Scott Webb (Host): Would you believe me if I told you that we're going to have a fun and lively conversation today about quality, compliance and risk mitigation at Sierra Tucson? Well, it's true, and I'm joined today by Edd Hill, Director of Quality and Compliance at Sierra Tucson and Lorraine Madrid. She's the Director of Risk at Sierra Tucson. And they're here today to tell us about what they do, how they do it, and what they love most about their jobs.

 This is Let's Talk: Mind, Body, Spirit by Sierra Tucson. Sierra Tucson, a leader in the field of behavioral healthcare since 1983. I'm Scott Webb.

Really awesome to have both of you on today. Nice to meet both of you. We're just going to sort of lay the foundation here a little bit. Have each of you tell the listeners about yourself, who you are, what you do, that kind of thing. So, Lorraine, I'll start with you. Tell me a little bit about your experience leading up to your time at Sierra at Tucson.

Lorraine Madrid: Well, thank you for the time today and allowing both Edd and I to talk about our professions. Both of us actually just completed our one year anniversary as of yesterday, so we were excited to get through our first year. My background is pretty extensive. Been in healthcare for over 40 years. That's almost a scary number to share. Um, but with that said, have just been truly, given the opportunity to work in several elements in areas of the healthcare field that probably in the last 20 years we're more focused on the executive level working in the C-suite and working at a level where it was more strategic, helping, uh, community health centers.

I came from a community health center background, the Federal Qualified Community Health Centers. Um, so really just had just various big background, broad knowledge, but continue to be a student of the business, if you will. Which has led me to this opportunity here, this new journey here at Sierra Tucson as the Director of Risk.

I think what you'll hear as Edd and I do compliment each other in our business, but for me, working with specifically with safety risk and a lot of crossover with Edd's position in compliance and other areas, various areas, has probably brought us here, brought me here, where now my focal point is really to broaden if you will, the vision and focus of the risk department here at Sierra Tucson.

Host: Yeah. Well, it's nice to meet you and nice that you guys are, uh, sort of celebrating your anniversaries there. We were talking about the weather, uh, today. A little bit windy outside, but generally pretty awesome there. So, uh, same question for you, Edd. Tell us a little bit about yourself before you got to Sierra Tucson.

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: Well, I'm actually from Tucson. I grew up in Tucson and then I spent about 20 years in the Air Force, 15 of those years were in the dental career field, and the other five was as a Leadership School Instructor. When I retired, I took good job at University of New Mexico Hospitals in Albuquerque. Very large, university hospital.

 I returned to Arizona via Quality Director Position in Lake Havasu City. Extremely hot. If you think Tucson's hot, you haven't been to Havasu. From there, I ended up coming back to Tucson. I worked at uh, Tucson Medical Center and then, uh, short stint at Northwest Medical Center before I accepted a Director of Quality and Risk Management position at a federally qualified health center just like Lorraine did, except I was up in Casa Grande when I did it. Then I was recruited here at Sierra Tucson. I've been here a year, as you heard.

Host: Yeah. Yeah. That's so cool. And want to stay with you, Edd. What made you interested in quality and compliance? You know, you said you'd been in the service there, and when you started saying that, then I started hearing the top gun theme in my head. So I'm trying to turn that down in my head right now. And why is different in healthcare than other industries?

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: Well, I think it was my time in the military that actually kind of got me interested in quality. The time when I was in, when I was a leadership school instructor, the Air Force was really pushing towards quality and they were using some of the lean methodologies that come from Toyota. Of course, in the Air Force we didn't speak Japanese, so we had our own version of it.

Host: Yeah sure.

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: And then same thing with the, the compliance aspect of it. You know, in the military you're ingrained to do, you know, standard work and doing everything the same across wherever you might be stationed. I think the difference in healthcare and other industries from a quality perspective is just the, the various measures that we have.

Host: Mm-hmm.

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: You know, in healthcare it's not just about, you know, like the manufacturing world where it's, how many widgets can you produce? It's more about patient care and the patient experience, right.

Host: Right. Mm-hmm. Yeah. And Lorraine, when I think about the word risk, I feel like most of us want to avoid risk. We're just not, let's keep a safe distance from risk. So what drew you to risk per se, and why is it different in healthcare than other industries?

Lorraine Madrid: Well thank you for that. That's, um, that's kind of the if you would say the approach that was similar to compliance, wouldn't you agree, Edd? They see us coming, walking down the hallway, there's probably an immediate response of, oh my, there's bad that just went down.

