Join Dr. Komal Bajaj, a renowned expert in healthcare performance enhancement, for a deep dive into the transformative role of simulation in healthcare. This session, titled "Integrating Simulation and Safety," will explore the pivotal connections between advanced simulation techniques, quality metrics, the environmental impacts of healthcare practices, and the safety of healthcare workers. Participants will gain insights into how simulation can be leveraged to improve healthcare outcomes while addressing critical safety and environmental challenges. Dr. Bajaj's expertise in medical simulation and her innovative approaches to integrating educational strategies with health policy development make this a must-attend event for healthcare professionals, policy makers, and environmental advocates.
[00:00:30] Janae Sharp: Hello, thank you for joining us with health impact virtual. I'm thrilled to sit down today with Dr. Komal Bajaj. She's an expert in health care performance enhancement, simulation, quality metrics, and also you're a physician. So, I'd love to hear more about your work and really dive in today to quality metrics, to Simulation to all the things that are important to you.
[00:00:56] Dr. Komal Bajaj: So, yeah, absolutely. Thanks for having me. I'm Komal. Komal means soft and gentle in Hindi, although most people wouldn't describe me as such. As you said, I'm an OBGYN physician. I'm honored to serve as the Chief Quality Officer for New York City Health and Hospitals. Jacoby NCB, which is a two campus facility located in the Bronx.
I also serve as the clinical director for the systems simulation program, which I know we'll get, we'll get into which really sort of helps unpack complex systems to solve problems.
[00:01:30] Janae Sharp: Alright, that's a great summary, just complex systems and also I'm really interested in talking to you about all these different topics that you kind of work at the intersection of and bring together.
I really want to level set with people, especially, you know, you're, you're working in New York. Talk to us about the impact of healthcare on the environment.
[00:01:53] Dr. Komal Bajaj: Yeah, absolutely. You know, it's, it's interesting for a lot of New Yorkers, their sort of climate moment was in June of last year. Many of you saw sort of, pictures of a very foggy Statue of Liberty due to, you know, smoke and wildfires that were thousands of miles away.
And certainly some of you who are listening to this probably also experienced poor air quality as a result. But you know, it's a troubling irony that. You know, on one hand, health systems and health care delivery entities are tasked with advancing health. And at the same time, health care delivery accounts for 9 percent of the greenhouse gas emissions in the United States and about 5 percent globally.
Right, so here we have this sort of interesting duality. And you know, I have to tell you, I think, you know, when I was in medical school, I learned nothing about climate. Really in the impact of climate change on health and it wasn't until my now 10 year old twins when they were six started asking us about our own carbon footprint, you know, these little precocious children and, you know, it sort of made us think about, well, what is our own sort of contribution to the universe?
And then certainly as a healthcare leader, I was thinking a lot about, well, You know, how does health care delivery player player role in all this? And, you know, the impact of of climate change on health is really profound. And and I have to tell you, in learning this, you know, some of the things that stood out to me, you know, we often think about, well, poor air quality, asthma, you know, things like that really, really hot days, people will think about, well, you need to hydrate more and the concerns on chronic diseases.
But climate change has a you. Real broad impact, including things like mental health, including you know, things like migrations, violence and certainly, you know, we all are connected by an experience related to climate change as it relates to vector borne diseases. Right. And sort of the changes that we, you know, are experiencing with sort of vector borne diseases.
And so the impact of climate change on health itself is very profound. We know that health care delivery is in fact also contributing to climate change. And so, you know, there's a lot of reasons why we need to take a hard look at ourselves. And certainly important to see some of the movement that's happening around that.
[00:04:21] Janae Sharp: Yeah, and I think also New York is a leader in that, you know, providing grants and providing funding to improve those, those initiatives. I'd also love to hear about climate principles and how they integrate with your work with quality and safety.
[00:04:36] Dr. Komal Bajaj: Yeah, without a doubt, you know, I think that climate action, so getting people, whether it's staff, community around, you know, thinking about climate and climate action is a really strong way to link quality, safety and wellness.
