Good morning, everybody, and welcome today to Equality Summit. I hope you had a great first day. It was wonderful seeing so many familiar faces and meeting a lot of new ones as well. And today is going to be another really terrific day with lots of good sessions. We've got our poster awardees that will be in the spotlight theater. Make sure you stop and see the posters, our exhibitors, and have just a wonderful second day. So, just a few housekeeping items. I'm happy to say that our shipment arrived, and I think most of you have gotten your bags. If not, stop by the registration desk and pick one up. That also means that our ACC marketplace is open, and that will be available throughout the conference, and check out some of our nice new items that we have for you. There's going to be a couple sessions today and tomorrow that will be using a polling feature that's in your app. So, to sort of warm up and get the day going, I want you to pull your phones out and go to this session, Thursday opening session. At the bottom, you will see the Q&A. Click that. And at the top, you will see on the right-hand side something that says polling. So I'll give you a minute for that. And if we can put up the first question. These aren't going to be tough. It's not going to be challenging. Some of you might have played Would You Rather. So we're going to start with that. So the first question is, would you rather give up chocolate or pizza for a year? So A is chocolate. B is pizza. Let's start the poll. »» Whoa, okay, that's almost 50-50. All right. I lean towards pizza, but that's a tough one. All right. Second question. Would you rather have slow Wi-Fi or only one earbud working? So A is slow Wi-Fi. B is that one earbud. Let's start the poll. And these are not as hard as Jeopardy questions, actually. Oh, wow. That surprises me. Yeah. Okay. All right. And finally, would you rather be able to mind read for a day or be invisible for a day? A is mind read. B is invisible. You might have to think about this one. Let's start the poll. Okay. Yep. All right. Well, you know, these are sort of fun and maybe at lunch you can talk to your table mates as to how they answered these questions. So let's go ahead and get started. It is now my pleasure to introduce Dr. David Winchester, the Associate Professor of Medicine at the University of Florida College of Medicine. And he's the chair of this year's Quality Summit. And I really want to thank him for all his leadership, commitment, and vision over these past two years as he's led the planning for our Quality Summit. Dave. Thank you very much. And while we're on that note, if I could get another round of applause for Barb, for Maria, for Maddie, for all of our staff that have really been doing an incredible job putting this meeting together. Well, thank you. And welcome to Orlando. Everybody enjoying the humidity? I ordered extra special just for you all. Yes. Thank you so much for being here. It's really a pleasure to be here. sharing quality with all of you that want to help us accomplish the ACC's mission of transforming cardiovascular care and improving heart health through quality, through our accreditation products, and our registries. So this morning, what I'd like to start off with is to share with you a few comments from our ACC president, Dr. Hadley-Wilson. Hello everyone, and welcome to ACC's Quality Summit. I am Dr. Hadley-Wilson, president of the American College of Cardiology. And it is with sincere apologies that I cannot be in Orlando with you for this incredible event. Each of you here, and the teams, hospitals, and health systems, and other facilities that you represent, play pivotal roles in helping to achieve our mission of transforming cardiovascular care and improving heart health for all. Your collective commitment to delivering quality cardiovascular care to your patients and communities is critical to creating a world where science, knowledge, and innovation optimize cardiovascular care and outcomes, which of course is the vision of the American College of Cardiology. Thank you for being here. This year's summit is an opportunity to come together to learn from each other about the latest best practices and quality improvement. And over the coming days, I encourage you to take advantage of this time together. Please gather ideas for rebooting and rebranding care quality. Learn how to best leverage accreditation and registries to support healthcare quality initiatives. Network with your colleagues and share ideas for engaging teams in the quality process. As you sit here today, the college is in the process of finalizing our next strategic plan, which care transformation is among the major initiatives. As you can well imagine, NCDR and ACC accreditation services will be significant and vital pieces of this effort as we move forward, which includes building a clinical data, operational data, and accreditation infrastructure for high quality provision of previously inpatient CV services, defining best practices for various CV team structures, processes, and reimbursement for various practice sizes and geographies, developing a digitally enhanced care model, and advocating to shape the structure of future payment models. Yes, these goals are lofty but doable, and if done right, will have a profound impact on our work and more importantly, the lives of the patients we serve. I love that Stephanie Mercado's keynote is about unleashing the potential of the workforce. Each of you and the work you and your institution do with NCDR and ACC accreditation services are already on this path. Leveraging the strengths of the entire cardiovascular care team to their full potential is fundamental to success, whether you're participating in NCDR or on the path to accreditation. And we, as a college, can learn much from you, and you can learn much from each other when it comes to optimizing patient care. Transforming heart health does not happen overnight, but the differences we have made over the last 25 years and the differences we continue to make in care delivery are tangible. Together, we are reducing avoidable hospital readmissions, minimizing procedural risk, optimizing patient transitions from hospital to home, ensuring safe and effective TAVR and mitral valve repair for patients who not too long ago had no options. And we are mitigating acute kidney injury and so much more along the way. You'll have an opportunity to dive into these issues and others over the course of the next couple of days. Let's unleash our potential together. Thank you again for being here and for your dedication to quality cardiovascular care. I wish you a productive and enjoyable summit. Thanks very much to Dr. Wilson for those comments, and now it's my distinct pleasure to welcome for our Ralph Brindis keynote, Stephanie Mercado, CEO of the National Association of Healthcare Quality. 