Leading Medicine with Houston Methodist

Building a Culture of Continuous Improvement | Quality Time with Dr. Schaal

• Houston Methodist

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 40:31

In this episode, Chris Siebenaler shares how his nearly 25-year Houston Methodist career has shaped his perspective on how to drive continuous improvement. As executive vice president of network hospitals, Siebenaler shares how incorporating lean management principals and daily management systems have empowered physicians and staff to identify issues, track performance and implement solutions.

Expert: Chris Siebenaler, executive vice president of network hospitals, Houston Methodist

Notable topics covered:

  • Fostering continuous improvement and frontline engagement through lean management
  • Creating a culture of excellence through transparency and staff empowerment
  • Quality is not just metrics — it’s about meaningful experiences for patients and caregivers

Links:                                                                       

♪ ♪

DR. SHLOMIT SCHAAL:

Welcome to Quality Time, a Houston Methodist Leading Medicine podcast. I'm your host, Dr. Shlomit Schaal, a clinician scientist and a retina specialist. And I serve as the Chief Physician Executive of Houston Methodist located in the world-renowned Texas Medical Center. I passionately believe that quality is the heart of healthcare and a commitment to quality is essential for every healthcare system. Join us each month as we discuss the latest advancement in quality in healthcare with clinicians, researchers, physicians, industry experts, and thought leaders who are as passionate as I am. Today I'm happy to welcome Mr. Chris Siebenaler. He is the Executive Vice President of Network Hospitals for Houston Methodist. He's responsible for the operation of our eight community hospitals which include more than 14,000 employees in the Greater Houston area. Welcome Mr. Siebenaler. Can I call you Chris?

MR. CHRIS SIEBENALER:

Yeah, of course.

DR. SCHAAL:

Okay. Welcome to our show. Tell us a little bit about yourself.

MR. SIEBENALER:

Oh, gosh. So, you know, I started my career in public accounting back in 1988. And I had a very exciting job. I was an auditor. DR. SCHAAL: Oh, wow. Sounds very exciting. Yeah, not so much. Yeah. So, that was 1988. I was working for, at the time, what was one of the big eight accounting firms which was Coopers & Lybrand. And it was kind of interesting because they were putting me on a path towards oil and gas because the audit manager who hired me was the audit manager on the large oil and gas clients that they had. And so, he wanted me on his team. And the re -- You know, the funny story is, the reason he wanted me on his team is that I used to wait on him when I was working at a fine dining restaurant in college. So, I kinda feel like I found my first job at Coopers & Lybrand because I was a good waiter.[Laughter] I'm not kidding.

DR. SCHAAL:

Well, being a good waiter is actually closer to healthcare than accounting, don't you think?

MR. SIEBENALER:

It's kinda crazy. Yeah, I was a good waiter. I have good memory so I would remember what people ordered without even writing it down most of the time, although I did write it down just to make sure. And he was a very efficient guy and I was able to get him out each time. So, when I walked into the interview with him and I did not know that he worked for Coopers& Lybrand at time. I walked in the room, shook his hand. We, you know, we introduced ourselves and then I said,"Broccoli cheese soup and breadsticks."[Laughter] And he just chuckled and he said,"I figured you might remember what my typical order is." So, that was how we broke the ice at my very first interview back in, my gosh, 1988, I guess it was.

DR. SCHAAL:

So, from 1988 till today, how did you come to where you're at today?

MR. SIEBENALER:

Yeah. It's not the typical path. I spent my first 13 years in, I'll call it, the for-profit world. Whether it was public accounting or whether it was for-profit healthcare. I did -- for three years I did start a business back when practice management businesses were the thing. I was working for HCA at the time, and another former HCA hospital executive and I started a practice management company. And so, I spent three years managing physician practices. I also did practice valuations. Back then, practices were selling based on what we called goodwill because they wanted to sell their businesses at multiples of whatever their cash flow was. And so, we had to make assessments on what the cost -- Excuse me, the value of their practice was which we never do that Houston Methodist. And frankly, no one's done that for years, and years, and years. But physicians, I think appropriately so, feel like, "Okay, I've invested my blood, sweat, and tears into this practice." Beyond what my collections are, there is value to those relationships I've built with my practice. Unfortunately, most people don't see there being goodwill value attributed to the value of a physician's practice. So, you know, that -- what that did for me though, those three years is it helped me understand how physicians think about the money side of their business. And it changed my relationship with physicians from that point on because that experience helped me understand how they think about their practice. It also helped to give me a sense of the entrepreneurial nature of how they think about things and how they're in charge."It's my patient. I make the decisions." And it gave me insight into how that flows into other parts of their lives. So, those were kinda critical moments, I think, for me.

