C-Suite Conversations

What healthcare leaders need to know now

Tejal Gandhi galvanized as merger of IHI, NPSF multiplies efforts around patient safety

By | July 17 th,  2017 | chief executive officer, patient safety, Blog, Institute for Healthcare Improvement, National Patient Safety Foundation, Tejal Gandhi | 1 Comments

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

The merger of the Institute for Healthcare Improvement and the National Patient Safety Foundation is now official, and Tejal Gandhi, who led the NPSF, couldn’t be happier.

 

“The reason for the merger was really based on mission,” she says. “IHI had been wanting to strengthen its efforts in patient safety, and that was part of its new strategy that it had been thinking about. And we on the NPSF side felt we had been doing some meaningful work in safety, but we’re small and wanted to expand our reach. It was a perfect union.”

 

In the new structure, Gandhi, a frequent honoree as one of the top leaders in healthcare, moves to a new role as chief clinical and safety officer for IHI. “I’ll be overseeing all of the safety efforts and, more broadly, getting engaged on some of the IHI’s other efforts across the spectrum of quality.”

 

In this, Gandhi will lean on her experience as the former executive director of quality and safety at Brigham and Women’s Hospital, and chief quality and safety officer at Partners Healthcare.

 

The patient-safety movement includes dozens of groups, with many different approaches and agendas. As a result, sometimes the approach and effectiveness can be fragmented. Gandhi says she hopes the merger, which combined two respected entities, can help focus future work.

 

“We want to be a single unified voice,” she says.

 

The NPSF released a major report in December 2015 called Free From Harm: Accelerating Patient Safety Improvement Fifteen Years After To Err Is Human, which outlines eight steps that the healthcare industry can take to significantly reduce mistakes and injuries in the healthcare setting. IHI’s muscle will allow for a broader discussion of the themes in that report. In addition, in conjunction with the American College of Healthcare Executives, IHI/NPSF recently released an executive “blueprint” to help healthcare leaders implement real, not theoretical, steps to reduce safety events under their watch.

 

“We think culture is driven through leadership,” Gandhi says. “The C-suite needs to take ownership and drive this culture of safety. We’ve been saying this for 15 years but haven’t necessarily given the C-suite the real tools to do it.”

 

The blueprint is designed to help change that. “If you look at data around the safety culture, we have a lot of room for improvement,” she says.

 

“There’s still about 40 percent of people who answer surveys who say they are worried about punishment if they speak up about an issue.”
A wide range of CEOs, safety officers and researchers convened to decide what would go into the blueprint.

 

“We’re very excited about the work,” she says. “It includes practical strategies and tactics for organizations to drive toward a culture of safety. And then, with the partnership of ACHE to help disseminate it, we have a lot of follow-up education planned.”

 

Gandhi also is taking her knowledge to the board room, knowing that directors can set the tone for healthcare organizations. Last October, she was asked to join the board at Aurora Health Care, a major Wisconsin health system.

 

“They wanted a physician, and they wanted someone who very much understood quality and safety,” Gandhi says. “I think Aurora has a great track record already in quality and safety, and they were enthusiastic about taking it to the next level. Given my new role at IHI, the opportunity to bring new ideas will be really exciting.”

 

Some of Gandhi’s ideas, thankfully, are catching on in patient safety, like looking at patient care in all settings, not just the hospital.

 

“When I started out in patient safety, my research area of interest was patient safety in the ambulatory setting,” she says. “We have constantly been pushing the fact that we need to think about safety across the entire care continuum. I think we’re finally seeing a shift now. People understand that it’s not just a hospital issue.”

 

IHI/NPSF currently has a grant from the Moore Foundation to conduct research on patient safety in the home, and Gandhi lists other areas that need scrutiny as well, from primary care to ambulatory surgery to dialysis centers.

 

Behind all these activities stands the need for transparency, which Gandhi has called a paramount attribute in a culture of safety.

 

“We’re making progress, but we have a long way to go – I feel like I say that about everything in safety,” she explains. “Compared to 15 or 20 years ago, there’s much more transparency about errors. There’s transparency about errors when they happen with disclosures and apologies, transparency with the public with data about mortality, infections and readmissions being available, and there’s transparency between clinicians or within and across organizations. But it’s far from perfect.”

 

Yet with all the progress, Gandhi remains wary about errors on another front – electronic health records.

 

“I’m a firm believer that EHRs can provide safety benefits through things like decision support and data accessibility,” she says. “We’ve seen many studies on the benefits of EHRs for quality and safety. But the flip side is that a lot of those studies were done in places that had customized, home-grown EHR systems developed with the end-user in mind. Most EHR systems aren’t like that. And we’ve seen examples of these systems actually creating unintended consequences or new errors.”

 

Gandhi says the IHI-NPSF merger is important because safety remains a bedrock issue that the healthcare industry has not fully come to terms with.

