcast.
Kimmy, welcome to the podcast.
Speaker 1 (02:29):
Thanks, jason, it's a pleasure to be here.
Speaker 2 (02:31):
So, kimmy, I think, starting at the start, I'm just
curious.
We've known each other for alittle while, but I don't know
that I've gotten fully into yourorigin story and I'm wondering
what got you into qualityimprovement and from their
quality improvement, leadership.
Speaker 1 (02:46):
Awesome.
So I'll go way back.
I'm originally from Boston, I'ma thoroughbred Northeasterner,
I consider myself a NewEnglander, patriots fan, celtics
fan, all that and you know, asI was going through my training
and education, I was influencedpartly by my family background.
My parents are both PhDscientists.
(03:08):
I tremendously respect whatthey accomplished in their
research careers, advancing andcontributing to basic science
and mainly immunology.
This was during the 80s and theboom of the biotech era and I
thought that was very cool.
I did a research experienceduring college.
I quickly realized, while itwas interesting, it really
(03:31):
wasn't for me.
I kind of liked the peopleexperience, part of it, which is
what led me ultimately tomedicine.
And as I was going through theeducational process I realized
that conceptually it waspossible that you could improve
patient outcomes by the way youdeliver care just as much as a
blockbuster cancer drug could.
(03:52):
And that concept fundamentallyis what still drives me today.
It still is what keeps meinterested in improving
operations, improving quality,improving safety and has sort of
been the, I think, thematicpassion through my career.
And so when I was a resident Iwas going through training at a
(04:16):
time where quality improvementwas really starting to take off
and that was starting topercolate within training
systems.
This was pre the ACGME clearrequirements and things like
that and really enjoyed thatconcept because it melded really
well with that concept ofimproving care and changing
outcomes.
And so I got involved there andstarted to do projects, even as
(04:39):
a resident, that were verysmall in scale, and then wanted
to do bigger and bigger projectsthat were very small in scale
and then wanted to do bigger andbigger projects and ultimately
I started to get interested inhow to organizations change from
point A to point B and that'swhat then drove my what I would
call my leadership, growth andexperience through my attending
hood career after my training.
Speaker 2 (05:00):
Yeah, Thanks for that summary.
I think a lot of peopleprobably listening to this can
relate to the enthusiasm thatyou built in understanding that
operations can be as profound oreven interesting as far as your
time at Mass General isconcerned.
(05:26):
So I understand you were thedirector of inpatient medicine.
You're also an epic physicianchampion and you have kind of an
informatics background, or atleast that's part of what's
brought you into this moment.
What were some of the earlylessons or experiences that set
the stage for your qualityleadership that came after?
Speaker 1 (05:43):
I think one of the things that I learned early on
in my career, thanks to mentorsthat I had, was to really take
away from every experience thatyou've been given as much as you
can.
So you know, when I was goingthrough my early career, I was
really just interested in doingsomething, making a contribution
(06:05):
, making change, learning,growing as a leader.
And so when I came out ofresidency and was starting to
develop my career as anattending and as a physician
leader, I was really given theopportunity to participate in
the EPIC deployment for MassGeneral, and at first I don't
(06:25):
really think of myself as aninformaticist, just to be clear
but I think that the project wasreally instrumental in my
career in development because ittaught me a lot about workflows
across both the inpatient andoutpatient space, and I'm a
hospitalist by clinical trade.
So learning about outpatientcare, pediatric care that was
(06:48):
all stuff that I would not havebeen exposed to otherwise in my
normal hospitalist day to dayTaught me about rev cycle,
taught me about data structures,quality reporting, and really
gave me an opportunity tointeract with a huge plethora of
people, and I was alsoattracted by the fact that at
the time it was being billed asone of the biggest changes that
the organization had gonethrough in its history, which I
(07:12):
think probably is true in termsof the overall impact it had in
touching every caregiver'sworkflow in life.
So I was really.
That's how I got started inthat realm.
And after I had that experience,I had experience working with
other leaders across theinstitution and healthcare
system.
That's when my chair at the timeasked me to take on some
(07:34):
operational responsibilityworking within the department,
and I absolutely loved that role.
It was great to interact andrepresent my department, but
also, really, you know, one ofmy mentors at the time that I
was starting that role told mehey, kimmy, if you're doing that
role correctly, you're going tospend most of your time not
(07:55):
with the people in yourdepartment but actually
interacting with others outsideof your department.
And that's absolutely whathappened.
Is I love collaborating withother departments, trying to
solve problems together, andthat's what exposed me into
issues such as capacity andboarding and working on
alternative pathways toadmission, and so I really liked
(08:18):
how I was able to meld both myclinical experience that I was
experiencing every day as ahospitalist caring for patients,
my Epic experience, myexperience with other leaders,
and now solving different kindsof problems and with a little
bit more operationalresponsibility.
So that's.
That was really how I wouldsummarize my MGH experience.
Speaker 2 (08:39):
Yeah, I mean there's.
There's so many kind ofinteresting themes in what you
just said and you know, one ofthem is kind of the theme of
being an outsider in a sense.
You're a hospitalist bytraining but then working really
cross-departmentally, and Ithink that some of us, when we
try and tackle this work, noticehow siloed our healthcare
(09:00):
systems can be.
I'm curious if you, as ahospitalist working with a lot
of others who are nothospitalists, if you would
consider that a relativestrength, being the non-expert
in the room when it came to, Idon't know, pediatric oncology
or, you know, orthopedic surgeryor something else.
Does that strike a chord withyou at all?
Speaker 1 (09:20):
You know, I think one of the things I always tried to
remember when I was approachingsomebody let's say during my
Epic role about changing aworkflow from homegrown IS
systems to Epic was to approacheach problem with humility,
right that everybody that I wastalking to had very good
intentions, wanted to take greatcare of their patients and
(09:42):
cared a lot about outcomes andquality and safety, and to try
not to kind of bring my ownbiases to these conversations,
to try to approach it with alearning mentality, and I think
that really helped me in myfuture quality leadership roles.
Because you know, we're oftenwe're going to go into a
situation when we're trying tosolve a quality problem, where
(10:04):
we're trying to understand maybethe signal is that the quality
isn't as good as it could be orthere was a safety issue, and so
you know, rather than coming inand saying like there was a
problem here, I think I learnedearly on in my career lessons
about how to approach situationswhere you don't assume the
worst in people.
Right, to a certain extent, youknow people might approach
(10:25):
these conversations with somesense of defensiveness to begin
with anyway.
So it doesn't help for you tocome in and kind of say, hey,
there was a problem, right, andI really tried to.
I learned that lesson over andover when I was doing the Epic
thing where you know you have tostart with inquiry.
You have to start with tell meabout how you do X procedure.
Right, if we're going to talkabout X procedures quality being
(10:51):
off, let's talk about thatprocedure Like what is it that
you do?
Tell me about it.
Tell me about, because I mightstart to hear things at that
part in the discussion thatcompletely changes my view about
what might be going on.
And I've had plenty ofexperiences, particularly in
quality, where we start talkingabout a problem and I all of a
sudden realize, oh, this mightactually be just a pure data
problem, just by some of thethings that I learned.
(11:13):
And so I think that was reallykey and really helpful in how I
approach problems now.
Speaker 2 (11:23):
Yeah, I love the idea of leading with humility.
I think that's a that's areally key theme that that I've
experienced as well.
So thanks for sharing that.
If that is you know.
What you're describing is youknow kind of the zoomed in
approach, in the sense that youmight be getting down to the
nitty gritty of of how aprocedure works or how a
particular process works?
(11:43):
I'd like to zoom out for aminute and actually talk about
your experiences at the JohnsHopkins Capacity Command Center,
which is an example I thinkthat a lot of the healthcare
world looks to.
They've had great success withthat command center.
It may even be the first of itskind, if I'm not mistaken, but
certainly among the first.
I guess.
(12:04):
For our audience, who may havedifferent levels of familiarity
with that, can you explain whata command center is and why it's
important?
Speaker 1 (12:12):
Absolutely.
You know capacity commandcenters over the past I would
say probably five to 10 yearshave really evolved and now I
think we're at a stage where youcan access in the literature,
for example, more standardpapers, documents about what a
command center is.
You know, fundamentally, Ithink, about command centers as
(12:34):
doing a couple things ultimatelyfor health systems and, frankly
, most command centers that I'veseen or interacted with have
been slightly different.
None of them are exactly thesame, but I think some of the
central functions that they'retrying to do is really act as a
hub for either one institutionor multiple institutions or
(12:54):
institutions, hospitals andoutpatient areas.
I think, too, they're trying toco-locate some services that
have commonality and synergyacross them, services that have
commonality and synergy acrossthem, and I think they also are
ultimately trying to act as adecision point for an
institution, whether that be asingle hospital, a health system
(13:16):
with multiple institutions as adecision point to adjudicate.