DR. SCHAAL:

So, those three years were when?

MR. SIEBENALER:

19 -- Oh my gosh. 1996 though mid 1998. DR. SCHAAL: Okay. That's when I was in medical school, okay? I just was trying to see how long ago. And then, how did you come to Houston Methodist? So, that venture, while successful, I had a partner, and my business partner and I had different perceptions of how we should run the business. And effectively, he squeezed me out because I was the person who ran the business, he brought in the business. And so effectively, while you would have thought it was a good match, I think he probably wanted to exert more control and not have a partner. So, I got back into hospitals back in 1998, and I worked for a large, for-profit spin-off of HCA called Quorum Health Resources and we managed hospitals across the country. And so, I had an opportunity to work in the Dallas-Forth Worth market as a contracted, if you will, Chief Financial Officer. Couple years in, we made a bunch of changes and I was still the Chief Financial Officer, but then I also got an opportunity to get more into operations and also had a Chief Operating Officer role. But then the -- Another long story. The bondholders and the insurance company that secured those bonds effectively foreclosed on that property and they asked the contracted company that I worked for, Quorum Health, to then sell off all the assets of that company to satisfy the debt that they had assumed as the bond insurer. So, they promised me a CFO or CEO job down the road, Quorum Health did, and honestly, young family, really didn't wanna relocate outside of Texas. I had family in the Houston area, and so I applied for a job on Monster and --

DR. SCHAAL:

On Monster? MR. SIEBENALER: On Monster. Can you believe that? It's so many -- That still fi -- That just feels so old. This was in 2000. And ended up getting a job, working for Mark Boom, his first CEO job. So, Mark went into the diagnostic hospital which is currently the West Pavilion. Mark ended up terminating his CFO and -- who he hadn't hired. This was someone that was part of the management team when he was put into that role. And so, Mark was looking to fill out his leadership team and I was the last executive on that leadership team. So, my first job was with Mark at diagnostic and nine months later, ten months later, Mark and I effectively, right after Tropical Storm Allison, our strategic plan for that hospital, that separate hospital, was to merge it into the main campus to give it a facility to help the Methodist Hospital at the time build back after losing the square footage from Tropical Storm Allison, you know, and their two subbasement floors. So, Mark went, you know, across the street to HMH or TMH at the time, and I moved out to Baytown as the Chief Operating Officer. And that's now 24 years later. So, for me to have had as many opportunities as I've had with this one company, I mean, it's very rare. So, I consider myself to be really blessed. So, a year ago, it's really a change of how we do things at Houston Methodist. Really, it's the first time that we have you as an Executive Vice President over all our community hospitals over the Greater Houston area. What is that job like and what are you responsible for?

MR. SIEBENALER:

So, I'm responsible for all of our network hospitals and that is eight hospitals. That's seven short-term, acute care hospitals, if you will. And I say it that way because we have our L-TAC, continuing care which is just across the freeway from the West Hospital. So, that's eight campuses, eight now that are our Cypress facility opened in March. So, it's roughly 14,000 plus employees. I'd say net patient revenues and the aggregate is somewhere around $4 billion dollars. So, it's a significant division of the organization. And so, another great opportunity for me to, okay, how do we run this?'Cause this job hadn't been here before. I mean, you know, we'd split these -- We'd split up our organization kind of in components. You know, we had a North region and South region. And so, they'd operated very differently. But then each of our hospitals within each of those regions also operated very differently. If I think back over time I had recognized probably seven, eight, nine years ago that we needed to operate differently. And it's kind of an interesting story for me. I'd probably spent a year or so thinking about at Sugar Land and, you know, being over Sugar Land and Clear Lake and Baytown. And I'd been thinking to myself,"I am trying to solve the same problems that I was trying to solve when I had my first hospital CFO job with HCA in 1994. And, you know, it's interesting'cause I was -- In my mind I was complaining about that. Like, "I can't believe I'm having to solve these same problems." And it dawned on me, I'm not the sharpest knife in the drawer, I guess. It dawned on me, well if I'm having to deal with these same problems, then I'm the problem. And so, I need to think differently. And so, that's what started me on this path that led me to effectively want to build a Lean operating model.

