Jefferson Health was a finalist for the AHA's 2024 Quest for Quality Prize, which celebrates hospitals and health systems that are committed to providing exceptional safe, and patient- and family-centered care. In this conversation, Jefferson Health's Cara Martino, DNP, R.N., enterprise vice president of clinical improvement and transformation, and Trish Henwood, M.D., executive vice president and chief clinical officer, discuss the organization's ever-growing patient population, and how an innovative platform is keeping employees unified when identifying and implementing patient-focused improvements.

To learn more about the AHA's Quest for Quality prize visit, https://www.aha.org/about/awards/quest-for-quality

Tom Haederle

Every hospital and health system is motivated to find ever-better ways to deliver patient care. But driving improvement across 17 hospitals serving two states is a challenge that defies a one-size-fits-all approach. That's why Jefferson Health, serving patients in New Jersey and Pennsylvania, created a unified platform it calls the OnPoint Program to keep everyone on the same page when it comes to identifying and implementing needed changes.

Tom Haederle

Chris DeReinzo, M.D.

Hi everybody. This is Dr. Chris DeReinzo. I'm AHA’s chief physician executive and we are coming to you from the AHA Leadership Summit in San Diego. We are here in the Innovation Hub, which is a perfectly apropos place to be, because we're here today to talk with some of Jefferson Health's senior leaders. Joining us on the podcast, I have Dr. Cara Martino.

Chris DeReinzo, M.D.

She is a DNP and she's the vice president of clinical improvement and transformation across Jefferson Health. And Dr. Trish Henwood, who is an M.D., and she is the executive vice president and chief clinical officer for the system. And you all are here in part because Jefferson has been recognized as one of the finalists for AHA's Quest for Quality Award.

Chris DeReinzo, M.D.

Congratulations. That is a spectacular achievement. And our listeners want to know a little bit about how you do it. And so, Trish, why don't we start with you.

Trish Henwood, M.D.

Thanks, Chris. We're really glad to be here and really excited for the recognition and to be here with all of the innovation conversation that's happening. For us at Jefferson Health, we have taken a different approach on how we're focused on improvement. We have a unified platform across the system we call the OnPoint program and that really is to us, a clinical operating system that helps drive our goals in quality and safety, in health equity, in patient experience and in population health and really is sort of the foundation for us and how we think about how our teams come together to work on these improvement efforts.

Chris DeReinzo, M.D.

It's a spectacular system and one that you've spoken about internationally. I'm curious, Cara, perhaps tell us a little bit about how you start from that system and then actually make it tactically happen with your teams?

Cara Martino, DNP

Yeah, sure. No problem. A few pieces. We have a clinical improvement approach where we really start by looking at our data across the board and identifying opportunities, looking at that by our divisions, our region and across the enterprise to really try to understand the playing field. And then we look at our process, our people and our technology. Once we kind of identify what we want to improve, what are the resources that we have in place, what are the technologies that those resources are interacting with to drive that workflow, and what are the different processes or policies?

Cara Martino, DNP

And then I think it's really important because Jefferson Health has so much expertise at the frontline and with the clinicians. We work with them to identify what is evidence based practice to drive that opportunity? And then we take that and we kind of build it into a system to make it easy for the frontline staff to do the right thing, to get the outcome that we need.

Cara Martino, DNP

Many times we do that through technology, but through process also, and then we continuously monitor that to really understand is what we intended happening, right? Because a lot of times it's what we think is going to happen or we think happens on the front line isn't always the reality. And so we continuously monitor that through process measures and through outcome measures.

Cara Martino, DNP

And then we tweak it. And over time we continuously improve on that. And I think that's really important. The first time that you try to improve something, you're not going to get there 100%. And so it's really important to have that continuous process.

Chris DeReinzo, M.D.

Chris DeReinzo, M.D.

And in order to get better tomorrow, you got to measure it. But remind me, our listeners know you obviously as one of the premier academic systems in the northeast, but your footprint spreads pretty far beyond, you know, it's kind of our traditional closed medical staff, academic model. Remind our listeners, when you talk about driving that process improvement to the front line, what kind of front lines are you driving it to?

Trish Henwood, M.D.

We have quite a variety across our system. We're a 17-hospital system. We span two states, southeastern Pennsylvania and southern new Jersey, nine county areas serving a catchment area of over 5 million people. Wow. So it's quite a large system, growing system as well in the coming months. So for us, it's very important for us to think about how we interact across all those teams and how we bring our teams together to have the prioritized focus that we are establishing as we move year on year.

Trish Henwood, M.D.

To piggyback on what Cara was saying, part of what we try to do in the discovery phase for our improvement is to think, to use principles from human factors engineering and resilience engineering, to think about the difference between work as done versus work as imagined. We know that at times the enterprise approach may be the work as imagined, and it's very important that our process is informed by our frontline teams, by telling us going across our system and understanding how is work actually done, how do we ensure that we have representation from our clinicians and or our team members if they're not clinical, that are interacting on these workflows?

Trish Henwood, M.D.