You know situations where weneed to make a decision that's
for the better good of thepatient and the health system,
and the reason why, in a systemwhere you don't have a command
center, why that might be alittle bit more difficult, is
that you're transacting thosedecision points just
(13:39):
unilaterally, kind of in aone-on-one-on-one situation.
But if you have a commandcenter, you can kind of take
into consideration all ofeveryone's interests and try to
make the best decision possible.
So I think that that's reallyto me what a command center is.
Now, what services you put intothe command center?
Do you include, for example,transport services yes or no?
(14:03):
Do you include a clinicalexpediter role yes or no?
Those are some of the sort ofthe nitty gritty and again
things look different.
But ultimately I think that'sreally what a command center is
founded on a foundation of dataand insight.
Increasingly now, commandcenters are hubs of advanced
(14:24):
analytics using AI and machinelearning and predictive tools,
and I think certainly we willsee, as we see, consolidation in
the healthcare market and wehave larger and larger health
systems, I think it's onlynatural that command centers
will just grow and not shrink.
That's my prediction.
Speaker 2 (14:42):
What would you say to hospitals that are working hard
to manage patient flow but theysee command centers as an
additional investment that theycan't afford?
And secondarily, what would youimagine to be the minimum size
or the minimum set of featuresthat you might need to make a
command center work?
Speaker 1 (15:01):
One of the most important lessons that I was
fortunate enough to learn at theHopkins Command Center was the
notion that while they did havea very cool NASA-looking room
with a bunch of computers andmonitors everywhere, we had this
cool wall of monitors, forexample one of the most
(15:24):
important things is to rememberthat what really matters is not
so much the material appearanceof the command center, it's
actually how is the commandcenter functions actually going
to get accomplished?
And what I mean by that is, Ithink so much there's oftentimes
a discussion of if we justco-locate these services and put
(15:45):
them in a shiny bunker with abunch of computers and data,
that all of our problems willjust dissolve and go away and
our length of stay will go downby 1.5 days, and that our
readmission rates will get cutin half and our aura holds will
disappear and that it'll benirvana.
But what I think that approachfails to recognize is that the
(16:10):
fundamental effectiveness of acommand center depends on some
of the key questions and guidingprinciples that you have to
answer generally to create aneffective command center.
So by that I mean thatconceptually, when we worked in
a more of a classic singlehospital style, you know,
(16:32):
ultimately, the institution canmake the decision of what it
prioritizes, in what order, butwhen you go and you try to solve
problems like where can I placea patient across our five
hospitals, it becomes morecomplicated.
The decision-making process nowincorporates five different
major stakeholders instead ofjust one, and so if you don't
(16:54):
have difficult discussions, forinstance, around how are we
going to manage the finances oftransfers between our hospitals,
or how, at the end of the day,when we resolve a disagreement,
how are we going to make thosedecisions, which inherently
means that we're going to havelosers and winners.
If we don't have those kinds offoundational principles laid
(17:15):
out, it doesn't matter how shinythe room and how many monitors
and computers and people youhave co-located, it's really not
going to work.
And so I think that a lot ofthe discussion and focus at
times is around the cooltechnology, ai, machine learning
, predictive learning aspect ofthings, but what I think folks
(17:38):
need to focus on actually moreis some of those principles,
some of those decision-makingpoints, conflict resolution and
because really what you'retalking about is how do we act
as a?
system and I think that's aquestion that, fundamentally, a
lot of institutions aregrappling with right now is how
do we act as a system, how do weorganize ourselves as a system
(17:58):
and this could be for quality orcapacity, really and I think
that the key questions are insolving those rather than
focusing on the product.
The product design will flowfrom whatever you organize.
Speaker 2 (18:11):
Yeah, it reminds me very much of what a lot of the
older QI literature about theevolution of Toyota and other
companies in differentindustries that have succeeded
in this kind of qualityimprovement journey, which is
when implementing technology, wewant to deeply understand the
workflow, deeply understand the,as you say, the principles or
the problems that are actuallybeing solved, because it can be
(18:35):
awfully tempting to think that anew technology will be a
panacea when in fact we haven'tdone the hard work of
understanding how our hospitalis structured, who is there, who
organizes and interacts withwhom.
So yeah, I really I appreciatethat perspective.
You know this may also overlapwith your command center
(18:57):
experience, but maybe not too.
I'm curious you are now atUMass Memorial now for about six
years, I think, and you were abig, big part of this transition
from one to four CMS stars,which is a really remarkable
achievement.
And I wonder if you can give mea sort of first 100 days
(19:18):
playbook idea of what is theinitial thinking in making that
transition, and obviously ittakes a lot more than a hundred
days, but I'm curious what thatkind of playbook looks like in
your mind now having gonethrough it.
Speaker 1 (19:34):
Yeah, it was, it was, it was.
It's probably one of the thingsthat I'm most proud of so far
in my career of being able toachieve.
You know, personally as aleader, I was really excited
about taking on the role ofchief quality officer, to be
given the opportunity to solveproblems like this.
(19:54):
How do you transform anorganization, whether it be
quality or otherwise, and moveit from one you know one
position to the other?
So, in terms of the first 100days, you know I'll talk about
what I felt early on.
One of the first things I feltwhen I got to the organization
(20:16):
and trying to again back to someof the principles we talked
about, what is the problem?
And you know, when I steppedonto the wards as a practicing
hospitalist at UMass MemorialMedical Center, I immediately
realized that the one out offive CMS stars was not a
reflection of the quality ofcare that was actually getting
(20:37):
delivered, and so part of myhypothesis early on was that
we're sort of not getting creditfor the quality of care that we
are providing and that approachstarts to take or that lens
starts to take you down acertain avenue of inquiry that I
began, which is making surethat our data was aligned, that
(21:00):
was clean and correct andvalidated, making sure that we
had good alignmentorganizationally amongst
frontline caregivers as well asthe most senior executives, on
what we're trying to achieve.
On quality and looking at howdid we ensure or improve on a
quality issue as it's identified.
(21:22):
You know, oftentimes I heardearlier on when I got to the
institution that quality hadbeen very much a flavor of the
month issue.
So you know, this month we'refocused on hospital-acquired
conditions, but next month we'reworried about infections.
Well, last month you wereworried about hospital-acquired
conditions.
What happened to that?
Oh, no, no, we're talking aboutinfections this month.
(21:44):
Right, and in that environmentyou can't sustain progress.
So the other key thing that wedid early on was to identify
what were the top things that weneeded to improve.
So you know, you might look atthe full slate of quality
outcomes and say we want toimprove on all of them, but
really pushing ourselves to sayno, no, no, like what are the
(22:06):
most important things that weneed to work on, and then
committing to a multi-yearimprovement process, cause, as
we all know, you can, in theshort term, improve any of these
quality outcomes pretty quicklywith a lot of effort.
But the real trick is can yousustain the improvement?
And if you want to improve onany of these externally reported
quality rating systems, youreally need sustained outcomes,
(22:30):
because the measurement periodsare often more than a year and
also they lag behind by a coupleof years, and so you need to be
aiming for sustained results,and that's what we're always
sustaining for in a good QIsense.
Right is that?
Final S is that sustainment.
And I also sort of knew that,based on the way that data is
(22:54):
structured and reported, thatwhat we needed to aim for was
not just incremental improvement, because that's what everybody
in your peer group is doing, andso you know, as we know, in
quality, each year our peerbenchmarks are generally
improving on any given metric.
So what we needed to do wassort of, you know, stepwise
(23:17):
function improvement, not justincremental improvement.
And the only way that I thoughtwe could do this is to
basically look to the highestachievers in every one of these
domains and then understand whatare they doing?
And then ask ourselves whycan't we do that today?
And that's a really differentmuscle than most academic
(23:40):
medical centers that I've been apart of are used to.
Most academic medical centersdon't move with that kind of
quick muscle.
But that was a challenge that Iwanted to put in front of others
is to say these are the peoplewho are doing the best on any
particular issue and they'redoing it this way.
Why can't we do it that wayalso?
(24:01):
And that helped to really cutthrough a lot of things.
Like well, kimmy, you knowwe've always done it that way
before, so you know we got tokeep doing it that way.
It helped to cut through issues.
Like you know, we don't thinkwe can do it because generally
people don't want to say thatthey're aiming to be third best,
(24:24):
right, generally, you know,most people, particularly
physicians, I find you know theywant to be the best and so when
you tell them that this is whatthe best is doing, they, it's
hard for them to say, well, Iwant to be like that.
Speaker 2 (24:35):
So I think that that really helped me mentor others
in leadership or those who mightaspire to be leaders in the
future.
I'm curious what are maybe somemistakes that you made along
(25:05):
the way that were reallyvaluable teachers?
Maybe lessons that you'd conveyto people that you mentor?
Speaker 1 (25:11):
Boy, there's a lot of mistakes that I can think of.
