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Episode Synopsis:

Welcome to Episode #71 of Habitual Excellence, presented by Value Capture.

Leah Binder and Richard P. Shannon Leapfrog Duke Value Capture

Joining us today as our guests are Leah Binder and Dr. Richard Shannon.

Leah Binder is President & CEO of The Leapfrog Group, representing employers and other purchasers of health care calling for improved safety and quality in hospitals. Under her leadership, The Leapfrog Group launched the Leapfrog Hospital Safety Grade, which assigns letter grades assessing the safety of general hospitals across the country.

Richard P. Shannon, MD serves as the Chief Quality Officer for Duke Health. He is responsible for the overall direction, leadership and operational management of the quality and safety programs of Duke Health, and provides leadership in strengthening a quality culture where everyone is engaged and respected.

Leah and Rick are both amongst the great lineup of presenters at an executive seminar that’s being hosted by Duke Health in Durham, NC — on September 15th and 16th — titled “Leading with Safety.”

Learn More & Register Today

Today we’re going to be talking about the urgent need to improve safety and quality in healthcare — and what leading organizations are doing to make progress toward ideal care and zero harm.

In today's episode, Leah and Rick talk with host Mark Graban, about topics and questions including:

  • How would you describe the landscape of patient safety today?
  • 20 years since the IOM Report - accelerating in the past decade? Getting worse during the pandemic?
  • Headline: “U.S. Hospitals Are Getting Safer for Patients, Study Finds” - Certain adverse events down from about 20% of patients to 10%… thoughts?
  • What’s the difference between the Leapfrog Hospital Safety Grade and the Leapfrog Hospital Survey / ASC Survey?
  • Beyond the grades, what do you see happening in the A hospitals vs. the others with lower grades??
  • Rick — Tell us about Duke Health’s language around having a “commitment to zero harm” and how that’s not just a slogan? How do you make practical and meaningful progress toward zero harm?
  • Leah — How do employers look at the issue and what are they asking for or demanding now?
  • Why are we doing this seminar for CEOs and the C-suite instead of quality leaders??
  • Rick, why host the seminar at Duke Health?
  • The Consolidated Appropriations Act of 2020
Click to visit the main Habitual Excellence podcast page.

Video Clips:

Via this YouTube playlist...


"I think there's good news and bad news. So I don't want to be the cynic and say, it's all bad news, but the bad news is pretty disturbing. We still have very high rates of adverse events and problems and errors. When you compare healthcare and other industries, the rates of harm are astronomical... The good news though, is we are seeing signs of progress. We are seeing signs that we figured out a few things that work and we're seeing some change.""I think what's pivotal at the moment is that we've got to take stock of the fact that we've gotten much better at measurement than we have at improvement. If we could begin to spend more time improving and less time measuring and getting some agreement upon what the measures are and holding there, I would argue we'd be headed in a better direction."

"[Employers] are much more focused on safety and quality. I have never seen anything like it in my time at Leapfrog, and I've been here 14 years. They are laser focused. I think in part, like hospitals, they have workforce shortages. They are competitive about attracting and retaining their workforce. So they do not want to be sending them into a healthcare environment that's going to harm them."

"[At the start of Covid] our first instincts were to make sure we were protecting our workforce. We weren't going to be able to care for anybody if we lost our workforce. And I think you see examples across the country where, when that attention wasn't paid to worker safety, there's no chance of preserving patient safety. It was a conscious effort to say, we have got to make sure our workers are safe."



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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 via 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 everybody. Welcome to Habitual Excellence presented by a Value Capture. I'm Mark Graban and our guests today are Leah Binder and Dr. Richard Shannon.

Leah Binder is the president and CEO of The Leapfrog Group, which represents employers and other purchasers of healthcare who are calling for improved safety and quality in hospitals. So under her leadership, The Leapfrog Group launched the Leapfrog Hospital Safety Grade, which assigns letter grades assessing the safety of general hospitals across the country. So Leah has been a guest here previously. We'll link to that episode in the show notes. So before I introduce Rick, Leah, first off, thanks for being here. How are you?

Leah Binder (1m 17s):
I'm great. Thanks for having me, Mark.

Mark Graban (1m 19s):
Thanks for being back. And again, we're joined also by Dr. Richard P. Shannon. He is the chief quality officer for Duke Health. He's responsible for the overall direction leadership and operational management of the quality and safety programs of Duke Health. And he provides a leadership and strengthening a quality culture where everyone is engaged and respected. So Rick, thank you for being here. How are you?

