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How to Improve Operations and Outcomes by Considering Human Factors with Dr. C. Adam Probst, Director of Human Factors Clinical Operations at Baylor Scott & White Health
Episode 110

Dr. C. Adam Probst, Director of Human Factors Clinical Operations at Baylor Scott & White Health

How to Improve Operations and Outcomes by Considering Human Factor

How to Improve Operations and Outcomes by Considering Human Factors with Dr. C. Adam Probst, Director of Human Factors Clinical Operations at Baylor Scott & White Health

Episode 110

How to Improve Operations and Outcomes by Considering Human Factors with Dr. Adam Probst, Director of Human Factors Clinical Operations at Baylor Scott & White Health

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes Rocket listeners will come back once again to the Outcomes Rocket podcast where we chat with today’s most inspiring and successful healthcare leaders. I want to really thank you for tuning in again and I invite you to go to outcomesrocket.health/reviews where you could give us a rating and review. I really enjoy hearing from our listeners and just hear in the feedback as well as things that you enjoyed or want us to do better. It’s just what makes the show better and what makes us give you those tidbits of information to help improve outcomes in whatever area of health care that you’re in. So without further ado I want to introduce our outstanding guest. His name is Dr. Adam Probst. He’s a director of Human Factors clinical Operations at Baylor Scott and White Health. He has an incredible amount of experience in the area of human behaviors and health care and he utilizes innovative methods and approaches grounded in human factors and systems engineering framework to create a robust health care work stream that helps see outcomes improve. I want to welcome Adam to the show and also want to thank Dr. Ballard for the introduction to this amazing gentleman that’s doing so much for health care so Adam welcome to the podcast.

Adam Probst: [00:01:36] Thank you very much. I’m looking forward to appreciate the opportunity.

Saul Marquez: [00:01:40] Absolutely. And so Adam let us know what is it that got you to decide to get into the medical sector to begin with.

Adam Probst: [00:01:47] I somewhat grew up around it you could say my father was a PCP. Growing up you and I you know I was really involved in his clinics really really enjoy the concept of being able to help people and you know naturally wanted to follow in his footsteps growing as I matured. I remember going you know he would introduce me to health care by we would watch surgery videos that he would bring home that he you know he was having me memorize anatomy and different functions of the body when I was in sixth grade. You know just to kind of help me get prepared. So I was always really really interested in the field. Unfortunately he and I were in an auto accident when I was 14.

Saul Marquez: [00:02:20] Oh my goodness.

