Rae Woods (00:02):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. You've probably all seen headlines about decreasing quality in US healthcare. Maybe you saw that the Joint Commission reported an almost 20% increase in adverse events in 2022. Or maybe you're tracking the rise in behavioral health needs or in maternal mortality. These are just some of the metrics that are sitting far from benchmark. The fact of the matter is in 2024, patients are not all right and I'm not sure that we in healthcare business are all right either. Our industry is challenged with ongoing workforce shortages, rising health needs, misprevention, cost avoidance, workplace violence, rising spend. I could go on. In fact, in many ways, patients and our industry are all emerging from the COVID era in worse condition.

(01:03):
Today, I want to talk about why the patients aren't all right. And I want to talk about how we even define and measure clinical quality and what leaders can do to improve outcomes for everyone. We're actually going to do this in a couple of different parts. First, I've brought my colleague Darby Sullivan. Advisory Board is trying to understand where quality and safety is today. And then we're going to turn to Dr. David Baker, he's the executive vice president for Healthcare Quality Evaluation and Improvement at the Joint Commission. Meaning, he's on the front lines of trying to measure, track, and ultimately improve quality and safety in healthcare. First, let's go to Darby.

(01:45):
Darby, welcome back to Radio Advisory.

Darby Sullivan (01:48):
Thank you for having me back.

Rae Woods (01:51):
Tell us where things stand today. I've seen the headlines, our listeners have seen the headlines. The sense I get is that quality and safety is not in a good place in 2024. Is that true?

Darby Sullivan (02:04):
Yeah, so that's exactly the question that our research team set out to find because we were also seeing these alarm bells ringing about safety and quality measures plummeting. And we wanted to have a sense of, "Okay, can we get a little bit more specific than that? Where exactly is this quality and safety problem if there is one?" So that we can get a better sense of the root causes.

Rae Woods (02:30):
And what did you find?

Darby Sullivan (02:32):
So we conducted a data analysis of a huge database from the AHRQ to try to figure out where quality was today. I think the bottom line was that it's an unclear picture. There are some areas where we're doing good or okay and then there are some areas where we are really, really struggling.

Rae Woods (02:55):
So what I'm hearing you say is that it is unfair to blanket statement categorize performance in 2024 as bad when it comes to quality and safety. We have to look deeper and actually look at where we are far from benchmark, and that's where we start to see certainly some improvements. That's a good thing. But we do see some stark declines. My question is why are things changing? Why are things declining in these certain areas today?

Darby Sullivan (03:22):
I think the reasons why we're seeing backslides in some specific areas today is for a few reasons. One, we might feel done with COVID, but the workforce is not. And how to address workforce shortages? Burnout is still the number one question that we get from the provider C-Suite these days. So that plus at the same time, patients are increasingly complex. They have more behavioral health needs, which makes it more challenging to manage their chronic conditions writ large. They're increasingly older. I've heard from clinical leaders that even four years on past the pandemic, they're still managing the aftereffects of delayed care.

Rae Woods (04:02):
Yeah. And of course, those two things are interrelated to each other, right? As patient care gets more complex and staff is strained, that is only going to put more of a strain on quality, which trickles down to outcomes, which trickles down to actual safety and adverse events.

Darby Sullivan (04:19):
Which all of these things cost money to address. And provider organizations have less and less of that these days.

Rae Woods (04:26):
I don't know how to ask this question any other way than bluntly, so forgive me here. But if we get into the weeds of these specific metrics, does that still get us to looking at overall quality as a collective ambition? Thinking back to our assumption at the beginning, which is that quality is suffering today, do these metrics actually help us understand a picture of overall quality?

Darby Sullivan (04:53):
In some ways. So like I mentioned, it's a pretty robust database. And what we learned were the areas that are struggling the most are not the areas that are getting the biggest attention in the press.

Rae Woods (05:06):
Really?

Darby Sullivan (05:06):
Yes.

Rae Woods (05:07):
I would think it's the opposite. I would think the areas that are struggling are exactly the areas where we're seeing headlines. Behavioral health is one that you mentioned. Maternal mortality is one that I'm sure we can talk about and so on and so forth.

Darby Sullivan (05:16):
Some of it depends on what we're talking about when we talk about quality. For a lot of folks, when there is quality and safety in a headline of an article, it's going to be about the inpatient setting and it's going to be about falls. Or it's going to be about hospital-acquired infections. Some folks only think about quality as the care that's delivered primarily in the inpatient setting. But our definition of quality is a little bit more expansive like you said. It's not only the care that's being delivered, it's also the outcomes of that care. The problem of that definition is that it's basically everything in healthcare.

