Improving patient safety is every caregiver's concern, but what does this look like in health care's rapidly changing environment? In this Leadership Dialogue conversation, Steven Diaz, M.D., chief medical officer at MaineGeneral Health and board member at the American Hospital Association, discusses his passion for patient safety, how his organization strives to meet quality care for its community, and how AI could potentially be incorporated into the overall work of patient safety.

This is an edited conversation. To view the full conversation, please visit: https://www.youtube.com/watch?v=wzia8UmU_qc

Tom Haederle

Improving patient safety is every caregiver's concern. While each hospital customizes its patient safety efforts and strategies to best meet the needs of the patients and communities it serves, certain practices hold promise to help just about everyone.

Tom Haederle

Tom Haederle

Let's join them.

Joanne Conroy, M.D.

Thank you for joining us today for another AHA Leadership Dialogue discussion. It's great to be with you. I'm Joanne Conroy, CEO and president of Dartmouth Health and the current chair of the American Hospital Association Board of Trustees. You can tell that I have some laryngitis, but I am delighted that I don't have to do a lot of the talking because I'm going to be joined by Dr. Steve Diaz, who is chief medical officer of MaineGeneral Health.

Joanne Conroy, M.D.

Joanne Conroy, M.D.

Last year, the AHA launched a national initiative to reaffirm our leadership and commitment to patient safety. AHA's Patient Safety Initiative is guided by a clinical advisory panel and a strategic advisory group. They focus on reducing patient harms, increasing health equity, and improving public trust. But before we jump into our discussion and my questions, Steve, our audience really wants to know about our speakers.

Joanne Conroy, M.D.

So can you share some information about your background and how you got to MaineGeneral, and how that's affected your approach to patient safety?

Steven Diaz, M.D.

Thank you. Joanne. Glad to join you today. I started in healthcare prior to medical school. I was an EMS at work in Sacramento, Sacramento Ambulance and decided I would take the plunge going to medical school. And I, growing up in California, I decided to have an East Coast experience. I went to Cornell New York hospital

Steven Diaz, M.D.

thinking after that, I go back to California. I was somewhat wayward, took a year off and taught there, and then decided to do family medicine training to start with and would go to a rural area - again, to grow up and figure out what I wanted to do for my life. So I said that I would go to Maine for three years 31 years ago. Finished my training and then went into emergency medicine and grandfathered into that a long time ago.

Steven Diaz, M.D.

And then became involved in disaster EMS and emergency medicine on my way to becoming an administrator for MaineGeneral. It's interesting. I think prior to medical school, having that EMS experience was key. We worked in teams. We've always thought we worked in teams, we've really strived to work in teams. And I see the thing that I focused on at MaineGeneral is flattening the hierarchy and moving things so that we're all taking care of patients in a coordinated fashion rather than everybody having a different care plan, if you will.

Joanne Conroy, M.D.

So, Steve and I share an affection for the state of Maine. My family grew up in rural Maine. But why patient safety? Because emergency medicine...you know, you can take many paths after training in that specialty. But why was safety such a passion for you?

Steven Diaz, M.D.

Safety is such as a passion because in emergency medicine, the times that we get involved in high acuity situations, it's not as common as taking care of amateur sense of conditions or even intermediate medical conditions. Because of that, when we do critical care in emergency medicine, it's not the most common thing we do. With our central line intubations, using vasoactive drugs or other things that are very aggressive

Steven Diaz, M.D.

you have to be sure that the whole team is ready for that. Today, of course, we all have, you know, care bundles and team practice in Stemi care, sepsis, stroke and trauma - all the time sensitive conditions. But that was not the way it was 30 years ago. One of the roles I had early in my career here in Maine was I was the medical director for Maine Emergency Medical Services,

Steven Diaz, M.D.

so the state medical director. And we worked to have state protocols for Stemicare for ER to cath lab. We work to have state protocols for stroke care. Prior to my time there, we had state protocols for trauma care. And now sepsis care. Again having state protocols or state initiatives that starts with EMS will hopefully change that curve as well.

Steven Diaz, M.D.

So it appealed to me because you have to plan for it. You have to have teamwork. Be critical of yourselves, both individually and as a team in order to improve the care and the outcomes of the patients we serve. So that's why emergency medicine, it called to me.

Joanne Conroy, M.D.

Now, you trained in a rural area. You know, that's gotta be different than delivering emergency care in an urban area. What are the challenges that you've run into really in rural Maine, where most of the hospitals are critical access hospitals, except for a handful of quaternary care facilities?

Steven Diaz, M.D.

I think the biggest issue in rural emergency medicine care is you don't have the consultants at your fingertips, if you will. Whether it's trauma, stroke, heart attacks or Stemis, you might have to be creative on how you get those patients the care they need and find your consultants. I think in many ways, I was fortunate that I was EMS medical director for Maine early on because I met a lot of people across all the systems.

Steven Diaz, M.D.

And again, the goal here was to have a system of care so no matter where you went, you'd have the same care. So let me give you an example. When I was a young ER doctor and I had somebody with a SD elevation, myocardial infarction or a heart attack in front of me, that referral centers of cath labs who did interventional cardiology had three different protocols.

Steven Diaz, M.D.

And so I had different colored folders - we all did in our E.R., depending on which tertiary care center they chose. And so, and heaven forbid that you picked the wrong folder color and someone changed their mind or there wasn't bed availability. Nuances were no significant, but they were nuances. And so, we work to have that really ironed out.

Steven Diaz, M.D.

And I think that is the same discussion you have with stroke care, although that have been helped by other entities having some standardized protocols, but then having the consultants know who you are and where you call them. Interestingly enough, my preferred shift was the weekend overnight shifts in the ER, it just seemed to be a shift that went by quickly.