60 years ago, a medical miracle occurred that allowed me to be here with you on this stage today. When my mom was three years old, she was diagnosed with VSD, ventricular septal defect. She was a sick little girl. The doctors told my grandparents that she had to wait to have surgery until she was about 10 years old. And then the chance of survival was 50%. So they waited, and they prayed, and they worried for seven years that their child would have the procedure that she so desperately needed. She had a procedure at Presbyterian St. Luke's Medical Center, which is now Rush in Chicago. The surgery was rough, and the recovery back then, it was really long. She spent three weeks in the hospital, 10 days in ICU. For 21 days, my grandmother held my mom's hand, wanting everything to just be okay. My mom has since gone on to live a great life. She has three grown kids, five grandkids, a great marriage, and a super social life. Thanks to the ongoing commitment of the healthcare support system and the work of marvels of modern medicine, we can focus on improvement. And kids who need this surgery today have better outcomes many times, as you know, in an outpatient surgical setting. So I have the opportunity to give talks like this pretty often. And each time I do that, I want to make sure that my comments resonate with the audience. So I do my homework. I've spent time speaking with the staff at ACC and also having conversations with the faculty and chairs of the program. I want to get things just right. And then my mom sent me an email right about the time I was preparing for this, and she said Aunt Marcia had reached out. My Aunt Marcia works on the ACC registry at OSF St. Joseph Hospital in Bloomington Normal. And she received an email, a promotion for this event, that I would be speaking here with you today. So as part of my due diligence, I called Aunt Marcia. I ran my talk by her. I shared with her my thoughts, and she gave me some ideas about how to just perfectly thread that needle for you. So I want to send a shout out to Aunt Marcia and thank her, and I think some of her team members are here in the audience today. So the program chairs and Aunt Marcia, they confirmed for me that this conference is all about quality, all about improvement, and the thing that you care about the very most is improving patient outcomes. My talk is about improvement, too, but it's about a different type of improvement. It's about improvement of the discipline of quality and safety via the workforce of all of us and each of you. We talk about improving healthcare delivery all the time, as we should. And I know that people who work on registries are very, very committed to that. Some might call you obsessed a little bit, right? But I totally get it. I get you. And so for the next hour, I'm going to ask you to think about improvement just a little bit differently so that you can understand and maybe further contemplate your own role and how to maximize your human potential. Because at NACU, the cue is you. I'm from Bloomington Normal, Illinois, where I grew up around Aunt Marcia. And I have to tell you that I had no idea that I was going to work in healthcare or that I would go on to run a nonprofit mission-driven healthcare organization. The closest I got to healthcare as a small child was hearing stories from Aunt Marcia about what was going on in the emergency department that she worked in at the time. So long story short, I was 24 years old in 2002, recently married, and out of a job. I found employment at the American Orthopedic Association. This organization was focused on academics, and it supported department chairs and program directors for residency programs. There, I had the opportunity to learn about academic pathways, and I became very interested in how physicians were trained to do their work. I learned about the academic pathway of medical school residency and fellowship. I also had the opportunity to participate in my first quality improvement project called Own the Bone. My boss said to me, congratulations, you've been chosen to run a $350,000 grant-funded nationwide quality improvement project to reduce secondary fragility fractures. My response was, what's a fragility fracture, and what's an improvement project? I went on to lead that improvement project and even publish with some of the brightest minds in orthopedics. The biggest industry leaders from NYU, Dartmouth, Emory, and many more participated in a successful program, and it was at that time that the quality bug bit me. In 2006, I was offered the opportunity to work at the American Academy of Physical Medicine and Rehabilitation. I went there to expand my scope of work. This organization was less about academic pathways and more about supporting physicians in practice. It was there I was asked to lead the education department. I learned about maintenance of certification, board certification, research, and how that all was designed to impact and improve healthcare delivery. I started asking questions like, where is the practicing curriculum for physicians? They need to know things different than when they were trained in medical school and residency and fellowship, right? A few professions, like ophthalmology, were really, really ahead of the game, and they had already developed practicing curriculums for their professions, and I convinced my board that we should, too. So we defined the practice-related competencies for PM&R physicians in a postgraduate environment. And today, that resource is the practicing curriculum for PM&R docs, and it is a point-of-care resource for them to use in practice. So I went on to work at NACU in 2013, and when I interviewed for the job, by the way, I was pregnant. Seven months pregnant, in fact, and just a quick sidebar, that