10 Leaders in the Area of Clinical Quality

Clinical quality in healthcare encompasses a vast spectrum of issues including patient safety, infection control, patient-centered care, management and cost. The following 10 clinical quality leaders have been chosen through research and consultation with healthcare professionals. Individuals were chosen based on leadership positions in quality-related organizations, research, success in raising awareness of key issues, implementation of initiatives and awards. Note: Names are listed in alphabetical order.

Donald M. Berwick, MD, MPP. Dr. Berwick is the outgoing administrator for CMS. He has helped initiate patient safety initiatives such as Partnership for Patients and patient safety incentives in health reform legislation. He is also adjunct staff in the department of medicine at Children's Hospital Boston and a consultant in pediatrics at Massachusetts General Hospital. Dr. Berwick has also served as president and CEO of Institute for Healthcare Improvement, chair of the National Advisory Council for the Agency for Healthcare Research and Quality and a member of Institute of Medicine's governing council.

Dr. Berwick was previously a clinical professor of pediatrics and healthcare policy at Harvard Medical School and a professor of health policy and management at Harvard School of Public Health. Dr. Berwick has studied using scientific methods, evidence-based medicine and comparative effectiveness research to improve tradeoff between quality, safety and costs in healthcare. In 1997 and 1998 he was appointed by President Clinton to serve on the Advisory Commission on Consumer Protection and Quality in the Healthcare Industry. Dr. Berwick won the 1999 Ernest A. Codman Award, the 2006 John M. Eisenberg Patient Safety Award and the 2007 William B. Graham Prize for Health Services Research.

Maureen Bisognano, RN. Ms. Bisognano is the president and CEO of the Institute for Healthcare Improvement. She took over the position from Donald Berwick, MD, after serving as the organization's executive vice president and COO for 15 years. She has been elected membership to the Institute of Medicine and appointed to the Commonwealth Fund's Commission on a High Performance Health System. Ms. Bisognano advises healthcare leaders around the world and is a frequent speaker at major healthcare conferences on quality improvement. She is also an instructor of medicine at Harvard Medical School, a research associate in the Brigham and Women's Hospital Division of Social Medicine and Health Inequalities and serves on the boards of the Commonwealth Fund, ThedaCare Center for Healthcare Value and Mayo Clinic Health System–Eau Claire.

Prior to joining IHI, she served as CEO of the Massachusetts Respiratory Hospital and senior vice president of The Juran Institute, an international consulting company focused on quality improvement, lean management and Six Sigma certification. The Wall Street Journal said Ms. Bisognano is "known in the industry as an expert on the nuts and bolts of improving healthcare systems while lowering costs."

Joseph L. Cappiello. Mr. Cappiello is the chief operating officer for the Healthcare Facilities Accreditation Program. He previously served as vice president of accreditation operations at The Joint Commission and led his own consultancy to help healthcare facilities improve and maintain compliance with accreditation standards. At The Joint Commission, he oversaw the surveyor cadre of more than 500 people and the sentinel event unit that focuses on preventing "never" events such as patient suicide and fatal medication errors. He also directed the office of quality management that served as a "care complaint department" for the organization and would investigate reports. In his consultancy, Mr. Cappiello worked with facilities to develop a process to ensure they were knowledgeable and compliant with all accreditation requirements. Although he has only worked at HFAP for a few months, Mr. Cappiello has significant plans for the agency that include increasing public awareness, focusing on care coordination and the inclusion of patient-centered care principles into the accreditation process.

Mr. Cappiello started his career in healthcare as a Navy nurse, and it was there that he acquired an interest in clinical quality. "I realized that you can be the best nurse or the best physician or the best respiratory therapist, but you end up dealing with only one patient at a time," he says. "I thought if I could get to a position to make my influence felt on a grander scale, that I had the chance — along with those that are likeminded with me — to change healthcare for the better on a national scale. We do have a chance to make things better if we understand what the challenges are, and we find reasonable and workable solutions."

