Healthcare organizations often tolerate ambiguity, workarounds, and recurring operational problems until they produce serious harm. Dr. Steve Spear explains how leaders can apply the same disciplined thinking used in clinical diagnosis to the systems in which care is delivered—making problems visible early, investigating them rigorously, and building problem-solving capability throughout the organization.

Key Ideas Explored

• High-performing organizations compete through distributed problem-solving capability.

• Standards work best as testable hypotheses, not rigid commands.

• Ambiguity and workarounds allow small problems to become serious failures.

• Amplification, slowification, and simplification create the conditions for learning.

• Leadership means developing others’ ability to see, solve, and share problems.

Takeaways for Quality Leaders

• Go directly to the point of work and observe where staff experience friction or suffering.

• Create clear expectations that make deviations and emerging problems visible.

• Respond to reported problems with curiosity, presence, and practical support.

• Pause when work departs from expectations rather than pushing teams to work around it.

• Build capability in frontline leaders so improvement spreads without depending on a large central quality team.

Continue the Conversation

Steve Spear on LinkedIn or through the See To Solve website

Resources & Frameworks Referenced

• Decoding the DNA of the Toyota Production System

• Fixing Health Care from the Inside, Today

• The High-Velocity Edge

• Wiring the Winning Organization

• See to Solve

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Patients spend most of their lives outside the hospital, yet healthcare teams often have limited visibility into what happens after discharge, between visits, or during long-term recovery. In this episode, Dr. Joshua Liu discusses how SeamlessMD was built to close that gap by helping patients navigate clinical journeys, giving care teams better insight into patient progress, and showing why successful health technology depends as much on workflow, incentives, and leadership alignment as it does on the product itself.

Key Ideas Explored

• The “black hole” after discharge and why patients need more support outside the hospital

• SeamlessMD as a healthcare GPS for surgery, chronic disease, cancer care, pregnancy, and recovery

• Why surgical pathways were easier to scale than complex chronic disease management

• How workflow fit determines whether health technology helps or burdens care teams

• Why strong outcome data may still fail to drive adoption without strategic and financial alignment

Takeaways for Quality Leaders

• Look beyond the hospital walls when designing quality and safety interventions.

• Do not assume better data or better outcomes will automatically create executive buy-in.

• Evaluate technology by how well it fits real clinical workflows, not just by its features.

• Engage both frontline teams and senior leaders early if pilots are expected to scale.

• Use patient questions and after-hours concerns as signals for improving education, navigation, and care design.

Continue the Conversation

Joshua Liu - LinkedIn

SeamlessMD

Resources & Frameworks Referenced

• Retrieval augmented generation

• Ontario Health at Home

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Healthcare has made real gains in quality and safety, but Ken Segel argues that too much improvement work still lives as projects, dashboards, or specialist-led initiatives rather than as part of how organizations are run every day. This episode examines what it takes to move from episodic improvement to habitual excellence: a clinical operating system where safety, flow, problem solving, leadership, and accountability are built into daily work.

Key Ideas Explored

•  The Pittsburgh Regional Healthcare Initiative and the early proof that zero harm could be pursued across competing hospitals 

•  Why safety, quality, patient experience, access, and cost are all connected through the flow of care 

•  The clinical operating system: the work system, the problem-solving system, and the leadership system 

•  Why quality and safety experts should advise operating leaders rather than own the work from the sidecar 

•  The shift from rear-view mirror problem solving to real-time learning while information is still fresh 

Takeaways for Quality Leaders

•  Look at whether improvement work is central to operations or still peripheral to how care is actually managed. 

•  Treat quality and safety as operating responsibilities, not just specialist functions or compliance activities. 

•  Go to where the work happens and observe how care flows, how problems surface, and how leaders respond. 

•  Build problem solving into daily management rather than relying only on retrospective reviews and dashboards. 

•  Use discipline to free clinical expertise, not constrain it. 

