Erik Mikaitis, MD (Host): Hello, and welcome to the latest episode of Pulse Check. This is an exciting episode as I'm joined today by a number of guests: Octavia Rolland, Executive Director of Ambulatory Specialty Care Operations; Joe Price, Executive Director of Ancillary Services, as well as two new clinical leaders: Dr. Lauren Smith, Chief Medical Officer, and Dr. Dan McCormick, Executive Chief Clinical Officer.

We'll be highlighting two great improvement projects with Octavia and Joe. But first I wanted to take a few minutes to introduce Dr. Smith and Dr. McCormick to our larger team. Dr. Smith is the health system's new Chief Medical Officer. She's taking on the role of CMO after Dr. Fegan's retirement last year. She'll provide leadership for medical care across the health system and is a familiar face for many as she came up through CCH's Emergency Medicine Program. Dr. Smith, could you tell us a little bit about yourself?

Lauren Smith, MD: Sure. Thanks for having me. And actually, I'll go back to prior to CCH, in my home, I'm a Hoosier at heart, so I grew up in Indianapolis, Indiana, and kind of traveled all over in different locations across the US for schooling. So, I went down south to Loyola University for my undergraduate degree. I went to University of Maryland in Baltimore for medical school. And then, I matched here at the illustrious emergency medicine residency at Cook County Hospital, and came here and really just fell in love with Cook County with the mission, with the city, with the patients, and was honored to serve as one of the chief residents in our emergency medicine residency program here.

Following that, I actually went and worked out in some community emergency departments across Chicago. So, I've worked at West Suburban and Westlake and Holy Cross, a lot of hospitals that's serving similar patient populations. And then, I was able to come back to Cook County on faculty within the emergency department and served in that role for approximately 12 years. And over that time, I was able to get more involved in administrative roles, hospital-wide committees, involved in the medical staff at Stroger, and really just started to grow into leadership, et cetera.

And then, an opportunity at University of Illinois or UI Health across the street opened up for an Associate Chief Medical Officer role. And so, I was able to go on and take on that role. And so, I did leave Cook County, and was there for just shy of five years, when the Chief Medical Officer role opened up here for Cook County Health. And so, I was more than happy to apply. Kind of getting back to I do feel like I'm a mission-driven leader and I've done a lot of Jesuit education throughout my life, and so really believe in being a person for men and women, for others.

And I think County lives out that mission, so it is perfectly aligned with my own goals and how I live and operate. And so, County is a perfect mission alignment for me. So, it's great to be back to serve the patients of Cook County, working alongside our executive team. And I still will be doing clinical shifts, still keeping boots on the ground. So, looking forward to getting back to doing shifts in our emergency department again. So, that's a lot about me.

In my free time, I love to travel. I'm a downhill skier, and I'm a true sports fanatic. And to some who might not appreciate this, I still root for Indiana teams. So, we're watching our pacers and the playoffs and cheering for them. I'm huge Notre Dame Irish fan, and I still follow the Colts as well. So, sorry, Chicago has adopted me, but not completely.

Host: I love it. Well, we're glad to have you back at CCH and welcome home.

Lauren Smith, MD: Thank you.

Host: So, I also want to introduce Dr. McCormick, who's joined us as Executive Chief Clinical Officer. I had the privilege of working with him at Franciscan Health, and he brings a wealth of experience to the health system. In his role, he's going to provide guidance to medical quality and experience leaders to improve care delivery, quality, and optimization. Dr. McCormick, do you want to tell us about yourself?

Daniel McCormick: Thanks for the introduction, Eric. Certainly. Dr. Dan McCormick. I am, by trade, a nephrologist. I trained actually here at the University of Illinois in medical school. I'm a Chicagoan by birth. I was actually born out down there in Cal City. I come from a medical family. My father was a physician. My mother's a nurse. I have a sister who was a nurse, and I'm married to a nurse who I actually met at Michael Reese Hospital back there in 1989 when I was doing my medical school rotation and in Internal Medicine. I did my next rotation at Cook County Hospital Surgery. And that was back in 1989. So, it's been quite a while that I've been running around the Great Lakes.

I went to the University of Minnesota for my residency after having a good experience here at the VA hospital with Dr. Schlesinger at University of Illinois for Gastroenterology and had all the aspirations to be a gastroenterologist, and those were soon dashed as I went to the University of Minnesota and met some very intelligent nephrologists and decided I was not quite as brilliant as them, and I was going to try. So, I went to the University of Minnesota. I spent three years there as a residency, and then I did a chief residency year there, as well at the VA hospital. After which I did go into nephrology at Northwestern, trained at Northwestern, and then went into private practice. And most of my nephrology training and Nephrology private practice was here on the south side of Chicago. I practiced at Holy Cross, Little Company, Palos, Christ, and South Suburban for the most part. And I did a couple stints in Indiana. But for the most part, the majority of my career has been on the south side of Chicago clinically.