DR. SCHAAL:

So, how did you get exposed to Lean? How did you learn about it?

MR. SIEBENALER:

Yeah, you know, it's interesting. So, my father ran plants and he was a -- he was kind of a Lean guy. That was never really part of my thought processes in healthcare for most of my career, but he was a -- if you go back 30 plus years, you know, he was the, you know, JIT, total quality improvement kind of factory leader. He and I talked about this stuff all the time when I was early on in my career. And he actually co-authored a book on kinda the high-performance enterprise back in the early 90s when he left the corporate world and went into consulting. And it's interesting because I've reread that book and a lot of what he and his partner talked about in that book are things that really tie very nicely to kind of a Lean type of leadership style. So, I feel like that always kind of stood in the back of mind if you will. And as I started thinking through, okay, I'm the problem. I need to do things differently. Then I needed to approach it a different way. And that's when I started looking at kind of a Lean model. And honestly, I started talking with outside consultants about what do they do, and how do they run their hospitals. And started reading up on that and started reading some of the stuff from HBR, you know.

DR. SCHAAL:

Tell us a little bit about what is Lean, because I'm not sure all our listeners understand. And, you know, what is Lean in general, kind of a big picture, but how do you implement it? How did you implement it? Sugar Land and what you called the South ways region. But really, you know, when I'm looking at our hospitals right now and even the physician organization clinics, I actually see a big transformation that you lead, a Lean transformation. So, tell us what it is and how you implement it.

MR. SIEBENALER:

I think Lean is misunderstood. I think a lot of times people hear the word Lean and sometimes attribute it to kinda tightening our belts. We're gonna lean out kind of a thing, which is not what it is at all. Of course, Lean comes from the Toyota Production System model. As I was coming to terms with, I really like this type of model. And I feel like for me, it makes sense because you engage front line staff. And I've always felt like if we're gonna have change, it's gotta be led by front line staff because they know what needs to be changed. You know, as executives, we have lots of experience and we can -- It's our job to determine strategically where we're going as an organization. But in terms of what are the problems that are happening at the front line for our patients, I mean, no one knows better than our front line physicians, and nurses, and technicians. No one knows better than that. And so, I think Lean is very focused on you have to engage your front line staff. It's that -- You know, the factory floor, if you will. You know, we started a transformation of looking at how we did strategic planning and then beginning in 2019 we started the process of understanding, okay, we really need more of a daily management system to put in place.

DR. SCHAAL:

So, tell us what is a daily management system.[Laughter]

MR. SIEBENALER:

So, daily management system really is the execution side of our business. And, you know, the executives in the organization determine the strategic direction. We, of course, wanna get input from front line staff in that direction, but ultimately, the executives decide on that direction. And so, it's up to the operators going from the executives down to front line staff and then back up. It's up to them to execute on all that. So, the daily management system is all about, first of all, empowering the front line to execute on that daily work. The daily work is really supported by standard work, really, job by job, department by department. It -- So that everyone knows,"Okay, this is my job. And my job is to do what's important within my unit." And, you know, one of the beauties about a daily management system is that they all have kinda these common components, and one of them is visual management. Visual management is we have to be transparent about everything we do. The department determines what its metrics are and how we're going to achieve them, how we're gonna manage them, how we're going to report out, improve, etcetera. But those should obviously flow up to our strategic priorities. And so, that unit should be able to drive that, and we reflect that through the huddle board, is what, you know, we call it at Houston Methodist. You know, you're -- at your predecessor organization, you call them idea boards. And I finally remember the podcast you did with Dr. Dixon at UMass and it so resonated with me because so many of the things that he experienced over his career, before me where he came -- kinda came to the conclusion that that was the direction that he wanted to go just so resonated with me because it's wow, it's a yeah. What they experienced and lessons they learned, these are lessons we've learned and are continuing to learn. And so, that daily management system kind of is the core at executing what we do. So, when Dr. Boom talks about safety, quality, and service, if you look at those three -- just those three words for a moment. To me, we're achieving at a very high level across our organization as we compare ourselves across the country. Those outcomes are really driven by the daily management system currently in place across all of our hospitals. So, the daily management system is important in producing those outcomes. I think the opportunity for us is to engage front line staff and physicians and how do we get even better at each of those things. And I think that's probably the challenge that an organization as successful as Houston Methodist is, getting people excited about getting just a little bit better. It may not be hitting, to use a baseball analogy, another home run. It may just mean hitting a whole bunch of singles, you know, in each of our departments every day and making it better. And that's -- To me, that's exciting. I know that sounds like oh my gosh. Incremental improvement is not as exciting as just some big improvement. But it is exciting.

