Leading Quality

Why This Episode MattersFor years, many Belgian hospitals invested heavily in accreditation. It brought structure, standards, and visible progress. But Kris Vanhaecht and other healthcare leaders began to notice a deeper problem: when accreditation became the goal, quality could become episodic. Energy rose before the survey, then faded after the label was achieved.The question became how to keep the useful discipline of accreditation while building something more durable. In this episode, Kris discusses the Flanders Quality Model, or FlaQuM, and the shift toward a co-created quality management system that connects bedside care, leadership, governance, culture, and shared learning.Key Ideas ExploredWhy accreditation can help, but still fall short of sustainable qualityThe FlaQuM pillars of Think, Do, LearnHow Juran’s trilogy informs modern quality management Why leadership, culture, and context matter alongside technical quality methods Co-design with clinicians, patients, executives, nurses, engineers, and other stakeholders Why quality models require local translation, not simple implementation Takeaways for Quality LeadersClarify your quality vision before beginning with indicators, audits, or standards. Treat quality management as an operating system, not a quality department project. Involve the people closest to the work early.Preserve the discipline of accreditation, but do not let the label become the aim.Build regular structures for shared learning across teams and organizations.Adapt leadership, culture, and context locally.Aim for quality that is sustained every day, not revived before external review.Continue the ConversationConnect with Professor Kris Vanhaecht on LinkedIn or through his website.Resources & Frameworks ReferencedFlanders Quality Model (FlaQuM)The Juran Trilogy: quality planning/design, quality control, and quality improvementAccreditation CanadaJoint Commission InternationalSafety-IIInstitute for Healthcare ImprovementLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersToo many healthcare organizations still respond to safety events as if the main question is who made the mistake. This conversation offers a better lens: what in the system made the event possible, and how can leaders learn early enough to prevent the next one?Using Annie’s story, Dr. Terry Fairbanks explains why strong event review matters, why timely response matters, and why healthcare falls short when it treats quality improvement and safety management as though they require the same skills. This episode gets beneath the language of safety and into the logic of safer systems.Key Ideas ExploredAnnie’s story as a case study in how system failures get mistaken for individual failure Why event reviews should begin immediately, even before every fact is known The difference between product design, implementation, and real-world use Why safety requires distinct competencies from traditional quality improvement A practical model of primary, secondary, and tertiary prevention in safety How hospitals could use existing data streams to identify hazards before harm occurs Takeaways for Quality LeadersDo not rush to discipline before a full systems-based review is complete Treat early family communication and caregiver support as core parts of the safety response Ask what design or implementation factors shaped the event Make sure safety expertise is in the room during technology and device implementation Stop assuming quality improvement training alone is enough for patient safety leadership Invest in ways to detect weak signals and emerging hazards before they become events Judge mitigation strategies by two standards: effectiveness and sustainabilityConnect with Dr. Terry FairbanksLinkedInTwitter / XResources & Frameworks ReferencedAnnie’s Story The MedStar Health National Center for Human Factors in HealthcareSystems-based event reviewAHRQ's CANDOR Framework IHI's RCA2 Framework Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersHealthcare organizations are investing heavily in new technologies, yet many implementations unintentionally add complexity to clinicians’ daily work. This episode explores a different question: what if we deliberately evaluate tools for their ability to reduce friction and support clinician well-being?Dr. Chris Dale and Dr. Ryan Dix discuss the development and evaluation of MedPearl, a clinical decision support tool built to streamline referrals and support frontline clinicians. Their conversation highlights why system design, not individual resilience, is often the most powerful lever for improving workforce well-being.Key Ideas ExploredMicro-frictions in clinical workflows accumulate into meaningful cognitive and emotional burdenOrganizational interventions often outperform individual resilience strategiesMedPearl was designed to capture and operationalize “tribal knowledge” in referral workflowsTechnology adoption spreads socially through trusted peer networksMeasuring well-being impact requires using existing data thoughtfullyThe future of innovation must include workforce impact, not just efficiency metricsTakeaways for Quality LeadersTreat clinician