After that, I went into administrative positions, working in Chicago Heights, Olympia Fields as the president over a multi-specialty group there in Chicago Heights. And then, I was asked by the Franciscans to take a role in Crown Point, where I was the Chief Medical Officer for the Crown Point facility. And soon thereafter, about four years in that position, I was asked to be the CEO and president of that hospital, which I did since 2018 until I came to this new position.

During my time at that hospital, I was tasked with the challenge that we all had, which was COVID. Eric and I both actually combined our talents and our, I would say, our determination to get through that and lead that hospital and stand up a vaccination clinic actually. And we did such a great job, we decided we needed to close that hospital, build a new one, and relocate it to the other side of town. And that's what I've really been doing over the last four years, and that was building a new facility and relocating that facility. And we had a successful open in 2024. I was there celebrating its first year in operations, it was quite rewarding.

And I'm now here after speaking with Eric. And missing our times together, I decided I could come back and maybe take that experience and help further improve a lot of their quality and safety improvements that you've already all seen, bringing everything to the front line, understanding that our strategy of quality and safety is driven by improvements that we're going to be involving with the frontline staff and really emphasizing the involvement of those doing the work and improvement.

So, that is what I'm hoping to do. Hoping to build sustainable improvement, which I think is really our goal. Improvement's one thing, but sustainable improvement's another. And as we improve all of those things sustainably, we improve the lives of our patients. And at the end of the day, that's why we are here. Everything should start with what's best for the patients from experience to quality outcomes. And that's what I hope to improve with my time with you all here at Cook County. So, I appreciate all of the consideration, and thank you.

Host: Yeah. That's great. We're looking forward to see the impact that both of you'll have. Thank you for joining the team. So to the broader audience, please join me in giving a warm welcome to Dr. Smith and Dr. McCormick. They're going to be visiting a variety of our sites in the coming weeks as they get oriented or, in Dr. Smith's case, reoriented to our system. And look for them out and about. Again, very thrilled that you're here and on board, and thank you both for joining the conversation today.

So now, I'd like to turn to Octavia and Joe for a conversation about the collaborative process improvement work that they've been undertaking. To start us off, can you each briefly describe your roles at Cook County Health and the communities your teams serve? Octavia, let's start with you.

Octavia Rolland: Sure. Thank you. I am the Executive Director over Ambulatory. And I'm responsible for the strategic and operational leadership over specialty care, which crosses over to hospital-based and community site clinics. And so, ultimately, my role, I'm responsible for access, staffing, process improvement, financial stewardship, and just ensuring that the coordination of care is seamless across all of our specialties. I've been here for four years, extremely excited about the journey, and I look forward to the future.

Host: Very good. Joe, tell us about yourself.

Joseph Price: Yes. And thank you, Dr. Mikaitis. I'm Joe Price. I am the Executive Director of Ancillary Services here at Cook County Health. My duties are responsible for the overall operations for the Ancillary Services Divisions. And also, making sure that those operations and the strategic initiatives are all in alignment with the organization's strategic goals and initiatives.

In addition to that, focusing in on quality, safety, and service are the three major objectives that we have within the Ancillary Services Divisions. In addition to that, once again, improvement, process improvement, improvement in quality, safety, and service. Thank you.

Host: Wonderful. So, you both mentioned process improvement, which I think sometimes can feel a little abstract. What does that mean to each of you in the day-to-day reality of patient care and frontline operations? Joe, we'll start with you on this one.

Joseph Price: As it relates for me, frontline operations, it's ensuring that our patients who are most important are actually receiving the quality care and service that they receive. And if there are any opportunities that we can take a look at, explore and see if there are any opportunities for improvement that's what it looks like for me. In addition to that, not only the patients, but also for the staff and the employees. From the medical staff right down to the frontline staff, taking a look to see how we can improve the work that they're doing on a daily basis, which actually transitions into the patient's experience. That's what it looks like for me.

Host: Octavia, what does process improvement mean to you and your teams?

Octavia Rolland: Same approach. Process improvement from an operational perspective. It's a day-to-day life. It's a day-to-day thing that we do to eliminate any barriers or challenges that would impede in patient care, that would impede in access, and in addition to really improving the experience, not only for the patient but also an employee, as Joe mentioned.

I think what is important that we acknowledge is that process improvement is not only just removing the barriers, it is all about not creating those barriers that we found ourselves in, right? How do we prevent from recreating those same opportunities? Doing a deeper dive and performing some root cause analysis to ensure that we're creating a very solid structure that's going to help propel this organization forward, especially looking at some of the trying times ahead of us.