Adam Probst: [00:02:22] Killed he didn’t survived but I’m one of the things really well thank you. One of the things that really got me interested is you know I was pretty severely injured in there and over the years I’ve had about 16 surgeries orthopedic you know even joint things and so I’ve always stayed really involved in health care. But it became really close with the orthopedic surgeon that has performed most of those surgeries for me and it began to kind of shift and say well maybe I would want to go from kind of a primary care role into more of a specialized skill perhaps or edicts. So I joined his office as a medical assistant throughout most of high school and in the first few years my undergrad at Texas Tech Gotzkowsky the behind the scenes working he would take me into the doors with the Met get to see a lot of providers lot of hands on things and so I got to say pretty involved through healthcare and my passion kind of yeah I’d lot of really great mentors that worked in the field that kind of took me under their wing and were happy to kind of show me how health care actually operated and how you can actually interact with patients. But my junior at Texas Tech I met just through happenstance taking an elective. Isn’t that part of my undergrad curriculum. I met a professor Dr. Keith Jones there who was a human factors engineer and he was one of the at the time was a pretty small program at Texas Tech a human factors program there. But I was really intrigued by the field it sounded really interesting. I was just looking for some stuff to do and so I was asked and granted permission to join his lab as an undergrad research assistant and he did a lot of his work in robotics human computer interaction. So I got to kind of see the build from that inside perspective from human factors learn more about it. I had like most people had never really heard about it. The field has been around since World War II but very few people are really familiar with it and get a lot of really great research experience with him. But I love that whole process. I really began to see that I thought human factors could be applied to healthcare of the same principles no human behavior reliability increasing safety and processes and that sort of thing like this is a perfect marriage with healthcare. But at that time this is you know in the early aughts right around 2000 2002 there really weren’t any applied Healthcare Human Factors folks do working. There were some that were working and in research capacities that maybe affiliated with some medical schools or hospitals for example. But there were no really applied human factors it was all kind of academic type approaches. So you know I decided that the human factors as a field for me. I think this would apply to health care. I wasn’t really sure how that would work or what that would lead to. But when I started my doctoral program I was partnered with my graduate advisors or came from the field of judgment decision making specialized and medical decision making particularly and so drug RĂ©gis school I got a lot of really good experience helping to design some patient decision aids and the know for making cancer treatment decisions how do we help patients understand the difference between a specificity and sensitivity of treatment options. Some of those kind of more abstract concepts. So that was kind of really the only thing that was the point that I could find in Healthcare Human Factors. But I had the opportunity to Internet NASA at the Johnson Space Center where I worked in a division they called the Utah have a usability testing and analysis but they had one of their human factors engineers there who was really really interested in working with the crew medical officers in trying to design some tablet based tools for them to use to treat injuries. So you know an national gets injured in Reno from a cut to a life threatening injury in microgravity. So I got to do some really neat research with her kind of figuring out how can we provide tools at the time of care in one of those really unique settings such as microgravity. But after I finish my internship I was lucky enough to wear a hospitalist from Children’s Mercy Health System in Kansas City. One of those physicians it was you know really passionate about safety and health care and learned about human factors and wanted to know more about it. And you know at Wichita State we were kind of the closest program to his hospital system so he reached out to my advisers kind of a natural fit. She was the only one doing research in health care is parsing of factors and so he and I began to partner and collaborate on a few different research projects that kind of led to my dissertation which was a PI medical decision making and kind of choice architecture and things to optimize ordering practices of physicians would we kind of focused on laboratory ordering for interest that there more recent yarder more common pet owners or you know failure to drive some of the more common diagnoses they were eating. So this is when it jars we’re just kind of rolling out people were trying to figure out how to use them they didn’t know how to design them. Most of them many of them still are not necessarily designed in what you would call high functioning or even have great usability. And so luckily as I was winding down that dissertation work. Keith Jones a professor at Texas Tech. Kind of started all this. He’s one of my first mentors and he and I still stay in touch. Send me an e-mail said Hey I know you want to get back today. I was there. I’m from Lubbock and the West Texas area because I want to come back to Texas. Michael good native Texans wanted to do. But he goes there’s a health system there at the time was a legacy Baylor Health facility goes they’re starting a human factor program and they want somebody who can do some applied human factors work and it was just the perfect opportunity that I was looking for and I jumped on it you know applied them and luckily was hired and over the last seven years I’ve been at what is now Baylor Scott White have kind of works in this director position that is 100 percent applied in the factors in healthcare. I do do some research on the side and try to publish when I can but for the most part you know I get to follow my passion which is being out with the providers out with the clinicians on the unit. You know I just got back from a two day trip to our Austin area hospitals I’m working on some of the Awaran sterile processing work and so I get to really be out there and get my hands dirty so to speak. And so you know I kind of throughout my whole life has really been interested in healthcare. And then as I am passionate about human factors and then luckily this one position opened up here that it was just the absolute perfect opportunity for me.

Saul Marquez: [00:07:54] Adam that is so interesting and your journey is amazing. It started early with your dad. Then it would lead to the unfortunate accident but yet you’re still through that time found a way to stay focused and your heart stayed there and you were taken in under the wings of many different leaders listeners. You are the average of your five closest peers. So the people that you surround yourself will determine your future. And what you do and as you surround yourself with some amazing leaders that help you pave a way into a really unique niche human factors in healthcare. And now you’re sort of leading the way so congratulations an amazing story. I really appreciate you sharing that with us.

