The Hidden Danger Outside the Hospital: How Families and Clinicians Reinvented Home Care for Pediatric Oncology Patients

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What if some of the biggest gains in patient safety aren’t inside hospitals at all—but at the kitchen table?

In this episode, Dr. Amy Billett and Dr. Chris Wong walk us through the groundbreaking, cross-disciplinary effort at Dana-Farber/Boston Children’s in collaboration with Ariadne Labs that cut ambulatory central-line–associated bloodstream infections (CLABSIs) for pediatric oncology patients by ~50%.

It’s a story of co-design, equity, humility, and design thinking—with families as full collaborators, not passive recipients.

Instead of pushing out top-down fixes, the team built the work with families, home-care nurses, and even a checklist engineer who transformed dense clinical instructions into clear, waterproof (yes, literally waterproof), one-page cognitive aids that could survive kitchens, bathrooms, and real homes. They aligned inpatient teaching with home supplies, created universal clean kits to eliminate equity gaps, rebuilt teach-backs to remove shame, and translated materials into Spanish and Arabic so safety didn’t depend on luck or language.

You’ll also hear how Amy’s three-decade career in pediatric quality and safety shaped the work—and how her mentorship of Chris helped fuel the next generation of system thinkers committed to closing the “know-do gap” in medicine.

At a time when more care is shifting homeward, this episode offers a playbook for making safety real beyond the hospital walls.

What We Cover

• The overlooked problem: Ambulatory CLABSIs after discharge and their impact on hospitalizations, chemotherapy delays, and family burden.
• Why usual fixes failed: Families were doing complex care with inconsistent, hard-to-use instructions not designed for home environments.
• Co-design in action: Families, clinicians, home-care nurses, and a checklist engineer created standardized, waterproof, one-page cognitive aids and aligned teaching with real home supplies.
• Human-factors design: The checklist engineer brought clarity, usability, and visual design clinicians alone couldn’t achieve.
• A new model for teachbacks: Judgment-free, normalized teachbacks led by nurse champions—resulting in >90% caregiver independence.
• Equity at the center: Universal clean kits and multilingual materials ensured safe care didn’t depend on resources or language.
• Leadership & mentorship: How Amy’s decades in pediatric safety and Chris’s drive to close the know-do gap shaped the work.
• Ripple effects: National collaboratives adopting ambulatory CLABSI prevention and emerging focus on home medication safety.

Key Takeaways

• Safety challenges often live beyond the hospital.
• Co-design works—families reveal solutions clinicians cannot see alone.
• Usability matters: Clear language and well-designed tools drive real behavior change.
• Equity requires universal design, not selective support.

Connect with Today’s Guests

Dr. Amy Billett

• Best contact method: https://www.linkedin.com/in/amy-billett-a351501a6/

Dr. Chris Wong

• Best contact method: https://www.linkedin.com/in/chris-i-wong-ciepiel-884880145/
• Profile Link: https://www.uhhospitals.org/doctors/WongCiepiel-Chris-1407171804

Episode Transcript

SPEAKER_02 (00:00):
You can actually improve patient care not by
improving the care to anindividual patient, but by
changing the system in whichthat care was taking place.
And that was like a breakthroughfor me.
The light turns on, like, oh,you can actually change care.

SPEAKER_01 (00:19):
Welcome to Leading Quality, the podcast
spotlighting the people movinghealthcare forward from the
front lines to the C Street.
I'm your host, Jason Meadows.
Most quality stories start in ahospital ward.

(00:41):
This one starts at the kitchentable.
Dr.
Chris Wong and Dr.
Amy Billet set out to solve aproblem almost no one was
looking at.
Bloodstream infections thathappen after pediatric oncology
patients go home.
The result was a years-longcollaboration between
clinicians, families, home carenurses, and even a checklist

(01:02):
engineer that cut infections inhalf and quietly redefined what
patient-centered design lookslike.
Amy's career spans three decadesat Dana Farber and Boston
Children's, where she went fromrunning chemotherapy safety
projects in the wake of theBetsy Lehman tragedy to becoming
one of the country's firstpediatric quality and safety

(01:23):
chiefs.
Chris trained under hermentorship, bringing her own
perspective from Puerto Rico andher drive to close the no-do gap
in medicine.
Together, they proved thatsafety doesn't stop at
discharge, and that families canbe true co-designers, not just
recipients of safer care.
I wanted them on leading qualitybecause this story captures

(01:46):
everything we talk about on thisshow pragmatic improvement,
humility, design thinking, andthe courage to cross traditional
boundaries.
You'll hear how they built trustwith families, rewrote the
language of teach backs,designed waterproof job aids
that actually survived realkitchens and bathrooms, and
created one of the firststandardized home care curricula

(02:08):
for children with central lines.
Why listen to this episode?
Because their approach, partscience and part empathy, points
to healthcare's next frontier.
Safety in the places wherepeople actually live their
lives.
If you've ever wondered how tomake co-design real or how
mentorship can ripple intosystem level change, this

(02:29):
conversation will stay with youlong after it ends.
Dr.
Wong?
Dr.
Billet.
Welcome to the show.

SPEAKER_00 (02:37):
Thank you.
Thanks.

SPEAKER_01 (02:38):
To start, uh I wonder if if each of you could
just kind of introduceyourselves.
You know, I've I will have givena description of you and a bit
of your work, but I'd like tohear in your own words what your
your story is, a bit of yourbackground, both the clinical
and the research focus that youhave.
Maybe Chris, we'll start withyou.

SPEAKER_00 (02:55):
Sure.
Thank you, Jason.
And I want to just take a minutejust to say thank you to Amy
because Amy always gives meincredible opportunities,
despite the fact that she's notacademically as active anymore
and has been an incrediblementor for me for the last 10
years.
So thank you, Amy, as always.
So, and that is with thecontext, really, because it this
is how I started.

(03:16):
So I was born and raised inPuerto Rico.
I went to medical school inPuerto Rico.
And that is important reallybecause when I was there, I was
incredibly frustrated really bynot being able to provide
high-quality care.
It is an incredible place.
Many people obviously have beenthere and know that despite the
fact that it is a territory ofthe United States,

(03:39):
unfortunately, it is aresource-limited setting.
And in the healthcare sector inparticular, it is very hard to
deliver high-quality care.
And so I left really with theidea that I would improve
things.
As vaguely as that sounds, Idon't know that I knew what that
meant.
I just knew that I wanted thingsto be better.
And so I thought that by goinginto a leading institution,

(04:03):
because I then was able to go toBoston Children's Hospital to
train in pediatrics residencyand stay there for a fellowship
in pediatric immatology andoncology at Boston Children's
and Dina Farber, that by doingthat, not only would I gain
incredible clinical exposure andtraining, but also academic
exposure and training that wouldthen allow me to go back to

(04:25):
Puerto Rico and really improvethings.
And so that was the initialplan.
I thought I would be a clinicaltrialist.
I thought that I was going to goback and build a clinical trials
unit and just improve outcomesfor pediatric oncology patients
that way, but I had no idea whatpediatric oncology clinical
trials was really.

