Team Structure for Embedding Equity Into Q&S

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Karthik Sivashanker, MD: [00:26] I want to spend a few minutes just walking through, again, the team structure, your team structure and roles and responsibilities because it's going to become increasingly important as we move forward. So I don't know if you're all familiar with the MOCHA framework; it's kind of racy. It's just a way of talking about roles and responsibilities. And so we're happy to share about that framework after if you need more information. But on the left side, you can see some kind of summaries about what each of these roles means in a general way.

[00:58] So the executive sponsor on your team is really here as the manager of this work at this point. They support and hold the owner accountable, and they are also ultimately accountable to the work themselves. They serve as a resource. They share the feedback, they ask probing questions, they review progress and intervene if the work is off track. They may or may not be the supervisor of the owner, and the owner is the quality and safety leads. So the ask of your executive sponsors is to be engaged throughout this process and support to set expectations with you, to normalize this work with leadership and teams. So they're really the ones who should be engaging other senior leaders across the organization, engaging the board--Andrew will be speaking to this later in the session--and providing support and resources and overcoming resistance. Whereas the quality and safety lead is really the owner of this work. They have the overall responsibility for driving the project forward and coordinating steps to accomplish the goals that we're setting out for. So they want to ensure that all the work is getting done, they may have helpers—and we'll talk about who the helpers should be or might be—and they're going to want to consult with others in a meaningful way throughout, as well.

[02:10] We think there should probably be one owner of the work, and so this is once again that quality and safety lead on your team. They're the subject matter expert. Their role is going to be multifactorial, but might include things like consulting with the safety specialists, the risk managers and the patient family representatives to provide that subject matter expertise, to co-facilitate and or lead more complex investigations. But really starting with leading and then moving to facilitation because the whole idea here is that we're not doing this work as a nice-to-have, on-the-side, led by DE&I folks, but it's led by the quality and safety teams who do this work every single day, which is part of normalizing this work as our everyday work, and then socializing this work internally and across the hospital. So we'll talk a little bit about that.

[02:59] The project manager is really there to support that quality lead, and support around the day-to-day program management to track the cases. At Brigham and Women's we actually empower them to do some of that initial exploratory investigation. So we get that event, we have a little bit of details, but we want to fill in the details--they might fill in the details. They might look up additional demographic information that's missing, they might do some early reaching out to folks to gather more information. And then ultimately, they update and own materials and the tools.

[03:32] The DE&I lead is the subject matter expert that is providing consultation to the quality lead and other folks on the team, but really the point person is going to be the quality lead. We want the quality lead and the DE&I lead working together closely, so that the quality lead can let that DE&I lead know where they need assistance and support. The DE&I lead should think about how they can bring their education, their existing education, to the quality and safety teams because we want the quality and safety teams to have that broad foundational understanding. So any content curriculums you're already designing, think about if it's appropriate to provide that to the quality and safety and community population health teams, as well. And then they're really subject matter experts to think about how do we integrate equity into existing quality and safety education in your institution? So for example, if there's complex cases that can be translated into case studies, those are really educational. If we go to the next slide.

[04:30] The patient family representative is also going to be in this helper category. So they're really ensuring that patient complaints are treated with the same rigor and standardized processes as our safety and other harm events. At Brigham and Women's it was easy because we use the same system, we use RL Solutions. But that may or not be true at your system. So it really depends on, is there some work that needs to happen to connect the dots or not? And then they're really there to represent that patient voice and perspective and to hold us accountable to the patient voice and the patient perspective.

[05:04] And then community and population health are subject matter experts. They are really there to support identification and action around social and structural contributors to harm. So as these events are emerging, and we start to identify those contributors to the social and structural levels, how do we connect that to existing work that's happening in community and population health, or is there new work that needs to happen? And vice versa: Is there work happening in the community population health area that can inform the work that's happening intra-institutionally in terms of quality and safety?

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