Adam Probst: [00:08:38] You know I. Yes without a doubt those other leaders that are you know took the time out of their busy schedules you know to help a kid that really wasn’t sure what he wanted to do. Like many of us as we try to grow up and a bit older and more richer. But each one of them left a very big impact and each one grew me in different ways and Yan Chao who is now no longer with Baylor Scott and why but he was really one of the first human factors in healthcare he worked at the University of Maryland is a senior professor in anesthesiology department doing both research into the Pi projects but he began kind of the groundwork here at Baylor Scott White for human factors and he did such a great job that they said hey we want to hire another fulltime Ph.D. to come in and try to work on applied stuff. So you know he was a he left a great mark on me in terms of how to actually bridge the gap going from graduate school to actually how do you take some of that stuff you’ve learned in and work in everyday life. And so each one of those leaders has made a huge impact on me. I’ve been very blessed to have some great mentors throughout the journey so hopefully I can provide that other forces are coming up as well.

Saul Marquez: [00:09:35] Now a true blessing at all. And you know I think it’s it’s a wonderful opportunity that you have in your hands. Can you give the listeners an example of how you guys have created better outcomes with what you’re doing.

Adam Probst: [00:09:50] Yeah we’re happy to. Luckily or unlikely however you would like the phrase of the you know there’s a lot of opportunity in healthcare right a lot of different things to focus on. One of the things that human factors brings to health care and you get a lot of questions that aren’t you guys very similar are lean and doing a lot of Six Sigma pipework. There is quite a bit of overlap we’re trained to look at differently. But human factors you know really is looking at ways in removal that definitely has a huge part to play in healthcare as it continues to try to shrink become more efficient and cost but human factors really focuses on the what you call the people side of that. So it’s kind of a blending of several different fields where it’s what you call the imperial side of psychology and your cognition perception decision making motor control. Basically how we interact with the world around us what people are good at what the better. And it applies that with industrial and systems engineering and design. So it gives us a lot of opportunity to kind of say OK we know what people can do well just naturally and we know what people struggle with just from our own cognitive and information processing capabilities. So how can we help design systems to make them safer in one of the key tenants that we really really look at. Is what we call the work system. You know a lot of different fields have similar concepts and similar names but it IIMA factors especially in healthcare when we talk about the work system that we try to focus on to drive some of the outcomes is really the intersection of you know the people the technology the processes. Sometimes it’s our own policies and procedures that we hamstring ourselves with. So by looking at that work system we’re able to kind of get the whole picture if you will which I think leads to a lot more sustained improvement. And I’ll give you kind of an example one of the projects I’m really really proud of is a nursing leader one of our facilities is doing very engaged rounded with frontline staff cosily kind of very much had an open door policy to get some of her nurses in there to say hey we’re really struggling with this or I have an idea I’d like to work on but this particular facility was a thousand bed facilities one of our flagship cities very very large very very busy very high IQ patients is a new way of saying that right. But while during rounding the nurse brought up to the chief nursing officer there that were not happy we’re overloaded we’re working too hard we’re making errors just because we’re trying to do too much and none of that would probably be earthshattering news to your listeners or anyone who works in healthcare right. But the Theano began to really dig into it and looked you know as all good leaders do begin to really get her hands around this figure out what was going on there and what are some of the areas we think are attributable to this overload of the work system. So what they found is that despite maintaining a constant ratio of 1 to 5 and a med search unit for example or a 1 to 2 in an ICU the nurses national database of nursing quality indicators Indian IQ scores were really falling and our error rates have risen by throwing you know every technology we had that we had a jar we had barcode scanning we had all the stuff you’re supposed to have. Oh we were still having these these kind of errors. And so the CEO who had worked with on a few projects previously called me up one day out of the blue and just said you know I think this is something human factors can work with to both increase our staff satisfaction but more importantly to reduce their workload and allow them to have a better working environment and also more importantly make patient safety and drive or outcomes. And so that kind of kicked off what it eventually became over a yearlong project that one of the nurses ended up kind of dubbing project sanity which I’ve got property. I don’t have a marketing brain so I had some kind of nebulous human factors terms. She’s always just a. You got to give it a funny thing right. Everybody likes to resonate with those. So we really begin to apply some human factors methods to really understand that clinical work system. A lot of that’s done via observation. I’m a firm believer just because of how busy everyone is that we really don’t have the time or we don’t make time to go out and just watch what our health care workers and staff and from any level are actually being forced to work in and what they are trying to accomplish. And so we really began to focus on you know what are some aspects of their broken work system we think could really drive some improvements at that particular units. We had a few pilot units we were working with and start began running through a series of CTCA cycle improvements that we really complete the redesigning almost the entire work system our nurses were operating in. You know everything from how