DR. SCHAAL:

Yeah, it is exciting. I'm a Lean enthusiast, you know that. When I joined the organization at Houston Methodist a little bit more than two years ago, I went and visited all our community hospitals and several of our clinics, and then I did it again and again, you know, kind of again and again, rounding and rounding. And I saw a big transformation in the last year in terms of these huddle boards, in terms of how teams get together, in terms of how you walk into a clinic, one of our PO clinic, any of our PO clinics, and immediately you know what the team is focused on. And it's on the board and everybody knows it, and I was very much impressed. How difficult it was to do that, to lead that change?

MR. SIEBENALER:

It doesn't sound difficult but it has been difficult. And it's been difficult because it's change. And any time you're implementing change or proposing change, people are gonna react to that. That's just the way it is. I think, "Why change?" is really the mindset. That's the question we have to ask ourselves, is why bother changing if you're already successful? And frankly, that's one of the challenges we have at this organization is, I mean, by every measure, this is a -- just a super successful organization. But that doesn't mean that we can't get a little bit better. And for me, yeah, it's obvious. Get better because there's a person on the other end of everything we do. That person may be an employee, may be a family member, it might be a caregiver, or it might be a coworker. So, we can all favorably, positively impact somebody else. And there's always a person. So, from my standpoint it's about making it just a little bit better tomorrow. It's kind of that concept of everybody every day. And just to step back from that a little bit and I'll answer your question more directly, but I don't wanna lose this thought. As I -- In preparing for our conversation today I thought through,"Okay, so how many huddle boards have we put up across our system?" And so, the team gave me a number and it's roughly 420 across our network hospitals. It's more than a hundred already in our clinics across the organization. And it's another roughly 50 at the academic campus. That's 600. DR. SCHAAL: Right. So, I would like to pause here a little bit to recognize it's not just the board. It's really, you said, 600, it's 600 locations when we -- where we, you, your leadership, and your teams really influence change in how we do things in 600 locations around the organization. It gives us that opportunity, right? And so, when you did your listening and learning tour, I think you called it when you first started, I remember I participated in that process. And I remember as you worked your way around each of the hospitals and you came back and you said it's just incredible outcomes and the people are so committed to this organization. But it's so variable. And we don't have any consistent way of doing performance improvement. And, you know, that's just really an opportunity. And, of course, you and I are kindred spirits I think as it relates to -- as it relates to Lean. And so, I think that -- if anything, you gave me an -- even another"shot in the arm" if you will. And that kinda helped me say,"Wow. There's -- Here's another person that I can partner with because it will make a difference to people." And so, we get back to the why. And the why is if you have governance at that unit level. And the unit level is determining, we're going to focus on these things in service and quality, in people, in financial, in efficiency, whatever it might happen to be, and if we're improving upon each of those areas, those improvements not only help the patient within that unit, they help the patient in their experiences throughout the hospital. It also gives us an opportunity to identify those best practices and replicate it somewhere else in our system that might not be as successful as that particular unit. And so, if you step back and you think, we have 600 or so huddle boards. We'll have a thousand probably by the end of next year across the entire organization. So, you know, I'm a numbers person. So, if you take a thousand huddle boards, a hu -- a thou -- and it's not the board itself. It's a thousand units that are having daily meetings and they're looking at their performance and they're identifying areas to improve, and they're doing problem solving. If we take one problem per week times a thousand that's 50,000 problems we might have solved over the course of a year. It's potentially even more impactful 'cause you can share the things that are most important and potentially replicate those across the organization. She had this layering impact that can occur when you build that kind of a culture where people share transparently not only the best practices but actually ask for help, that,"Hey, you know what, we're struggling with this." It's just, the impact is incredible. So, that's why I get excited about it.