Continue the Conversation

Ken Segel on LinkedIn

Ken Segel at Value Capture

The Habitual Excellence Podcast

Resources & Frameworks Referenced

•  Pittsburgh Regional Healthcare Initiative 

•  Value Capture 

•  Value Capture Canada 

•  Toyota Production System 

•  Decoding the DNA of the Toyota Production System (The Four Rules in Use) 

•  Shingo Institute 

•  Prisma Health Pulse

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Patient safety has often been built around what happens after harm occurs: incident reports, investigations, accountability, and corrective action. In this episode, Dr. Peter Lachman argues for a more proactive and moral view of safety: one where teams talk about risk every day, anticipate who may be harmed next, and make safety part of the “genome” of healthcare education, leadership, governance, and frontline work.

Key Ideas Explored

•  The early safety event that became Dr. Lachman’s “big why” for patient safety work. 

•  Why professionalism and good intentions are not enough to make care safe. 

•  The shift from retrospective harm review to proactive risk prediction. 

•  The SAFE program as a practical way to help frontline teams talk about safety every day. 

•  Why safety and quality need to become social movements, not just programs or products. 

Takeaways for Quality Leaders

•  Treat adverse events as signals of system design, not simply individual failure. 

•  Build daily routines that help teams ask who is at risk before harm occurs. 

•  Make safety part of training, clinical reasoning, and leadership language from the start. 

•  Pay attention to culture: what people talk about, what they notice, and what they are willing to learn from. 

•  In low-resource settings, do not underestimate the power of people, relationships, and practical methods. 

Continue the Conversation

Dr. Peter Lachman on LinkedIn

Resources & Frameworks Referenced

•  SAFE program / Situation Awareness for Everyone 

•  Patient Safety Movement Foundation Kiani Fellowship 

•  The Institute for Healthcare Improvement (IHI) 

•  To Err Is Human (Institute of Medicine Report, 1999)

•  Crossing the Quality Chasm (Institute of Medicine Report, 2001)

•  Donabedian’s structure-process-outcome model 

•  SEIPS model / Systems Engineering Initiative for Patient Safety 

•  Safety-I and Safety-II 

•  Great Ormond Street patient and family safety reporting work 

• FlaQuM / House of Trust model 

•  Quality 1.0, 2.0, and 3.0 

•  Patient safety as a social movement

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Healthcare organizations often know they have problems with flow, safety, delays, frustration, and waste, but they may not actually see the work clearly enough to solve them. In this conversation, Maria Mentzer explains how See to Solve helps organizations surface hidden problems, involve the people closest to the work, and build practical problem-solving capability through simple, repeatable behaviors rather than heavy improvement infrastructure or abstract training.

Key Ideas Explored

• Why leaders often see only the tip of the iceberg of organizational problems 

• How See to Solve helps teams make work visible before jumping to solutions 

• The role of process and relationship mapping in creating shared understanding 

• Why leadership support is essential for sustaining improvement behavior 

• How small, rapid experiments help teams generate learning instead of just implementing fixes 

Takeaways for Quality Leaders

• Start with a narrow slice of real work rather than trying to solve the whole system at once. 

• Involve the people who actually do the work; they see barriers leaders often cannot. 

• Treat mapping as a way to create insight, connection, and energy for change. 

• Make leadership participation visible, practical, and sustained beyond the first workshop. 

• Build internal coaching capacity so improvement becomes part of daily work, not a consultant-dependent event. 

Continue the Conversation

Maria Mentzer on LinkedIn

Resources & Frameworks Referenced

• See to Solve

• Decoding the DNA of the Toyota Production System

• The High-Velocity Edge

•  Iceberg of Ignorance (Sidney Yoshida)

Disclosure: This episode is not sponsored. Jason has no financial or commercial relationship with See to Solve. The conversation reflects his editorial interest in the work and in Steven Spear’s contributions to improvement science.