You know, there was a really interesting study by the Commonwealth Fund where they surveyed a lot of healthcare professionals, all kinds. You know, all kinds of, of, of folks. And what was really interesting was that four or five said, you know, we think that climate matters and we think that our organization should do something about it.
And this was the kicker six of 10 sort of vocalize that they think about where they work, what they choose to do. based on sort of the organizational approach to addressing climate change. That is crucial. In the era that we live in of burnout and staff shortages, anything that we can do to sort of not only do great work, but also sort of promote great, like promote staff during great work is huge.
And so, you know, That survey, we're seeing sort of the day to day embodiments of that, you know, people feel like more connected to purpose, people feel like they get to release their climate anxiety you know, and it's a great way of sort of linking people to, you know, Quality improvement. So what we've done is, you know, really thought deeply about all of our sort of performance improvement agenda and how can we incorporate a climate lens.
So either, you know, working towards practices that are higher quality and planet friendly. Or the other side of the coin, thinking about how do our quality and safety initiatives promote climate resilience, because the problem is climate change is here. Right. And so while we're working to combat it at the same time, you know, things like, you know, how does climate impact a process, you know, Environmental justice clearly you know, demonstrates a lot of disparities.
And so, you know, do your processes hold when the temperature is 95 degrees, you know, who is likely to be the most affected by things like poor air quality or heat, right? All of these things, I think, lend itself to Naturally to environmental sustainability and climate resilience being a part of a quality and safety agenda.
Right. Is that
[00:06:57] Janae Sharp: also part of the national agenda that you know of, or just curious? There's
[00:07:01] Dr. Komal Bajaj: tremendous work that is ongoing. You're absolutely right. You know, you mentioned some of the New York City levers. There are also state lever levers at different sort of states. And certainly from a federal perspective, there are Through the Inflation Reduction Act and other initiatives, there are there are tremendous opportunities to improve infrastructure you know, and training and education, you know, and you know, structures to promote climate action at the federal level as well.
And so it's been really heartening to sort of see, you know, how each of these build on each other. Right.
[00:07:35] Janae Sharp: I'd love to talk more about that, like some of the federal initiatives and the priorities. You've told me some about. Your ability to bring insights for them and ask, you know, are these measures what matter and I hear that a lot too.
Like, do quality metrics actually help patients? Do they actually help physicians? Like, like, how, how do you do that? How do you bring that?
[00:07:58] Dr. Komal Bajaj: Yeah, certainly. It's so interesting, right? Like, we were just talking about environmental sustainability, which clearly, like, we're just all starting to figure out, right?
Like, you could say, well, measuring how much carbon, you know, or greenhouse gases an entity is emitting is one thing, but, you know, how does that impact the community that surrounds a particular institution? And so, you know, what I'll say about it. Quality metrics are, they need to exist, they're important, right?
How do we know that we're making impact? How do we know that we're moving the needle is by measurement, right? At the same time, measurement has a cost, an actual dollars and cents cost, and by focusing on certain things, are we missing the opportunity to focus on others? And so some of the things that, you know, I've been sort of, you know, Thinking about vocalizing in sort of different forums is exactly what you mentioned, right?
Are we really hitting the mark? Right? You know, for example, when we are tracking a particular infection, that's a really important measure, right? No doubt. No one wants, needs, deserves a hospital acquired infection. But how does that translate into someone meeting their own personal goals, right? Not getting an infection is like the baseline, right?
Like, we want them to be able to get to the vacation, the family vacation that they wanted to go on, or walk their dog around the block, right? And so I think, you know, many in the community are sort of swirling around, we need to have measures, we need to make sure that they are really helping us advance what we need to advance, and how do we make sure that they're incorporating sort of person centeredness into what we do.
[00:09:39] Janae Sharp: That's important. I'd also love to hear your insights about how that works with specifically maternal health. Like, you're, you're an OB, the U. S. has the worst outcomes for mothers. And that disproportionately affects like, you know, historically minoritized groups. Do you feel like the measurement is helping with that?
Like how, how are we combating that?