(04:45):
And so I really then started tounderstand what were some of the
strengths and skills that I had.
And during that time, I had amentor who is a leader in global
pediatric oncology care andimproving outcomes access in
international settings, who atthe time said, you should meet

(05:07):
with Amy Billet, because Amy is,and I quote, and you are as
well, both very pragmatic.
I didn't really understand whatthat meant either, but those
were his exact words.
He said, You should meet, youwere both very pragmatic.
And once I met Amy, I think thatwas very clear.
So I think the first thing thatwe both realized, or altogether

(05:28):
realized, was that what mymentor meant was that although
Amy and I really wanted to movethe science forward and increase
knowledge for pediatric cancer,I think where we were most
interested was really closingthe knowledge-doing gap, that
no-do gap.
And I at the time I didn't knowwhat that meant either, but I

(05:52):
thought that she would be agreat mentor for me to just help
me understand how to do that.
The second part was that I hadalways wanted to be at the
bedside, be with patients.
That's why I went into pediatriconcology care and I wanted
really to continue doinginterdisciplinary work.
And Amy was the same way.
She was always patients first.

(06:12):
And so it was an incrediblematch early on where I realized
that if I was going to doquality improvement in patient
safety, I could still be at thebedside and improving things
very quickly.
And so the third thing that Ilearned was that I knew nothing
about quality improvement inpatient safety.
And I needed a path and I neededa mentor, I needed a project.
And everyone probably knows thatwhen you train in a place like

(06:36):
Boston Children's and DanaFarber, most people come already
knowing what they're going to dofor the rest of their lives as a
career.
And yet I had not chosen what myniche would be, what the area of
leadership, and that is reallythe goal that you would have an
area that you would flourish.
And so quality improvement inpatient safety was new.
It was exciting, but no one haddone it.
I was a fellow that had no onehad ever really done quality

(07:00):
improvement in patient safety astheir area of interest.
Most people would go into abasic science lab, maybe some
health services research, butreally no one had done quality
improvement in patient safety.
And so then at that point, theopportunity came for me to
really be under Amy'smentorship.

(07:21):
But at the same time, theHarvard Medical School had a
patient safety and qualityfellowship that I was able to do
during my third year ofPediatric Hematology Oncology
Fellow.
I also then was a fellow inquality and safety.
And that really opened out a lotof opportunities.
One, it let me understand thescience of quality and safety.

(07:42):
It allowed me to have a master'sin public health and really the
background, but also theexposure to a lot of people, a
lot of networking, and I thinkmost importantly, just gave me
time.
That was 80% of my time wasdedicated to learning about
quality and safety and thendoing projects in quality and
safety, which is really a prettyincredible blessing that most

(08:02):
people don't have because theydon't have 80% of their time
dedicated to learning or doingsomething except when you're in
your training.
And so after that, there weremany other opportunities that
have led to where I am today.
And so I am currently themedical director of quality and
safety at university hospitalsfor the hematology oncology

(08:24):
service line.
And that's both adult andpediatrics.
I had some leadershipopportunities previously at
Boston Children's and at DanaFarber, also on the adult and
pediatric side, and a lot of itreally is from Amy's mentorship.

SPEAKER_01 (08:38):
Well, that's a great uh on-ramp to to hearing Amy's
uh Amy's version of thebackstory.
And I I love that you've uh hadthat background and and sounds
like really uh you know pavedthe way in some sense, perhaps
for for other future uh uhpediatric hemonk fellows uh to
do quality and safety.
Amy, what would you add to that?

SPEAKER_02 (08:58):
Well, I will start with two thank yous.
One, Jason, thank you forputting together a podcast for
people interested in patientsafety and quality improvement,
because it always feels likeit's a little niche and then the
world doesn't know a heck of alot about it.
And two, Chris, thank you.
You can't know how exciting itwas for me to get to meet
someone as capable as you whoactually thought what I cared

(09:21):
about was exciting andwonderful, and you wanted to do
it too.
So it was just amazing, and youhave so taken off with every
opportunity you have ever beenoffered, and you've accomplished
so much.
So thanks.
So my version of the story isthat I never imagined I would
even become a clinician.
I went to medical school becauseI thought it was a good way to

(09:44):
learn how to be a laboratoryresearcher because you got all
this, you know, musicalknowledge.
And then when I was in medicalschool, I kind of said, no, I
kind of like patient care.
I actually kind of liked adultoncology until I did an adult
oncology rotation at Dana Farberand was just so devastated at
the outcomes.
And I said, Well, I had a lotmore fun in PEADS, so maybe I'll

(10:05):
do a PEEDS residency.
And then when I was an intern,everybody had one month on the
pediatric hemoglobin board, andI had three.
So I was getting pointed in adirection.
So going into pediatric hemogwas just pointed to me.
I did my clinical year, Idutifully went into the lab,
realized this is not the placefor me, and actually went to my

(10:28):
boss and said, I want out of thelab, I want to be a clinician.
And in retrospect, my careerkind of had three main phases in
my 30 plus years at Dana Forkfor children.
So I was a clinician slashclinical researcher for 10-ish
years, and I, you know,developed incredible clinical
knowledge, and you know, justbecause you had to, it was no

(10:48):
choice about it, ran clinicaltrials.
And then a number of thingshappened because life is filled
with serendipity.
So 1995, Dana Farber had a fatalchemotherapy overdose when Betsy
Lane, Boston World Reporter,received a what was it, fourfold
overdose of chemo.
You know, the good old is itfour times each day, or is it

(11:12):
once each day, times four?
Um and in that leadershipvacuuming that happened, I
suddenly found myself as theperson in charge of the
inpatient oncology service atBoston Children's.
And in that same general timeframe, Boston Children's was
first discovering clinicalpractice guidelines.
Every program had to have one.

(11:33):
And we spent nine months with, Ican't tell you how many people
trying to come up with aguideline for fever and
neutropenia.
And we mapped out every aspectof care, including how often the
biosign should be performedwhile the patient was in the ED.
So as a result of being on thisclinical practice guideline
committee, what I learned wasyou can actually improve patient

(11:55):
care not by improving the careto an individual patient, but by
changing the system in whichthat care was taking place.
And that was like a breakthroughfor me.
The light turns on, like, oh,you could actually change care.
So, and I think that was veryimportant to my own career.
And then going back to sort ofwhere I was as we had there had

(12:18):
been a Dana Farber chemotherapyoverdose that was very public.
There was another chemotherapyoverdose, which I will not
provide any details of, otherthan say the patient recovered
beautifully and had no long-termharm.
But I suddenly discovered I wasrunning a large project to
improve chemotherapy safety forthe pediatric oncology program.