experience of being seven months pregnant interviewing, by the way, it was really hard to find an outfit twice to interview with, but that story and the story of NACU's journey and how we are unleashing human potential was recently featured in a book that I had the opportunity to author a chapter in called Unstoppable, and this book is all about advancing women leaders and all the proceeds do go to advancing women leaders, so I want to tell you about that because that's a really great story, and you're going to get a sneak peek into that today. So as I took the job at NACU, one of my main objectives was to really understand more about the back of the house of healthcare. I had worked with physicians in orthopedics and PM&R and had a pretty good grip on what went on in the front of the house of healthcare, but to put that together with what went on in the back of the house, where a lot of you work, was really exciting for me. I also did it because I believed that quality was the future of healthcare and would provide the answer to many of the challenges that we experience today. So new on the scene in 2013, I started a self-directed orientation, and the first question I asked the board of directors was, where's the body of knowledge? Where are the procedures, the standards, the curriculum for this profession, for this discipline I need to learn about it? They told me, well, you should look at this textbook. Someone said, you should look at that textbook. Another said, well, the body of knowledge is the CPHQ. How many of you are CPHQ out there today? Yep. Me too. Great. Good representation. We now have more than 15,000 CPHQs today, and it's an outstanding certification. But it isn't a body of knowledge. So my question to the board at that time was, how are we going to advance a profession and a discipline without a body of knowledge? So what started as question asking soon became pencil sharpening. And we created a solution. But first, I want to tell you more about the question asking part. So I drew on my experiences from the American Orthopedic Association and the American Academy of Physical Medicine and Rehabilitation that taught me about the bodies of knowledge. I learned that in absence of an academic pathway for quality, that quality had been built on the fly at a local level without the benefit of a standard. And that each time there was a new rule or regulation or new ambition for quality, a new person, a new role or a new layer would be added to the infrastructure to support it. As a result, what we have is homegrown systems, processes, structures, and even a homegrown workforce where the dominant strategy has been on-the-job training. So I asked myself another question. Why are all these skills so variable? Most people working in quality come from nursing, are physicians, or have some other clinical background. Why are they not all learning this in their clinical practice setting? What I learned is that each of them are trained differently based on the profession that they grew up in. Or sometimes they weren't trained at all. So my big aha here was that most people who come into quality were really good at something else first. How many of you have been formally trained in quality and safety? Higher ed programs, structured, multi-month year boot camps of any sort? Yeah, not very many. This is a second profession. And that does not come with an academic pathway. So what happens when all of us show up to work from different professions and from different training programs? Well, what happens is some know what a PDSA is. Some don't. Some know what an RCA is. Some don't. Some know how to collect and analyze data and tell stories with that data. Some don't. Some know what a culture of safety is. And some simply don't. Different vocabularies, different toolkits, and different sensibilities for quality and safety mean that we have a high degree of variation in our workforce. So the result is that stuff can get missed. Wrong site surgery, med rec, care, transition issues. And we see these things going wrong, but if we're not trained to know how to fix it, it just keeps happening. It's super annoying, it's super frustrating, and I believe it's one of the main contributing factors to the burnout that we experience in healthcare. We see the same pens rolling off the desk all day, every day, and nobody seems to care. Because a lot of people aren't sure what to do about it anyway. In healthcare, it is our highest ambition to reduce variability in healthcare delivery. So we have to do that for our own work. And even though this is a second profession for most everyone who is in it, it's a unique profession, it's a unique discipline, and it needs a training pathway and a body of knowledge too. Because you know, if there's no best practice, no standard or measure, how are we gonna know if we're improving our own selves and our own contributions? How can we improve? So herein lies the problem. The focus has been on what needs to change in healthcare. One more rule, one more reg, one more standard, one more ambition. That will make it all better, right? Wrong, definitely wrong. We've had too little focus on how to achieve these goals. We haven't talked enough about who should be doing what work, at what level, and what skills and behaviors and competencies must be present to meet these demands for all of the improved outcomes that we wanna see for our patients. So here's the pencil sharpening part. We gotta fix this. So NACU set out on a journey, and our goal was to retrospectively redesign quality and safety from the outside in. And what we did was develop a healthcare quality competency framework that has eight domains, 29 competencies, and 486 skills, which we stratified against foundational, proficient, and advanced levels. Now, when I say 486 skills, people, I gotta like block the exits, right? I'd be like, I don't wanna do 486 of any of those things. So it's okay, because this framework was designed to support the entire quality infrastructure with individual contributors supporting it in pieces and parts to create the whole. So not only did we create this standard, but we validated it twice in the market, first with those doing the work, and second with those leading the work that said, yes, that's what I want my people to be doing. And now, we are creating a