Transcript:

MATT CLANCY
This is Matt Clancy, director of recruitment solutions for NEJM Group. I’m talking today with Dr. Shephali Wulff, system vice president of quality and safety at SSM Health, a Catholic, not-for-profit, fully integrated health system working to advance health equity across Illinois, Missouri, Oklahoma, and Wisconsin. Among her many achievements, Shephali has recently been recognized for leading the development of a multi-disciplinary systemwide initiative to prevent patient infections. I’ve asked her to speak with me today about some of the ways SSM Health is empowering its clinicians to be innovators and leaders in improving quality care for diverse patient populations that they see. Shephali, thank you for speaking with me today.

SHEPHALI WULFF
Thanks for having me on. I’m glad to be here.

CLANCY
Let’s get right into it. Tell me a little bit about your health care journey.

WULFF
I’m happy to. I think for a lot of clinicians, myself included, becoming a doctor was really the end goal — that was the whole reason to go to medical school. I was very happily in private practice in St. Louis from the time I left fellowship in 2011 to about 2019. As a lot of infectious disease doctors do, I was supporting a little bit of infection prevention work at my own hospital and antimicrobial stewardship. Then, at the end of 2019, we started to track reports of a new respiratory virus that was circulating through China. Of course, in the spring of 2020, we all know that the entire world changed. The senior leadership of the organization said, “I think we really need an infectious disease doctor to help us navigate our way through the pandemic.” They asked if I would do that, and I was permitted to build a team that would really help the organization navigate its course through COVID. That team included infectious disease physicians, both adult and pediatric across the system, infection prevention, microbiology[, and ]pharmacy. That group became the nucleus of our COVID response. It was everything from treatment to isolation precautions, PPE, vaccines, and testing — everything that you can think of related to COVID. Through that process, I learned a lot about the complexity of the health care system — the interconnectedness of the health care system — more than I would have being a doctor at the bedside. It was a tremendous couple of years of growth for me personally and for us as a team. Then in 2021, when the work of the pandemic started to slow down, we as a team knew we wanted to stay together. There was tremendous reward in the work that we had done through the pandemic, and we started to look inward at what we could do to improve safety and quality through the lens of infectious disease for our patients within SSM, bigger than manage the pandemic. At that point, we started to focus on reducing preventable harm through hospital-acquired infections. That work laid the foundation for my interest in safety and quality more broadly than when I was a practicing clinician.

CLANCY
Very interesting. I wasn’t sure when I said the word “journey” that we were going to hit on something so relevant to that term, but it certainly does sound like a journey — to your point, something that you may not have been able to do just as a bedside physician. Incredible experiences.

WULFF
Yes, for sure.

CLANCY
You’ve recently been named as one of Modern Healthcare’s 2024 innovators. Can you tell me a little bit about some of the work that you’ve been doing? What’s earned you the spot on that prestigious list?

WULFF
I think a lot of it has to do with what we were just talking about. A lot of it was the work of this team in improving safety and quality initially through the lens of infectious diseases and then, thinking more broadly about safety and quality across the enterprise. In 2021, we started to think about how we can work to prevent catheter-associated urinary tract infections, central line-associated bloodstream infections, and hospital-onset C difficile infections. These are things that patients who come into hospitals across the country are at risk for, and these are initiatives that every health system wrangles with every day. The work that we did as a team focused on standardizing care across multiple disciplines in partnership with critical care, the hospitalists, supply chain, and lab. This helped ensure that we’re using standard products, practices, and processes, and that we’re testing patients appropriately, and that we have an escalation path for removing devices the patients might not need. Doing all of that work to standardize care across the system in partnership with so many different teams led to this improvement. What’s most rewarding about that work is that we started in 2021 and started to see some quick wins, which was good for the team. This work has been sustainable since then, even though it’s no longer an organizational key performance indicator. It’s work that has been self-sustaining, which means that it’s hardwired across the organization.

CLANCY
That really speaks to the impact that it made. It sounds like it built some serious momentum beginning in 21, and over time it’s been ingrained in the DNA of the organization.

WULFF
It is.

CLANCY
It’s been a great accomplishment.

WULFF
It’s exciting, and I think the other piece of that is that it has taught the organization that we can do this work. We don’t need external consultants. We have the expertise within the organization to do it, and we just need to build and empower teams to do the work, and then we can actually take on some of these bigger projects that really do impact safety and quality.

CLANCY
It’s so amazing how success can breed more and more confidence.

WULFF
Yes. It does.

CLANCY

Let’s talk about how, as an organization — I think you’ve already alluded to this in some instances — SSM has supported and empowered you to implement some of these initiatives.

WULFF
For me personally — if I reflect on the last five years or so — I’ve been tremendously fortunate in having great leaders along the way. As an organization over the last six years or so, our leadership team has committed to increasing the bench of our physician leaders, which is an exciting place to be as an organization. That’s number one. We’ve had tremendous senior leadership support.

For me personally, I’ve had really good leaders who have both served as mentors and sponsors, and there’s definitely a difference there. In terms of mentorship, I’ve had great individual coaching. As an example, I’ve had leaders who have taught me how to build successful teams and who have taught me how to facilitate productive meetings, which is something that we as physicians don’t learn in medical school. I’ve had direct coaching such that, if meetings don’t go well, someone has called me and said, “Hey, you didn’t quite get the team where you thought you were going to get them. Here’s why, and here’s what you can do next time to get them there.” That individual mentorship has been hugely beneficial to me personally. Adding on to that, I’ve had great sponsors along the way in the organization who have made sure that I’ve been in meetings that I need to be in — have had a seat at the table for conversations that involve the work that our team thinks is important—and who have advocated for the work that our team thinks is valuable even when we’re not in the room. That direct mentorship and sponsorship has been hugely helpful.

The other piece is that there’s been investment in my own development through continued medical education. Last year, there were six of us that were sponsored to participate in Stanford’s Advanced Course in Improvement Science. This was a year-long curriculum in learning the tools to develop a system of improvement. That’s enormously valuable for people who are interested in quality and safety. So, there’s been lots of different levels of support that I personally have had or that my team has had to continue the work that we love doing.

CLANCY
It sounds like you have a little bit of a recipe there. It’s being surrounded by a great team. It’s being surrounded by great leaders. It’s open and effective communication, and sprinkle in a little bit of intellectual curiosity to make all those great things happen. That’s fantastic.

Talking about innovation, what role do you think that plays in improving clinical quality and furthering the mission and vision that SSM Health has?

WULFF
Absolutely. I think it’s critical. If I can give you a few examples. Over the last few years, as we just talked about, there’s been tremendous investment in developing physician leaders to do this type of work. This work is happening across a number of different disciplines, and I’d love to share that with you. Within the behavioral health space, we have Dr. Erick Messias, who’s one of the nation’s experts on psychiatry. One of his key priorities for his team is to improve access to behavioral health care, and we know that this is a gap. A lot of physician specialties are struggling with shortages of physicians across the country and within behavioral health that is certainly true and was exacerbated by the pandemic. One of his key priorities is expanding access. He’s put into place a virtual health platform both on the inpatient side and on the medical group side so that patients who need access to psychiatry can access it no matter where they are, which has been transformative for our patients and for our teams.

Dr. Kate Appleton, one of our breast surgeons, has taken a patient-centered approach to mammography. Her team is tailoring our breast cancer screening based on women’s individual risk factors, which is a huge win for our patients.

And in the women’s health space, Dr. Karen Fowler and her team are looking to improve maternal morbidity and mortality and to decrease the health disparities that live between black and brown and white women, and they’re doing this in a couple of innovative ways. They’re expanding the work that Dr. Messias is doing with virtual behavioral health so that all pregnant women have access to behavioral health care, which is critically important both in the prenatal and postpartum period. They’re using remote patient monitoring to ensure that women who struggle with, let’s say, high blood pressure during pregnancy are being monitored even when they’re outside of their physician’s office, which will improve their health outcomes. And they recently just won a grant from the state of Missouri that will allow them to create a maternal home model that will allow women to get holistic health care in one setting so that if that woman has social determinants of health needs — for example, has food insecurity at home — she has a way to access food for both her and her developing baby but also for other kids that might be at home. Or if that woman needs access to a cardiologist or an MFM provider, she can do all of that within one care space.

CLANCY
It sounds like a really talented, creative, and motivated team that you’re working with. That’s really exceptional, great stuff.

WULFF
What’s really exciting about some of the work that’s happening now within the organization is that as we’re empowering physicians to build teams — these clinical programs — they’re not only working to standardize care, but because they are deep subject matter experts in this space and we’re teaching them how to build teams and do this work, they’re already thinking, “How can we improve access? How can we improve quality and safety of care?” They know the answers because they’re the ones that do this work every day. As an organization, we just have to create space for them, empower them, teach them a little bit about how to do this work, and then get out of their way.

CLANCY
It ties us back to some of the things you were saying earlier. As an organization, you’re really focused on supporting your talent to become difference-makers, and then you’ve given them the autonomy to do great things, which then results in positive outcomes for your patients, which is really the ultimate goal of all of this.

WULFF
That’s right. And along the way we build in satisfaction, well-being and engagement, because this is the work that we want to do as health care professionals. We want to be part of a system where you feel good about the care you’re providing. It becomes this self-fulfilling prophecy.

CLANCY
Once you get the flywheel going, it just sort of runs itself. Yeah, that’s fantastic. Talking about SSM as a diverse organization — you’re spread across multiple states, you’re very large, and you serve a very diverse set of communities. How does the system go about determining what initiatives to support, and how does it go about implementing improvements across this entire broad system?

WULFF
That’s a good question. At an enterprise level, we go through a process every year that we call “catchball,” and we work with all the teams in the organization to think about what we should prioritize as an enterprise in the following year. We set both short-term goals, which are things that we think we can accomplish over one year, and a few long-term goals that we think are going to take us three years to do. Those goals span different aspects of the organization. They might be related to the operational side of the house. They might be related to philanthropy or quality and safety. And that catchball process allows us to align on what short-term and long-term goals we need to focus on across the enterprise. We’re going through that process now. Once we land on the big themes, then we start to set goals that we think we can achieve, and we catchball those goals as well. Those goals have to be approved by the board, and that allows us, as this large organization, to align on the seven or eight things that we are all committed to across all disciplines. So, no matter what work safety needs to do in 2025, they are also aligned to some of these bigger organizational objectives.

CLANCY
I can imagine that is a very hectic time period, but I bet you it’s also very invigorating to think about those special things that you can do and then think how you can align them throughout the organization.

WULFF
Yes. Exactly. At the VP level of organization, we just went through something that we call “horizontal catch ball,” and it was one of the most, in your words, “invigorating” meetings that we’ve had all year. People were so excited to think about how the work of their team could influence the greater organizational goals.

CLANCY
That’s so great. It sounds like there are a lot of people who are inspired to do great things, and usually the outcomes in those circumstances are positive.

A final question for you, Shephali. You’re a physician executive, but you’re also a clinician. What would you say is the value of being able to practice someplace like SSM that supports and innovates the way that you do your work?

WULFF
For me personally, it’s been hugely rewarding. For all of us who work in health care, we see every day how complex health care is, and we see how difficult health care can be to access or to understand from our patients’ perspectives. We see it because we work in this space. What’s been hugely helpful and rewarding to me personally is that it’s a space where I’ve been permitted and encouraged to think about how to make health care safer, more accessible, and slightly easier for my patients. That’s a much healthier place to be than in an organization where I might be a cynic on the sidelines. I’d rather be part of the team that’s building solutions, and I get to do that in my work today. I see it at the bedside, and I see it in the teams that we’re building to provide safer care, and I see it with my physician colleagues along other specialties. It’s not just within infectious diseases. It’s not just within the vertical of quality and safety. It’s happening in other disciplines across medicine, and the more we build that community of improvers — especially with physicians being part of this community of improvers — that’s when we really start to see health care get better.

CLANCY
You’ve hit on a couple items that I’ve heard consistently — ironically — over the past few weeks. You’re focusing on the “what” and then figuring out how to solve for that, but you’re also discussing giving physicians a voice in the decision-making and implementation process. That’s a really important and special thing when you can do it right.

WULFF
Yes. I think so too.

CLANCY
Shephali, thanks so much for today. Hearing your insights was really interesting. I’ve had a great time, and I hope we can do this again.

WULFF
I’d love that. Thanks for having me on.

CLANCY
Thanks.