BHE Podcast, Episode 031 – Ahmad AL-Musa, MD, DHS, LSSBB, PHP, Gosnold Senior Director of Quality, Risk and Compliance

At the Cape Cod Symposium on Addictive Disorders, September 8-11 in Hyannis, Massachusetts, Ahmad AL-Musa, MD, DHS, LSSBB, PHP, senior director of quality, risk and compliance at Gosnold, presented a session on how understanding work culture better assists with the quality of clinical care. Dr AL-Musa joins the BHE Podcast to discuss the characteristics that define a quality infrastructure for a behavioral healthcare organization, keys for establishing appropriate goals and benchmarks, and the importance of receiving both qualitative and quantitative feedback from internal and external stakeholders.

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Tom Valentino: Hello and welcome to the Behavioral Healthcare Executive Podcast. I'm BHE Digital Managing Editor Tom Valentino, and today we are joined by Dr Ahmad AL-Musa, who is the senior director of quality risk and compliance for Gosnold in Massachusetts. This weekend at the Cape Cod Symposium on Addictive Disorders, Dr. AL-Musa is presenting a session on how understanding work culture better assists with the quality of clinical care. We're happy to have him join us today. Dr AL-Musa, welcome to the BHE Podcast.

Dr. Ahmad AL-Musa: Thank you so much for having me.

TV: All right. So why don't you tell us a little bit more about Gosnold and the work that you do in your role.

AA: My name is Dr Ahmed Al-Musa. I'm the senior director of quality risk and compliance at Gosnold. I've been at Gosnold for about 2 years now. Really, my main focus is to look at policies, procedures, processes, and understand what opportunities we can do to better improve this service line here at Gosnold. So Gosnold's been around for about 50 years now. They are a behavioral health service in whereby they provide the full continuum of care for behavioral health services across the line between inpatient, outpatient. And we're looking for the next 50 years. We're actually this year, we're celebrating our 50-year anniversary.

TV: That's a fantastic milestone. Congratulations to your organization for that.

AA: Thank you.

TV: What characteristics would you say define a sound quality infrastructure within a behavioral healthcare or addiction treatment organization? What are the traits that you're looking for to identify a healthy organization and show that you're in a good place structurally?

AA: When you go to Google and you put in the term “quality,” you have various definitions. But from my own biased perspective of working in healthcare quality for the last 10 years, I've really narrowed down the meaning of quality to really 3 different buckets. The first bucket is around compliance. The second bucket is around performance and the third bucket is around risk. And so, what does that mean, basically? The first bucket compliance is really, is the organization aligning itself with standards, brought to it by agencies, state agencies, for example, the Department of Public Health, CDC? They set standards forward for healthcare institutions to implement at their institutions. And so, are we aligning, are we compliant with that? If yes, then you did well in that bucket of quality.

The second bucket of quality is around performance. Right. Performance could mean a lot of things here. It could mean outcomes, data, information, clinical, financial. And so, when I talk about performance, it's really how well the organization is doing in all the different departments, areas, and domains. And how do we do that? We utilize data and measurements and monitoring to understand where we are and what we need to do to provide a better tomorrow for our clients, for our patients, and for our stakeholders.

No. 3 is risk. Risk is understanding what safety means for the organization. There’s 2 areas over here. The first area is understanding what potentially could cause harm to whether employees, patients, stakeholders, whether the environment or policies or procedures, that's 1 bucket. Identifying the harm before it happens and minimizing that risk as much as possible. And then the second area, the second domain is if risk does happen and if harm is done, how do we understand from that? How do we learn from that? And how do we break that down to prevent that from happening in the future? So really these 3 buckets define what quality means. So again, it's risk, performance, and compliance. And so having those 3 buckets is really fundamental to the essence when it comes to having a solid infrastructure around quality.

TV: What are some warning signs that you look for that your organization could be falling short of your goals in any of these three buckets as you describe them?

AA: It really comes down to, is there an internal system that's put in place to continuously audit these areas throughout the organization? Are we continuously auditing compliance? Are we continuously auditing performance? And are we continuously auditing risk? And is that happening regularly? And are we pulling results and feedback and data out of those audits and sharing that with leadership, and sharing that with management? And if not, then that's a risky system that you have in place. And I believe the more we audit our organization internally, the more, again, the more quality services we're able to provide, because you're able to identify opportunities in areas that you may not know about, that you were probably not doing as well in, and you address those. You address those at an earlier point, and so you become high performing in those areas. I believe for an organization to really have a solid infrastructure within these 3 buckets, you have to have a constant level of auditing internally to ensure that the product that you're providing, the service line you're providing is solid, basically.

