What Can The Medical Industry Teach Us About Industrial Work Quality?
In the healthcare system, maintaining the highest quality standards is an absolute must. After all, quality care is directly tied to a patient's well-being, and failing to follow quality measures can result in life or death situations. Likewise, industrial construction must also adhere to stringent quality standards in order to promote worker safety, decrease rework, and enhance safety for surrounding communities.
You might be wondering: how is quality in the medical industry at all similar to industrial construction? While these sectors might seem disparate at first glance, there exists a significant opportunity for cross-industry learning. By examining the rigorous quality control measures embedded within the healthcare system, we can glean invaluable insights into enhancing industrial work quality, ultimately resulting in safer, more durable structures and systems that stand the test of time.
That's why for this week's episode of Work Done Right, we are joined by Dr. Nina Dadlez , a renowned quality and patient safety leader in the medical industry, to delve into the intriguing world of quality. Dr. Dadlez shares valuable insights into the commonalities between the medical and industrial sectors when it comes to ensuring top-notch quality, detailing key learnings that can be applied to any industry.??
Join us as we explore the significance of conducting thorough root cause analyses to address quality mishaps effectively. Dr. Dadlez also sheds light on the fundamentals of creating a culture of safety that encourages open communication and fosters continuous improvement. Get ready to dive into the world of quality with an expert guide and gain practical strategies to achieve quality and safety excellence at your organization.?
About Dr. Nina Dadlez
Our guest today is Dr. Nina Dadlez. Dr. Dadlez is the Associate Chief Medical Officer at Tufts Medical Center. She works alongside other leaders at Tufts to progress the institution on its HRO journey, as well as co-leading a quality improvement and safety training program targeting all 7000 employees across Tufts Medical Center.??
Dr. Dadlez is a strong proponent of patient safety, family-centered care, and evidence-based medicine. She is interested in rigorously investigating pediatric patient safety and quality improvement. Her research focuses on reduction of medication, prescribing errors, diagnostic errors, and safe transitions of care throughout the medical system.??
She is passionate about using-data driven performance improvement methods to fuel organizational change. She has served as a quality improvement coach for a national quality Improvement Collaborative to reduce diagnostic errors and in another to improve the use of evidence based medicine.??
Dr. Dadlez attended the University of Connecticut School of Medicine and completed her pediatric residency training at Morgan Stanley Children’s Hospital. She completed a pediatric hospital medicine fellowship at the Children’s Hospital at Montefiore, where she studied quality improvement methodology and obtained a master’s in Clinical Research Methods at the Albert Einstein College of Medicine.??
3 Top Episode Takeaways
Episode Transcript???
Wes Edmiston:??
Dr. Dadlez, welcome to the show.??
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Dr. Nina Dadlez??
Thank you so much for having me today. Wes. Excited to be here.??
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Wes Edmiston:??
Yeah, I am thrilled to have you here. I’m very excited for this conversation. I’ve been talking with a lot of different people leading up to this just because I’ve been really excited to do this.??
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So before we get started on, I guess the bulk of our conversation, though, I’d like to do just a little bit of level-setting because much of our audience might not be aware of what an associate chief medical officer does.??
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So could you describe a bit to our audience kind of what it is that you do and what the mission of your position is???
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Dr. Nina Dadlez??
Sure. So I’m the associate chief medical officer for quality at Tufts Medical Center, which means, really, that I have oversight over our quality and safety practices both for patients and employees across the organization.??
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I really partner with other leaders across the organization. A lot of the work that we do is multidisciplinary. So working with other physician and nurse leaders, our public safety officers, employee health, our environmental services team so that we can all work together to give the best care that we can give to patients.??
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Wes Edmiston:??
Thank you for that. Excellent description. Now, some of our audience is likely wondering, I guess, why we would have somebody like yourself on the show, given that our backgrounds are quite different.??