Rae Woods (05:52):
Wait, wait, wait, wait. You just said something that sparked my interest. You said that we as a research team came up with our own definition of quality. Is that because the industry doesn't have its own definition? I guess, who decides what quality means?

Darby Sullivan (06:09):
What we found in our research was that every single organization has their own definition of quality. Well, I should say they have their own two definitions of quality. One is the ideal. So in an ideal world, quality means we're providing holistic care across all settings. It's patient centered, it's equitable, it's efficient, it's timely. All of these things.

Rae Woods (06:34):
Yields very high-level, dare I say gauzy.

Darby Sullivan (06:36):
Dare you say gauzy. So everyone has their own special tweak on that. That's the ideal, which I think everyone in healthcare would want us to get to. But at the same time, we have a practical definition of quality. Or at the same time, every organization in every healthcare sector has a practical definition of quality. And what that means is that when we have such a gauzy ambition, well, how do we know what to focus on? We're going to focus on the things that we are financially incentivized to do. And only those things-

Rae Woods (07:08):
To do, to track, to measure, to be rewarded for, penalized against. And we should remind our listeners that a lot of different players are responsible for setting those standards on the interior of the delivery system.

Darby Sullivan (07:22):
Correct. And that's what makes provider organizations pull their hair out sometimes, is that they have to react to quality dictates that are coming from many different payers. All of a sudden, they have hundreds and hundreds of quality metrics they need to track and report on. And some of them, they don't feel like are clinically relevant, they're burnt out.

Rae Woods (07:44):
And it seems like you might be circling around one of the root causes. And the very reason why we are seeing declines in some of these benchmarks is that there isn't a set definition, there isn't a set standard. There are all these different metrics that all these different stakeholders are holding providers accountable for in a time where their patients are getting sicker, and their workforce is getting more strapped. Is that right?

Darby Sullivan (08:10):
Exactly. So a big first step I think in starting to make more progress in the quality space is for plans and providers to start to come together more. To come to consensus on what are the most important metrics and elements that we need to be tracking and streamline from there.

Rae Woods (08:30):
I like this idea. And I think it's really, really important and very true that we need to get other players, other stakeholders involved if we're actually going to address this root cause. What specific advice do you have for the provider organizations and the plans in particular who are listening to this episode?

Darby Sullivan (08:48):
I think number one is to get a better sense of where your partners are coming from. Sometimes folks tend to finger point because they have so much on their plates and feel overburdened. So for example, provider organizations feel a huge burden to keep up with the number of different metrics they have to track for quality. And sometimes they don't even think about, "Hey, how can I start conversations with my payer partners to streamline these or to understand where some of these are coming from and to understand the clinical value?" And at the same time, plans who of course want to hold providers accountable for higher quality care, they also need to align with dictates that are coming down from CMS regulatory bodies. They can do a better job of explaining the why behind some of the metrics. So yeah, as I mentioned, the big first step is coming together to get a more aligned definition of quality. And figure out what are the minimum amount of metrics that we need to sufficiently incentivize improvement. And at the same time, letting providers be agile.

Rae Woods (09:56):
This is a lot. Where do you want our listeners to start?

Darby Sullivan (10:00):
For that, I would go back to our findings from our data analysis. We found that the primary areas where quality is furthest from where we want it to be, where it's getting worse. And where we're seeing marked racial disparities, all surround, unmanaged, chronic diseases including and especially opioid use in diabetes, which I'm not sure would surprise anyone. But all chronic diseases. When we look at hypertension, when we look at heart failure, asthma, COPD, all of these chronic disease metrics were spiking. And notably, when we looked at which of these metrics had racial disparities, 85%, the vast majority of these metrics were demonstrating racial disparities.

Rae Woods (10:47):
Wow.

Darby Sullivan (10:48):
So that's not to say that every organization should focus 100% of their efforts on opioid use in diabetes. Obviously, this will depend on your market, on your patient needs. But I think when you start to parse through the data to find out which ones are furthest from our goal, which ones are actively getting worse over time. Meaning, we have some potential to get back to baseline. And which ones have marked racial disparities, that's a great place to start.

