Care, Cost, and Cliff. Stephanie Mercado on the state of quality in healthcare. || EP. 151

[00:00:00] We need to be laser focused on that and do a much better job. Some of the reasons why that's occurring, we see medication errors, we see missed diagnoses, delayed diagnoses, all sorts of things that are really causing that. So I think that we're not as far along as I think anybody thought we would be on the quality and safety agenda post 1999 to error is human. And we're not as far along in the value based care journey as we expected

[00:00:30] to be. And I think that there's one sort of underlying reason for that maybe one of a few or many, but certainly one that is missed a lot which is the workforce readiness to deliver high quality, save care, to meet the demands and promise of value based care. We tell people what to do in health care all the time make it safer, make it more affordable. But we are not really good at telling people the work for the

[00:01:00] workforce, the leaders how to achieve it. And that is really where we need to focus is as much on the how as we are on the what.

[00:01:10] This is Inspiring Women and today I'm speaking with Stephanie Mercado now Stephanie has been an executive leader in health care for over 20 years. But for the past 10 years she's been at the helm of make you the National Association of Health Care Quality.

[00:01:29] Stephanie was also most recently recognized as a top 100 most influential person in health care. I'm really excited to be speaking with you, Stephanie. Thank you for being on Inspiring Women.

[00:01:42] Of course, thank you so much for having me. All right, well Stephanie let's get into it and where I want to start is I want to talk a lot about quality the state of play and quality why it's becoming so important why wasn't it always so important.

[00:01:57] And but maybe if you could just start with like day to day, what does it look like to be at the helm of make you complex and

[00:02:07] super fun. So health care is moving about a mile a minute and the stakes are really, really high.

[00:02:15] So we are really living that at make you really trying to stay out front ahead of a lot of the issues that are going on in the industry and really trying to position ourselves as a driving force and a solution to meet some of the most pressing challenges that are facing health care today.

[00:02:37] And those challenges for us would are vast, but I think could be sort of summarized in three words care cost and cliff.

[00:02:47] We want to stay ahead of where health care delivery is going. We want to make sure that from a cost perspective that we are helping to make health care sustainable.

[00:02:56] And that we are readying ourselves for the workforce cliff because we know workforce shortages are going to get much worse over the next 15 years and we really see quality and safety, equity and value as huge drivers and really business strategies to advancing all of that. So we keep ourselves quite busy at make you headquarters.

[00:03:16] Yeah, well I want to like almost go back a little bit. So can you just like tell us like what is make you do like what is the association for what is it defining in terms of setting standards for the industry and the area of quality.

[00:03:32] So make you begin as a professional membership and certification organization serving individual contributors.

[00:03:40] The organization started in 1976 and has rich history and great experience in the space.

[00:03:49] And we have a vault too is really meeting the market where it's at and that involves very much advancing health care organizations as they aim to increase their capabilities of their staff and then to build capacity for quality and safety.

[00:04:07] So we actually can support individual contributors but also come into healthcare organizations to help them figure out how to set up and situate health care quality in a more effective way so that they can achieve their results.

[00:04:26] We are on the front end of the workforce development sort of side of quality and safety, making sure that the workforce is coordinated and that it is competent and aligned to do its very best work.

[00:04:40] And I like the focus on you know that you started with on like the cliff. I mean, you know, I think that everyone is becoming acutely aware just in the industry of the workforce shortages.

[00:04:51] The you know, the burden that clinicians are feeling the burnout we talk about and that has to have impact on quality and nothing about that sounds like a good thing in terms of what's out there.

[00:05:06] So it's definitely maybe even like if we can get really basic, what can you just define quality for us and safety? How should we be thinking about that?

[00:05:16] Those are big questions and actually make you does a lot of research on that. It is yes because as healthcare has evolved over many decades, so has the definition of quality.

[00:05:29] So you know, back in the 60s when Lyndon B Johnson signed Medicare into law, quality was really all about utilization review.

[00:05:39] Then quality became much more about compliance over the past couple of decades. It's really had a focus on improvement and today it really means equity and safety and value.