(12:41):
I didn't know what a projectwas.
I didn't know how to run one, Iknew nothing.
But eventually, what we figuredout that handwritten paper
orders by individual fellowsthat were co-signed by
attendings was not an adequatebasis for chemotherapy safety.
So we designed and built apediatric chemotherapy order

(13:01):
entry system that could be usedat two different institutions at
the same time.
And we did this out of scratch.
So that ended up leading toanother 10 plus years focused on
clinical informatics, whichincluded Boston Children's
deciding to implement its firstcommercial electronic health
record, which at the time wasCERN, and making an agreement

(13:22):
between two separate hospitalsthat the pediatric program at
Dana Barber would use the sameelectronic health record as
children's.
But a lot of electronic healthrecord implementation is not,
it's all that pragmatic stuffthat Chris was talking about.
You got to make the systemactually do the things you want
it to do.
And but it was also, there's anincredible amount of patient

(13:44):
safety work that is built intothat.
So after 10 years of, you know,designing and building
chemotherapy order entry system,implementing electronic health
records, CERN or children's, I,in retrospect, was having an
every 10-year itch to change.
I was ready for my next phase,and that was coincident, you
know, good old serendipity, thatBoston Children's is also saying

(14:08):
that all programs need to have aleader for quality and safety.
And no one, our program wasvolunteering, and people would
say, Hey, Amy, you should go dothat.
So, you know, my usual self,Michael Volunteer.
And that led to really the next10 years focused on patient
safety and quality improvement.
Actually, at three differentinstitutions, because you know,

(14:31):
the outpatient and clinic forcancer care was at Dana Farber,
the radiation ontology was atBrigham and Women's Hospital,
and everything else was atBoston Children's and trying to
figure out how do you get thingsto work well across three
institutions with remarkably fewformal agreements and hardly any
shared systems, other thanthankfully the electronic health

(14:53):
record was quite challenging.
So that sort of led to the mythe you know my focus at Boston
Children's and Data Barber forabout 10 years of quality and
safety.
And during that time point,again, serendipitous moment, I
had been on the American Boardof Pediatrics PDHEMOC subboard.
And they would come tell us howthey were going to implement

(15:15):
this part four.
You had to do qualityimprovement or whatever they
called it.
And they would come to us andsay, we have a module for
nutrition, or we have a modulefor treating asthma.
And I'm like, you know, you'renever gonna get a pediatric
hemonk doctor interested intreating asthma or nourishing
babies.
That's just not what we do.
And so, of course, they invitedme to a meeting to create

(15:38):
national quality projects inpediatric hemog.
I had to, I found two otherhemonch docs who I didn't even
know personally, but others hadtold me about them who thought
they would be interested indoing that.
And so all of a sudden we foundthat we had created and were
running a national collaborativeto eliminate inpatient CLABS in

(15:59):
the pediatric hemoglobin.
And that, if you want to getsomething to call an
improvement, you know, everydoc, every nurse, everyone hates
the fact that our patients had,you know, these inpatient you
know, we didn't know thedifference between a CLABS and a
bacteremia.
We had thought they were thesame thing.
We learned a lot.
So it was an incredibleexperience to get this network
up and running, and it was very,you know, self-run, seat of the

(16:22):
pants learning.
I think there was one facultymember who actually had training
in hemonic, immunity quality andsafety, and he wasn't a hemonic
person.
The rest of us was all justseat-of-the-pants.
How do we make this happen?
What are we trying to do?
But it was really, reallyexciting.
What I can't even remember nowis how we then went from that to

(16:44):
outpatient collabsy, except aswe started to pay attention,
there were more outpatientcollabs every year than there
were inpatients.
We knew there was a big problem.
But I realized I'm getting aheadof myself because the bottom
line was as I hit my next tenureitch, I realized I had never
applied for a job in my adultlife.

(17:04):
I had applied for a job at ajewelry factory the summer after
I graduated from high school,but other than that, I had just
went right along.
So I decided it was time toapply for a job in my adult
life.
And I applied for a job andbecame the chief, the first
chief pediatric quality safetyofficer at the Morris Children's
Hospital in Woman, Delaware.

(17:24):
Happened to be, oops, I startedtwo weeks before the world shut
down with the pandemic, so itwas a bit more of a challenging
job, but it allowed me to reallyfocus on quality and safety
until I realized I'm getting tooold for this and I don't want to
live in a different state thanmy husband.
So I came home to Massachusettsand had to quit my job as a
result.
So here I am in the happy phasesof retirement.

SPEAKER_01 (17:48):
Well, congratulations on the beginning
of the happy phase ofretirement.
That gives a great segue intothe work that I think will be
the bulk of our discussiontoday.
You mentioned the you know thecentral line associated
bloodstream infections orso-called CLABC that will be
familiar to a lot of ourlisteners.
And uh, you know, you've alreadygiven some of that background as

(18:09):
to how that came to be.
I'm curious, Chris, if you cangive us a little more background
as to how you uh joined thiswork in uh in CLABSY.

SPEAKER_00 (18:19):
Yeah, sure.
So again, a lot of the work wasreally just Amy presenting
opportunities, and there wasthis was sort of falling into my
lap.
And so I think the first thingthat had occurred is that there
was a lot of attention ofinpatient CLABSI.
We all know that there was anincredible risk of morbidity and
mortality for our patientpopulation, because despite the

(18:41):
fact that maybe some infectionswould not be classified as a
CLABSI, our patients were stillbeing admitted to the hospital,
potentially stoppingchemotherapy for a period of
time and were ill sometimes fromthese infections.
So the classification, yes, it'simportant, but at the same time,
clinically, for us, anybloodstream infection was
important.
And we realized that some ofthem were happening on the

(19:03):
ambulatory side.
And as Amy mentioned, there werefar more happening.
I think when we looked back oneyear, there were somewhere
between 20 to 30 that wereoccurring per year in our
hospital setting.
And of course, we were at BostonChildren's Hospital, which is
serves a large population ofpediatric oncology patients and
those with hematologicaldisorders as well.

(19:24):
But it that's a very largenumber for children, right?
Like 20 to 30 was incredible.
And so we didn't know reallywhat the impact was.
Is that there was a lot of workon trying to understand what's
the cost associated withinpatient CLABC, what is the
morbidity associated with that.
And so the first thing that weneeded to understand is how big
was the problem.