Process improvement is not a theory. It's what we do. It's a mindset. And I think as we continue to connect the dots for our future leaders and having them understand that the archaic thought process that it's a department, it is a job-- No, it's within all of us. As leaders, you cannot improve operations without thinking about how do we do this as a process improvement project. It's something that has to be very unnatural, but yet the tools that it's lended to us from the quality team, it's what guides us into, "Okay, how do we do this systematically? How do we ensure that we are looking at or working towards a broader purpose?" And once again, as I mentioned before, how do we not recreate those opportunities?

Host: Yeah. I especially love the part about it's not a department over here doing the work that it has to be something that's incorporated into all of us and all of our departments and all of our teams. And I'm hearing that from both of you. I love it. So, you guys both had projects. Octavia, maybe we'll start with yours. You led a multidisciplinary effort to complete a large backlog of sleep study reads. So, can you walk us through, to start, kind of the problems that your team was facing?

Octavia Rolland: For sure. The team was dealt with several opportunities for improvement and barriers, right? When I was engaged in this project, I had to kind of understand what was driving this variance. Someone can easily say, "Well, we have a backlog because we're not reading," right? But why? So, it is the obvious on the surface. But yet underneath, that is not totally the big picture. And we were faced with some challenges in regards to obsolete equipment, you know, things that were out of our control.

However, as we perform a deeper dive, we were able to identify on a larger scale beyond just studies that are not read. Now, it was important to outline the impact, delay in patient care, right? Quality, safety, all of those things, right? But if you think about the impact to the system from a reimbursement standpoint, you know, in order to really gain a full understanding, you have to understand the experience. You have to understand the throughput, the experience of the journey of a patient, your technologist and that involvement and how that impedes on the provider reading. You also have to understand the things that we didn't have control of at that time was the limitations with the system. No interface, right? So then, that means manual steps, which we did not have control over. However, using STAR as a guiding force or tool for us to ensure that we're not making human mistakes, which will also drive studies being left unread. And in a sense, it was just, "Okay, how do we really explore every aspect of this operations versus looking at the obvious and not just fixing one opportunity, which were very obvious? How do we fix the big picture? How do we improve the experience of the patient? How do we improve the experience of the provider?" And the only way to do that is have a multidisciplinary team that would help charge us in a way that it's going to be more impactful and valuable for everyone on the team, including the team members as part of the group, as part of this journey.

But Dr. Mikaitis, what was crucial for the entire team was that we all had the same vision. And there was humility, there was passion behind what were we trying to achieve and, most important, discipline. Every project is not going to have an easy task, right? You're not going to have low-hanging fruit, which one you're trying to achieve. You know, the bigger picture of things, right? But the reality is, if we're fighting towards that common goal to ensure that patient and safety quality are not being compromised, that multidisciplinary team, it's going to be the driving force for any project moving forward.

So, just to let you know, it was more than just about the unread studies. It was about the big picture and the experience and ensuring that financial stewardship was not being compromised, because there was opportunity there.

Host: Definitely. And I'm hearing very complex, right? It's not just people on your team where you can set the expectation. It's a lot of collaboration and bringing various departments together. In this case, it sounds like at least pulmonary and health information services and quality. So, how did you bring everybody to the table? You talked a little bit about that, but maybe unpack that a little bit more. How did you get everyone around a shared goal?

Octavia Rolland: Absolutely. As a leader, you have to do your homework. You know, you cannot share a compelling story to gain followers unless you understand as a leader what drives the organization. And, you know, it starts with the standards that are set by AASM. The body of work that's within my portfolio is Joint Commission. But the standards through AASM said, "Hey, those studies have to be read in less than 14 days." And then, I needed to understand how were we tracking and monitoring, measuring our metrics, and what reconciliation that we had in place.

And then, I talked about the equipment. I needed to understand was there an interface? How long did it take for the tech to score? What was the risks that were involved with the manual processes? So, really interviewing the entire team. And that includes the physician understanding what works well and what doesn't. What have we always done this way, right? Explain that to me and why? And then, just continue to really kind of drum up a story to be able to engage those key stakeholders and say, "Hey, this is what I was able to discover and this is what our current state and how it's impacting patient quality, safety, and all those things, including access." However, you guys still have to have the same experience that I had the privilege of experiencing in really interviewing and understanding this entire workflow from the time that the referral is generated, the patient is scheduled, throughput, reading, and claim submission.

And so, the team was extremely engaged. And shout out to Rene Jackson, because she was the first person to have total transparency and say, you know, "Octavia, the team really haven't been involved since we went live. But we are committed." The only way the HIS team is, you know, part of process improvement project is when leaders are engaging them. And she said, "You know, I'm excited about what we can do here. I know there's tons of opportunities for improvement and you have our commitment." And then, that started to trickle down.

