High reliability is often treated as a collection of visible practices: safety huddles, rounding, event review, reporting systems.  But Nicholas Testa argues that the practices matter only if they create an organization that can reliably surface risk, learn, and respond. The harder leadership problem is durability: can those behaviors continue when the CMO changes, the CEO turns over, or the original champion leaves? This conversation examines the organizational scaffolding that makes safety less dependent on personality. It also surfaces a critical tension: psychological safety cannot mean the absence of accountability. Leaders need people to report mistakes, near misses, and uncertainty without fear, while still creating clear expectations that problems will be examined and acted upon. The goal is not simply a safer culture, but a system capable of seeing and correcting its own weaknesses.

Key Ideas Explored

• Psychological safety and accountability have to rise together. Testa describes high accountability without psychological safety as an environment of anxiety, while psychological safety without accountability can drift toward apathy. The leadership task is to make it safe to expose problems without lowering expectations for responding to them.

• People learn whether it is safe to speak up by watching what leaders repeatedly do with bad news. Testa recalls a CEO whose consistent response to serious problems was essentially: thank you for telling me; now what are we going to do about it? Predictability matters because culture is built from repeated responses, not declarations about openness.

• Improving safety reporting can initially make an organization look less safe. When Testa pushed hospitals to conduct regular event reviews and encourage reporting, his region began accounting for a disproportionate share of reported events. That increase was not necessarily deterioration; it exposed previously hidden problems and created the information needed to learn, track patterns, and eventually reduce harm.

• Near misses may contain more learning than the harm events leaders naturally prioritize. Serious events demand attention, but precursor events can show where defenses nearly failed before a patient was harmed. Testa’s work on lost and mislabeled specimens illustrates how something routinely categorized as a near miss can reveal substantial patient burden and recurring system weakness once leaders examine it closely.

• High reliability requires an operating structure, not a collection of rituals. Testa’s core scaffolding includes visible senior leadership commitment, structured rounding, a daily safety huddle, and multidisciplinary event review. A huddle is not “high reliability” merely because it exists; it earns that value only when information moves through it, problems are acted upon, and feedback loops close.

• Metrics can become dangerous when protecting the metric replaces seeing reality. Testa describes a hospital nearing 350 days without a harm event that resisted classifying a medication error as serious because doing so would reset the count. The episode exposes a recurring safety problem: once an organization becomes attached to the appearance of success, accurate classification can begin to feel like failure.

Takeaways for Quality Leaders

• When reporting suddenly increases after a safety initiative, ask whether performance worsened or whether the organization has finally become better at seeing what was already happening.

• Examine your own response to bad news. Would staff who watched you handle the last serious event predict curiosity and action?  Or would they expect anger, blame, defensiveness, or surprise?

• Test the durability of your safety system by imagining the current senior leaders disappearing tomorrow. Which practices would continue because they are embedded in operations, and which survive only because a particular person keeps pushing them?

• Look beyond the events that reached the patient. Ask whether your review processes have enough bandwidth to identify recurring near misses and precursor events before they become the next serious harm.

• Audit cherished performance streaks and “days since” metrics for unintended consequences. If acknowledging an event feels organizationally costly, the measure itself may be creating pressure not to see the system clearly.

Continue the Conversation

Dr. Testa 

...on LinkedIn

...via Email: ntesta@sentact.com

Resources & Frameworks Referenced

• High reliability organizations (HROs) — the broader framework Testa uses to distinguish dependable outcomes from merely adopting safety practices.

• Amy Edmondson’s work on psychological safety and accountability — referenced in framing the relationship between safety, anxiety, apathy, and high performance.

• Deming — referenced in discussing the importance of defining what good healthcare outcomes actually mean before attempting to improve them.

• Safety huddles, leadership rounding, and safety event roundtables — the core operational scaffolding Testa describes for making high reliability durable.

• Good catch programs — a mechanism for recognizing and reinforcing the identification of near misses before they reach patients.

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.

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 cannot learn simply because they have dashboards, safety reports, improvement methods, or formal escalation processes. Learning depends on whether people can surface what leaders do not know, challenge assumptions, admit uncertainty, and act on problems without making truth-telling personally dangerous. This second year-in-review episode examines the human conditions that make a learning system work: leadership humility, trust, psychological safety, accountability, high expectations, and agency. The central tension is that these ideas are often treated as opposites. Leaders are expected to be confident, yet must remain open to being wrong; organizations need psychological safety, yet cannot abandon accountability; and improvement should support people without lowering the standard of care. The challenge is to build systems that are demanding about the work while remaining curious about why reality falls short.

Key Ideas Explored

• Leadership increasingly means leading knowledge you do not personally possess. As problems become more complex, the leader’s advantage cannot be knowing more than everyone else. The work shifts from providing answers toward connecting expertise, asking better questions, and creating conditions in which the organization can use what its people collectively know.

• An open door is not an information system. Leaders inevitably operate with an incomplete picture of their organizations, and simply inviting people to raise concerns places too much responsibility on those with less authority. Rounding, specific questions, escalation mechanisms, safety huddles, and deference to expertise can reduce the personal courage required to make important information visible.