Rae Woods (11:17):
Darby, I'm reflecting on our conversation and all of these light bulbs are going off for me. I hear you loud and clear that we actually don't have an industry-wide definition for quality. And that is exactly why individual providers set goals and standards for themselves. And why all of these other stakeholders, all these other regulating bodies set their own standards metrics have means of tracking. So that we can both see where there are problems and ultimately advance towards better quality. And it sounds like that is a necessary and important step so that we can keep moving the industry forward.

Darby Sullivan (11:55):
That's right.

Rae Woods (11:56):
I love the research that you all have done thus far, but I almost want to talk to one of those partners, one of those regulating agencies.

Darby Sullivan (12:08):
I think you should. And I think you should start with the Joint Commission.

Rae Woods (12:12):
Darby just set the stage for us. We talked about where we are as an entire industry at a high-level. But as she said, we really need to talk to some of the partners that are responsible for tracking, measuring, and helping to find gaps. And ultimately, improve quality in healthcare. So with that, we're going to turn to our friend at the Joint Commission, Dr. David Baker.

(12:46):
Dr. David Baker, welcome to Radio Advisory.

Dr. David Baker (12:51):
Well, thank you. It's a pleasure to be here, Rae.

Rae Woods (12:53):
Do you mind if I call you David?

Dr. David Baker (12:55):
Oh, of course, please.

Rae Woods (12:57):
Well, I want to make sure all of our listeners are on the same page. The great thing about this channel is that we have listeners from all across the industry. We even have students listening, which is something that's really exciting for us. So let's just make sure that we're all level set here. What is the role of the Joint Commission in healthcare and in quality? Tell us and tell our listeners the kind of work that you do.

Dr. David Baker (13:21):
So the Joint Commission is the world's largest healthcare accreditation and certification or organization in both the United States and over 70 countries worldwide. At the core of our work, we survey healthcare organizations to determine whether they have structures and processes in place to provide safe, effective, equitable, and patient-centered care. And we accredit organizations across the full spectrum of care. So we're best known for our work accrediting hospitals, but we also accredit post-acute care, home care, ambulatory care, behavioral health, et cetera. With respect to the processes, what does that actually mean? Surveyors go into organizations and spend anywhere from one to five days working with the organization depending upon the size of the facility. So obviously, there's a huge variation in the size and type of those facilities.

(14:18):
And the survey team talks to leadership and staff reviews policies and procedures and inspects the physical plan. And surveyors also, very importantly, they review patient's charts and talk to the patients to what we call trace their course of care. So based on this, they can drill down into any issues that they find and determine whether they're what we call requirements for improvement. So these are what the organizations get at the end of that process is a listing of what they need to address. And organizations usually have 45 to 60 days to correct any problems that were found and provide evidence that they're into compliance.

Rae Woods (15:06):
And these are problems in quality, in safety, in outcomes, in all of the things that we as patients, and we in healthcare business, want to make sure that care delivery is upholding their end of the bargain. Is that right?

Dr. David Baker (15:18):
We are credit organizations. So we look and say, "Did they have the structures and the processes in place to provide a high-quality and safe and equitable care?" And the best example to me is medication management. If you do not have certain processes in place, regardless of the condition where you are in the hospital, then somebody's going to get a wrong medication.

Rae Woods (15:45):
Yes, yes. So that's what the Joint Commission does. Let me step back for a second. And if I'm honest, a lot of our listeners are probably aware of headlines, frankly, that they've seen that are about quality and safety in US healthcare today. But what are you seeing? How does that compare to what you're seeing at the Joint Commission when it comes to the industry's performance in 2024?

Dr. David Baker (16:12):
So I'll say it is a real mixed bag what we're seeing. There are some tremendous bright spots. And then we also see there are many organizations that are struggling. One of the biggest things, bright spots is just the scientific advances that we're seeing. So cancer care, we have stroke certification programs, and the advances in the stroke and neurologic diseases are just amazing. But the areas that we're seeing... The biggest challenge is right now is the nursing shortages. The nursing shortages, everybody has heard so much about this from COVID, but it's still a persistent problem. And we're seeing problems with medication errors, pressure injuries, sometimes failure to rescue. That in other words, a patient is declining, and they don't have adequate staff to address that. And one thing that's also very interesting to me, and particularly in the behavioral health, we're seeing complaints that because of inadequate staffing, there's workplace violence. Yeah. And I want to emphasize as well, it's not just the nursing shortage, there's shortages of respiratory therapists and of pharmacists.