But in order to gain that level of engagement, it starts with the story. And as a leader, you can't tell a story unless you understand the actual throughput, the operations, the business, whatever the case may be. You have to be able to interview your team and try to get some sense of what is happening, why is it happening, and how can we make it better?

Host: Yeah. I love that. And I think it's reflected even in some of the work we've done with high reliability, right? It's that reluctance to simplify. You really have to unpack the issue to understand it so that you can create meaningful interventions and align the team. That's fantastic. Again, it sounds very complex. I'm sure you had some challenges, some barriers. What were some of the biggest ones and how did you navigate them?

Octavia Rolland: Getting the buy-in from the physicians in terms of adjusting how they're reading, right? The timing of it. Because we had some barriers with the system, workstations, giving the physicians the capability of where they can read. You couldn't read everywhere, right? just because of that was one of our limitations.

So then, we have to look at the structure and the timing of that. And once again, shout out to that entire team for putting a plan together to clean up the backlog. But then, it was all about sustainability. And so, trust was really one of the barriers, because here I am coming as an operational leader who's not doing the job, trying to provide some type of support and recommendation to ensure that if we make some pivotal changes, the small bit of changes, it would have a more impactful and valuable impact to our entire operations and then, in addition to, as I mentioned before, the system being obsolete and no interface. And so, that limited your amount of solutions that you can, you know, drum up with to be able to say, "Okay, this will fit." You can't control that, the system is not interfaced, right? But that is a process in itself. But at least, we are able to decide how can we clean up this backlog? What would it take? And then, put a timeline to it. So, a little bit of a source of some ownership and continued partnership. And, Dr. Mikaitis, sometimes trust is difficult, especially when you're not involved in their day-to-day lives. But it's all about how I can show my commitment to help improve those feelings that these physicians and team members are feeling, considering that we have been doing it this way for quite some time.

But needless to say, after we continued on on this journey and then highlighting the wins, showing the progress, that, in a sense helped with our relationship and helped with that foundation of trust and knowing that we're going to move these barriers together. There are some that are out of our control. However, there's a team that I can leverage to kind of help move the needle with our equipment, right? Help move the needle with ensuring that we can get the best system in to serve our patients and give high quality care, but that doesn't mean take your eye off the inefficiencies that we currently have control over.

And so, those conversations are sometime difficult. But however, it is the approach, it is how you have the conversation and showing that we're in this together and we're going to do this in very organized, structured segments. So then, that way, we're not putting a Band-Aid on the operations. We're getting to the root cause and we're going to fix it, but we have to sustain it. We have to ensure we do not recreate the opportunities-- as I mentioned before, right? So, we have to ensure we don't find ourselves in those opportunities of unread studies, because it impacts on a greater scale of things. And ultimately, the patient suffers from that.

Host: Definitely. And I think you touched on a key point around building that trust, but a key piece of that was as you kind of came in and perceived yourself as an outsider, right? I don't do this job every day. You know, you kind of don't know. But I think there's value in that, right? Because you do come in with fresh eyes, you're kind of that naive expert where you're able to ask those questions that maybe people aren't asking anymore because this is how we've always done it, right? So, there isn't that kind of challenge put into the equation, right? So, I think there's a crucial piece there. And I think that also, as you show that you've driven some improvement, that's, I think, how you start building trust, right? And I know it might sound a little corny, but I love the saying, that change happens at the speed of trust, right?

Octavia Rolland: Absolutely.

Host: You have to build that trust to be able to drive that. And I think you've really done that. So, give us high level kind of what has happened? What was the reduction? Give us some numbers. What was the improvement?

Octavia Rolland: Oh, for sure. We tracked per provider, and we've seen an 86% improvement in terms of unread studies. And in addition, we were averaging or aging at over 365 days. And we were able to get it down to less than 45 days. Now, granted, AASM expectation is less than 14 days. But considering we only had limited stations to read from, which serves as a barrier, right? But due to the system and what we don't have control over. However, with the manual processes in place and the system not being interfaced, I thought that that was a phenomenal win, considering the fact that we were averaging over a year.

Host: Absolutely. That's incredible improvement and that's really the point of continuous improvement, right?. this is an incredible reduction in the wait times, but there's still more to do, right? So, how do we continue to challenge ourselves? How do we keep looking for those opportunities and continuing those conversations? Well done, Octavia. This is really impressive.

Octavia Rolland: No, thank you. And last but not least, Dr. Mikaitis, before you go, you know, I read on LinkedIn this quote that says, we do not inherit the future. We create the future. And I believe in it. And I think that sometimes what we're trying to achieve is very challenging, and it seems farfetched. But if we have the mindset that we can create any standards for our institution being a safety net, we can do that. We can create the future here for CCH. And I'm a firm believer of what it takes and the multidisciplinary team and the commitment from everyone else. So, thank you for this opportunity. I really appreciate it.