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But as we talked once before, and kind of just as I’ve been doing a little bit of research, kind of looking around at some of the overlap between the industrial oil and gas sector and the medical industry, it seems like we actually have a good amount of overlap.??
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I mean, we’re both providing to the highest quality of service so that the folks down the line from us are safe and that they’re able to go home at the end of the day. Right. Do you see similarities between, I guess, the medical industries and the industrial sector???
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And what can we learn from one another???
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Dr. Nina Dadlez??
I was so excited to be invited because honestly, we’ve learned so much about how we practice quality and safety and medicine from industrial engineering. And really a lot of the practices that we’re bringing, things like standardization, having safe checklists, really making sure that we’re debriefing, and learning from every error that happens in the system are originating in industrial drill engineering and thinking about human factors and how it influences the way we work.??
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So I feel like we’ve learned so much from your industry and was excited to have the opportunity to come and speak about it with you today.??
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Wes Edmiston:??
Perfect. Well, yeah, I’m interested in diving a little bit deeper on that because you keep saying quality and safety at the same time.??
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And whenever I was a Foreman just running crews right, I would always tell my folks that the quality of work that you do directly influences the safety of the person that’s going to be operating this facility.??
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And by the sounds of it, it’s very much married together in your industry as well. So with that kind of interrelated correlation between the two, do you have any, I guess, stories from your industry???
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Obviously all things HIPAA considered, but something that, well, guess demonstrates that the relationship between safety and quality in your industry.??
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Dr. Nina Dadlez??
Sure. So we really use data in everything that we do to ensure that the changes that we’re making are truly improvements.??
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So I’ll tell you a little bit about a journey that we had to really improve our culture of safety at Tufts and how that ultimately impacted patient safety. So we implemented a number of different interventions really geared towards creating a culture where everybody can speak up if they have a safe concern across the organization.??
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We think it’s so important that the people that are really boots on the ground experiencing their workflow are the ones that are really driving change. And we really want to hear from everyone when they have a safety concern because we think that’s the best way that we can improve our processes.??
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So we instituted a series of interventions, including Huddles on all the medical units so that we could talk about things that happened the last 24 hours. If there are any safety concerns, any new protocols or processes that we’re rolling out in the next 24 hours so that we could prepare everyone and learn from them.??
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We funneled that up to a high reliability briefing where we had leaders from across the organization all reporting out from local Huddles and making sure that we are all learning from each other. We instituted a good catch program to really reward people for reporting and make sure that we are actually thanking people for putting these event reports in, because people are concerned that speaking up might be punitive.??
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And really we want to celebrate that and learn how we can fix our processes. So when we really implemented this bundle, we saw actually we went a year without having any serious safety events in our children’s hospital as a result of these preventions and then started spreading them across to the adult side of our hospital as well.??
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So it really was very impactful and we’re able to drive change through these processes.??
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Wes Edmiston:??
Yeah. First off, whether we’re talking about my industry or your industry, a year with no incidents is impressive for everybody.??
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So great job on that, and congratulations. I’m interested in, I guess, a little more about kind of how it is that you do, I guess, implement some of these changes, what KPIs it is that you’re looking at and what quality looks like.??
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Truly, in measuring this benchmarking, it affecting any level of change in your industry as well, because in the industrial sector, obviously, and really, all things quality KPIs are critical. So how do you all address this and what are you looking at in the medical industry???
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Dr. Nina Dadlez?
Yeah, so I imagine that our KPIs are a little bit different than what you’re looking at, really centered on a lot of patient level outcomes. So we look at things like medication errors, whether we have certain hospital acquired infections, infections that patients are picking up.??
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While they’re under our care in the hospital. We look at things like length of stay and mortality for our patients and. Really track that and benchmark nationally so. We have some risk adjustments that we can do as part of our national collaborative so that we can benchmark ourselves.??
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Against other academic medical centers. And really, data needs to be at the heart of all that we do, because when we implement changes, we can’t really tell if they’re actually an improvement if we aren’t looking at the data.??