You know, one of the mistakesthat I talk about a lot when I'm
talking with others is the factthat the one of the biggest
blunders I still consider thatI've made in my career happened
like within the first year thatI was out of training and it's
(25:32):
and there's something about thatfirst major mistake that really
catches your attention andsticks with you year over year
over year.
And really what that mistakeboiled down to was that I
thought that I had this greatidea, that the idea itself was
great, but I so fell short onstakeholder engagement and
(25:59):
generating buy-in andunderstanding others'
perspectives that it was acomplete fail.
It didn't actually matter.
In that instance I realized itdidn't actually matter how good
my ideas were when I totallyfail at engaging others and
including them in theconversation.
And so in that instance again,one of my really early projects
(26:23):
that I was trying to champion itnever went anywhere.
It got killed almostimmediately and never saw the
light of day.
I still think it was a prettygood idea, and so I try to
really, and I'm going to focus alittle bit on physician leaders
.
I'm a little biased to that,being a physician.
But I think sometimes, you know,there's such, there's so much
(26:44):
focus on in our training as aphysician about getting the
diagnosis right, getting thecorrect medication for that
disease, getting the rightsurgery for that injury, that I
think we become very solutionfocused and that works against
us often when we're now put in aleadership role where it's not,
(27:07):
most of the time it's not aboutthe idea, and in fact your job
as a leader is not so much ideageneration but it's about
generating buy-in and supportand fostering a sense of
collaboration.
And so I think that I talk aboutthat a lot and I try to pay
attention to that myself a lot,because I recognize that I've
(27:31):
spent my entire sort ofupbringing and training to be so
answer oriented, that to reallyremind myself always like it's
about the process, it's notabout the solution.
You know, I've really tried tosay like now, the best solution
is the one we come up with as ateam.
It's not the smartest answer orthe most pure, perfect answer,
(27:54):
and so I think that's a realimportant lesson that, um, I
felt directly, uh, that mymentors have taught me and that
I try to pass on to others.
Speaker 2 (28:04):
Yeah, I mean again that theme of of humility that
you mentioned before comingthrough 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 itunfolds, so I can really relate
to that.
You had a paper published thisyear in April entitled
(28:29):
Navigating the Pathway toQuality Leadership Perspectives
from Contemporary QualityExecutives.
There's a lot of good in there.
It's a great read.
I recommend it to the audience.
But I was curious about oneparticular question.
Essentially, you surveyednationwide a bunch of
self-identified quality leadersand one of the things that was
(28:52):
overwhelmingly agreed as acritical skill by those surveyed
was about 92.6%, I believe,agreed strongly that data and
storytelling were essentialfeatures for a, or essential
skills for a quality leader.
I'm wondering how much you knowwe, as you've kind of alluded
(29:13):
to there, we focus on the data.
We focus on getting the rightanswers.
How much has data andstorytelling been important to
your journey and are there anyspecific examples where that
combination was important foryou?
Speaker 1 (29:27):
Yeah, the project was really interesting.
We were trying to get a currentsnapshot of those who are in
quality leadership and I thinkit was kind of an interesting
time that we did it, becausequality has really matured over
the past 20 years and I thinkit's gone from a conceptual
(29:51):
topic to one where it's almostnormal to have folks who are
chief quality officers and VPsof quality and directors of
quality and whatnot.
That's almost nobody blinks aneye anymore that that's a normal
key function within anorganization.
So we were trying to understand, you know, who are these people
(30:11):
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 thatit would be a little bit of an
informative piece too to folkswho aspire to be in quality
leadership roles so that theycan kind of understand what are
the things that are importantfor them to get there.
(30:31):
And, as you mentioned, you knowdata and storytelling I think is
one of the most critical things.
You know as quality folks youand I, we do that all the time
and I think is one of the mostcritical things we you know, as
quality folks, you and I, we dothat all the time and I think
sometimes, while we can get overfocused on data and quality, I
do think that the rigor that itforces is a good one, and that's
(30:55):
that.
Let's start with what the datais telling us.
You know, for instance, whenearly in our quality journey at
UMass Memorial Medical Center, Iwould hear about problems being
solved with solutions and theywere not seeing results.
And when we dug deeper into thecases, into the data, and we
(31:20):
did things like Pareto charts,we realized that we were working
on solutions that were notaimed at the majority of the
issues that were driving theproblem.
And so sure, we could work onthat solution all you wanted,
but it's never going to move thedial to actually, you know,
work in the problem.
So I think that's those aresome examples of where data
(31:43):
really helps cut through a lotof noise.
And you know even it could bethat maybe they were working on
that project because the mostsenior person on the team
insisted that that's what theyshould work on.
Or maybe they were working onthat project because it's the
most politically easy thing towork on.
It doesn't ruffle feathers, it'seasy to do, nobody's upset by
(32:05):
it, we don't, nobody has toreally make a lot of change, and
so I think that data can sortof force some of those difficult
conversations.
And but again, I think you knowwe touched on this a little bit
earlier too when I bring dataas a quality leader to others, I
generally like to sort of havean idea of what I think the data
(32:29):
, what story the data is tellingme.
But I actually try not todisclose that early on, right,
because those are stories thatI've formed with my limited
understanding and my biases.
And again, to try to approachit from a position of curiosity
and learning and to say this iswhat the data is showing us, how
(32:51):
do you interpret this expertand then see if it resonates
with how I've been looking atthe data or not.
Um, and I think that's that'sso much of how we drive change
as a quality leader.
That's how much, uh, that's howmuch you know we can.
we can do our work and figureout how we get people on the
(33:11):
same page to work on qualityprojects, uh, or safety
initiatives, um together, and soI I was not surprised at all
that that came out as a keytheme and a key trait.
Speaker 2 (33:24):
Yeah, and you know we talked a little bit about how
this work contrasts with medicalschool and residency in terms
of you know, a lot of theseleadership skills maybe all of
them are not explicitly taughtand I wonder, just like there's
a proliferation of roles like VPof quality and chief quality
(33:46):
officer, there's been aproliferation of other
post-secondary education optionsmaster's degree in quality and
safety and that type of thingand that makes me wonder whether
those programs I also know youtook your MBA and there may have
been this.
This may have been part of thecurriculum there, but but I'm
curious if, if there is, youknow, does this work and you
(34:08):
identifying these criticaltraits, does that?
Does that evolve into a qualityleadership curriculum or a
leadership curriculum morebroadly?
Speaker 1 (34:19):
leadership curriculum or a leadership curriculum more
broadly, as I think about.
You know what is the pathway toa quality leader, and actually
even in one of the papers thatwe were just talking about
regarding the current qualityleadership landscape, you know a
lot of people did have advanceddegrees and secondary degrees
I'll call them and I think thatthat's a reflection of a couple
of things.
I think one quality has become,to a certain extent, a fairly
(34:43):
specialized skill set andknowledge.
There's a decent amount ofcontent, or you know hard skills
that I'll call them that youprobably do need to be familiar
with now being in a qualityleadership role.
So I think that qualitydevelopment programs can be
helpful in that, in making surethat you have the requisite
(35:04):
content, knowledge, for example.
I think it's pretty hard to bein a quality leadership role
without understanding thefundamentals of quality
improvement.
I think that's like a veryconcrete example of one where
you know that's a content thatyou just need to acquire, and
then I think the other thingthat you know that's a content
that you just need to acquire.
And then I think the otherthing that you know quality
(35:24):
development programs can behelpful 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 ofthings.
Usually, now, you know, qualitytraining programs have some
element of that incorporated.
We have, for instance, at UMSMemorial Health, we have an
internal quality developmentprogram particularly aimed at
(35:48):
clinicians that incorporatesleadership training and
leadership themes along withteaching them lean methodology.
So I think you know you can getthose soft skills.
And then, third is thenetworking piece, and networking
, I think when I was in medicalschool, almost had a negative
connotation.
(36:09):
You know people think of it assomewhat maybe subversive or
slimy or something, but it'sreally not that.
First of all, you know, peoplelike us get to connect and
connect with each other andlearn about each other and all
the common problems that we face.
And so that's one fun aspect.
But the other really importantaspect is when, when I was early
(36:33):
in my journey here at UMSMemorial Medical Center, I
talked a lot about incorporatingbest practice.
Well, I can't incorporate bestpractice if I don't have folks I
can reach out to and ask forhelp and learn from.
And so that's the other partthat networking can really help
with and, I think, one of thereally special things about the
quality community, as I'vegotten to know folks, is one of
(36:57):
the common traits that everybodyhas is they're very open to
sharing and there's not thiscompetitive sense of well, I've
figured it out so I'm not goingto share it with you.
I've never seen that within thequality community and that's
one of my most favorite things.
And so this willingness toshare, this willingness to share
(37:17):
is the other part, that, theother reason why that networking
part is so important.
So you know, I think, ingeneral, 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
(37:37):
you're aspiring to lead quality,you will in one way or other
have to pick up those threemajor domains of hard skills,
soft skills and kind of thatnetwork.
