Health Insight New Mexico: Ask Me Anything with Margy Wienbar

Margy Wienbar

Executive Director at HealthInsight New Mexico

December 21, 2015

Q: What does Quality Improvement mean to you?

A: Quality improvement is both a science and an art. Quality improvement literature tells us we need to be methodical and systematic in our approach to change, but we have to account for variability. And, as Dr. Sanjeev Arora, founder of Project ECHO, has stated, there is a lot of variability when people are involved. This is where the art of quality improvement must also be applied, by customizing best practices and evidence based interventions to account for unique individuals, contexts and systems.

Q: Can you share more about your role and organization? What efforts do you/your team pursue to advance quality improvement in Healthcare?

A: As the Executive Director of HealthInsight New Mexico, one Quality Improvement Organization in a three-state Quality Improvement Network that has recently embraced two End Stage Renal Disease (ESRD) Networks, I can share that there is a focus on multi-state coordination to develop efficiencies and ensure best practice dissemination. Having state-based staff is a key to ensuring success at the local level, due to the ability to have a keen understanding of local dynamics, including other organizations engaged in improving health care quality and health status. In our states, we are seen as a neutral facilitator that can help build collaboration across health care systems, from public health to specialty clinical care. In addition to the work we do to improve quality of care for Medicare recipients across three states on behalf of the Centers for Medicare and Medicaid Services, HealthInsight partners with health departments at the state level. In Nevada, HealthInsight leads efforts to improve Health Information Exchange, and our organization supports similar efforts other states. In New Mexico, we are the External Quality Review Organization for Medicaid. We are actively engaging with our ESRD partners and hope to support the Practice Transformation Networks as well.

Q: What advice can you offer for others who seek to promote quality improvement in healthcare?

A: A dear friend of mine often said, “you don’t anything learn’ by talking’.” I have taken that advice to heart, and I believe that listening is critical to quality improvement. People can best be change agents by first listening to and understanding the particular needs, wants and hopes of patients, families, communities and health care delivery staff.

Q: What are some of your favorite resources/tools around this subject?

A: I’ve become a fan of the book “Switch: How to Change Things when Change is Hard,” by Chip and Dan Health. It offers a way of thinking about complex problems that, for me, often leads to a new understanding. In addition, the principles taught in the book are practical and easy to implement. They often help me get “unstuck,” when thinking through a complex problem. For example:

• Follow the bright spots. Look for what’s working and replicate it

• Design a specific action such as “drink 1% milk” instead of “eat less fat”.

• Communicate the vision. One of my favorite examples of this is NASA engineers with a large picture of the moon on their wall.

• Identify the compelling story that motivates and inspires.

• Break big tasks into smaller steps.

• Tweak the environment. One of the first things I learned in quality improvement is that the problem is more often the system than the people. Make the right choice the easy choice.

• Build a movement not a project. People want to feel a part of something greater than themselves. In one New Mexico community, hospital cleaning staff began to see themselves as part of the infection control team and critical to patient safety.

Q: Is there a particular person (co-worker, speaker, mentor) that you look to for thought leadership on Quality Improvement? Who is at the forefront of this work?

A: Earlier I referenced Dr. Sanjeev Arora. His vision, for Project ECHO to touch one billion people by providing the right knowledge, at the right time, in the right place, is inspiring. He understands the desire that rural health care practitioners have to interact with colleagues and experts to better serve rural patients, and he developed a methodology to help meet that need and improve health care delivery.

Q: How does Quality Improvement impact the greater Healthcare improvement movement?

A: Quality improvement methodologies and tools are driving health care improvement, and when you improve quality in health care, you improve health care itself. In other words, quality improvement is a means to an end, and it provides a methodical and systematic approach to health care improvement. We can improve health care by being thoughtful, disciplined and knowledgeable or we can be subject to random change which is certainly less desirable and less effective.