Leading Quality

Why This Episode Matters

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

Key Ideas Explored

• Why goals-of-care documentation became a “conversation in the haystack” problem 
• How Providence made serious illness communication a system priority, not a palliative care side project 
• Why training physicians alone did not move the needle, and how nurses became critical to implementation 
• The tension between standardized documentation and preserving the humanity of the conversation 
• How AI helped identify meaningful goals-of-care conversations without relying on checkboxes or dot phrases 

Takeaways for Quality Leaders

• Treat important clinical conversations as part of system design, not just individual clinician skill. 
• Build measurement only after defining what meaningful quality looks like in practice. 
• Engage the disciplines closest to the workflow; nursing involvement may reveal implementation paths leaders miss. 
• Avoid designing metrics that reward documentation behavior while missing the underlying clinical purpose. 
• Look for AI use cases where language, workflow burden, and quality measurement intersect. 

Continue the Conversation

Dr. Gonzalez -  

Email: [email protected]

Dr. Unger - 

Email: [email protected]
Bluesky: @qoflmd.bsky.social

Resources & Frameworks Referenced

• Providence Institute for Human Caring
• Ariadne Labs Serious Illness Conversation Guide
• Guide Successful Strategies for Operationalizing Goals-Of-Care Documentation - NEJM Catalyst
• Finding the Conversation in a Haystack: Leveraging AI to Detect Goals-Of-Care Documentation - Journal of Pain and Symptom Management

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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

For years, many Belgian hospitals invested heavily in accreditation. It brought structure, standards, and visible progress. But Kris Vanhaecht and other healthcare leaders began to notice a deeper problem: when accreditation became the goal, quality could become episodic. Energy rose before the survey, then faded after the label was achieved.

The question became how to keep the useful discipline of accreditation while building something more durable. In this episode, Kris discusses the Flanders Quality Model, or FlaQuM, and the shift toward a co-created quality management system that connects bedside care, leadership, governance, culture, and shared learning.

Key Ideas Explored

• Why accreditation can help, but still fall short of sustainable quality
• The FlaQuM pillars of Think, Do, Learn
• How Juran’s trilogy informs modern quality management 
• Why leadership, culture, and context matter alongside technical quality methods 
• Co-design with clinicians, patients, executives, nurses, engineers, and other stakeholders 
• Why quality models require local translation, not simple implementation 

Takeaways for Quality Leaders

• Clarify your quality vision before beginning with indicators, audits, or standards. 
• Treat quality management as an operating system, not a quality department project. 
• Involve the people closest to the work early.
• Preserve the discipline of accreditation, but do not let the label become the aim.
• Build regular structures for shared learning across teams and organizations.
• Adapt leadership, culture, and context locally.
• Aim for quality that is sustained every day, not revived before external review.

Continue the Conversation

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

Resources & Frameworks Referenced

• Flanders Quality Model (FlaQuM)
• The Juran Trilogy: quality planning/design, quality control, and quality improvement
• Accreditation Canada
• Joint Commission International
• Safety-II
• Institute for Healthcare Improvement

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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

Too many healthcare organizations still respond to safety events as if the main question is who made the mistake. This conversation offers a better lens: what in the system made the event possible, and how can leaders learn early enough to prevent the next one?

Using Annie’s story, Dr. Terry Fairbanks explains why strong event review matters, why timely response matters, and why healthcare falls short when it treats quality improvement and safety management as though they require the same skills. This episode gets beneath the language of safety and into the logic of safer systems.

Key Ideas Explored

• Annie’s story as a case study in how system failures get mistaken for individual failure 
• Why event reviews should begin immediately, even before every fact is known 
• The difference between product design, implementation, and real-world use 
• Why safety requires distinct competencies from traditional quality improvement 
• A practical model of primary, secondary, and tertiary prevention in safety 
• How hospitals could use existing data streams to identify hazards before harm occurs 

Takeaways for Quality Leaders

• Do not rush to discipline before a full systems-based review is complete 
• Treat early family communication and caregiver support as core parts of the safety response 
• Ask what design or implementation factors shaped the event 
• Make sure safety expertise is in the room during technology and device implementation 
• Stop assuming quality improvement training alone is enough for patient safety leadership 
• Invest in ways to detect weak signals and emerging hazards before they become events 
• Judge mitigation strategies by two standards: effectiveness and sustainability

Connect with Dr. Terry Fairbanks

LinkedIn

Twitter / X

Resources & Frameworks Referenced

• Annie’s Story 
• The MedStar Health National Center for Human Factors in Healthcare
• Systems-based event review
• AHRQ's CANDOR Framework 
• IHI's RCA2 Framework 
• Trigger tools 

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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 are investing heavily in new technologies, yet many implementations unintentionally add complexity to clinicians’ daily work. This episode explores a different question: what if we deliberately evaluate tools for their ability to reduce friction and support clinician well-being?