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So typically, we track our data longitudinally over time so that when we implement different interventions, we can see the effect of those interventions.??
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Wes Edmiston:??
That’s such a critical component about all things.??
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I guess quality in general, right, is you have to have some level of understanding of where you started, what changes you made, and be able to measure that same thing in the outcomes. In studying for this episode, I was looking at and saw that a lot of this kind of originates out of the work of, what, florence Nightingale in the 18 hundreds, which is the interesting component about that is she was also a statistician which kind of reiterates this point of the importance of good metrics.??
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So you’re saying that you’re really looking at the outcomes as far as what it is that the patients are receiving in the end of this. Right. It’s not just kind of intravisit, it’s overall through the lifecycle care of the patients.??
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So how is it that you all kind of dissect that down and see, I guess, group that in between what it is that’s the responsibility of maybe the providers or for the hospital itself and kind of affect that change.??
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Dr. Nina Dadlez?
Yeah. So one of the godfathers of quality improvement that we always look at in healthcare is Edward Deming. And he said, “Trust in God, all others bring data.” So you really need the data to drive change.??
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And we do look at our outcome data, as you said, like, what’s the ultimate effect on the patient? But it’s also important to have process measures. So when we’re rolling out an intervention, we might see that the outcome is improving, but if we don’t track.??
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Each step in the process and make sure that the interventions that we’re carrying out are happening in an effective, reliable way, in a standardized way, then we don’t know that the changes that we made are ultimately driving those outcomes.??
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So we usually try to have a cadre of both outcome measures and process measures so that we can really tell that the interventions that we’re implementing are happening in a reliable way and driving those outcomes.??
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And then sometimes we look at balancing measures too. And when we look at balancing measures, those are really the unanticipated outcomes of the interventions that we’re implementing. So it might be that we’re implementing a particular intervention that actually adds time to the process, and so we might be reducing efficiency while improving safety.??
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And we really want to track those balancing measures, one, so that we don’t actually cause a problem when we’re implementing change, but two, because it’s really important to get buy in, as I’m sure you know, in your industry as well, sometimes actually getting people to modify their behaviors can be quite challenging.??
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And so when we look at all those different aspects, it sometimes can help us get buy in when we’re sharing the data with our colleagues. And then you were talking about how this funnels down to all members of the team.??
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So really, I think part of my job in quality and patient safety of my colleagues is to get data in front of our people that are doing the work so that they can see the impact of the interventions that they’re putting in place and how important their work is to the quality and safety of the patients that they care for.??
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Because everyone comes to work wanting to really take care of patients, do their best. And so we want to make it easy for them to do the right thing and really be able to motivate them to understand the impacts of the interventions that we’re asking them to carry out.??
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Wes Edmiston:?
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Yeah, I think that’s extremely valuable to think about. Not just I guess a lot of people will focus on the start, this is the change that we need to implement. But you’re saying really driving that through the whole lifecycle of the implementation, coming with robust data to be able to help support these decisions.??
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And also that gives people a good feeling that you’ve thought of, we’ll say, quote, air quotes everything, right. That you’re not just lobbying this out there saying, hey, we’re going to make this change as seemingly a knee jerk reaction.??
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No, you have in fact considered all of these kind of externalities so that it’s not coming from left field, right. That it’s really a substantiated, a well supported decision. Yeah. And we’ll pick back up later about talking about the different personalities, definitely, because I imagine we have some similarities there.??
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But one of the things that I think is interesting that you just brought up also is implementing change like this sometimes does come at the detriment of another area. I was listening to a couple of different podcasts on medical quality improvement.??
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Again, just kind of trying to get prepared for this episode because while we do have some similarities, these are drastically different industries. And it was interesting to hear there are a bunch of different kind of stakeholders that are trying to implement other key performance indicators out there in order to try to provide the most robust quality out there.??