Host: Yeah. Thank you, Octavia. Okay, Joe, let's come to you now. So, reducing imaging wait times, it's no small feat. It's a challenge everywhere, every health system, right? So, tell us what inspired the effort. And what did the initial challenge look like for you?

Joseph Price: What actually inspired this initiative really was post-COVID. PoPost-COVIDwe were in a recovery phase, and we had limited resources. Staffing resources, equipment resources, but we had this high demand for imaging services, which is highly demanded for imaging services. It still goes on. We need those tests to diagnose and treat our patients. But post-COVID, and we were in the recovery phase and we were able to successfully make it through that recovery phase with the assistance of Andrea Gibson-- I give kudos to her and her team because we ended up outsourcing some of our services just to meet the demand and what we had in our queue. That was the recovery phase. But now, we've recovered, but the demand was still coming, and the demand was still coming, the queues were still being filled with orders. Limit to MRI scanner went down, resource limitations. And then, for ACHN, we had to meet that demand, physicians and providers, access to services. Dr. Irons in one of the meetings said, "Hey, Mr. Price, where are we with those next available appointments? How soon can my patients get their test done?"

So as a result of that, the team, we decided to collectively take a look and see what we could do. And what we did was we took a look at our scheduling work queues and the schedulers that we had, and then we began to establish quotas. We even met with the frontline staff and said, "Hey, this is what we need to do." So, it was really identified post-COVID, to answer your question and then, that recovery phase. And then, we actually met with the frontline staff and engaged everyone. And then, we went across the system for ACHN, the medical staff, and BI, Amanda Grasso, because we didn't have templates. I'm a firm believer if you can't measure it, you're not managing it. I really am a firm believer of that. So, Amanda Grasso along with Andrea Gibson and John Prendergast. So, this was a multidisciplinary and multi-department initiative. They all gave us input and gave us the tools that we needed to put in place to be successful in actually going down this journey and this path.

Host: That's great. So, you talked about the people who were involved and a little bit on kind of how you got started. So, maybe give a little more detail, if you can, about how you started diagnosing the issue. How did you get to root cause in terms of the delays?

Joseph Price: Oh, we were able to diagnose the issue because the queues, we took a look to see really on an average, how many orders are we receiving in a queue on a daily basis? So, that can be anywhere from 50 to 60 orders coming in on a daily basis. And then, how many orders are being scheduled on a daily basis outgoing? And then, what do we need to do in terms of establishing some form of quota for the schedulers to actually successfully say, "Hey, how do we manage this?" And then, what we did was once we got that under our belt, we actually put in place documentation, forms and sheets to get feedback from the frontline staff who were scheduling to say, "Hey, why were you not able to complete 50 or 60 orders scheduling appointments? What were some of your barriers?" They provided us with those barriers. For example, "I have to answer the calls. I have people walking up to my desk," all of these different things. And then, with the frontline staff and the schedulers, we were able to assist them with removing those barriers so that they could actually meet those quotas that we had.

And then, in addition to that, once again, resources. So, we began to cross train staff, clerk Vs and looked within their job descriptions, and cross-train them to assist with scheduling in these queues. But at that particular point, the most important tool that we had was a report that was established by BI that we could run on a daily basis and say, "Hey, we have this many orders coming in on the queue. We've scheduled this many orders going out. This is our delta. And how do we manage it?" And then, we need to establish thresholds to say, "When the queues get to this mark, 150 orders, we need to put all hands on deck, boots on the ground, to streamline those and bring those back down under 150." And not only here at Stroger, we pulled in resources from Providence as well, who were scheduling to assist us as well.

Host: Wow. Really all hands on deck.

Joseph Price: All hands on deck. Yes.

Host: So, what do you think, and it may be just that, but what do you think the biggest change or innovation that really created a difference in cutting down the wait times?

Joseph Price: I believe the change-- I can honestly say the change has been the team. The team. I can tell you that's the change. Because once there was a buy-in from the frontline staff along with the managers, and then providing the feedback on a daily basis to say, "Hey guys, this is where we are. And everybody's focusing in on it with that report," that report was the major driver for us to be able to see the data. And for the frontline staff, not only them, but the managers to say raise the flags. If you see something, say something, "My queues are getting here, Mr. Price." They would call me and say, "Hey, Mr. Price, the queues are getting out of hand right now. What do we need to do?" And then, we would all come together to strategically make some of those decisions. But I would really say the major driver for all of this has been the staff and the team.

Host: And you mentioned multiple different teams, really, you know, BI, and I'm sure the physicians, and the scheduling team. And so, how did you get staff to buy in across all of those different departments and teams?