[00:05:52] And that you know all sort of in the mix, it means different things to different people. But to us, it is both the process and the result that we are looking to achieve so that we can have people living their very best lives.

[00:06:09] So we take that and let's just move it front to the patient's perspective because I think that as a person who might go into a hospital or might be receiving care, I mean those are stressful times.

[00:06:21] There's always something else that you're thinking about. How does a patient think about quality?

[00:06:27] You don't care about everyone leading their best lives in the hospital they care about getting best care for whatever they're going to see a physician or clinician for.

[00:06:37] Right, yeah so you know leading NACU is one thing and you know I myself and my family members are often patients and the healthcare environment.

[00:06:49] Patients walk into it with the full faith and trust that the industry and the people working in healthcare have been fully trained on quality and on safety.

[00:06:59] And in fact, that is not universally true. Most people that you walk past in the hallways are interact with in a healthcare delivery setting where the physicians or nurses or tech.

[00:07:12] Or even people in the executive offices have all been trained really differently or not at all in quality and safety competencies.

[00:07:22] And so I think from a patient's perspective, you know most recently I was in the hospital with my son, my youngest was diagnosed with meningitis.

[00:07:32] And yeah it was a, it was very scary. And I wanted Ben to be safe and I wanted to make sure that his medication was dosed correctly and that he didn't get an infection from his procedure.

[00:07:46] And that if something went wrong, that the oxygen that was sort of stationed there on the wall was actually going to be flowing when and if they needed to administer that to Ben.

[00:07:56] So these are all the things that behind the scenes, you know healthcare is working hard to make sure are working properly.

[00:08:03] And that they are doing the best work for the patients, but mistakes happen and we are humans. And so I think that you know we can do a better job for our patients and their families to make sure that we're a little more consistent from a quality and safety perspective.

[00:08:21] And that we're focused on the highest priority areas that really cause a lot of risk and harm to patients.

[00:08:28] Well, first of all, that sounds extraordinarily scary as a mom, how is Ben, how is your son?

[00:08:36] He's doing great. He bounced back pretty quickly. We were in the hospital for about a week and he bounced back about a week after that. It took us about two more weeks to bounce back.

[00:08:46] Well, I'm glad to hear it. I'm glad to hear it. And you know, as a mom, but also as the head of the helm of, you know, the standards as it relates to quality and safety.

[00:08:57] I'm sure you were checking a whole bunch of things that what I would just say a normal patient lay person might not be thinking about now.

[00:09:07] Well, as you know, Stephanie, I come from the electronic health records space. That's where I grew my career in healthcare and it was 1999 when to air is human came out that really put a spotlight on the fact that hey, we didn't have consistency.

[00:09:24] I didn't necessarily have standards for the adoption of technology. And this was just clinical documentation electronic health records, which led to a sea change of adoption of new standardized approaches for documentation.

[00:09:39] So in the world of quality as a patient, I expected to just be in there. What is the state of play really, you know, across the United States in terms of quality.

[00:09:51] I think we can be excited and optimistic about the marvels of modern medicine because they are, you know, saving lives and improving lives every single day.

[00:10:04] I also think that we have a long way to go, most certainly on the safety agenda at present, approximately one in four people who are entering the healthcare system to get better to solve what is them will experience harm or death as a result of that experience.

[00:10:24] And we need to be laser focused on that and do a much better job. Some of the reasons why that's occurring, we see medication errors, we see missed diagnoses, delayed diagnoses, all sorts of things that are really causing that.

[00:10:42] I think that we're not as far ahead long as I think anybody thought we would be on the quality and safety agenda post 1999 to error is human.

[00:10:52] And we're not as far along in the value based care journey as we expect it to be.

[00:10:57] And I think that there's one sort of underlying reason for that maybe one of a few or many, but certainly one that is missed a lot, which is the workforce readiness to deliver high quality, save care to meet the demands and promise of value based care.

[00:11:15] We tell people what to do in healthcare all the time, make it safer, make it more affordable, but we are not really good at telling people the workforce, the leaders how to achieve it.

[00:11:29] And that is really where we need to focus is as much on the how as we are on the what.