Speaker 2 (37:50):
Yeah, I agree we need to do a rebrand on the word
networking, because I felt thesame aversion to it early in my
career and you know we we talkso much in in the quality world
about kind of expanding ourcollaborative circles.
You know something along thoselines of it, just.
You know networking, but by adifferent, by a different brand,
(38:13):
and certainly the themes thatyou're touching on with the
projects you've worked on andand and same with me are you
know all about engaging andpartnering with people.
You know across domains, acrossexpertise silos, and I think
the paper that you werereferring to a minute ago was
the one also published this yearDemographic Profile and
(38:35):
Oversight Duties of today'shealthcare quality leaders.
Can you tell me a little bitabout the, the key findings from
that Cause?
I think this may also speak toan equity lens that has gotten a
lot more, a lot more press inin the quality improvement world
.
Speaker 1 (38:51):
Absolutely.
You know, just like othersurvey-based studies are,
results were obviously subjectto reporting bias and the
results that we reported werebased on the folks who decided
to return our survey.
But With that limitation beingacknowledged, what was
(39:13):
fascinating was thepreponderance of women in the
cohort and the vast majority ofthem were white.
We saw a very skewedrepresentation of Black and
Latino and otherunderrepresented in medicine
(39:38):
races and they tended to be allfairly what I would call
probably mid to mid-advancedcareer folks and mostly in
clinical roles of either nurse,physician, pharmacist, those
kinds of things.
And probably, you know, when wetake a step back, it's maybe not
(40:00):
that big a surprise.
You know, as we were justtalking about, it takes a little
bit of knowledge and experienceto have the requisite skills to
be a quality leader, so thattakes a little bit of time to
acquire.
It definitely helps as aquality leader to have what I
call clinical credibility,meaning that you have experience
(40:22):
either directly providing carein one way, shape or form or
participating in the careenvironment, because you can
interpret and understand howdata 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 weremuch bigger than you would have
expected, just based onstatistics of either other
(40:44):
leadership types within medicineor within the general workforce
, are definitely something thatgenerated pause and more
questions in my mind.
Something that generated pauseand more questions in my mind.
Frankly, I don't really knowwhy we saw what we saw, so I
think we just need to kind oflook at that more.
Speaker 2 (41:01):
Yeah, I think not enough people are looking at
that and I really appreciate howthat has also kind of you know,
entered into your work and youknow, as we're looking ahead
from where we are now hopingthat equity is a bigger and
bigger part of the picture.
Where do you see the qualitylandscape in healthcare going?
Speaker 1 (41:25):
Well, I think I'd be remiss to not at least start
with the word AI in talkingabout the future of anything.
But I do think that, you know,increasingly it's an attractive
proposition or vision to thinkthat we can measure quality in a
more scalable way.
(41:46):
I think the amount of resourcesthat 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 thatthe amount of resources it takes
to do data and analytics andmaintain that and all the
(42:06):
servers and all these otherthings, it's a tremendous amount
of resource investment.
So I think if we can lightenthat load and, you know,
thinking about the concept oflike working to the top of our
license, really reserve thehuman capital for the
improvement, the cognitive, theinterpretation parts, I think
that's a real attractive conceptconcept.
(42:31):
I worry, as all of our qualitynerds do, about automation and
metrics and numeratordenominator and gaming the
system and all of these things,but theoretically we should,
(42:55):
over the long term, be able toget to a much more manageable
system that's, I would say,automatically captured and
reported.
And the other part of that isthat if we can do that at scale
meaning you know there's so manyareas where surgical site
infection is a good example.
For instance, you know, I'm notaware that there's a lot of
institutions that can dosurgical site infection
(43:15):
monitoring on every singleprocedure that they do and then
stratify by surgery, stratify byprovider, stratify by team,
stratify by time of day locationall those things that that's
not usually easily done.
And that's because most of thetime to do surgical, true
surgical site infectionreporting, most of the time to
(43:36):
do true surgical site infectionreporting, you need somebody
looking through the cases orjust querying the electronic
health record for diagnoses, andthings like that is often not
enough, and so the promise thatthings like AI will transform
that and enable you to get amuch more holistic picture of a
problem is very, very attractive.
So I certainly think thatthat's going to be a way of the
(43:59):
future, but I think what won'tchange is, you know, some of the
things that we talked aboutbefore, like, while the data
might get a lot more easier tokind of extract, someone's gonna
have to tell the story right.
Someone's still gonna have todo the work of trying to
understand where a workflowmight need to change, understand
where the challenges are thatare occurring, and I think for
(44:22):
that, you know, there's going tobe no substitute for human
connection and leadership.
So I think that will probablybe an area, and then I think
we're going to have to createthis is kind of like a systems
on systems kind of thing, but,like you know, ways of
monitoring our automated systemsto make sure that they're not
(44:43):
running awry right.
And so, you know, thinkingabout how do you measure safety
in the world of AI is animportant concept.
And then, clearly, you know, Ithink the settings in which we
deliver care is diversifyingincreasingly outpatient,
increasingly in the homeenvironment.
I don't really see that shifting.
(45:05):
I do think that there willalways be patients who have
super complicated medical needsthat require some what I'll call
hospital-like building, medicalneeds that require some what
I'll call hospital-like building.
But no doubt more of the careis getting pushed out outside of
the walls of a traditionalhospital or clinic and trying to
(45:30):
understand safety in that realmis much more complicated.
The nice thing about a hospitalis you sort of have a captive
audience, and in the olden dayswhen we used to keep people for
21 days, 28 days, regularly fornormal admission, you had a lot
of control.
You saw them day in and day out.
You had a lot of control, butnow if, let's say, you're
delivering care virtually or inthe home setting, there's a lot
more things you don't control.
(45:50):
And how do you account for thatin monitoring safety?
And I think those are somereally cool questions we have
yet to answer.
Speaker 2 (45:59):
Yeah, I wasn't going to ask the AI question directly,
but I got the answer and I hearyou.
It makes one wonder too, wherethere's so much talk about AI
democratizing, for example,coding right, so software
engineering becomes moreamenable to just natural
(46:20):
language input with hard codingoutputs.
It makes you know one of thebottlenecks, I think, that we
face in quality work you know tosome extent, no matter where
you are, even if you're in avery well-resourced place is
that there's only so many peoplewith the right expertise to do
quality work, and it certainlymakes you wonder whether that
(46:43):
might also be a catalyzing forcefor democratizing this work to
people with less expertise, withmaybe fewer minutes in their
day to devote to this.
That's you know.
It's kind of definitely makesme think that that's, you know,
(47:05):
the future direction we'reheading in.
So, as we're wrapping up forlisteners who'd like to follow
your work or invite you to run aworkshop or give a talk, where
should they go?
Speaker 1 (47:19):
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 orother venues.
I probably should be a littlebit more social media savvy, but
I'm not that way.
But certainly folks can reachout to me through venues like
(47:39):
LinkedIn and you know I'm stillkind of old school in this way.
But I do look forward to, youknow, connecting with colleagues
through things like conferencesand such still.
So, hopefully, you know, lookforward to making many more
connections.
Networking there's that word,there's that dirty word
networking, things likeconferences.
Speaker 2 (48:01):
Will you be at the IHI annual forum this year?
Speaker 1 (48:05):
I'm not sure yet.
I haven't decided on that yet.
I have to plan out myconference.
What is it?
The conference tour?
I have to still do that.
Speaker 2 (48:17):
Very good Well, Dr Kimiyoshi Komeishi, thank you so
much for sharing your insightson command centers, on capacity
management, on leadership andthe future of QI.
I really appreciate you joiningme here for Leading Quality and
, if you enjoyed the episode,please follow Leading Quality in
your favorite podcast app andleave us a review.
(48:37):
It really helps others find theshow.
Until next time, stay curiousand keep leading quality.
Thanks for listening to LeadingQuality.
I'm Jason Meadows and I'm gladyou joined me for today's
(48:59):
conversation.
If you enjoyed this episode,follow the show on your favorite
podcast app and share it with acolleague who cares about
improving healthcare.
You know, I think one of the things I always tried to
remember when I was approachingsomebody was to approach each
problem with humility and to trynot to kind of bring my own
biases to these conversations,to try to approach it with a
learning mentality.
Speaker 2 (00:23):
Welcome to Leading Quality, the podcast
spotlighting the people movinghealthcare forward from the
front lines to the C-suite.
I'm your host, jason Meadows.
I'm excited to welcome Dr KimiYoshi Kobayashi to the show.
(00:46):
Kimi is one of those rarephysicians who marries deep
operational expertise with agenuine passion for improving
patient care.
As chief medical officer atUMass Memorial Medical Center,
an 850-bed academic hospital incentral Massachusetts academic
hospital in centralMassachusetts, he provides
clinical leadership for safety,quality and capacity management,
(01:07):
while overseeing hospitalmedicine, the EICU, employee
health and palliative care.
He also invests heavily inmentoring the next generation of
physician leaders.
