Quality and safety in pediatric care have transformed over the past three decades, moving away from a culture of blame toward one centered on thoughtful system design and continuous improvement.
Pediatric quality and safety leaders from across the country discuss how that evolution has enabled more proactive approaches to preventing harm, along with stronger collaboration throughout hospitals and health systems. We also explore how insights from frontline care teams, partnerships with families, and the use of predictive analytics are helping identify risks earlier and improve outcomes for children across the care continuum.
Watch the episode on YouTube.
Featuring:
Jared Capouya, MD, MS, HQS, Vice President, Chief Quality and Safety Officer, Nemours Children’s Health
Sandip Godambe, MD, PhD, MBA, Chief Medical Officer, SVP Medical Affairs, Rady Children’s Health Orange County, Orange and Mission Viejo
Lara Wood, MN, RN, CPN, CPPS, Senior Associate Clinical Director, Children’s Hospitals’ Solutions for Patient Safety (SPS)
Host/Producer: Carol Vassar
TRANSCRIPT:
Announcer (00:00):
Welcome to Well Beyond Medicine, the world’s top-ranked children’s health podcast, produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/co-producer (00:12):
Each week, we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you’re here, let’s go.
MUSIC (00:30):
Let’s go, oh, oh
(00:32):
Well Beyond Medicine.
Carol Vassar, podcast host/co-producer (00:34):
In 1999, the Institute of Medicine, now known as the National Academy of Medicine, released a landmark report entitled To Err is Human, which fundamentally changed how healthcare systems approach patient safety. The central message was that healthcare must move from a culture of blame to a culture of safety by designing systems that make it easier for clinicians to do the right thing and harder for deadly medical mistakes to happen. The report became a catalyst, and it launched a global movement to rethink how care is delivered and how health systems can become safer and more reliable. In the years since, children’s hospitals have played a lead role, even a unique role in that work by collaborating across institutions, sharing lessons learned, and applying new approaches from safety science and other industries to improve care for kids. Today, we’re taking a closer look at how that journey has evolved, what we’ve learned along the way, and how those efforts continue to shape safer and more cost-effective systems for children and their families.
(01:44):
Joining me right now are Dr. Jared Capouya, Dr. Capouya is Vice President and Chief Quality and Safety Officer for Nemours Children’s Health, Dr. Sandip Godambe, Chief Medical Officer and Senior Vice President for Medical Affairs at Rady Children’s Health in California, and Lara Wood, Senior Associate Clinical Director for the Children’s Hospitals Solutions for Patient Safety or SPS, as you’ll hear it referred to today. I want to start right now with the big picture. When you look at pediatric safety work today compared with 10 years ago, 20 years ago, what do each of you see is different, especially in the way children’s hospitals approach safety and improvement? Dr. Capouya, I’m going to start with you.
Jared Capouya, MD, Nemours Children’s Health (02:30):
Sure. Thank you, Carol. For me, thinking back 20 years, probably around the same time as that landmark article was published, I was coming out of training, and I think back to those times and really, I think much of the harm that we recognize today and that we try to prevent today was really seen as really then as the price of doing business. And I don’t think there was much of an appreciation of us working in such complex work environments where we have so many different people from different backgrounds. We’ve got complexity in the children that we’re taking care of, and really that really required more than a simple or even complicated problem-solving sort of toolkit, so to speak, or pointing to an individual and saying, “Hey, you could have done better in that situation.” So I think that’s one thing.
(03:19):
The other thing that I think I’m really proud of, and I know many of us have been down these journeys of really having the ability. So when harm does happen, obviously we want to prevent it, but we’re really having conversations where we’ve migrated from a culture of deny and defend and having our caregivers, the folks taking care of the patients, as well as our parents and families suffering in isolation to one in which we embrace that as an opportunity to learn and reshape our systems, ensure our caregivers, patients, and families are taken care of and that their needs are met. And so lastly, I’ll just say, I think we’ll talk about this in a minute. The other thing that I think that has really changed is our move more into proactive identification of risks and something we probably didn’t do so well about 10, 20 years ago consistently.
Carol Vassar, podcast host/co-producer (04:03):
Dr. Godambe, you are nodding your head. What are your thoughts? What’s different now?
Sandip Godambe, MD, Rady Children’s Health (04:09):
Well, I would agree with everything that Jared just stated. I would really embellish some of his points, which is, I think he alluded to, and I think clearly that we used to think that a lot of the harm was due to individual mistakes, and we relied on a lot of retrospective review of issues. And to some degree, we still do, but we’re getting better about realizing that we have to be proactive. We have to walk amongst our teams who oftentimes are working in difficult environments and are often innovative in their approach to overcome some of the obstacles. And instead of blaming them for something they may not be doing, which is conforming to an unreasonable norm that someone has to design from a boardroom or from a conference room, they realize the true challenges of the systems that have been created at the individual hospital level.