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But sometimes it comes at too much of a cost for the duration of the stay, for the patient, how long the turnaround time for the patient visits, or even potentially the service of care, the level of care that you’re able to provide to the patients.??
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How do you balance, we’ll say, adding in another KPI or having a robust quality program with efficiency? With the turnaround time for patients, because where it is that you do start having longer and longer lag times well, now it is that you’re potentially budding out somebody else from being able to get in altogether.??
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So that dramatically impacts all of this. So how do you address that balance???
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Dr. Nina Dadlez??
Sure, and that’s why I think it’s important to have a portfolio of KPIs. So you’re looking at the different aspects that you’re trying to drive the needle on, but really to have a few North Stars that you’re really focused on.??
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And then I think those balancing measures are critical. So like you said, you have to understand the impact of your work and you might be doing that in a number of different ways. You have your hard metrics that you have the data on, but sometimes you have soft metrics too.??
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And I think it’s really important to be talking to our frontline staff, the people that are actually doing the work, understand how it impacts their workflow, what are they seeing? And so often we’ll roll out changes as small tests have changed, learn from them, tweak and then implement at a larger scale.??
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That way we can ensure that the process is really tight before we’re rolling it out across the entire organization.??
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Wes Edmiston:??
That’s a really interesting way of thinking about it in the sense of kind of like the Facebook, what is it???
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Work fast and break things. Right. Let’s iterate a whole bunch at a smaller scale before we roll this out at a broader level. So that’s taking that same approach and implementing change that carries with it, we’ll say some level of risk, but it also derisks everything else that you’re doing before you cascade this out broadly.??
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And you might think about it actually in terms of how much risk there is. So something that’s really risky to implement and you think maybe people are a little bit more resistant to implement. You might want to roll out in a smaller test of change to kind of get data behind you, get some buy in and then go big, whereas something that’s maybe less risky and you think people will be easily bought into, you might roll out at a large scale right off the bat.??
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That’s a good way of approaching it. You keep bringing up this idea of getting buy in all of the different stakeholders that you have from whether it is that we’re talking about the nurses or the physicians themselves, really anybody else in the medical administration, anybody, again, who is a stakeholder in this, how is it that you navigate the personalities, right???
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Because you’re working with people met are very proficient, high level professionals in a given field. They went to school just as you did, right? You went to school for an extremely long amount of time to learn your craft.??
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And when again preparing for this episode, I was thinking to a friend of mine, a really good friend of mine, he’s an anesthesiologist and from what he says, he’s very good at what he does. He’s very proud of the work that he does and commits to providing the highest level of care that he possibly can.??
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And very bright guy. We’ve known each other quite a long time and I couldn’t possibly imagine going to Chris and saying, Chris, you need to change what it is that you’re doing. Right? So how do you manage those different personalities in order to, again, affect change???
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Dr. Nina Dadlez?
I think a big part of that is having an initial improvement team that has involvement of all different key stakeholders. So I try to put together a team that would probably have. Chris on it, or one of his colleagues, right, actually have anesthesiologists at the table.??
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We’re making a change in the org. I might have surgeons there, or nurses, some of the surgical techs, and I really want the idea to come from them. Honestly. I see myself as a facilitator. They understand their processes best.??
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I bring a quality lens and an idea of really what a strong intervention is. So rather than dictate to people, I really want them involved in the process. And people tend to have a lot more buy in when they feel like it’s their idea and they’re bringing forward the interventions.??
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And then the other component is really when I think about getting buy in, I bring data because I think that’s really important and people are motivated by that data. I bring stories. So if it’s about something that a process in the or that’s really impactful, listen, we want to make sure that we have all of our specimens labeled correctly because ultimately this is going to be really important in diagnosing a patient’s cancer, for example, right???
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So having actual patient stories is really important to get buy in. And the last part is the “what’s in it for me” piece. And I think that’s where having some of those balancing measures showing that maybe something that we’re doing actually improves efficiency for them or could actually make their life easier is really important in terms of getting buy in.??
