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Episode Synopsis:

Welcome to Episode #69 of Habitual Excellence, presented by Value Capture.

susan moffatt-bruce

Joining us today as our guest is Susan Moffatt-Bruce, M.D., Ph.D. M.B.A., FRCSC. She is a thoracic surgeon and she is the Chief Executive Officer at the Royal College of Physicians and Surgeons of Canada.

She was previously executive director of The Ohio State University’s Wexner Medical Center University Hospital. 

Prior to that, she was the OSU Wexner Medical Center’s first chief quality and patient safety officer. She and her team were celebrated for their success in reducing patient safety events and hospital re-admissions.

Dr. Moffatt-Bruce completed medical school and residency in General Surgery at Dalhousie University. She undertook a PhD in Transplant Immunology at the University of Cambridge, England, and completed her Cardiothoracic Surgery fellowship at Stanford University, California. 

She also trained at Intermountain Healthcare, the Institute for Healthcare Improvement, Harvard School of Public Health. Dr. Moffatt-Bruce has a Lean Six Sigma Black Belt certification. She earned her Masters of Business Operational Excellence and her Executive Masters of Business Administration at the Fisher College of Business at the Ohio State University.

In today's episode, Susan talks with host Mark Graban, about topics and questions including:

  • How did you get interested in the practice of continuous improvement?
  • “Science of continuous improvement”
  • Engaging surgeons in continuous improvement?
  • From singular improvements to a System level — How would you describe a “Culture of Continuous Improvement” in healthcare?
  • Successes — examples and impact?
  • Reducing patient safety events
  • Reducing hospital re-admissions
  • Challenges and lessons learned - things you would have done differently?
  • MBOE program — any other surgeons in that program? What did you learn about C.I. through that?
  • Aravind Chandrasekaran - Episode 25, academic director
  • How would you suggest others get started in their organization?

Click to visit the main Habitual Excellence podcast page.



"As a surgeon, I'm always been invested and really interested in continuous improvement. I think, as a surgeon, we're problem solvers."

 "You cannot over-communicate. You have to communicate, communicate, communicate, and communicate in different ways. I think the pandemic has shown us that you can never over-engage stakeholders."

"There's no improvement that's too small [to be helpful]."


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Automated Transcript:

Mark Graban (2s):
Welcome to Habitual Excellence presented by Value Capture. This podcast. And our firm is all about helping you and your organization. Achieve Habitual Excellence. Be a one unifying focus, one value based structure and one performance system. In other words, it's about helping you capture dramatically more value through achieving perfect care and perfect safety for patients and staff. To learn more about Value Capture and our services visit Well, hi and welcome to Habitual Excellence. I'm Mark Graban. Our guest today is Susan Moffatt-Bruce. She is among other things, a thoracic surgeon.

Mark Graban (45s):
She is the chief executive officer at the Royal College of Physicians and Surgeons of Canada, and she was previously executive director of the Ohio State University Wexner Medical Center and University Hospital. So before I tell you a little bit more about Susan, let me first say welcome. Thank you for being here.

Susan Moffatt-Bruce (1m 3s):
Pleasure to be here today. Thank you so much for having me.

Mark Graban (1m 7s):
And so Susan's had many roles. She was the OSU Wexner Medical Center's first chief quality and patient safety officer where she and her team were celebrated for their success in reducing patient safety events and hospital readmissions. So we'll have an opportunity to talk about that in a lot more today. She's trained with our friends at Intermountain healthcare, our friends at the Institute for healthcare improvement. Now I need to call everybody I'd say like there's pressure. I don't know the people at the Harvard school of public health, but they're good people too. Susan has a Six Sigma black belt certification and she earned her masters of business operational excellence and her executive MBA at the Fisher College of Business at the Ohio State University, our friends there at the MBOE program.

Mark Graban (1m 54s):
So Susan, thank you. Thank you again for joining us. And you know, we're going to talk about continuous improvement on a number of levels here today. You know, first off, I'm curious, you know, from your background as a surgeon or a hospital leader, like at what point in your career did you really get interested in the practice of continuous improvement?