[00:11:36] Yep, and we've moved just in healthcare in terms of you know sort of like the physician being the sort of like you know one person in charge of sort of like all things perhaps, you know for our patient to really this team based care environment, whose responsibility is quality and in the healthcare delivery system.

[00:11:56] Well, most people would say quality is everyone's job and therefore it's hard for it to be anyone's job.

[00:12:03] Yep so just a couple of words on that you know so yeah we used to have our primary care physicians were the quarterback for the healthcare team.

[00:12:14] Yep and that is no longer the case. And so what I observe is that we've put five generations of individual contributors to work in healthcare to produce high quality, save cost effective care.

[00:12:32] But they're all approaching that very differently. They all have different skills, they all have different competencies and they all have different sensibilities for quality and safety as well.

[00:12:41] So just putting them together doesn't solve the problem or telling them to do better doesn't solve the problem.

[00:12:48] I think what we really need to do is to be figuring out how we specifically define the role that each individual contributor will play in advancing quality and safety.

[00:13:00] And then we figure out how to put those teams together to do their best work in our research.

[00:13:05] We find that a lot of individual contributors are not at the doing the level of work or the type of work they need to be doing and not only that, but they're not sort of docking in to their team in the most effective way.

[00:13:19] So I think a real need to focus on how we are ready and align work forces to achieve quality and safety.

[00:13:29] Right, and I think that I mean there's no clinician or care deliverer that does not want to deliver quality.

[00:13:38] So like that is you know I think that we can all expect that. But standards are emerging.

[00:13:43] Nakew is defining some of those standards in terms of the language of quality and how to apply that on to the workforce as you do that work Stephanie and you think about sort of like what's needed.

[00:13:55] One of the things that we saw in the adoption of EHRs, one of the accelerants of that started to be when they were incentives to adopt, you know, standardized tools.

[00:14:07] And then penalties if you didn't adopt them, but then that also caused some negative effects. The whole bunch of burden higher costs and some instances not taking costs out of the system.

[00:14:20] So as we look at emerging standards for quality and safety, a lot of which is the work of Nakew.

[00:14:28] How do you see it playing out? Are there penalties are there incentives in place to adopt some of the work of Nakew and other standards emerging.

[00:14:38] Yeah well, there are lots of reward and incentive programs and penalty systems for healthcare today.

[00:14:47] And they're just vast and incredibly complex. What we would like to see is more of reward for organizations that are sort of structurally orienting their organizations for success.

[00:15:04] So we hear a lot about outcome process measures and outcome measures that has sort of been the name of the game and healthcare quality and safety and really measurement.

[00:15:16] One of the things that we think we could do a better job on is actually focusing on structural measures. So what that means is that is that the things that must be sort of a foundationally in place in order to achieve, you know, process outcomes or higher processes or outcome measures.

[00:15:38] And so those structural elements would include things like a highly engaged board who is really locked into the quality and safety agenda, knowledgeable about that, invested in that.

[00:15:50] It would include things like a workforce that is supported and trained by their leaders today about half of the people who are trained in quality and safety are paying for themselves.

[00:16:02] Their employers are not paying for that. And so we would like to see structural progress being made on competency based training, certainly funding for that training and getting executives really engaged in board members and quality and safety.

[00:16:20] Yeah, well, I mean there's definitely something happening here in terms of I mean quality going from, you know, sort of like an unfunded mandate to really sort of moving out of the basement into the board room and in a different and new way.

[00:16:35] And I also, you know, Stephanie, I want to congratulate you on being recognized as a top 100 most influential person in the United States in the world of health care. I mean certainly a testament to you, but also the work that you're doing in NACU now I've heard you called just in some circles as a force of nature.

[00:16:59] But what do we take from this recognition, you know, in addition to you being fantastic. What does it say about sort of what's happening in quality across across the state's quality and safety across the state today?

[00:17:13] Yeah, well I think it what it is pointing towards is that quality and safety has gone from the basement to the board room.

[00:17:21] And not only do we have a seat at the table, but we have a commanding seat at the table and that quality and safety if leverage of a business strategy can really solve a lot of the challenges that we have today.