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So I think having those three components is really key and then having the right people at the table. And as I said, I really want them to originate the idea. So I’m trying to facilitate everybody at the table, having a voice and really participating in that and also having them be champions for the project.??
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I go and tell a bunch of nurses what to do. It’s not as impactful as one of the nurses coming forward and saying, hey, this is a really great idea, why don’t we try to implement this in our unit? I’ve seen it work in another unit, for example.??
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So that’s really important to have the local champions as well. Yeah, I can definitely see the overlap is how it is again in the world of industrial construction, of having the buy in from the boots on the ground level and having them involved in the procedure, rewriting in the investigatory process for an RCA and for really driving that level of change for all things quality and safety implementation.??
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Wes Edmiston:??
Yeah, so there is there’s a tremendous amount of overlap in our industries. You wouldn’t think it until we start talking about this and kind of breaking it down a bit. So then, heaven forbid, something does, I guess, happen in your industry.??
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What is your root cause analysis process, and how is it that you approach these situations in order to get down to the root cause of what it is that happened and to drive change to assure that this doesn’t happen again???
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Dr. Nina Dadlez?
Sure. So, unfortunately, some errors do happen in the medical industry as they do in construction. And really, we want to, as you said, make sure that we fully understand the problem so that we can devise a very strong action plan to prevent it from happening in the future.??
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So we usually have an initial huddle in the first 24 to 48 hours that makes sure that we identify if there’s any immediate mitigating factors that we need to put in place, and then we do a full root cause analysis.??
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So we’ll interview all the people involved in the event, make sure that we understand, sometimes even recreate an aspect of the event so that we can learn from it, and then we put an action plan together.??
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We try to think about strength of interventions. That’s another part that I try to help facilitate. A lot of times when there’s an error, people want to do education, and we know that education isn’t actually a strong intervention.??
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When we think about human factors engineering. Policies and education are kind of on the low end of the spectrum, but really, when you put in things like forcing functions, things that make it easier for people to do the right thing, harder to do the wrong thing, really leveraging technology, that’s where you can really get to the safer solution.??
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So we really want to make sure that all of our interventions are strong interventions, and then we audit those inventions. We want to make sure that if we’re implementing them, that they’re actually happening as intended, that we put in a standardized process and make sure that we’re really driving change in terms of that outcome.??
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Wes Edmiston:??
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Yeah, I think the easy answer is, like you said, kind of education around that, but really thinking outside of the box and maybe reaching out. Do you ever reach out to we’ll say, in my world, it’d be reaching out to other projects, but do you ever reach out to other medical centers, other practices, in order to see how it is that they address similar situations???
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And how do you, I guess, perform that outreach if you do???
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Dr. Nina Dadlez??
Yeah, so definitely, I’ve talked to colleagues at other organizations about interventions that they’ve put in place, and we also search the literature.??
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So there’s a lot of medical literature around quality and patient safety. And in quality, we have a phrase that we steal shamelessly. It’s always okay. Everybody wants to keep patients safe, right? So it’s okay to pull from other people and do what they’ve been doing and make sure that we’re learning and spreading that knowledge.??
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So I think that’s really key. It’s very important to reach out to others, as you said, and do your background research and make sure that you’re seeing what the newest things are that are out there and what you can implement to keep patients safe.??
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Wes Edmiston:??
Yeah, that’s something that we tend to on project, and maybe it’s out of the virtue of we’re we’re working 70, 80, 90 hours a week, and we don’t necessarily have time to to pick up the phone and call somebody and say, hey, how’s everything going on your project???
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You know, we’re all just down in the down in the firefight day in, day out. But that’s something that that we don’t, I feel we don’t do a great job of is. Is reaching out to our peers on other projects in order to see what it is that they’re doing, what problems are they having and what is it that they’re doing in order to kind of ameliorate some of those issues or potentially even whether or not they’ve had some of the same issues that we are having.??