(19:45):
And so Amy had come up with thisidea of trying to understand
first really how much does itimpact our patients in a
tangible way.
And so we were able to look backretrospectively over two years
at the infections that hadoccurred in our hospital
setting, in our patientpopulation.
And it turned out that therewere about 70 of these

(20:06):
infections or so.
And the charges that wereassociated with these infections
were about$36,000.
If you were only admitted to thehospital for just the treatment
of the infection, if you werethen receiving care for your
cancer diagnosis or part of theother care that you were

(20:27):
supposed to be receiving in theambulatory setting was now
translated into the inpatientsetting, obviously, those
charges were even more.
And these then hospitaladmissions were associated with
a length of stay of about sixdays.
And they let these childrenactually, some of them obviously
ended up going into theintensive care unit.
I think it was about 15% of thepatients ended up going into the

(20:49):
intensive care unit, and about50% of those actually needed
central venous catheter removal.
So it was very tangible thatthis was a problem, that no one
was looking into it.
But then how would we convinceothers that we needed to work on
it?
And so then we were able topresent some of this information
to others, to otherstakeholders, to really get them

(21:11):
invested into doing this becausewe realized we needed some
resources to be able to do this.
A lot of the work again wasfocused on the inpatient CLAB C.
A lot of the benchmarkingexisted only for inpatient CLAB
C.
So all of that needed to beestablished.
And so Amy and others had donesome of the work on this, and
she can speak a little bit moreabout this.

(21:32):
But how I became involved whenwas that again, I had time.
I had time to do this.
I had 80% of my time as a fellowto do this, and Amy did not.
She had many hats that sheneeded to pay a lot more
attention to.
And I needed a project, I neededa career, I needed a niche.
And this was really the babythat she had been really

(21:54):
hatching for a period of time,but then gave me the opportunity
to grow it.

SPEAKER_01 (21:59):
And she didn't know.
It's great.
I can hear the organic evolutionof that uh of that partnership.
Sorry, Amy, go ahead.

SPEAKER_02 (22:06):
Well, I was gonna say, and you know, Chris really
took it and ran.
But you know, again, you know,serendipity has such an amazing
impact.
So um Atul Gwande had startedhis Ariadne labs, and they would
have weekly speakers that we Iwould go to and I would listen
and like you know, blow yourmind, people who think

(22:28):
creatively about things, and youlearn, you know, you have to
think outside the standard path.
So there was an incredibleopportunity there, and I don't
even know how I don't know.
I said, well, maybe I should youknow ask if I can talk about
ambulatory collabsy and see whatpeople come up with as ideas

(22:48):
because it seemed to me like itwas something we needed to
figure out.
So I didn't have an officialtalk, but I got to do the little
presentation at their end of theyear, you know, big
get-together.
And I also got some feedbackfrom people, which was helpful.
But there was a donor forAriadne Labs who listened to
this and said, Well, I want tohelp solve this problem.

(23:08):
It just spoke to her in someway.
As I think it really resonatedwith her as a mother who
remembered her child in thehospital, you know, I don't
remember all the details.
So we ended up with a donor whowanted to help with this work.
And at the same time, BostonChildren's was working with the
three main payers in the area ona payer provider improvement

(23:33):
initiatives, and they wereoffering funding.
And Chris helped us.
We broke this a grant proposalbasically, and they funded us.
So now we had funding sources,we had people we had to report
to, you know, they're like beingheld accountable for what we
were doing, which is always avery good thing, as well as each
of us being our pragmatic.

(23:54):
Well, how do we solve thisproblem?
What do we do?
So that's kind of was like howit really kicked off.
And Chris, I don't even rememberhow we came up with the idea
that we had to have patients andtheir families as part of this
team, not recipients of ourimprovements, but making the

(24:14):
improvements with us.
Do you remember Chris?

SPEAKER_00 (24:18):
Yeah, some of it was organic.
So there were two patient familyadvocates that were participants
in inpatient CLABSY.
And I think, again, this speaksto sort of how Amy thought about
the domains of quality of Oversebeing patient-centered, that as
part of these, despite the factthat in these meetings we would
discuss the infections, what hadgone wrong, they were active

(24:39):
participants in all of theseconversations during our CLABSY
prevention committee, whichmostly was inpatient CLABSY.
And so then as ambulatory CLABSstarted to evolve, we started
asking really these two familymembers that had had children
with a cancer diagnosis and whohad had a central venous
catheter, these were notcatheters that they were caring

(25:02):
for every single day, but stillthey were there, right?
There was the risk of infection,and they knew that they watched
other people, especially nursestaking care of the central line.
So they understood the riskassociated with a central venous
catheter.
And so when we sort of talked alittle bit about the idea of
doing ambulatory CLAB Cprevention, it really was a

(25:25):
joint decision to really focuson the home caregivers and to
have them as active participantsbecause we realized that they
needed to be key stakeholders.
At that point, I was not amother.
I was barely an oncologist.
I knew nothing really aboutpediatric, hematology, oncology
care in the home or taking careof the central line.
I was not a nurse.

(25:45):
And so I think we really neededthe front line.
And the front line was just notonly the nurses, it was the home
caregivers.
And so we had no idea how toteach non-clinically people to
take care of a medical device,do a complex medical task at
home, and how best to do it,then really to work with them to

(26:07):
design a quality improvementproject.

SPEAKER_01 (26:09):
Well, and you did something so well there, it
sounds like that that wesometimes, we often I think fail
to do when we're attemptingquality improvement uh efforts
in healthcare, which isinvolving families uh from the
start and co-designing with themrather than designing for them
from afar and dispensing asolution that we think will

(26:29):
work.
As I'm hearing this, I also amreminded that when we're
launching into qualityimprovement projects like this,
one of the things we do atfirst, beyond establishing which
stakeholders we're going toinclude, is deciding what is in
scope, what's out of scope, andbasing that often on what
factors we control.
This work, I guess, would haveinvolved many factors outside of

(26:53):
clinician control, you know,families, uh supplies, home
environments.
Was that a daunting challenge atfirst?

SPEAKER_00 (27:01):
It was incredibly daunting, especially because, as
you very well said, we had nocontrol over all of it.
And so the way that many of thethings happen at Boston
Children's in Dana Farber is sothe pediatric patients, when
they're in the hospital, theyare at Boston Children's, where
they're outside of the hospital,they get their ambulatory care
at Dana Farber.
And then in the home, they mayhave many, many different home

(27:26):
care institutions that wouldprovide care in the home, which
was great because we were movingmore to administering
chemotherapy in the home ordoing antibiotics in the home.
But these were all externalvendors, right?
That we had no control overwhatsoever.
And then, of course, you takenow all of these home care
givers and the many socialdeterminants of health, of which

(27:48):
we had very little control over,some families that are made up
of many different people ofvillages.
And how do we actually startidentifying who are really the
true stakeholders?
And so that's exactly why weneeded the caregivers to be
co-designing this with usbecause we had no idea what we
were doing.
We had really no way ofapproaching this.

