How To Create Actionable Value Based Care Policies and Best Practices with Chris DeRienzo, System Chief Quality Officer at Mission Health

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.

: Welcome back once again to the Outcomes Rocket podcast where we chat with today’s most successful and inspiring health leaders. Today I have Dr. Chris DeRienzo appointed member of North Carolina Medical Care Advisory Committee. He’s a dedicated husband and proud father and also a triathlete. He’s also a physician executive dedicated to improving health for all Americans and currently serves as a chief quality officer for Mission Health. In this role, he gets to practice neonatology with Mission Children, teach as an adjunct professor of pediatrics with both Duke and USC and volunteer as a member of the Blue Ridge Regional Hospital Board, the Mercy Health Board quality committee and the YMCA Blue Ridge assembly board mission Impac committee. He’s board certified in both pediatrics and neonatology Dr. Dary Enzo completed his M.D. Master’s in Public Policy and postgraduate medical training at Duke. He’s certainly passionate about what he does for populations and it’s a true pleasure to have Chris on the podcast with us Chris. Welcome.

: I’m happy to be here,Saul Thanks for having me.

: It is a true pleasure my friend. Now did I leave anything in that intro that maybe you want to share with the listeners?

: The only thing I might add is I’m a mediocre triathlete at best.

: Hey listen you know how to finish them and that’s all I care about my friend.

: Amen to that.

: I was able to do two triathlons and man major respects. Do you do the Olympics, do you do the sprints? What do you prefer to do?

: So I started in the in the shorter course. And I actually just did it an Olympic. We were visiting some friends in New Jersey this past weekend. But I’m trying to work out towards the Iron Man. It is a lot of training and I have an incredibly understanding wife.

: Oh my gosh. That’s awesome. Well if you’re shooting for the Iron Man, I’ve never done it but I admire those that could get it done. And if you apply even a fraction of what you’ve been able to do in your career and what you do and what you love so much, I have no doubt you’ll be able to finish it.

: I appreciate that. We shall see come mid October.

: Fingers crossed. Hey so Chris why did you decide to get into the medical sector?

: Yeah when I was a kid I was really interested in science and I had this fantastic neighbor who is an oncologist and she took me into her lab one summer she was doing great research on cancer science and I thought it was really cool but I felt like I was missing something. And finally one day she brought me to one of their cancer conferences where they talk through patients and what the best strategies were to help treat this cancer that cancer and something just clicked for me and I said wow I can really very directly have impact on individual people’s lives and on lots of people’s lives at once by getting into benison and once that’s sort of been struck I was off and running.

: That’s so cool. So from the very beginning Chris you were interested in and impacting populations at large. What would you say today, you know now fast forward to where you are in your career and as a healthcare leader is a hot topic and needs to be on every medical leaders agenda and how are you guys addressing it?

: I think that we are clearly undergoing a time of great transformation in healthcare from the way that we think about providing health care to what’s available to us to treating patients not just inside the four walls of our institutions but throughout the courses of their lives. So I think if folks are not innovating today, if they’re not continuously improving then you’re already ten steps behind the rest of the field.

: Yeah you know that’s a really great call out. And so as a health leader within the system, a provider system – what type of advice would you give to others trying to do something trying to innovate?

: So within Mission we’ve been really successful in innovating through our continuous improvement pathways. And so the way that we think about continuous improvement is kind of like fishing. All right so you’ve got to first teach folks that it’s part of their job that they need to fish. Otherwise they don’t know that they either can’t do it or need to do it. So right from day one, the Chief Operating Officer of our system in day one of orientation tells everybody at mission that you’ve got two jobs. First to do what we hired you to do as well as you possibly can do it. And second figure out ways that we can make it better. And so we go folks who join the team in from the very beginning that continuous improvement is in our DNA. And so once you know that you need to go fishing you need to have some tools to fish. So we equip folks through a variety of different trainings with the tools that they need to perform continuous improvement at the bedside and finance and H.R. you name it. And we use a variety of tools including analytics platforms more basic continuous improvement methodology and then we teach folks how to use them. So once you’ve got your fishing pole unless you know what to do with it you know it’s not of much use to you. So you’ve got to focus time, energy and resource on training and coaching on how to use continuous improvement tools and methodologies relevant to whatever that individual’s area of practice is. And then finally once your teams begin achieving great outcomes and you know that they will because equipping folks at the frontline – frontline managers line level leaders with continuous improvement methodology is all of a sudden their eyes are open to the opportunities surrounding them and they will achieve outcomes. Their leaders have to then positively reinforce it. And so we highlight those outcomes everywhere we could possibly think about it. We have quality awards every year. It’s on their boards, at their units, in their clinics and it begins to generate this profound flywheel effect on continuous improvement.