Rae Woods (17:29):
Oh yeah, it's everyone. It's everyone up and down the clinical care team, right? Yeah. And so I'm trying to think about what this means at a high-level? Is it correct to characterize the state of performance now as variable that there are these bright spots, there are these scientific advancements, there are these great improvements. But at the same time, we're falling short in other areas? Is that kind of variability how you would characterize performance generally, or should we have a different conclusion here?

Dr. David Baker (18:00):
I think that that's accurate. That again, we get to see the best of the best. Let's face it. I mean, some of the hospitals, particularly that you go out and see, they're doing amazing care. But they're also, they've got very rigorous data collection methods for measuring quality and safety. And they're using that at the bedside. The teams are working with this information. But then like I say, there are some that are really struggling financially and that has impacts across their entire systems. It's this vicious circle that there's a nursing shortage and nursing costs and other staffing costs are going up. So that limits the resources that organizations have to do other things, including quality improvement activities. I think things are improving somewhat. But many organizations were still seeing problems because when I talk about the surveys, what I said before, Rae, it's important. We also evaluate about 20,000 complaints per year.

Rae Woods (19:10):
Complaints from patients, from caregivers?

Dr. David Baker (19:14):
Patients, families, staff. So this is one of the other things that we see when these complaints are coming in. Nursing shortages in particular is one of the biggest issues that organizations are struggling with.

Rae Woods (19:32):
And what you're leading me towards is the fact that in 2024, we need organizations, we need leaders, we need executives to be focused on improvement. Even though there are these bright spots that we're seeing, even though we don't want to characterize performance in 2024 as we're all in this terrible state, there is still a focus on improvement. Particularly on quality, particularly on safety. I want to get into what we want to see from our listeners and from health leaders next. Even though there are these bright spots, there's this variation that we have to deal with. There's the fact that there are, I should say, areas of underperformance. We need to focus on improvement in terms of safety, in terms of quality. And I want to get into how to do that. And I want to talk about the Joint Commission's role specifically. How do you even determine what to survey, what to measure, what to focus on in a world where there is so much going on for today's providers?

Dr. David Baker (20:32):
Well, the majority of things that we survey are routinely surveyed. We have to survey to CMS is what we call conditions of participation. So I mentioned medication management, environment of care. There's a number of areas that are just standard things that always need to be surveyed.

Rae Woods (20:53):
These are muscles we're flexing all the time, right? Yeah, I got it, yeah.

Dr. David Baker (20:57):
Yep. And we've been doing the same thing for decades. But then we look at these emerging issues and where we can develop requirements and go above and beyond the conditions of participation. So every year, we used to look over the ECRI report a lot and rely on that where they would come out with what are the top 10 safety issues. And we would always say, how are we doing on these things? Do we need to develop new things? But the reality is a lot of these things that we've dealt with, they're just very high-profile issues. So we've already talked about workplace violence, maternal health. There are all of these issues that come forward and we don't have requirements for survey methods. So we go through a process of developing, talking to experts, understanding what's the issue. And the key questions that we ask is how common is the problem? How severe is the problem? Another, how much harm occurs as a result of that? And very importantly, what are the solutions? What are the leading practices for organizations?

Rae Woods (22:14):
This is super interesting to me. Yes. And I love this idea of proactively looking at specific areas of focus. And back to where we started, those are probably the headlines that our listeners are referring to or the pain points that they're most fearful of. Maternal mortality, the opioid epidemic, that's probably another one that's really top of mind for our listeners that I know that you focused on. So what is this process of saying, we need to get ahead of and help set standards so that this problem doesn't get worse, but ultimately improves because it is such an area of focus?

Dr. David Baker (22:48):
Yeah. So most of the time, things are already a pretty serious problem when they come to attention.

Rae Woods (22:55):
Yes.

Dr. David Baker (22:56):
The maternal crisis is an interesting one because the data was around for a long time. But then about 2016, 2017, people began to say, "Oh, this is not just something that our rates are going up because patients are sicker and older, but it's actually a quality issue and the huge disparities emerge." So when we found out about that and we started looking at the literature, then again, our typical processes. We meet with the leading people in the field, and we talk. And again, we say, "What are the specific issues that need to be addressed?" So we focused in on the two biggest causes of maternal mortality, which were severe hemorrhage and severe elevated blood pressure.

(23:49):
And we said, "Okay, what are the things that those leading organizations are doing to try and address this?" And just one example was having hemorrhage carts, for example. So that if you have a severe hemorrhage, you don't want to have nurses running around trying to find the equipment that they need. They should be able to come to one place and within seconds have all the equipment that they need to save a woman and the baby. So that's one of the requirements, for example. And there are others, obviously.