DR. SCHAAL:

So, now we are doing what we call the JIMI Tour, the Joy In Medicine Initiative Tour. And I get to talk with physicians and people who don't yet have huddle boards really say that they feel that they're not involved in decision-making, they can't really influence how their own clinic are running. But people who participate in huddle boards both in our primary care group and our specialty care group, I mean, physicians who do that, they -- It adds to their joy. It's very interesting. It adds to the sense of,"I can influence my own clinic. It's not something that is done to me, I actually lead the clinic." And I have met all these physicians around the systems and I truly believe that it adds to the sense of satisfaction, sense of control as well that modern medicine may have taken away from some physicians.

MR. SIEBENALER:

I -- No, I think that's a great point. It really does empower that sense of kind of self-governance because the board really isn't for you or for me. It's helpful for us because it gives us at a glance perspective on what's happening in the clinic, what's happening in a particular department or unit within the hospital. But for the team in that department it's a tool to be able to self-assess,"This is how we're doing. Here's how we're trending. Here are the issues that we're having. Now, let's solve the issues, the problems that are showing up most frequently, and that's concept behind the Pareto, right, and then how do we problem-solve that. Sometimes the problem, they can resolve within their unit. Sometimes the problem, you know, is cross-functional. It actually is something that upstream or downstream from your department, there is a -- There are problems with how we're delivering our workflow. And so, we have to do something that is maybe requires more resources to help us solve that problem. And that's the whole concept around kaizen, which is, you know, change for the good is what kaizen means. And that, of course, you know, came through the Toyota Production System. But the whole concept behind that is you gather your data. You -- First, you identify what your problem is. You gather your data and then during a one week period of time, you implement a change and you track that change that you've made during that week based upon the data that you pulled in advance. But it all started with a Pareto chart that said this was the problem, and then you problem- solve that, get to root cause. And then ultimately, during that kaizen you get people from across those units, you know. It's not led by an executive. These are led by front line staff or front line leaders with the help of, maybe, a process engineer, or performance improvement experts in one of our campuses. And the goal is to show improvement then to track that improvement. And if we can sustain that improvement, then we do it elsewhere within the organization. So for instance, we might have come up with a process at one of our nursing units, we pilot it there. Based on the results it shows that we can sustain that performance, that's then an opportunity to take that times eight, or ten, or 12 units.

DR. SCHAAL:

Give me a concrete example. I know you have many. One example of how this kaizen event, how the team came together and really made process improvement that led to better patient outcomes, better patient experience. MR. SIEBENALER: Oh, gosh. Yeah. We have a lot of great examples. I'll -- Let me start with a huddle board and then I'll move to kaizen. DR. SCHAAL: Okay.

MR. SIEBENALER:

Because the huddle board in a way is a little simpler. So for instance, interventional radiology team at Sugar Land was tracking how long it was taking to get ports placed for cancer patients, and it was taking 21, 24 days, this was a couple of years ago, to get the port placed. Well, three weeks to get a port placed. Man, that's terrible, right? If you have a cancer diagnosis and you're waiting three weeks, that's crazy. They were tracking that. The technicians, the nurses, and the radiologists decided,"Well, why? Why is that?" They found out that they just weren't scheduling those patients in the afternoons. So, what they ended up doing was talking with the radiologist about how they managed their schedules. And what they ended up doing was doing more port placements in the afternoon. But they didn't wanna do them because they didn't think patients would want to be NPO until the afternoon to do those procedures. And in reality, patients are actually just fine with it because guess what? They have a cancer diagnosis.

