Joey Wahler (Host): It's an organization aimed at improving U.S. Healthcare, so our guest is Dr. Robert Valdez. He's Director of the Agency for Healthcare Research and Quality for the U.S. Department of Health and Human Services.

This is the Healthcare Executive Podcast from the American College of Healthcare Executives, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org.

Business intelligence and data analytics can uncover opportunities to improve revenue capture and optimize savings without compromising patient care. Learn how at amnhealthcare.com. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Valdez. Thanks for joining us.

Robert Valdez, PhD: Hi there. I'm so glad to be with you today.

Host: Wonderful. Great indeed to have you aboard. To begin with, you have an extensive background in health services, research, and health policy analysis. So in a nutshell, how did you get involved in those areas and why are they so important to you?

Robert Valdez, PhD: Well, I came to Health Services Research and Health Policy Analysis really out of my interest in leading and running as my University of New Mexico professor used to say, Professor John Griffith, and he outlined in his massive book that has led many of us to figuring out how to run a well-managed healthcare organization. in that book, he outlined the notion of applying evidence-based practices that really lead to high-performing organizations. And it's based around six basic practices that in many ways health services research has helped establish through developing the evidence that's required to do that. Establishing a transformational culture, probably the most important thing that we can do as leaders. Continuous improvement, trying to figure out how do we stay ahead of the game. Benchmarking, tracking, and measurement, all of those are techniques that are natural in the health services research world and that you learn trying to become servant leader and also, you know, empowering your staff and retaining high quality staff. It's really about also building interprofessional teams, recognizing that every member of your organization, from the janitorial services, through your supply chain people, to staff nurses, to the technicians, to the clinicians, they're all part of that team. And building that interprofessional team is what produces a well-managed healthcare organization.

You know, health services research and policy analysis are, in many ways, the research and development tools of our industry. They're what allows us to pursue the goal of this high-performing organization. I started my career at UCLA by actually teaching in the health and hospital administration programs. We had three at the time. It was an MBA, MPH program with the Anderson School of Business and the School of Public Health, our hospital administration program, and our health planning program. And all three of those really required us to use the tools that we learn in health services research and health policy analysis to apply those to the management environment.

Host: Well, you said a couple of things there, doctor, that got my attention. One is, I know from my own experience, it's cool, isn't it? When years after schooling, we still remember some of the teachings of our college professors, right?

Robert Valdez, PhD: Oh, absolutely. And having been a university professor for most of my career off and on, it's always great to see my students take on the next generation of work.

Host: And then, one of the things you listed there a moment ago was the importance of building the right culture. It's a term we hear used so much nowadays For instance, in the sports world, have to have a winning culture, have to have the right culture. What to you is the right culture in the world that you work in?

Robert Valdez, PhD: Well, the world I work in is the one that audience works in, and that is the healthcare industry. Nothing's moving faster than the healthcare industry and the way we organize and deliver services, the kinds of payment schemes, and approaches that get pulled together. And that really requires us to have a transformational mindset, and that is a lifelong learning mindset because nothing stays the same for very long in our industry.

Host: That's for sure. Now, the agency for healthcare research and quality is the lead federal agency charged with improving the safety and quality of healthcare for all Americans. So, I'm sure it's a long list, but what are just some of the objectives and strategies to accomplish this?

Robert Valdez, PhD: Well, you know, actually, the Agency for Healthcare Research and Quality is unique among federal agencies, because we're charged with improving healthcare. And people forget that it's care, which is the product of our industry. And for the last 35 years, we've been pursuing how to improve the quality of care that consumers receive and really improving the consumer experience with their care. Quality improvement can only be driven by understanding the consumer experience in allowing us to pursue quality among its six dimensions. For some reason or another, people talk about safety and quality, but quality is the large concept. And within it, we pursue six different dimensions of that quality in order to create truly a high quality product, which is our services. And it's really patient centeredness, safety, which is, you know, one of those dimensions that you mentioned, timeliness, the effectiveness of the care and the efficiency in which we provide it, and the fact that it needs to be equitably distributed across our nation.

Now, AHRQ goes about this work by generating the evidence that makes this possible. It disseminates and helps implement what I call actionable knowledge, and that is the synthesis of this evidence that's been generated in our R&D work, in our health services research activities. And it also is focused on improving primary care, the base for a strong healthcare delivery system.

Now, all healthcare is local. And so, we've got to really partner with consumers and healthcare leaders in all of our local communities, as well as the clinicians and the local and state governments that are really the regulatory bodies in our industry. In some ways, I like to call the Agency for Healthcare Research and Quality is to healthcare systems as CDC was to set up to serve public health systems. That is we generate the evidence, that is we try to understand how care is delivered now and how it can be delivered better. We move evidence into practice by filling that evidence to implementation gap. We do the synthesis of evidence that creates actionable knowledge that allows us to develop tools and trainings and resources that are available on our websites and other training programs. And our webinars to help healthcare leaders do their work better. And we also provide and collect the data that's necessary for monitoring and feedback to understand performance and to do the analytics and reporting that are required to create the industry regulatory environment.

As director, I've really pursued three main objectives at the Agency for Healthcare Research and Quality, and that is to help improve local healthcare performance by reducing fragmentation, which is something that American healthcare is known throughout the world for, probably not the best thing that we want to be known for, to improve primary care in a variety of different ways to improve patient and workforce safety because we've suffered tremendously, particularly during the course of the pandemic with a rise in patient safety events.

The second objective is really about aligning financial incentives to respond to the opioid crisis, to integrate behavioral and primary healthcare and really improving the practice standards that lead to improved guidelines making value-based contracting a real possibility.