Dr. Richard P. Shannon (1m 44s):
Great Mark. Great to be with both of you.

Mark Graban (1m 47s):
So of course today, as you can tell from the introductions, and hopefully you're already familiar with Leah and Rick, we're going to be talking about really, I think what we'd all agree is an urgent need to continue improving safety and quality in health healthcare, and, and what leading organizations are doing to make progress toward ideal care and zero harm. So I do want to mention real quickly that Lee and Rick are both part of a great lineup of presenters at an executive seminar. That's being hosted by The Leapfrog Group Value Capture, and it's being held at Duke Health in Durham, North Carolina, September 15th and 16th. It's titled Leading With Safety. To learn more.

Mark Graban (2m 27s):
If you'd like to register and come take part in this, you can look for a link in the show notes, or you can visit So a question, you know, first off for the both of you, maybe Leah first, how do you describe or characterize the landscape of patient safety today?

Leah Binder (2m 49s):
I think there's good news and bad news. So I don't want to be the cynic and say, it's all bad news, but the bad news is pretty disturbing. We still have very high rates of adverse events and problems and errors. When you compare healthcare and other industries, the rates of harm are astronomical. They're almost unthinkable in other industries. For instance, just a study just came out, said one in four people admitted to a hospital, suffer some form of apartments. Just one in four is not something that the auto industry considers in the realm of possibility. So, so they still, we still have a very long way to go. That's the bad news. The good news though, is we are seeing signs of progress.

Leah Binder (3m 32s):
We are seeing signs that we figured out a few things that work and we're seeing some change, but again, I, the bad news is bad, but the good news is, is there. And I think we have to make sure we don't lose sight of it.

Mark Graban (3m 45s):
Yeah. So we're not yet to zero harm, but we can recognize progress and hopefully learn from it to help others continue down that path. You know, so Rick, you know, is, is we're here middle of 2022. How would you characterize the state of patient safety?

Dr. Richard P. Shannon (4m 5s):
Well, I think we are unquestionably better. The, the issue is how can we accelerate the progress that's been made so that we don't have to wait another decade to see the kinds of gains that I think we, we have seen over over the last 10 years in certainly over the last 20 years. And you know, I've been at this for those two decades. And I absolutely know that the number of events that we first described Mark together, and one ICU now is the total number of events for 138,000 discharged at Duke Health.

Dr. Richard P. Shannon (4m 49s):
So we've gone from a 16 bed CCU with lots of bad things happening to a whole health system where that total number of events, you know, is what occurs across 138,000 discharges. I will say though, that I think what's pivotal at the moment is that we've got to take stock of the fact that we've gotten much better at measurement than we have at improvement. You know, most of us have been with Leapfrog for a long time and think of it as kind of one of the, you know, the celebrated historical ways in which we, our performance was assessed, but there are 12 other reports that I could count today that characterize Duke and it, you know, in a different way than arguably what we do with Leapfrog.

Dr. Richard P. Shannon (5m 48s):
And this is part of this cottage industry of measurement that, you know, we've got US News coming out next week and a week after that, there'll be the Lowel report. I will tell you if we could begin to spend more time improving and less time measuring and getting some agreement upon what the measures are and holding there, I would argue we'd be headed in a better direction.

Mark Graban (6m 15s):
So a quick follow-up you mentioned the 20 years, it's been more than 20 years since the, the famous Institute of medicine report came out. Do you feel like the most recent 10 years has seen more improvement than the previous decade? I'm curious what you think and Leah, maybe what you're saying, are we accelerating? And

Leah Binder (6m 36s):
I'll say, I'll jump in. I, I see more improvement in the past decade. We, when we look back at 2010 and we look back at the IOM report, that's 10 years earlier and we said, what's going on? And the answer was nothing. If anything were worse. And that was every study and said that, and now we're looking at some studies that are saying, might've not changed. That's, that's the worst we're seeing, but a lot of them are showing some small improvement in very significant in areas that we change. I didn't to Rick's point, you know, there is a, there, there is certainly measurement fatigue that's out there, but I want to add one, one corollary. There's a difference between measurement and transparency. I believe that transparency while it's not going to make the change, it's the absolutely indispensable foundation of change and what we have changed in the past 10 years, especially through the affordable care act, publicly reporting on measures, as well as I will say, Leapfrog, having, being able to grab onto that change from CMS and really build a much more transparent environment for healthcare.