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Healthcare organizations often treat improvement as a set of projects, tools, or training programs. Amar Shah’s work at East London NHS Foundation Trust (ELFT) and NHS England points to something larger: the long-term work of building belief, capability, infrastructure, and leadership routines so improvement becomes part of how a health system thinks and operates. This conversation explores what it takes to move from local improvement activity to organization-wide and national-scale improvement strategy.

Key Ideas Explored

• Building belief as a core design challenge in improvement 

• Moving from centralized QI support to distributed improvement capability 

• Why storytelling is essential improvement infrastructure

• Co-design as both an ethical commitment and a driver of better results 

• Scaling improvement from ELFT to NHS England’s national improvement work 

Takeaways for Quality Leaders

• Treat belief in improvement as something you must deliberately build, not something you can mandate. 

• Invest in stories that make improvement visible, credible, and emotionally meaningful. 

• Build distributed coaching capability so improvement support lives closer to the work. 

• Help boards learn improvement through better questions, better data, and better routines. 

• Use co-design early and seriously, especially when tackling complex system problems. 

Continue the Conversation with Dr. Amar Shah

LinkedIn

Resources & Frameworks Referenced

• NHS IMPACT

• NHS Frailty improvement collaborative

• Kostal & Shah, Putting improvement in everyone’s hands

• IHI/ELFT, Fostering an Improvement Culture

• Shah, Applying improvement to the co-creation of quality 

• Shah, How to move beyond quality improvement projects

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Goals-of-care conversations can profoundly shape serious illness care, but in many health systems they remain difficult to find, inconsistently documented, and hard to measure. In this episode, Matthew Gonzales and Deborah Unger describe how Providence treated serious illness communication as a systemwide quality problem, combining leadership commitment, clinician training, nursing engagement, informatics, and AI to make “what matters” conversations more visible and actionable across 51 hospitals.

Key Ideas Explored

• Why goals-of-care documentation became a “conversation in the haystack” problem 

• How Providence made serious illness communication a system priority, not a palliative care side project 

• Why training physicians alone did not move the needle, and how nurses became critical to implementation 

• The tension between standardized documentation and preserving the humanity of the conversation 

• How AI helped identify meaningful goals-of-care conversations without relying on checkboxes or dot phrases 

Takeaways for Quality Leaders

• Treat important clinical conversations as part of system design, not just individual clinician skill. 

• Build measurement only after defining what meaningful quality looks like in practice. 

• Engage the disciplines closest to the workflow; nursing involvement may reveal implementation paths leaders miss. 

• Avoid designing metrics that reward documentation behavior while missing the underlying clinical purpose. 

• Look for AI use cases where language, workflow burden, and quality measurement intersect. 

Continue the Conversation

Dr. Gonzalez -  

Email: Matthew.Gonzales@providence.org

Dr. Unger - 

Email: Deborah.Unger@providence.org
Bluesky: @qoflmd.bsky.social

Resources & Frameworks Referenced

• Providence Institute for Human Caring

• Ariadne Labs Serious Illness Conversation Guide

• Guide Successful Strategies for Operationalizing Goals-Of-Care Documentation - NEJM Catalyst

• Finding the Conversation in a Haystack: Leveraging AI to Detect Goals-Of-Care Documentation - Journal of Pain and Symptom Management

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

For 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 Explored

• Why accreditation can help, but still fall short of sustainable quality

• The FlaQuM pillars of Think, Do, Learn

• How 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 Leaders

• Clarify 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 Conversation

Connect with Professor Kris Vanhaecht on LinkedIn or through his website.