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Dr. Nina Dadlez?
Right. And they’ve been trying to do that more and more in healthcare. There’s something called patient safety organizations that a lot of hospitals are joining. They’re national groups that are actually federally protected in terms of HIPAA and the legal aspect of medical errors, so that people can share errors that have happened in their hospitals and also share some of these lessons learned and action plans.??
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Really, the goal is to accelerate patient safety. So Tufts Medical Center that I work at just created a patient safety organization for our system, Tufts Medicine, so that we can share across our sister hospitals and make sure that we’re learning from all of our events.??
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So it’s really a great way to really collaborate and make sure that patients are safe. And it’s one of the things I always admired about the nuclear power industry. Whenever I’m talking about high reliability, I talk about nuclear power.??
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And they always, when they have an error, do an RCA and then actually share it out across all the other power plants in the country. And I just know it’d be so cool if we could really get there in healthcare to be able to share all those lessons learned.??
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Wes Edmiston:?
Yeah, I couldn’t agree more oftentimes. It’s like we take these incidents personally, whether or not we even were directly involved in it. We seem to take them personally and get embarrassed by it, rather than saying, hey, everybody, listen.??
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This is what happened to me, or, this is what happened to somebody on my project or at my medical facility, please learn from this to assure that we don’t ever do this again, which is, in my opinion.??
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Is the right approach. We need to do what we can. A smart man learns from his mistakes. A wise man learns from somebody else’s. So let’s all help everybody be a little bit wiser to learn from the mistakes that we’ve already made.??
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So I couldn’t agree with that more.??
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Dr. Nina Dadlez??
And we have had some employees here that have really embraced that. So a nurse that had a medication error, for example, and shares it with all of her colleagues in her department government, and that’s really great because as you said, people often take this really personally.??
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No one wants to make a mistake. Everyone’s here to do good. And so we do have some peer support programs in place too, to help people after there’s been an event. But really, we see that those people are often the best safety champions when they go forward and they’re willing to talk to other people about their error.??
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And we can share so much and learn together. So it’s really great.??
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Wes Edmiston:??
Yeah, I’ve seen similar things in our industry where the people who have oftentimes some of the worst stories, right, the best stories as far as an example goes, but they’re just devastating stories whenever it comes to a safety incident.??
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They’re the ones that end up as long as they step forward and they own that. They become the best champions for a better way. And you hate to see it because the cost that it took in order to have that occur, but it’s at the same time making the best out of a terrible situation.??
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So again, whatever we can do in order to share lessons is great. This actually segues into something I wanted to ask about, which earlier on in the episode you had said that kind of fostering that atmosphere and environment.??
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It where people can come forward and bring up issues, really before maybe they turn into a safety incident of some sort. How is it that you approach kind of building that culture to where people are feeling like they can approach you with some level of issue or with some concern that they may have??
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Dr. Nina Dadlez?
Yeah. So people are nervous sometimes to come forward with safety concerns. And that’s why we really have to make sure that people understand that any concerns that are raised are a learning opportunity, and I can’t fix a problem that I don’t know about.??
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So we have a couple of ways to come forward. In the hospital, we actually have a reporting system where if there’s an error, a near miss, something that maybe goes wrong, that doesn’t actually reach a patient but signifies a small signal in the system, we can find out about those and act on them to drive change.??
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And then people can raise safety concerns right in the moment. Right. You might see your colleague do something that’s unsafe, they might forget to wash their hand before procedure, and you just need to speak up and say something to them right in the moment.??
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And that’s sometimes hard for people to do because they aren’t sure how that’ll be received. So I’m actually teaching a course across the organization about what it means to be in a high reliability organization and how to broach these concerns with colleagues because they are uncomfortable.??