well-being as a system property, not an individual responsibilityLook for “sticky note problems” that signal hidden workflow frictionUse existing organizational data sources before launching new surveysExpect heterogeneous impact. Not every tool benefits every group equallyPair product design thinking with traditional improvement methodsMonitor indirect indicators of well-being, not just annual survey scoresRecognize that meaningful improvement will come from many small changes, not one solutionContinue the ConversationConnect with Dr. Ryan Dix through the Wellbeing Trust website to learn more about Providence’s workforce well-being initiatives. Follow Dr. Chris Dale on X (Twitter) or LinkedIn or visit Arborgenie.com to explore his work in AI and clinical data. This episode is especially useful for quality leaders, CMOs, CMIOs, operational leaders evaluating new clinical technologies, and anyone interested in the intersection between AI, data, quality improvement, and clinician wellbeing.If you found this conversation valuable, consider rating, commenting, or sharingLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersMany healthcare organizations say quality matters. Far fewer are built so improvement is part of daily operations. Too often, quality is treated as a department, a committee agenda, or a set of projects at the edge of the real work.In this conversation, Dr. David M. Williams offers a different frame. He argues that quality should function as an organizational strategy: clarifying purpose, understanding the system, choosing the right work, building capability, and creating conditions for learning. For leaders trying to move beyond scattered projects and initiative fatigue, this conversation offers a more coherent way forward.Key Ideas Explored Quality is not a department. It is a way an organization pursues its purpose.  Many “errors” reflect poorly designed systems, not isolated individual failures.  Project work loses power when it is reactionary, peripheral, or poorly aligned.  Leaders need a theory for how quality works across the organization.  Shared methods make improvement more teachable, scalable, and reliable.  Improvement capability must connect to governance, priorities, and daily work. Takeaways for Quality Leaders Revisit your organization’s purpose and what it demands of the system.  Examine whether your improvement work is focused on core work or safer side projects.  Look for signs that quality is structurally marginal.  Build a shared improvement method, not a patchwork of frameworks.  Invest in helping teams get better at rigorous improvement.  Treat implementation and spread as part of the work.  Ask whether quality is changing how the organization actually operates.Continue the ConversationConnect with David M. Williams, PhD via his website or LinkedIn profile.His next QOS Series starts in April 2026: https://davidmwilliamsphd.com/qos-series/Resources & Frameworks ReferencedQuality as an Organizational StrategyThe QOS Field Guide W. Edwards Deming’s system of profound knowledge Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersQuality functions in healthcare often struggle with perception. Too frequently, they are viewed as auditors or enforcers rather than strategic partners in improvement. In complex environments like post-merger health systems, this perception can become an even greater barrier to progress.In this episode, Lisa Harton, DNP, MBA/MPH, RN shares a grounded, experience-based approach to reshaping the role of quality by focusing first on relationships, mindset, and psychological safety. Her work offers practical insight for leaders trying to move from compliance-driven activity toward true system improvement.Key Ideas ExploredWhy quality teams must first become trusted partners before driving accountabilityUsing appreciative inquiry to unify teams after a merger of equalsHow clinicians move through “stages of grief” when confronted with performance dataWhat healthcare underestimates about the human side of high reliabilityThe role of boards and governance in advancing quality strategyWhy changing mindsets is prerequisite to changing behaviorsTakeaways for Quality LeadersStart culture change by intentionally redesigning the relationship between quality and operationsWhen clinicians question data, lean into joint learning rather than defensivenessUse established frameworks to create shared language across the organizationInvest deliberately in teamwork and communication training, not just technical fixesEngage boards with accessible tools that build confidence in quality oversightRecognize and celebrate small wins to build momentum and trustAnchor improvement work in purpose and shared aspiration, especially during mergersContinue the ConversationConnect with Lisa on LinkedIn to continue the discussion. This episode is especially useful for quality leaders navigating culture change, mergers, or reliability work. If you found this conversation valuable, consider sharing it with a colleague or leaving a brief rating or review.Resources & Frameworks ReferencedAppreciative Inquiry frameworkIHI Whole System Quality frameworkIHI's Framework