Host: Here comes Lorraine Edd. Somebody's in trouble.

Lorraine Madrid: But with risk, in healthcare it really is more of a model of prevention. And what I probably would say this with risk that I enjoy so much is that it really gives you an opportunity to work at the front end of mitigating kind of prevention. It's that prevention of someone getting hurt. In healthcare, it's always about people. It's our patients, how we best make sure they're safe, um, secure.

 It's just that whole mitigation piece to ensure that we're doing the very best in providing their services, that they're also receiving good services, but more importantly that we have good processes in place. So it's really that prevention piece, I think that's really important is preventing, something from happening terribly, you know, before it ever gets to that point.

And I think that's kind of, you know what is probably complimentary with Edd and I is prior to us, the one department had one person over everything. And as you know, over the years, both professions have been very defined in healthcare. Risk is not only just risk safety mitigation, but we handle a lot of the litigation piece.

You know, we're kind of the liaison between our legal counsel versus our corporate to here. There's a lot of aspects of it. And then working closely with Edd and the processes, ensuring that we do have processes that are good, that keep us in compliance. So it kind of tag teams very nicely. But if you just talk about risk, risk, whether you're even in healthcare anywhere else, it's the mitigation and prevention. It's that prevention piece that we're primarily responsible for.

Host: Yeah, and I'm assuming then that, you know, when we think about preventing risk, it's when you work with staff members, right, at Sierra Tucson, it's the residents at Sierra Tucson. It's basically helping everybody to prevent and avoid that risk. Maybe you can drill down just a little bit and talk about that, uh, what you do kind of on a daily basis to you know, help and supervise staff and the residents and so on.

Lorraine Madrid: I think we will agree that the risk department it's more of an extension, if you will, to the rest of the departments. We are a resource, a complimentary resource where, you know, our departments and our staff here know they can reach to us to you know, discuss any concerns they have, specifically to risk and safety.

If there's a concern on campus, or even policy, you know, we, we drill down to so many different things, working directly with the staff. The other role, if you will, is really the advisement role. You know, we do offer a lot of advice and direction. That, you know, will help staff making the right decisions, um, that pertain to, for example, if a patient there's at risk for patient care or something like that, we would be their first resource to reach out to, to ensure that we're doing the right thing or following the right process.

Host: Yeah, and as you were saying, your positions, the two unique positions you both have at one time, were just thought, you know, all bundled together, just smush 'em together and then one person can handle everything. And a, as you say, over the years it's been more defined and separated out. But you two do work together and obviously know each other really well.

So give you a chance, Edd, start off here, just how your jobs and positions just sort of naturally work together, even though they're very sort of separate in a way.

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: Yeah, well, although they are separate, I think the common thread that really overlaps and connects the two departments is patient safety. You know, from a risk standpoint, a lot of it's proactive risk assessments and looking at patient safety before bad things happen. Whereas in the quality world, oftentimes it's how do we improve things if there's any risk to patients or not. And then specifically looking at any patient safety initiatives, and or metrics that we may track and trend.

Lorraine Madrid: Exactly. It kind of goes in a circle, if you will. It could either start with quality and go with risk, or can you start with risk and go back to quality. For example, you know, if we're addressing a safety concern or let's say, for example, risk, there is you know, some sort of element within our process that needs some improvement. Risk will put that on the radar for quality and then quality quickly will get those stakeholders involved to make improvement to that process.

And then, you know, most of the time, it gets us back in compliance. And that's really, I think the success of both departments is that we're a checkoff system. You know, one checks the other off, and that would be the same if Edd found something during a quality process and he felt like, you know, we could be at risk for something, he would bring it to our attention, and then we would do the investigation on that or look at that and then make the next steps on how we have to work on that together to get that back in compliance.

Host: Yeah, I just want to talk a little bit about, you know, on a daily basis besides sort of walking down the hallway sometimes just to frighten people Uh oh, here they come. Uh, but besides that, what do you guys do on a daily basis? How do you spend your days at Sierra Tucson?

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: So well being in the compliance world, it seems to be that everybody thinks that, you know, quality department knows everything about everything. So unfortunately, since we don't, a lot of my time and a lot of my day is just spent researching the various rules and regulations that kind of dictate, you know, what you can and can't do in a behavioral health setting, from a state standpoint, and we're joint commission accredited. So you have to make sure you follow all of the rules of, everybody that makes up the rules. And I think the other part of it, probably the more fun part of my job would be actually facilitating some of the process improvement teams. Um, cause I work with a lot of the various teams. If they identify an opportunity, then I kind of show them the tools and techniques to help them fix it right the first time.