movement to align the profession and the discipline towards these standards. We set the standard for individual clinical contributions and for teams so that you could do your best work, because we know physicians, nurses, quality support teams, care coordinators, risk, infection control, the queue is all of you. So where you work, there are five generations of individual contributors who have either been trained or some maybe even not trained on quality and safety. And so I think I pretty much litigated that, right? Like we're on the same page? Okay, got it. But any quality person worth their salt is gonna want data to prove it. So fine. We'll create an assessment, and we'll get in there, and we'll understand what the market is doing so we can understand where we are today and get a plan to go forward together. NACU's research around this competency framework show us a few things. I have a few slides to share with you on the data. At the highest level, around the eight domains of quality that NACU developed and validated, we see that the workforce writ large is focused largely on three things. They're working at the highest levels of the competency spectrum in these three areas, quality leadership and integration, regulatory and accreditation, and patient safety, which totally makes sense. Think about the past 25 years of healthcare, 1999 to error is human, right? Safety movement is born. We were focused on safety before, but we got a lot of momentum in 1999 and beyond for that. Also, lots of work around regulatory and accreditation, more rules, more standards, more guidelines, that will fix all of this, right? And so we've put a lot of attention on this. These are the areas that the workforce writ large is performing at lower ends of the competency spectrum. Population health and care transitions. Health data analytics, which I know you here dive into that a lot. Performance and process improvement and quality review and accountability. Quality review and accountability, your president just mentioned, y'all are interested in advancing payment models. That's kind of what this is. This is measures, practitioner feedback loops, and payment models. So the things that are going to require us to, we need to have in order to advance healthcare quality and safety and meet all the ambitions we have, are the things that we're actually performing the lowest on as an industry. Next level of data. So we can take this national data set and drill it down by systems, regions, sites, and all the way to individual contributors, which I'll show you in just a minute. So here's an interesting data point. So here we looked at the example domain of performance and process improvement. That's one of the eight domains that we have. And the competencies in that domain are implement standards to improve processes and PPI, use change management, and apply project management methods. So let me just help you out with a key real quick to make it easy, and then I'll summarize what the data says. So blue is advanced, green is proficient, yellow is foundational, and gray means that the respondents who said they work in that area didn't identify with any of the skills or behaviors that we laid out. Okay, vacant. So we take the national data set, we drill it down, we're in a system, we have three hospitals we're looking at. The leader of the hospital says to, we say, how do you think you're doing? They say, well, we feel like hospital one's doing pretty good. Hospital three is a star. And hospital two has some pretty serious concerns. So we show them the data. And there it is. We can see it too. We don't just have to think it anymore, we can prove it out. We can see that in hospital one, across all three categories, they're pretty well distributed, and strong at the proficient and advanced levels of the competency framework in PPI. We can see that hospital three's got a lot of blue, and they're operating at more advanced levels, and we can see that hospital two's got quite a bit of gray. They have people working in roles, and they don't do any of the things that we have validated and said they should be doing in the national standard. So this is my favorite visual that we have of our work, and this visual represents a single system, single region, with people in the same role, same job title. Each bar represents a person. So the height of the stack is their cumulative level of contribution in relationship to the competency framework, and the color represents what they do at the highest level. And what you can see here is, we have a highly variable workforce. The levels are different, the types of work are different, but they have one goal and one agenda, and so they gotta level this back out. So what we help them do is take all of this data, their larger data sets, hospital data sets, individual data sets, and then we help them target set. We say, well, what do you want your workforce to look like? How do you want them set up and situated? And after we define that, we help the leaders and each individual get their multi-month, multi-year commitment to workforce alignment, workforce development, so that we can meet this mission. So I don't know about you, but I'm pretty tired of hearing about reports from the OIG and others that continue to confirm that Medicare beneficiaries, 25% of patients will be harmed as a result of receiving medical care. That proves out in other papers outside of the Medicare population, by the way. And I'm frustrated that 43% of the harm that is experienced in healthcare is identified as preventable. And I'm really done hearing about our broken finances in our healthcare system. It's exhausting. We know that 25% of all spending in healthcare is waste. So I think most of these problems are driven by variation, driven by variation, not only variation in care, which you all are focused intently on, but variation in our skills. And the one thing that we haven't focused on as an industry writ large is the workforce, which by the way, is the single largest expenditure in any healthcare organization. So at NICU, we're wondering, maybe, just maybe, if we focused on us, if we focused on the team, if we were committed to moving the workforce forward, we could reduce adverse events. We could reduce waste. And we could bend the curve on the heartbreak that is experienced by