[00:10:04] Dr. Komal Bajaj: You know, I'm so glad that you brought that up. And I think this brings up to me kind of where the movement of safety in general, right? I'm very heartened to see, you know, sort of presidential reports on the importance of safety, additional funding going around thinking about safety.
And when I say safety, it's safety of, you know, people. patients as well as staff, right? And particularly as it relates to maternal health, I think, you know, we, we can and we must do better, right? And one way that I think is crucial in maternal health is really sort of widening our aperture and thinking about long before birth happens, right?
Or immediate, the sort of immediate postpartum period. You know, what can we sort of do for patients? How can our health systems, our health delivery entities promote Efficient diagnostic journeys. And so what I mean by that is, you know, when someone comes in for a delivery and has a hemorrhage or sort of increased bleeding, right?
If they are anemic, that puts them at higher risk of all kinds of bad things. Well, what about sort of the opportunity to diagnose that anemia long before? and address it long before they come in for birth. And so, you know, I've been thinking a lot about how do we incorporate a diagnostic excellence approach to maternal health, which would include long before patients are pregnant to well after they deliver, right?
And so there's, you know, as we think about sort of data collection, as we think about tech tools that might sort of. Address this public health crisis of maternal mortality and morbidity. Right. Some of the things that are going to do the sort of move the needle are going to be the things that can do exactly that.
Right. And certainly, you know, I've talked with a lot of folks and collaborators and important to see, you know, sort of how Things like artificial intelligence, you know, are, are sort of playing a role, right? In a way of sort of taking these disparate pieces of information, which are seemingly not connected, and in fact, connecting them in a way that gets people the care they need, the treatments they need, in a time they need it.
[00:12:18] Janae Sharp: Right, and it sounds like, you know, better data collection from earlier on is a crucial part of that and connecting the earlier care to the outcomes is something that I think, you know, healthcare could stand to work on. Let's move to another thing that we're really, it's a top of mind issue, which is healthcare worker safety.
You know, we want to make sure women are able to go to the hospital and have a safe delivery. We also want to make sure that people are safe in the place that they work. And I know that you probably have great experience, you know, you have experience with that. And I know New York Health and Hospitals is also working on integrating that into their planning.
So, can you share some of that work?
[00:13:02] Dr. Komal Bajaj: Yeah, absolutely. I mean, you know, I, I think that this attention on the continuum of safety from staff and patient, I think is really important. And just even an important sort of mind shift to think that, as you said, right, anyone who walks. Through our virtual doors or real doors, right, should have the kind of experience.
That they want to have, whether they're working there or receiving care. And so, you know, I think that the strategies around workforce safety, right, which we know is from talk about data collection, right? There was an article recently that said that within a 40 hour period, you know, healthcare workers experienced, you know, essentially at least two episodes, right?
And if you sort of, you know, you sort of first define what it's Workforce safety or injuries or violence is right. I think oftentimes staff's threshold as to what is an episode, right? So much depends on sort of what, what they're accustomed to. Right. And what do you mean? What does that mean?
[00:14:08] Janae Sharp: Like, like, if you're used to patients yelling at you, it doesn't faze you anymore,
[00:14:12] Dr. Komal Bajaj: you know, that's absolutely right.
Right. It's kind of like this interesting thing that happens. Oh, they just yelled at me. Right. They didn't, right. Spin at me or they didn't, you know, what, you know, sort of physically intimidate me, right? It's, it's, it's sort of this interesting threshold. So I think the first thing is kind of just having open and honest conversations about what does it mean?
How do we track it? Right? And so I think that's been sort of a really important sort of piece of our journey. And then the next sort of components relate to Making things physically safer, right? Thinking about entrances and exits, signage, you know, different deterrents that exist, right? There's a lot of evidence around this.
[00:14:53] Janae Sharp: It's like industrial design helps. You
[00:14:55] Dr. Komal Bajaj: got it. You got it. And then I think there's a big cultural piece to this, which, which we've seen sort of a lot of, right? Again, coming back to that idea of person centeredness, you know, if there's a culture where Certain questions are asked or certain kinds of behaviors are not tolerated.