: Chris I think that’s wonderful and it’s very clear to me that continuous improvement is inside of the very fabric of the culture of your organisation from the beginning through out the individuals’ careers their mission and I could hear the passion in your voice for this continued improvement that leads to those innovations. You use the fishing analogy I recently had a guest on a podcast that talked about you’ve got to keep tension in the line and that tension in the line always helps you understand the communication between you and the things that are going on within the organisation. And I think it just meshes really well with the example you’ve provided. Can you give the listeners an example of something that’s come out of this culture of continuous improvement?

: Absolutely on the clinical side we structure that continuous improvement around something called care process models and so a care process model team comes together around a clinical condition or a disease state and very purposefully walk from start to finish through what are the best practices nationally on driving patients to the best possible outcome with colon cancer, with lung cancer, with paediatric asthma and so on we bring those teams together and we give them 90 days and say in a 90 day sprint We need you to find the problem. Figure out what the best practice is we resource the clinician who leads a team with a member of our performance improvement team with informatics folks, with an analytics resource, with education resources, and then with all of the folks in the clinical care team who are relevant to that condition so if it’s in the clinic environment we’re talking about medical assistance, nurses, pharmacists if it’s on the inpatient environment you know care managers are there and so and so forth. So we empower that team to tell us what is the best practice said it mission we need to build into our workflows and then we build it we build it into the electronic medical record in a workflow that is as frictionless to use as possible which makes it easy to do what our CPM has decided is the right thing and just a little bit harder not to follow that pathway. But that’s not enough. You then have to measure outcomes. So we’ve built the analytics environment for each and every one of these care process models so that we can get to a physician, provider and a patient level and know are using the pathways making a difference on relevant clinical outcomes. So for example in the inpatient world if we’re using the sepsis CPM what the differences look like in patient mortality, in readmission rate, in length of stay, in cost per case. And right now I could pull ups Saul across over 60 of these care process models and if you were you know one of my supervisors you would say Derienzo “you know if you look across our group most folks are using the pathway 80 percent of the time and this is what their outcomes look like. You using it 30 percent of the time and look at your readmission rate is higher this number is where what’s going on?” and sometimes we found that conversation is well you know my patient panel has a really high percentage of say chronic renal failure and we don’t have the right dosing built into the pathway. And then within two weeks we fix the CPM and now it’s there and sometimes it’s more of an eye opening conversation saying oh my gosh I didn’t realize that I wasn’t using x. And so we then bring folks along and we have seen dramatic, Saul, dramatic changes in clinical outcomes as a result.

: What a great example Chris. Just thinking through this application you know I had a guest about a year ago we were talking about she’s at the New School of Medicine, Nadia, who I’m putting this conference together the healthcare thinkathon. She talked about how innovation in health care is implementation and what you’re talking about here Chris is implementing right away like not even waiting. You have the conversation you identify the gap and then boom you get to work.

: That’s exactly right. When I think about implementation science and health care we’ve got still a lot of low hanging fruit in just knowing what the right thing is and finding as seamless an easier way to do it. And when you move from that place you begin with that foundation and start to turn a flywheel. Your caregivers then begin innovating and saying why is over here when it could be over there why are we having to file 13 different ways to do X when all we really need is one. And so by teaching folks continuous improvement by resourcing them to do it you begin turning an innovation flywheel that begins to then drive itself.

: That’s so awesome. And folks I also want to give you a heads up so we’re having a great discussion with Dr. Chris DeRienzo. He as you can tell is so in just deep into this subject of continuous improvement but overall improving patient outcomes. And I want to invite you to check out some of his thoughts. He keeps a blog. You go to drderienzo.com, you’ll find his blog where you’ll see much of his work. He’s got videos on their blogs. It’s just a wealth of his thought process there so don’t miss that if you’re a clinician or anybody in the industry looking to get better. I truly recommend this blog to you. He pours a soul into it and allow best practices. So definitely one to check out and we’ll also leave a link to that show in the show notes that we’ll share a link to you for as well. So Chris obviously some great things going on at Mission with what you and your team are doing. Can you share a time when you had a setback as a team or personally and what you learned from that. I feel like we learn more from those times and the successes.