DR. SCHAAL:

NPO means fasting. MR. SIEBENALER: Yes, thank you. Sorry, I should have said that. And so, the 21 days, the three weeks went to three days, and literally almost overnight because they just decided to change their workflow. And that was built upon just assumptions over time. They changed it. They didn't -- You know, I was the CEO at the time. It's not like they talked to me and got my approval. They didn't talk to the COO who they kind of reported up through. They did it. Sometimes you can just do it because you know this is what you're tracking. So, that's one example that just bubbles up daily. So, what is the number now? How long?

MR. SIEBENALER:

Oh, it's still three days. It's still down around that three days. So, yeah, they were able to sustain it which I think is incredible.

DR. SCHAAL:

Yeah. So, I think, you know, when I'm listening to you I'm th -- I can't help but think that, you know, every time we talk about innovation, a lot of times it's very tempting to talk about the shiny, expensive technology that is coming our way, and it is very exciting. It is shiny. It is expensive. It is improving our processes and the way we do things. But sometimes simple things that come from the team can have the same kind of impact or even greater impact because the ideas, as I hear you talk about it, the ideas come from the team. The problems are problems to better serve our patients. And then the pride that comes with it, it's not the -- you know, some software that somebody else designed somewhere else. It's really you and your team and the local team that solve the problem. And then they also can teach other breast centers, for example, in our system. So, I think, you know, it's important to emphasize that this is a kind of innovation that we rarely talk about. MR. SIEBENALER: Oh, for sure. There are countless examples of an employee filling out, hand writing an idea ticket that they then put on to the huddle board under the V, the voice pillar, on that board, and the team works their way through that and they keep those idea tickets. There's submissions, there's in process, and there's ones that have been completed and they keep the completed. And I remember seeing the EVS department at Sugar Land. I keep referring to Sugar Land mostly because this is where we started this. But trust me, there is phenomenal work going on at every one of our hospitals. And our PO clinics also.

MR. SIEBENALER:

And the clinics as well. Yeah, that -- I've talked with some of your doctors and administrators who are thrilled with some of the outcomes from the daily management system. I'm -- You know, for me, you get so many -- staff get so comfortable with submitting their ideas that literally you just can't keep them on the board any longer. And so, we had some departments that actually will take idea tickets that they've completed, and they'll take dozens of them and they'll put them in a bag, and they'll hang the bag on their huddle board as a reminder that,"Look at all the things we completed, we as a team. These things came from you in -- during the huddle process." Or, if someone happen to walk by the board and wrote it down and put it up there, it's just -- It's an amazing feedback loop and we -- We need to do a better job of celebrating some of those successes that come through those idea submissions. I mean, that's an opportunity for us. And that -- The team has come up with some great ideas about how to celebrate more. We've done some virtual celebrations of excellence where we ask the teams to come on to a virtual setting and talk about what they improved, the things they're most proud about, okay. Some of these things connect back with your system quality awards. I mean, some of the awards that the system quality that -- the council that you've put together to designate awards have bubbled up from these same sorts of processes. And so, what I see is the opportunity for this to become an almost exponential process of growth. And I think that's tremendously exciting from my perspective.

DR. SCHAAL:

So, you're building an army of problem-solvers? That's what you're doing. MR. SIEBENALER: Yeah, for sure. Absolutely. And that's exciting because who has those ideas? Well, physicians, and nurses, and techs. They're the ones who have the ideas. Wonderful. So, what's next for us? What are you thinking?

MR. SIEBENALER:

So, I think it's this year we're working to fine tune the daily management system. So, the daily management system, you know, part of it is the, I'll call it the tiered meeting structure. So, tier one is kind of your unit-based huddles. The next tier up is a cross-functional huddle. That might be something like a multidisciplinary round. It might be a bed management meeting where units across the hospital get together to, you know, better manage throughput and where to allocate patients and such. And then tier three really are organizational-wide huddles. Sometimes some of our hospitals call them stand-ups where literally they'll go into a room for 15 minutes. So everyone's standing and someone will be, you know, kinda running the meeting. It's usually not the CEO. It's usually one of the leadership team that's running that meeting. So, I think getting that tier one, tier two, tier three really gets the daily management system humming. Because what's the whole point of a daily management system? We identify something today and we try to fix it today. And if we can't fix it today, we wanna fix it within 24 hours. So, we need to make sure that we provide opportunities for those things to bubble up within the organization and then get resolution. And sometimes if we can't resolve them, they then go back to what we've set up at each of the hospitals so far. And those are guiding coalitions. And those guiding coalitions they identify, okay,"Here are all the things we're focused on as an organization. We need to prioritize where we apply resources to improve process." And so, we apply a lot of what we -- We give a lot of weight towards strategic priorities, so access, cancer growth and redesigning how we care. That gets a lot of emphasis, but we should also focus on resources that look at things that just bubble up through the daily management system. What I would see coming for us over the next several years is as the daily management system becomes more and more robust and gets more connected back to our strategic planning and how we just develop strategy for the future, the better our outcomes will be, the better or more comfortable people will feel at the front line to actually resolve those problems, and raise their hand and say,"Hey, I need help with this." And that help may come from the hospital's process engineering or the system process engineering team. But it also might mean someone within the system goes,"Hey, yeah. I see you're struggling with that. Let me help you with that." I mean, ideally, this would be part of that kinda self-perpetuating process. I mean, that's where I would like for us to be over these next several years where it just has its own organic momentum.

DR. SCHAAL:

One thing that I would like to mention is you and I were at one Vizient conference a couple of years ago, and we -- as we were in this top performers, Vizient top performers. These are organizations that are the top of the country in terms of ranking of quality and patient safety, you know, the best quality performing organization in this nation. And we were in this top performers' room and we asked around, you know,"Are you a Lean organization? Do you have tiered huddles?" In every organization except us at the time, had this. And this actually empowered us to go and get this journey going.

MR. SIEBENALER:

It was validating honestly, to be in that room and to ask the question. And to see every hand go up in the room was pretty impressive to me. I think for us, it's, you know, how do we nurture, create the right culture within our organization that is constantly focused on continuous improvement? Because it matters to someone.

DR. SCHAAL:

So, I have to end with a question that I ask all my guests here today. And the question is what does quality mean to you?

MR. SIEBENALER:

That's a big question. When I talk to people, to consumers or to people outside of healthcare, they describe the things that we did and how it made them feel. And so, when I think about those things, they are patients. They know more than just we made them feel better. They know that we do certain things while we're caring for them that we do it for a reason, whatever that might happen to be. And we're getting more and more data around on how patients and family members perceive, how we round, we talk to them, how we include them in the care planning process. And so, for me, what I see is I would envision an organization where every single individual in that organization knows exactly what their role is and how it contributes to this organization being the best it can possibly be. And when you can walk up to anybody, I don't care what that person's job is in the organization, they can tell you,"This is my job and this is how I make a difference every day," to me that is kind of the picture of quality. Because then everyone knows exactly what they're trying to do. And I think that's kind of my mental picture for how I envisioned this being. That at any point in time I could walk up to any employee, in any clinic, in any setting and they would te -- be able to tell you,"I know exactly what my job is and how I contribute, how I make it better, and how that ultimately makes it better for patients or for my colleagues down the hall."

DR. SCHAAL:

So, I love that you said that quality is how a product makes you feel. You're original in that way. I haven't heard that answer on this podcast yet. And you know, while reflecting on this, we have people coming to us not because they feel good. Usually, they have a disease, something that makes them feel unwell. And also, the people who give care. It's a very stressful environment and not always you feel good, so quality maybe is getting to a state where we can help everybody feel better because everybody knows their role, everybody is improving, and everybody is committed to what they need to do. I love that. Thank you, Mr. Siebenaler. I very much enjoyed, you know, talking to you, Chris, today.

MR. SIEBENALER:

That was a pleasure. And you're a great partner, and so I enjoy not only working with you but you challenging, kind of, our mindset around how we do things. And I love that sort of interaction 'cause it helps us become better and better.

DR. SCHAAL:

Thank you for listening. Quality Time is part of Houston Methodist Leading Medicine series of physician- led podcasts. So that you never miss an episode, subscribe to Quality Time. New episodes will download to your podcast device. If you enjoyed our conversation today, please consider rating this episode and sharing it with your colleagues. I appreciate your support. Thank you. And until next time, I am always listening.♪ ♪