When Kimmy joined UMassMemorial in 2019 as chief
quality officer, he founded theCenter for Quality and Safety
and helped lead the hospital'stransformation from one to four
(01:31):
CMS stars in just four years, ashift that represents a real
difference for patients andstaff alike.
His research focuses on handoffsafety, hospital transfers and
how capacity management impactsoutcomes.
Hospital transfers and howcapacity management impacts
outcomes.
Before UMass Memorial, he heldleadership roles in medical
(01:54):
informatics, clinical operationsand capacity management at
Massachusetts General Hospitaland Johns Hopkins Hospital.
Nationally, he serves on theVizient AMC Chief Quality
Officers Network SteeringCommittee and the Society of
Hospital Medicine's Quality andPatient Safety Committee.
What I love about Kimi's story,and why I wanted him here, is
(02:15):
that he's not just makingimprovements on paper.
He's changing the day-to-dayexperience for patients and
staff, and that's exactly thekind of leadership that we
celebrate on this podcast.
Kimmy, welcome to the podcast.
Speaker 1 (02:29):
Thanks, jason, it's a pleasure to be here.
Speaker 2 (02:31):
So, kimmy, I think, starting at the start, I'm just
curious.
We've known each other for alittle while, but I don't know
that I've gotten fully into yourorigin story and I'm wondering
what got you into qualityimprovement and from their
quality improvement, leadership.
Speaker 1 (02:46):
Awesome.
So I'll go way back.
I'm originally from Boston, I'ma thoroughbred Northeasterner,
I consider myself a NewEnglander, patriots fan, celtics
fan, all that and you know, asI was going through my training
and education, I was influencedpartly by my family background.
My parents are both PhDscientists.
(03:08):
I tremendously respect whatthey accomplished in their
research careers, advancing andcontributing to basic science
and mainly immunology.
This was during the 80s and theboom of the biotech era and I
thought that was very cool.
I did a research experienceduring college.
I quickly realized, while itwas interesting, it really
(03:31):
wasn't for me.
I kind of liked the peopleexperience, part of it, which is
what led me ultimately tomedicine.
And as I was going through theeducational process I realized
that conceptually it waspossible that you could improve
patient outcomes by the way youdeliver care just as much as a
blockbuster cancer drug could.
(03:52):
And that concept fundamentallyis what still drives me today.
It still is what keeps meinterested in improving
operations, improving quality,improving safety and has sort of
been the, I think, thematicpassion through my career.
And so when I was a resident Iwas going through training at a
(04:16):
time where quality improvementwas really starting to take off
and that was starting topercolate within training
systems.
This was pre the ACGME clearrequirements and things like
that and really enjoyed thatconcept because it melded really
well with that concept ofimproving care and changing
outcomes.
And so I got involved there andstarted to do projects, even as
(04:39):
a resident, that were verysmall in scale, and then wanted
to do bigger and bigger projectsthat were very small in scale
and then wanted to do bigger andbigger projects and ultimately
I started to get interested inhow to organizations change from
point A to point B and that'swhat then drove my what I would
call my leadership, growth andexperience through my attending
hood career after my training.
Speaker 2 (05:00):
Yeah, Thanks for that summary.
I think a lot of peopleprobably listening to this can
relate to the enthusiasm thatyou built in understanding that
operations can be as profound oreven interesting as far as your
time at Mass General isconcerned.
(05:26):
So I understand you were thedirector of inpatient medicine.
You're also an epic physicianchampion and you have kind of an
informatics background, or atleast that's part of what's
brought you into this moment.
What were some of the earlylessons or experiences that set
the stage for your qualityleadership that came after?
Speaker 1 (05:43):
I think one of the things that I learned early on
in my career, thanks to mentorsthat I had, was to really take
away from every experience thatyou've been given as much as you
can.
So you know, when I was goingthrough my early career, I was
really just interested in doingsomething, making a contribution
(06:05):
, making change, learning,growing as a leader.
And so when I came out ofresidency and was starting to
develop my career as anattending and as a physician
leader, I was really given theopportunity to participate in
the EPIC deployment for MassGeneral, and at first I don't
(06:25):
really think of myself as aninformaticist, just to be clear
but I think that the project wasreally instrumental in my
career in development because ittaught me a lot about workflows
across both the inpatient andoutpatient space, and I'm a
hospitalist by clinical trade.
So learning about outpatientcare, pediatric care that was
(06:48):
all stuff that I would not havebeen exposed to otherwise in my
normal hospitalist day to dayTaught me about rev cycle,
taught me about data structures,quality reporting, and really
gave me an opportunity tointeract with a huge plethora of
people, and I was alsoattracted by the fact that at
the time it was being billed asone of the biggest changes that
the organization had gonethrough in its history, which I
(07:12):
think probably is true in termsof the overall impact it had in
touching every caregiver'sworkflow in life.
So I was really.
That's how I got started inthat realm.
And after I had that experience,I had experience working with
other leaders across theinstitution and healthcare
system.
That's when my chair at the timeasked me to take on some
(07:34):
operational responsibilityworking within the department,
and I absolutely loved that role.
It was great to interact andrepresent my department, but
also, really, you know, one ofmy mentors at the time that I
was starting that role told mehey, kimmy, if you're doing that
role correctly, you're going tospend most of your time not
(07:55):
with the people in yourdepartment but actually
interacting with others outsideof your department.
And that's absolutely whathappened.
Is I love collaborating withother departments, trying to
solve problems together, andthat's what exposed me into
issues such as capacity andboarding and working on
alternative pathways toadmission, and so I really liked
(08:18):
how I was able to meld both myclinical experience that I was
experiencing every day as ahospitalist caring for patients,
my Epic experience, myexperience with other leaders,
and now solving different kindsof problems and with a little
bit more operationalresponsibility.
So that's.
That was really how I wouldsummarize my MGH experience.
Speaker 2 (08:39):
Yeah, I mean there's.
There's so many kind ofinteresting themes in what you
just said and you know, one ofthem is kind of the theme of
being an outsider in a sense.
You're a hospitalist bytraining but then working really
cross-departmentally, and Ithink that some of us, when we
try and tackle this work, noticehow siloed our healthcare
(09:00):
systems can be.
I'm curious if you, as ahospitalist working with a lot
of others who are nothospitalists, if you would
consider that a relativestrength, being the non-expert
in the room when it came to, Idon't know, pediatric oncology
or, you know, orthopedic surgeryor something else.
Does that strike a chord withyou at all?
Speaker 1 (09:20):
You know, I think one of the things I always tried to
remember when I was approachingsomebody let's say during my
Epic role about changing aworkflow from homegrown IS
systems to Epic was to approacheach problem with humility,
right that everybody that I wastalking to had very good
intentions, wanted to take greatcare of their patients and
(09:42):
cared a lot about outcomes andquality and safety, and to try
not to kind of bring my ownbiases to these conversations,
to try to approach it with alearning mentality, and I think
that really helped me in myfuture quality leadership roles.
Because you know, we're oftenwe're going to go into a
situation when we're trying tosolve a quality problem, where
(10:04):
we're trying to understand maybethe signal is that the quality
isn't as good as it could be orthere was a safety issue, and so
you know, rather than coming inand saying like there was a
problem here, I think I learnedearly on in my career lessons
about how to approach situationswhere you don't assume the
worst in people.
Right, to a certain extent, youknow people might approach
(10:25):
these conversations with somesense of defensiveness to begin
with anyway.
So it doesn't help for you tocome in and kind of say, hey,
there was a problem, right, andI really tried to.
I learned that lesson over andover when I was doing the Epic
thing where you know you have tostart with inquiry.
You have to start with tell meabout how you do X procedure.
Right, if we're going to talkabout X procedures quality being
(10:51):
off, let's talk about thatprocedure Like what is it that
you do?
Tell me about it.
Tell me about, because I mightstart to hear things at that
part in the discussion thatcompletely changes my view about
what might be going on.
And I've had plenty ofexperiences, particularly in
quality, where we start talkingabout a problem and I all of a
sudden realize, oh, this mightactually be just a pure data
problem, just by some of thethings that I learned.
(11:13):
And so I think that was reallykey and really helpful in how I
approach problems now.
Speaker 2 (11:23):
Yeah, I love the idea of leading with humility.
I think that's a that's areally key theme that that I've
experienced as well.
So thanks for sharing that.
If that is you know.
What you're describing is youknow kind of the zoomed in
approach, in the sense that youmight be getting down to the
nitty gritty of of how aprocedure works or how a
particular process works?
(11:43):
I'd like to zoom out for aminute and actually talk about
your experiences at the JohnsHopkins Capacity Command Center,
which is an example I thinkthat a lot of the healthcare
world looks to.
They've had great success withthat command center.
It may even be the first of itskind, if I'm not mistaken, but
certainly among the first.
I guess.
(12:04):
For our audience, who may havedifferent levels of familiarity
with that, can you explain whata command center is and why it's
important?