Susan Moffatt-Bruce (2m 15s):
Excellent question Mark. You know, I think that if I look back and maybe as a surgeon I'm always been invested and really interested in continuous improvement, you know, I think as a surgeon we're problem solvers, you know, you come to us either with a diagnosis or an issue that needs to be remedied or helped. And so we're always looking at ways to improve the outcomes of our patients to improve their lives. And, and so that's kind of a case by case basis, right? Patient by patient, family, by family. And then fast forward when I became the inaugural chief quality and patient safety officer, I had only been in practice for about five.

Susan Moffatt-Bruce (2m 58s):
And so I had to shift my focus from individual patients and families to assist them a system that was taking care of thousands of patients a year, you know, over 1500 beds. So at any one time we get to know really a large number of patients to care for. And I, although I had done it on a singular basis or on a case by case basis, I didn't have the skills to apply continuous improvement to assist them and really thought, you know, w if I can do it on a small scale, a model cell, I know it's called now, you know, how can I apply it on a larger system-based to improve outcomes ultimately as well.

Susan Moffatt-Bruce (3m 41s):
And that's when I really got interested in the science behind continuous improvement.

Mark Graban (3m 45s):
So I it'd be interesting to hear you elaborate on when you, when you talk about the science of continuous improvement, what does that mean to you?

Susan Moffatt-Bruce (3m 56s):
Well, excellent question. And I think in the beginning, when I first started as being really a learner and a student of continuous improvement, I knew that there were ways in which you could take a problem, analyze it, apply solutions and measure, but I didn't quite understand the tools. So I think understanding continuous improvement is really understanding the tools that are used at the right time, in the right instance with the right teams and ultimately then using the right tools to measure whether or not you really have improved a process, always in that kind of learning cycle.

Susan Moffatt-Bruce (4m 37s):
And so that, that takes some discipline to learn those tools. I think it takes some discipline to understand where they're applied and then it takes discipline to share the usage of those tools with the teams that you're working with in order to improve the outcomes for patient populations.

Mark Graban (4m 54s):
So, are there parallels you, you talked about, you know, a surgeon as problem-solver, or are there parallels in some of the thought process that helps other surgeons or other physicians relate to the science of continuous improvement?

Susan Moffatt-Bruce (5m 10s):
I think there are many parallels actually, and I think that's why those surgeons, those physicians that become involved in continuous improvement usually find it to be very satisfying and not totally dissimilar to how we were trained. For instance, you know, in my instance, you know, I, I'm a cardiac surgeon by training and thoracic surgeon by training. And so there's a, there's a group of diseases that I am trained to deal with. I have to look at the diagnosis. I have to look at the treatments. I have to look at what the desired outcomes are. Similarly, if you're in a healthcare system and you want to reduce falls, you know, what's the problem. How do you apply the solutions and how do you measure the outcomes?

Susan Moffatt-Bruce (5m 54s):
So whether or not it's a, it's a, or a care paradigm that you want to influence the processes and the applications of the science are not dissimilar.

Mark Graban (6m 7s):
I can imagine. I mean, I, and I, and I say this, or ask this as an engineer, I would hope like when I'm a patient that a doctor or a surgeon is not jumping to solutions, kind of like the way we would try to avoid doing in continuous improvement.

Susan Moffatt-Bruce (6m 23s):
Yeah. Well, it's very, very interesting. I think that oftentimes we may, because we all were very problem, very solutions focused. Sometimes we do jump to a solution, which is why we teach our residents and our medical students to always look at what's called a differential diagnosis. What could be one of many diagnoses, get the right tests, look at the patient, the exam, the situation that's going on clinically, and then come to the ultimate diagnosis and treatment. So it is a process and that's how we have to teach our residents and our students really how to be patient and to apply the science of clinical diagnoses, not dissimilar to continuous improvement.

Mark Graban (7m 13s):
Yeah. Diagnosing the problem, understanding the problem. And then I, I, I appreciate the connection to measures. Like there, there may be some small improvements. We can think of an example where we just know that's, it's, it's better. And maybe we don't need to measure, but for, you know, more complicated problems or I would hope as a patient, maybe this is easier when it comes to let's say medication, if the doctor understands, okay, we, we, we agree. There's a problem. There's a diagnosis. There could be a countermeasure of some medication, but then there's probably lab results or measurements to then evaluate when we tried something. How do we w we don't assume that that solution is working.

Mark Graban (7m 53s):
I'd be curious to hear your thoughts on that. Maybe even on the continuous improvement side of it.