Resources & Frameworks Referenced

• Flanders Quality Model (FlaQuM)

• The Juran Trilogy: quality planning/design, quality control, and quality improvement

• Accreditation Canada

• Joint Commission International

• Safety-II

• Institute for Healthcare 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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Too 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 Explored

• Annie’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 Leaders

• Do 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 sustainability

Connect with Dr. Terry Fairbanks

LinkedIn

Twitter / X

Resources & Frameworks Referenced

• Annie’s Story 

• The MedStar Health National Center for Human Factors in Healthcare

• Systems-based event review

• AHRQ's CANDOR Framework 

• IHI's RCA2 Framework 

• Trigger tools 

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Healthcare 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 Explored

• Micro-frictions in clinical workflows accumulate into meaningful cognitive and emotional burden

• Organizational interventions often outperform individual resilience strategies

• MedPearl was designed to capture and operationalize “tribal knowledge” in referral workflows

• Technology adoption spreads socially through trusted peer networks

• Measuring well-being impact requires using existing data thoughtfully

• The future of innovation must include workforce impact, not just efficiency metrics

Takeaways for Quality Leaders

• Treat clinician well-being as a system property, not an individual responsibility

• Look for “sticky note problems” that signal hidden workflow friction

• Use existing organizational data sources before launching new surveys

• Expect heterogeneous impact. Not every tool benefits every group equally

• Pair product design thinking with traditional improvement methods

• Monitor indirect indicators of well-being, not just annual survey scores

• Recognize that meaningful improvement will come from many small changes, not one solution

Continue the Conversation

Connect 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 sharing with a colleague.

Resources & Frameworks Referenced

• MedPearl clinical decision support tool

• Quadruple Aim framework

• PDSA cycles

• Epic EHR integration concepts

• Physician well-being survey methodologies

• Physicians Foundation research funding

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Many 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 Conversation

Connect 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 Referenced

• Quality as an Organizational Strategy

• The QOS Field Guide

•  W. Edwards Deming’s system of profound knowledge 

•  Deming’s “production viewed as a system” 

•  The Model for Improvement 

•  IHI Whole System Quality 

•  The Chief Quality Officer Professional Development Program 

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Quality 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 Explored

• Why quality teams must first become trusted partners before driving accountability

• Using appreciative inquiry to unify teams after a merger of equals

• How clinicians move through “stages of grief” when confronted with performance data

• What healthcare underestimates about the human side of high reliability

• The role of boards and governance in advancing quality strategy

• Why changing mindsets is prerequisite to changing behaviors

Takeaways for Quality Leaders

• Start culture change by intentionally redesigning the relationship between quality and operations

• When clinicians question data, lean into joint learning rather than defensiveness

• Use established frameworks to create shared language across the organization

• Invest deliberately in teamwork and communication training, not just technical fixes

• Engage boards with accessible tools that build confidence in quality oversight

• Recognize and celebrate small wins to build momentum and trust

• Anchor improvement work in purpose and shared aspiration, especially during mergers

Continue the Conversation

Connect 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 Referenced

• Appreciative Inquiry framework

• IHI Whole System Quality framework

• IHI's Framework for Effective Board Governance of Health System Quality

• Barbara Fredrickson’s Positivity research

• TeamSTEPPS

• High reliability principles (nuclear industry examples)

• Root Cause Analysis (RCA)

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Healthcare 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 Explored

• The gap between current performance and true system potential

• Learning health systems as a way of operating, not a series of projects

• De-implementation and “subtraction neglect” in healthcare

• Holding paradox: efficiency and humanity, population and individual care

• The role of co-design and implementation science in scaling improvement

• Asking better questions as a leadership intervention

Takeaways for Quality Leaders

• Start 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 Conversation

Connect 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 Referenced

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

In 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 Explored

• Data 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 Leaders

• Prioritize 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 Conversation

Connect with Gayle Grout on LinkedIn to follow her work in supporting primary care data use.

This episode is especially useful for primary care leaders, quality officers, data strategists, and anyone interested in how measurement can empower frontline clinicians.

Please rate and comment to help other listeners find insights that can support improvement in daily practice.

Resources & Frameworks Referenced

• HDC Discover (Health Data Coalition’s aggregated EMR data platform)

• Bright Spots stories from primary care clinicians using data to drive change

New episodes published every other Thursday at 7AM Eastern Time.

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

What 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 Conversation

• Patient 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 Leaders

• Where 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 on improvement science and leadership development.