Right. All of a sudden it's a collective sort of norm, right, that happens. And so I think that, you know, lots of health systems, you know, are on this sort of journey to make sure that anyone who walks through our doors. Right. Has the best experience.
[00:15:31] Janae Sharp: Right. How is that developed when you say like, you know, no tolerance for certain things?
Is that from a federal level? Is that from an individual level? Is that, you know, the nurses or is that your health system?
[00:15:46] Dr. Komal Bajaj: Yeah, well, first it takes all of us, right? And I think that there are certain federal, you know, there are certain levers at, again, city, state, federal levels that can talk about these things, can provide certain guidance, certain levers to do certain things.
But at the end of the day, right, culture and practice is hyper local. Right? The physical barriers, the doors, the how things move, you know, how, how flow moves, you know, how people interact with each other. Does someone say good morning when you walk in? Right? All of that is hyper local. And so I think it's an interesting, important compilation of both, right?
The things that are coming down the pike that sort of promote These activities and then the leadership and really all of us, right, interprofessionally sort of modeling the types of cultures and behavior we want to see.
[00:16:38] Janae Sharp: I was also reading a little bit about your work with simulation in this topic. And I don't know if you have a story or like, tell us more about that.
[00:16:48] Dr. Komal Bajaj: Yeah, you know, it's interesting. My, I never thought that I was going to be a sort of healthcare quality and safety leader, sort of serendipitously. You know, I had been spending a lot of time thinking about simulation. So the use of robots, augmented reality, virtual reality. On one spectrum or things like, you know, a papaya and a stethoscope, you don't need much to really sort of provoke thought around sort of things that happen in the healthcare environment.
And so, you know, often you could often wait for a one in 10, 000 event to happen. Right. Or you can create the circumstances for that thing to happen and then talk about it afterwards. Right. And so it's that idea of simulating something could be tabletop could be immersive. Right. Could be individually, you know, with VR goggles could be a large team and then reflecting on it.
Right. Right. Healthcare staff, our patients are the experts. at how care is delivered, right? And by harnessing those amazing gems, right? Those ideas, not only is the right thing to do, right? It's often the most effective or amongst the effective things to do, and it makes people feel great, right? I remember you know, we talk about maternal morbidity and mortality.
We, you know, had. some outcomes that we weren't thrilled about. And so, you know, some places might make more policies, buy new widgets, right? But we instead chose to, you know, sort of deploy this methodology of simulation to really understand what's happening. Right. And debrief and reflect on it. And it took not very long, just about six weeks for people to really get behind it.
Oh, and by the way, I have one other thing to tell you. Right. And, and what an agency building thing when someone tells you something, you know what, I really think that if we did this, Right. And you try it and it works right all of a sudden they're more likely to share. And so, you know, I am firmly convinced that simulation and debriefing is not a nice to do it's not an add on.
It really is foundational to improving and proving systems by sort of unpeeling them and understanding, you know, sort of how they're all put together. And. You know, we're seeing a lot of our sort of trainees, whether they're medical trainees, nursing trainees, you know, other kinds of health care trainees.
almost all professional schools have some level of simulation sort of built into their training. And so now here we have a switched on group who's accustomed to these kinds of modalities, who almost sort of it's normal for them to be a part of these experiences. So why not take advantage? of, you know, sort of practicing together, understanding together, right?
Healthcare healthcare teams, you know, are on all the time, right? Basketball teams have 80 games a year or something like that, but they practice every day, right? And so this is a nice opportunity to really unpack complex systems and understand them. And I really think that you know, the evidence is now, you know, 10 years ago, if you'd asked me, I'd be like, Oh, they, you know, we're getting there.
It feels like it's going to work, but you know, now we have tremendous evidence to show that simulation has impact on mitigating risk, improving reliability and really enhancing relationships.
[00:20:18] Janae Sharp: Sounds like something that's critical. I also, so last week was the high tech committee met and one of the comments relates to what you were just talking about with like training.
I think it was John Brownstein and, and others talked about how some of the barriers that people face are really workforce education and change. A lot of the problems that we have, are they technology problems or are they people problems? And I'd like to talk more about that. About that intersection that I think you naturally brought up with simulation, like, what's the intersection with workforce change and and your work?