Mark R. Chassin, MD, FACP, MPP, MPH. Dr. Chassin is the president of The Joint Commission and of the Joint Commission Center for Transforming Healthcare, which he established in 2009 to address quality and safety issues in healthcare. The Center for Transforming Healthcare is currently working on developing solutions through the application of the Robust Process Improvement methods and tools that other industries use.

He previously served as the Edmond A. Guggenheim Professor of Health Policy and founding chairman of the department of health policy at Mount Sinai School of Medicine and executive vice president for excellence in patient care at Mount Sinai Medical Center in New York City. While at Mount Sinai he formed a quality improvement program that focused on safety, clinical outcomes, patient and family experiences and the caregiver working environment. He also conducted research on healthcare quality measures and health policy. Dr. Chassin has also served as the commissioner of the New York State Department of Health and practiced emergency medicine for 12 years. He was part of the Institute of Medicine committee that published "To Err is Human" and "Crossing the Quality Chasm." He has received the Founders' Award of the American College of Medical Quality and the Ellwood Individual Award of the Foundation for Accountability.

Jack Egnatinsky, MD. Dr. Egnatinsky has served as a surveyor for the Accreditation Association for Ambulatory Health Care since 1996 and currently serves as president of the AAAHC board of directors. Dr. Egnatinsky has been an instructor for the AAAHC Surveyor Training Program and he has served on the accreditation committee and chaired the surveyor training and education committee. He is also a member of the board of directors for AAAHC's Institute for Quality Improvement.

He is a board-certified anesthesiologist and received his medical degree from the State University of New York, Upstate Medical. He completed his anesthesia residency at the U.S. Naval Hospital, Philadelphia, and Children's Hospital of Philadelphia. He served in the U.S. Navy Medical Corps from 1963-1971, achieving the rank of lieutenant commander. "Healthcare is not static," he says. "In order to move in the right direction, we need to measure what we are doing and see how we can improve it to achieve the best outcome possible. Quality improvement studies and projects, benchmarking, continuing education and continual attention to internal policies and procedures must be part of your everyday activities."

Linda Groah, RN, MSN, CNOR, NEA-BC, FAAN. Ms. Groah is the CEO and executive director of the Association of periOperative Registered Nurses. Ms. Groah has focused on improving patient safety throughout her career. While a volunteer member of AORN, Ms. Groah served as AORN's representative to the professional and technical advisory committee of The Joint Commission where she was on the task force that met to develop the procedure for side and site verification, the task force that developed the Universal Protocol and the CMS steering committee for the Surgical Care Improvement Project that focused on reducing surgical site infections by 25 percent. As the director of hospital operations at Kaiser Foundation Hospital San Francisco Medical Center, she introduced and piloted several patient safety initiatives including the "Just Culture" concept, an environment where actions are analyzed to ensure that individual accountability is established and appropriate actions are taken.

Ms. Groah was awarded AORN's Award for Excellence in Perioperative Nursing in 1989 and inducted in 2000 as a fellow of the American Academy of Nursing. She currently serves on the board of directors of the Nursing Alliance for Quality Care, is a member of the editorial board of Nursing Spectrum and a member of the board of directors for the Anesthesia Foundation for Patient Safety. "As a young professional I was very concerned about the gaps in care that I observed," Ms. Groah says. "The gaps included short cuts, lack of adherence to policies or procedures and practitioners lacking current competencies. I knew that I wanted to impact these behaviors and that required being in a leadership position."

Gary S. Kaplan, MD, FACP, FACMPE, FACPE. Dr. Kaplan has been the chairman and CEO of Seattle-based Virginia Mason Health System since 2000. He implemented the Virginia Mason Production System to reduce costs and improve quality, safety and efficiency. Virginia Mason was named a distinguished hospital for clinical excellence by HealthGrades in 2011, a top hospital by The Leapfrog Group for five consecutive years and was one of two hospitals named a Leapfrog Top Hospital of the Decade for patient safety and quality.