families and friends who experience medical error. So any new way to work is gonna require us to do things differently. And it's gonna take time. And it's gonna take resources and an unwavering commitment to quality and safety. And I believe it's gonna take transformational leadership. So the elements of transformational leadership are listed here. You need, and there are many different versions of this, but to simplify, clear vision. What are we trying to accomplish? Rally cry, align the team, charge the hill. Strong relationships, and the ability to celebrate shared success. The good news is this is entirely doable. And organizations all over the country are actually doing this. They are actually transforming their workforce. They are resetting and rebranding quality and taking this whole operation to the next level intentionally. So I work with a lot of health systems in the U.S. and recently I've been able to work with the largest health system in the U.S., the Veterans Health Administration. The VHA has had its fair share of quality issues. We're clear on that. But the VHA today is using transformational leadership strategies to reset, rebrand, and reboot quality in their organization. Under the leadership of Christine Groves, they are reimagining quality systems, process, structure, and workforce competencies. And I'll tell you what, if the VHA can do it, anybody can do it. The VHA has a clear vision to make veterans care the best care. The VHA has a rally cry. It's the NACU framework, it's the wheel. For them, the wheel represents the way. And it has become the center of gravity at this organization. They don't have a meeting or talk about advancing quality and safety objectives without having the wheel physically present and referenced multiple times throughout the meeting. Not only that, but we've partnered up with them and we've given them an NACU navigator. That's like a coach, a professional trainer who locks arms with you that says, we're gonna get you from here to there. VHA is developing strong teams with strong relationships. They're empowering their staff to spread this across all VHA visits. VHA has literally hooked their wagon to the NACU terrain for quality and safety competencies, and they're reimagining how to pull this through their entire workforce. They're celebrating their success and they're participating in communities of practice to improve veterans' care and to improve the effectiveness and the engagement of their team. Christine even told me that someone she didn't even know reached out to her from one of the regions and said, I wasn't sure that the VHA cared much about quality. And I didn't know if they cared about me. But now that you're working with NACU and doing the wheel, I can see that you do care about quality, you do care about me, and I'm taking my resume off the market. I'm here to stay. Pretty impressive. So Robin Betts, she's the Vice President of Quality, Safety, and Regulatory Services at Kaiser's Foundation Hospitals and Health Plans in Northern California, and they are doing this too. They have assessed their team, they have organized their team, and now they are skilling their teams to do their very best work. KP is leveraging this methodology and using NACU's framework to bring in the data about their own teams. And it prompted them to sort of take a deep dive, because one area for the national data set and also Robin's data set, which was true, is that ethics is an area that most people don't think about. And 42% of people who are working in quality, by the way, with our national data set, said that they do not do ethics. I don't even know exactly what that means. I think they might do it and not know. We gotta peel back the onion on that. But Robin saw the same data and said, oh my gosh, maybe I ought to be having workshops and teaching my team about ethics, especially when you're dealing with data, right? So Robin has meetings with her team, an hour-long Lunch and Learns, where they're unpacking content that we give to them to really teach their people about ethics. And not only that, but Robin's president of the Northern California region found out about this, and now at their executive team meetings once a month, they pause for ethical moments, and they talk about how they should approach things and what behaviors need to be present to proceed with the highest levels of integrity. KP has a clear vision to move from the compliance mindset, as Robin calls it, which she says, you do compliance, you get the C. They want the A. So they're moving to the excellence mindset. They have a rally cry. It is the NACU framework. It's the wheel. The wheel represents the way. Kaiser is advancing time and building their relationships, and they're celebrating success. Earlier this summer, over a happenstance lunch I had with Robin at a conference just like this, she told me her team now pauses for what they call accelerator moments. That's how we kind of talk about the work that we do. It's a workforce accelerator. It's like we do accelerator moments where we stop and we learn and we share so that we can all grow together. My last example is Augusta Health. So Augusta Health is a smaller organization. It's located in Fishersville, Virginia, and they are making their way to excellence as well. So their leader there is Chief Medical Officer Dr. Mufaz Haque and Laurel Malloy is the Administrative Director of Quality and Safety. So those two people have teamed up because they wanted to create a standard process for their quality infrastructure. They have goals to improve data governance, establish more robust improvement tools and methodologies, and to expand their impact in population health. Not only that, but Dr. Haque wants to take this content and put it into his residency program. What could happen if we moved upstream and started teaching all health care contributors the same vocabulary, the same toolkits, the same skills, the same behaviors, the same competencies? Dr. Haque is setting an amazing example in this space and there's a lot of nursing programs that are too, by the way. George Washington University, Western Governors University, they're locking in and docking in to this competency framework. So Dr. Haque and Laurel, they have a clear vision. They're aligning their team and they're even pulling in their service