Dr. Chris Dale and Dr. Ryan Dix discuss the development and evaluation of MedPearl, a clinical decision support tool built to streamline referrals and support frontline clinicians. Their conversation highlights why system design, not individual resilience, is often the most powerful lever for improving workforce well-being.

Key Ideas Explored

• Micro-frictions in clinical workflows accumulate into meaningful cognitive and emotional burden
• Organizational interventions often outperform individual resilience strategies
• MedPearl was designed to capture and operationalize “tribal knowledge” in referral workflows
• Technology adoption spreads socially through trusted peer networks
• Measuring well-being impact requires using existing data thoughtfully
• The future of innovation must include workforce impact, not just efficiency metrics

Takeaways for Quality Leaders

• Treat clinician well-being as a system property, not an individual responsibility
• Look for “sticky note problems” that signal hidden workflow friction
• Use existing organizational data sources before launching new surveys
• Expect heterogeneous impact. Not every tool benefits every group equally
• Pair product design thinking with traditional improvement methods
• Monitor indirect indicators of well-being, not just annual survey scores
• Recognize that meaningful improvement will come from many small changes, not one solution

Continue the Conversation

Connect with Dr. Ryan Dix through the Wellbeing Trust website to learn more about Providence’s workforce well-being initiatives.
Follow Dr. Chris Dale on X (Twitter) or LinkedIn or visit Arborgenie.com to explore his work in AI and clinical data.

 This episode is especially useful for quality leaders, CMOs, CMIOs, operational leaders evaluating new clinical technologies, and anyone interested in the intersection between AI, data, quality improvement, and clinician wellbeing.

If you found this conversation valuable, consider rating, commenting, or sharing with a colleague.

Resources & Frameworks Referenced

• MedPearl clinical decision support tool
• Quadruple Aim framework
• PDSA cycles
• Epic EHR integration concepts
• Physician well-being survey methodologies
• Physicians Foundation research funding

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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

Many healthcare organizations say quality matters. Far fewer are built so improvement is part of daily operations. Too often, quality is treated as a department, a committee agenda, or a set of projects at the edge of the real work.

In this conversation, Dr. David M. Williams offers a different frame. He argues that quality should function as an organizational strategy: clarifying purpose, understanding the system, choosing the right work, building capability, and creating conditions for learning. For leaders trying to move beyond scattered projects and initiative fatigue, this conversation offers a more coherent way forward.

Key Ideas Explored

•  Quality is not a department. It is a way an organization pursues its purpose. 
•  Many “errors” reflect poorly designed systems, not isolated individual failures. 
•  Project work loses power when it is reactionary, peripheral, or poorly aligned. 
•  Leaders need a theory for how quality works across the organization. 
•  Shared methods make improvement more teachable, scalable, and reliable. 
•  Improvement capability must connect to governance, priorities, and daily work. 

Takeaways for Quality Leaders

•  Revisit your organization’s purpose and what it demands of the system. 
•  Examine whether your improvement work is focused on core work or safer side projects. 
•  Look for signs that quality is structurally marginal. 
•  Build a shared improvement method, not a patchwork of frameworks. 
•  Invest in helping teams get better at rigorous improvement. 
•  Treat implementation and spread as part of the work. 
•  Ask whether quality is changing how the organization actually operates.

Continue the Conversation

Connect with David M. Williams, PhD via his website or LinkedIn profile.

His next QOS Series starts in April 2026: 

https://davidmwilliamsphd.com/qos-series/

Resources & Frameworks Referenced

• Quality as an Organizational Strategy
• The QOS Field Guide
•  W. Edwards Deming’s system of profound knowledge 
•  Deming’s “production viewed as a system” 
•  The Model for Improvement 
•  IHI Whole System Quality 
•  The Chief Quality Officer Professional Development Program 

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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

Quality functions in healthcare often struggle with perception. Too frequently, they are viewed as auditors or enforcers rather than strategic partners in improvement. In complex environments like post-merger health systems, this perception can become an even greater barrier to progress.

In this episode, Lisa Harton, DNP, MBA/MPH, RN shares a grounded, experience-based approach to reshaping the role of quality by focusing first on relationships, mindset, and psychological safety. Her work offers practical insight for leaders trying to move from compliance-driven activity toward true system improvement.

