Leading Quality

Why This Episode Matters

Healthcare organizations can run successful improvement projects while leaving the conditions that undermine their results untouched. Executives pursue competing priorities, governance processes underperform, and middle managers receive requests they cannot reconcile. Clinical teams are then expected to deliver improvements that last. Drawing on her work with health systems through IHI, Jennifer Lenoci-Edwards argues that these difficulties require attention to quality planning alongside improvement methodology. Her distinction between strategic, structural, and clinical variation helps explain why an organization can achieve promising project results yet find itself addressing the same problems three years later. The leadership challenge is to negotiate shared priorities, understand what patients and staff need, and arrange the structures and support that make execution possible. It is also to recognize when leaders’ own decisions are contributing to the confusion they want frontline teams to overcome.

Key Ideas Explored

• Clinical variation is only one part of the improvement problem. Jennifer’s framework also identifies strategic variation—leaders pursuing different agendas—and structural variation, where governance, peer review, root cause analysis, and huddles fail to function effectively. She argues that unresolved problems in these areas weaken the sustainability and spread of clinical gains.
• Quality planning requires concessions, not just agreement that everything matters. Executives must negotiate what they will prioritize collectively and what they will relinquish. Shared direction does not require every department to contribute equally to every target: a maternity service may have little contribution to an organization’s mortality goal while retaining legitimate improvement priorities of its own.
• A well-designed process can conceal a critical failure in practice. Jennifer describes an impressive escalating huddle system in which the most serious problems never reached the CEO because staff were nervous about escalating them. The existence of a structure says little about whether it delivers the information leaders most need.
• Dashboard colors can create consequences without demonstrating change. Jennifer recalls a colleague describing red and green reporting as “pizza party or punch in the nose.” Without examining data over time and distinguishing common from special cause variation, organizations can alternate between celebration and criticism while the underlying process remains unchanged.
• Knowing the strategy does not guarantee having a role in it. While working in an emergency department, Jennifer recognized a patient’s connection to a population health initiative but had no defined contribution to make. Middle managers and frontline teams need clarity about their role, relevant evidence, and usable improvement tools; additional meetings alone do not provide that connection.

Takeaways for Quality Leaders

• Before commissioning another project, ask which supporting arrangements need to change: who must work together, what tools are missing, and how successful changes will enter quality control.
• Prepare for priority-setting with evidence about regulatory requirements, contractual commitments, patient experience, and workforce needs. Which proposed priorities reflect those needs, and which primarily reflect an executive’s interests?
• Trace a serious concern through your escalation process. Where might it stop, and what response do people anticipate from the next leader?
• Give middle managers enough improvement knowledge to question requests constructively: does this result suggest special cause variation, and is the requested action likely to produce a meaningful change?

Continue the Conversation

Jennifer Lenoci-Edwards on LinkedIn

Resources & Frameworks Referenced

• Three types of variation: Strategic, structural, and clinical variation.
• Whole System Quality: IHI white paper informing the organizational assessment rubric Jennifer describes.
• Model for Improvement and PDSA: Improvement approaches referenced in the discussion of clinical projects and iterative learning.
• Quality planning, quality improvement, and quality control: Connecting priority-setting, execution, and sustained performance.

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

Why This Episode Matters

The pressure to prove yourself in a new quality leadership role can push you toward solutions before you understand the organization expected to implement them. Dashboards reveal performance, and organizational charts identify formal authority, but neither explains whom people trust, why previous efforts stalled, or what happens when someone challenges a senior leader. Drawing on his own entry into quality leadership, Dr. Jason Meadows offers six maps for understanding these less visible realities during the first 90 days. The central argument is that disciplined inquiry is substantive leadership work: it helps establish which problems deserve attention, where improvement capability already exists, and what others expect you to accomplish. This is also a framework for experienced leaders to revisit assumptions about an organization they believe they know.