Rae Woods (24:22):
And I love that example because we spend a lot of time on the healthcare business side. We've spent a lot of time on the Radio Advisory podcast, in particular, talking about some of the other structural issues within things like maternal mortality. But I love that you're getting to these root causes and saying, "Ah, this is the thing that we need to frankly hold folks accountable too with the ultimate goal of making patient care, patient outcomes better." We'll be right back with more Radio Advisory after this short break.

(26:25):
One of the trends that we've seen over the last several years, regardless of who we're talking to, is that when it comes to quality, there's this focus on moving away from the average. Moving away from the median and saying, "We need to look at outliers because we want to make sure that we're providing as equitable care as possible." That's absolutely something that is sparking in my brain and I'm sure our listeners' brain when we talk about maternal mortality in particular. How do you start to think about equity in this process?

Dr. David Baker (26:59):
I hope most people know that equity is one of the top priorities for the Joint Commission. Last year, we launched new accreditation requirements around healthcare equity, and we've also recently launched a certification program. So we look at this... I look at this pretty simply. Is there patients within your organization that are not getting the care that they need or subgroups of patients? And that could be race, ethnicity or language. New studies just came out, there's still major problems with women not getting the cardiovascular care that they need. So as you said, organizations need to be looking at their data and saying, "Are there groups of patients for whatever reason that are not getting the care that they need?" And if that's the case, then we need to put in strategies, interventions to try and reduce that. So that's it in a nutshell. I mean, obviously, this is a social justice issue as well. But first and foremost, it's a quality and safety issue.

Rae Woods (28:10):
Yes. And I'm sure that one of your goals is to see more and more hospitals, health systems, delivery organizations try to seek that extra layer of certification and accreditation.

Dr. David Baker (28:24):
Absolutely. I think the certification program is really across a broad swath. So if you want to say, what's a framework for addressing equity? Look to the certification requirements because again, it's not specific to any one area. It's engaging the community. It's screening for health-related social needs. So we hope that many organizations go down the pathway to achieve certification. But the other thing is even if they never get certified, we've got the resource center and they can go to and say, "Okay. Well, we might not be able to do all of these things, but let's choose some of these and start." Move down the pathway so that as many people can benefit as possible.

Rae Woods (29:11):
What I love about what you're saying, and the takeaway that's forming in my head is that we have to focus on continuous improvement. And that means changing what we're measuring, changing our goals, changing our focus areas, maybe even taking things off of our to-do list. Because we have to continuously shift and move the goalposts if we want to get to quality and safety improvement. And I hear that from you when it comes to the specific areas of focus, maternal mortality, workplace violence. But also, in measuring different things like focusing on certification with equity. And even though all of those are specific to your role in your organization, every single one of our listeners can take that mindset of continuous improvement, changing what we focus on, changing what we stop focusing on when it comes to their quality and safety efforts.

Dr. David Baker (30:06):
Absolutely. And I'll just point out that we did exactly what you're talking about, Rae. And we retired almost 400 requirements that we thought were no longer necessary last year.

Rae Woods (30:17):
Wow. How?

Dr. David Baker (30:18):
There are other things that organizations should be focusing on.

Rae Woods (30:23):
And that's actually where I want to go next. And your role is really interesting to me because you've lived in both worlds, right? You are a physician, you've been a practicing physician, you've been at the Joint Commission for some time now. And I imagine that you're going to tell me that any organization's quality and safety strategy should not begin and end with the role of the Joint Commission. There are other things that every organization needs to be doing to focus on quality, equity, safety, et cetera. My question for you is, what's on your wish list? What are the things that you want health leaders to be focused on if we're really going to get out of this moment of variation and really continue to improve?

Dr. David Baker (31:04):
Well, first of all, let me say you're exactly right. Couldn't agree with you more. The Joint Commission requirements are a starting point to make sure that these fundamental structures and processes are in place. Absolutely critical. But then they need to be able to use, again, the advanced data systems that organizations have now, electronic health records to be able to identify where there are issues. Talk to your clinicians, listen to the teams and say, "Here are areas that we need to work on." So they should be able to concentrate on those. And some of those may be safety issues, some of them may be quality issues. When I was chief of general medicine in geriatrics at Northwestern, and we did a lot of work on immunizations in general medicine. And then we were talking to the people in rheumatology. And many of their immunocompromised patients were not getting vaccinated, and that's a common nationwide issue. So we worked with them to try and improve that.

