by: Karlee Prince | Washington Patient Safety Coalition Intern, University of Washington Senior

The Washington Patient Safety Coalition had the opportunity to speak with Dr. Paul Sharek, the Vice President, Chief Quality and Safety Officer and Interim Chief Medical Officer (Quality/Safety) at Seattle Children’s Hospital in Seattle, Washington. Paul is well versed in Quality Improvement (QI) and patient safety, proven by the expertise and positive change he has brought to Seattle Children’s, and in his role in building the new Seattle Children’s Center for Quality and Patient Safety

Paul completed medical school at Columbia University, residency and chief residency at UC San Francisco, fellowship in Health Services Research/Quality Improvement at Stanford University, and received his Masters in Public Health and epidemiology from UC Berkeley . Prior to his arrival to Seattle Children’s, Paul was a professor of pediatrics at Stanford University and the inaugural medical director of quality and chief patient safety officer at Lucile Packard Children’s Hospital, Stanford (LPCH). It was at LPCH where Paul conceived of and built the LPCH Center for Quality and Clinical Effectiveness, a novel structure that caught the attention of executive leadership at Seattle Children’s Hospital. Soon after the launch of the LPCH Center, Paul was asked to provide advice to Seattle Children’s Hospital leadership related to establishing a center for quality improvement and patient safety in Seattle. In 2018, Paul made the more permanent move to Seattle, where he has been the chief architect in creating the new Seattle Children’s Center for Quality and Patient Safety .

When we asked Paul what he is most proud of related to his work in QI or patient safety, he told us that he feels “blessed and humbled to be in a position to contribute to children’s health and improve quality and safety”. Paul then described that he believes he has made the most impact in children’s health via the dissemination of his research and scholarship related to pragmatic quality and patient safety improvement. For example, his part in a 2007 publication in the Journal of the American Medical Association. This publication describes a statistically significant 18% decline in mortality after implementation of a relatively novel (at the time) rapid response team intervention at LPCH, directly resulted in rapid national and international adoption of this now routine patient safety program. “The impact that local quality and patient safety improvement work can have on children’s health across the world, when translated through publication, is humbling,” says Paul.

“A commitment to improvement science research and scholarship is critical to improving pediatric patient safety around the world”.

            Improving QI and patient safety in the pediatric setting does not come without challenges, specifically those that are unique to pediatric practices. When we asked Dr. Sharek what these challenges consist of, he outlined two main challenges unique to optimizing patient safety in the pediatric population. First, children have a variety of developmental stages and are thus not always able to effectively communicate about their symptoms. This circumstance highlights the critical importance of establishing and sustaining relationships between patient, family, and medical providers. Second, children’s physiology changes significantly as they migrate through the various stages of development. Children react differently to interventions (such as medications) in various stages of development, calling for attentive and adaptive care that is molded specifically to individuals in their respective life stages.

            As expected, developing the new Center for Quality and Patient Safety at Seattle Children’s required a deep understanding of the history, culture and relationships of Seattle Children’s Hospital. When Paul first arrived in Seattle he studied and experienced the culture and strategic direction of the organization through interviewing and listening to staff, attending on the hospitalist service, and digging into the process and outcomes data across the organization. He consulted with his colleagues across the nation’s most elite children’s hospitals (children’s hospitals have a long history of freely sharing their ideas and work to learn from one another). This included Cincinnati Children’s, Children’s Hospital of Philadelphia, Boston Children’s, Nationwide Children’s, Colorado Children’s, and, of course, his old home at Stanford. The next step was a SWOT (strength, weakness, opportunities, threats) analysis to organize the foundational ideas of what was to become a blueprint for the build of and a 10-year quality strategic plan of the Center. Since arriving in late 2018, Paul has faced the unique challenge of building and executing the new center on a new and ambitious quality strategic plan. On top of this, the hospital has been challenged by multiple significant crises including closures of operating rooms and COVID-19. Paul explained the importance of being proactive in a time where the hospital was also needing to be reactive. Although Paul entered into a slightly turbulent atmosphere, his resilient, forward thinking, and collaborative mindset distilled out the salt and left him with this: “In times of crisis, groups and people can bond or drift apart, but in Seattle Children’s case, we have become more resilient, formed better partnerships, and established a more unified purpose”. The Seattle Children’s Center for Quality and Patient Safety has supported and led responses to these crises which has encouraged several Center directors to work even closer together, fostering trust and as Paul describes, “molding our Center leadership into a family”.