we were managing supplies and storing them how do we reduce and mitigate a lot of these interruptions that we know are leading to errors. How can we streamline and improve our medication administration process and even how we’re even educating our patients on their care. And so we kind of had several interventions we began focusing on looking primarily at the med prep workflow and administration supply management and work efficiencies. But one of the big ones was How can we really in today’s climate where everybody is literally a touch screen away from being interrupted or you know how can we really begin to understand and mitigate some of those interruptions. And so throughout a yearlong cycle we went through several different iterations of this and we actually ended up we calculated that we saved about 250 minutes per nurse per shift in the ICU and 160 minutes per nurse per shift in the Med surge. Yeah it was you know given them actually time back to what they’re trying to do what they like to do and what they have a passion for which is treating patients and being with patients. And we did that all through the redesign of the works as that we didn’t add a single FTE. We didn’t hire more nurses we didn’t hire more patient care techs. So that was Neba one of the really cool things that we found out after we implemented this went back a year later and said let’s go look at our nurse reported medication errors and see to have an impact on any of those. And so the ICU unit tohe from you know we did a year before the interventions and a year after the interventions so we went back and looked in the ICU from 11 events to zero from admit errors and then the lead surging it went from 52 events to 12. So yeah we actually you know thanks to all the great literature out there you could pretty easily calculate what the estimated adverse drug event costs and we we estimated that that saved that particular facility about 500000 dollars a year. So you know you went further. Yeah it was great. We went a bit further and said OK well what are you know how can we better quantify. Not only from the nurse supported error rate but how can we better quantify what are we doing for and versus actual workflows and workloads. And one of the facilities we’ve done this on had a nurse tracking system and we were able to use that tap into that data and basically as an example they were running back and forth to two different medication rooms there were all different. It was led to a lot of interruptions or partial med administration that would start passing that I forgot to grab this then I would have to go back and you know a lot of walking around a lot of wasted time and potential opportunities for error because as you’re walking around you get distracted more interruptions. It was where you were in the workflow for example and we were able just to redesigning the way that we manage their interruptions and supplies and the way we streamlined the Med prep process where were able to reduce their recurrent visits to the medication rooms by over 30 percent. And so you know they actually calculated to spend about one point one hours less every day walking around trying to find and administer medication. And so we really said OK well how do we get this out to the masses. Right this regimen is on a few pilot units. How do we really diffuse this. We’re really big on diffusing some of these practices obviously. So while that was really successful project you know Baylor has a really great quality improvement some of that they do every year is called the blast and quality improvement summit and what it is is designed for projects like this that can be done by anyone and have a very formalized CTCA cycle isn’t it. Have your data in a certain way it’s a very structured process but it celebrates some of these outcomes and things and so we use that as a platform to kind of get the word out we applied and we won first place that year. So thank you. Thank you. And so that got a lot of other facilities interested in doing that type of work and so you know we ended up publishing this work and journal nursing administration and then began to kind of spread it and as we went from beyond the ICU and the Med surge units we went into you know Cub units and oncology units and labor and delivery units orthopedic units and so we’ve kind of created a standardized toolkit now. And I actually had a meeting early yesterday morning with the nursing director in our central Texas division when I was down in the Austin area who had heard about the work and said hey we meet for breakfast while I was up to. And so I was able to hand over a toolkit that says OK here’s our process here’s your data collection methodology. Here’s how he recommends you. You kind of frame this work out. The type of people you’re going need on your team all that you know multidisciplinary approach. And so I was able to hand over this toolkit and now she can take it and run with it and implement it there because there is one of me and a system of 45000 or so. Being able to find ways to drive these outcomes through kind of this diffusion mechanism is really critical as part of what we do. So basically that project started off with the Seno a good leader who was engaged and actively listened and was concerned and didn’t just kind of have the checkbox I look at I got to do my rounding today but literally listened to it and thought hey you know I think human factors and you know really really help with this and started on a way of just trying to focus on how can we make the nurses work life easier which obviously is really really important because we want them focusing on patient care and not on oh I have to spend a third of my time documenting the HR. You know we found a lot of really great reduced Menderes you know patient satisfaction scores went way up reduced time spent wasted and walking around and so we had a lot of really really great outcomes all because of a leader who said yep I think I can help you with that and then use some system resources. One of the benefits of being such a large health system we have a lot of really great people who really need work and so we could tap into those. And so that’s that’s one of my my favorite examples of how Max Baucus has been applied and by looking at that clinical work system you know how can we really redesign it and reduce error and make things more cost effective which is you know health care has to do that.