line leaders on this and making sure that they have a pathway to pull it through the organization. HR, they're involved too. They're planning to incorporate all of this and engage across the organization and they're using the rally cry too. The wheel is the way. And they're building relationships cross-functionally and establish a new management team that is really advancing all of this. So by improving us as individuals and as teams, we really have a good chance at impacting the outcomes that we want to see. We can deliver higher quality health care that is absolutely safer and we can support the workforce. We can make sure they have the skills that they need. We can make sure there's talent development plans, career pathing, succession planning, and I think, I believe that we can reduce burnout in the process and bring joy back to work. Because when we focus on the Q, we're focusing on all of you. So you know, quality is impacting lives and it gives life. It even gave me mine. It's because of quality improvement that this beautiful person, my grandparents' little girl, and my mom survived. To have kids and to have grandkids. So I never expected this to happen but this is actually a full-circle moment for me. I'm literally here advancing quality and safety because at the point in time when my grandparents needed cardiac surgery for her little girl, it was high quality and safe. So the Q is me too. Thanks everybody. Thank you so much for that fascinating call to action for all of us. Where should we sit? Just wherever. I'm gonna sit here. Okay. Barb, do you have questions from the audience for us? No, but I think Dr. Brindis might have some. Go ahead. I do. First of all, Stephanie, thanks for an incredible inspirational talk. You know, when I look at the people in the room and we want to design, lead, and achieve, that seems exactly what NACU has been offering healthcare. The transformational wheels and tools and the accelerators that you have done and so congratulations in arming healthcare with the necessary tools to improve quality. So again, thank you so much. Before I ask some softballs and maybe even some hardballs, I also at this time want to acknowledge all the people in the room. You are the people that is making cardiovascular quality great in the United States. You are the people that are inspiring the ACC and the NCDR staff to do our work. Every time I come here, I get rejuvenated in the NCDR work in seeing what you mean for healthcare and I suspect that you also become rejuvenated by your presence here and interacting with your fellow colleagues and bring back ideas to your own institutions. So again, I want to thank all of you for being here. My last comment is I want to give a special shout out to the clinicians, the physicians, and to the cardiology fellows who are in attendance because it is with you and your partnership with our quality analysts and our quality people in the room that you can form the collaborative team necessary for transformational change that NACU is offering us in your wheel. So again, thank you all for being here. So one of the challenges, Stephanie, that we all see who support quality in healthcare is how do we convince the C-suite about the necessary investment to do such? Paying money a little bit forward to save money to improve care when oftentimes they're more concerned, and I try not to make this a pejorative, to make money or they have limited resources with which to put in a new intensive care unit, neonatal intensive care unit. How do we sell that business case that what the work of NACU to our healthcare systems? So this is a tough question to answer and I think that it's something that, you know, is going to take a long time. So there are things, you know, you guys can prove out an ROI on some of the work that you're doing and we have case examples and lots of trainings on how to kind of articulate the value of the work that's being done, but I actually think it's going to take a lot more support and organizations like NACU and ACC and others really pushing the narrative to say if you're looking for ROI, your denominator should be years, not weeks and months, and that if we really look at the long-term situation that we're in, it's actually, we are sort of set up to be in a worse situation than we are today, and so we have to have a longer-term view on this, and so what I mean by that is right now, from a workforce perspective, we know we're squeezed with workforce. There's not enough individual contributors, regardless of their training, kind of ready to work or able to work, so right now there are seven people of working age for every person over the age of 65. In 1955, that number was 12, so we've about halved it, right? In 2040, that number is going to be four, so we had, remember we heard the fiscal cliff a few years ago, right? I'm looking at the workforce cliff saying, wow, we better make sure that our people are really trained to do their best work because we are going to have to do more with less, so I think it's kind of leveling them up, trying to help them see the longer-term views, and I also think too is one of my strategies is working with some of the younger leaders who are going to be here longer to solve the challenges, right? Like there are some people who are late executives, later stage in their career, who know how to play this game and deliver this result, and they're really good at it, but that's not the game anymore. The game has changed, and so we really need to, I think, invest in the people who are going to be solving the problems in the future. So you gave three examples of health care systems. The VA, I'm actually from Kaiser Permanente, so I'm very appreciating of the underlying culture at KP and also Augusta. What's different in the leadership of those places that the secret sauce that will allow us to spread this message and also the underlying investment needed to all health care systems? What have you, what are some of the lessons you've learned? Well, I think that the people who have been great partners and the ones who were really able to activate the change in the organization, first of all, they really care, and they're incredibly sincere in their efforts and their interest, and they really understand. They've slowed down long enough to ask themselves that critical