[00:21:00] Dr. Komal Bajaj: Yeah, it's so interesting, right? Like, you could have, I remember a situation where someone called me up and they said, you know, we got this grant, we bought this, like, really fancy, very technically advanced robot, right? Hey, we love robots. Love me some robots, right? It can measure how good chest compressions are.
It can tell you if you're, like, bagging someone properly and giving them enough oxygen, right? But they bought the tool, but they, in the grant, didn't write in for the people, right? Oops. Right, so they just bought a really expensive paperweight, basically, right? Mm. And so I think to me, right, technology is wonderful.
It's so crucial, right? But like anything, anything that we sort of are implementing, there's a few principles, I think, that come to mind. And these are all sort of things that are make quality and safety amazing, right? The first is this idea of co design, right? Who is being targeted by this tech, whether it's staff, patients, or both, and how are they weighing into, you know, sort of the design and implementation?
And, and to me, that's like just such a human component of tech, right? I think the other sort of key piece is like, what's in it for me, right? You know, we all sort of remember the people who were like clutching on to their like palm pilots. Right. Are there blackberries? Like what's in it for me? Let me rub off me a blackberry, but you know, like things have moved on, right?
And so, you know, that's a girl was a while ago, but I think like understanding, right? Like, well, what, why is this change happening? Right. Sometimes it's a regulatory lever. Sometimes it's a, the evidence suggests this is better, right? Sometimes it's we got a grant or someone we want to try something, right?
But at the end of the day, I think unleashing people's intrinsic motivation by really sort of being clear on why, because oftentimes solutions, beautiful, brilliant solutions will be plunked somewhere. And then you're like, now what? Right? Like what do I do with this? Right? What is, what is being taken off my plate as a result of this being put on my plate or given to me to use?
Right? And I think the other thing that, you know, two sides of the coin. First is, I think we need to learn and be okay with not everything being a home run right out of the gate. So this idea of sort of piloting and iterative exploration and understanding and tweaking and modifying. And I think that sometimes there's a lot of pressure naturally, right?
Got to get it out of the gate, right? But the point here is that humans are messy. They're amazing, right? And sometimes things don't go as planned. We've all been there, right? Sometimes things don't go as planned. And so being above board about this idea of sort of iteration. Things that may not be a homerun right out of the gate, I think is really crucial.
And the flip side of that is, you know, when people share successes, the first question I want to ask them is, how did you do that? Like, how? Not just like, oh, you know, we implemented something. Like, tell me the granular steps. And I think that, like, I wish that more Leaders would unpeel and unpack that sort of journey because it's not a straight line, right?
It is a little bit of this and I think the how people do things which will involve amazing humans is a key part of that,
[00:24:31] Janae Sharp: right? Well, do you have the story of how you've solved a problem that you want to share?
[00:24:37] Dr. Komal Bajaj: So many problems. It's so interesting. Pick one or two. When I When I was asked to be chief quality officer, it was really interesting.
They were like, Oh, you'll, you'll have an EHR implementation. There might be a joint commission site visit. Right. And then, you know, who would have known like sort of all, they said
[00:24:53] Janae Sharp: it with a low tone, like it was no big deal, right.
[00:24:55] Dr. Komal Bajaj: But in fact, There was a pandemic. Just like a small
[00:25:01] Janae Sharp: EHR implementation.
[00:25:02] Dr. Komal Bajaj: That's right. A tiny little thing. So, so tiny little thing. Well, I think that I will share a story with you that I think ties together this idea of iteration, this idea of community partnership, and this idea of You know, quality and safety, promoting planet friendly practices. So COVID naturally disrupted a lot of things for a lot of people, you know, and some things have sort of gone back to baseline, whatever that is.
Some people, some things have gotten worse, some things have gotten better, right? And so an unfortunate thing that happens when patients for whatever reason pass away in the hospital, sometimes those decedents. There's a delay in the decedent being released to a funeral home, a religious org, whatever, whatever, sort of where, wherever their sort of support, their family, their loved ones, whomever, you know, decides.