Susan Moffatt-Bruce (7m 59s):
It's an, it's an excellent example, mark. So say you're treating a patient with maybe a type of cancer. You give them a certain chemotherapy you're then going to see whether or not the cancerous area has shrunken. That's the outcome metric that you're going to be measured. And you're going to measure that for the lifetime of the patient. Similarly, in continuous improvement, if you're trying to reduce, say an infection rate amongst intensive care patients, again, you're going to implement some changes. You're going to measure whether or not that actual metric that the incidents of those infections have decreased. And you're going to continue to measure, because if you don't continue to measure, you're sure to fall back into maybe some of the, there are a lack of the processes that are needed to make sure that those outcomes are very, very good.

Mark Graban (8m 47s):
Yeah. And then one other, maybe, I don't know if there's a parallel here, but we've probably heard this phrase, you know, every patient is unique and I wonder if there's an app. And so how do we find the balance? We might say every problem is unique. Every continuous improvement opportunity is unique. When do we rely on frameworks? You know, we have a consistent framework for unique situations. Is that useful in either medicine or continuous improvement?

Susan Moffatt-Bruce (9m 19s):
No, I think that's absolutely correct. I think that every patient is unique. However, I think that with whatever clinical disease you're dealing with, there's a certain way to approach it. That's the science. And then the art of medicine is applying the science in a way that is the best for that patient. With a lot of our Molech molecular testing. Now we know that if a patient has a certain type of cancer, that they need certain type of chemotherapy, but if you can then look at what genes are being expressed in that cancer, you can actually fine tune, you know, personalized, personalized medicine is very much a bit of an art based on the science of that medicine.

Susan Moffatt-Bruce (10m 9s):
So if you convert that and parallel to continuous improvement, similarly, so if you look at again, infection, say in the ICU, you know, you need to wash your hands. You know, that we need to use certain techniques to put the line, and we know you need to use certain antibiotics, but now we're taking care of patients say that are immunocompromised for patients that are transplanted. Well, they're going to need a different set of, of personalization to those improvements. So that for those patients, they get the same good outcomes as a patient that perhaps isn't a transplant patient. So I often say that it's, you know, it's really trying to find, to add art to a science that allows us to at least start the process of improvement.

Mark Graban (10m 59s):
So maybe let let's, let's take a step back then to, you know, what you described as the system level of improvement from singular improvements to system level, you have this ideal of a culture of continuous improvement in healthcare. Like how would you describe that? What are the elements that you would expect to see in a culture of continuous improvement,

Susan Moffatt-Bruce (11m 23s):
Continuous improvement and health care is something that really takes discipline and has to be worked at. It takes, it takes leaders that truly endorse curiosity and the sense that you never get to a finish line, but you always want to do things even better. A culture of continuous improvement in healthcare also requires the enablement of it. So it needs systems like electronic medical records. It needs antibiotic algorithms, it needs good training programs. It needs the right type of skills within the healthcare system, so that the system is enabled to provide the best care.

Susan Moffatt-Bruce (12m 11s):
And then truly, if you believe in continuous improvement, as always looking at what you've done, seeing, if you could do it better every time you get to a good place, you see if you can get to a better place for those patients and for the population you serve.

Mark Graban (12m 26s):
So I, I be curious to hear more about enablement and the role of leaders know, cause it would be one thing to do training whether we certify people or train them to whatever length of time. But if, if the environment doesn't allow people to use the problem solving skills that they were exposed to in that training, it might be all for not. So from your experience, what are things leaders at different levels can do or need to do to really make sure that enablement is there?

Susan Moffatt-Bruce (12m 59s):
Excellent question. Because continuous improvement within the system is totally dependent on multiple stakeholders. And in particular, the leaders within the organization, I'll give you an example that resonates deeply with me. I completed my MBA COE. I was a, you know, a Lean Six Sigma black belt. And I went to see my CEO at the time and what I needed from him and what he was able to provide to me as a chief quality officer, was the audience for me to be in front of the board for me to be able to produce and, and report on quality outcomes as the first agenda item on the board meeting, you know, he had, he enabled me to be in front of the right people to see the importance of quality outcomes.