Saul Marquez: [00:19:19] That’s so great. Appreciate you sharing that amazing story. It’s such a great thing that you were able to create a tool kit to disseminate to diffuse to just scale it out. And congratulations.

Adam Probst: [00:19:31] Thank you.

Saul Marquez: [00:19:32] One of the things that I wanted to ask is you’ve had success. Give us an example of a setback that you had and what you learned from that setback.

Adam Probst: [00:19:41] Oh yes I did put some thought into this one and it was this was very early on in my career here at Baylor. It was one of those things as nursing leaders and physician leaders throughout the system we kind of became aware that OK we have this team of factors program we’re not really sure what they do yet but we think we have some different projects we might want them to work on. And one of the nursing leaders at a facility really wanted to work on the redesign of their crash cards. They wanted to make it more usable less searching time actually designed the way that we were buying the cards. We can’t change the cards but how can we stop the cards differently and that sort of thing to make it more accessible and will be Aster Su Holbeck who who’s now at Mayeux. But at the time was that and Nebraska had done a project like this and I know her professionally and reached out to her and said Can you give me some lessons learned on what you did and she had a lot of really great work on some ideas on how they redesigned the crossguard but what I learned and where that failed is I took that and ran with it but did not have the time or I did not take the time I should say to make sure I had a really engaged team. It was one of those things that the nursing leader was Yeah we want him back to help with this. And so I took that and it was a great idea. From my standpoint it made perfect sense on just my training in terms of human error and that sort of thing but did not have the time to get the frontline. I did not have the time to make sure of it. What can I do for you that works from a human factor standpoint this may make perfect sense but it does not fit your work does not fit your expectations and so basically that project went nowhere. I spend a lot of time on it is really frustrating from moment as a really good learning opportunity. So I learned from that that man you’ve really you know especially in today’s world. Everyone’s running from the new flavor of the month to the flavor that you’re going to reduce falls. Now we’re going to turn our attention our attention to a happy reduction or whatever it may be. I didn’t build the team needed and get the engagement needed and get inside early on enough of the project. So when I came back with my recommendations they were like OK this isn’t going to work for us. It may work on this one unit you worked with but it’s not going to work on the ice use for example. So with a system as large as we are you’ve got to have that a project steering type team for our big initiatives. You’ve got to really have those those implementation folks because the one of the things I learned for me and one of the really good mentors that I mentioned earlier is that especially in patient safety and trying to reduce this at least us those of us at the corporate level don’t own the process. The frontline staff to the ones that are actually treating the patients using the equipment were buying for them and asking them to use. So without having that kind of proactive approach to really understand what is a problem they’re trying to solve. So can come through and it sounds great around a conference room table to say yet we want to make our. We want to design our crash car to have a standard layout for every crash cart across the system. So we have floating nurses or whomever. They’re all the same. That sounds great around a common room. But when you actually go out and try to figure out how to implement that and defuse it if you do not get the right votes engage and you do not take their perspectives into account early enough on and have an ability to kind of not only just keep them engaged but how do you diffuse some of the work we’re going to do then it’s just not going to go anywhere. And so you waste the kind of spin your wheels quite a bit. And so that’s what and luckily I learned that lesson early on and since then you know sometimes I do think that you know would be nice to move things a little bit more quickly and yet have this problem we’re going to run with it and we’re going to fix it in a couple of weeks and then move on to the next. It does take more time to get those folks engaged and involved and build a team that is going to own the process because once I’m done I leave and then they’re kind of stuck what’s left whatever the deliverable was for that particular project. And so luckily I learned that early on and I’ve applied it it takes a little bit longer and sometimes I think we would like but without those kind of engagement without that kind of multidisciplinary approach and looking at the true work system we’re just not going to be able to drive any improvement going forward because it’s just going to you know move on it and then whatever the next target is whatever the next project they want to work on is will take precedence and then it just kind of goes away into the.