And the last major objective is how do we improve the resilience of our healthcare systems? We lack the evidence really to understand that in an all-hazards kind of world, where we face hazards biologically, such as the COVID 19 pandemic. Pandemic that we just went through. But also climate disasters that are occurring in all of our different communities, whether it's a tornadoes that we've been seeing in the Midwest the last couple of days, or the hurricanes we can expect in the coming months from the Gulf.

Coast or the mudslides that we often see in the West Coast where I used to live. But also financial vulnerabilities that we've seen as a result of the pandemic. how do we become much more resilient to those kinds of threats to a high performing organization? That's really this set of goals that the Agency for Healthcare Research and Quality are working towards and working in partnership with the American Hospital Association, with healthcare executives around the country and clinicians and clinician organizations around the country.

Host: Certainly a full plate indeed. And switching gears just a little bit, doctor, healthcare leaders are starting to prepare for the use of generative artificial intelligence in their organizations. So, how would you say they can use it to enhance the patient and customer experience? And what do they need to consider when applying it in a healthcare setting? We hear it talked about in, of course, many other walks of life and industries these days.

Robert Valdez, PhD: Yeah. There's a real interest in generative AI and people think artificial intelligence is new, but we've been using artificial intelligence tools in healthcare since the early 1960s. The current generation of AI tools represented by large language models like generative AI offers multiple opportunities, opportunities to optimize workflows, opportunities to improve communications, because much of our work is about communication, or improve decision-making by using analytic tools to make predictions and to figure out where and how we can move our patients through the system and through their care better.

Much of public focus and discussions have been around clinical applications. I think it's probably a little too soon to talk about extensive clinical applications using generative AI, but it's not too far off. For healthcare executives, it's really about understanding the maturity of the tools vetting the feasibility of their use, making sure that the algorithms and models that are used are based on reasonable data that that makes sense for your organization and also taking care in how those tools are being implemented in practice so that we can transform care both thoughtfully and equitably.

Now, one of the biggest issues that people have with generative AI is this concern around the fact that if you use bad data, you're going to end up with biased results. And, of course, many of the clinical concerns are the result of disparities in health and healthcare that we've seen even without that generative AI tools. If we take what we know now and implement just what we know without questioning those data and how they were collected, they can lead to very biased results and harm. So, some of the areas that all healthcare executives need to think about as they begin to implement AI tools is potential for using them for patient safety reporting, or the automation to reduce medication errors, one of the biggest sources of patient safety events. It also allows us to think about new ways that we enhance our communications for care transitions, an area that clearly could promote patient and family engagement in ways that we haven't in the past. And of course, you know, we've been playing with predictive analytics, but generative AI gives us new tools to do that kind of work differently and perhaps better in association with other tools that we already use for clinical decision-making.

Host: One thing you mentioned there is safety, and I want to ask you, your agency recently launched the National Action Alliance for Patient and Workforce Safety. What's the purpose of that initiative and its goals, and what can healthcare leaders do to support that?

Robert Valdez, PhD: Well, actually this was an initiative that was started through the discussions of the secretary. And it's a departmental initiative that the Agency for Healthcare Research is guiding along with the National Leadership Alliance. That was a discussion that started in November of '22 between the Secretary and the healthcare executives of the 25 largest healthcare systems in the country, and a recognition that patient and workforce safety events had gone through the roof. All the success that we'd made and progress we'd made over the last 25 years in this area had almost vanished or in some areas completely vanished and made worse.

And so, the goal of the National Action Alliance is really to bring together, on a voluntary basis, healthcare systems and leaders to reduce by 50% by the end of 2026 patient safety events. It's a doable goal. It sounds undoable or not doable. But we have the tools, we have the know-how. We just need the commitment. And we were talking about culture earlier. Part of that is really recognizing that we need to have a real culture safety in our organizations, no matter whether we're talking about large hospitals or small clinics or long-term care facilities. It's really an issue of commitment and focus. And so, what the National Action Alliance is doing is bringing together a learning community of healthcare organizations that can share their learnings of how to reduce patient safety events, how to improve workforce well-being, to share the tools that, quite honestly, the public has invested in developing here in the department and make those more readily available to those people who need them.

The Agency for Healthcare Research and Quality, just as by way of example, CDC, HRSA, and others, other agencies, CMS, offer other tools and other approaches, but we're consolidating them, we're curating them so that they're easily found by those who need them when they need them. And so the National Action Alliance is really about how we work together to bring down the rise in patient safety events.

The good thing is that in the year that we've started this, we've already seen progress. Eighty-five percent of hospitals have made some improvement in hospital-acquired infections among the three that have been tracked by our colleagues at LeapFrog. And that's really great to hear, because it's a recognition that working together we can actually regain the confidence and the trust that we must from the public. Because unfortunately for those of you who follow the New York Times, you've seen a series of investigative reports that illustrate how the public is losing trust in their healthcare system. And when they talk about that, they're talking about our local healthcare delivery.

Host: And speaking of which, I wanted to end by asking you, speaking of patient or public confidence, in summary here, doctor, what would you point to as the main ingredient that goes into being an effective leader nowadays in the healthcare industry to help facilitate that trust?

Robert Valdez, PhD: Well, part of that is recognizing and listening to the voice of your consumers. Consumer experience is the key to quality improvement of the services that you provide. Unless and until we listen to our customers so that we can better understand what they need and want, it's going to be difficult to improve the quality of the services that we provide them.

Host: I'm sure those are words that many people listening are glad to hear especially coming from a man of your stature. Well folks, we trust you're now more familiar with the Agency

Joey Wahler (Host): for Healthcare Research and Quality

Host: Dr. Robert Valdez, thanks so much again.

Robert Valdez, PhD: It's my pleasure. Thanks very much for inviting me.

Host: And again, for more information, please visit ache.org. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to the Healthcare Executive Podcast from the American College of Healthcare Executives.