Dr. Fleshman speaks on intersection of Quality, Leadership, and Zero Harm in Abcarian Lecture

James Fleshman, MD, FACS, FASCRS
James Fleshman, MD, FACS, FASCRS

To be a true high-reliability organization (HRO), hospitals need to foster emotionally intelligent leadership and culture, according to James Fleshman, MD, FACS, FASCRS, who delivered the 2020 Herand Abcarian Lecture: Quality, Leadership, and Zero Harm, on Tuesday morning, October 6. The lecture will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.

Dr. Fleshman, the Sparkman Endowed Professor and chair, department of surgery, Baylor University Medical Center (BUMC), Dallas, TX, spoke on the how the American College of Surgeons helped BUMC to identify its quality strengths and opportunities to improve, as well as the lessons he and fellow leaders have learned on how a positive culture can promote high reliability.

Surgeons are self-described leaders, want the best for patients, and are responsive to data. “Most surgeons are independently driven by the search for excellence, and they are all willing to function as part of team if they understand that the goal is excellent patient care,” Dr. Fleshman said.

The ACS Quality Programs offer invaluable resources for improving surgical quality, but it is not a simple task to define what quality means. When considering a definition for BUMC, Dr. Fleshman said the hospital reviewed all its separate data and quality mechanisms. To become an HRO, BUMC contacted the College to begin a review based on the principles for Optimal Resources for Surgical Quality and Safety (the Red Book). “I trusted the fact that the College has over a century in support of quality, and I knew we would get an answer to our questions of ‘how do we become a HRO?’” he said.

The multistep review included a pre-review questionnaire, multidisciplinary team meetings, leadership interviews, review of QI mechanisms, and more, which revealed in BUMC that the 12 reviewed Red Book standards were rated good or better, and several were great or excellent. The ACS provided 10 opportunities to improve, and the direct results have been impressive. BUMC has instituted a standardized peer review process, increased collaboration between the SQO and medical quality officers, and has started communicating root-cause analyses with the entire health system, among other achievements.

With these improvements and standards in place, how does a high-quality institution achieve zero harm? “No one wants to hear it, but I think we have to change culture,” Dr. Fleshman said. “You can state it any way you want, but it’s all culture change. And the only way to change culture is for the leaders to get involved.” Leadership, Dr. Fleshman said, “is emotional intelligence applied.”

Dr. Fleshman suggested that emotional intelligence, or EI, “allows us to be socially aware and learn optimism in our own practices, and is reflected in team functions and conflict management.” An institution and leadership that can identify and prevent conflict and improve care of a patient is an ideal institution to become an HRO, according to Dr. Fleshman. EI-conscious leaders are dependable and act purposefully while being cognizant of their workers’ emotions—all traits which are necessary to changing culture and that lead to sustained quality improvement.

At the Baylor department of surgery, steps to zero harm are focused around applying enhanced recovery after surgery principles in the five phases of care; professionalism education; interdisciplinary team education on communication styles, conflict training, and data dashboards to drive opportunities to change; and more. Leadership drives culture, which drives quality improvement at BUMC, and the goal of zero harm is their motivator, Dr. Fleshman said, noting that, “Ultimately, it’s the patient that benefits, and that needs to be paramount in our thought processes.”