(28:10):
And so it wasn't just the homecaregivers that co-designed this
with us.
We had, for example, a homenurse that was part of these
home agencies that providedcare.
They also were part of theco-design as well.
We had ambulatory nursechampions that would help us
co-design this as well.
We had infection preventioniststhat would help us think through

(28:31):
this.
It was such an interdisciplinarywork that needed to occur
because Amy having herexpertise, me just learning this
expertise.
Obviously, we were trying tolead the charge, but needed the
perspective from so many morepeople.

SPEAKER_02 (28:45):
And I would add to that, there were a couple other
key members of the team, whichis we thought when you were
focused on ambularic calamityprevention, it was really an
outpatient effort.
It turns out, oh, inpatient iscritical because who was doing
the teaching about Lyme careprior to discharge are the home

(29:06):
care nurses.
I mean the hospital nurses.
Turns out we also learned thatthere was no standard teaching
curriculum.
Everybody did it their own way.
I mean, it's the usual completelack of standardization.
But there is no way to work onangulatory collabsy prevention
without full engagement ofinpatient.
Um, we also had to make sure thephysicians were infinitely more

(29:29):
aware of and involved in makingit do it.
But the other person who we hadwas, you know, everybody knows
about Updulande and thechecklists.
Well, we had his quote checklistengineer.
And the great thing about hischecklist engineer is he's not
an insider of healthcare.
He just reads the words andsays, Does this make any sense?

(29:51):
How do you make it clear?
Which is when you start torealize that there is the
dressing, there's the bandage,there's I mean, there are five.
Five different words for all ofthe same things.
And also things like, well, inthe hospital, they teach you by
saying, pick up the blue capwith the red whatever.

(30:12):
Well, the home care kit doesn'tlook anything like the hospital
kit.
So having someone outside us whohelped us understand how to
create consistent, simple, easyto understand language.
And then I remember as we gotinput from patients, we don't
want real videos, we wantcartoons.
But if you show us a picture ofa real person, we start to think

(30:33):
about the person, not what we'relearning.
You know, there are all theseincredible things that we learn
because the broader the teamwas, the more you learn.
And then I remember the homecare nurses had seen some
previous teaching videos we'dmade, and they said, You think
it looks like that in apatient's home?
You know, patient homes aren'tfilled with beautiful, clean,

(30:55):
white, sterile drawers that arecleaned daily by someone and
stuck daily by someone.
You just kind of learn.
Like reality has nothing to dowith what you think.

SPEAKER_01 (31:07):
That's that's so true.
And the the fact that thehospital and the home are so
deeply connected is not at allsurprising.
And yet I can imagine howsurprising it might be within
the context of the project thatyou suddenly have this light
bulb moment that this is uh, youknow, everything we're doing in
the hospital, you know, isn'tstandardized and could benefit

(31:28):
from.
Chris, I'm hoping you can tellme more about how you created
the teaching materials for thecurriculum.

SPEAKER_02 (31:34):
Well, Chris, I'm gonna let you talk about how we
created the teaching materialsfor the curriculum.

SPEAKER_00 (31:40):
Yeah, sure.
So we um we, as Amy mentioned,we worked with this checklist
engineer, and all of theseprototypes started with me
drawing something.
And again, you know,hematologists, oncologists
trying to design care in thehome.
And so we were very cognizant tohave the patients always have a

(32:02):
voice.
And so we would bring it to thepatients, have them look at it,
and there would be, yeah, look,it looks fine, we can use it.
But there were examples ofthings that I would have never
known, again, because I wasn'tcaring for a patient in the
home, one of which was the factthat things were not waterproof.
And so you're expected to washyour hands and then dry your

(32:24):
hands and then move thiscognitive aid or this tool that
you're utilizing to follow thesteps to provide central line
care in the home in astandardized way.
But then every time you use it,it's going to get wet and it's
going to get completelydestroyed and things that we
would never even think about.
Very similarly, the fact thatyou needed to, for example, turn

(32:45):
the page when you were supposedto be sterile.
How are you supposed to do that?
As opposed to having all thediagrams in one page where you
could easily access it and itwould be more visual rather than
reading all of these words.
And so the checklist engineerhelped us to design several
tools.
One of the tools, which wecalled the quick aid, really was

(33:06):
in one page, you could see everysingle step that you needed to
do for each one of the tasks.
And so, as an example, we wantedto standardize how families in
the home were flushing thecentral line, which is the most
common thing that patients wouldhave to do on a daily basis.
Every single day, the patientsin the families that had an
external central venous catheterneeded to maintain this line by

(33:29):
flushing the central line.
And of course, that presented anopportunity that every time that
the line was being cared for, itis an opportunity that bacteria
or any sort of microorganismwould go then into the
bloodstream and cause one ofthese infections.
And so we knew that it needed tobe standardized, but how do we
again sort of close that no-dewgap?

(33:51):
And so these cognitive aids thatwere created with the checklist
engineer were very visuallyappealing, but they took many
iterations.
And so we again would take themback to the patients, the
patients that were caring forthe line.
We would give them sort of thesepilot tools, take it home, see
how it works, and they wouldprovide feedback back to us that

(34:11):
then the checklist engineerwould restructure it until we
had a final product.
And so the most utilized one wasthat quick guide, which sort of
was like a flashcard with a ringattached, which you would always
just have the two sides facingeach other for the test that you
needed without ever having totouch it.
And there was there was a largerone, which was utilized more in

(34:34):
the hospital setting as thenurses were teaching the
patients and the and the homecare versus home care givers how
to take care of the centralline.
Because what we realized wasalso that we needed to
standardize the trainers.
The trainers were reallyincredible.
They were doing careappropriately, but everyone had
their little nicks of how theywould do things.

(34:56):
Maybe sing this song for 30seconds while you're flushing
the line, and that song couldvary and could be 45 seconds for
some people, it could be fiveseconds for the other person.
And so, how do we standardizethat for the trainers as well,
which were really mostly thenurses?
And so we utilized this othercognitive aid, which was bigger,
also just one page ofillustrations where they could

(35:17):
use it for caring for the line,really prompting them to do the
steps as they should, but alsoteaching the family in the way
that we wanted it to be done inthe home.

