|Photography: Ann Johansson|
When the phone call came asking Robert A. Cherry, MD, if he might be interested in becoming UCLA Health’s chief medical and quality officer to lead system-wide quality-improvement efforts, his response was immediate. “I didn’t even have to think about it,” he says. “UCLA has such a great reputation, and I was instantly intrigued with the opportunity. I was very impressed with the degree of enthusiasm and passion about quality and safety. It was an easy decision.” Dr. Cherry, who trained as a critical-care and trauma surgeon, was appointed to the newly created position in January 2014. Before coming to UCLA, he served as director of clinical and operational excellence at Navigant Consulting, in Chicago, Illinois, where he was responsible for the strategic development and implementation of such key healthcare initiatives as the early adoption of accountable-care-organization models, physician integration strategies and enhancement of quality and safety systems. He also served as chief medical officer and vice president for clinical effectiveness at Loyola University Medical Center, outside of Chicago. Becker’s Hospital Review named him among the “100 Hospital and Health System CMOs to Know.” Dr. Cherry spoke about his vision for UCLA’s role as a world leader to shape the future of healthcare delivery with U Magazine contributing writer Dan Gordon.
How do you define quality, and what’s the basis of your strategy for promoting quality within UCLA Health?
Dr. Robert A. Cherry: Quality can mean different things to different people. And there are so many metrics and initiatives that it can be difficult to communicate within large, complex organizations what we need to achieve in order to be successful. That is why I’ve been articulating a quality strategy, called MOVERSTM, as a way to provide a structured framework for positive change. It’s an acronym with six buckets that represents the overall quality strategy for UCLA Health. Within each bucket, we have initiatives to move the needle forward. The idea is that everyone here is a change agent for safety and quality; everyone contributes to the overall quality strategy and is part of the fabric that makes up our safety culture.
What does MOVERSTM stand for?
Dr. Cherry: The M is for reducing risk-adjusted mortality. Right now we’re especially centered on reducing mortality rates related to sepsis, as well as integrating early-warning systems and intervening rapidly before a patient gets into real trouble. O stands for outcomes. We’re focused on a variety of publicly reported metrics in areas ranging from inpatient surgical care to outpatient population health measures. Where there are specialty-specific metrics, we encourage individual departments and clinical-service lines to pursue those outcome measures as well. V is for value — delivering optimal care while also being responsible stewards of our limited resources. Consumers, employers and health plans are increasingly looking at that. So that bucket is about redesigning the clinical care in a way that provides value, reduces cost and increases the quality of care. E is for patient experience. We look at selected measures related to both inpatient and outpatient experience to make sure that it is optimized. R is for reducing readmissions. This is increasingly important because as people live longer, they are sometimes living with complex chronic diseases that need to be appropriately and safely managed within the home environment. And S is for safety. Our ultimate goal is to make sure that all patients are safe from harm during the course of their care and treatment. We look at the list of publicly reported patient-safety incidents and call them “never” events — we never want to see them. A high-performing safety culture requires open communication, transparency and trust to be successful.
You have said you envision UCLA as a global leader in this arena — not just one of the best, but a true change agent.
Dr. Cherry: We want to be the healthcare system in the United States that organizations and individuals turn to for leadership in quality and safety. To get there, we need to be consistent and high-ranking in terms of our publicly reported measures. Consumers, employers and health plans are increasingly looking at these measures to make judgments about our organization, and we have to make sure that the reputation of the organization matches the publicly reported outcomes. That’s one aspect of leadership. But the other is for UCLA Health to be a visionary leader and innovator within the broad realm of quality and safety.
What would be an example of an area in which UCLA can serve as a healthcare change agent?
Dr. Cherry: Leveraging technology is one area that we have been looking at for some time. For example, wouldn’t it be great to have an app on your smartphone that enables you to better manage your clinical condition — based on your doctor’s recommendations — by recording your response to treatment and making it possible to communicate more effectively with your physician? With these kinds of interactive apps, the physician can understand exactly what’s going on with you at home; when you come in for an appointment, the physician then has a much-more complete picture and is able to render much-more precise and individualized care. The UCLA Inflammatory Bowel Disease Center has already developed a patient-centered, interactive app, and there are other physicians who are exploring these concepts. The advent of social media and smart technology will provide a level of connectivity between the physician community and the patient that, in the future, will allow us to leverage knowledge and decision making in ways that we don’t yet fully understand. We’re also looking into how the electronic health record can be used in new ways for clinical-decision support. Technology is going to continue to be a major driver of change in healthcare, as it has been for a while.
