Leading Quality

This week, we're revisiting one of the earliest episodes of Leading Quality—and a conversation about what it really takes to build lasting improvement capability in healthcare. We'll be back with an all-new episode in our next release. How do you build a culture of quality improvement across an entire healthcare system? And what happens when you start with frontline clinicians rather tha...

Why This Episode Matters High reliability is often treated as a collection of visible practices: safety huddles, rounding, event review, reporting systems.  But Nicholas Testa argues that the practices matter only if they create an organization that can reliably surface risk, learn, and respond. The harder leadership problem is durability: can those behaviors continue when the CMO changes, the CEO...

Why This Episode Matters Healthcare organizations cannot learn simply because they have dashboards, safety reports, improvement methods, or formal escalation processes. Learning depends on whether people can surface what leaders do not know, challenge assumptions, admit uncertainty, and act on problems without making truth-telling personally dangerous. This second year-in-review episode examines t...

Why This Episode Matters Healthcare organizations can run hundreds of improvement projects without becoming fundamentally better at improvement. After 26 conversations in the first year of Leading Quality , a larger question emerged: what makes an organization capable of learning repeatedly, across problems, teams, and time? This episode examines the difference between having people who know impro...

Why This Episode Matters Healthcare organizations often tolerate ambiguity, workarounds, and recurring operational problems until they produce serious harm. Dr. Steve Spear explains how leaders can apply the same disciplined thinking used in clinical diagnosis to the systems in which care is delivered—making problems visible early, investigating them rigorously, and building problem-solving capabi...

Why This Episode Matters Patients spend most of their lives outside the hospital, yet healthcare teams often have limited visibility into what happens after discharge, between visits, or during long-term recovery. In this episode, Dr. Joshua Liu discusses how SeamlessMD was built to close that gap by helping patients navigate clinical journeys, giving care teams better insight into patient progres...

Why This Episode Matters Healthcare has made real gains in quality and safety, but Ken Segel argues that too much improvement work still lives as projects, dashboards, or specialist-led initiatives rather than as part of how organizations are run every day. This episode examines what it takes to move from episodic improvement to habitual excellence: a clinical operating system where safety, flow,...

Why This Episode Matters Patient safety has often been built around what happens after harm occurs: incident reports, investigations, accountability, and corrective action. In this episode, Dr. Peter Lachman argues for a more proactive and moral view of safety: one where teams talk about risk every day, anticipate who may be harmed next, and make safety part of the “genome” of healthcare education...

Why This Episode Matters Healthcare organizations often know they have problems with flow, safety, delays, frustration, and waste, but they may not actually see the work clearly enough to solve them. In this conversation, Maria Mentzer explains how See to Solve helps organizations surface hidden problems, involve the people closest to the work, and build practical problem-solving capability throug...

Why This Episode Matters Healthcare organizations often treat improvement as a set of projects, tools, or training programs. Amar Shah’s work at East London NHS Foundation Trust (ELFT) and NHS England points to something larger: the long-term work of building belief, capability, infrastructure, and leadership routines so improvement becomes part of how a health system thinks and operates. This con...

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...

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 kee...

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, a...

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...

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: cl...

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 app...

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 lea...

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 ele...

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 e...

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 impr...

Why This Episode Matters Healthcare organizations invest enormous effort in quality improvement projects, yet many struggle to achieve durable change. Too often, improvement is treated as something that happens at the frontline, while leadership behaviors, management systems, and organizational culture remain untouched. In this episode, Dr. Lee Erickson reflects on decades of hands-on improvement...

Why This Episode Matters Healthcare quality work often stalls not because of a lack of methods or data, but because organizations fail to build the leadership and culture needed to sustain improvement. In this episode, Dr. Todd Allen reflects on his journey from frontline emergency medicine to senior quality leadership at Intermountain Healthcare and The Queen’s Health Systems , and how his view o...

What if some of the biggest gains in patient safety aren’t inside hospitals at all—but at the kitchen table? In this episode, Dr. Amy Billett and Dr. Chris Wong walk us through the groundbreaking, cross-disciplinary effort at Dana-Farber/Boston Children’s in collaboration with Ariadne Labs that cut ambulatory central-line–associated bloodstream infections (CLABSIs) for pediatric oncology patients...

What if the hardest part of quality isn’t finding the right answer, but making the right action unmistakable for the people who deliver care? That’s the thread we pull with Dr. Hilary Babcock—infectious disease physician, longtime infection prevention leader, and now chief quality officer helping steer a 12-hospital system of 33,000 people through transformation without losing its soul. We talk ab...

A door swinging open in the OR. A tiny defect in IV tubing. Both seem trivial—until you realize they expose how fragile our systems really are. In this episode, Allie Muniak , Executive Director of Health System Improvement at Health Quality BC , shows how human factors turns everyday frustration into lifesaving insight. We follow her path from psychology to system redesign, uncovering how design,...