SPEAKER_01 (35:28):
So it sounds like you benefited a whole lot from
methodologically from thiscollaboration with our Yadni
Labs and this checklist uhengineer.
One thing that occurs to me isthere must have been some a lot
of real life challenges.
And I wonder if if there wereany challenges related to
equity, how you deliver thisclear teachback process to

(35:50):
people with different levels ofhealth literacy, with different
primary language.
How did that factor into thework?

SPEAKER_02 (35:56):
Well, I want to go back to our donor who at the
very beginning, our donor saidto us, How do you know everyone
has materials in their home thatthey can create a clean surface?
So she made us think aboutequity at the very, very
beginning.
And so part of what we did is inaddition to your more standard

(36:19):
health care supplies, we usedsome of the funding she provided
to have a what the, I can'tremember what we called it.
It was basically a paper bagfilled with things you use to
clean.
And we didn't try to guess whoneeds this and who doesn't need
it.
We grade it uniformly toeverybody.
So she kind of pointed us in agood direction at the very
beginning.
Um, and the other thing that wassort of nice about all these

(36:42):
teaching materials, weeventually ended up having them
what, Spanish and Arabic, whichwere our two dominant
non-English languages at thattime.
So we didn't even know what theysaid, but thankfully, well,
Chris knew what the ones inSpanish said, but neither of us
knew what the ones in Arabicsaid, but we compare.
So we did do that as part ofthis work.

(37:04):
And then related, it's not justhealth equity.
It's have you ever been in asituation where you're learning
to do something for the firsttime and you're doing it on your
child?
We had one practice mannequin sothat you didn't have to just
practice on your child becausethat was awfully scary.
But the other thing is, youknow, you've studied it in the

(37:24):
hospital, you've practiced it,but now you're home, right?
It's kind of scary and verydifferent.
So the other thing we did tosupport families, and this is
all families, it didn't haveanything to do with anything
else, was there was what wascalled a teachback that would
happen in the clinic.
And it was a great idea.
And initially, all of ourattempts completely failed to

(37:45):
even do the teachbacks.
And we realized it's because thevery language we used when
talking about this to patientsand families, people felt
incredibly judged and scaredthey were gonna be considered
failures.
Um, and we ended up having topractice the language by which
we were really asking them tohelp us make sure we were doing

(38:06):
a good job teaching thesecomplicated skills.
And Chris, I don't remember whatelse we did, but we had to do
all this work to just be able toengage people in this.
But then we had this phenomenalnurse in the clinic, who, thanks
to our funding, we couldactually support some of her
time, who did most of theteachbacks.
And she learned from, again,from the families, what was hard

(38:26):
in the home that was and whatwas different, as well as if
people needed more support,especially, you know, maybe mom
was taught in the hospital, butit's grandma who's doing a lot
of the care at home, things likethat.
So the clinic teachback was anincredible part of the program
that I think in some waysleveled the playing field
because it gave us much morecontent about what was working

(38:48):
and what wasn't working forindividual patients, that then
the teaching could be even moresupportive at the areas where
they were struggling.
Chris, what would you add tothat?

SPEAKER_00 (38:59):
I would say that we mostly normalized having to do a
teachback in the clinic.
It was an expectation in thesame way that we expected every
family to be able to demonstratecorrect line care prior to going
to the hospital.
We then normalized it so thatwhen you came into the clinic
anywhere from your first to yoursecond ambulatory clinic visit,

(39:22):
it was really an expectationthat you would perform central
line care with one of our nursechampions.
And so, as Amy said, we neededto really change how we
approached this because Iremember there were two families
as I was walking in clinic, andone mother told the other one,
Are you ready for your centralline test today?
And that, I mean, she had noidea that I was one of the

(39:46):
people involved in this.
And obviously that struck me.
And then I went back to the teamand said, We need to do
something about this, becauseobviously it cannot be a test.
And if this is being interpretedthis way, we're never going to
have any engagement whatsoeverand can affect obviously our
patients so differently.
And so we worked very closelythen with the with the patient

(40:10):
family advocates to reallyunderstand what the language
would be that would be mostappropriate of how we would
normalize this, that would thiswas expected as their routine
care, that it was going to beembedded into their routine
care.
And ideally, if we had theopportunity, then we would go to
the home as well to be able tosupport them.
To your point, Jason, I thinkthose brought some complexities,

(40:32):
right?
Because it's hard to welcome astranger into a home where
you're performing complexmedical tasks with the many
other complexities that go intohome care.
And so it was it waschallenging, I would say, to
then go into the home of some ofthe patients to really observe
central line care for many,many, many reasons.

(40:55):
I think the other thing that wealso learned is that some
teenagers were caring for theirown central line, and we had not
accounted for that either.
And we needed, again, to developsome language that would help
engage these teenagers,sometimes even before more like
preteens, who were very capable.
But how do we engage them inagain being trained in a complex

(41:17):
medical task when they're notclinicians in any way?
And so it really went back toworking with our stakeholders,
working really with the patientsand the home caregivers to see
how do we develop language thatreally engages families into
doing the work together.

SPEAKER_01 (41:35):
Yeah.
It sounds like you had a lot ofa lot of important hurdles to
overcome.
And I imagine, you know,succeeded in overcoming a lot of
these.
Can you tell me a little aboutthe results of this work?
What was the, what were kind ofthe final bottom line numbers
here?

SPEAKER_00 (41:51):
So we measured different things.
The first thing that we wantedto measure was the percentage of
families and mostly onecaregiver.
We focused on the primarycaregiver in the home, which
could be either the own patient,if it was a preteen or a
teenager that wanted to care fortheir own central line or a home
caregiver, and whether theycould be independent in central
line care.

(42:11):
And we had a standardized way ofassessing that.
And what we determined was thatif you were performing central
line care during one of theseteachbacks and you need a no
prompt from one of our nursechampions, then that meant that
you were independent.
And so we were able to achievemore than 90% of home caregivers
being independent with centralline care.

(42:33):
That had never happened before.
No one had documented this orattempted this before.
And it was the first time thatwe were utilizing a standardized
curriculum to have familieslearn how to perform a complex
medical task at home, but thenalso be proficient in that,
demonstrate that they areproficient in it.
And then what we wantedobviously was that was our

(42:54):
process measure.
We wanted that to be tied to anoutcome measure, and that was
the ambulatory collabsy rate.
And so we demonstrated about a50% reduction in ambulatory
collabsy rate, and that was doneover about five years or so.
And we know that probably thattook a period of time because
although the denominator can bequite large, the numerator is

(43:16):
actually quite small, and so therate was very small.
And so, in order to have somestatistical significance, it was
going to take a large sample andtherefore a significant amount
of time.
And so we saw about a 50%reduction in ambulatory CLABSE,
which again, there hasn't been alot of work that has
concentrated in the ambulatorysetting, especially not in
ambulatory CLABSE.
And to be able to do this withthe focus mostly being on home

(43:39):
caregivers was really anincredible opportunity.