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So we talk about, first asking a question, raising something in a nonchalant way, and then how you might escalate and then actually make a request and if you need to go up the chain of command. But part of that course is actually setting key expectations for all of our employees across the hospital.??
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One, that we all own safety, that it really belongs to all of us. Two, that we need clear and complete communication. I’m sure in your teams as well, it’s so critical that the team that’s working together is communicating.??
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We’re all doing a lot of high risk procedures and processes, and we need to make sure that we’re on the same page at all times. And the last part is having a questioning attitude that really means, one, raising a question if you have a concern.??
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We know in medicine, the data shows us. That before an error reaches a patient. It’s actually made it through eight or nine people in that process. And people might have felt a little uncomfortable, but maybe they didn’t speak up because the attending doctor was there or there was a senior nurse present, and they thought, oh, they couldn’t make a mistake.??
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But we really want people to just ask the question, start the dialogue, and we should all pause and make sure that everything’s okay before proceeding. But what we also teach the flip side of having a questioning attitude is being okay with having your practice questioned.??
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So if someone comes to me with a safety concern and I dismiss them, they’re not speaking up again. Right. They think that I’m not receptive and they don’t feel comfortable. But we all need to create an environment where it’s okay to speak up, because we all have a common goal of keeping patients safe and keeping our colleagues safe, and we have to work together to do that.??
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Wes Edmiston:??
And yeah, I couldn’t agree more. Everybody needs to take kind of an approach of we’ll say humility in whatever it is that they’re doing so that they can learn. Right. Even the best in whatever field you were talking about out there, Michael Jordan, in his prime, still had multiple specialist coaches because he knew that he could get better.??
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Right. We can all improve off of where we are. So you have to understand that. There’s room for improvement before you can approach that. So that’s great.??
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Dr. Nina Dadlez??
Exactly. And I don’t know about the construction industry, but medicine has traditionally been pretty hierarchical.??
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And another thing that we learned from reliability, looking at other areas, is that really, we have to flatten that hierarchy. Right. So, like in the airline industry, there was a lot of work done around making it okay for copilots to speak up to pilots when they had concerns, because there used to be a lot of hierarchy there, and people weren’t willing to do that.??
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Similarly, on aircraft carriers, anybody is charged with speaking up and stopping the line, and they again thank people and applaud them for doing so because one small move could signify a huge problem that could really cause loss of life.??
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And so it’s really the same thing for us. Any aspect of medicine really could have a devastating consequence if there’s an error. And so we really want to make sure that everything we’re doing is safe and that we’re keeping our colleagues safe and our patients safe.??
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Wes Edmiston:??
Yeah, that goes also back to kind of how it is that you’re managing personalities, and it’s great that you’re having that internal course on how to address these situations that can oftentimes be, especially in my industry, one of the most difficult things.??
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You were saying it, right. We’re all trying to do the best job we can. I’ve said it. I’ve heard it from many different people. Nobody wakes up in the morning and says, I’m going to go to work and do a bad job.??
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So we all go with the best of intentions. We all want to put forward an honest days of living and to do the best we can. So when we’re challenged on that, I see why it is that we would take it personally.??
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Right. We think that we’re doing the right thing and somebody’s coming through and accusing us of something otherwise. But we have to be able to learn from each other as best we can. And if you are speaking up, you need to be able to do it with some tact, right???
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Because likely you’re going to be met with some level of resistance. Ah. With that, though. One of the things that can happen, that I’ve seen happen in my industry is that we get very focused on, we’ll say, abiding by the procedures, which I was a quality individual for years.??
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The procedures are there for a reason. However, we don’t want to stifle innovation, right? How is it that you all balance between, we’ll say, adherence to the SOPs with the ability in order for somebody to innovate and excel???
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And with that, how do you all because when thinking about quality, sometimes you end up getting this connotation of you’re punishing people to do bad. Not necessarily. How are you rewarding people for doing well???