Joseph Price: Really, it's relationships, one, I can say. And two, everyone that was involved in the process had some, I would say, skin in the game, because access to services here is critical from the strategic initiative, from the data collection initiative, which turns back into revenues. And also, it turns into our actual providing the service to our patient population, being able to provide that service.

So once I explained the initiative to everyone, and this was post-COVID, remember that we need to be able to main and sustain this. That is how I was able to get the buy-in. And I reached out to those subject matter experts, if you notice, in each one of those divisions, including John Prendegrast because he has that call center. What avenue that we have here in this organization for access to services than the actual call center. The call center, actually, he was able to tell me about a report and the ability to use the report to get the data. So, everyone who was part of the team right down to IT, they were really, really receptive to helping me with this initiative.

Host: Wonderful. So, high level, what was the change? Give us the success story. What happened?

Joseph Price: Well, the success story for overall of this was, I would say we set a target and a goal for 50 days, for the actual CCH goal with a stretch goal of 45 days for wait times. And keep in mind, within those timeframes, two weeks out of those 50 days is actually to obtain the authorizations. So really, we are shaving this down to roughly 30 days in terms of a wait time, 30, 35 days. We've gone from 60 to 80 days down to our goal of 50 days, and 45 days even with ultrasounds down to 38 days and 35 days for wait times with those appointments. That has been the change that we've made.

Now, I can tell you, honestly, this week the flag was raised once again. "Our queues are getting up there, Mr. Price. What do we need to do to get those queues down?" Because we did have a little spike in volume this month and last month.

Host: But that's okay. It's just showing you the system's working, right? The flags are still going up. And can move to all hands on deck when needed, right?

Joseph Price: Exactly. And that is what we've actually implemented all hands on deck. And we are also in the process now-- I just met with the team this morning of actually cross-training our staff who are on the second shift. We have clerks on the second shifts who can actually get cross-trained to schedule as well and contact those patients, who may be at work during the day, in the afternoon.

Host: Amazing. Well, congratulations to you as well, Joe, to you and your team. It was just fantastic work. So, we're going to come back to kind of just questions for both of you. I think a common theme through both of these success stories was the power of teamwork. So, let's talk a little bit about the experiences that you had that taught you about leadership in a complex healthcare environment. So, maybe, Octavia, let's come back to you.

Octavia Rolland: Yeah, sure. So, you know, my first 10 years in healthcare, I was a scheduler. I had the ability to really work at that front line and have first line view of what it took to engage a diverse team to create or improve any project or process improvement.

And in addition too, I've developed certain experience of what not to do as a leader. And of course, I had great role models of what to do as a leader. Taking those experiences from the frontline and really bringing those forward as I developed within my career, starting as a supervisor on up to where I'm at today, is never losing sight of the team that is performing the work, the team who understand all the nuances that can give you a very good, clear picture of what's happening, what's not happening.

In addition to that, just really looking at my journey and some of the failures that are very successful journeys within my leadership, you have to look back. You have to assess and understand what went wrong and how can you do this better as a leader? And so in the overall, staying connected to the team members that are really driving our strategy, ensuring that we are including in the decision-making and engaging them as much as we possibly can, but also being transparent on where are we headed as a system, and what will it take and how are we going to do this together.

So for me as a leader, my journey has been a little bit different coming from the frontline, but the experiences have been so rewarding because it allows me to look at this full circle and ensuring that I'm telling that Octavia 20 plus years ago how and why it is important that we improve in some of these inefficiencies and then, asking that frontline team member, "What do you think? What solutions do you have? Let's hear from you." And then, just being consistent. You have to be consistent in what you're promoting, and you have to be consistent in the engagement tactics, and you ultimately just have to care. There has to be empathy and knowing that it's the team that's seeing the patients, it's the team that's driving the action plans. Now, the team has to help lead the action plans, and sometimes we leave them out of the equation. But in all honesty, this also built better experiences for them and helped propel their career and where they're headed. And some of them are on the trajectory of being leaders. And so then, it becomes more of a mentorship, but you will see that the team kind of respect the fact that you're actually asking them my thoughts, right?

And then once again, as we talked earlier, that trust. And so for me, I've taken all of those experiences, the good and the bad. There have been times where I've made solutions because it was an obvious solution for a problem, but yet I missed a very important step. That was that engagement. It was that communication. And so, as a leader to self-reflect, I said, "You know what, Octavia? Regardless if we had the same idea, that gives you no right. You have to ensure that you stay consistent and stand true to the respect of what those teams are asking for us to do." And that's just engage them, have them part of the team, and to ensure that they are informed of, and a part of any decision-making that, you know, we're embarking on from this day forward.

Host: Yeah, definitely. So really, it's start with why and then empower and engage your frontline teams to solve the problem. I love it. Joe, how about you? What have these experiences taught you about leadership?