How does the Affordable Care Act (ACA) affect an academic institution such as UCLA?
Dr. Cherry: A lot of changes actually started before the ACA. We are looking more systematically at managing the health of populations, potentially in collaboration with other employers. Employers are now thinking about how to manage resources within healthcare, as well, and they’re interested in innovative strategies and new partnerships with healthcare facilities. An example of such a partnership is UCLA’s new collaboration with other leading healthcare centers in Los Angeles and Orange counties to offer an integrated, multicenter health-plan option through a new Anthem Blue Cross entity called Vivity. The California Public Employee’s Retirement system already has signed on as the plan’s first major customer. In another example, some very-large employers are developing centers of clinical excellence, not just within their local community, but also at places distant from their primary location. For certain types of tertiary and quaternary care, patients are traveling to facilities where the employer knows that the outcomes are consistent and strong. Employers want to know that their workers, who go to particular facilities for certain types of care, are not only getting high-quality care, but they’re also getting it at a cost that may be less than if they were to go to a local hospital or, in some cases, a local academic medical center. For us to be able to compete in that environment, we need to demonstrate that we can provide services to patients that employers will find attractive as well. In addition, employers are looking very carefully at their network of physicians and hospitals, and they are starting to develop preferred-provider networks so that they can manage their employee population with a set of healthcare facilities that are favorable in terms of the types of healthcare outcomes they are seeking. They are also reading publicly reported measures and making judgments about organizations. With that degree of transparency, it becomes very important that we put our best foot forward so that we’re attractive to employers and health plans. Finally, some large companies are starting to consider public and private healthcare exchanges, and that’s putting pressure on academic medical centers, which are structured for high-end complex tertiary and quaternary care, making the cost structure unfavorable for a lot of routine care. It means that we need to deliver value in the care that we’re providing — whether it’s primary and secondary care or tertiary and quaternary care.
What advantages does UCLA offer over some of these other options for employers?
Dr. Cherry: UCLA has extraordinary advantages because it has a cadre of faculty who are looking to innovate in this area. From a health-system-leadership point of view, we have a chief innovation officer, Dr. Molly Coye, who encourages faculty and other staff to look at creative ways of redesigning care within the institution through new technology and innovative treatment models. In addition, we have a chief operations officer, Shannon O’Kelley, who is also looking at innovative ways to deliver care more efficiently and effectively. Dr. Sam Skootsky, our chief medical officer for the UCLA Medical Group, is consistently implementing novel strategies to improve the health of our patient population. We also look outside of our own organization; if there are others who are implementing unique strategies, we spend time learning about those organizations and try to replicate some of those initiatives here.
Is it more difficult to maintain high quality at a time when there is such a strong mandate to reduce costs?
Dr. Cherry: The key is to use evidence-based practice and make sure that physicians, as best they can, reduce the day-to-day clinical-practice variations in their approach to patients. The more that physicians and surgeons collaborate as a team, and come up with consensus opinion after reviewing the literature, the better off we’ll be in terms of managing our limited resources while improving the care that is delivered. You find that the cost of care becomes much-more expensive when we’re not all on the same page regarding optimal treatment. The outcomes may be the same, but one physician may be using more expensive treatment options than another. Getting the same, or better, outcomes by using our resources more wisely is part of the task ahead.
Do you see any tension between quality and cost constraint? As we try to reduce costs, does that necessitate trade-offs in quality?
Dr. Cherry: Not at all. When we’re able to provide improved care with reduced cost, we can take that savings and reinvest it in ways that will allow for better care over time. As an academic research institution, we must continue to invest in cutting-edge technology to care for patients. To do that in this era, we have to make sure we manage our resources well. In the past, we didn’t have to think about that as much. Now, it’s imperative that we provide care that is as efficient and lean as possible and then use the savings to invest in new technology, supplies and pharmaceuticals for the betterment of our patient population.
How has your background as a trauma surgeon influenced your thinking in more executive-focused roles?
Dr. Cherry: I always received a great deal of satisfaction from taking care of the individual patient, but I’ve also found extraordinary satisfaction from managing clinical systems and contributing to the delivery of optimal care at a macro level. In trauma surgery, it is tremendously rewarding to rescue a patient from the brink after he or she has gone through a life-threatening or limb-threatening emergency. Now, there is a tremendous reward from watching mortality rates decrease, infection rates decrease, and fewer adverse events occurring within a facility because of creative teamwork, as well as the collaborative implementation of new and creative ways of delivering care.