Host: Sure. I thought you were going to say your favorite part was just sort of bluffing, just, just convincing everybody that you know more than you actually do, just to see how they react.

Lorraine Madrid: He's very good at that.

Host: I have a feeling, uh, those former military guys, uh, they have a way of making you feel like you've done something wrong, even though you haven't.

Lorraine Madrid: Uh, yeah, he's not being really truthful cause he has this beautiful office that faces the Catalinas and I see him over there and he's gazing outside, so

Host: I love it dreaming about playing golf. I'm sure Edd.

Lorraine Madrid: Yes, exactly. I've gotta keep him focused.

Host: So Lorraine then for you, how's your daily, you know, daily life, it's here at Tucson. Uh, what do you like about what you do? What do you look forward to when you wake up in the morning? That kind of thing.

Lorraine Madrid: Well, uh, you know, there's so much, there's so much opportunity here that it really continues to go untouched. But overall, if you look at what typically my day can be, it varies. It can start with just addressing, you know, we do get all the complaints and grievances in our department. So there is this piece of the department that has a lot to do with patient grievances and having to do the investigations on those and then to, you know, respond whether or not we could substantiate some of those claims, so forth and so on.

Another piece of it is actually making safety rounds. You know, we have a piece that we work in collaboration with our facilities department where we check the grounds for safety. You know, we're in the middle of wildlife out here, so we have a lot of, especially during in summer we're out typically doing ground checks and looking and making sure everything's okay. Making sure patient, you know, safety's good.

Host: Maybe stop by the horses just to say hi.

Lorraine Madrid: Oh, absolutely. You know, we have, you know, we have carts that we drive, so I, I got to tell you, overall, it's a wonderful journey here. But like I said, Sierra Tucson, so I'm a native as well. I didn't probably talk about that at the beginning, but, what has been exciting for me is when Edd and I both came on board at the same time, and of course, you know, Edd could speak for himself.

I think we both ideally came with a very strong and broad ex, you know, background. And like what we find in a lot of organizations you join, they're either somewhat behind or they're somewhat way ahead of themselves. I will say on a positive note, Sierra Tucson is incredible. It's an incredible, I don't want to call it organization, but just even the mission of what we do and the care that we provide and the treatment of services, it's bar none the best.

And we have both learned a lot about how therapy works and the different modalities, you know, you almost have to reeducate yourself in residential care. And, it has been, just a wonderful journey thus far working with a therapist. I probably will say, you know, as Edd does a lot of the teaching and training, as he's mentioned, I've had the opportunity to really work closely with the therapy teams and just kind of really observing what they go through, through their day and how we can best ensure that they're feeling good about what they're doing with their patients and that kind of thing.

Host: So, Edd, I'm going to give you the last word here. Talk about what you look forward to when you come to work, whether it's the quality and compliance part of what you do, or your beautiful view out your window or the carts, whatever it might be. Uh, what do you love most about your job?

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: Well, of course I do love my job and the beautiful view I have. But I think what I like most about it is when I'm teaching the lean concepts and techniques; I do a, a six week course that anybody frontline staff to executives, can be in the course and really to see their eyes open to say, oh, there's a, there's actual structured way. We just don't think there's a problem and jump to the solution. We need to figure out what's the root cause of it. And kind of just keeping it very basic and simple so that they can repeat it and they can take those tools and, and use them in their own departments. And the, at the end of the course, they actually, they pick a class project, and then we do a rapid cycle project based on that. So they get to actually participate in a real project, something that they're fixing at Sierra Tucson, and they can see, you know, how to apply the education they got in the four weeks prior to that.

Host: Yeah. Something less theoretical that's actually happening, you know, on the ground there at Sierra Tucson. That's so cool. Well, this has been great. You know, when I saw we were going to talk about risk and quality and compliance. I'm not saying you guys, but in general, I've met some folks like you guys before and they haven't had the personalities you two have and we haven't been able to laugh and and have fun. Uh, so you guys are awesome, doing great work as everybody is there at Sierra Tucson. Thank you so much. You both stay well.

Lorraine Madrid: Okay. Thank you.

Edd Hill, MIT, CQIA, CPHQ, CQM/OE, CPPS, LSSBB: You too. Thank you.

Host: And for more information, go to sierratucson.com. And if you found this podcast to be helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.