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Q&A with St. Luke's new chief quality officer
Chief medical officer and executive vice president at Golden, CO-based HealthGrades, Samantha Collier, MD, MBA, is changing hats and moving inhouse. In September, Collier took the position of vice president and system chief quality officer at St. Luke's Health System. Hospital Peer Review asked her opinion on the field of QI with her unique background.
Q: What did you learn about quality of care and quality improvement being a part of HealthGrades?
I had the opportunity to work with hundreds of hospitals. I learned that there is a growing divide between the belief that your organization delivers the highest-quality care and the objective results that demonstrate great quality. A recent survey showed that most hospital executives and board members believe their organization has top quality, yet numerous studies demonstrate this is not the case.
It's hard for physicians, nurses, and administrators to embrace quality gaps because we know lives are at stake. However, I learned that better is possible and that the best face their biggest gaps head on with courage and humility.
The most important quality role model is the CEO. The CEO sets the tone and the pace of organizational acceptance and change. I always ask one question of CEOs to predict the organizational capability for rapid change and meaningful quality improvement who do you believe is the most accountable person for quality in your organization? If the CEO names themself, then I know this organization is on the path from good to great. If the CEO names someone else, then it's likely the status quo will remain.
Q: What will your priorities be at St. Luke's? Both specific and conceptual.
As the system chief quality officer (CQO), I am responsible for ensuring that St. Luke's does not have a gap between its reputation for high quality and its actual quality results.
Specific goals and targets will be determined after a full gap analysis is performed.
Q: What do you think are the most important skills a QI director should have? And how in today's health care system, can QI directors "make their mark"?
The most important skill a QI director should have is being able to execute on plans and staying focused on achieving those milestones and goals. Many QI directors spend too much time collecting, scrubbing, and sorting data. Too little time is spent using this data to guide the execution of performance improvement.
QI directors can "make their mark" if they work confidently and collaboratively with key stakeholders to develop the right quality goals and metrics and then stay focused on achieving these goals through diligent execution. There is no success without execution. The QI director can take the lead in this area and really stand out.
Q: I read St. Luke's just was awarded the VHA's leadership award for clinical excellence based on patient care in four clinical areas: heart attack, heart failure, pneumonia, and surgical infection prevention. Why do you think the hospital received the award? Any specific initiatives on improving quality that you can point to?
St. Luke's is proud of its many accomplishments, and the VHA award is just one of them. As with most hospitals and health systems, there are many key quality and safety initiatives that have been successful and some that are not so successful. I believe that St. Luke's was awarded for their successes and that the executives and staff balance this well-deserved recognition with the need for better. We don't get it right all the time. A big reason I joined the organization is that St. Luke's does believe in better and the staff bring courage and humility to their quality improvement and view of their performance.
Q. How do you think your background will help you in your role as chief quality officer? Does it help to have a clinical background?
I don't know how one would be successful as a CQO without a strong clinical background. Certainly my status as an actively practicing hospitalist provides me with both up-to-date clinical knowledge and experience and enhanced credibility with the medical staff. My experience as an executive vice president at HealthGrades has provided me with a strong business and performance management experience with successful execution. My role as chief medical officer at HealthGrades provided me the experience of innovation, performance transparency, and consumerism. Also, the CMO role allowed me to work with the best and the worst of hospitals. I worked with Dr. Pate at one of the best in Houston. I followed him to St. Luke's to do even better.
Q. Are you knowledgeable about certain change management systems, and do you think QI directors should be?
Yes. There are various change management processes, but they all tend to follow a similar philosophy. I do think QI directors and anyone involved in QI/PI should have a basic understanding of a change management process because this will increase the likelihood of alignment, accountability, and success.
Q. Do you think the current move toward value-based purchasing and EMR implementation and the health care reform, all of this, does it really get at quality improvement or utilization and finances?
I think all the various initiatives mentioned are aimed at increasing accountability in health care. It's a significant part of our GDP and growing economic concerns, yet we know little about the value we provide. I believe, as does St. Luke's CEO, Dr. David Pate, that the sustainable competitive advantage will lie with those organizations that take the lead to define and consistently demonstrate value.