Why This Episode Matters

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

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

Key Ideas Explored

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

Takeaways for Quality Leaders

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

Continue the Conversation

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

Resources & Frameworks Referenced

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

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

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

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

Why This Episode Matters

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

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

Key Ideas Explored

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

Takeaways for Quality Leaders

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

Continue the Conversation

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

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

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

Resources & Frameworks Referenced

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

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

Episode Summary

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

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

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

Core Ideas from the Conversation

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

Questions This Episode Raises for Leaders

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

Resources & References Mentioned

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

Continue the Conversation

You can connect with Dr. Abraham Jacob via email at akj@umn.edu or on LinkedIn.

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

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

Why This Episode Matters

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

The Arc of the Conversation

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

Key Ideas Explored

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

Takeaways for Quality Leaders

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

Publications & Frameworks Explicitly Mentioned

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

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

Continue the Conversation

You can connect with Brian Wong on LinkedIn.

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

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

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

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 work to explain why real progress depends less on tools and more on how leaders think, learn, and show up. The conversation challenges familiar assumptions about accountability, expertise, and authority and offers a grounded alternative rooted in scientific thinking, transparency, and coaching.

Key Ideas Explored

• Why improvement fails when leaders don’t change how they manage
• Thinking like a scientist as a leadership skill, not just a clinical one
• How daily management systems surface problems early — without blame
• Why spread depends on culture, trust, and peer-to-peer learning
• The limits of outcome targets without process understanding
• Building networks of change agents instead of relying on heroic leaders

Takeaways for Quality Leaders

• If you want front-line behavior to change, leadership behavior must change first
• Don’t demand answers before experiments — design systems that allow learning
• Use data to create transparency and motivation, not fear or punishment
• Build truly interdisciplinary teams for complex problems like flow and discharge
• Treat spread as a relational process, not a rollout plan
• Replace command-and-control with coaching and problem-solving support
• Invest in developing people who can think, test, and teach others

Continue the Conversation

Connect with Dr. Lee Erickson on LinkedIn or through her organization Adaptient to continue the dialogue.
This episode is especially useful for executives, physician leaders, and quality professionals trying to move beyond project-based improvement toward lasting cultural change.
If this conversation resonated, consider sharing it with a colleague or leaving a thoughtful review.

Resources & Frameworks Referenced

• Lean and Toyota Production System principles
• A3 problem-solving methodology
• Plan–Do–Study–Act (PDSA) cycles
• Lean Daily Management Systems
• Interdisciplinary improvement teams
• Helen Bevan’s work on change agents and spread (including the School for Change Agents)
• Incident Command System lessons from the COVID-19 response

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

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 of quality evolved from tools and measurement to leadership, trust, and psychological safety. The conversation explores the design and impact of physician leadership development as a core strategy for cultural change—offering a perspective on quality improvement that goes far beyond projects, dashboards, or checklists.

Key Ideas Explored

• Quality and leadership are inseparable: Sustainable improvement depends on leader behaviors, not just methods.
• Psychological safety enables learning: Without it, clinicians won’t question assumptions or surface problems.
• Technical skills aren’t enough: Character determines how tools like finance, strategy, and operations are used.
• Culture changes through behavior: Daily actions—not slogans—shape how organizations function.
• Leadership can be measured: Imperfect measurement still supports learning and accountability.

Takeaways for Quality Leaders

• If improvement fades, examine leadership capability before redesigning projects.
• Pay attention to whether people feel safe speaking honestly in leadership spaces.
• Don’t assume leadership will develop on its own—teach it deliberately.
• Treat skepticism as a signal of missing trust, not resistance.
• Look for character-based leadership in everyday decisions.
• Invest in leadership development as a system capability, not a one-off program.

Continue the Conversation

• Connect with Dr. Todd Allen on LinkedIn
• This episode may be especially useful for leaders building clinical programs, leadership pipelines, or communities of practice.
• If this conversation resonated, consider
  • Rating and commenting on it to help others find it.
  • Sharing it directly with someone interested in for leadership development or shaping culture in your organization.