Susan Moffatt-Bruce (13m 51s):
And for me to be in front of the right people, when things weren't going so well, and we needed the support of the board either for funding or other system opportunities. So, so he, didn't Dr. Gabbe who was the CEO at the time of Wexner Medical Center did not need to be a black belt in six Sigma, but he needed to understand the importance of continuous improvement and the importance of a chief quality officer being able to do her job. And that's what he enabled the right audience, the right opportunity to provide what was going well, what wasn't going well. And then to always be able to come forward with problems and solutions when needed.

Mark Graban (14m 31s):
So I'm guessing then that tone or that example from the top, then flowed through you to other leaders throughout the organization.

Susan Moffatt-Bruce (14m 41s):
It has to, it has to cascade. Now it's not always adopted as if you turn the light switch off, it does take some effort. It does take an ability to be able to engage with other stakeholders, share where the opportunities are, share how we might improve things together. And all we center the patient in the, in that work. So that for whatever stakeholder they understand the why, then you help them with the how, and then you measure with them. So we can see whether or not it really improved the environment or the patient outcome that they are part of.

Mark Graban (15m 23s):
Yeah. So maybe we can, we can take a look at some more specific examples, kind of come back down a level things that affect patients, reducing patient safety events. For example, I was wondering if you could, well, maybe along those lines, talk about the, why the, how, and some of the measures, how, how the, how that success was accomplished.

Susan Moffatt-Bruce (15m 45s):
Yes. It would love to one particular example that we had at the Wexner medical center that I think was maybe one of the greatest accomplishments of the team that I was able to be part of was reducing falls for patients that were in the hospital. So the why was that we had patients that were falling in the hospital. And so we had to prevent that because these patients are vulnerable. These patients have medical issues. And to also then have a fall within the hospital led to very, very unfavorable outcomes. We were able to bring together multiple teams, nurses, physicians, physiotherapists students, even ward clerks, and ward aids that were answering call bells and such within the hospital and come together with the patient to see what the solutions might be.

Susan Moffatt-Bruce (16m 40s):
We then had a series of tests of change that we were able to put in place. And then it became such that we were measuring every day if a PA, how many patients fell. And it was immediately reported that if we had a patient fall so that everybody was aware of how important it was to get to a zero fall day. And when that happened celebration, the, the, the pride amongst the team was palpable.

Mark Graban (17m 10s):
So that immediate reporting is something people don't always have, or don't always talk about. So that, you know, from our origins of Value Capture, that was something Paul O'Neill emphasized as CEO of Alcoa, that immediate reporting that a CEO, regardless of anywhere around the world, if there was a problem he wanted to know about it immediately. So there could be rapid response, rapid problem solving. I, that was my future to sort of elaborate on the importance of, of, of that and how that reporting hopefully turned into effective problem solving positive progress, as opposed to, you know, what I imagine sometimes do we want to be afraid of "Oh no, Reporting's going to mean blame or punishment.

Mark Graban (17m 59s):

Susan Moffatt-Bruce (17m 59s):
That's right. That's right. Yeah. And we have to be really thoughtful about that immediate reporting. That is not the shame and the blame, but it's rather how you can make things better in the moment very early on in quality improvement. I think what we were finding is that we were trying to do these root cause analysis of an event that had happened a month ago. Very difficult to know exactly what happened, what the variables were, what was going on with the patient. And so moving to that real time reporting became important in order to do that, you have to do that within a safe culture and be able to do it such that, you know, when you hear of these events first, you see if you can stabilize the patient, see how you can address and help the patient, how you help the provider that this might've happened to in that environment, make sure the doctor, the nurse, whomever was involved is feeling safe and protected, and then immediately do a rapid root cause analysis to see how to prevent it, and then to make the, the solution.

Susan Moffatt-Bruce (19m 4s):
The problem never happened again, we, there are many great, great examples of this across the nation. The, the institution that comes to my mind immediately is the Cincinnati Children's Hospital that has real-time reporting every day. It's obvious to everyone and not, not that they know exactly what the event was, but they know when a patient safety event has happened. And in the moment everybody takes a pause and sees how best they can help address the issue, not blame what happened, but set an accountability framework in place to go forward in a better way.

Mark Graban (19m 46s):
Yeah. It seems like one of the benefits of being a system, I think it's in your bio at one point that you had seven hospitals

Susan Moffatt-Bruce (19m 55s):

Mark Graban (19m 55s):

Susan Moffatt-Bruce (19m 55s):

Mark Graban (19m 56s):
Within that system. So it seems like there would be a huge opportunity to not have every unit or every hospital working in isolation. Like how did that reporting lead to, to sharing, you know, knowledge of risks or knowledge about how to eliminate said risks?