Saul Marquez: [00:23:35] Very very real advice there. Adam and a great lesson to learn. We all face this. Listeners there will always be a flavor of the month like Adam said. And if we don’t do the work to get the frontline engaged to get there by and to give us feedback and to make give them ownership in the process then the outcomes not going to be there so make sure you learn from this lesson. Adam Sharon Adam thanks so much for sharing that.

Adam Probst: [00:24:02] Yes thank you happy to. It was a painful lesson but a good lesson.

Saul Marquez: [00:24:05] But you learned early on and it’s a good thing so I love that. Let’s pretend that you and I are building a medical leadership course on what it takes to be successful in medicine today. The 101 course are the ABC of Dr. Adam Probst. And we’re going to ride out the syllabus here with this lightning round so we’ll get some quick responses to these four questions and then we’ll finish it up with a book that you recommend to the listeners. You ready.

Adam Probst: [00:24:31] I’m ready.

Saul Marquez: [00:24:32] Awesome. What is the best way to improve healthcare outcomes.

Adam Probst: [00:24:35] Well I am biased obviously but I truly believe you know with as complex as health care has become with all the integration of technology and we we keep throwing technology at the problem and wondering why our costs aren’t going down and why our outcomes aren’t improving. Is that healthcare leaders really really need to understand how do we deliver care in the framework of this clinical and work system that I’ve been mentioning throughout the whole time. How all of this comes to go how that technology comes together what people behaviors will do you know culture change all that stuff that we don’t understand the clinical work system and then it sounds like a very nebulous topic but it’s really not so you never really going to hit the goals you have zero harms for patients. It really only Ciulei to do that usted understand not by sitting around and asking people around a conference table but going out and seeing and learning how health care is actually delivered and so by using that through the lens of a work system approach that human factors can provide. You’re going to identify those barriers as that phase you’re going to figure out what are our big challenges what are low hanging fruit versus things that are going to take a huge year long process. And so you know human factors can help with that. But I think Jim Collins has a really really great book and this isn’t the book I’m necessarily recommending. We’ll get to that I know but that gives meter’s a kind of a key mechanism to achieve that is right. So it’s good to great book is get the right people on the bus and then decide where to take it. So I think future health care leaders that we’ve got to approach things from a multidisciplinary approach everything’s tied into each other nowadays the work system is very very complex. We’re not getting any more FTE not going to just throw staff and money at the problem. We’ve got to improve the way our health care is delivered and so by understanding how that intersects together I think it would be step number one in really understanding how to drive outcomes for healthcare.

Saul Marquez: [00:26:16] What’s the biggest mistake or pitfall to avoid.