for Effective Board Governance of Health System QualityBarbara FredricksLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersHealthcare organizations are rich with intelligence, talent, and commitment. Yet leaders across systems feel exhausted, constrained, and stuck solving the same problems year after year.In this conversation, Dr. Laura Desveaux challenges the idea that improvement is primarily about adding more initiatives. Instead, she reframes leadership as the disciplined practice of learning, from everyday evidence, from diverse voices, and from the tensions we often try to resolve too quickly. This episode explores what it means to lead a true learning health system in operational reality.Key Ideas ExploredThe gap between current performance and true system potentialLearning health systems as a way of operating, not a series of projectsDe-implementation and “subtraction neglect” in healthcareHolding paradox: efficiency and humanity, population and individual careThe role of co-design and implementation science in scaling improvementAsking better questions as a leadership interventionTakeaways for Quality LeadersStart every initiative by clearly naming the problem you are trying to solve.Before adding a new project, ask what can be removed to create capacity.Integrate multiple forms of evidence: data, lived experience, front-line insight.Move beyond either/or thinking. Many leadership challenges are both/and.Build routines that embed learning into daily operations, not just pilot cycles.Revisit meeting structures, reporting formats, and governance processes with subtraction in mind.Anchor teams to shared outcomes while staying flexible on the path to get there.Continue the ConversationConnect with Dr. Laura Desveaux on LinkedIn or visit her website to follow her work in learning health systems and leadership development. This episode is especially useful for senior leaders, quality executives, and clinicians navigating complex system change. If this conversation resonated, share it with a colleague and consider leaving a review.Resources & Frameworks ReferencedLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersIn health systems around the world, the promise of better data is often discussed—but rarely realized in a way that actually supports clinicians at the point of care. In this episode, Gayle Grout shares her journey from technology and consulting into leading the Health Data Coalition of British Columbia (HDC), a physician-led not-for-profit organization that aggregates electronic medical record (EMR) data across multiple systems to help primary care providers understand their practice patterns, monitor improvement, and better serve patients. From dissecting processes to building trust with busy clinicians, this conversation explores how data becomes useful only when it is contextualized, trustworthy, and actionable.Throughout the episode, we dig into why measurement matters, how feedback loops can reconnect clinicians with purpose, and what it takes to nurture a culture where data supports learning rather than judgment. Grout’s experiences reveal the tension between consumer expectations of information access and healthcare’s lagging systems, and her vision for the future centers on equipping primary care with the tools and support it deserves.Key Ideas ExploredData is a byproduct of good processes, not the starting point of improvement.Trust and non-judgmental engagement are core to clinician adoption of measurement.Feedback loops that empower rather than penalize clinicians change culture.Aggregated EMR data can reveal both practice-level and community-level insights.Primary care needs both technology and human support to improve meaningful outcomes.Takeaways for Quality LeadersPrioritize trust in any measurement initiative—clinicians must feel safe to explore their data.Focus measurement on questions clinicians care about, not what organizations assume matters.Support adoption of data tools by meeting clinicians in their workflows, not imposing them.Use stories alongside numbers to connect data back to patient care and clinician motivation.Consider how aggregate data can advocate for services and system change at community and policy levels.Recognize that measurement is not just technical; it’s cultural and relational work.Continue the ConversationConnect with Gayle Grout on LinkedIn to follow her work in supporting primary care data use.This episode is Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Episode SummaryWhat does the Chief Quality Officer role actually entail once you get past regulatory compliance and dashboards?In this episode, Dr. Abraham Jacob draws on years as a system-level CQO to explain how quality leadership really works in practice: where to start, what to prioritize, and how culture, safety, and accountability interact over time. The conversation is grounded in lived experience, including successes, failures, and lessons learned during periods of workforce instability and change.This episode is most useful for CQOs, CMOs, senior clinical leaders, and anyone building improvement capability at scale.Core Ideas from the ConversationPatient