Lee Kim Erickson, M.D., is Senior Vice President and Chief Quality Officer at Burlington-based Wellforce (now Tufts Medicine). Before coming to Wellforce in 2021, Dr. Erickson was Deputy Physician-in-Chief for Clinical Operations at Memorial Sloan Kettering Cancer Center in New York City. She has more than 20 years of experience using Lean methodology for process improvement and holds a Master Black Belt in Lean Six Sigma. Dr. Erickson has also been a teacher for more than 20 years, serving as faculty in family medicine/primary care in the Allegheny Health Network and University of Pennsylvania Health System and providing clinical teams with the skills and tools needed for problem solving and best clinical practice.
The Betsy Lehman Center: With COVID exerting more pressure than ever on clinicians and health systems in general, can you suggest ways to maintain a focus on patient safety during times of crisis?
Dr. Erickson: Yes, everyone is tired, and compassion fatigue is palpable. We all worry about patient safety in this context. I try to help clinicians focus on safety by reframing the story around the patient and encouraging them to tap into why they went into health care in the first place.
Patient safety and quality are more about operational issues than clinical problems. For the most part, our clinicians know what’s right for each patient. They know what to do. The problem is we've made it almost impossible for them to do it by over burdening them with tasks that add no value to the interaction between the clinician and the patient. We make it hard for them to do the right thing. People in health care are geniuses when it comes to workarounds, and it's sad that we've forced them into that position because they face so many barriers.
We all do this work because we want to help people feel better or even save their lives. And when conditions and the systems around us make caring for people hard, bad things can happen, and we feel terrible. But it really isn’t our fault as individuals. I've seen that everyone benefits when we make it easier for clinicians to do their work well.
The Betsy Lehman Center: What do you observe about physicians, nurses and other professionals who are beginning their careers during the pandemic? How do you think this experience will shape them as future safety leaders? What can health systems do to help them learn and succeed?
Dr. Erickson: Physicians, nurses and other front-line health-care people starting their careers now are intensely interested in learning how they can make health care work better — far more so now than when I trained, just before the Institute of Medicine published To Err Is Human. We can't keep up with the demand! Young people want to do projects, take classes and shadow us in the hospital and in clinics. We don’t have enough experienced frontline teachers for the number of professionals and students who want to learn.
I love to teach by having learners participate in improving things. When people learn through experience, they are converts for life! They see what works and feel the power of being able to make things better for themselves and their colleagues. Teaching is fun but hard, especially right now because it takes time, and time is so scarce.
On the positive side, the pandemic offers opportunities for learning. For example, I was working in New York City when COVID-19 hit and was deployed to the hospital’s incident command system. I quickly saw that it was essentially a Lean Management System. We used huddles, sometimes two or three a day. It struck me to wonder why we don't do this all the time. It was a management system that produced as near to real-time situational awareness as I’ve ever seen, with interdisciplinary leadership teams that talked to each other multiple times a day. And the people you needed to solve problems were right there in your huddle. It was like having the ultimate patient safety structure. I hope that experience of agility will stick with at least some organizations.
Another way that we teach and learn by experience is through simulation, which I’ve used extensively in teaching over the years. People in health care are smart. When you engage them in realistic simulations, they quickly catch on and start identifying and solving problems on their own. After a while, they don't need you anymore.
The Betsy Lehman Center: You have responsibility for quality and safety across settings that vary from inpatient units to physician offices to home care. How do manage such a diverse portfolio? What common threads for quality and safety do you see across Wellforce’s operations?
Dr. Erickson: The answer comes entirely from my Lean background: Stop thinking about care in silos and start thinking about it from the patient's point of view. We need to identify all the touch points from the patient's perspective. There's the emergency department, inpatient service, the case manager, home care nurse, hospice attending physician and so on. To tackle problems in safety and quality, I want a multidisciplinary team with representatives from all those touch points, which is classic, end-to-end value stream management from Lean. The only perspective that matters is that of the customer; in our case, that's the patients and the people who take care of them and their families.
Wellforce is about to implement a new electronic health record, which I expect will help us cut down on fragmentation and coordinate care for the patient’s benefit. All Wellforce services are going up on the new EHR. The original system is siloed, but Wellforce has created a digital platform that will interconnect all departments and settings. We will be able to see the patient's path through all the touch points within our own system, and we will be able to connect to outside organizations — community pharmacies, for example. After sending a prescription, we should be able to see if the patient picked it up, or, even better, dispatch an Uber driver to deliver it to the patient’s home.
I think of myself as a connector in this process. I explore what care looks like from the patient's perspective and then connect all the points along that journey to provide the best experience and outcomes.