[00:17:35] I also think that the recognition was important, not just for me and thank you for that, but really for NACU because the National Association for Healthcare Quality has been leading on this.

[00:17:48] There has not been another organization before nor will there actually be one ever again to was sort of first on the scene that said we're going to own this issue.

[00:17:58] We're going to own the issue of the profession of health care quality advancing the discipline of healthcare quality and we're going to be the professional home for the people and the leaders really advancing this cause.

[00:18:11] And we're going to define that through a competency standard and really try and bring shape to something that has really been left unkept for too long.

[00:18:22] So it was a great nod to NACU and all of the leadership from our staff and board who have been fully supportive and engaged along this really exciting journey.

[00:18:33] Well, congratulations and again we have a long way to go so you know keep at that work because I think that we all want to just simply expect and not worry about you know harm issues that you were on talking about.

[00:18:47] Stephanie I want to turn the conversation sort of back to you and again I wasn't kidding you have been called a force of nature in some circles.

[00:18:54] What did you want to be when you grew up when you grew up when you were little what were you thinking about back then?

[00:19:01] So two things one I was always interested in healthcare but I was not interested in being a clinician so I never knew exactly what that you know how that would work what that would shape that would take.

[00:19:14] But I was very interested in a profession of being a journalist so I wanted to be that sort of like the yeah.

[00:19:22] The person telling the story and really bringing stories to life and so that was my early ambition was to be in journalism.

[00:19:32] Okay, and so at what point along this career journey you know from journalists to to city suite executive on national stages when did sort of like the sea suite kind of power positions that you are in when did that become something that oh I want that did you just get.

[00:19:53] Ball into it was it a pursuit what what's that all about.

[00:19:58] Yeah, I think it was a very intentional sort of you know growth effort and strategy on my part and when I realized that I would be good at it was when I actually sort of channeled that journalistic training because I think a big part of leadership is being able to come into a situation and industry.

[00:20:22] And in an industry and organization be able to get your arms around that.

[00:20:27] And in order to do that you have to really be able to both have that bird's I view but come in on the ground and have a nuance understanding of things.

[00:20:35] And so I think you know one of my strengths is being able to help people understand where they were where they are and where they're going and that actually take them there.

[00:20:46] And to to bring them along on that journey and really unleash the human potential that is on board and that is part of staff teams and say you know we can get there and we're going to get there together.

[00:20:59] Yeah, so Stephanie you you have an amazing presence on finance you know in terms of how you show up on in so many different ways behind the scenes in the head are you as confident as you appear all the time.

[00:21:16] Well there's always some of that self talk right I don't think I think anybody who doesn't have some of that negative self talk or doubtful self talk is probably maybe a little too big for their bridges and it should be careful because nobody is that good.

[00:21:34] So I think that yes, I have a good presence you know things that you're saying but it is really important to check yourself, I think.

[00:21:46] But also not to be too mean to yourself I heard someone say once you know if I talk to my if somebody talked about my best friend the way that you are talking about yourself I you know that you know knock them out.

[00:21:58] So I think we need to remind ourselves of that too that we we should be careful and thoughtful about how we handle ourselves but never too hard if we can be a little gracious with other people maybe we should try and do that with ourselves and that requires constant discipline to be able to do that especially if you're perfectionist and I I'm probably one of those so.

[00:22:21] So just like along that journey and having an expectation of yourself that this is intentional I want to achieve these levels of you know sort of power positions top of the pyramid types of positions that you're in was there some point along the way some learning something that stuck out to you that helped you get there because.

[00:22:42] You know so many women who are ascending into leadership they are working hard to quell the self doubt they are working hard to build the skills that you have clearly built what can you give us an example of a time or an experience that helped you before you were the person that you are today.

[00:23:03] Yeah, I mean probably there's many of them so I would say first of all.

[00:23:10] Very important to be prepared so I think it's very hard to be confident if you are not prepared a lot of people get out and maybe sort of get ahead of their skis on some things and not be able to walk the talk so I think that's important but I can remember one instance in particular where I was maybe under estimate.