• IHI Chief Quality Officer Professional Development Program
  A national program supporting CQOs in building system-level improvement capability.

• High Reliability Organizations (HRO) in Healthcare
  Principles focused on reducing harm and building reliable systems under pressure.

• Intermountain Healthcare – Advanced Training Program
  Cited as an early influence on variation reduction and outcomes-focused care.

• Key Driver Diagrams
  Discussed as a durable tool for linking strategy, drivers, and improvement work.

Continue the Conversation

You can connect with Dr. Abraham Jacob via email at akj@umn.edu or on LinkedIn.

Reflection and dialogue are central to improvement, so take a moment to notice where these ideas show up in your own system.

New episodes published every other Thursday at 7AM Eastern Time.

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Quality 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 Conversation

This 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 Explored

• Why 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 Leaders

• If 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 Mentioned

These are named in the transcript and are often things listeners may want to look up:

• SQUIRE Guidelines (Standards for QUality Improvement Reporting Excellence)

• Equity-focused QI scholarship

  • “Equity in action: a scoping review and meta-framework for embedding equity in quality improvement" BMJ Quality and Safety 2024

  • “Taking Action on Inequities: A Structural Paradigm for Quality and Safety” BMJ Quality and Safety 2024

Continue the Conversation

You can connect with Brian Wong on LinkedIn.

Learn more about the Center for Quality Improvement and Patient Safety.

This episode may be especially useful to leaders grappling with sustainability, scale, or equity in improvement work.  Consider sharing it with colleagues facing those same tensions.

New episodes published every other Thursday at 7AM Eastern Time.

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Healthcare 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 Explored

• Why improvement fails when leaders don’t change how they manage

• Thinking like a scientist as a leadership skill, not just a clinical one

• How daily management systems surface problems early — without blame

• Why spread depends on culture, trust, and peer-to-peer learning

• The limits of outcome targets without process understanding

• Building networks of change agents instead of relying on heroic leaders

Takeaways for Quality Leaders

• If you want front-line behavior to change, leadership behavior must change first

• Don’t demand answers before experiments — design systems that allow learning

• Use data to create transparency and motivation, not fear or punishment

• Build truly interdisciplinary teams for complex problems like flow and discharge

• Treat spread as a relational process, not a rollout plan

• Replace command-and-control with coaching and problem-solving support

• Invest in developing people who can think, test, and teach others

Continue the Conversation

Connect 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 Referenced

• Lean and Toyota Production System principles

• A3 problem-solving methodology

• Plan–Do–Study–Act (PDSA) cycles

• Lean Daily Management Systems

• Interdisciplinary improvement teams

• Helen Bevan’s work on change agents and spread (including the School for Change Agents)

• Incident Command System lessons from the COVID-19 response

New episodes published every other Thursday at 7AM Eastern Time.

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Healthcare 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 Explored

• Quality 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 Leaders

• If 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 Conversation

• Connect with Dr. Todd Allen on LinkedIn

• This 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 Referenced

• W. Edwards Deming and Total Quality Management

• Intermountain Healthcare Advanced Training Program (ATP)

• Crucial Conversations (Patterson et al.)

• Kotter’s Change Management Model

• High Reliability Organization (HRO) principles

New episodes published every other Thursday at 7AM Eastern Time.

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

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 Cover

• The 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 and emerging focus on home medication safety.

Key Takeaways

• Safety challenges often live beyond the hospital.

• Co-design works—families reveal solutions clinicians cannot see alone.

• Usability matters: Clear language and well-designed tools drive real behavior change.

• Equity requires universal design, not selective support.

Connect with Today’s Guests

Dr. Amy Billett

• Best contact method: https://www.linkedin.com/in/amy-billett-a351501a6/

Dr. Chris Wong

• Best contact method: https://www.linkedin.com/in/chris-i-wong-ciepiel-884880145/

• Profile Link: https://www.uhhospitals.org/doctors/WongCiepiel-Chris-1407171804

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

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, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic