Patient Story: A Q&A with Raj Behal, MD, MPH, Chief Quality Officer

Raj Behal, MD, MPH, joined Stanford in May 2014 as the new chief quality officer and associate dean for quality. Behal comes to Stanford from Rush University Medical Center in Chicago where he was associate chief medical officer and patient safety officer.

Tell us about your background (family, clinical, academic, research, etc.)



I am an internist, and have been in practice for about 16 years. After I finished medical school and residency in medicine at Rush University in Chicago, I completed a fellowship in Healthcare Informatics at Harvard and MIT, and received a Masters in Public Health from Harvard with a focus in clinical effectiveness. Much of my applied and scholarly work has been in clinical outcomes improvement, patient safety, change management and physician leadership development.

How did you get into quality and patient safety work?

Over a decade ago I started my career developing risk adjustment models for measuring in-hospital mortality. I quickly realized that data was necessary for improvement, but not sufficient alone. Without physician engagement and thoughtful change management, there could not be sustained improvement.

I started working with academic medical centers, both in the US and internationally, to understand and improve patient survival in teaching hospitals. While examining mortality, I noticed that system capabilities, especially for complex care, variations in care, patient safety gaps, end of life care issues, problems with recognition of deterioration and rescue from complications, and even team dysfunction were affecting all aspects of quality of care. When we addressed these factors, outcomes improved measurably, which was very gratifying. So, what started as intellectual curiosity for me turned into a career.

What do you see as the strength of Stanford's quality/patient safety program?

The strength of any robust quality and safety program is the physicians and staff who take care of patients and those who support them. We have exceptional clinicians at Stanford. The same holds true for those working within quality; we have a very capable and talented team to support quality measurement and improvement. Stanford has an exceptional foundation to build on! 



What do you see as the most important quality/patient safety challenge currently facing Stanford?

If you look at data from the last 10 to 15 years, nationally we have not made much progress in improving patient safety, at least in net. While we have gotten better at reducing some risks, new risks have emerged. One of the key challenges for all academic medical centers is the increasing complexity of health care delivery. We can take care of much sicker patients with newer technologies and therapies and improve survival. A second challenge we face is variations in care. From a systems and safety science perspective, increased complexity and variations will generate new care-related errors. Fortunately, these same sciences also provide insights into how we can mitigate these issues while advancing care.

What do you envision as Stanford's quality/patient safety strategies going forward?

The core strategies in this regard are: 1) broad-based engagement and collaboration; 2) managing complexity of care and reducing variations in care; and 3) scholarship in care improvement so we can learn, innovate and set new standards. These strategies are geared toward enhancing patient-centered, safe, clinically effective care.

I can also highlight the key themes. Ensuring patient safety is always the first priority. Second, we will focus on continually improving patient survival and reducing morbidity. Third, we will work on enhancing patient recovery and function, and focus on improving the quality of life of our patients in meaningful ways. As we do this work, we need to acknowledge and tackle the high cost of health care delivery. Just like we think about medical side effects, we need to be mindful of the financial side effects of care many patients face. And finally, we must excel on the national measures—core measures, patient safety indicators, readmissions, chronic disease measures, among others. These affect public perception of our quality. I see an opportunity for us to inform and shape the national agenda on these and new measures via scholarship.

Are there any specific tactics you would like to develop or implement to execute those strategies?  

We will work with the physician leaders of our clinical programs and multidisciplinary teams to examine quality and cost outcomes side by side, examine variations and use clinical effectiveness methods to improve quality while lowering costs. We are developing next-generation smart clinical pathways that standardize medical assessment, anticipate risk and build in both mitigation of and rescue from potential complications. We will implement proactive risk assessments and redesign them as key safety improvement interventions.

I'd like to instill the rigors of research methods to quality improvement so we know what to target, what worked and why. Much of this work requires integrated clinical and financial data, advanced analytic methods and tools. Our goal is to achieve preeminence in clinical quality, safety and efficiency. I have no doubt we will get there! 




If you have comments, suggestions or questions about the hospital's quality programs, contact Steve Chinn, DPM, administrative director, Accreditation & Regulatory Affairs at sdchinn@stanfordmed.org.