TV: Let’s take a step back just for a second here. We've been talking a lot about making sure that you're meeting your objectives and meeting your goals, reaching that standard that you're striving for. What are some keys or best practices for establishing a baseline—those appropriate organizational goals and objectives—for your program?

AA: For healthcare, there's really 1 main objective. Regardless of what service line, what product you're producing as an organization, the main goal is to provide safety. And to provide, now safety can mean different things, but the main objective that you as a healthcare organization have to provide is safety. Now, safety can come in the terms of outcomes, clinical outcomes, can come in the role of clinical treatment, can come in the role of environment.

And so, if the organization is trying to understand and trying to guess and trying to brainstorm what type of goals they should highlight throughout their organization, you have to have safety as the No. 1 priority and branch out from that. What kind of safety goals do we want to address as an organization? And of course, the more safe the organization is, the more compliant, the more performing and the less the risk they have going on. But the less they side away from the importance of safety, the more likely there'll be harm, whether its patient harm, or employee harm, or stakeholder harm. And the treatment may not as be good. And you might even end up with deaths, whether patient death, or maybe someone falling or slipping or hurting themselves. And so that's really the main objective when it comes to understanding what our goals need to be as an organization, especially within healthcare.

TV: Can you expound a little bit on what makes a good feedback system? You're talking about some of the data you're compiling and some of the areas that you're looking at. Are you also looking for feedback from staff members, from patients, from both? Are there stakeholders outside your organization who have input in this area as well?

AA: When we talk about the word stakeholders, there's really 2 main categories when we talk about stakeholders. We have internal stakeholders and external stakeholders. So, internal stakeholders are employees. These are the people that are coming in the morning and providing the care and providing the service and implementing the policies. And then you have the external stakeholders. These are our patients, our contractors, the community, our board members. And so, I think providing, obtaining, and suggesting questions to both sides of stakeholders is critical to understanding the process because sometimes what we do is become so busy in our day-to-day operations that we may not know of an opportunity to better improve it. It’s by prompting these surveys, prompting these face-to-face methods, prompting these meetings with these stakeholders is critical. Right. And that's how we start understanding what we need to do more, what we need to do more efficiently, what we need to do to develop something today, to create a better tomorrow, and develop a better infrastructure when it comes to quality.

TV: In much the same way that you need feedback from both internal and external stakeholders, it's also pretty clear that it's important to get both qualitative and quantitative information about the state of your operations. Can you tell us a little bit more about some examples of feedback that fits into both of those categories?

AA: For any type of results within healthcare, there should be 2 types of analysis. There should be a quantitative and a qualitative analysis. And the question is, why? Why do we need quantitative and qualitative? Well, because one states exactly what that number is, but the other one is the content, is the story behind that number. And just to give you an example of what that means, let’s say you provide, you push out a satisfaction survey, and you send it out and it comes back that you received an 85% satisfaction rate on your service. Well, 85% is not bad. It's telling you that it's a good service, but there's a 15% of your population telling you that they're dissatisfied. And how are you supposed to know what you should be addressing and what you should be fixing, what you should be amending to get to a better score, to get to that 95%, to get to that 100%?

It's using that storyline, it's using that qualitative analysis, it's using that question at the end of the survey that says, what else would you like to see more of? What else would you like us to improve? If there's something that you would like to improve, what would that be? It's understanding the comments, the feedback, the storylines, the qualitative analysis behind the story, behind the numbers is critical for you to understand the complete story. And so having both, when you're presenting a result, regardless of what the results are within healthcare is critical to understand the number and the storyline behind the number as well.

TV: Dr AL-Musa, you've given us a lot of good guidance and information here. Anything else that you wanted to touch on before we let you go?

AA: What I would like to conclude on is at the end of the day, quality is our friend and quality is there to provide a safer tomorrow, a better tomorrow, a better environment for everyone throughout healthcare. And it's really, it's not just the quality's department job is to implement. It's really everyone's job to implement quality. It's everyone's job description to ensure that what they're doing, the policy, the treatment, the interaction with the patient, every single point of that journey with the patient is to provide a quality experience, is to provide a quality service. And because at the end of the day, we want to make sure that the patients and the clients that come to us are feeling better and are getting the treatment they deserve at the end of the day.

TV: That is a great thought for us to conclude on. Dr Ahmad AL-Musa, thank you so much for sharing your insights and taking the time to speak with us today.

AA: Thank you so much and it's an honor to be on your podcast.

TV: As a reminder, you can subscribe to the BHE Podcast on Apple Podcasts and other podcast listening platforms. Past episodes are also available on our website, behavioral.net. Our thanks once again to Dr Ahmad AL-Musa for joining us. I'm Tom Valentino, and this has been the Behavioral Healthcare Executive Podcast.