Leah Binder (7m 42s):
And particularly for hospitals as a result of that transparency, we have seen the opportunity for change, and that has happened. I think that has accelerated change. So however we grapple with measurement, we absolutely have to preserve transparency as the core principle for really accelerating change. Yeah.

Mark Graban (8m 3s):
And Rick may be bouncing it back to you, a different, slightly different version of the question, like thinking of first decade, second decade. And then within that, the last two plus years of the pandemic era, how has that affected any trends that you see?

Dr. Richard P. Shannon (8m 19s):
Well, I would agree with Leah, I think in the first decade, there were a lot of healthcare organizations in the wake of the IOM report that sort of, kind of stood on the sidelines and just sort of said, okay, this will pass. You know, if we can just stay out of the headlines for, you know, a few years we'll be on to something else. I think organizations like Leapfrog, you know, and some others kind of kept people's feet to the fire. And as public reporting became, you know, evening news, I think institutions stood up and started to pay attention.

Dr. Richard P. Shannon (8m 59s):
So, so I think the consequences of that is you've got a lot more engagement in this last decade, a lot more organizations, really trying to think about the, how of quality and safety. We know the what and the why we continue to still struggle with the how. And I think as people have built that reflex and those instincts, I think you're now seeing, you know, some more sustainable changes. So fast forward to the last few years, I think it's a, it's a shining example of how standard work around bundles and other interventions that have proven to be effective in reducing harms when those standards were interrupted by COVID, as they necessarily were.

Dr. Richard P. Shannon (9m 48s):
I think you saw give back a lot of the gains, but I think that was because we were instructing people in a very uncertain time to minimize contact with patients. And, you know, if you've got a bunch of COVID patients who instead of turning them every two hours, you're being told, minimize contact, what you saw were increases in pressure injuries. I think it only reinforces the fact that we had good methods and when we weren't able to execute on those methods or we weren't able to change those methods quickly enough, you saw an uptick in events. So if we get back to those methods, which I think most places now are, hopefully we'll see a return of that trend toward a decrease in harms.

Leah Binder (10m 37s):
Well, it's very disturbing though. I mean, I think the, the New England Journal of Medicine piece that was done by leaders from CMS and, and CDC that pointed out that deterioration and patient safety during the pandemic, in many cases, we were seeing out gains that have been made earlier, really talked about how we need more resilience in the healthcare system, so that we can deal with a public health emergency at the same time, keeping patients safe. I mean, it's just very disturbing. It's not just the COVID patients who suffered from know pressures. So that was every patient was in danger when they walked in the door of a hospital. And that is because in large part, I think to your point, that they had less attention from, from providers.

Leah Binder (11m 20s):
And that's really, really frightening and disturbing. We know from a patient's point of view, from a purchaser point of view, we are extremely disturbed and really want to figure out how we can make sure that attention does not wane because there's a public health emergency. It should be the opposite when it's a public health emergency. People need more attention.

Dr. Richard P. Shannon (11m 39s):
Yeah. You know, we, I, I, I understand, you know, I have to say that the other side of this coin was the duty to make sure that our workers were safe. And I will tell you, in the early days of this facing some of the things that we saw, our first instincts were to make sure we were protecting our workforce. We weren't going to be able to care for anybody if we lost our workforce. And I think you see examples across the country where, when that attention wasn't paid to worker safety, there's no chance of preserving patient safety. So it wasn't just benign neglect. It was a conscious effort to say, we have got to make sure our workers are safe.

Dr. Richard P. Shannon (12m 22s):
And if that means not turning a patient every two hours, because it takes six nurses to do it in a COVID unit, then we're going to have to, for the moment, figure out how we can modify our standard, how to handle a bladder catheter or a central line in a patient who's prone is not an exercise anybody ever did. So we were clearly in totally uncharted waters. Now we just weren't capable of learning fast enough, how to do that. But I will tell you, in that window of time, we had a duty to protect those workers, or there would have been a lot more casualties than we saw.

Leah Binder (13m 4s):
I don't think it's it's either or though. I mean, I recognize that that's true. I think that's a big difference that you can a hospital like June and some others that we watched from a Leapfrog perspective. Now, from our perspective, we looked at numbers. So I recognize we're not on the ground, like certain like you are, but I will say that the hospitals that don't have a long-term history of putting patients safety first have really a laser focus on patient safety as top priority. That's where the workers really safe. I mean, frankly, when you looked at the, well, we watched the New York City surge when it first started in the pandemic, I frankly looked at some of the hospitals that have consistently had very poor safety records on every metric, not just our metrics, any other metrics for safety records.