safety is a leverage point Reducing preventable harm creates alignment, urgency, and moral clarity in a way few other priorities do.Quality assurance is necessary but insufficient Meeting regulatory standards does not, by itself, produce better outcomes or learning systems.Variation reveals system design problems Unwarranted variation signals where workflows, standards, or training have failed the system.Psychological safety enables performance, not comfort Teams improve faster when speaking up is expected, acknowledged, and protected.Turnover threatens reliability more than leaders expect Standards erode quickly when onboarding, retraining, and reinforcement don’t keep pace.The CQO role is shifting toward stewardship and value Mature organizations expect CQOs to help lead system transformation, not just oversight.Questions This Episode Raises for LeadersWhere does your quality function spend most of its energy: assurance, improvement, or capability building?What forms of harm are still tolerated because they’ve become routine?How do new staff actually learn “how we do things here,” beyond policies?Where might turnover be quietly undoing prior improvement gains?When was the last time you publicly reinforced speaking up, especially when it was inconvenient?Resources & References Mentioned“What Google Learned From Its Quest to Build the Perfect Team” Charles Duhigg, New York Times Magazine On psychological safety as the strongest predictor of team performance.Institute for Healthcare Improvement (IHI) Referenced as a formative influence oLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersQuality improvement in healthcare is still too often treated as a series of isolated projects—well-intentioned, time-limited, and disconnected from daily operations. Despite decades of progress, this approach struggles to sustain change, reach every patient, or address equity at scale. This episode explores why that gap persists and what it takes to move from episodic improvement to system-level capability. It’s especially relevant for clinical leaders, quality executives, and educators trying to build improvement that actually lasts.The Arc of the ConversationThis conversation traces Dr. Brian Wong’s journey from early exposure to system-level problem solving to his current role building quality improvement capacity across institutions. Rather than focusing on tools or frameworks, the discussion centers on how improvement becomes durable—through structure, relationships, education, and operational integration. What makes this episode different is its emphasis on how systems learn, not just how projects succeed.Key Ideas ExploredWhy project-based QI has a ceiling: Small, local projects can teach skills, but rarely sustain impact or scale across populations.Improvement without operations doesn’t last: QI efforts fail when they sit outside day-to-day workflows and resourcing.Structure shapes outcomes: Structural change creates the conditions for new behaviors and results to emerge.Equity requires system design: Improvement efforts can unintentionally exclude patients unless equity is embedded from the start.Education as a force multiplier: Building improvement capacity through training is foundational.Takeaways for Quality LeadersIf improvement feels fragmented, ask whether your system is optimized for projects rather than learning.Notice where QI work depends on individual heroics instead of organizational support.Reflect on whether equity is treated as a separate initiative or built into how improvement is done.Consider how much protected time and infrastructure exist for people to improve the system they work in.Ask whether your organization is building capability or repeatedly relearning the same lessons.Pay attention to how improvement work is aligned (or misaligned) with operational priorities.Publications & Frameworks Explicitly MentionedThese are named in the transcript and are often things listeners may want to look up:Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersHealthcare organizations invest enormous effort in quality improvement projects, yet many struggle to achieve durable change. Too often, improvement is treated as something that happens at the frontline, while leadership behaviors, management systems, and organizational culture remain untouched.In this episode, Dr. Lee Erickson reflects on decades of hands-on improvement work to explain why real progress depends less on tools and more on how leaders think, learn, and show up. The conversation challenges familiar assumptions about accountability, expertise, and authority and offers a grounded alternative rooted in scientific thinking, transparency, and coaching.Key Ideas ExploredWhy improvement fails when leaders don’t change how they manageThinking like a scientist as a leadership skill, not just a clinical oneHow daily management systems surface problems early — without blameWhy spread depends on culture, trust, and peer-to-peer learningThe limits of outcome targets without process understandingBuilding networks of change agents instead of relying on heroic leadersTakeaways for Quality LeadersIf you want front-line behavior