Susan Moffatt-Bruce (20m 15s):
Yeah, that's actually the beauty of working within a system is that you actually have seven or multiple stakeholders, more resources and more ideas of how to improve problems. One of the challenges though, and it's, it is something just to be mindful of is that when you roll out a program or you roll out an improvement strategy, it really needs to be holistic. And, and we had the mantra that unless every hospital did, we wouldn't, we wouldn't proceed. And so it took a lot of engagement upfront, but it also made us address problems that affected everyone.

Susan Moffatt-Bruce (20m 56s):
And, and so that really helped us holistically address issues that were really system-wide. It's not to say that each hospital didn't have their own initiatives around in situations that were inclusive of just that type of patient that was in that hospital. But when you are trying to reduce infections or falls, it really has to be at the system level. And really because the patient, regardless of where they are in the system, they should feel the same patient safety strategies, regardless of which bed they're in within the, within that system.

Mark Graban (21m 31s):
I mean, it seems like there's an ethical or moral obligation to, to spread some of these practices as quickly as you can. So we don't want to say, well, this units, the control group, where we expect more people are going to fall because we haven't implemented things yet. I mean, there's, there's a different, it's, it's different than doing, let's say a double-blind controlled study on a, on a medication. That's a different type of science. Okay.

Susan Moffatt-Bruce (21m 60s):
It is implementation. Science is like that. You know, you really have to do it at a, at a system level if you want to make system change. And then beyond that, you know, what we were able to do at the Wexner medical center was then actually disseminate beyond our walls, but, and to other peers, to other organizations and institutions, but we were doing so to improve outcomes elsewhere. And that was really, really impactful. In fact, every year we published somewhere between 12 and 16 research papers that, that were only based on the, the work that we were doing in continuous improvement. And so really, really elevating the science to the point where it was in the peer review literature.

Susan Moffatt-Bruce (22m 46s):

Mark Graban (22m 46s):
So, you know, with this focus on a couple of things, you mentioned talking about patient safety events, cross-functional teams and participation from different disciplines, tests of change. I'd be curious to maybe if you could talk a little bit about reducing hospital readmissions, cause that seems like the type of thing, that screams system problem that requires cross-functional cross departmental collaboration. Tell us about some of the successes you have there.

Susan Moffatt-Bruce (23m 16s):
Yeah. Reducing readmissions is such a, such an important initiative in, in hospitals, not only from the efficiency of the hospital itself, but from the patient experience, you know, when a patient is discharged, they want to go home and they want to stay home. And so it's really an important issue. We were able to address it from, from multiple stakeholder involvement, the physician that was discharging the patient, the themselves, but then also looking at the community supports. So if you have a patient that gets discharged, but they don't have the medications at the pharmacy so that they can take the right medicines to keep them at home, then you have a community-based issue.

Susan Moffatt-Bruce (23m 59s):
And so whenever we had a readmission, we do a small wrap, a root cause analysis and look at all the different components that influence that readmission. And then we would address each of those issues within the hospital walls and in the community as well, that were even more important than what was happening in the hospital

Mark Graban (24m 21s):
And the measures, I guess, there's there's readmission rates as the core measure. Are there related measures that you could use to see if you're making progress more quickly or does that translate pretty quickly into the readmission rates?

Susan Moffatt-Bruce (24m 39s):
So there's balancing and counterbalancing metrics with readmission rates. So you can measure the readmission rates as a, as a one metric, but then you have to balance that with the length of stay. So you don't want to keep a patient in the hospital so long that you get to a point that that would be impossible for them to be readmitted because they're completely resolved or whatever clinical dilemma they had. So that's a countering measure, but the one that I think is much more important is patient experience. So let's met within the patient experience domain. There's certain components of it, you know, was my medication explained to me, did the team give me a great, you know, a good way to figure out how best to care for myself at home.

Susan Moffatt-Bruce (25m 27s):
If I had an issue, I think that really looking at it from the patient reported outcomes, it was much more impactful to understand how our continuous improvement was working or not working to help those patients not be readmitted.