: No doubt Saul. And I think one of our greatest successes being the CPM work. We also feel that in almost every possible way you could without impacting patient harm or regulatory failures. And so as we walked through a driving CPM work we took way too long at the beginning. My chief quality frame to Tory Dr. Darrell I think compares it to the gestational period of an elephant which is something like 600 days or taking a year year and a half to get these care process models live. We were biting off way more than we could chew at the start and we were winding up with 80 to 90 page documents which were filled with great practice but were not usable and so we learned from that mistake. We didn’t have the right folks on the team. We didn’t ensure that those who would be using the CPM were the same ones developing we didn’t protect the time right for people who were engaged in it to really focus on this work and as purposeful a way as they could and so we made lots of mistakes and in healthcare as long as you’ve defined the box to avoid your mistakes reaching patients and causing harm I think we need to be comfortable making mistakes on our continuous improvement work because the best innovators are going to make mistakes. And unless you’re making those kinds of mistakes you are within a safe boundary. You’re never pushing hard enough.

: I think that’s such a great column Chris and you mention that documents got up to 90 pages what did you guys get it down to.

: So we’ve improved from there. We still have eight to ten page documents with references for folks who want to review them but now we actually have just a video walk through now how to use the pathway and then a demonstration in the analytical portal of how to measure that utilization and as you imagine utilization has dramatically increased when you make it much easier to learn how to use it.

: Wow that’s outstanding. You know it’s eight to nine pages of video from ninety pages. Huge kudos to you and your team, man.

: Well again I can’t take much credit for that. That’s turning it over to the team and saying here’s what our goal is. We need to work from getting one of these live every 45 days to one every 10. And the why is because as our state moves very purposefully into treating populations we need to be prepared as a health system to meet that need. And we knew three – four years ago that we weren’t there and that it was going to take a getting 30 to 40 of these care process models life each and every year across subspecialties, inpatient and outpatient ambulatory and post acute. So when we sat down with the team and said what’s it going to take to get there we had to totally redesign the document totally redesign the EMR workflow. We had to totally redesign the approach in the analytics environment – moving from perfect solutions to 80 percent solutions and then creating incremental improvement from there. And so it was that kind of teamwork and then some momentum as we started the very first one. Gosh I want to say it was like November 2016 and Dr. Dauer actually took ownership of it herself on the ambulatory side and put a win on the board and folks could see wow. No one believed we could do these in 90 days. And all of a sudden there’s proof. And that one it was copd exacerbation. That one alone Saul has prevented emergency department use it’s prevented inpatient hospitalizations and saved on the order of 200 thousand dollars a year in direct cost.

: Huge. That’s so awesome and you know so kudos to you guys for really putting the right team together and just getting it done and you know Sir Richard Branton once said It takes a true expert to simplify anybody could complicate things. And there’s no doubt in my mind folks listening to this that Dr Chris DeRienzo and his team are experts at what they do so if you wanna learn more about them again check out Dr. DeRienzo’s blog where you could find a little bit more about him and the things that he’s up to. So what would you say your proudest medical leadership experience is to date, Chris?

: Oh Saul, there are many. I have been really fortunate to be a mission for four years working with some spectacular teams. But one one early win that I had I’d call out. I remember it was a couple of years ago and we had just begun really the socialization work of building our culture of continuous improvement that would be grounded in data analytics that I had spent a lot of time with various clinical leaders showing them dashboards and pitching the story as to why this mattered and how it could serve to improve the work that they were doing. And I remember one day in a meeting one of those clinical leaders without any prompt just pulled the dashboard up and started driving it himself. And I thought to myself oh my gosh this is the tipping point. If Jeff can pull this up in a meeting be confident in the data use it to make a point and drive it home then I know that we have crested that hill of acceptance. And we’re only going to keep driving from here. And that was like three years ago and I’m just incredibly proud of how far teams have been able to come with that since.

: That is amazing. And what would you attribute the uptake on because a lot of organizations do struggle as you know, Chris.

: I think there are a couple of things. First as we started our work in analytics and we began with what was most core to our mission which is the bigger aim to get each patient to their desired outcome first without harm, without waste and with superlative experience for every patient family and team number. And so beginning in that space speaks to the core of who we are. And so it got to the Y right. If you begin notes why then it is much easier to explain the House and the what’s that springing out of it. It’s about beginning with why because we need to dramatically improve the health of the population we serve developing tools then didn’t become just shiny objects that sat on a wall. They became the house to delivering on our why.

: That’s so cool that’s so cool and yeah just again a reminder listeners we’ve got to keep that why front and center, find ways to weave it into the culture of your organization and that message got to come from the top all the way through the organization and that’s how we make outcomes better. Tell us about an exciting project or focus that you’re working on today, Chris.