Leah Binder (13m 51s):
And those were hospitals that were seeing massive casualties from their workforce. And so I think the habits of putting patients first focusing on safety, constantly that culture of safety had to stand you in good stead at Duke. And it has to be part of what we think about going forward and what we learned from so that we can have a safe workforce because absolutely we have to keep the workforce safe. It's not, it's not different from keeping patients infants. These are human beings. We all have to be safe. Yeah.

Mark Graban (14m 18s):
Well ask one other question. Maybe if you both, you know, you, Leah, you talk about measurement and there may be variation in different measures, different methodologies, different studies. You mentioned a number that I've seen of, you know, one in four patients being harmed or having an adverse event. There was a headline just recently that I shared with you, us hospitals are getting safer for patients study fines and I'll link to that in the show notes. But, you know, the summary seemed to be that certain adverse offense events were down from 20% down to 10%. So whether it's 10% or 25% curious to hear your thoughts on some of the measurement variation and what are the implications for what we need to continue doing

Leah Binder (15m 9s):
Well, the study you mentioned in JAMA was very frankly, very exciting for us to see, because it takes the time period. But when we started the safety grade to about eight years into it, so 2019, so prior to the pandemic, and really saw significant improvement across the range of adverse events. So not just one adverse event, but many. So, you know, a lot of times in patient safety, the habit is to say, well, we're going to focus on central line infections. So we're going to focus on this or pressure one thing, and then we see it achievement, but then we break open the champagne. And then the next day it's back.

Leah Binder (15m 50s):
Like we don't, we have this way of kind of taking on one at a time. This was about a really cultural shift that had that we just don't see results like that ever. I'm just, I don't recall an almost any factor regarding whether it's safety or anything else you think public outside, you don't see results like this across the board, 15, 20% improvements, et cetera. Okay. So, so there's lots of reasons to be excited that somehow we're on the right track. We like to think, you know, yes, having some transparency around patient safety, having hospitals for the first time advertising that they did well, or putting out press releases that they did well on patient safety. We've seen hundreds of thousands of that over the past.

Leah Binder (16m 31s):
And that's a new factor. The whole idea of being very, very public about patients has changed. And we, so we take some grants. So that's all great. Sadly, we aren't looking at all of the events that happened. We're looking at those measures and that's not all of them. And as we just talked about, unfortunately we did see massive deterioration during the pandemic. So I've loved to be excited, but I think we have a long way to go, but we definitely are doing something right. I would have to build on that. Yeah.

Mark Graban (16m 60s):
So maybe just a slightly different version of the question for you to react to Rick, you know, not to discount 50% improvement, but I I've seen data that you've shared in different stops, different organizations that you've been a part of showing closer to say, 90 or 95% reduction. And for example, CLABSI rates, I'm curious to hear your thoughts on, you know, celebrating 50% gain improvement while recognizing there are pockets where we have and can do much better.

Dr. Richard P. Shannon (17m 36s):
Yeah. You know, so let me take the 30,000 foot view that was presented in the, in Harlan Krumholz's study in JAMA calling attention, this, this, I think, important improvement that we've seen and then sort of do what we do, which is distill it down to. So rather than looking out the window at these aggregated data, what does it look like at Duke? Right. So the first thing I did when you sent me that last night was asked the question, okay. If I look at the adverse events listed in that study, and I look at Duke in 2022 fiscal year 2022, and ask the question, what is our rate of adverse event?

Dr. Richard P. Shannon (18m 19s):
Now I didn't pick five categories. I just said, take all of our adverse events, pressure injuries, medication errors, falls, C diff, whatever, you know, in that category and look across the 138,000 discharges and try and do a quick back of the envelope calculation. We are at eight per thousand discharges at Duke. So, you know, that's not zero, but that's better than we were pre pandemic where, you know, we, you saw, you know, I would say we'd seen about a 33% improvement over the last three years.

Dr. Richard P. Shannon (19m 7s):
I'm sorry. Prior to the pandemic, about a 33% year over year improvement. And then that, that rate of change did slow during the pandemic. But, you know, I think what each place has to do when you see those datas go look at your own data, you know, stop having conversations around the aggregate, say, okay, if, if that's the national story, what's the story of Duke. If that's the national story, what's the story at UNC and, and each leader should then look at their own data and say, okay, how are we doing now? You shouldn't feel good necessarily that you're better than those numbers, right. Which you should feel good about is are you seeing year over year improvement?