(32:14):
So I think the key thing is engage your staff, listen to them, and then say, "These are the areas that we need to improve in." Use your data to identify those different areas and explore those. And that includes, obviously, this is one of the ways that you're going to find inequities. But just more generally, this is the high reliability system is constantly looking and saying, "Are we doing as well as we possibly could be?" So again, at Northwestern for cardiovascular disease, for some of our measures, we are at 95% and you could pat yourself on the back. But I said that means that there are 50 patients in our clinic who have coronary artery disease that aren't getting care. Really engage everybody in this quality effort. That's the most important thing.

Rae Woods (33:15):
I love the relentless focus on... And I'll say the relentless focus on the ones digit, I think is actually really, really important because we are talking about real people. And thank you for giving our listeners a clear takeaway for what they can be doing in 2024 as they strive to improve quality and improve safety. Before I let you go, I want to ask about what's next? What's next for you? What's next for the Joint Commission when you think about quality and safety improvement in 2024 and beyond?

Dr. David Baker (33:45):
So we have four priorities and we use the HELP acronym. The H we've already talked about, which is healthcare equity. And that's such an important activity for us. I would really encourage organizations to look to the resource center that we have that's openly available. And we really want to help organizations move forward and go above and beyond the accreditation requirements. The second is environmental sustainability. And this has been a controversial topic.

Rae Woods (34:26):
Not something that folks would think about. But is actually something that we've also talked about on Radio Advisory as something that is important, not just for patient outcomes. But also, we talked about it for business sustainability moving forward. So that's exciting for me to hear that that's on your radar.

Dr. David Baker (34:41):
Absolutely. The healthcare system is such a major contributor to emissions, carbon emissions in the United States, as you know, and you've talked about. And there is so much that can be done to address this. So we have a very basic certification program for this and a resource center. We're partnering with organizations around the country to try and push organizations forward. And just one nice example, we've been talking with people at this Project SPRUCE, University of Washington, on reduction of anesthetic gases. And it's unbelievable, 80, 90% reduction in the anesthetic gases for this children's hospital.

(35:31):
So everybody really needs to pitch in for this. People don't think about this as a quality and safety issue. But I use the example of if somebody comes in because of a heat emergency and they have an exacerbation of heart failure or lung disease, they get treated and then they go home. And my sister lives in Portland, Oregon. And a few years ago, it hit about 113 degrees, and they're going to go back. Nobody has air conditioning there. So they're going to go back to an environment that is just going to lead them to end up back in the hospital.

Rae Woods (36:10):
So that's H and E. What else is on the radar?

Dr. David Baker (36:14):
L is learning. And right now, one of the most important things for organizations to be doing is to strive to be a learning healthcare system. So again, they've got all of this data. We've talked about this, how you want to be able to use the data for improvement. But you also want to be able to use the data for research, new insights. Artificial intelligence creates tremendous opportunities for improving quality and safety, as well as innovation. But how do you use that data in a responsible way? So we've got a certification program for responsible use of healthcare data that ensures that organizations are following best practices. For example, de-identification of data and making sure that patients' privacy and their rights to control their data are being followed. P is performance improvement. I think people know that we have a strategic affiliation now with the National Quality Forum. And we think that that's really going to be able to allow us to accelerate our development of performance measures that really matter. So engagement with payers, as well as healthcare organizations and work on that next generation of measures, particularly electronic clinical quality measures or digital measures.

Rae Woods (37:44):
No shortage of things to focus on. I am happy to say that a lot of those are some of the same areas where we would advise health leaders need to be involved in. And frankly, what we're going to be talking about on this very podcast. So stay tuned for more from the Joint Commission and more from Radio Advisory in 2024. Thanks so much for coming on the pod.

Dr. David Baker (38:02):
Well, thank you so much for having me. This has really been a pleasure talking with you.

Rae Woods (38:13):
Sometimes on this podcast and in healthcare business, I feel like my role is to frankly scare you all a little bit, right? Spur action by telling you about the problems that are in healthcare. I don't know that I'm going to do that this time because I think some of the headlines are actually maybe not painting the full picture. Yes, we need to address quality and safety today, but we've also seen a lot of improvements. It will take partners that come together to address the specific challenges that we see today and to proactively address the challenges that might come tomorrow. There's a lot that all of you need to do together. But remember as always, we're here to help.

(39:10):
If you like Radio Advisory, please share it with your networks. Subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Kristin Myers, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, and Erin Collins. Thanks for listening.