Mark Graban (25m 43s):
So, yeah. And it seemed like it's interesting to think about the counterbalancing. Cause if somebody else was doing a project trying to help reduce length of stay, readmission rate, readmission rates, or a counterbalance to that,

Susan Moffatt-Bruce (25m 57s):
Right. And you always have to measure. Absolutely. So for instance, if you're measuring readmissions, the counterbalance would be length of stay. If you are say, you are trying to measure, you know, quiet at night from a patient satisfaction on the same hand, you want to make sure you're, don't have any patient safety events that are making it such that it's, it's not helpful for the patient. So you always have to think about what are the failure modes to the continuous improvement that you put in place and the metrics that are being recorded always think about what, what are the unintended consequences of a very good improvement strategy?

Mark Graban (26m 47s):
Yeah. So maybe stepping back to the system level, again, of the different things that, that you and other leaders are doing to try to encourage or create this culture of continuous improvement. Were there some lessons learned along the way, things that you would have done differently, you know, things that you discovered maybe through different tests of change at a system level?

Susan Moffatt-Bruce (27m 11s):
Yeah. I think that there are lots of lessons learned and continuous improvement, you know, I think that's part of the, the beauty of it and why I think it's something that I've been so humbled to be part of for almost two decades. I think lessons learned is that you cannot over-communicate, you have to communicate, communicate, communicate, and communicate in different ways. I think the, the pandemic has shown us that I think that you can never over engaged stakeholders. And I think the most important one that I wish I had maybe known even earlier in my career is that ask the patient first and then make sure that you implement with their voice at the heart of that implementation.

Mark Graban (28m 0s):
Can you, can you think of an example? I mean, that's a powerful statement, an example, or even a scenario of, you know, something that might not go well, if we don't get that direct voice of the patient, if we assume we know what the patient wants or needs.

Susan Moffatt-Bruce (28m 18s):
Yeah. I think there are a couple of scenarios that come to mind, maybe, you know, a larger example and then maybe a smaller example, you know, there's, there's a lot of tension out there around public reporting, what patients want to know and what, what they want to see when they come into a hospital. I think early on in our career, we thought that, you know, making it really clear with a big poster on the wall, that what your infection rate was, or your hand hygiene rate was on a floor with something the patient wanted. We went to meet the patients and they're like, no, we trusted you when you think, you know, transparency is always thought to be the best.

Susan Moffatt-Bruce (29m 0s):
It may not be when you're vulnerable as a patient. Right. Yeah. Another example was when we were actually designing the hospital rooms for the new hospital at the Ohio state university, I think we had a sense looking at all the literature and all the human factors work, et cetera. What are an ideal room set up would be we mocked it up with cardboard and styrofoam put the patients in it and they were moving things all over the place. So I'm glad we did that before we poured the concrete,

Mark Graban (29m 32s):
It's a powerful example of prototyping and doing small tests of change, it's still affordable to make changes. Yeah.

Susan Moffatt-Bruce (29m 42s):
Yes, yes. Cardboard is much better than concrete yet.

Mark Graban (29m 45s):
So I only to ask one other question, Susan, about, you know, surgeons and continuous improvement. I think, you know, there are so many opportunities, you know, the little bit of time I've, I've, I've spent in these parts of the hospitals, you know, opportunities to improve processes, to provide better service to the surgeons and their patients. I'm, I'm curious, you know, your thoughts on like, you know, using continuous improvement to support surgeons. And then does that become maybe an on-ramp to get surgeons participating more in continuous improvement?

Susan Moffatt-Bruce (30m 24s):
Yes. I mean, I think that's a really good observation. I think first and foremost in surgery, because we can measure outcomes pretty reasonably. Now there's many good national organizations that really measure patient outcomes that are meaningful. I think that's really helped surgeons be mindful, be aware and help them to implement change because they can measure whether or not the improvements are making a difference or not. I think too, because of that and because of the, you know, there's certain public pressures to be very transparent with surgical outcomes, more and more surgeons in their training programs in their residency programs learn about continuous improvement very early on in their career, you know, at the Royal college, in all of our surgical disciplines and our specialty disciplines that continuous improvement quality improvement is a core piece of their learning.