Speaker 1 (12:12):
Absolutely.
You know capacity commandcenters over the past I would
say probably five to 10 yearshave really evolved and now I
think we're at a stage where youcan access in the literature,
for example, more standardpapers, documents about what a
command center is.
You know, fundamentally, Ithink, about command centers as
(12:34):
doing a couple things ultimatelyfor health systems and, frankly
, most command centers that I'veseen or interacted with have
been slightly different.
None of them are exactly thesame, but I think some of the
central functions that they'retrying to do is really act as a
hub for either one institutionor multiple institutions or
(12:54):
institutions, hospitals andoutpatient areas.
I think, too, they're trying toco-locate some services that
have commonality and synergyacross them, services that have
commonality and synergy acrossthem, and I think they also are
ultimately trying to act as adecision point for an
institution, whether that be asingle hospital, a health system
(13:16):
with multiple institutions as adecision point to adjudicate.
You know situations where weneed to make a decision that's
for the better good of thepatient and the health system,
and the reason why, in a systemwhere you don't have a command
center, why that might be alittle bit more difficult, is
that you're transacting thosedecision points just
(13:39):
unilaterally, kind of in aone-on-one-on-one situation.
But if you have a commandcenter, you can kind of take
into consideration all ofeveryone's interests and try to
make the best decision possible.
So I think that that's reallyto me what a command center is.
Now, what services you put intothe command center?
Do you include, for example,transport services yes or no?
(14:03):
Do you include a clinicalexpediter role yes or no?
Those are some of the sort ofthe nitty gritty and again
things look different.
But ultimately I think that'sreally what a command center is
founded on a foundation of dataand insight.
Increasingly now, commandcenters are hubs of advanced
(14:24):
analytics using AI and machinelearning and predictive tools,
and I think certainly we willsee, as we see, consolidation in
the healthcare market and wehave larger and larger health
systems, I think it's onlynatural that command centers
will just grow and not shrink.
That's my prediction.
Speaker 2 (14:42):
What would you say to hospitals that are working hard
to manage patient flow but theysee command centers as an
additional investment that theycan't afford?
And secondarily, what would youimagine to be the minimum size
or the minimum set of featuresthat you might need to make a
command center work?
Speaker 1 (15:01):
One of the most important lessons that I was
fortunate enough to learn at theHopkins Command Center was the
notion that while they did havea very cool NASA-looking room
with a bunch of computers andmonitors everywhere, we had this
cool wall of monitors, forexample one of the most
(15:24):
important things is to rememberthat what really matters is not
so much the material appearanceof the command center, it's
actually how is the commandcenter functions actually going
to get accomplished?
And what I mean by that is, Ithink so much there's oftentimes
a discussion of if we justco-locate these services and put
(15:45):
them in a shiny bunker with abunch of computers and data,
that all of our problems willjust dissolve and go away and
our length of stay will go downby 1.5 days, and that our
readmission rates will get cutin half and our aura holds will
disappear and that it'll benirvana.
But what I think that approachfails to recognize is that the
(16:10):
fundamental effectiveness of acommand center depends on some
of the key questions and guidingprinciples that you have to
answer generally to create aneffective command center.
So by that I mean thatconceptually, when we worked in
a more of a classic singlehospital style, you know,
(16:32):
ultimately, the institution canmake the decision of what it
prioritizes, in what order, butwhen you go and you try to solve
problems like where can I placea patient across our five
hospitals, it becomes morecomplicated.
The decision-making process nowincorporates five different
major stakeholders instead ofjust one, and so if you don't
(16:54):
have difficult discussions, forinstance, around how are we
going to manage the finances oftransfers between our hospitals,
or how, at the end of the day,when we resolve a disagreement,
how are we going to make thosedecisions, which inherently
means that we're going to havelosers and winners.
If we don't have those kinds offoundational principles laid
(17:15):
out, it doesn't matter how shinythe room and how many monitors
and computers and people youhave co-located, it's really not
going to work.
And so I think that a lot ofthe discussion and focus at
times is around the cooltechnology, ai, machine learning
, predictive learning aspect ofthings, but what I think folks
(17:38):
need to focus on actually moreis some of those principles,
some of those decision-makingpoints, conflict resolution and
because really what you'retalking about is how do we act
as a?
system and I think that's aquestion that, fundamentally, a
lot of institutions aregrappling with right now is how
do we act as a system, how do weorganize ourselves as a system
(17:58):
and this could be for quality orcapacity, really and I think
that the key questions are insolving those rather than
focusing on the product.
The product design will flowfrom whatever you organize.
Speaker 2 (18:11):
Yeah, it reminds me very much of what a lot of the
older QI literature about theevolution of Toyota and other
companies in differentindustries that have succeeded
in this kind of qualityimprovement journey, which is
when implementing technology, wewant to deeply understand the
workflow, deeply understand the,as you say, the principles or
the problems that are actuallybeing solved, because it can be
(18:35):
awfully tempting to think that anew technology will be a
panacea when in fact we haven'tdone the hard work of
understanding how our hospitalis structured, who is there, who
organizes and interacts withwhom.
So yeah, I really I appreciatethat perspective.
You know this may also overlapwith your command center
(18:57):
experience, but maybe not too.
I'm curious you are now atUMass Memorial now for about six
years, I think, and you were abig, big part of this transition
from one to four CMS stars,which is a really remarkable
achievement.
And I wonder if you can give mea sort of first 100 days
(19:18):
playbook idea of what is theinitial thinking in making that
transition, and obviously ittakes a lot more than a hundred
days, but I'm curious what thatkind of playbook looks like in
your mind now having gonethrough it.
Speaker 1 (19:34):
Yeah, it was, it was, it was.
It's probably one of the thingsthat I'm most proud of so far
in my career of being able toachieve.
You know, personally as aleader, I was really excited
about taking on the role ofchief quality officer, to be
given the opportunity to solveproblems like this.
(19:54):
How do you transform anorganization, whether it be
quality or otherwise, and moveit from one you know one
position to the other?
So, in terms of the first 100days, you know I'll talk about
what I felt early on.
One of the first things I feltwhen I got to the organization
(20:16):
and trying to again back to someof the principles we talked
about, what is the problem?
And you know, when I steppedonto the wards as a practicing
hospitalist at UMass MemorialMedical Center, I immediately
realized that the one out offive CMS stars was not a
reflection of the quality ofcare that was actually getting
(20:37):
delivered, and so part of myhypothesis early on was that
we're sort of not getting creditfor the quality of care that we
are providing and that approachstarts to take or that lens
starts to take you down acertain avenue of inquiry that I
began, which is making surethat our data was aligned, that
(21:00):
was clean and correct andvalidated, making sure that we
had good alignmentorganizationally amongst
frontline caregivers as well asthe most senior executives, on
what we're trying to achieve.
On quality and looking at howdid we ensure or improve on a
quality issue as it's identified.
(21:22):
You know, oftentimes I heardearlier on when I got to the
institution that quality hadbeen very much a flavor of the
month issue.
So you know, this month we'refocused on hospital-acquired
conditions, but next month we'reworried about infections.
Well, last month you wereworried about hospital-acquired
conditions.
What happened to that?
Oh, no, no, we're talking aboutinfections this month.
(21:44):
Right, and in that environmentyou can't sustain progress.
So the other key thing that wedid early on was to identify
what were the top things that weneeded to improve.
So you know, you might look atthe full slate of quality
outcomes and say we want toimprove on all of them, but
really pushing ourselves to sayno, no, no, like what are the
(22:06):
most important things that weneed to work on, and then
committing to a multi-yearimprovement process, cause, as
we all know, you can, in theshort term, improve any of these
quality outcomes pretty quicklywith a lot of effort.
But the real trick is can yousustain the improvement?
And if you want to improve onany of these externally reported
quality rating systems, youreally need sustained outcomes,
(22:30):
because the measurement periodsare often more than a year and
also they lag behind by a coupleof years, and so you need to be
aiming for sustained results,and that's what we're always
sustaining for in a good QIsense.
Right is that?
Final S is that sustainment.
And I also sort of knew that,based on the way that data is
(22:54):
structured and reported, thatwhat we needed to aim for was
not just incremental improvement, because that's what everybody
in your peer group is doing, andso you know, as we know, in
quality, each year our peerbenchmarks are generally
improving on any given metric.
So what we needed to do wassort of, you know, stepwise
(23:17):
function improvement, not justincremental improvement.
And the only way that I thoughtwe could do this is to
basically look to the highestachievers in every one of these
domains and then understand whatare they doing?
And then ask ourselves whycan't we do that today?
And that's a really differentmuscle than most academic
(23:40):
medical centers that I've been apart of are used to.
Most academic medical centersdon't move with that kind of
quick muscle.
But that was a challenge that Iwanted to put in front of others
is to say these are the peoplewho are doing the best on any
particular issue and they'redoing it this way.
Why can't we do it that wayalso?
(24:01):
And that helped to really cutthrough a lot of things.