 

“I have spoken to many clinicians who say they would never let a loved one stay in a hospital without them present at all times,” says Gandhi, herself an MD. “But it’s unrealistic to think that’s a solution. Not everyone has a clinician in the family, and even those who do cannot avoid risks entirely. We need to improve safety for all patients in all settings at all times.”

 

 

SIDEBAR: Eight recommendations on safety from ‘Free From Harm’

 

Tejal Gandhi, MD, mentioned the report, “Free From Harm,” contains eight key goals for “achieving total systems safety”:

 

  • Ensure that leaders establish and sustain a safety culture.
  • Create centralized and coordinated oversight of patient safety.
  • Create a common set of safety metrics that reflect meaningful outcomes.
  • Increase funding for research in patient safety and implementation science.
  • Address safety across the entire care continuum.
  • Support the healthcare workforce.
  • Partner with patients and families for the safest care.
  • Ensure that technology is safe and optimized to improve patient safety.
  •  

     

    ICYMI: Top 25 Women in Healthcare: Tejal Gandhi

    By | October 23 rd,  2015 | Lucien Leape Institute, Modern Healthcare, patient safety, Blog, boards, Brigham and Women's Hospital, CEO, chief quality and safety officer, National Patient Safety Foundation, Partners Healthcare, safety, Tejal Gandhi MD MPH CPPS, quality, Top 25 Women in Healthcare | Add A Comment

     

    Classic content from 2015: One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

     

    The patient-safety movement has made slow and steady progress in the U.S. healthcare industry. But to achieve a faster pace of change, Tejal Gandhi, MD, MPH, CPPS, says change needs to come from the top of each organization – and that means above the CEO.

     

    “We talk about CEOs and leadership in terms of patient safety, but I think the involvement of governance and boards is a major gap we’re overlooking,” says Gandhi, president and CEO of the National Patient Safety Foundation. “Most boards don’t know much about quality and safety. They tend to leave that to the clinicians and aren’t necessarily demanding better performance in this area.”

     

    The move away from fee-for-service payment in healthcare makes this even more critical, she adds.

     

    “If you start to pay for value, part of the value is quality and safety,” Gandhi says. “Boards are going to have to become more knowledgeable, and they will; they are smart people and will ask the right questions. Workplace safety is a big issue in every industry. The directors will need to demand more and even think about CEO incentives being tied to safety and quality.”

     

    Gandhi, who served as chief quality and safety officer at Partners Healthcare and executive director of safety and quality at Brigham and Women’s Hospital before joining NPSF, believes most healthcare CEOs want to improve safety but get overwhelmed about where and how to begin.

     

    “I think CEOs want to create the right culture – they know a culture of safety is important – but how to actually do it is where the challenge is.”

     

    One key element of NPSF is its respected think tank, the Lucian Leape Institute, named after the Harvard physician and researcher regarded as one of the pioneers of the patient-safety movement. At the institute’s retreat last February, Gandhi said the leaders came to the conclusion that they needed to sharpen their focus on helping healthcare CEOs.

     

    “For the last five years, we’ve been focusing on what we call the transforming concepts, the big issues that we need to see change to really make advancements in safety – issues like patient engagement, transparency and reforming medical education,” she says.

     

    “At the retreat, we asked, ‘Where are we struggling, and what theme ran across all five of the reports we released on the major issues?’ The theme was culture.”

     

    Back when the seminal “To Err Is Human” report on medical harm was published in 1999, little was written about culture in the healthcare environment. Today, notes Gandhi, culture can be measured and stakeholders sometimes insist that organizations do just that. Going forward, the Leape Institute plans to get down to brass tacks to help CEOs create safer systems.

     

    “We can’t just say, ‘Go change your culture,’ ” Gandhi says. “We need to give people things that are much more tactical. And I come from an operational, tactical background so I like the fact that we’re going to create a playbook that says, ‘Here are the concrete steps you can take as a CEO to start down this path.’ ”

     

    As a relatively young CEO who has been on the job for two years, Gandhi has great empathy for leaders. She says her own learning curve was steep and that getting up to speed on issues ranging from finance to human resources to even real estate “was like drinking through a fire hose for the first six months. There’s a different level of stress when you’re the leader, so that’s taken some time to get used to. But what makes this job fun is the learning.”

     

    Key to any discussion of quality and safety in a healthcare setting are the doctors, and Gandhi, a board-certified internist, worked in clinical care for many years.

     

    She is hopeful that the transition to value-based care will allow mid-level providers to participate more in patient care and allow physicians to get back to having significant conversations with their patients. Primary care physicians, she said, sometimes have a tough time even visiting their patients in the hospital because they’re seeing an overwhelming number of patients in clinic on any given day.

     

    “The primary care physician is the person who can advocate for the goals and values of the patient when interfacing with the rest of the healthcare system,” she says. “I’ve seen payment models where the primary care doctor gets reimbursed for going to the hospital and seeing a patient. It’s very important.”