(05:03):
And I think that’s a different dialogue there. And I think it helps our team members. We realize our team members are the solution to a lot of our problems, and also compartmentalizing some of the work into individual units, but trying to figure out as leaders, how do we share that learning across our health systems? And also, Lara will be talking about the same thing too: how we learn from our sister hospitals, especially in the pediatric realm? The other biggest piece I think is partnering with our families. Families are at the bedside. They too care about their loved ones just like everyone who comes to work at a children’s hospital, and learning how that partnership will be invaluable for moving our journey towards zero harm or reduced harm for sure at the local children’s hospital level. And I could go on, but I do want to hear from Lara.
Carol Vassar, podcast host/co-producer (05:58):
Lara, what are your thoughts? What’s changed? And also talk a little bit about the Children’s Hospital Solutions for Patient Safety Network that I mentioned in the intro. That is really, that partnership amongst all of these hospitals has helped to shape how children’s hospitals learn from one another. Talk about those two things.
Lara Wood, MN, RN, Children’s Hospitals Solutions for Patient Safety (SPS) (06:15):
Yeah. So first, I’ll just reflect for a moment on a couple of the comments that Jared and Sandip made that, totally agree, and want to highlight that point around the shift toward proactive safety. One of the big changes that I’ve noticed in the safety arena in pediatric healthcare over the last 15-ish years is that when we started the safety improvement journey across children’s hospitals, I think most of our work, rightfully so, was really centered around identifying best practices around high-frequency harm areas and working towards standardization around best practices. And that is a fabulous foundation. That is a great place to start, really helps us move from a place of chaos to more consistency around best practices. And so that has been extremely fruitful in our improvement journey. And also we recognize that we’re starting to receive diminishing returns from that approach of incremental improvements in reliability to best practice bundles, for instance.
(07:23):
And we’re recognizing, you heard both of them mention getting a little bit more proactive. And so we are appreciating the fact that standardization, extremely strong foundation in the safety space, and also we need to expand our lens of learning to better understand the challenges that our frontline team members are experiencing so that we can adapt our systems to make it easier for them to do the right thing. And we have some great tools and strategies now to learn more proactively to be able to improve, not just in response to the things that have happened. So I think that’s kind of part one of your question. Part two is sort of this collaborative effort around the Children’s Hospital Solutions for Patient Safety Network. So for those who aren’t familiar, SPS is a network of now 155 children’s hospitals across the United States and Canada who have come together; we have been a growing network over about the last 15 or so years, where we are collectively committed to eliminating serious harm across children’s hospitals.
(08:32):
And a few things I think make this network unique. I have had the pleasure of participating as a member participant and now formally on the team, and we really operate based on a set of guiding principles as a network, which I think is really transformative in terms of the member experience and our ability to collectively achieve progress that, first and foremost, we’re committed to that mission of eliminating serious harm. So do no harm is central to every decision we make, all of our prioritization.
Carol Vassar, podcast host/co-producer (09:05):
Absolutely.
Lara Wood, MN, RN, Children’s Hospitals Solutions for Patient Safety (SPS) (09:07):
We also recognize that regardless of what size of children’s hospital you come from, regardless of whether you’re freestanding, whether you’re a hospital within a hospital, whether you’ve been at this for ages or you’re just getting started, every single one of us has something to teach and every single one of us has something to learn. And I think when we embrace that mindset that there’s no one hospital that has it all figured out, that we all get to learn from each other and we all get to help each other on the journey, we’re able to accelerate progress. And the other guiding principle that’s really foundational to our work at SPS is that in order to be a part of this network, we are committing that we are not going to compete on safety, that we’ll compete on lots of things, we’ll compete on market share, we’ll compete on staff skill mix and all of those good things.
(09:59):
But really, when it comes to our patients and our team members staying safe, we all win when everybody wins, and that is really how we do our work. And so that allows us to be a team, that if you’re a sole dedicated safety person in a small children’s hospital, you actually have a huge team of folks to rely on, and that allows us to improve faster. And so we’ve gotten pretty good at trying things out. We’re focused on quality improvement science and applying changes, and we fail sometimes, but we learn quickly, and it allows us to accelerate improvements.
Carol Vassar, podcast host/co-producer (10:39):
That’s amazing that you’re not competing on quality and safety. You’re really, as a system of 155 hospitals across the US and Canada, looking toward the best outcomes for all children that you serve. Dr. Godambe, I’m curious, when you look at this kind of shared learning across all of these hospitals and when it’s working well, how does it translate into change inside, say, a single hospital or even a healthcare system? And what does that look like operationally on the ground?
Sandip Godambe, MD, Rady Children’s Health (11:16):
So I’ve been fortunate to be part of two children’s hospitals through my time working through SPS since 2013. And I think, first of all, I think Lara nailed it, which is now all of the colleagues within, say, my current system have friends across the country they can reach out to learn from. So oftentimes, in meetings, either virtual or in person or just a phone call- there’s learning. And that learning, I think the biggest challenge for us is to make sure that learning is shared across our system, whether it comes from an intern or an external source. And there’s a lot of value in when someone goes someplace, say, to an SPS national meeting and comes back excited. That excitement is palpable. And oftentimes when you’re at a local system, you sometimes feel like you’re in a silo just because the events happen and you struggle.