to change, leadership behavior must change firstDon’t demand answers before experiments — design systems that allow learningUse data to create transparency and motivation, not fear or punishmentBuild truly interdisciplinary teams for complex problems like flow and dischargeTreat spread as a relational process, not a rollout planReplace command-and-control with coaching and problem-solving supportInvest in developing people who can think, test, and teach othersContinue the ConversationConnect with Dr. Lee Erickson on LinkedIn or through her organization Adaptient to continue the dialogue. This episode is especially useful for executives, physician leaders, and quality professionals trying to move beyond project-based improvement toward lasting cultural change. If this conversation resonated, consider sharing it with a colleague or leaving a thoughtful review.Resources & Frameworks ReferencedLean and Toyota Production System principlesA3 problem-solving methodologyPlan–Do–Study–Act (PDSA) cyclesLean Daily Management SystemsInterdisciplinary improvement teamsHelen Bevan’s work on change agents and spread (including the Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Why This Episode MattersHealthcare quality work often stalls not because of a lack of methods or data, but because organizations fail to build the leadership and culture needed to sustain improvement. In this episode, Dr. Todd Allen reflects on his journey from frontline emergency medicine to senior quality leadership at Intermountain Healthcare and The Queen’s Health Systems, and how his view of quality evolved from tools and measurement to leadership, trust, and psychological safety. The conversation explores the design and impact of physician leadership development as a core strategy for cultural change—offering a perspective on quality improvement that goes far beyond projects, dashboards, or checklists.Key Ideas ExploredQuality and leadership are inseparable: Sustainable improvement depends on leader behaviors, not just methods.Psychological safety enables learning: Without it, clinicians won’t question assumptions or surface problems.Technical skills aren’t enough: Character determines how tools like finance, strategy, and operations are used.Culture changes through behavior: Daily actions—not slogans—shape how organizations function.Leadership can be measured: Imperfect measurement still supports learning and accountability.Takeaways for Quality LeadersIf improvement fades, examine leadership capability before redesigning projects.Pay attention to whether people feel safe speaking honestly in leadership spaces.Don’t assume leadership will develop on its own—teach it deliberately.Treat skepticism as a signal of missing trust, not resistance.Look for character-based leadership in everyday decisions.Invest in leadership development as a system capability, not a one-off program.Continue the ConversationConnect with Dr. Todd Allen on LinkedInThis episode may be especially useful for leaders building clinical programs, leadership pipelines, or communities of practice.If this conversation resonated, consider Rating and commenting on it to help others find it.Sharing it directly with someone interested in for leadership development or shaping culture in your organization.Resources & Frameworks ReferencedW. Edwards Deming and Total Quality ManagementLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

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 CoverThe 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 andLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

What if the hardest part of quality isn’t finding the right answer, but making the right action unmistakable for the people who deliver care? That’s the thread we pull with Dr. Hilary Babcock—infectious disease physician, longtime infection prevention leader, and now chief quality officer helping steer a 12-hospital system of 33,000 people through transformation without losing its soul.We talk about learning to lead beyond subject-matter expertise and how COVID pressure-tested every leadership instinct. Hilary shares how she and her team turned dashboards into decisions, building a centralized quality hub with deep resources and a one-page “top five” for each priority so busy managers could act today. She explains why outcome views must be paired with real-time process visibility—knowing not just that CLABSIs ticked up, but exactly who is overdue for a dressing change right now—so data becomes a map rather than a mirror.We also go inside vaccine policy and trust. BJC implemented one of the nation’s earliest influenza mandates, treating it as a safety tool within a clear accommodation process. During the COVID rollout, transparency, values, and personal candor anchored tough choices about prioritization and access. The organization’s values—kindness, respect, excellence, safety, teamwork—moved from posters to practice, and a shift to centrally led, locally embedded quality teams helped spread best practices across hospitals while protecting local relationships.If you care about healthcare quality, leadership, and culture, you’ll leave with practical tactics and renewed optimism. Hit play, then share this with a colleague who wants to turn analytics into action. If the conversation resonated, subscribe, leave a review, and tell us the one change you’ll try this week.Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