SPEAKER_01 (43:42):
Wow.
A 50% reduction.
I mean, that's that's trulyremarkable.
Congratulations.
Amy, in um in a 2016 article,uh, you were quoted, uh, if I
can just share a quote, yousaid, at a time when many
aspects of care are beingshifted to the home and of
heightened attention to safetyand costs, this is the new
frontier.

(44:03):
Uh, what we learn aboutpreventing outpatient
bloodstream infections in thesepatients could have broad
relevance.
Nine years later, where have weseen this new frontier explored?
And uh where do you think thelessons from your work are most
relevant today?

SPEAKER_02 (44:18):
It's a great question that I will confess
that as a retired person, Idon't keep up with the medical
literature.
So Chris may have things to addthat I don't know.
But I was always struck thatevery time I did a lit search
for anything related to qualityor safety, 99% of everything was

(44:42):
about inpatient.
And then I start to see a littletrickle of, oh, maybe someone
tried to do something in theclinic.
And that's it.
There's a lot of improvementthat has happened in emergency
rooms.
But in a lot of ways, those arelike a busy inpatient unit
there, you know.
So, but you know, people haddone so little in a setting that

(45:04):
looked anywhere outside thehospital.
And obviously, big bad thingshappen in hospitals, but on a
practical level, a lot morehappens in the home.
And so I was really excited whenSolutions for Patient Safety,
which is the big nationalpediatric safety collaborative,
actually, after many years said,you know, this angulatory classy

(45:25):
thing, that'd be a really goodthing to work on.
Let's start getting our teamsorganized around that.
And Chris, you can probablyprovide some updates on, you
know, how that work has orhasn't progressed.
And similarly, during one oftheir national learning
sessions, they were veryinterested in you know, when I
was at Nemours presenting on themany different things that were

(45:47):
being done in the outpatientsetting, including like how do
you get to make sure that's theright patient who's checked in
for the appointment?
Because, you know, there arelittle things like that, but if
you don't do that, boom,everything is gonna go wrong
from there.
Or some of the work that wasdone on preventing falls in the
outpatient setting and how theyengage the whole clinic.

(46:10):
In you know, you can't sit thepatient on the counter while
you're checking in and oh, yourshoelaces are on pie, let me
help you get them.
But all these little things thatpeople just weren't really
thinking about.
So I'm hoping Chris is going totell me about all the wonderful
new things that are happening inoutpatient or home, not even

(46:31):
outpatient, but home-based,although I fear she is not.

SPEAKER_00 (46:40):
So I think mostly the thing to highlight is the
work that Solutions for PatientSafety has been doing.
And so um they were able togather a number of different
leaders that have collectivelyworked on this to try to focus
again on ambulatory collapsingprevention, very similarly to
how we did it at BostonChildren, but at a larger
setting, mostly at a nationalsetting and some internationally

(47:03):
as well.
And so the idea was really tohave the home caregivers being
the main stakeholder again, sothat instead of necessarily
providing a script of how to dothings, it's really to learn
from them, having learningconversations about how it is
that we are training caregiversto go into the home and then
take the next step after that.

(47:25):
So they have some preliminarypilot cohort that they're
working on.
Some of those results are notavailable yet.
But I think the most importantthing is that a lot of the work
is concentrated on preventingambulatory collapsy in the
outpatient setting.
And it's being done nownationally or internationally,
if you will, which has not beenhappening, obviously, in the

(47:48):
last decade or so.
So incredible progress that hasbeen done.
I think the other main point toyour question, Jason, is how do
we apply this really to otherareas?
And so we know that in pediatriconcology, we know that our
patients go home with verycomplex medical regimens for

(48:08):
medications, sometimes 10 to 15medications that they have to
take.
And unfortunately, the systemsthat we have in place do not
support home medication safety.
And so, if we can learn to adaptsome of the things that we
learned from ambulatory CLABS,meaning how do we co-design
interventions with homecaregivers?

(48:29):
How do we measure improvementsin other areas that occur in the
home?
And how do we teach really, orhow do we support how to do how
do we perform complex medicaltests in the home to prevent
things like medication errors?
Then that would be the goal, isreally to scale and spread the
work.
And so there is a lot of workthat is being done there.

(48:50):
I think it's a little bit harderto measure because ambulatory
collapses obviously they comeinto the hospital always
whenever there is an infection.
When you have an error inmedication, that may lead to a
problem, but it may not.
And so it's very hard to measurethat.
And I think that is where we areneeding to spend the majority of
our energy is really tounderstand how to measure

(49:11):
because you can't improve whatyou can't measure, obviously.

SPEAKER_01 (49:15):
Given the desire to spread this work further and to
have impact in areas both withinand outside uh ambulatory CLABC,
what advice would you give tohospitals who want to launch
their own family-centeredambulatory CLABC or other uh
ambulatory safety projects thatuh, you know, maybe an
organization that wants to dothis but doesn't know where to

(49:37):
start?

SPEAKER_00 (49:38):
I think most importantly is really working
with the right stakeholders.
I really cannot put enoughemphasis on the importance of us
working with the families andthe patients.
I mean, there were teenagersagain that would give us
feedback as a teenager would do,right?
And it was great because that'swhat's happening in the home.
And so we, as you said earlieron, Jason, we think we assume

(50:02):
what is happening in the home.
We assume how we can best designcare in the home, but we have no
idea.
And so I think the partnershipof doing that taught us some
incredible lessons.
Most importantly, is that weneed to be there with them and
let them really design theseinterventions as much as

(50:24):
possible, obviously with thesupport and the expertise that
others can provide, but itreally has to come from the
voices of the patients andfamilies because they are the
ones that are experiencing allof these different complex
situations.

SPEAKER_02 (50:36):
If I can add to that, I think what systems,
hospitals, institutions can dois one, they don't already have
a patient-family advisorycouncil, you know, get one.
In fact, encourage as manyspecialty programs within their
hospital to have their own.

(50:59):
Get over the, oh, we can't tellpatients and families the truth.
If you can't be transparent, youcan't do this work, right?
And because otherwise you can'treally get good input in solving
problems if you can't includethe patient and the family and
what those problems are.
So I think those are two reallyimportant institutional lessons.

