How quality leaders must evolve, per Nationwide Children’s CQO
Maitreya Coffey, MD, began her career at the bedside, navigating the complexities of pediatric care while spearheading quality improvement projects. Now, as the first chief quality officer of Columbus, Ohio-based Nationwide Children’s Hospital, she is focused on creating scalable structures and processes to support continuous quality improvement across the organization.
This focus reflects a broader shift in healthcare, where quality has evolved from being managed by a single department to becoming an enterprise-wide strategy aimed at lowering costs, improving outcomes and addressing inequities.
Becker’s recently caught up with Dr. Coffey, who was named chief quality officer in May, to discuss her vision for Nationwide Children’s quality agenda and the evolving role of quality leaders.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: The chief quality officer role has evolved significantly in recent years, moving beyond compliance to become a strategic pillar of clinical and operational performance. How have you seen this shift materialize in your own leadership experience?
Dr. Maitreya Coffey: I perceive that focus on compliance and regulation has continued to proliferate, but I absolutely agree that quality has extended beyond that. In the early days, we had a lot of choice in what projects to work on, but we had to be opportunistic and creative with resourcing, sometimes having to do it all ourselves from soup to nuts, including clinical expertise, change leadership, QI methodology and data analytics. A lot of projects failed, and while we learned from every experience, it consumed a lot of energy.
Now that quality is so much more prominent and people subspecialize in different aspects, the system can support a much greater number of quality initiatives more efficiently and with more chance of success. This means my role has changed from doing the hands-on QI I loved, to being more of a monitor for the whole system, and an architect of structures and resources to have the greatest impact. I count on the learning from those early days as a “QI generalist” to ground me as I have taken on more strategy focused roles.
Q: What are your top priorities in the first year as Nationwide Children’s inaugural CQO? When you look back a year from now, where do you hope to see a measurable impact?
MC: This organization was intensely focused on quality long before the creation of this role. One example is our clinical outcomes group that supports champions from nearly every corner of the organization in achieving improvements in effectiveness, access and equity. Their skills are in very high demand, so one of my priorities is to ensure everyone gets the support they need to impact outcomes as we continue to grow in patient volumes, geographic footprint, and innovative partnerships and models of care.
Patient safety, which has also been a long-term focus at Nationwide Children’s, remains a priority while continuing to pursue the best outcomes in the context of post-pandemic recovery. The health human resources landscape requires an all-hands-on-deck effort. In addition, the approach to safety in the broader multi-industry context is changing and moving toward a set of mindsets and approaches some are calling collectively “modern safety.” Nationwide Children’s was an early adopter of some of this, but I see an opportunity to make this more front and center.
Q: A sentiment that increasingly comes through in conversations with hospital leaders today is that quality isn’t the responsibility of one team — it’s everyone’s job. How do you plan to engage all departments (including those often behind the scenes like environmental services, etc.) in the system’s quality and safety mission?
MC: This is something I think about a lot. When I started out two decades ago, improvement work was not well organized, but the early adopters were drawn to the creativity and spontaneity of it. As we strove to establish legitimacy by organizing ourselves, the era that followed saw quality as the domain of the “quality department.” Healthcare has since evolved dramatically toward the broader expectation that everyone has a role in quality and safety.
A couple of weeks ago, I attended a presentation by an environmental services leader who had completed a proactive safety assessment of employee musculoskeletal injury risk. It is very gratifying to see this evolution. But it means that quality leaders have to evolve as well — becoming experts not just in quality methods but in knowing how to continually fine tune the balance between centralized and distributed ownership for quality.
Q: Uncertainty around federal funding — from Medicaid cuts to proposed limits on research reimbursement — is already prompting budget shifts across hospitals. How do you plan to navigate these unknowns from a clinical leadership perspective?
MC: The thought that a child could lose healthcare coverage or endure cuts to essential services is extremely concerning. I feel prepared to navigate this because, like a lot of quality leaders, I think frequently about the costs and return on investment of our work. This is something that the Children’s Hospitals Solutions for Patient Safety network has taught us well.
We work together to eliminate harm in children’s hospitals because it is the right thing to do, but we also stay attuned to the enormous cost avoidance brought about by the work. We improvers are creative, we’re drawn to change, and we’re surrounded by the people of healthcare — an industry that continues to attract the most compassionate, intrinsically motivated people who want to do the right thing for patients and staff and to make the world better. So, I feel optimistic.
Q: What’s one challenge or trend in quality and safety that keeps you up at night? What do you believe the healthcare industry should be paying closer attention to?
MC: I worry about the pendulum swinging back toward blame culture vs. just culture. I think this is in part a product of our success in building accountability through policies and procedures and the broad expectations we discussed above. But it’s a dangerous trend in terms of the negative impact it could have on our ability to keep learning and evolving and designing harm out of the system. I urge all healthcare leaders to pay attention to this.