Susan Moffatt-Bruce (31m 25s):
And so I think that we're now able to bring surgeons along that have some of that information set up some of that training so that it becomes more innate to their practice. And then I do think I have seen over the past decade more and more surgeons become involved in quality improvement, continuous improvement, and do more training, you know, in our national meetings, there's often a whole day or two with very good training for surgeons of all types in quality improvement, patient safety, and many are doing programs like the masters of operational excellence because it, it advances their practice and helps them to affect the systems that they're working in.

Mark Graban (32m 11s):
That's good to hear. I was about to ask you if you were the only surgeon in your class or there's more coming into it, hopefully other physicians

Susan Moffatt-Bruce (32m 19s):
Many more, many more and all kinds of different surgeons, neurosurgeons, orthopedic surgeons. We have a fairly robust group of us. And like I said, it's now becoming a key component to our national meetings and conferences because it's such, it is as important as of the basic science as

Mark Graban (32m 39s):
Yeah. And for regular listeners will remember backing up. So at 25 I had a chance to interview <inaudible> saccharin and the academic director currently at the mvoe program, I've had a chance to visit that program. And yeah, it seems like great people, great program.

Susan Moffatt-Bruce (32m 59s):
Yes. AC Aerobahn did a great project with us as surgeons to actually reduce readmissions among kidney transplant patients. I mean, it was a phenomenal trip that he tripped at that and a phenomenal project. He worked with us nurses, physicians, patients, the outpatient clinics, and it really improved the outcomes of our patients that were getting a kidney transplant. It was an amazing project.

Mark Graban (33m 26s):
Yeah. Well, it sounds like there's an amazing why behind that one and that that's so powerful in healthcare.

Susan Moffatt-Bruce (33m 32s):
It was, it was amazing. And you know, it was so interesting when people show you that you're looking at and you don't notice what AC showed us was that for one kidney transplant patient, if they went home, they had eight different ways that told them how much water to consume some doc one document's a little bit, the next one would say two glasses. The third one would say one leader, you know, so just standardizing some of the education, but you know, we're seeing it every day. You don't notice it.

Mark Graban (34m 1s):
Yeah. Well that's where maybe the patient perspective, the opportunity to get some of their feedback or, you know, I, you know, certain, certain, you know, if, gosh, if I, I hope I wouldn't be in that situation, but yeah, I would notice that. And I would probably, I would try to say something, but then the question is who owns that? Who do I tell? So I know there's questions around, you know, coordination of care and then that question of coordination of the system.

Susan Moffatt-Bruce (34m 27s):
Absolutely. Absolutely. And there's no improvement, that's too small. So simply aligning those information sheets was helped tremendously to reduce the readmission rate amongst those patients and improve their satisfaction.

Mark Graban (34m 44s):
Yeah. So maybe one last question for you, Susan, you know, thinking of, you know, people who are listening, who, you know, in the organization, they're still there, they're trying to foster this culture of continuous improvement, or they're trying to, you know, kind of, you know, move, move things along and build momentum. Do you have, do you have a piece of advice that you would pass along to them?

Susan Moffatt-Bruce (35m 6s):
Yes. Well, first of all, I would thank them tremendously because it is, it is the gift that keeps on giving. There's always opportunities to improve. I think patience and humility in this work are absolutely key. You're always, you'll always be in a rush to improve things, but you have to slow down sometimes to make it right. And then secondly, humility, humility for the patient's perspective, humility for what really is going to improve and then being so grateful and humble when you do make an improvement and that patient has a better outcome than you had anticipated.

Susan Moffatt-Bruce (35m 50s):
That's a wonderful feeling. And it really is at the core of what we're doing here.

Mark Graban (35m 55s):
Those are great. Reminders are great ideas. It might be the first time somebody is hearing those tips. And thank you, Susan, for sharing those. So again, our guest here today has been Dr. Susan Moffatt-Bruce, currently the CEO of the Royal college of Physicians and Surgeons of Canada. So thank you. Thank you so much for being here today and really enjoyed the discussion.

Susan Moffatt-Bruce (36m 19s):
Great. Thank you so much, Mark. It was absolutely my pleasure.

Mark Graban (36m 23s):
Thanks for listening to Habitual Excellence presented by Value Capture. We hope you all subscribe to the podcast and please also rate and review it in your favorite podcast, directory or app to learn more about Value Capture and how we can help your organization on this journey to Habitual Excellence, visit our website

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