The most effective chief quality officers possess a fluency in two distinct tongues: the language of people — rich with the nuances of human connection and collaboration — and the language of spreadsheets, marked by the objective precision of data.
As Beth Israel Lahey Health's inaugural chief quality officer, Yael Heher, MD, effortlessly moves between these two realms on a daily basis, weaving together the narratives of team members' daily experiences and culture with the hard evidence of quality metrics.
"It's everything from culture change — and the covenant between caregivers and patients and how we deliver care — to these very quantitative metrics," she told Becker's. "That span keeps me really excited."
Beth Israel Lahey Health was formed in 2019 through the merger of Boston-based Beth Israel Deaconess Medical Center and Lahey Health in Burlington, Mass. As a younger system that paused some executive governance decisions during the pandemic, the Cambridge, Mass.-based system has spent much of the past year carving out its leadership structure.
As part of this effort, Dr. Heher was named chief quality officer in November. She previously served as associate chief of pathology quality and safety and head of renal pathology at Massachusetts General Hospital in Boston. She was also vice chair of quality and safety for Boston-based Mass General Brigham's enterprise lab service.
In her new role, Dr. Heher oversees a broad range of domains, including quality, safety, regulatory compliance, employee safety, medical staff affairs and infection control.
Dr. Heher recently spoke with Becker's about her new role, top priorities for 2024 and more.
Editor's note: Responses have been lightly edited for length and clarity.
Question: What are the key challenges and opportunities that come with stepping into a newly created C-suite role?
Dr. Yael Heher: It's good and bad. It's good because you can deliberately think about the governance and the structure and your priorities. You're not inheriting any sort of structure you have to change. I think the challenge is decision-making. The thing about quality and safety is it's not its own tribe. We intercalate with everyone — with diversity, equity and inclusion; with the Office of General Counsel, with medical staff affairs, with regulatory affairs, with infection control. It's like a marriage with all those folks, and you have to decide "who's on first." We're going to collaborate, but someone has to be accountable and own it and deliver results.
Deciding also what stays local and what becomes central is a really interesting governance process. We have 14 hospitals and tens of thousands of employees. The tough thing about making decisions as an inaugural person is deciding what works best — for not only patients and for performance — but also for our employees and then figuring out your priorities.
Q: How do you decide what stays local and what becomes central? Can you share an example?
YH: Serious safety events are rare in healthcare, but there are a lot of near misses that occur. It's like driving — how many near misses do you have where you look down at your phone for a moment or encounter an intersection where there should be a stop sign at the corner, but nothing happens and you kind of go about your day. That happens 100,000 times a day in healthcare but we don't record that, and we don't detect risk. You could never have the capacity to do that on the system level, but you could potentially at a local level. You could detect some signal like "we've had seven near-miss events with X happening."
I think some things need to be local in order to investigate a granular event. But there is also a benefit to detecting signals and to creating strategies for systemwide initiatives. For example, the company making our inferior vena cava filters changed the way they deploy. We had employees deploying them the original way, which caused some filters to migrate up to the heart. If you've been deploying them the same way for 30 years, you might not catch that change in the instructions. So that's something to correct at all of our hospitals.
We have a patient safety organization where we're permitted to share safety events or alerts between our 14 hospitals and hundreds of ambulatory care sites. Imagine if you could do that nationally. Why do we all have to be making the same mistakes in our own little silos?
Q: How does your background in laboratory work shape or inform your current role?
YH: Labs are a really interesting example because by design, they're not tribal. They involve a ton of operations both before things reach us and after. There's diverse stakeholders, very different cultural practices and a very different understanding of medicine. I think that background has helped me to understand it's much more amenable to sort of production-line type of thinking, or even cultural aspects of the hierarchy and escalation and standardization. You can't extrapolate everything, but it has helped me think about how to optimize labs specifically for the system so that we can deliver better service. You may have read about the partnership between Dana-Farber and BILH. Obviously diagnostics for cancer patients is everything. If you don't have the right diagnosis, the buck stops. So that is a priority for me.
Amongst all the other quality and safety focuses, I am thinking more strategically about the sort of behind-the-scenes services that help healthcare move forward, such as transport services or folks who answer the phones. One of our 2030 goals for our health system is to think about being more patient-centered, delivering more seamless care, and who's more in charge of those seams than all the coordinators? So I think my lab hat helps me think about those behind-the-scenes folks who really are at the core of that work.
Q: What other core priorities are you focusing on this year?
YH: Our system is going to be a single instance of Epic in June. That will allow us to pull big data systemwide and get our arms around performance and safety events. I'm very interested in using that to leverage dashboards. The actual design of them is really critical. What are you looking at? How are you looking at it? What are the targets? Are you looking at the variability or are you just looking at the target? Both are very important. And I think also having a feedback mechanism to make it safer. People need to build a report when things are going wrong with the new Epic system, and although there's a ticket system within Epic and they have a patient safety committee, I don't think we've really perfected that feedback loop. There are technical errors that are just for the IT team to fix but then there are systemic structural things that could be about patient safety. And I think that's a really exciting opportunity and also daunting even for the most dedicated patient safety professional.