Joseph Price: The experience has taught me similar to what Octavia just mentioned. But I can say this, one thing that it has taught me is as a leader. We're always on stage. We're always on stage. Always. The frontline staff being engaged is one thing, but are you walking the walk yourself and talking the talk? They provided the input. "Now, I've given that to you, Mr. Price. What are you doing with it?" And it comes full circle. You provided it for me. Now, I'm showing you what I did with it. So, that is why I give them the feedback because once again, I'm on stage, they're looking at me and they're looking for me to execute some of those recommendations that they have put in place. So, I would say it has taught me more importantly that I'm always on stage.

And then, the other piece of it is relationships are key. Not only external, outside of my department, but within the department. And the trust builds the relationship. So, those two things, the staff and the team, they trust me. And then, they trust me so much and I trust them. That is why I had them to present at the Quality. Because I said, "You're doing the work more than likely, let me make sure that you are actually showcasing the work that you've done." And that was a big win for them. They were so appreciative of that. And like Octavia said, we are mentoring and we are coaching and we are developing future leaders. So, that was part of the initiative as well.

But once again, I'm on stage. So, they're looking to me, "Mr. Price, what are you doing? What are you going to do?" And you're setting that on stage. So, I take a look at that no matter where I go to see if there's a leader in the room or in the area, how they respond, how they react. And people are looking at you when you don't think they're looking at you. So, I would say we're always on stage. It's taught me that. And even those people I mentioned, Amanda, John, and all of them, they're looking at me as a leader and saying, "Hey, we provided you with this information and this data, and now it's being showcased. And I'd like to thank you, Dr. Mikaitis and the entire health system, for giving us the opportunity to showcase these initiatives.

Host: Oh, of course. And I think to your point, letting your team have the spotlight when they've done the hard work and really have driven that change and that improvement. It's so crucial. I was at that quality meeting and got to see them present and they just did a phenomenal job. And, you know, they have every reason to be proud, but you could see how proud they were of the results. So, kudos to you for that leadership.

Now, it's come up a little bit already, but it's around engaging your staff and around process improvement. So, how do you do that, especially when people have so much on their plate? Maybe, Joe, we'll stay with you on this one.

Joseph Price: How do I engage the staff? Now, I can tell you when it comes to process improvement, and I just met with one of my managers this morning. I was rounding early this morning. So, I engage them because when I was a frontline staff and member, keeping the vision or keeping the information before them, they're engaged by that once giving them the feedback.

And by that I mean, if and when you round and you go into the CT department, this is an example, I have a huge board of the data for the turnaround times, which is tracked daily. The supervisor informs the team during huddles. This is where we are, or were yesterday, We didn't meet the target because of these different initiatives and providing them so they're engaged and then guess what they do? They start providing feedback to the supervisor and it cascades back up. As opposed to cascading down, now it's cascading up to us. And so, they're engaged in that way, one way.

The other way that staff have been engaged in the department is the ability to speak up and say something. I enforce that, you know, while rounding, "Is there anything I can help you with? Do you have the tools that you need to be successful?" They don't mind stopping me. As a matter of fact, sometimes I walk through the area and I say-- this is a joke-- I just say, "I'm not taking any assignments today." Because they always want to say, "Hey, Mr. Price, I have something that I'd like for you to help me with." So, they're really engaged in that sense, or they may have an idea, "Have you ever thought about this?" So, being accessible and they speak up and they say something, even when I may be wrong, they pull me to the side and say, "Mr. Price, you know, have you ever tried that suggestion that we put in place?" And I go, "I don't know. Let me speak to your supervisor and see where we are. Why don't you go speak to them?" So, that is the way they're engaged, rounding on them and giving them the ability to feel comfortable enough to speak up and say something.

Host: Absolutely. Yeah. You're building that psychological safety with your team. It's empowering them to be able to speak up and you know more because of it. I love it. That's great. And then, the other piece is the visual management, right? You're putting it out there. It's pared down. There's so many other things that they're focusing on. But that's, I think, a signal that this is important, right? We are focusing on this and we're trying to drive improvement here. It's another saying I've heard, right? It's, "What my boss finds interesting, I find fascinating," right? So, Octavia, how about you? How have you found room for-- you know, there's so much on the plate. How have you found room to keep your staff engaged on process improvement?

Octavia Rolland: You have to find a time to listen. This is not a checkbox. It's not a checkbox. People feel that passion and that empathy when they know you truly care. And it's just what we do as leaders. You have to find the time to listen. And that is understanding what's happening in this space. It is listening about, as I mentioned earlier, what's working well and what's not. But then, you have to come back and close the loop. That is important. Why round if you're not going to do anything with it, right? Rounding for purpose and for a passion. And so, that communication is key. And then, also, listening to their solutions.