            To learn more about this center, I asked Dr. Sharek to describe its main goals. I learned that the Center strives to “centralize resources around quality and safety and to establish a hub of quality and patient safety skill sets and teams to better align on a uniform purpose”. With yearly goals to improve QI and patient safety, the Center acts as a magnet to ensure these goals align and are not counterproductive across departments. By pooling quality-related resources in a central hub, quality-focused personnel can cross train and learn one another’s roles in ways that build more comprehensive skill sets that accelerate internal professional development. In crisis, it is important that the CEO, and other leadership responding to the crisis, know exactly where to go to find personnel to help; with the establishment of The Center, this is made much easier. As these, and other goals of the Center (such as producing improvement science scholarship), begin to be achieved there is evidence that the Center is garnering national and international attention.

            One particularly critical element of the quality strategic plan being implemented at Seattle Children’s is the establishing of clinical microsystems. This organizational framework for quality has been adopted by the vast majority of top children’s hospitals across the country, and is strongly endorsed by the Institute for Healthcare Improvement. Clinical microsystems teams are unit-based multidisciplinary teams that are formally trained to carry out continuous quality improvement and are described by Paul as an established best practice for how to build out a quality structure. At Seattle Children’s, Paul has established clinical microsystems in the Cardiovascular ICU, the Neonatal Intensive Unit, and the Pediatric ICU; with the Cancer Unit Microsystem on its way. These trained, front-line, lead quality improvement “engines” are supported by resources from the Center for Quality and Patient Safety, including an  improvement advisor, an infection prevention and control consultant, a data analyst, a specialist in environment workforce and safety, and a clinical effectiveness specialist on each team.  The teams meet every week and are accountable for the clinical outcomes of their respective units.

            Overall, Paul painted us a picture that portrayed the beautiful collaboration that exists (and is critical to QI and patient safety) among children’s hospitals across the country, and even across the globe. With similar unique challenges and the same objective to improve children’s outcomes, it is nothing but beneficial and of the utmost importance for children’s hospitals to work collaboratively together. By turning away from competition and profit, Children’s hospitals have created a unique and collaborative spirit that betters outcomes and saves lives. Just as Paul brought expertise and his former knowledge from his experience with Lucile Packard Children’s Hospital to Seattle Children’s, Seattle Children’s now has a model of QI and patient safety that will act as a blueprint for other children’s hospitals to willingly “shamefully steal”.

We thank Dr. Paul Sharek for taking the time to tell us so many wonderful things about himself, his work, and Seattle Children’s hospital. Thank you for supporting the Washington Patient Safety Coalition!

ABOUT THE AUTHOR:

Karlee Prince is the 2020 WPSC intern and graduated from the University of Washington in June 2020, with double majors in Public Health and Communication. She has spent her college career as Vice President of Risk Management for her sorority, being involved in leadership opportunities on campus such as the Husky Leadership Initiative, and also working on campus as a Student Office Assistant in the UW Student Activities Office. She also has spent a lot of time becoming a global citizen, by studying abroad in Rome, Italy, installing solar panels with an on-campus RSO (Global Renewables for Infrastructure Development) in Guatemala, and taking an educational trip to Israel. Karlee is passionate about understanding and working towards more equitable and accessible health care and health insurance, especially as it relates to government funded programs. She hopes to one day write a book, and also to go back to grad school for Public Health policy. Karlee will start as a consulting analyst with Mercer Government Human Services Consulting group in January.