(51:20):
And uh, you know, yeah, we'rewe're very peaky in our
approach, obviously.
But you know, for example, thechildren's hospital in Hartford,
Connecticut has one of the bestapproaches to patient family
advisory councils, and they sendthe chair of their big council
for national training, then theydo train the training, they
support programs like that inevery part of their whole

(51:42):
hospital.
I think that goes light years toeven creating the atmosphere in
which patient safety work cantake place and is critical if
you're gonna try to do it in theoutpatient setting.
And I just have to give a plugagain for medication safety.
Only so many people have acentral line at home, right?
It's a pretty small numbercompared to all patients out

(52:04):
there.
I would love if people can thinkabout what you can possibly
measure for home medicationsafety that could allow really
that work to proceed forwardbecause there are so many
patients of many sorts who havevery complex home medication
regimens.

(52:25):
And, you know, I heard of onehospital where they actually
looked at their patients ontheir most complex regimens, and
then they would have apharmacist get involved to try
to make their regimens lesscomplex.
Well, that's great.
But they're still going to beleft with patients on complex
home medication regimens, andhow do you make that safer for
them?
And even what proxy measuresthat we could come up with,

(52:48):
including, you know, simplequestions like do families under
I say families, patients andfamilies understand what their
medications are?
Can they report how they'regiving them in some way that's
relatively accurate?
You know, or is it normalizedthat you can actually ask a
patient medication historywithout saying the way I used to

(53:09):
do it, which is I would read alist of meds aloud to the mom
and say, this is what your childis taking, isn't it?
As compared to, wow, it must bereally hard to give your child
their medications.
What do you actually do?
How does it work?
What do you do when you screwup?
Because I would certainly screwup.
You know, things like that thatwould go light years, I think,
to thinking about homemedication safety, which affects

(53:31):
so many patients, adult andpediatric.

SPEAKER_01 (53:34):
I think Chris mentioned earlier the size of
the denominator and thenumerator with the the collabsy
work.
I mean, what you're talkingabout with the medication safety
at home is so much bigger of adenominator than you know than
the relatively smaller size ofthe number of people with the
central line.
So that would be uh, you know,an area ripe for improvement.

(53:55):
If this work flourishes, if thistype of work flourishes in the
next five years, what doeshealthcare look like for
pediatric hemonk or pediatriccare generally?

SPEAKER_00 (54:06):
I think it goes beyond just pediatrics.
I mean, I think there's so muchscalability beyond just the
pediatric world, certainlybeyond pediatric oncology.
But if if you think about it, ifwe could prevent errors and I
classify errors as anycomplication that can occur in
the ambulatory setting as carethat is not provided as

(54:27):
intended, that could lead withto some incredible improvements
in the inpatient setting, whichpeople obviously have so much
interest in, right?
If we think about readmissions,for example, there are so many
things that potentially lead toreadmissions because our
communications are not great,because errors occur in the
outpatient setting, becausepatients, for example, we have

(54:49):
many patients that have thesedevices in the ambulatory
setting that malfunction, andthe only way that you could get
it to function is by going tothe emergency department.
And so that clogs up theemergency department, obviously
leads to a readmission.
And so if we could link thehospital care to the ambulatory
setting, and especially in thehome, and really then provide

(55:13):
the capabilities for the systemto work in the ambulatory
setting, how much more impactcould we have than for the
inpatient setting, freeing upbeds, freeing up the emergency
department, and then allowingother resources to be utilized
in the appropriate ways?

SPEAKER_01 (55:29):
Anything to add there, Amy?

SPEAKER_02 (55:31):
Well, I was just thinking, for example, could we
improve outcome for solid organtransplant by getting people to
give their medications asintended in the home?
And also that means theproviders have to do their part
of making sure the clarity ofwhat medications their patients
are supposed to be on.
You know, talk about thingsdoses go up and down, but

(55:53):
patients, you know, can wereduce the rejection rate?
Can we prevent hospitalizationsfor complications?
I mean, there are so many areasof, you know, and I'm sure, you
know, so many adult patientswith complex medical conditions
who are on these crazy homemedication regimens.
So how do we actually make thathappen?

(56:14):
I think is challenging.
And I think we need some reallycreative approaches to what we
can measure, what are the proxymeasures that will help us?
And you know, if someone's a lotsmarter than me at big data, you
know, looking at emergency roomvisits or medication overdoses,
you know, could you look at thatin a very global way, even

(56:36):
though your interventions aregoing to be in a very local way?
I don't know.
Those are my big thoughts.
Get to figure out how you woulddo them.

SPEAKER_01 (56:44):
That call to action and hopefully inspiring uh
someone listening to pursue thatwork is a great place to round
out the conversation today.
Dr.
Chris Wong, Dr.
Amy Abillet, I really appreciateyou coming on the podcast today
for sharing your story in insuch beautiful detail and uh
also with such striking results.
So thank you for sharing that.
For listeners who'd like tofollow your work or connect with

(57:08):
you, where is the best place?
LinkedIn or your your website orsome other way?

SPEAKER_00 (57:13):
Yeah, mine for an example would be LinkedIn, and
then at the University Hospitalswebpage as well, you can find my
profile as well, and and you canemail me at any point.

SPEAKER_01 (57:24):
And Amy, how about you now?
Entered into retirement, is iteasy to to uh connect with you?

SPEAKER_02 (57:30):
Actually, I still have my LinkedIn profile, so
that is definitely there.
And I enjoy mentoring.
So I'm more than happy whensomeone reaches out for
mentoring.
That's actually one of my mostthat's the most rewarding thing
I've ever done.
And Chris will be a lovelyexample.
But just I I love to mentorpeople and to help them think
about how they can, you know, dostuff.

(57:51):
In fact, I'm gonna get to mentorsome people in quality
improvement through the AmericanSociety of Kematology this
coming year.
So feel free to use my LinkedInprofile.
I might not respond immediately,but I will respond.

SPEAKER_01 (58:04):
Very good.
And they'd be uh they'd bebetter off for it.
Um I can see the mentorshiprelationship has been uh
mutually beneficial and producedsome great work.
We'll we'll link to thoseresources and uh your contacts
through LinkedIn in the shownotes.
Again, Dr.
uh Dr.
Billet, Dr.
Wong, thank you so much forjoining me and for for sharing

(58:25):
uh how you make care safer, uh,not just inside hospitals, but
in the places where familiesactually live their lives.
Thank you so much.
Thank you.
Thanks so much for listening totoday's episode of Leading
Quality.
If you enjoyed the show, pleasetake a moment to like,
subscribe, and share it withsomeone who might find it
useful.

(58:45):
You can find all our episodes atleadingquality.bugsprout.com or
in your favorite podcast app.
The show is written and hostedby me, Jason Meadows, edited by
Milan Milostafievich, andproduced by Thrive Healthcare
Improvement.
See you next time.