A door swinging open in the OR. A tiny defect in IV tubing. Both seem trivial—until you realize they expose how fragile our systems really are.In this episode, Allie Muniak, Executive Director of Health System Improvement at Health Quality BC, shows how human factors turns everyday frustration into lifesaving insight. We follow her path from psychology to system redesign, uncovering how design, teamwork, and curiosity prevent harm long before checklists or policies do.Allie explains what human factors really means in healthcare—how people, technology, and environments interact under real-world pressure. She shares how normalizing observation as learning (not policing) helped surgical teams transform the safety checklist from a compliance tool into a culture of attention, anticipation, and role clarity.Then, a gripping case study: ICU nurses reporting spontaneous over-infusions after a new pump rollout. Rather than defaulting to “retrain the user,” a multidisciplinary team dug deeper—partnering with engineers and vendors to discover a hidden tubing defect that led to a global recall of hundreds of millions of sets. It’s a powerful example of how listening to the front line and rejecting blame can reshape safety worldwide.We close with lessons for every leader: slow down to see work as it’s really done, balance reactive review with proactive learning, and design systems that support clinicians instead of constraining them.If you care about real root cause analysis and systems that make the right action the easy one, this episode is for you.🔗 Additional ResourcesHealth Quality BC – Learn more about the organization’s work in system improvement and patient safety: ➡️ https://healthqualitybc.ca/Allie Muniak – Executive Director, Health System Improvement, HQBC ➡️ LinkedIn: linkedin.com/in/allisonmuniak/?skipRedirect=true ➡️ Health Quality BC: https://healthqualitybc.ca/about-us/meet-our-team/allison-muniak/📚 Mentioned in This EpisodeThe Checklist Manifesto by Atul Gawande — the seminal book behind the global surgical safety checklist movement. 👉 https://www.goodreads.com/book/show/6667514-the-checklist-manifestoSafety-I and Safety-II Framework (Erik Hollnagel) — foundational ideas for balancing reactive reviews with proactive learning. 👉 https://www.england.nhs.uk/signuptosafety/wp-content/uploads/sites/16/2015/10/safety-1-safety-2-whte-papr.pdfWorld Health Organization: Surgical Safety Checklist — global reference tooLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

A small change at the bedside can ripple across an entire system. That’s the spark behind this conversation with Dr. Khalil Sivjee, Medical Director at Cleveland Clinic Canada and pulmonary–critical care physician, as we explore how data, design, and relentless measurement turn delays into decisions and anxiety into action.We begin in the ICU, where a simple ventilator-liberation protocol challenged “that’s how we do it” and proved that even a junior clinician can drive measurable improvement. From there, Khalil zooms out to outpatient redesign—mapping the lung-cancer journey from first nodule to treatment and collapsing months-long waits by pre-ordering imaging, biopsies, and consults. Supported by EMR flags that signal when access drifts off target, this work redefines what it means to be data-driven.We unpack “metrics that matter”—from reducing “scanxiety” through faster imaging turnaround to tracking safety events and service-line dashboards that keep teams focused on what patients actually feel. Then the conversation expands into the workplace, where Cleveland Clinic’s corporate advisory model helps companies build healthier environments through smarter design—air quality, ergonomics, mental-health screening, and on-site “pre-primary” checks that spot hypertension and diabetes early.Finally, we look to the frontier of access: portable diagnostic kits and AI-enabled triage that bring care to students, remote workers, and underserved communities. The distance between a question and a clinical answer keeps shrinking.The takeaway: the future of outpatient care is near-home, proactive, and measurable. Put the patient at the center, bring services to them, and measure everything that matters. If this resonates, follow, share, and leave a review—and tell us the one metric you think every clinic should track.🔗 Resources & LinksGuest LinksDr. Khalil Sivjee – Cleveland Clinic Canada Profile: https://my.clevelandclinic.org/canada/staff/sivjee-khalilDr. Khalil Sivjee – LinkedIn: https://www.linkedin.com/in/khalil-sivjee-a3021a9a/Specific References Mentioned in the EpisodeCleveland Clinic Canada — Official site for outpatient and corporate health programs: https://my.clevelandclinic.org/canadaTytocare — Remote diagnostic platform discussed in the episode: https://www.tytocare.comLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Safety isn’t a side project.  It’s the operating system. We sit down with Paul Lambrecht, a rare blend of front line paramedic sensibility and executive discipline, to unpack how high reliability organizing moves from idea to front line work. From standing up daily safety huddles to building a just culture where ARCC and SBAR actually get used, Paul explains how to turn near misses into gold, flatten authority gradients, and create a system where performance as intended becomes the norm.We trace his journey through a post-merger health network that unified on a single EMR and chose safety as its identity, leading to dramatic reductions in preventable harm. Paul breaks down the five principles of high reliability—preoccupation with failure, sensitivity to operations, reluctance to simplify, deference to expertise, and commitment to resilience—and shows how to operationalize each with simple, durable tools. You’ll hear how a 20-minute, whole-house huddle can give real-time situational awareness, how a shared dashboard closes loops fast, and why top-down sponsorship paired with frontline ownership changes behavior at scale.We also look forward. Human factors is reshaping patient safety by designing systems that make the right action the easy action—clear interfaces, standardized kits, cognitive offloading, and smarter workflows. Paul shares candid lessons on psychological safety and just culture, how to coach leaders who default to blame, and where to start if you’re resource-constrained: round for safety, mine near misses, train in ARCC and SBAR, and build reliability into daily routines.If this conversation sparks ideas for your team, follow and share the show, leave a review to help others find it, and tell us: what’s the one safety ritual you’ll start this week?Connect with Paul Lambrecht on LinkedInAdditional ResourcesFoundational BooksManaging the Unexpected — Karl E. Weick & Kathleen M. Sutcliffe (Wiley). The classic HRO text outlining the five principles. The Engaged Caregiver — Joseph A. Cabral & Timothy R. Clark (McGraw-Hill). Discusses the “virtuous cycle” linking safety → engagement → quality → efficiency. The Fearless Organization — Amy C. Edmondson (Wiley). Psychological safety as the backbone for speaking up and graded escalation. Peer-Reviewed / Authoritative Articles & HRO Background“High-Reliability Health Care: Getting There from Here” — Mark R. Chassin & Jerod M. Loeb, The Milbank QuarterlyLeading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

As Stephen Covey once wrote, "Change happens at the speed of trust." This simple yet profound insight applied by this week's guest, Dr. Curt Smecher captures the essence of how British Columbia's Physician Quality Improvement program transformed healthcare from the ground up. Affectionately known as "Papa QI," Smecher shares the remarkable journey of creating a physician-led improvement movement that has trained over 1,600 clinicians across the province.What makes this story exceptional isn't just the scale, but the approach. Rather than following the conventional wisdom of starting with executive buy-in, PQI began with frontline physicians and built upward. This counterintuitive strategy created a powerful foundation of clinical expertise while gradually earning administrative support through demonstrated results. The program's governance structure – with physicians, administrators, patients, and Doctors of BC as equal partners – represents a radical departure from healthcare's typical hierarchies.Perhaps most revolutionary was the early decision to include patients as full participants in all aspects of the program. When questioned about involving patients in budgeting discussions, Smecher's response was telling: "Most of our patients know more about budgeting than our doctors do." This authentic partnership approach has been central to PQI's success and sustainability over its decade-long existence.The program's impact extends beyond clinical improvements. Physicians trained through PQI demonstrate 40% higher engagement levels compared to their peers, suggesting that meaningful involvement in improvement work serves as a powerful antidote to burnout. Protected funding ensures resources remain dedicated to improvement rather than being diverted to immediate clinical pressures – a recognition that investing in system improvement requires dedicated space and time.Looking ahead, Smecher describes PQI's evolution from building capacity to effectively utilizing that capacity, with the ultimate vision of "whole system quality" that addresses upstream factors rather than playing healthcare whack-a-mole. For anyone seeking to create lasting healthcare transformation, this conversation offers invaluable insights into building improvement capability that outlasts any single leader or initiative.Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