Dr. Richard P. Shannon (19m 48s):
So yes, I think benchmark from a public reporting perspective is important, but for an institutional perspective, are you getting better? So, you know, that's kind of the way I would argue a leader in a healthcare organization has to look at data like that and say, okay, how do I shape up? So that that's, that's, you know, the way I would urge every healthcare leader to look at the data. Now we're not going to go out and run a news ad and say, Hey, we're better than the JAMA article, but what we're going to say, okay, how do we get here? And how do we proceed? How do we continue? That kind of thing.

Mark Graban (20m 26s):
Yeah. And as a quick follow up question within Duke Health, do you help leaders of different site leaders, even let's say at a departmental level, understand their data and their rate of improvement?

Dr. Richard P. Shannon (20m 38s):
Yeah. You know, and, and I do want to say sort of in, in what I call the big six C-Diff bloodstream infections, urinary tract infections, falls, pressure injuries, and surgical site infections. Those are kind of the big six. We call them the phenotype of who has a harm has changed dramatically. So if you take those six harms at Duke Health, and you ask the question, what's the average length of stay of patients that have one of those harms, it's 27 days. The average time on a ventilator of that core group is 13 days. What we are seeing is harms largely aggregating in populations of patients desperately ill requiring intensive care, 80% of all adverse events at Duke occur in intensive care setting.

Dr. Richard P. Shannon (21m 35s):
So this is a dramatic change from, Mark, early days where we would tell the stories about, you know, leukemic patients undergoing chemotherapy, who would get a bloodstream infection and die, right. That's not what we see anymore. We see this aggregated in really discreet, very complex care settings. And what the beauty of that is, is you can really focus there. So I'll just give you an example, you know, to a point we made earlier, our surgical intensive period unit 33 beds level one trauma center, all kinds of badness, all kinds of badness has gone for 120 days without a bloodstream infection or urinary tract infection.

Dr. Richard P. Shannon (22m 20s):
And the NICU throughout, which was ground zero for COVID has gone two years without a C diff infection, right? So you can get really good at this stuff, but you've got to focus it. You really have to focus it, this idea that we're doing this everywhere, won't get it done.

Leah Binder (22m 40s):
There was a culture of safety issue here too, because you also have, you're focusing on six different conditions or six different adverse events. We can't do that without a culture of saving. You can't do that as like, we're going to focus on, on one thing your time, unfortunately cannot do that in the healthcare system. So I'm really impressive. But do you think that's also because you're Duke? I mean, because you're, you're at a very hot, you know, your, your numbers are great. You do incredible.

Dr. Richard P. Shannon (23m 5s):
They weren't always, they weren't always that way. So yes, because a great place, but you know, at a place like Duke, you know, back in 2017, I think it was when we slipped from a Leapfrog a to Leapfrog B, there was a lot of attention that was focused inside the organization on what accounted for that. And so there is the sense that we are publicly responsible for our performance as kind of a, you know, a, a major academic medical center that we are that last hope for those really people.

Dr. Richard P. Shannon (23m 46s):
And if that's where the harms occur, we just gotta get better at that. You know, we can't just say, oh, they're too sick. We have to say, okay, we're Duke. We got to figure out how you solve for that. So yes, it is. It is a culture of safety and it is contagious. Meaning once you get it, no one wants to ever go back. So part of what we're going to have a chance to talk about in, in September Leah is how do we continue to nurture that culture in our organizations? What are the lessons we can learn from others, but you're right. Once you get the bug, no one wants to go back.

Mark Graban (24m 24s):
So Rick mentioned the, the grades, and I was going to ask you, you know, what, what's the difference between the Leapfrog Hospital Safety Grade and the Leapfrog Hospital Survey in terms of approach what you're looking for in each of those methodologies?

Leah Binder (24m 43s):
Sure. The Hospital Safety Grade is a composite measure of the bad things you never want to see happen. And so the errors, the accidents, injuries, infections, just the bad news. And we grade hospitals, ABCDEF on a curve on how they do in preventing those things from happening. And so it's really a snapshot and we update that snapshot every six months on how hospitals are doing. And we use for that, a bunch of, we use 30 measures, actually, most of them from CMS and some from our own data, but we have, we, we bring it all together into that grade.

Leah Binder (25m 26s):
That's the grade, the Leapfrog Hospital Survey and the Leapfrog ASC Survey are questionnaires basically that asks hospitals and ASCs to give us information about their safety, as well as about their quality. So quality, I would define as the good things you want to have happen, do they happen well? So how do you do on a maternity care? How do you do on a surgery? We want, we want those things when we go to a hospital and how well do you do it, providing them as opposed to the things we don't want. We don't want an infection ever at a hospital, but unfortunately that does happen. So we look at both safety and quality in the survey, we collect data through the survey, and then we, we publicly report it as well on our own Leapfrog Group website.