Key Ideas Explored

• Why quality teams must first become trusted partners before driving accountability
• Using appreciative inquiry to unify teams after a merger of equals
• How clinicians move through “stages of grief” when confronted with performance data
• What healthcare underestimates about the human side of high reliability
• The role of boards and governance in advancing quality strategy
• Why changing mindsets is prerequisite to changing behaviors

Takeaways for Quality Leaders

• Start culture change by intentionally redesigning the relationship between quality and operations
• When clinicians question data, lean into joint learning rather than defensiveness
• Use established frameworks to create shared language across the organization
• Invest deliberately in teamwork and communication training, not just technical fixes
• Engage boards with accessible tools that build confidence in quality oversight
• Recognize and celebrate small wins to build momentum and trust
• Anchor improvement work in purpose and shared aspiration, especially during mergers

Continue the Conversation

Connect with Lisa on LinkedIn to continue the discussion.
This episode is especially useful for quality leaders navigating culture change, mergers, or reliability work.
If you found this conversation valuable, consider sharing it with a colleague or leaving a brief rating or review.

Resources & Frameworks Referenced

• Appreciative Inquiry framework
• IHI Whole System Quality framework
• IHI's Framework for Effective Board Governance of Health System Quality
• Barbara Fredrickson’s Positivity research
• TeamSTEPPS
• High reliability principles (nuclear industry examples)
• Root Cause Analysis (RCA)

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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 are rich with intelligence, talent, and commitment. Yet leaders across systems feel exhausted, constrained, and stuck solving the same problems year after year.

In this conversation, Dr. Laura Desveaux challenges the idea that improvement is primarily about adding more initiatives. Instead, she reframes leadership as the disciplined practice of learning, from everyday evidence, from diverse voices, and from the tensions we often try to resolve too quickly. This episode explores what it means to lead a true learning health system in operational reality.

Key Ideas Explored

• The gap between current performance and true system potential
• Learning health systems as a way of operating, not a series of projects
• De-implementation and “subtraction neglect” in healthcare
• Holding paradox: efficiency and humanity, population and individual care
• The role of co-design and implementation science in scaling improvement
• Asking better questions as a leadership intervention

Takeaways for Quality Leaders

• Start every initiative by clearly naming the problem you are trying to solve.
• Before adding a new project, ask what can be removed to create capacity.
• Integrate multiple forms of evidence: data, lived experience, front-line insight.
• Move beyond either/or thinking. Many leadership challenges are both/and.
• Build routines that embed learning into daily operations, not just pilot cycles.
• Revisit meeting structures, reporting formats, and governance processes with subtraction in mind.
• Anchor teams to shared outcomes while staying flexible on the path to get there.

Continue the Conversation

Connect with Dr. Laura Desveaux on LinkedIn or visit her website to follow her work in learning health systems and leadership development.
This episode is especially useful for senior leaders, quality executives, and clinicians navigating complex system change.
If this conversation resonated, share it with a colleague and consider leaving a review.

Resources & Frameworks Referenced

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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

In health systems around the world, the promise of better data is often discussed—but rarely realized in a way that actually supports clinicians at the point of care. In this episode, Gayle Grout shares her journey from technology and consulting into leading the Health Data Coalition of British Columbia (HDC), a physician-led not-for-profit organization that aggregates electronic medical record (EMR) data across multiple systems to help primary care providers understand their practice patterns, monitor improvement, and better serve patients. From dissecting processes to building trust with busy clinicians, this conversation explores how data becomes useful only when it is contextualized, trustworthy, and actionable.

Throughout the episode, we dig into why measurement matters, how feedback loops can reconnect clinicians with purpose, and what it takes to nurture a culture where data supports learning rather than judgment. Grout’s experiences reveal the tension between consumer expectations of information access and healthcare’s lagging systems, and her vision for the future centers on equipping primary care with the tools and support it deserves.

Key Ideas Explored

• Data is a byproduct of good processes, not the starting point of improvement.
• Trust and non-judgmental engagement are core to clinician adoption of measurement.
• Feedback loops that empower rather than penalize clinicians change culture.
• Aggregated EMR data can reveal both practice-level and community-level insights.
• Primary care needs both technology and human support to improve meaningful outcomes.

Takeaways for Quality Leaders

• Prioritize trust in any measurement initiative—clinicians must feel safe to explore their data.
• Focus measurement on questions clinicians care about, not what organizations assume matters.
• Support adoption of data tools by meeting clinicians in their workflows, not imposing them.
• Use stories alongside numbers to connect data back to patient care and clinician motivation.
• Consider how aggregate data can advocate for services and system change at community and policy levels.
• Recognize that measurement is not just technical; it’s cultural and relational work.

Continue the Conversation

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

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

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

Resources & Frameworks Referenced

• HDC Discover (Health Data Coalition’s aggregated EMR data platform)
• Bright Spots stories from primary care clinicians using data to drive change

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

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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

Episode Summary

What does the Chief Quality Officer role actually entail once you get past regulatory compliance and dashboards?