And so like, "Wait, let's trial it. If it doesn't work, tweak it. Let's fix it. But let's keep the momentum of moving forward because eventually something will work extremely well to the fact that it will stick." But the reality is engaging the team and hearing the solutions, having them drive and pilot the change. Meeting as a group, even at my level to hear the feedback. Ensuring that I'm removing the barriers that my team does not have the ability to do at that level. You know, we all have a job. And then, making sure that we stay true to that commitment. It's like using the stoplight report. If there's some items in red that we just cannot move as of right now. It doesn't mean it's not going to happen. It's just not today, right? And this is the reason why it's going to take a little time.

However, we're going to celebrate the small wins. We're going to acknowledge what we've accomplished here. We're not going to lose sight of where we come from, and how much did it take for us to get where we are today. So, that acknowledgement from all of us at my level above, you know, I see you do it when you round, Dr. Mikaitis and, you know, folks feel that, they really have a sense of I know they care. I know the leaders care. But yet those matters in terms of the engagement being a part of and closing the loop and ensuring that we're consistently communicating. I'm not saying that we are perfect because we're not, but it's owning up to it, accountability. Performance service recovery, saying, "You know what? I apologize. You're right, I did not close loop on this. Let me get back with you." This is how you develop the relationship of trust. This is how folks look at you as a problem solver, because my job is to ensure that I solve your problem, so then that way you can focus on patient care.

Host: That's great. And it may be it, but we've covered a lot of, I think, very important things to consider about how you lead, not just a performance improvement project, but how you lead a team, how you engage with other teams. So, what is the biggest piece of advice, and this is our last question, that you would give to other leaders, either inside or outside of CCH, who are looking to make meaningful operational change? And, Octavia, we'll start with you.

Octavia Rolland: You lead people, not process improvement. If you lead people the right way, process improvement will follow. As I mentioned of the quote that I came across, we do not inherit the future. We create it regardless of what entity or setting that we're sitting in, in terms of our structure of our organization. We have the ability to create whatever it is that we're looking for within our institution, right? The goals that we're looking to achieve through every challenge. It's like the needle in the haystack. The needle is there. It may be difficult to find that needle, but you keep trying. So, you got to have that dedication. You have to be disciplined. But yet, you have to come forward with that passion and knowing that you just can't give up. The answer may not always be obvious. But if collectively we do this together as a team, you engage the right people and you lead the right way, the process will follow.

Host: Joe, what about you? One piece of advice.

Joseph Price: The advice I would give would be one of-- and this is a little quote or cliche that I kind of stand by sometimes-- the journey is just as important as the destiny. Along this journey of improvement or whatever you're taking on in life in general, how we get there, what we do as we go through in getting there is just as important as that end result.

So as we're making process improvements and we're starting in the beginning, first thing I would say is listen. Just listen. Be still, be quiet. Just listen and get the feedback from everyone because we don't have all the answers. Although we may think we do, we don't. But just listen.

And as you go along that journey to get to the end, there are going to be some obstacles. There are going to be some hiccups, there are going to be some stumbling blocks. Just like Octavia said, press that reset button and start back over. And we may have to restart or go in a different direction. But as we go along that journey, and once we get to the end, we celebrate. We celebrate the successes of what we've done and that journey as we go along.

And I'm going to share with you, once again, rounding this morning with one of my managers in the IR suite because we have a quality initiative going on in that area, I shared with him, I said, you know, "Next month let's meet with the team. I would like for you to outline all of the accomplishments that you've done in this department. Give a whole litany and a list of all of those things--" once again, the journey-- "that you've actually implemented in here. And then, we are going to take a look at this initiative that we are have in place right now. Give them some feedback, and then we are going to ask them to give us some feedback, okay? And during this meeting that we're going to meet next month, we're going to celebrate all the successes because once again, this is a journey. And then, when we get to the end, and you'll be surprised--"" I told him once again, "I'm coaching and mentoring at the same time. You'll be surprised the input and the buy-in that you're going to get from the team. And then, once again, they're going to be accountable for these outcomes. But once again, the journey is just as important as the destiny." That's what I would tell.

Host: Yeah. And I really appreciate the listen piece, right? As a leader, it becomes so easy sometimes to just jump to solutions and say, "Well, I know the answer to this. Like, just do this," right? You lose that engagement, right? You lose that empowerment of your team. And that is so crucially important from an ownership standpoint, from an engagement standpoint.

So, kudos to you, both of you, for the work that you've done. So, thank you very much for your time today and, more importantly, for your leadership in advancing our care and our mission. To our viewers, thank you for watching. Tune in next month for more updates and our next episode of Pulse Check. Thanks, everyone.