Steven Diaz, M.D.

Lots of teamwork. No offense, less suits around. But also made it so that I really had to know my consultants and know where I was going. In rural emergency medicine, rural states and or rural health care in general, again, you have to know where you're going to go because you may not have a lot of things in-house.

Steven Diaz, M.D.

And that was true 30 years ago as and it's still true today. Making it more important that we know our networks of care and our consultants.

Joanne Conroy, M.D.

So, you know, there's a lot of conversation about AI. Is AI going to improve safety, do you think, or is it going to jeopardize that?

Steven Diaz, M.D.

Steven Diaz, M.D.

And I think that's where AI could help us. If you have somebody getting a procedure or going on chemotherapy or who has other complex medical conditions, informed consent to ongoing education could be a boon for AI that identifies, you know, people with heart failure and which class they're in what they need as education. AI could say well, hold on, once you're done with them in the office, you know, you can send them this or they'll be identified by AI to receive these education, either online or print, depending on how they learn best.

Steven Diaz, M.D.

And it's always available to them. And we'll check in with them. It sounds like it'll be perhaps a cure management, but it's even beyond that because it'll speak to them in a way or then you can test them so they get the information the best way they get it. Right now all those things are done by people.

Steven Diaz, M.D.

You know, it's not the decision, it's the NPA or it's the nurse or the care manager. And they're all, we're all happy to do it. But none of us had that conversation once. Oncology is my favorite example of this. If you see an oncologist and you're told you have something that usually happens in the first few minutes and the next 15, 20 minutes, no offense,

Steven Diaz, M.D.

the patient and family don't hear anything else. Yeah, and that'll be me, if I remember. You know, there's no way I'm gonna remember anything past whatever they tell me that just shifted my whole world. But wouldn't it be great, though, if someone had a link, that was identified for them? Or AI can help answer their questions and gets information back from them

Steven Diaz, M.D.

that's given to the care team to help create the right message for them. That'd be incredible. That would be role changing, giving people back time, to not be burdened by the admission.

Joanne Conroy, M.D.

So it's almost personalizing their treatment plan. You know, we actually do videotape on your phone, our visits. So patients actually can refer to the conversation later 'cause you're absolutely right, Steve. After they hear that they have a diagnosis of cancer, they don't hear anything else. And all that important information is lost. Let's talk a little bit about AI in like, record abstraction.

Joanne Conroy, M.D.

Remember when we started using algorithms to oversee our ICU care? We identified that there were some early warning signs so we could anticipate when somebody might be unstable before they actually became unstable. What do you think about using AI for chart abstraction and kind of identifying things that are very difficult for our chart of structures currently pick up?

Steven Diaz, M.D.

I think they'd be ideal. Right now, you know, we spend a lot of administrative time either at the physician level MPPA coder, biller, trying to find those magic words that people are looking for in order to determine your risk stratification and thus your billing and even quality metrics at the back end. It shouldn't be a game, right?

Steven Diaz, M.D.

We should be able to say, I remember early on as a young doctor when I kept saying, urosepsis. I got the nastygram saying, no, you mean UTI with sepsis? You know, very specific words. So AI should be able to help with that, to be able to take the human element out of it.

Steven Diaz, M.D.

Let us practice and talk and then make the crosswalk so that it gets categorized the correct way and in the correct format. To me, that's a yeah, another easy lift. I've seen the products, I've been demo'ed by some of our younger medical staff who have me as a patient, and they're the doctor, and we just have a conversation and they hit a button and it can either generate a consult note, the agent P, the soap note, you know, and it's better than anything we could have delivered or dictated.

Steven Diaz, M.D.

And so, yeah, we do think there's a way coming that will make it more compliant and hopefully, again, get some of that red tape, some of the administrative burden out of health care.

Joanne Conroy, M.D.

Let's talk a little bit about safety and how we create community partners. Because patient safety is of great interest to people in our communities. And you live in a community like mine that people come up to you in the grocery store and in a coffee shop, and safety is probably one of the number one things that our patients worry about.

Joanne Conroy, M.D.

How do you actually engage the community so you have internal and external partners that are working on safety across the community?

Steven Diaz, M.D.

I will take an example in the behavioral health addiction medicine realm. When I was a young ER doc here, again, decades ago, the contract in the community for behavioral health is very strong. And today all those community partners are under duress. We actually surveyed them about two years ago on the Pediatric Realm Tracker. How we bolster more, resources for people who would need help in either mental health or addiction medicine services.

Steven Diaz, M.D.

And I would just say that everybody needs more help. And so we convened from that discussion, a small conference, that it's now an ongoing symposium where we try to bring all our partners together to discuss this openly. How are we sharing patients, what's the best way to go forward? Where should we go speak to the community,

Steven Diaz, M.D.

who's our audience? And so that's one small example of taking a piece of what we have to try to do more with it. It's not surprising that was spurned by the adolescent mental health crisis that's sweeping the nation that's also linked to suicide. So that was sort of the call to arms for that. I take that same paradigm, and that is sort of how we go out there to meet people where they live, whether it's behavioral health, CHF, COPD, there's a lot of community partners that we need to intersect with in order for the people to have the care they need, because we can't do it all alone.

Joanne Conroy, M.D.

Especially in rural America. We figured out that, our external partners are really important in actually keeping our community healthy and keeping our community safe.

Steven Diaz, M.D.

Right.

Joanne Conroy, M.D.

I want to thank you, Steve, and I want to apologize for our audience for having laryngitis today. But Steve did most of the talking, and I thank him for that. We appreciate you sharing your valuable expertise and insights. Thank you very much from rural Hanover, New Hampshire, to rural Augusta, Maine.

Tom Haederle

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