In this episode, Dr. Abraham Jacob draws on years as a system-level CQO to explain how quality leadership really works in practice: where to start, what to prioritize, and how culture, safety, and accountability interact over time. The conversation is grounded in lived experience, including successes, failures, and lessons learned during periods of workforce instability and change.

This episode is most useful for CQOs, CMOs, senior clinical leaders, and anyone building improvement capability at scale.

Core Ideas from the Conversation

• Patient safety is a leverage point
  Reducing preventable harm creates alignment, urgency, and moral clarity in a way few other priorities do.
• Quality assurance is necessary but insufficient
  Meeting regulatory standards does not, by itself, produce better outcomes or learning systems.
• Variation reveals system design problems
  Unwarranted variation signals where workflows, standards, or training have failed the system.
• Psychological safety enables performance, not comfort
  Teams improve faster when speaking up is expected, acknowledged, and protected.
• Turnover threatens reliability more than leaders expect
  Standards erode quickly when onboarding, retraining, and reinforcement don’t keep pace.
• The CQO role is shifting toward stewardship and value
  Mature organizations expect CQOs to help lead system transformation, not just oversight.

Questions This Episode Raises for Leaders

• Where does your quality function spend most of its energy: assurance, improvement, or capability building?
• What forms of harm are still tolerated because they’ve become routine?
• How do new staff actually learn “how we do things here,” beyond policies?
• Where might turnover be quietly undoing prior improvement gains?
• When was the last time you publicly reinforced speaking up, especially when it was inconvenient?

Resources & References Mentioned

• “What Google Learned From Its Quest to Build the Perfect Team”
  Charles Duhigg, New York Times Magazine
  On psychological safety as the strongest predictor of team performance.
• Institute for Healthcare Improvement (IHI)
  Referenced as a formative influence on improvement science and leadership development.
• IHI Chief Quality Officer Professional Development Program
  A national program supporting CQOs in building system-level improvement capability.
• High Reliability Organizations (HRO) in Healthcare
  Principles focused on reducing harm and building reliable systems under pressure.
• Intermountain Healthcare – Advanced Training Program
  Cited as an early influence on variation reduction and outcomes-focused care.
• Key Driver Diagrams
  Discussed as a durable tool for linking strategy, drivers, and improvement work.

Continue the Conversation

You can connect with Dr. Abraham Jacob via email at [email protected] or on LinkedIn.

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

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

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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

Quality improvement in healthcare is still too often treated as a series of isolated projects—well-intentioned, time-limited, and disconnected from daily operations. Despite decades of progress, this approach struggles to sustain change, reach every patient, or address equity at scale. This episode explores why that gap persists and what it takes to move from episodic improvement to system-level capability. It’s especially relevant for clinical leaders, quality executives, and educators trying to build improvement that actually lasts.

The Arc of the Conversation

This conversation traces Dr. Brian Wong’s journey from early exposure to system-level problem solving to his current role building quality improvement capacity across institutions. Rather than focusing on tools or frameworks, the discussion centers on how improvement becomes durable—through structure, relationships, education, and operational integration. What makes this episode different is its emphasis on how systems learn, not just how projects succeed.

Key Ideas Explored

• Why project-based QI has a ceiling: Small, local projects can teach skills, but rarely sustain impact or scale across populations.
• Improvement without operations doesn’t last: QI efforts fail when they sit outside day-to-day workflows and resourcing.
• Structure shapes outcomes: Structural change creates the conditions for new behaviors and results to emerge.
• Equity requires system design: Improvement efforts can unintentionally exclude patients unless equity is embedded from the start.
• Education as a force multiplier: Building improvement capacity through training is foundational.

Takeaways for Quality Leaders

• If improvement feels fragmented, ask whether your system is optimized for projects rather than learning.
• Notice where QI work depends on individual heroics instead of organizational support.
• Reflect on whether equity is treated as a separate initiative or built into how improvement is done.
• Consider how much protected time and infrastructure exist for people to improve the system they work in.
• Ask whether your organization is building capability or repeatedly relearning the same lessons.
• Pay attention to how improvement work is aligned (or misaligned) with operational priorities.

Publications & Frameworks Explicitly Mentioned

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

• SQUIRE Guidelines (Standards for QUality Improvement Reporting Excellence)
• Equity-focused QI scholarship
  • “Equity in action: a scoping review and meta-framework for embedding equity in quality improvement" BMJ Quality and Safety 2024
  • “Taking Action on Inequities: A Structural Paradigm for Quality and Safety” BMJ Quality and Safety 2024

Continue the Conversation

You can connect with Brian Wong on LinkedIn.

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

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

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

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

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