Adam Probst: [00:26:19] I think and I see this a lot since I’m at the corporate level but I often think we fail by really not clearly communicating our system goals and how specifically individual units in offices and departments really dock into those efforts. For example I’ve found that you know frontline staff will typically know obviously you know what the general goals of their facilities like this know we reduce our folds by X percent or drop our Clapp’s the rates or increase our age cap scores. But you know if you really sit and talk to a frontline nurse who knows what her unit goals are but say you know what are you doing and how can you talk into that. That will help drive and achieve the goals that the system corporate and other health care leaders have done. They often don’t have they can’t articulate that well you know I don’t want a patient to fall. Okay that’s great. We always want patients to fall but what can we do with you and how can we give you the tools you need in order to make sure that that doesn’t happen and so you know I always kind of use that flavor of the month example. But we push those so often upon our frontline staff that it’s really nebulous as to how they can really make a difference and that when what they can contribute on a day to day basis to actually help us hit our goals. So I think as healthcare leaders our job is to not only really set the goals for our system but really ensure the goals have a clear pathway forward. They have each staff member understand that everyone plays a role in this from any B.S. person to a senior V.P. of you know what can they do that applies. And what are some realistic and measurable differences and actual work that they can do to help us achieve those goals. I think we often fall flat on not articulating clearly enough how individual steps fit into the overarching symbols of performance.

Saul Marquez: [00:27:54] Straight call out Adam how do you stay relevant as an organization. Despite constant change.

Adam Probst: [00:27:59] It is a definitely a huge challenge that everyone is facing. I think continuous quality improvement is obviously going to be required to continue to do so especially with its healthcare leaders try to set a path for the future. Not really even knowing for sure what that future is going to be because no changes in DC and this we’re going to have this type of healthcare coverage we’re not we’re going to change you know. So being able to really have that continuous quality improvement mechanism we have a really great way of doing that here at Baylor Scott White. We have what we call the steep global efforts these are our pillars are providing you know a safe timely efficient equitable patients. So we have a mechanism down that where people are given the tools and through a kind of a class type environment to complete a prior projects and say okay here’s really how you’re going to understand and map out workflows here’s how you develop a charter is how you develop goals and aim statements and that sort of thing but it gives them a very PDC a rapid cycle improvement but it’s training everyone from healthcare leaders that were required to take it from the director level of your Bailer or frontline staff who want to maybe work on a capstone project. They want to make improvements so giving them the tools and the ability to say okay here’s some general structure around what you can do continuous quality improvement quickly within kind of teaching them and then turning them loose and let them go and actually make a difference. I think that’s the net would have that mechanism to train your staff and to give them the tools to let them do those quality improvement initiatives. The only real way I think to keep that sustainment and stay relevant going.

Saul Marquez: [00:29:22] What’s the one area of focus that should drive all else in your organization.

Adam Probst: [00:29:27] For us. And I think a lot of help you know everyone likes to say we’ve always put our patients first. Obviously that’s why many of us are in health care. We want to make a difference in people’s lives. We want to help people. But I think you know particularly health care leaders is really really focusing not only just on patient experience which is so important now because reimbursement tied to age test scores and all that but really just understanding and putting names to the faces of why we’re really really doing this. Yes we all have a career. Yes we ought to make our ends meet financially and so we ought to have a job of some sort but we’re really here to make a difference for people that we see in their worst right and who are. Nobody wants to go to a hospital nobody will be there. So you know really keeping that as a sinner and we’ve done that a lot through actually just sometimes it’s as simple as putting a face with a problem is you know hey we’re having this issue on over sedation. Well here’s a patient that had a negative outcome. And this is who this patient was. They had family and friends and goals and aspirations. They wanted to do. And so I think keeping that centered and making that a priority. And sometimes it seems kind of almost colloquial or sometimes even cheesy or rah rah to say you know we want to put our patients first. But I think you’ve really got to make sure and not get stuck in the day to day of it. We so often fall into. Yeah. It’s a job I’m doing. But that patience truly are the focus for what we need to be working on and the only way to really provide them the care that not only we want to give but that they deserve is to make sure that they stay at the center of every decision.

Saul Marquez: [00:30:51] I love it. I’m what book would you recommend to the listeners as part of the syllabus.