[00:23:32] And I was at a dinner with a very powerful and impressive man who's a CEO of a major healthcare organization.

[00:23:43] And he was sort of sending me in a direction and said well why don't you just go work with that guy because he's your peer and I.

[00:23:50] You know kind of quickly even almost on a reflex snap back and said you know that individual is not my peer and I've tried to work with them before and I am really trying to push an agenda so let's get the right people in the room and let's get some stuff done.

[00:24:04] And so I think that moments like that you know sometimes they certainly surprise the person on the other end of the table but they bring a certain level of respect and you know curiosity about the capabilities of the individual.

[00:24:20] And sometimes i'm surprising myself with those things right I didn't know that until I said it and but I think it was right.

[00:24:27] Well, it's that that's such a cool story first of all that's awesome and the when you do surprise yourself in those moments of reflect that also demonstrate.

[00:24:38] You know like you are all that you are and can actually command the moment i those are the types of things that sort of like build for the next time and the next time so Stephanie as you think about and just you know for all these other i'll just say you know women who want to be Stephanie Mercado.

[00:24:58] You know in their career journeys would advice would you give them what advice would you give to other people who are aspiring to be a leader like you.

[00:25:11] I would say do your homework work really hard be able to absolutely walk the talk and I would say also the secret maybe one of the secrets to my success has been the very important thing is that you can do it.

[00:25:28] It's very much knowing when to push hard and go fast and when to slow down and when to be patient because both you know most certainly you know have a role to play and sort of how.

[00:25:46] So I think that you show up and so I think that pacing and timing a lot is absolutely everything and I also think that just really spending time and developing yourself one of the favorite things for me about my career and especially my career at make you i've been here 10 years.

[00:26:06] I think that you know it's very different person and make you was a very different organization 10 years ago.

[00:26:11] And I think that if you think about all of the challenges that are ahead even the ones that are maybe you know take your breath away for a minute here and there what I view them as is an opportunity to continue to reinvent and redefine myself.

[00:26:26] I think that I would push myself to places that I didn't even think that I was capable of going I wouldn't define myself what were the words that you used.

[00:26:37] Top leader force of nature for me yeah I would not describe myself as force of nature I would describe myself as just hard working and you know I I on the goals and advancing the mission.

[00:26:51] Last question I want to ask you Stephanie as we close out here you know top leaders I often see a sort of like through line that they're lifelong learners and they're always you know sort of like you know they never feel like they know enough on and that's always sort of like a death now if you will it just like if you if you believe that so just as someone who is a learner and pushes yourself what's what are you learning recently that surprised you.

[00:27:19] So many things so well I think part of the learning is just keeping up with current news so I read a lot about what's going on and the health care environment and otherwise one of the other things I've started to do you know I'm a little press for time I have a lot going on thank you I do have two sort of small-ish children at home 10 and 14 years old some and the husband and a dog and rather busy.

[00:27:48] And so I have found a lot of right isn't it how don't you have that in your life.

[00:27:53] Two kids and travel hockey yeah so it's a lot but what I would say is one of the things that I try to figure out is like how can I continue to consume information without having it bogged me down and also not just fully abandoning that idea that I would want to keep learning so there is a new app that I'm pretty into and it's called headway I don't know if you know what it is but it's a it's sort of like the readers

[00:28:17] digest version of a lot of interesting books that are out there and so what I found is if I can spend 15 or 20 minutes while I'm walking the dog around the treadmill or something and listen to one of those if I'm interested then I could kind of dig in and you know access the entire publication.

[00:28:37] So that's been I think a really effective way for a busy person to kind of try and stay engaged in some new content that is out there.

[00:28:46] Well that is awesome I will check it out and this has been a great conversation you've been generous with your time Stephanie I've been talking to Stephanie Mercado

[00:28:54] and Stephanie thank you so much.

[00:28:56] Thank you.

[00:28:57] This has been an episode of Inspiring Women with Laurie McGraw please subscribe right in review we are produced by Kate Cruz at executive podcast solutions.

[00:29:07] More episodes can be found on InspiringWomen.show I am Laurie McGraw and thank you for listening.