question of what's my barrier here and understanding that it's workforce. So I think it's sort of that commitment to quality and to safety to say, you know what, we've done a lot of other things that have gotten us to where we are today, and they know their job is to take them where they need to go next, and they need new solutions. And so I think that that is a big part of it, and they're really transformational leaders. Not only can they lead their teams, but they can lead their leaders, and they can help them see the quality promised land and the workforce promised land that is very much achievable and within reach with commitment. So it's a really strong leadership as well. Maybe those, now I have sort of a semi-hardball inside slider, particularly germane in that my Dodgers are now out of the Major League Playoffs, but there was an editorial in JAMA that talked about the issue of improving health care quality measurement to combat clinician burnout. And to give an example, and a lot of our quality analysts here are dealing with these issues. To give an example, CMS has over 2,200 quality measures. 2,200. Some people, it's sort of like, it's a concept of slow death by measures. Now I credit to CMS, they're trying to improve that and narrow it down, but what are your thoughts, and you talked about clinician burnout, what are your thoughts on how we can go forward in improving the area of quality measurement? What sort of things in NACU and maybe even AHRQ or others have as a role in trying to get us to the right place here? Yeah, well just confirming and agreeing that, you know, it's a very burdensome situation and more and more measures are coming into the mix. Even well-intended measures just continue to sort of crush the system. I sat in a nursing leadership meeting at Roper St. Francis last week where they were trying to figure out how to incorporate the Joint Commission's new equity measures and get that through the process. Not only getting the data in, but they're like, what are we supposed to say to the people after we ask the question? And we learned that they don't have electricity or water or, you know, what's the intervention? How are we going to deal with that? So I can completely relate to that. I think, you know, I've been having conversations with healthcare executive CEOs, in fact, of larger hospital systems and they've kind of had it and they're actually wanting to have a movement of some sort that says enough is enough, let's measure what matters. Now we got to get everybody to agree on what that is, right? Which is the hardest part, right? But they want to move in that direction and this CEO told me, he said, listen, we're A with LeapFrog every reporting period. He said, but I don't know if we're actually a safer, higher quality system or we're just better at playing the game. And, you know, it's kind of like that's creating burnout even at the highest levels too. So I hope and expect that there will be, you know, changes on that in the future. I was with Leah Binder, CEO of LeapFrog, in her office a week ago and we were just talking about staffing ratios, you know, like just dealing with that and it's a really hard thing because we want to make sure that the patients have the appropriate amount of staff and we have a workforce shortage. So like these, we have two polarities that we're balancing and so sometimes we could be looking at a situation where, you know, if we can't get those, the staffing ratios where they need to be, then we'll just eliminate access to care. And that causes a lot of other challenges. So there's just, it's incredibly complex. I'm hoping that the leaders in the healthcare system step up, get together, find some common ground and really lead towards a new destination for all of us. I teach cardiology fellows. I do a lot of teaching for medical students at the University of Florida and I'm interested in your thoughts on how do we, how much should we be putting into the basic curriculum and at what stage for physicians, for nurses about doing quality improvement methods, right? There's an incredible amount of content one needs to pick up in those curricula to just do your basic, you know, bedside clinical care, you know, so how much should we be committing additionally training and quality improvement methodologies? So I absolutely appreciate the complexity of that challenge because like you said, teaching clinicians just to be good at their craft is hard enough, right? It takes a lot of effort, not only from the individual to learn and retain all that, but from faculty too, right, who are spending their time on all that. So my perspective, you know, from a NACUES perspective would be as soon as possible, as much as possible and the reason why is because what we don't want to do is have, you know, people like the individuals here in the room working on the registries that are, you know, go packing to, you know, make, you know, collect data and improve and then they're met with someone who doesn't understand, doesn't know what they're talking about, maybe doesn't share their sensibility, and so I think that the more we can get the training and almost the quality indoctrination, at least like, you know, conceptually ingrained in the earliest part of people's career and see quality as a solution, not a burden, that that's going to be the best situation for moving forward. Sort of building on that, and I'm glad you asked that question, David, is actually UCSF actually now has a special chief residency in quality. Interestingly, I don't know how widespread that is. What hints or ideas would you give our audience in terms of engaging clinicians related to quality? That's usually a common theme that we hear from here. They're really interested in engaging their clinicians. As you point out, clinicians are busy, but when you see these places with the secret sauce, what seems to be the culture engagement clues that you could offer this audience? So I think it's, for this audience in particular, you know, people really like to do things that add value to their own selves, and so if you can really help become a master at positioning of what's in it for the clinician and they care deeply about the patient, so what's in it for the patient, I think that that will be really helpful. Also to make it really simple for