Leah Binder (26m 16s):
So the survey really is about collecting data. We can't get anywhere else and reporting it on quality and safety. The grade is about giving a snapshot for the public on how hospitals are doing on safety only.

Mark Graban (26m 31s):
And, and what do you see in terms of practices or culture or leadership that puts a hospital into the realm of a performance as opposed to lower grades? Like what can other hospitals learn from the hospitals?

Leah Binder (26m 49s):
I will say anecdotally from my own experience, visiting hospitals, I would say that one of the features I noticed first at a hospital that tends to get an a, is what you see in Rick and Duke as a hospital tends to get an a, a, and that is restlessness and never being satisfied with where they are always wanting more and more and more, better, better, better, faster, faster, faster, just a restlessness. And you see it in the CEO on down and see from everyone. So I think just that, that desire, that cultural feeling. I think Rick also talked a little bit about the contagiousness of improvement. Then once people get that bug where they, they're not satisfied has to be better, better, better, that it spreads to everyone and you can create a culture that way.

Leah Binder (27m 35s):
So I think what we want to do is learn how to create that because safety is not really about just one measure. It's not just about one thing. You can't improve your safety. If you say, I got my central line of fiction, write down one thing down because it just doesn't, it's not really what it's about. Safety is about everything at the same time, and that's only possible if everyone's contributing 24, 7 and excited about doing it and never ever letting it go, that is what creates safety. And so I feel that when I walk into a hospital that has this record of, of getting an a, and it's possible for anyone to get there, that's the good news.

Leah Binder (28m 15s):
Restlessness is possible for everyone.

Mark Graban (28m 17s):
So Rick can, we, we've kind of touched on the idea of, you know, aiming for zero harm and that's something Paul O'Neill talked about. Of course, that's something we advocate for at Value Capture. Could you tell us about Duke Health's language about as, as it's described there, a commitment to zero harm, how do you make sure that's not just a slogan and make sure that that really helps drive practical and meaningful change and progress?

Dr. Richard P. Shannon (28m 46s):
Well, I think to the, to the point that Leah made earlier, it is now a part of the culture. So every huddle every morning from tier one through tier four, begins with that statement that we are here gathered for the purpose of committing to zero. I will tell you that it continues to be a point of contention with some in our organization, just as when I first started telling you about perfect patient care. People said, what's wrong with you? You know, that that's not possible, but we've adopted the philosophy that I'm not gonna fight it. I'm just going to say, okay, then just get to become the best at getting better.

Dr. Richard P. Shannon (29m 28s):
If you're the best unit at Duke at getting better, we'll get to zero. We'll get to perfect, but just commit to meet for me that you will work to be the best at getting better. And that translates much better to people for those that just don't believe in zero and it's motivating to them, but it is about creating that culture. And beginning every day with that kind of a pledge, you know, puts in front of our entire team twenty-five hundred managers across our organization, something that we're really trying to aspire to. And so, so, you know, I think that's part of it.

Dr. Richard P. Shannon (30m 11s):
You know, Leah and I were were, were talking and let me just sort of splice this in for a second. We were also thinking that looking at Duke specific clinical outcomes could be a next new chapter for us in getting to improvement. So what do I mean by that? You know, if you come to Duke, what's your five-year survival for lung cancer. If you come to Duke and have your, your gall bladder out, you know, what's your complication rate. And when you returned to work beginning to create around this idea of measurement assessments of the quality of the clinical product, and you know, what we're able to now layer on top of that is something that is critically important at the moment, are those outcomes the same for everybody.

Dr. Richard P. Shannon (31m 6s):
And so you can look at them through the lens of race and ethnicity. So we're really beginning to say, okay, you can, you can capture a lot of the safety elements that we've been focused on. If you look at the broader context of a quality clinical product is the worst thing to destroy. The quality of an outcome is to have a complication. It clearly remains the biggest factor that disrupts an outcome. So, so thinking about reframing some of this, perhaps partnering with some professional societies who do a really good job at building these, but aren't particularly public about them. Leah, you know, I think that's a challenge.

Dr. Richard P. Shannon (31m 46s):
I think this might be a next chapter for us.

Mark Graban (31m 50s):
So a final question for you, Rick, you know, what, what, what's the, you know, motivation and purpose and drive behind hosting the seminar, the Leading With Safety seminar at Duke Health. And thank you for doing that.

