Podcast: Outreach, Quality & Safety

Charles Roberts, Executive Vice President/Executive Medical Director

Interview by Jason Newland, MD | June 10, 2013

JN: Welcome to another edition of our Employee Discovery Podcast. I’m Jason Newland, the Medical Director

of Patient Safety and a pediatric infectious disease physician here at Children’s Mercy, and again I will be your

host for another edition of this great podcast…at least I think it’s great, so far!

CR: And you just discovered me, I found out.

JN: And I just discovered Charlie Roberts, so I would like to say I feel fortunate that I have our Chief Medical

Officer of the hospital, Dr. Charlie Roberts, who yesterday received a phone call from me that we needed to

record a podcast, and he graciously said ‘Yes, I’ll do that (today).’ Charlie, welcome, and I appreciate your time

today.

CR: No problem.

JN: So Charlie, we’ve talked with a lot of folks over the last month/two months on this podcast, one of which

was Dr. O’Donnell about, you know, kind of his view of the future, and we thought it would be nice from your

perspective as the Chief Medical Officer what you think the future holds for us here at Children’s Mercy in the

coming year.

CR: Well, I think everything we’re going to do is based on what Rand has been saying ever since he got here 20

years ago, which is let’s make this the best children’s hospital out there. And to do that in the next year, the

things I think we need to focus on are Quality and Safety, maybe number one, it all starts there. We could talk

about what all that means for an hour. The other thing I think is really important to us is outreach into the

region. I know a lot of people think, “Oh, that idiot Roberts thinks that’s important, he needs to go to

Springfield” and all that stuff, but for us to have the critical mass of specialists and patients to be that great

hospital we want to be, we have to capture the region. We’re not in a population of 5 million people in the

metropolitan area. So it’s not a luxury, I think it’s an absolute. We’re working on that, but I think that has to be

a continuing priority.

JN: So talk a little bit more about that. I mean, what kind of strategies have we done in the past to try and help

reach out to these other areas of, kind of, rural America, or rural Midwestern America?

CR: Well, for years we’ve done outreach in different cities in Missouri and Kansas, and we continue to do that.

But what we’re trying to do is be more focused. So we actually have what I call a node in St. Joseph, at

Heartland. It looks like Children’s Mercy, and we’re just getting started, so we’re ramping that up. We want

that to be a real presence that St. Joe and Northwest Missouri feel, and realize it’s Children’s Mercy.

JN: So when you say a “node,” kind of almost like a clinic, like with signs; a place they can go physically.

CR: Yes, yes, exactly. It looks just like a Children’s Mercy clinic. It’s been renovated to look like that. We’re

doing the same thing in Joplin; and we want to consolidate our outreach. Many times we’ve had outreach in

five or six different spots in a community, and they didn’t necessarily know it was us. So we would like people

to know that, and we get some economy of scale, and we can have somebody there in the community helping

run it; and, I think it’s a great place to set up a real meaningful telemedicine program, where we can have

somebody in the community, and you could have 7, 8, 10 consults a day, all done by telemedicine out of one of

those facilities. In Wichita, we’re taking it one step further in that we’re doing exactly that, but we also have an

employed pediatric nephrologist, and an employed pediatric endocrinologist, with a second endocrinologist

coming this summer.

JN: That’s great! I mean to actually get people physically there, present, I think also helps us kind of talk with

them and almost create a safer environment in many respects. How far do we reach out? Meaning, what

states do we go to, where do you see us going?

CR: Well, I think the important region that we just have to have the confidence and the capacity to meet their

needs is Missouri and Kansas; and more of Western Missouri, but all of Kansas. But we have programs now,

some I’m sure I’m not all familiar with, but we’re attracting patients from around the country. I know our

Epilepsy program is attracting patients from around the country because of the great job we’re doing with the

ketogenic diet in the Epilepsy Monitoring Unit. We have a great sleep program. I think we’re going to be doing

that in other areas as well...Recruiting Dr. (Steven) Shapiro, he’s a national expert on kernicterus, so we’re

getting patients from around the country. So we do get patients from outside of our natural region, but we

can’t ever forget the importance of the natural region.

JN: I agree, kind of get home in that providing that to a rural community. I grew up in a small town in

Oklahoma, my Dad’s a doc, and he really relied on the places that had more – the Oklahoma Cities, and so on.

So I think it’s really important. So in light of that, how are we kind of—you know, our Project Access type of

work that we’re doing to try and help people get into the hospital, or get into our clinics faster…how is that

going? What do you see in that going forward?

CR: Well, that’s critical, because part of, quote, “Meeting the Need of the Region,” is to see the patients in a

timely fashion. Everybody’s working hard, but we have to figure out ways to be more efficient. Telemedicine

might be an example of where we can do that. But it’s not necessarily just work harder and faster, grind it out.

Not to highlight this as something to hold up, but it’s what I lived for many years as a GI doc. We changed how

we scoped kids, from sedating them with Fentanyl and Versed, to having the anesthesiologist give the kids

Propofal, and in the process, we doubled the number of kids we could do in a day, and it was a much better

experience for everybody. So in terms of running harder and faster all the time, we didn’t, but we clearly

improved efficiency. So things like that I think we have to focus on.

JN: Yes, which is great; it’s good, the work we’ve done. Now, obviously the first thing you mentioned going

forward is quality and safety. Obviously I’m going to jump on that a little bit to talk about…

CR: I set you up…

JN: Yes, you set me up…

CR: You’re welcome!

JN: I agree, it will drive the hospital, so from your perspective, what do we have to do to get ourselves to the

next level in Quality and Safety at our institution?

CR: I’m about to say, change the culture…but I don’t really like that because everybody does care about it; so

heighten the awareness of the issues that really are there. I think we have to be more transparent so people

know…If you don’t realize…I used to joke, teenagers are not going to put their seatbelt on if they don’t think

they’re going to get in a wreck, why would you bother? So you have to be aware of it. Changing that culture, if

you want to put it that way, I think is paramount. There’s data that says if you follow all the bundles, you get

them all written and do all of that stuff, you can only get so good. We have as our Number One statement,

goal, in the strategic plan: Eliminate Harm. It might have been an accident that it got Number One, but I’m

thrilled that it’s there because everything will follow from people taking that seriously. We’ll get better

teamwork, we’ll have a much better culture, where people are not afraid to speak out and say, “Hold the

phone, Charlie, what are you about to do?” And then they save my backside. So I think that’s the important

thing, it’s going to take some time, but we have to have everybody buy into the fact that it’s everybody’s

responsibility to make sure we don’t hurt anybody.

JN: Yes, I agree and I think you hear a lot about accountability. You know, are we going to hold everybody

accountable if someone doesn’t treat someone with respect when they speak up, and that piece. And so, I

mean, how do we even do that better? How do you and I, as leaders of the hospital, do that better? Holding

people accountable?

CR: I think role modeling. People have to walk the talk. If they see the medical staff, the nursing staff, the

respiratory therapy staff, all doing that together, and the leaders in those areas role modeling that behavior,

then I think it grows.

JN: Yes, I agree. I completely agree. Well, Charlie, I really appreciate you joining me for the first time this

week, and I hope we can do this in the future to give people the updates from your perspective as the Chief

Medical Officer. Thank you everybody for listening. Again, if you have any questions or advice or concerns or

topics that you’d like to hear, please don’t hesitate to email me at jnewland1@cmh.edu, and I look forward to

talking to you all next week.

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