them, I think that sometimes some individuals can be very enthusiastic about quality when, let's go, let's change the world, and then maybe a physician's like, okay, I'll do that with you. They're like, okay, what do you want to do, right? So we have a plan, right? Be prepared to dock in and lead with the individuals that you, you know, want to create change with. I think it's really important to be really assertive and have your act together, you know, as you're, you know, working to engage with them, and I would say on the leadership level is required as well. You know, from the C-suite, I think we want a no-nonsense approach to quality and safety, and it's just expected that clinicians would engage in this. It's expected that they would have some portion of their CME committed to learning about, you know, elements of quality and safety, so I think that expectation setting and accountability from the top is important, and then really having individual contributors who are making it easy to follow your lead prepared to do their work. Well, thank you very much. Wonderful having you here, and we're all excited now to go out and do those things, right? All right, great. All right, well, thanks everybody. It was great to be here with you today. Good luck, and I appreciate you a lot. So just one or two more items before we close out today. I want to acknowledge our recipient this year of the Ray Barr Award. This award acknowledges somebody who has achieved excellence and vision in advancing health care, and this year she unfortunately couldn't be with us today, but the Ray Barr Award is going to go to Roxana Mehran, who is director of the Women's Center at Mount Sinai, where she's also a professor of medicine, so a round of applause, please, if you would, for Dr. Mehran. The award is named for Dr. Barr, who back in 1981 created the very first chest pain center in the United States at St. Agnes Hospital in Baltimore in conjunction with another famous cardiologist, Paul Dudley White, and Dr. Barr was very, very passionate, is very, very passionate about early heart attack care, and so I'd like to invite Amy Westfall to the stage to give us a little update on early heart attack care in the ACC. »» Thank you Dr. Winchester for the introduction. We have a very special guest with us today who will be sharing her story. And we wanted to just take another moment of your time to talk about the importance of EHAC or early heart attack care. So those of you who are familiar with accreditation, you understand the importance of providing the education to not only your staff, but taking it out into the community. Because there are so many people that still do not understand the signs and symptoms and what they're looking for. And then the importance of calling 911. We still have so many patients driving to the ER and they're just delaying that important care. So with that, I'm going to go to our next slide. And I would like to introduce Summer Royal-Smith. And will you please cue the video. »» November 6th, 2022. Very early morning, I developed pain in my chest that radiated to my shoulder and into my back. I knew that something was not right. I was very restless. It was textbook heart attack symptoms, textbook. We called 911, paramedics got to my house. They did an EKG in my living room and determined that I was having heart attack. The paramedics took me to the ambulance, started an IV, and I really started to feel worse. And I remember telling the paramedic that I felt like I was going to pass out. We were nearly to the hospital when I woke up and found out that I had gone into cardiac arrest in the ambulance. For the past eight years, I have been the comprehensive cardiovascular coordinator for Cape Verde Valley. So these are the patients that I work with all day long. And it is very humbling when you realize that you are going from looking at somebody's data to being that data. Calling early, recognizing those symptoms early and activating that 911 system early is truly a lifesaver. There was a four-minute time difference between the paramedics getting to my living room and the time I went into cardiac arrest. Had I waited any longer to call 911, or had my husband attempted to drive me to the emergency department himself, my outcome would be very much different. I am so grateful to have the opportunity to be here with you all today. I'm about three weeks shy of one-year anniversary of my event. And those videos never get any easier to watch, especially with my daughter sitting in the front row. What I want to say to you all, this room is full of people who have the perfect platform and bandwidth and knowledge base to be able to educate not just the lives that you touch as a caregiver, but in your community, your family members, and your friends. We all know that heart attacks have beginnings, and they don't always follow all the rules. My cardiac arrest last year was my second STEMI, was my second heart attack. I've had coronary artery dissections both times. I don't have any blockages. But what I want to say to you all is educate those around you. Early heart attack care, hands-only CPR, because the life that you save by educating your community may very well be your own. Thank you, Summer. So we would like you all to join us as Summer leads us through the EHAC pledge. And then at the conclusion of the pledge, we ask that you all take a moment and go outside There's a banner for EHAC. And if you'll take a picture, upload it to social media. We also have resources in the booth. Please make sure you take a moment, provide education, even if it's one person like Summer said. You have the potential to save a life. So Summer, will you lead us through the pledge? »» Absolutely. I understand that heart attacks have beginnings and that may include chest discomfort, shortness of breath, shoulder and or arm pain. These may occur hours, weeks, or before the actual heart attack. I solemnly pledge that if it happens to me or anyone I know, I will call 911 or activate our emergency medical service. »» Thank you so much, everyone. All right. Well thank you all for being here this morning and enjoy the rest of the sessions.

Equality Summit

transcript

attendees

quality

cardiovascular care

workforce competency

healthcare systems

quality improvement

heart attack care

EHAC pledge