And there's a lot of reasons for that, right, in New York City, but really beyond New York City. You know, funeral homes and other institutions are
You know, paying for a funeral, a burial, a cremation, whatever, are not minor. Right? And so there's, and there's some sort of administrative backlogs. So there's a lot of reasons why across the country, some institutions are, are, are sort of having a delay in decedence. And so, We, we had an above what we would have liked to see in release rate on average about two weeks, right?
And that delays grieving that causes a lot of operational challenges, right? But when families are unsure what paperwork they need, right? To fulfill whatever they need, right? There's a lot of barriers, right? And so we did a lot of things, including Working with our community partners, so our funeral homes or religious institutions, we spoke to patients and patients told us all kinds of things.
I am not sure what website I need to go to. I don't speak English, right? I need help paying for the funeral, right? There were a lot of different things that came out as a result of talking to patients. And so we built different structures around and different, even down to like a packet. For people that kind of explains all of that.
Through that process, we were able to improve the seed and release rate, such that 100 percent of decisions are released within a week. So about halving that that period, right? Staff who work really hard, but don't often get a lot of attention, right? Like, the morgue doesn't get a lot of attention, right?
The ICU where lives, you know, like oftentimes where lives are saved, gets a lot of attention. And. Not only was that great for our community for our operations, it also saved a lot of carbon because we did not have to trigger refrigerated trucks when the morgue itself was full.
[00:28:05] Janae Sharp: Well, that's, that's so
[00:28:07] Dr. Komal Bajaj: heavy.
[00:28:07] Janae Sharp: I mean, you hear a story about that from COVID. Like it was a disaster.
[00:28:12] Dr. Komal Bajaj: Totally. And, but those trucks still exist and people need to use them for lots of reasons. So here we have a situation where staff feel better because things are moving. Patients and our community feel better. Right. And we have sort of operational efficiencies and a climate savings.
Right. And so how do we do that? Some of the actions I described, but underpinning all of that were the human side of change that I talked about. Co design. Unleashing intrinsic motivation. Right? The first time we, like, tried something, it didn't work. We had no change. Right? No change in operations. So we had to be like, well, why didn't that work?
Let's learn. Right? So we learned, iterated, and that's how we got to where we got. Right? Again, the journey is always like this. It's never. Never completely linear.
[00:29:01] Janae Sharp: Right. I think that's important to remember. Like, you know, you, you will have failures on your journey. And I'd love to wrap up with you sharing what you're looking forward to.
Like, what, what are you looking forward to solving next?
[00:29:16] Dr. Komal Bajaj: Yeah, there's so, so many things to solve, right? You know, I, I just want to honor, you know, sort of the, the multitude of challenges from financial constraints, operational constraints. You know, human resource constraints. And challenges that exist for health delivery entities and for patients who are interfacing with those health delivery entities.
With that said, you know, I, I think that I'm heartened to see the attention as was mentioned previously in our sort of policies and in our political decision makers on quality and safety. You know, recognizing that you know, we all have a play a role in sort of doing better and being better.
I'm really excited about some of the, the tech tools. That exist as a quality and safety leader. And I'm very mindful of how do these, you know, sort of promote great outcomes for all, you know, and sort of what are the challenges to equitable care outcomes that these tools will hopefully advance, right?
And if they don't, how do we iterate so that they do? And then I think the emphasis on You know, climate action and how climate action can link quality, safety and wellness is something that for me, just as a human, as a mom you know, as a healthcare leader you know, it, it, it, it's one of those things where, again, right, like, it feels like it's overwhelming sometimes, but 1 percent better each day, each quarter adds up to a lot.
[00:30:56] Janae Sharp: Right. And then you can give your kids the answer that your carbon footprint's going down. That's right. That's the goal. Well, thank you so much for your time and for meeting with me today. And thank you also for your work in this space.
[00:31:11] Dr. Komal Bajaj: Hey, listen, thank you for having me and thanks to all for listening.
You know, we all play a role and we can do this.
[00:31:18] Janae Sharp: Yes.