• The goal is to lead a less imaginary organization. Every leader carries a mental model of how the organization works, but certainty can cause contradictory information to be filtered out until the picture reaching leadership becomes cleaner and less true. A learning posture treats unexpected observations as evidence that the model may need revision rather than as resistance to be overcome.

• Psychological safety and high expectations are not competing choices. Taking a stand on zero harm can express what an organization believes patients deserve without pretending that perfect performance will be achieved immediately. The gap between aspiration and reality should become a source of disciplined learning rather than an automatic trigger for blame.

• Accountability and systems thinking require separate questions. Asking what the system needs to learn is different from asking what accountability is appropriate. Mature organizations must distinguish human error, risky behavior, and system failure rather than defaulting either to punishment or to the idea that individual choices never matter.

• Improvement can create agency rather than additional burden. Repeated workarounds and poorly designed processes can produce helplessness. Improvement becomes a “science of hope” when people have a method for understanding problems, testing changes, redesigning their work, and removing unnecessary friction—including through subtraction rather than continually adding new requirements.

Takeaways for Quality Leaders

• Ask what information currently requires unusual courage to reach you. If a serious problem depends on one brave individual speaking up, the organization may have a weak information system rather than a strong safety culture.

• When a room goes silent after “Any questions?”, do not interpret silence as agreement. Reconsider the design: ask what you may be missing, where the plan could fail, and what people closest to the work are seeing that leadership cannot.

• Examine how your organization responds to performance data. The same number can open a conversation about what is happening in the system or signal that judgment has already been made.

• When performance falls short, separate aspiration from response. Maintain a demanding standard while asking what the miss can teach you before deciding what accountability is warranted.

• Before adding another checklist, alert, meeting, field, or training requirement, ask what could be removed. Improvement should not automatically mean asking already burdened clinicians to absorb more work.

Continue the Conversation

Follow Dr. Meadows on LinkedIn

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.

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 can run hundreds of improvement projects without becoming fundamentally better at improvement. After 26 conversations in the first year of Leading Quality, a larger question emerged: what makes an organization capable of learning repeatedly, across problems, teams, and time? This episode examines the difference between having people who know improvement methods and having a system that can recognize problems, understand the work producing them, test its assumptions against reality, and carry what it learns forward. The challenge is not to move beyond projects because projects do not matter. It is to ensure that successful projects leave behind more than better results; they increase the organization’s capacity to solve the next problem.

Key Ideas Explored

• A successful improvement project is not the same as organizational learning. The deeper test is what happens after the project ends: whether new knowledge becomes part of standard work, travels elsewhere, survives the departure of its champions, and leaves the organization more capable of solving future problems.

• The people with the greatest authority often have the least direct visibility into the work. As information moves upward, frontline experience becomes metrics, categories, and dashboards. Leaders therefore need mechanisms that connect the knowledge held by people doing the work with the authority required to change the systems around them.

• Seeing a bad outcome is not the same as understanding the system that produced it. Safety events can be recognized and investigated while still being fundamentally misinterpreted. Direct observation, frontline knowledge, human factors, and measurement reveal different parts of reality; none is an adequate substitute for the others.

• Standards can be treated as hypotheses rather than permanently correct rules. A standard represents our current prediction about how a process should behave. When reality differs from that prediction, the discrepancy can become an opportunity to investigate what we misunderstood rather than simply evidence that someone failed to comply.

• Quality cannot remain in the organizational “sidecar.” Quality, safety, patient experience, and operations are produced by the same underlying work. Improvement expertise remains essential, but responsibility for producing quality ultimately has to be integrated with the people who operate the system.

• Learning requires infrastructure, not heroics. Training people in improvement is insufficient if they return to environments without meaningful problems to work on, protected time, coaching, data, governance, or mechanisms for spreading what they discover. Capability becomes organizational only when the system knows how to use it.

Takeaways for Quality Leaders

• Ask what happens to knowledge after a successful improvement project. Does it alter how work is done and make the next improvement easier, or does it remain primarily with the team that generated it?

• When an important metric changes, resist moving immediately from the number to a solution. Ask what the measurement reveals, what you would need to observe directly to understand the work producing it, and what the people doing that work know that the metric cannot tell you.

• Before acting under uncertainty, make the prediction explicit: What do we expect to happen, and why? Then compare that expectation with reality and investigate meaningful discrepancies, including results that are better than expected.

• Examine your organization’s theory for how improvement actually happens. If someone identifies a recurring problem tomorrow, where does it go, who responds, who can act, how can frontline knowledge shape the investigation, and how does anything learned travel?

• Consider whether your improvement capability exists mostly in individuals or in the organization itself. The critical question is not simply how many people have been trained, but whether their knowledge has somewhere to go.

Resources & Frameworks Referenced

• Flanders Quality Model — an integrated approach to quality management

• Physician Quality Improvement program in British Columbia

• East London NHS Foundation Trust improvement journey

• The High Velocity Edge

• SeamlessMD

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.

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 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