What transforms a one-star hospital into a four-star institution in just four years? The answer lies not in fancy technology or complex solutions, but in approaching problems with genuine humility and data-driven focus.Dr. Kimiyoshi Kobayashi brings a refreshing perspective to healthcare quality leadership in this illuminating conversation. As Chief Medical Officer at UMass Memorial Medical Center, he shares the critical mindset shift that helped him lead a remarkable quality transformation: "I always tried to remember when approaching somebody to approach each problem with humility." This approach—starting with curiosity rather than assumptions—has proven more valuable than any technological solution.The discussion delves into common misconceptions about capacity command centers, revealing that despite their NASA-like appearance with monitors and co-located services, their effectiveness depends entirely on answering fundamental organizational questions. "It doesn't matter how shiny the room is," Dr. Kobayashi explains, "if you don't have difficult discussions around how decisions will be made when there are winners and losers."For physicians transitioning into quality leadership, Dr. Kobayashi offers hard-earned wisdom from his own mistakes. He describes how his medical training conditioned him to be "answer-oriented," while leadership requires focusing on process and collaboration. This insight resonates deeply for clinical leaders who must unlearn the habit of individual problem-solving to embrace collaborative improvement.Looking toward healthcare's future, Dr. Kobayashi envisions AI transforming quality measurement by enabling more comprehensive monitoring across all procedures and settings. Yet he maintains that human judgment will remain essential: "While data might get easier to extract, someone still has to tell the story and understand where workflows need to change."Subscribe to Leading Quality for more conversations with healthcare leaders who are transforming patient care through innovative approaches to quality improvement.Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

Dr. Lawrence Yang's powerful story begins with a stark confession: "My body had to say no for me because I didn't know how to do it myself." This candid admission sets the tone for a conversation that weaves together personal vulnerability, system transformation, and the science of hope.As a family physician who once installed a bedroom and shower in his clinic to work longer hours, Dr. Yang's burnout journey will resonate with healthcare professionals everywhere. His turning point came through an unexpected avenue—quality improvement science—which provided both methodology and community when he needed it most. "I think quality improvement science is a science of hope," he explains, revealing how structured approaches to system problems can alleviate the moral distress that accompanies witnessing poor care experiences repeatedly.The conversation explores British Columbia's innovative Physician Quality Improvement program, which has trained nearly 800 physicians through a unique collaboration between government and clinicians. This "silent army" represents tremendous potential for healthcare transformation, demonstrating what's possible when improvement capacity is intentionally built at scale. Dr. Yang artfully distinguishes between moral injury, moral distress, and burnout, while explaining how joy in work requires leaders to facilitate safety, purpose, autonomy, community, fairness, and recognition.Looking toward 2030, Dr. Yang envisions primary care transformation through honest quality assessment, team-based models enabling everyone to work at top-of-scope, and transparent metrics aligned with the "sextuple aim." His advice to new clinicians cuts through professional martyrdom culture with refreshing clarity: "The system will not benefit from your martyrdom. What's in your job description is to model sustainability and wellness for your patients, colleagues, and family members."This conversation isn't just about surviving in healthcare—it's about finding the courage to bring our full selves to the work we care about, and in doing so, creating the conditions for healthcare transformation. What might be possible if we approached system change with both vulnerability and courage? Dr. Yang's journey suggests the answer could be revolutionary.Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic

 Healthcare is more complex than ever — with patients seeing multiple specialists, interacting with advanced technology, and relying on coordinated teams to deliver safe, effective care. In this introductory episode, host Dr. Jason Meadows shares why he created Leading Quality and what listeners can expect. This podcast will spotlight the people — from senior leaders to frontline innovators — who are moving healthcare forward. Together, we’ll explore their stories, lessons learned, and the vision for a more connected, trustworthy, and human healthcare system. Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.Help us build this podcast  community from the ground up: share your top insight from this episode and where you’re seeing it in your own work. I read every response and will share what we’re learning over time in future episodes and other ways.New episodes published every other Thursday at 7AM Eastern Time.Credits:Host, Writer, and Executive Producer Jason Meadows, MDProduced by Thrive Healthcare ImprovementEdited by Milan Milosavljevic