     

    While patients can and should partner with physicians on decision-making and with organizations by being welcomed onto quality improvement committees, Gandhi says the predominant responsibility for patient safety should be with the caregivers.

     

    “The whole ‘ask-me-if-I-washed-my-hands’ thing drives me a little crazy because the patient shouldn’t have to ask – that’s on us,” she says. “But we do need their advocacy, making sure patients feel comfortable asking questions, that they agree with and understand their plan of care and that their voice is part of creating that plan.”

     

     

    Tejal Gandhi: Push for quality, safety needs to come from boards

    By | July 24 th,  2015 | Lucien Leape Institute, patient safety, physicians, Blog, boards, Brigham and Women's Hospital, CEO, chief quality and safety officer, directors, National Patient Safety Foundation, Partners Healthcare, Tejal Gandhi MD MPH CPPS, culture, quality | Add A Comment

     

    One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

     

    The patient-safety movement has made slow and steady progress in the U.S. healthcare industry. But to achieve a faster pace of change, Tejal Gandhi, MD, MPH, CPPS, says change needs to come from the top of each organization – and that means above the CEO.

     

    “We talk about CEOs and leadership in terms of patient safety, but I think the involvement of governance and boards is a major gap we’re overlooking,” says Gandhi, president and CEO of the National Patient Safety Foundation. “Most boards don’t know much about quality and safety. They tend to leave that to the clinicians and aren’t necessarily demanding better performance in this area.”

     

    The move away from fee-for-service payment in healthcare makes this even more critical, she adds.

     

    “If you start to pay for value, part of the value is quality and safety,” Gandhi says. “Boards are going to have to become more knowledgeable, and they will; they are smart people and will ask the right questions. Workplace safety is a big issue in every industry. The directors will need to demand more and even think about CEO incentives being tied to safety and quality.”

     

    Gandhi, who served as chief quality and safety officer at Partners Healthcare and executive director of safety and quality at Brigham and Women’s Hospital before joining NPSF, believes most healthcare CEOs want to improve safety but get overwhelmed about where and how to begin.

     

    “I think CEOs want to create the right culture – they know a culture of safety is important – but how to actually do it is where the challenge is.”

     

    One key element of NPSF is its respected think tank, the Lucian Leape Institute, named after the Harvard physician and researcher regarded as one of the pioneers of the patient-safety movement. At the institute’s retreat last February, Gandhi said the leaders came to the conclusion that they needed to sharpen their focus on helping healthcare CEOs.

     

    “For the last five years, we’ve been focusing on what we call the transforming concepts, the big issues that we need to see change to really make advancements in safety – issues like patient engagement, transparency and reforming medical education,” she says.

     

    “At the retreat, we asked, ‘Where are we struggling, and what theme ran across all five of the reports we released on the major issues?’ The theme was culture.”

     

    Back when the seminal “To Err Is Human” report on medical harm was published in 1999, little was written about culture in the healthcare environment. Today, notes Gandhi, culture can be measured and stakeholders sometimes insist that organizations do just that. Going forward, the Leape Institute plans to get down to brass tacks to help CEOs create safer systems.

     

    “We can’t just say, ‘Go change your culture,’ ” Gandhi says. “We need to give people things that are much more tactical. And I come from an operational, tactical background so I like the fact that we’re going to create a playbook that says, ‘Here are the concrete steps you can take as a CEO to start down this path.’ ”

     

    As a relatively young CEO who has been on the job for two years, Gandhi has great empathy for leaders. She says her own learning curve was steep and that getting up to speed on issues ranging from finance to human resources to even real estate “was like drinking through a fire hose for the first six months. There’s a different level of stress when you’re the leader, so that’s taken some time to get used to. But what makes this job fun is the learning.”

     

    Key to any discussion of quality and safety in a healthcare setting are the doctors, and Gandhi, a board-certified internist, worked in clinical care for many years.

     

    She is hopeful that the transition to value-based care will allow mid-level providers to participate more in patient care and allow physicians to get back to having significant conversations with their patients. Primary care physicians, she said, sometimes have a tough time even visiting their patients in the hospital because they’re seeing an overwhelming number of patients in clinic on any given day.

     

    “The primary care physician is the person who can advocate for the goals and values of the patient when interfacing with the rest of the healthcare system,” she says. “I’ve seen payment models where the primary care doctor gets reimbursed for going to the hospital and seeing a patient. It’s very important.”

     

    While patients can and should partner with physicians on decision-making and with organizations by being welcomed onto quality improvement committees, Gandhi says the predominant responsibility for patient safety should be with the caregivers.

     

    “The whole ‘ask-me-if-I-washed-my-hands’ thing drives me a little crazy because the patient shouldn’t have to ask – that’s on us,” she says. “But we do need their advocacy, making sure patients feel comfortable asking questions, that they agree with and understand their plan of care and that their voice is part of creating that plan.”

     

     

    Page 1/1