Like well, kimmy, you knowwe've always done it that way
before, so you know we got tokeep doing it that way.
It helped to cut through issues.
Like you know, we don't thinkwe can do it because generally
people don't want to say thatthey're aiming to be third best,
(24:24):
right, generally, you know,most people, particularly
physicians, I find you know theywant to be the best and so when
you tell them that this is whatthe best is doing, they, it's
hard for them to say, well, Iwant to be like that.
Speaker 2 (24:35):
So I think that that really helped me mentor others
in leadership or those who mightaspire to be leaders in the
future.
I'm curious what are maybe somemistakes that you made along
(25:05):
the way that were reallyvaluable teachers?
Maybe lessons that you'd conveyto people that you mentor?
Speaker 1 (25:11):
Boy, there's a lot of mistakes that I can think of.
You know, one of the mistakesthat I talk about a lot when I'm
talking with others is the factthat the one of the biggest
blunders I still consider thatI've made in my career happened
like within the first year thatI was out of training and it's
(25:32):
and there's something about thatfirst major mistake that really
catches your attention andsticks with you year over year
over year.
And really what that mistakeboiled down to was that I
thought that I had this greatidea, that the idea itself was
great, but I so fell short onstakeholder engagement and
(25:59):
generating buy-in andunderstanding others'
perspectives that it was acomplete fail.
It didn't actually matter.
In that instance I realized itdidn't actually matter how good
my ideas were when I totallyfail at engaging others and
including them in theconversation.
And so in that instance again,one of my really early projects
(26:23):
that I was trying to champion itnever went anywhere.
It got killed almostimmediately and never saw the
light of day.
I still think it was a prettygood idea, and so I try to
really, and I'm going to focus alittle bit on physician leaders
.
I'm a little biased to that,being a physician.
But I think sometimes, you know,there's such, there's so much
(26:44):
focus on in our training as aphysician about getting the
diagnosis right, getting thecorrect medication for that
disease, getting the rightsurgery for that injury, that I
think we become very solutionfocused and that works against
us often when we're now put in aleadership role where it's not,
(27:07):
most of the time it's not aboutthe idea, and in fact your job
as a leader is not so much ideageneration but it's about
generating buy-in and supportand fostering a sense of
collaboration.
And so I think that I talk aboutthat a lot and I try to pay
attention to that myself a lot,because I recognize that I've
(27:31):
spent my entire sort ofupbringing and training to be so
answer oriented, that to reallyremind myself always like it's
about the process, it's notabout the solution.
You know, I've really tried tosay like now, the best solution
is the one we come up with as ateam.
It's not the smartest answer orthe most pure, perfect answer,
(27:54):
and so I think that's a realimportant lesson that, um, I
felt directly, uh, that mymentors have taught me and that
I try to pass on to others.
Speaker 2 (28:04):
Yeah, I mean again that theme of of humility that
you mentioned before comingthrough 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 itunfolds, so I can really relate
to that.
You had a paper published thisyear in April entitled
(28:29):
Navigating the Pathway toQuality Leadership Perspectives
from Contemporary QualityExecutives.
There's a lot of good in there.
It's a great read.
I recommend it to the audience.
But I was curious about oneparticular question.
Essentially, you surveyednationwide a bunch of
self-identified quality leadersand one of the things that was
(28:52):
overwhelmingly agreed as acritical skill by those surveyed
was about 92.6%, I believe,agreed strongly that data and
storytelling were essentialfeatures for a, or essential
skills for a quality leader.
I'm wondering how much you knowwe, as you've kind of alluded
(29:13):
to there, we focus on the data.
We focus on getting the rightanswers.
How much has data andstorytelling been important to
your journey and are there anyspecific examples where that
combination was important foryou?
Speaker 1 (29:27):
Yeah, the project was really interesting.
We were trying to get a currentsnapshot of those who are in
quality leadership and I thinkit was kind of an interesting
time that we did it, becausequality has really matured over
the past 20 years and I thinkit's gone from a conceptual
(29:51):
topic to one where it's almostnormal to have folks who are
chief quality officers and VPsof quality and directors of
quality and whatnot.
That's almost nobody blinks aneye anymore that that's a normal
key function within anorganization.
So we were trying to understand, you know, who are these people
(30:11):
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 thatit would be a little bit of an
informative piece too to folkswho aspire to be in quality
leadership roles so that theycan kind of understand what are
the things that are importantfor them to get there.
(30:31):
And, as you mentioned, you knowdata and storytelling I think is
one of the most critical things.
You know as quality folks youand I, we do that all the time
and I think is one of the mostcritical things we you know, as
quality folks, you and I, we dothat all the time and I think
sometimes, while we can get overfocused on data and quality, I
do think that the rigor that itforces is a good one, and that's
(30:55):
that.
Let's start with what the datais telling us.
You know, for instance, whenearly in our quality journey at
UMass Memorial Medical Center, Iwould hear about problems being
solved with solutions and theywere not seeing results.
And when we dug deeper into thecases, into the data, and we
(31:20):
did things like Pareto charts,we realized that we were working
on solutions that were notaimed at the majority of the
issues that were driving theproblem.
And so sure, we could work onthat solution all you wanted,
but it's never going to move thedial to actually, you know,
work in the problem.
So I think that's those aresome examples of where data
(31:43):
really helps cut through a lotof noise.
And you know even it could bethat maybe they were working on
that project because the mostsenior person on the team
insisted that that's what theyshould work on.
Or maybe they were working onthat project because it's the
most politically easy thing towork on.
It doesn't ruffle feathers, it'seasy to do, nobody's upset by
(32:05):
it, we don't, nobody has toreally make a lot of change, and
so I think that data can sortof force some of those difficult
conversations.
And but again, I think you knowwe touched on this a little bit
earlier too when I bring dataas a quality leader to others, I
generally like to sort of havean idea of what I think the data
(32:29):
, what story the data is tellingme.
But I actually try not todisclose that early on, right,
because those are stories thatI've formed with my limited
understanding and my biases.
And again, to try to approachit from a position of curiosity
and learning and to say this iswhat the data is showing us, how
(32:51):
do you interpret this expertand then see if it resonates
with how I've been looking atthe data or not.
Um, and I think that's that'sso much of how we drive change
as a quality leader.
That's how much, uh, that's howmuch you know we can.
we can do our work and figureout how we get people on the
(33:11):
same page to work on qualityprojects, uh, or safety
initiatives, um together, and soI I was not surprised at all
that that came out as a keytheme and a key trait.
Speaker 2 (33:24):
Yeah, and you know we talked a little bit about how
this work contrasts with medicalschool and residency in terms
of you know, a lot of theseleadership skills maybe all of
them are not explicitly taughtand I wonder, just like there's
a proliferation of roles like VPof quality and chief quality
(33:46):
officer, there's been aproliferation of other
post-secondary education optionsmaster's degree in quality and
safety and that type of thingand that makes me wonder whether
those programs I also know youtook your MBA and there may have
been this.
This may have been part of thecurriculum there, but but I'm
curious if, if there is, youknow, does this work and you
(34:08):
identifying these criticaltraits, does that?
Does that evolve into a qualityleadership curriculum or a
leadership curriculum morebroadly?
Speaker 1 (34:19):
leadership curriculum or a leadership curriculum more
broadly, as I think about.
You know what is the pathway toa quality leader, and actually
even in one of the papers thatwe were just talking about
regarding the current qualityleadership landscape, you know a
lot of people did have advanceddegrees and secondary degrees
I'll call them and I think thatthat's a reflection of a couple
of things.
I think one quality has become,to a certain extent, a fairly
(34:43):
specialized skill set andknowledge.
There's a decent amount ofcontent, or you know hard skills
that I'll call them that youprobably do need to be familiar
with now being in a qualityleadership role.
So I think that qualitydevelopment programs can be
helpful in that, in making surethat you have the requisite
(35:04):
content, knowledge, for example.
I think it's pretty hard to bein a quality leadership role
without understanding thefundamentals of quality
improvement.
I think that's like a veryconcrete example of one where
you know that's a content thatyou just need to acquire, and
then I think the other thingthat you know that's a content
that you just need to acquire.
And then I think the otherthing that you know quality
(35:24):
development programs can behelpful 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 ofthings.
Usually, now, you know, qualitytraining programs have some
element of that incorporated.
We have, for instance, at UMSMemorial Health, we have an
internal quality developmentprogram particularly aimed at
(35:48):
clinicians that incorporatesleadership training and
leadership themes along withteaching them lean methodology.
So I think you know you can getthose soft skills.
And then, third is thenetworking piece, and networking
, I think when I was in medicalschool, almost had a negative
connotation.
(36:09):
You know people think of it assomewhat maybe subversive or
slimy or something, but it'sreally not that.
First of all, you know, peoplelike us get to connect and
connect with each other andlearn about each other and all
the common problems that we face.
And so that's one fun aspect.