Key Ideas Explored

• Recurring friction can reveal a process working against its own purpose. Clinical case reviews intended to generate learning instead left participants feeling scrutinized and humiliated. The diagnostic task is to distinguish a worthwhile purpose from a design that undermines it—before deciding whether to repair or abandon the process.
• Every organization has a second organizational chart. Formal reporting relationships coexist with networks of trust, influence, and practical problem-solving. A respected frontline nurse may make a pilot feasible in ways that a senior title cannot; discovering those relationships changes where and with whom improvement can begin.
• Culture becomes visible when the preferred story is challenged. A leadership meeting that moves directly from a broadly defined problem to a predetermined solution reveals something about the organization’s tolerance for uncertainty. Watch both how questions are received and what happens after concerns are raised: repeated inaction teaches people whether speaking up is worthwhile.
• Communicating strategy does not establish that it has been implemented. A plan may “cascade” through leadership without influencing daily decisions. Hiring, performance evaluation, resource allocation, and meeting practices offer more concrete evidence that stated priorities have reached the work.
• Improvement capability may exist outside the quality department, yet remain difficult to mobilize. Staff with engineering, Lean, or change management experience can be overlooked by formal structures. Capability also depends on whether someone with a good idea can obtain data, coaching, and permission to test it.
• A job description leaves inherited expectations unwritten. The same quality leader may be seen as a potential disciplinarian, a source of individual accountability, or someone who can resolve longstanding operational frustrations. Understanding these conflicting expectations is necessary to define the role deliberately; it does not mean accepting them all.

Takeaways for Quality Leaders

• At the end of each introductory meeting, ask whom else you should meet. Follow recurring names beyond the formal leadership structure, especially people others call when a problem cannot be solved locally.
• Trace one frontline improvement idea from identification to a possible test. Where would it encounter missing data, unavailable coaching, or layers of approval? This makes the gap between improvement ambition and capability tangible.
• Ask people at different organizational levels to describe current priorities and how their work contributes. Listen without correcting them; differences between answers are findings to investigate.
• By day 90, aim to explain recurring problems, trusted relationships, existing strengths, and conflicting expectations. Act on immediate safety issues and removable barriers along the way; listening should produce visible responses when something important surfaces.

Resources & Frameworks Referenced

• Six-map framework: Work friction, people, culture, strategy, improvement capability, and role expectations.
• Companion field guide: Modular questions, prompts, and exercises at jasonmeadowsmd.com/resources.

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

This week, we're revisiting one of the earliest episodes of Leading Quality—and a conversation about what it really takes to build lasting improvement capability in healthcare. We'll be back with an all-new episode in our next release.

How do you build a culture of quality improvement across an entire healthcare system? And what happens when you start with frontline clinicians rather than executive leadership?

In this episode, I speak with Dr. Curt Smecher, a retired anesthesiologist and one of the architects of British Columbia's Physician Quality Improvement (PQI) program. Affectionately known as "Papa QI," Curt helped grow a small, physician-led initiative into a province-wide program that has trained more than 1,600 clinicians in improvement science.

What began with just 12 physicians in 2015 offers a compelling alternative to conventional approaches to healthcare transformation. Rather than waiting for top-down direction, PQI built improvement capability from the ground up, creating opportunities for clinicians to tackle problems in their everyday work while gradually building trust and stronger relationships with health system leaders.

We explore how intentional governance, protected funding, and meaningful patient partnerships helped sustain and scale the program. Curt describes why patients were included as equal partners from the beginning, how PQI graduates became more engaged in their work, and why building improvement capability is only the first step toward meaningful system-wide change.

We also look ahead to PQI's next challenge: moving beyond individual projects toward whole system quality, where improvement, measurement, and planning come together to address the underlying problems facing healthcare systems.

In this conversation, we explore:

• Why PQI took a bottom-up approach to improvement rather than starting with executive leadership
• How shared governance and authentic patient partnerships helped change organizational culture
• Why protected time and funding are essential to sustainable improvement
• How involvement in QI can strengthen physician engagement, autonomy, and relationships
• The challenge of moving from training improvement leaders to deploying their skills at scale
• Why lasting system transformation depends on relationships, shared purpose, and trust

Curt's story is a reminder that building a learning organization requires more than teaching improvement methods. It means creating the conditions for people to work together, share power, solve meaningful problems, and develop trust over time.

Because, as Curt reminds us, change happens at the speed of trust.

This episode is an ICYMI (In Case You Missed It) re-release from the Leading Quality archive. We'll return with a brand-new conversation in our next regularly scheduled episode.

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

Why This Episode Matters

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: [email protected]

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

Why This Episode Matters

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

Why This Episode Matters

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

Why This Episode Matters

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.

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

Why This Episode Matters

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.

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

Why This Episode Matters

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.

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

Why This Episode Matters

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.

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