Resources & Frameworks Referenced

• W. Edwards Deming and Total Quality Management
• Intermountain Healthcare Advanced Training Program (ATP)
• Crucial Conversations (Patterson et al.)
• Kotter’s Change Management Model
• High Reliability Organization (HRO) principles

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

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 by ~50%.

It’s a story of co-design, equity, humility, and design thinking—with families as full collaborators, not passive recipients.

Instead of pushing out top-down fixes, the team built the work with families, home-care nurses, and even a checklist engineer who transformed dense clinical instructions into clear, waterproof (yes, literally waterproof), one-page cognitive aids that could survive kitchens, bathrooms, and real homes. They aligned inpatient teaching with home supplies, created universal clean kits to eliminate equity gaps, rebuilt teach-backs to remove shame, and translated materials into Spanish and Arabic so safety didn’t depend on luck or language.

You’ll also hear how Amy’s three-decade career in pediatric quality and safety shaped the work—and how her mentorship of Chris helped fuel the next generation of system thinkers committed to closing the “know-do gap” in medicine.

At a time when more care is shifting homeward, this episode offers a playbook for making safety real beyond the hospital walls.

What We Cover

• The overlooked problem: Ambulatory CLABSIs after discharge and their impact on hospitalizations, chemotherapy delays, and family burden.
• Why usual fixes failed: Families were doing complex care with inconsistent, hard-to-use instructions not designed for home environments.
• Co-design in action: Families, clinicians, home-care nurses, and a checklist engineer created standardized, waterproof, one-page cognitive aids and aligned teaching with real home supplies.
• Human-factors design: The checklist engineer brought clarity, usability, and visual design clinicians alone couldn’t achieve.
• A new model for teachbacks: Judgment-free, normalized teachbacks led by nurse champions—resulting in >90% caregiver independence.
• Equity at the center: Universal clean kits and multilingual materials ensured safe care didn’t depend on resources or language.
• Leadership & mentorship: How Amy’s decades in pediatric safety and Chris’s drive to close the know-do gap shaped the work.
• Ripple effects: National collaboratives adopting ambulatory CLABSI prevention and emerging focus on home medication safety.

Key Takeaways

• Safety challenges often live beyond the hospital.
• Co-design works—families reveal solutions clinicians cannot see alone.
• Usability matters: Clear language and well-designed tools drive real behavior change.
• Equity requires universal design, not selective support.

Connect with Today’s Guests

Dr. Amy Billett

• Best contact method: https://www.linkedin.com/in/amy-billett-a351501a6/

Dr. Chris Wong

• Best contact method: https://www.linkedin.com/in/chris-i-wong-ciepiel-884880145/
• Profile Link: https://www.uhhospitals.org/doctors/WongCiepiel-Chris-1407171804

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 about learning to lead beyond subject-matter expertise and how COVID pressure-tested every leadership instinct. Hilary shares how she and her team turned dashboards into decisions, building a centralized quality hub with deep resources and a one-page “top five” for each priority so busy managers could act today. She explains why outcome views must be paired with real-time process visibility—knowing not just that CLABSIs ticked up, but exactly who is overdue for a dressing change right now—so data becomes a map rather than a mirror.

We also go inside vaccine policy and trust. BJC implemented one of the nation’s earliest influenza mandates, treating it as a safety tool within a clear accommodation process. During the COVID rollout, transparency, values, and personal candor anchored tough choices about prioritization and access. The organization’s values—kindness, respect, excellence, safety, teamwork—moved from posters to practice, and a shift to centrally led, locally embedded quality teams helped spread best practices across hospitals while protecting local relationships.

If you care about healthcare quality, leadership, and culture, you’ll leave with practical tactics and renewed optimism. Hit play, then share this with a colleague who wants to turn analytics into action. If the conversation resonated, subscribe, leave a review, and tell us the one change you’ll try this week.

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

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

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

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