Dr. Kaplan is also a clinical professor at the University of Washington, secretary-treasurer of the Institute for Healthcare Improvement and chair of the National Patient Safety Foundation's board of directors. Dr. Kaplan is a founding member of Health CEOs for Health Reform. In 2009, Dr. Kaplan won the John M. Eisenberg Award for patient safety and received a Harry J. Harwick Lifetime Achievement Award from the Medical Group Management Association.

Denise Murphy, RN, MPH, CIC. Ms. Murphy is vice president for quality and patient safety at Main Line Health System in Philadelphia. She handles patient safety, risk management, clinical performance improvement, infection prevention and control, medical staff peer review and credentialing, regulatory compliance, bioethics and performance measurement. She entered the field of infection prevention and control in 1981 and has served as an epidemiologist in hospitals ranging from 100-1,200 beds in rural and urban settings. Ms. Murphy is an active member of Association for Professionals in Infection Control and Epidemiology, the Society for Healthcare Epidemiology of America, the American Society for Healthcare Risk Managers as well as a past president of the APIC board of directors. She was the 2010 winner of the Carol DeMille Achievement Award. She has served as long time member of the CDC's hospital infection control practice advisory committee, The National Quality Forum's patient safety advisory committee and SHEA's patient safety committee. She recently co-authored the patient safety chapter for ASHRM's Risk Management Handbook for Healthcare Organizations (Sixth Edition).

Ms. Murphy previously served as the vice president and chief safety and quality officer at Barnes-Jewish Hospital at Washington University Medical Center in St. Louis. She spent seven years as director of healthcare epidemiology and patient safety for BJC Healthcare, a 13-hospital system and parent company of Barnes-Jewish Hospital. Ms. Murphy went to nursing school in Philadelphia, received her BSN in Portland, Maine, and a master of public health degree from St. Louis University, School of Public Health.

Peter J. Pronovost, MD, PhD, FCCM. Dr. Pronovost is a professor at the Johns Hopkins University School of Medicine, the Bloomberg School of Public Health and the Johns Hopkins University School of Nursing. He created and currently directs the quality and safety research group at Johns Hopkins University School of Medicine and directs the Center for Innovation in Quality Patient Care at Johns Hopkins Medicine. He chairs the ICU advisory panel for quality measures of The Joint Commission and the ICU physician staffing committee for The Leapfrog Group. He also serves on the quality measures work group of the National Quality Forum and leads patient safety monitoring and evaluation efforts at the World Health Organization.

He wrote "Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out" as well as more than 200 articles and chapters on patient safety. He won the 2004 John M. Eisenberg Patient Safety Research Award and was named a MacArthur Fellow in 2008. One of Dr. Pronovost's greatest contributions to patient safety is his checklist of basic safety practices, such as handwashing, that has been shown to greatly reduce catheter-related bloodstream infections. It is estimated that his program, first tested in Michigan, saves 2,000 lives and $200 million annually. Forty-four states have implemented Dr. Pronovost's checklist.

Lisa Schilling, RN, MPH. Ms. Schilling is the national vice president of Health Care Performance Improvement and director of the Kaiser Permanente Improvement Institute. She is currently heading the deployment of an enterprise-wide performance improvement and execution system and leads strategic partnerships with external organizations. "Kaiser Permanente has focused on developing capacity to improve and using data as information to understand where variation in care and clinical practice is happening across care delivery," she says. "We plan to continue to focus in this area and identify the most significant opportunities to reduce variation in care to improve overall patient clinical outcomes, safety and care experience."

Ms. Schilling previously served as the director of clinical performance at VHA, where she led clinical care initiatives with more than 100 organizations focused on improving clinical outcomes and patient safety. She also served as director of health improvement at Fletcher Allen Health Care, and led the surgical critical care service line at Fletcher Allen's Level 1 Trauma Center. Ms. Schilling serves on the editorial board of the Joint Commission Journal for Quality and Patient Safety.

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