Dr. Richard P. Shannon (32m 5s):
Well, look, we welcome the chance to learn from others. We have a lot of learning to do, and I have always believed that the best way to grow is to bring in other experts, to hear their stories. And more importantly, by hosting it, I get to bring more people. So they get to learn from some of these experts, you know, for people to have a chance to be in a room with, you know, Leah Binder is, is, you know, is just a privilege. So we, we, you know, arguably are the benefactor of hosting because we get to have a lot more people listening in and learning.

Dr. Richard P. Shannon (32m 46s):
So that's the reason to come together. Let's, let's learn, what's working and what isn't, what those new lessons can be. And let's rededicate ourselves. I think the beauty of these engagements is it allows you to come together and say, boy, I just went to this meeting and now I'm going back and I'm really going to nail it

Mark Graban (33m 3s):
Well, and I see Leah nodding. So I, I knew you would agree. It's a privilege also Rick, to have you in a room like that, sharing and learning leading by example, that you can do both. You can share your progress and still be focused on what lies ahead. So thank you for sharing everything with us here today, and thank you in advance for what you're going to share there at the seminar.

Dr. Richard P. Shannon (33m 27s):
Well, thank you, Mark. Thank you, Leah. We really look forward to it. I think it's going to be a great occasion.

Leah Binder (33m 32s):
Thank you, Rick. I look forward to learning from you.

Mark Graban (33m 35s):
So you have, you know, Leah, I think I need a position where you have the pulse of healthcare providers, the pulse of employers, those who are paying for so much of healthcare in the United States. What, what are you hearing from them? Are they, are they asking or demanding anything different in the last couple of years,

Leah Binder (33m 56s):
They are much more focused on safety and quality. I have never seen anything like it in my time and Leapfrog. And I've been here 14 years. This is, they are laser focused. I think in part they have like hospitals, do they have workforce shortages, they are competitive about attracting and retaining their workforce. So they do not want to be sending them into a healthcare environment. That's going to harm them. They want to have a very competitive healthcare benefits program. So there's that. And well, the term I've heard from a consultant benefits is that I, that I think is interesting is HR is PR. So HR is a very core factor of how they're able to attract and retain.

Leah Binder (34m 41s):
And healthcare is a major element of any HR program. So I think they're very focused on that. And they I'm seeing, I'm seeing employers investing enormous sums of money on programs that go beyond their health plan to serve their employees and help them navigate the healthcare healthcare system to get the best care. So they're buying services outside of what their health plan office offers like navigation services to help people get through, or just additional services or special centers of excellence that may identify that they send their, their employees to. So I'm just seeing this enormous investment and this incredible focus by employers on absolutely getting the best care and seeing that as a competitive advantage for themselves as a, as a business.

Leah Binder (35m 31s):
So very different environment. And that's only accelerating.

Mark Graban (35m 35s):
So what I hear you saying, I think is a, from focusing on costs to also focusing on safety and quality, and I mean, it seems like this is not just a theoretical stance. The data seems to bear out that these go hand in hand, better quality, better safety, lower costs,

Leah Binder (35m 56s):
Right? And I think we're as recognized, they recognize that for a long time, but they are finely tuned to that back. Now here's another reason that employers are starting to come more focused on quality. And that is that there's, there's a new law that they're complying with called the Consolidated Appropriations Act. It's really the budget that was passed in 2020, but it is, it was, it was signed by president Trump, but it's something that President Biden very much supports, which really strengthens the fiduciary responsibility of employers to make sure their employees are getting the best care that has changed the, and is changing the, our responsibility of employers to make sure this happens.

Leah Binder (36m 41s):
So I think the current market conditions anyway are such that employers are highly focused on quality, but it's only going to accelerate. I think as this particular law becomes increasingly regulated

Mark Graban (36m 54s):
And then they made that law again was

Leah Binder (36m 56s):
The Consolidated Appropriations Act. And now it's one of those Washington names. She even got an acronym CAA, but it's was passed in 2020, and it's real thing. So it's definitely having an impact already.

Mark Graban (37m 11s):
Okay, well, I'll link to something more about that in the show notes, for those who want to take a deeper dive, that's something new that I learned here. So thanks for mentioning that, Leah. So to talk a little bit about the, the seminar, this executive seminar leading with safety, again, it's September 15th and 16th hosted by Rick and the great people at Duke Health. You know, thank you for collaborating with Value Capture on this. Leah, I want to hear your thoughts of, you know, why, why structuring it this way as a seminar for CEOs, the C-suite boards, senior leaders, why, why have this be sort of a small intimate experience with them?