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So how do you, again, balance the SOP with the innovations? And also how do you reward the people that are really excellent at what it is that they do? Who are those high performers???
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Dr. Nina Dadlez??
So that’s a great question, because we do have policies and standard procedures that are really vital, right, to keep our employees safe and keep our patients safe.??
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And so we certainly want people to adhere to those and we want to do it in a non punitive way, so that we have. What we call a just culture, right? So we don’t want to punish people when they make a mistake, if what they’re doing was with good intention.??
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But we want to make sure that we’re kind of doing our mini root cause analysis there to say, why did they actually deviate from that procedure? Right? And it might be that it’s like a normalized deviance.??
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Like, everybody in this unit is doing the workaround, and that means that the process is broken and we need to figure out how we actually fix that process. Maybe their workaround isn’t ideal. Maybe it creates some risk, right???
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But then we need to, as you said, innovate and fix the process and look at other opportunities for change. I like to think that we reward change. The other part of our Department of Quality and Patient Safety is a group of process improvement specialists.??
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And we really are trying to do a lot of different initiatives across the organization to have that innovation, reward that innovation sorry. And bring change through intervention. So when we have people that are doing the work, different doctors and nurses that might see a new process that they think would be better, often they’ll bring that to our team and they’ll ask for help from the Performance Improvement Department.??
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How do we actually implement this? What can we do to drive change? And we help them come up with metrics and track that. So we really do try to encourage innovation. I think the leaders in our organization appreciate the innovation, and we’ve actually had some quality improvement grants that we give out to give some funding for new projects.??
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But as part of that, as we said, data is so important, we expect people to come back and present us with the data and show us what they’ve done with that money.??
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Wes Edmiston:??
Yeah, that’s, again, an excellent approach.??
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Having rooting this in, not just kind of we’ll say something qualitative, but really quantitative. Right. Because at the end of the day, if you can’t quantify it, we haven’t really changed much of anything.??
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So that’s great that you all keep such an open mindset whenever it comes to really that these processes aren’t written in stone, that there’s always, always room for improvement and that it is that you’re looking for opportunities in order to really increase the standard of care for all of your patients coming from the providers.??
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That’s fantastic.??
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Rapid Fire Questions?
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Wes Edmiston:??
Dr. Dadlez, I think we’re coming up kind of close toward the end of our discussion here. Coming up close on time. So I was just going to ask some last minute rapid fire questions to get to know more than just Dr. Dadlez, get to know Nina a little bit. So first question is what continues to motivate you in your career? Really the mission???
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Dr. Nina Dadlez??
I just want to make quality better for our patients and their families.??
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So that really keeps me coming to work every day, excited to do the work I do.??
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Wes Edmiston:??
That’s excellent. What is the one word that best describes you???
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Dr. Nina Dadlez??
I think an accelerator. I think my job, as I said, is to facilitate amongst others and really be able to accelerate change.??
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Wes Edmiston:??
What is your idea of a perfect vacation???
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Dr. Nina Dadlez??
Relaxing on the beach? I don’t get to relax a ton, so that’s my ideal.??
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Wes Edmiston:??
Yeah. So the idea is just an off switch, right???
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Dr. Nina Dadlez??
Exactly. Separate a little bit.??
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Wes Edmiston:??
Right. What is your favorite book???
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I think I’m going to geek out a little bit here, but talking about high reliability. So Managing the Unexpected is a really great book. Kind of looking at a number of different industries, figuring out what really was successful in creating principles of high reliability.??
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So I’ll go with that.??
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Wes Edmiston:??
Excellent. I’ll have to look that up. What is your favorite quote???
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Dr. Nina Dadlez??
It’s “Be the change you wish to see in the world.” I have it behind me on my shelf.??
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Wes Edmiston:??
Perfect. What is your dream job???
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Dr. Nina Dadlez?
I want to be a Chief Quality Officer when I grow up, in a hospital or hospital system.??
Sales Associate at American Airlines
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