But the other really importantaspect is when, when I was early
(36:33):
in my journey here at UMSMemorial Medical Center, I
talked a lot about incorporatingbest practice.
Well, I can't incorporate bestpractice if I don't have folks I
can reach out to and ask forhelp and learn from.
And so that's the other partthat networking can really help
with and, I think, one of thereally special things about the
quality community, as I'vegotten to know folks, is one of
(36:57):
the common traits that everybodyhas is they're very open to
sharing and there's not thiscompetitive sense of well, I've
figured it out so I'm not goingto share it with you.
I've never seen that within thequality community and that's
one of my most favorite things.
And so this willingness toshare, this willingness to share
(37:17):
is the other part, that, theother reason why that networking
part is so important.
So you know, I think, ingeneral, 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
(37:37):
you're aspiring to lead quality,you will in one way or other
have to pick up those threemajor domains of hard skills,
soft skills and kind of thatnetwork.
Speaker 2 (37:50):
Yeah, I agree we need to do a rebrand on the word
networking, because I felt thesame aversion to it early in my
career and you know we we talkso much in in the quality world
about kind of expanding ourcollaborative circles.
You know something along thoselines of it, just.
You know networking, but by adifferent, by a different brand,
(38:13):
and certainly the themes thatyou're touching on with the
projects you've worked on andand and same with me are you
know all about engaging andpartnering with people.
You know across domains, acrossexpertise silos, and I think
the paper that you werereferring to a minute ago was
the one also published this yearDemographic Profile and
(38:35):
Oversight Duties of today'shealthcare quality leaders.
Can you tell me a little bitabout the, the key findings from
that Cause?
I think this may also speak toan equity lens that has gotten a
lot more, a lot more press inin the quality improvement world
.
Speaker 1 (38:51):
Absolutely.
You know, just like othersurvey-based studies are,
results were obviously subjectto reporting bias and the
results that we reported werebased on the folks who decided
to return our survey.
But With that limitation beingacknowledged, what was
(39:13):
fascinating was thepreponderance of women in the
cohort and the vast majority ofthem were white.
We saw a very skewedrepresentation of Black and
Latino and otherunderrepresented in medicine
(39:38):
races and they tended to be allfairly what I would call
probably mid to mid-advancedcareer folks and mostly in
clinical roles of either nurse,physician, pharmacist, those
kinds of things.
And probably, you know, when wetake a step back, it's maybe not
(40:00):
that big a surprise.
You know, as we were justtalking about, it takes a little
bit of knowledge and experienceto have the requisite skills to
be a quality leader, so thattakes a little bit of time to
acquire.
It definitely helps as aquality leader to have what I
call clinical credibility,meaning that you have experience
(40:22):
either directly providing carein one way, shape or form or
participating in the careenvironment, because you can
interpret and understand howdata 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 weremuch bigger than you would have
expected, just based onstatistics of either other
(40:44):
leadership types within medicineor within the general workforce
, are definitely something thatgenerated pause and more
questions in my mind.
Something that generated pauseand more questions in my mind.
Frankly, I don't really knowwhy we saw what we saw, so I
think we just need to kind oflook at that more.
Speaker 2 (41:01):
Yeah, I think not enough people are looking at
that and I really appreciate howthat has also kind of you know,
entered into your work and youknow, as we're looking ahead
from where we are now hopingthat equity is a bigger and
bigger part of the picture.
Where do you see the qualitylandscape in healthcare going?
Speaker 1 (41:25):
Well, I think I'd be remiss to not at least start
with the word AI in talkingabout the future of anything.
But I do think that, you know,increasingly it's an attractive
proposition or vision to thinkthat we can measure quality in a
more scalable way.
(41:46):
I think the amount of resourcesthat 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 thatthe amount of resources it takes
to do data and analytics andmaintain that and all the
(42:06):
servers and all these otherthings, it's a tremendous amount
of resource investment.
So I think if we can lightenthat load and, you know,
thinking about the concept oflike working to the top of our
license, really reserve thehuman capital for the
improvement, the cognitive, theinterpretation parts, I think
that's a real attractive conceptconcept.
(42:31):
I worry, as all of our qualitynerds do, about automation and
metrics and numeratordenominator and gaming the
system and all of these things,but theoretically we should,
(42:55):
over the long term, be able toget to a much more manageable
system that's, I would say,automatically captured and
reported.
And the other part of that isthat if we can do that at scale
meaning you know there's so manyareas where surgical site
infection is a good example.
For instance, you know, I'm notaware that there's a lot of
institutions that can dosurgical site infection
(43:15):
monitoring on every singleprocedure that they do and then
stratify by surgery, stratify byprovider, stratify by team,
stratify by time of day locationall those things that that's
not usually easily done.
And that's because most of thetime to do surgical, true
surgical site infectionreporting, most of the time to
(43:36):
do true surgical site infectionreporting, you need somebody
looking through the cases orjust querying the electronic
health record for diagnoses, andthings like that is often not
enough, and so the promise thatthings like AI will transform
that and enable you to get amuch more holistic picture of a
problem is very, very attractive.
So I certainly think thatthat's going to be a way of the
(43:59):
future, but I think what won'tchange is, you know, some of the
things that we talked aboutbefore, like, while the data
might get a lot more easier tokind of extract, someone's gonna
have to tell the story right.
Someone's still gonna have todo the work of trying to
understand where a workflowmight need to change, understand
where the challenges are thatare occurring, and I think for
(44:22):
that, you know, there's going tobe no substitute for human
connection and leadership.
So I think that will probablybe an area, and then I think
we're going to have to createthis is kind of like a systems
on systems kind of thing, but,like you know, ways of
monitoring our automated systemsto make sure that they're not
(44:43):
running awry right.
And so, you know, thinkingabout how do you measure safety
in the world of AI is animportant concept.
And then, clearly, you know, Ithink the settings in which we
deliver care is diversifyingincreasingly outpatient,
increasingly in the homeenvironment.
I don't really see that shifting.
(45:05):
I do think that there willalways be patients who have
super complicated medical needsthat require some what I'll call
hospital-like building, medicalneeds that require some what
I'll call hospital-like building.
But no doubt more of the careis getting pushed out outside of
the walls of a traditionalhospital or clinic and trying to
(45:30):
understand safety in that realmis much more complicated.
The nice thing about a hospitalis you sort of have a captive
audience, and in the olden dayswhen we used to keep people for
21 days, 28 days, regularly fornormal admission, you had a lot
of control.
You saw them day in and day out.
You had a lot of control, butnow if, let's say, you're
delivering care virtually or inthe home setting, there's a lot
more things you don't control.
(45:50):
And how do you account for thatin monitoring safety?
And I think those are somereally cool questions we have
yet to answer.
Speaker 2 (45:59):
Yeah, I wasn't going to ask the AI question directly,
but I got the answer and I hearyou.
It makes one wonder too, wherethere's so much talk about AI
democratizing, for example,coding right, so software
engineering becomes moreamenable to just natural
(46:20):
language input with hard codingoutputs.
It makes you know one of thebottlenecks, I think, that we
face in quality work you know tosome extent, no matter where
you are, even if you're in avery well-resourced place is
that there's only so many peoplewith the right expertise to do
quality work, and it certainlymakes you wonder whether that
(46:43):
might also be a catalyzing forcefor democratizing this work to
people with less expertise, withmaybe fewer minutes in their
day to devote to this.
That's you know.
It's kind of definitely makesme think that that's, you know,
(47:05):
the future direction we'reheading in.
So, as we're wrapping up forlisteners who'd like to follow
your work or invite you to run aworkshop or give a talk, where
should they go?
Speaker 1 (47:19):
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 orother venues.
I probably should be a littlebit more social media savvy, but
I'm not that way.
But certainly folks can reachout to me through venues like
(47:39):
LinkedIn and you know I'm stillkind of old school in this way.
But I do look forward to, youknow, connecting with colleagues
through things like conferencesand such still.
So, hopefully, you know, lookforward to making many more
connections.
Networking there's that word,there's that dirty word
networking, things likeconferences.
Speaker 2 (48:01):
Will you be at the IHI annual forum this year?
Speaker 1 (48:05):
I'm not sure yet.
I haven't decided on that yet.
I have to plan out myconference.
What is it?
The conference tour?
I have to still do that.
Speaker 2 (48:17):
Very good Well, Dr Kimiyoshi Komeishi, thank you so
much for sharing your insightson command centers, on capacity
management, on leadership andthe future of QI.
I really appreciate you joiningme here for Leading Quality and
, if you enjoyed the episode,please follow Leading Quality in
your favorite podcast app andleave us a review.
(48:37):
It really helps others find theshow.
Until next time, stay curiousand keep leading quality.
Thanks for listening to LeadingQuality.
I'm Jason Meadows and I'm gladyou joined me for today's
(48:59):
conversation.
If you enjoyed this episode,follow the show on your favorite
podcast app and share it with acolleague who cares about
improving healthcare.
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