Adam Probst: [00:30:56] Yeah one of my favorite books is Stephen Casey. He has a book called set phasers on stun and other true tales of design technology and human error. An old book. It’s kind of one of these but it’s no different edited versions and more updated versions through the years. But it was really one of the first books I read there was Jones and others actually recommended to me when I became interested in the field of human factors it’s basically a collection of disasters that occur when designers don’t take the user into consideration. He uses a lot of airplane crashes but obviously there’s health care examples in there just due to the way we’re designing the equipment the machines that kind of we’re asking folks to use and it really highlights what I think is a critical really understanding order to drive outcomes and safety is to understand the difference between use error and user error. Everybody like a lot of systems move to a fair and consistent culture type approach where we don’t want to point fingers. We want to help everyone and we understand what was a process that broke down and all that. But we often sometimes we when person says they should pay. How could you give the wrong drug to do that kind of stuff. And so this is a really good framework of helping people shift that. Oftentimes people are just a result of the equipment the technology they’re being asked to use. So a really good job highlighting that I would recommend that to the listeners for sure and it’s a fun read. I mean not fun is a funny haha but it’s very intriguing and interesting and I think it’s a really unique perspective on how leaders can help drive healthcare by really focusing on. We’ve got to take usability and users and everything into account on the technology we’re asking our patients healthcare staff to use.

Saul Marquez: [00:32:28] Now this is really great Adam and listeners an amazing syllabus we just put together here for you all and a great book. You don’t have to write any of this down. Just go to outcomesrocket.health/AdamP. that’s ADAMP. As is Peter or P as in Probst. And you’ll be able to find all the show notes links to Baylor Scott White all the books that we just talked about. And just the projects that Adams up to go to outcomesrocket.health/Adamp he you’ll be able to find that there. And before we conclude Can you share one closing thought and where the listeners can get a hold of you.

Adam Probst: [00:33:06] They can get a hold me through our Steeb Global Institute as part of Baylor Scott White Health. We’ve actually done a lot of collaboration and almost as a consultant I’ve worked with systems that may not have human factors personnel available but you can get that through my Baylor Scott and White websites and then not have linked in profile. Please feel free to add them Jaro BSD. Feel free to reach out to me. They’re always eager to learn and collaborate from other healthcare leaders. And yeah a closing thought is that and I’ll give a brief but human factors in healthcare is now much much more common than it was even five years ago 10 years ago. I think a good example of that is you know there’s a national team of factors and ergonomics nation and society that puts on a yearly conference for people working at Google and aviation and health care. But there’s so much health care now that it has now a specific healthcare focus conference that it does on a three day once a year. And so I think you know as healthcare leaders move forward really want to make a difference is that it doesn’t have to be human factors necessarily but really understanding that the work system we’re giving our staff and what we’re asking them to do is broken and then we wonder why we still have these safety events and we have these never events. And all this did happen. And it’s because we’ve designed the work system in a way that is no longer feasible. Someone mentioned that healthcare is broken when the health care is up for healthcare is working the way it was designed to work. It’s just it was not the. Well and so I think leaders moving forward by understanding this work system approach. You know we now have to look at it from a holistic almost 30000 foot view of understanding where all of this stuff comes together and that the only way to really drive improvement is not to point fingers at staff and say you should pay more attention or to hire more staff necessarily but has to really redesign and restructure the work system in which we’re asking staff to provide care.

Saul Marquez: [00:34:52] I love it Adam. Well listen I think you hit the nail on the head with that you know health care isn’t broken. It’s working the way it was designed to work. And I encourage listeners to take some words of wisdom from Dr. Probes here and think about how you could involve the idea of human factors in the way that you improve outcomes in your facility and how you design your equipment or drugs to improve outcomes. Just want to thank you once again for taking the time to join us and really looking for you to stay in touch.

Adam Probst: [00:35:25] Yes thank you for the opportunity was great. I really enjoy the podcast and I love all the love. This is a great mechanism to try to bring healthcare leaders together look at you know how can we fix this broken work system from a number of different ways. Thank you for what you’re doing.

: [00:35:41] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at wwww.outcomesrocket.health for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Set Phasers on Stun: And Other True Tales of Design, Technology, and Human Error

The Best Way To Contact Dr. Adam:

Linkedin – Adam Probst

Mentioned Link/s:

https://www.bswhealth.com/

Sponsor for the Episode:

Healthcare Podcast