: Yes it’s springing from the same why. One of the things I’m most passionate about right now is the ability of using technology in much smarter ways to scale humanity in healthcare. And so our first data science project that’s bringing a machine learning model live into the clinical environment is around readmissions predictor. So we have terrific teams of transitional care managers whose role it is to screen through lists of patients who are discharged and figure out who do I need to focus on today and how can I keep them home and healthy and not be readmitted to the emergency department or the hospital. And that is an incredibly challenging job and it’s a job that impart only a person can do in that you’ve got to figure out what do I do for this person. But who to focus on is a problem that machine learning can help solve. So our spectacular data science team led by Dr. Andy Johnson spent months developing the machine learning model that consumes data every day about the patients who were discharged yesterday and serves a prediction at 8:00 o’clock in the morning to our transitional care manager team on who is most likely to be readmitted and why. And what that does as we’ve iterated and continue to improve the user interface and continue to improve the model itself is allow our care managers to spend less time hunting and pecking for information that tells them who do I need to focus on and scales the time that they actually get to spend focusing on patients. That’s what they went to school for. That’s what brings our caregivers joy. If you ask any unit, any clinic, anywhere at Mission we’ve done it a hundred times. What brings you joy. The answer is spending time with my patients spending time with my team. And so the more that we are able to scale opportunities for our caregivers to be with patients and connect with their teams the happier they are the better outcomes we’re going to get. So I’m super excited we’re now six months into implementation. We’ve gone through multiple, multiple waves now Vater of improvement aspect will keep doing so for the next six months and I’m confident this will become a core part of the way that we approach readmission prevention moving forward.

: That’s awesome. Chris congratulations to your team for that. And you know it’s a great example of how staying focused on the why and the specifics of what your organization is up to that you can actually use tools like machine learning to augment the work that humans must contain to do.

: Amen to that.

: Getting close to the end here. Let’s pretend you and I are building them medical leadership course on what it takes to be successful in medicine. The one of Dr. Chris DeRienzo. We’re going to write out a syllabus – four questions followed by a book that you recommend to the listeners. You ready?

: We’ll go for a man. I’ve listened to lots of these and so I’m hoping it’s lightning fast as the guests.

: I know you’re going to kick butt. What’s the what’s the best way to improve health care outcomes?

: Focus on getting better. I think that we constantly fear perfection and we’ve got to focus everyday on just be better than yesterday.

: Great message. What’s the biggest mistake or pitfall to avoid?

: Fearing making mistakes.

: How do you stay relevant as an organization despite constant change?

: You need to continuously improve.

: What’s one area of focus that should drive everything in a health organization?

: It’s our mission if we return to the Y which is our big dream. What we do next is never in doubt.

: Love that. What’s your all time favorite book, Chris, that you’d like to recommend as part of the syllabus?

: Oh my gosh I’ve got so many good ones. I think on the leadership side every year I return to Colin Powell: It worked for me because there are just so many solid lessons in leadership that every year that I’ve been in a leadership role I wonder rereading it and getting some other kernel of good learning out of it from just totally off base book perspective. I just finished reading River of Doubt which was about Teddy Roosevelt’s journey down an unknown River in the Brazilian rain forest. And you want to talk about sort of exciting an adventure that was a kicker.

: Wow that sounds super interesting. Two amazing books both haven’t been recommended before. So for the listeners take those down and check them out. All the things that we discussed today are available at outcomesrocket.health/derienzo You can find that there links to this podcast links to the show notes, as well as a full transcript. Chris, this has been a blast. Really appreciate you spending time with us before we part though. I love if you could just leave the listeners with a closing thought and then the best place where they could get in touch with or follow you.

: You got it man so I think I’m just so grateful that you’re providing this kind of a platform for folks across health care to engage with each other. You know I think that increasingly as healthcare evolves from being a field in which we engage with people episodically in different settings for walls to continuously throughout their lives we have to be thinking fundamentally different than we did yesterday because our solutions for yesterday are not going to solve problems of tomorrow. And so I think that the foundation that you’re creating here the platform for folks across industry vertical and horizontally to get together to talk to each other and to spark ideas is just spectacular. And so you’ve mentioned my blog. I really appreciate you noting it there are there links to follow me on Twitter and on LinkedIn there as well. And always happy to engage with folks who are committed to continuously improving the way that we deliver health to Americans across the country.

: Outstanding Chris. And again listeners the blog is drderienzo.com. Chris it’s been an absolute pleasure and we’re really looking forward to keeping up with your success and the things that you do for our industry so keep up the great work and thanks again for making time for us.

: Likewise, Saul. Really appreciate it.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.

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