Leah Binder (37m 57s):
I think CEOs are and C-suite, but particularly CEOs are absolutely critical to truly changing healthcare. I basically think we aren't going to change until we get CEOs who have the vision and the leadership and the passion and the commitment to make the change. It is inevitably what we will see that leadership, wherever we see improvement, wherever we see consistency of excellence. Anytime we look at the numbers, there's a CEO behind it. It doesn't mean they're the only ones that you would, of course not, but they are the ones that make it possible and set the conditions.

Leah Binder (38m 38s):
And they're indispensable to that change. If the CEO is not behind the transformation and safety than it is highly unlikely, they will see change. Now we first did the safety grade. Will you stick it? Quality leaders will call us up and they'd say my boss, the CEO's that I'm going to get fired if we don't get an a, you know, so we knew that that CEO was not going to make that change. They were not going to transform because they didn't understand their own role. They didn't understand the role of the whole organization. Quality and safety is not something you delegate to one person. It's something, a leader initiates and sets on fire. And that is where and in change as an organization, but it's about leadership.

Leah Binder (39m 21s):
So we need that leadership. And I think leadership is sensitive and hard and lonely. So we want to bring those key leaders together in a setting where they you'll trust and comfort with each other, because they've all been down the same road and hopefully can learn from each other and, and build that change.

Mark Graban (39m 44s):
And people can see the list of the other executive participants and presenters on, on the website, the registration page. Again, look for a link in the show notes. But, you know, as, as Rick emphasize and you know, the people that we have gathered here are of that same mindset. It's not for them to just preach what they've done. It's going to be discussions, Rick and others are eager to learn. I know Leah is as well. And you know, there's going to be a cocktail, reception and opportunities for interaction. You know, it's a small enough group. I know when we get leaders together in this way, it's, it's a special opportunity. You know, maybe as a final question for you, Leah, why should senior leaders make something like this, a priority?

Mark Graban (40m 33s):
Or if somebody is listening and they are in a position where they're, they're a director or vice president, they're trying to maybe find an experience that can be eye-opening, you know, in a non-threatening way, like how, how, how could a leader either make the case to themselves? If they're hearing this and thinking about going, or how can somebody maybe help one of their senior leaders prioritize this?

Leah Binder (41m 1s):
I have to bring it to a personal level. Anyone who's leadership, most people who are in leadership look, look in the mirror and they want to feel like they made a difference at the end of the day. And when you're in leadership, you find that you have more influence to make more of a difference. The bigger your realm of authority grows, the more difference you can potentially make. And when you see problems with safety and quality in your organization, it is personal for you. You have, it's a failure, that's personal, it's an area that is undermining your legacy. What you will leave behind when you depart this earth, you are seeing parts of that go away because of preventable problems that no, there must be a way to solve, and there is a way to solve it.

Leah Binder (41m 54s):
And it has to do with leadership. And it has to do with your own ability to convey to the people who work in your, in your environment to convey to them your values, your vision, and your purpose. And that is not easy to do easy. Everyone would do it. It would all work. It's extremely difficult. So you need to come together with people who have done it or people who are also grappling with it and learn together. So that really for you personally, for your family, for your life legacy, you can make a difference. So, I mean, I think it comes to that. This is, this is leadership at its most primal let's make a difference.

Mark Graban (42m 39s):
Well, it's very well said, very powerfully said, Leah, so thank you for everything that you're doing to make a difference. I appreciate everything that Rick is doing and has been doing for a long time to make a difference. So again, you can learn more about the leading with safety seminar by looking for a link in the show notes, or you can go to Value Capture with safety. Leah, thank you for joining us here today.

Leah Binder (43m 7s):
Thank you, Mark. And thanks for all that. You've done to make a difference as well. It's really great to be working with you.

Mark Graban (43m 14s):
Well, thank you. I appreciate it. Well, thanks again to both Leah Binder from The Leapfrog Group and Dr. Richard P. Shannon from Duke Health. Again, they are both going to be part of this really outstanding executive seminar. That's being held September 15th and 16th. It's titled leading with safety to learn more. If you are a hospital CEO or board member or C-suite member, or if you want to come and bring somebody else from your team, you can learn more about all of this. So you can look for a link in the show notes or go to Thanks for listening to Habitual Excellence presented by Value Capture.

Mark Graban (43m 54s):
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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