As we think about designing something that's going to work across an entire system of our size, where we have complex academic medical centers, where we have smaller community hospitals. We have obviously a large ambulatory footprint in addition to urgent care. And so how we think about things in our different care settings and how we think about things across the continuum of care.

Chris DeReinzo, M.D.

I love that thinking, because I remember being at a health system in the western part of North Carolina, and the approach that we took to drive something like improvement in timed one-hour antibiotics in the emergency department could follow one pathway, and it's pretty classic pathway. But then once we brought that out into the region in the critical access hospitals, you just can't do that because their pharmacy isn't even open from like 11 p.m. to 7 a.m..

Chris DeReinzo, M.D.

This was ten years ago now, but I love the flexibility in that approach. But talk to me a little bit about the kinds of people who do that work are fundamentally some different skill sets than perhaps what we've seen in the quality and safety world in the past.

Cara Martino, DNP

Yeah, absolutely. As we were developing the team, what we really started to realize is that we needed to advance the skill sets of the people that are in quality and safety and in this improvement work. And I think that today we really look for people that understand informatics and analytics and can take that deeper dive into where the opportunities are for improvement and really drive those through with process improvement and project management and really get down to kind of tactical items that we can do to really change that.

Cara Martino, DNP

And I think to your point around what's going to work for our maybe Center City hospital, our academic hospital, may not work for the regions where there are community hospitals. And we try to have a standardized approach, but build in for those nuances and those complexities that are at the local regions and divisions. And we do that through our quality and safety folks, kind of as the glue between the groups that really help with that connection.

Chris DeReinzo, M.D.

Talk to me about how you make that bridge real, because you both, like me, have a clinical background. But we're talking about design thinkers and informatics folks that come from fundamentally different backgrounds sometimes. How do you make that bridge happen so that the folks who live exclusively in one, you know, our bedside clinicians who aren't going to go to design school, but how do they understand the challenges?

Trish Henwood, M.D.

I think we certainly take a matrixed approach, right, to how our teams interact. We work very closely in terms of the office of the chief quality and chief clinical officer with our office of the CIO, and thinking about how we interact with our ISNT teams, making sure that our teams are appropriately connected, and then again, bringing in our frontline caregivers, clinicians and patients and community member voices, again, depending on what the process is, so that we make sure that from the front of the process, we're thinking about all of the different stakeholders, making sure that we're thinking about the entire health care ecosystem. And we ensure that those voices are represented, but supported again

Trish Henwood, M.D.

by the clinical improvement design team that's helping to think about, okay, this is the perspective that we have from all of our key stakeholders. And how are we going to think about how we build that into the system? Where are there things that we can standardize across the board, and where are there areas where - to Cara's point - we know that we have to allow for some local adaptation?

Chris DeReinzo, M.D.

Bingo. I mean, it takes so much energy to do what you guys are describing. It sounds simple. We can cover it in a ten minute podcast, but the amount of time and effort you put in to making such a complex organism seem so simple. I know from firsthand experience it is a ton. And through AHA's Patient Safety Initiative, one thing we've heard from our members in this innovation engine is they want to hear not only the what folks are doing, but some of the really tactical hows.

Chris DeReinzo, M.D.

So I'm curious. In just the couple of minutes we have left, again, recognizing that you all span the entire spectrum from large academic inner city to rural community. What about our smaller, more independent members who are listening saying, wow, I wish I had OnPoint, or a stats team, or the kind of dashboards that I've gotten to see coming from Jefferson, but I just don't even know where to start.

Trish Henwood, M.D.

I think one of the key considerations is just thinking about that interdisciplinary collaboration. I think that's really been key for us in thinking about how different teams communicate and work together, and are clear on the prioritized goals and quality and safety. So that's part of the fundamental approach for us, is making sure that we are working with all of those different teams and stakeholders and that everyone knows what matters most in the organization, and everyone can work from their perspective in helping us drive that.

Trish Henwood, M.D.

So communication has been key as well as a real foundational focus that we've had in safety. We see safety as the bedrock. We can't focus on quality until we're ensuring that we can deliver safety. We obviously are moving as a learning organization continually in many areas at the same time, but that has been a fundamental area that we build our safety management system and build our quality management system on top of that.

Chris DeReinzo, M.D.

Outstanding. Cara, any final thoughts for our listeners?

Cara Martino, DNP

Yeah, I would say two things. Focus. You can't do 100 improvement projects. You have to focus. You have to prioritize. And that's when you're really going to see the outcomes. And the second thing I would say is brand your product because people can feel connected to it. And I think that's something we've found with OnPoint that people know what it is and they feel their work connects to something larger

Cara Martino, DNP

and that's been really helpful for us to drive it across such a large health system.

Chris DeReinzo, M.D.

You heard it here first, folks. This has been really one of the most fun podcasts I've ever had a chance to do. Trish, Cara, thank you for joining us. Thank you for being here onsite, sharing your stories here in the Innovation Hub at the AHA's Leadership Summit. Thank you, listeners for tuning in, and we hope that you'll tune in next time as well.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.