(12:10):
And when they come back from other health systems, hearing from other health systems that have done things well and succeeded, that energy is often brought back, and it’s a can-do approach rather than, “I’m not sure what to do.” And I think applying that knowledge is helpful. Similarly, I would also add that oftentimes we’ve had some situations where we’ve struggled, we’ve implemented a checklist, and that’s where teaching our teams local problem solving is also important because oftentimes there’s something unique about our system. I’ve been here at Rady Children’s Health now for about just over five years, and there’s my predecessors in different units that have created systems that it might be different, say, than the system at Nemours.
(12:55):
And learning how to take that checklist that we’ve learned at a national level and sometimes getting guidance from colleagues, say, at Nemours or elsewhere, at Seattle Children’s, is helpful for us to locally problem solve. And oftentimes we learn a lot in that process. And similarly, we want to promote: if we have a unit locally that’s doing something unique and succeeding, how do we figure out how to share that information? That’s the value of our local meeting: making sure we have newsletters, and also our meetings, given that we all operate in a virtual space as well, and the expanse that we cover in Southern California, it’s important for us to figure out ways to share and also celebrate when teams are doing things well.
Carol Vassar, podcast host/co-producer (13:40):
It must be hard in some of the rural pediatric hospitals or hospitals within hospitals when you’re the only quality and safety person, and knowing that you have this network backup and that kind of support must take some of the burden off of clinicians. Dr. Capouya, I’m wondering, how does that kind of improved system design reduce the burden on clinicians who are already quite burdened? How does it improve care and the way it’s delivered and ultimately make things better for children and their families?
Jared Capouya, MD, Nemours Children’s Health (14:14):
Thanks, Carol. And to build off what Lara and Sandip had said, and it’s interesting, I kind of got my start in one of those facilities that was a hospital within a larger system, and this was probably what? 2013, ’14? I really got exposed to SPS, and Lara Wood happened to be my clinical partner in that effort to get that off the ground, which was great. But no, it’s a great question. I think how we design systems- I was reading something recently in a New England Journal article that quoted Don Berwick, and he said, “The primary method for affecting safe care, the remedy is really in design.” And as we’ve said, I think historically we’ve really been reactive and learned from what’s not gone right and use that as a primary method. And I think as we embrace more modern approaches, we really embrace the humans doing the work, or what we might call the frontline, and really think about how we learn from them and develop solutions that come from them because they’re really the ones understanding how the system’s working every day and how that variation is occurring that we just talked about.
(15:17):
And I think really the ideal would be to create operating systems that can really continuously understand and learn and even anticipate from that variation. So again, understanding that work that’s happening every day so that we can put those right safeguards in place so that as our workforce is adapting on a daily basis, we’re not leading to catastrophic harm or that we’re really avoiding and getting in front of that. And as we learn from those data points, we can really think proactively about what plans we need to put in place, which actually reduces burden later on for folks, I think. And the other thing is, I was just having a conversation about this the other day.
(15:53):
I think the other thing that happens is if we can develop systems and design systems really in that frame, I think we don’t have to rely on heroism as much or people being heroes or really saving the system that we’ve created this resiliency within the systems, and we’ve engineered that into them for the people receiving the care and the people providing the care. So I think in that frame, I think we’ve really reduced a lot of the, or we will reduce and have reduced burden on our teams that there’s at least a smarter way to do things as we learn from them how that looks.
Carol Vassar, podcast host/co-producer (16:30):
I would love to ground this in a real example. Efforts to reduce unplanned extubations, for example, particularly in pediatric ICUs, have involved multiple children’s hospitals learning together. What did that improvement journey teach the field, Lara, about quality and safety improvement within complex systems?
Lara Wood, MN, RN, Children’s Hospitals Solutions for Patient Safety (SPS) (16:52):
Yeah, it’s really a fun example to talk about. So unplanned extubations, I think Jared mentioned at the beginning, that recognition that not so many years ago, we often approached some of the harms that we now consider to be serious harms as sort of just the cost of doing business in pediatric healthcare. Unplanned extubations was one of those that as recently as 10 years ago, really it was an area of harm that was just thought to be sort of a normal occurrence in the critical care setting, in pediatric hospitals. And we are thankful for the thought leaders who push us to think differently and say, “Nah, you know what? I think we need to challenge our assumptions about this.” And lo and behold, a group of folks got together through a network effort to say, “Hey, let’s see if we can identify some factors. We’ll do factor testing around things that we could do to potentially reduce the likelihood of these unplanned extubation events from occurring.”
(18:01):
And lo and behold, it was wildly effective. And so we were able to identify a bundle for unplanned extubation prevention that over the course of several years was deployed and spread, and a lot of work around reliability to that bundle across our network of children’s hospitals led to an over 50% reduction in unplanned extubation events. Unplanned extubation is one of the most frequently occurring hospital-acquired conditions, serious hospital-acquired conditions that we see in children’s hospitals. So this was a massive improvement; super exciting to see the progress. And as I mentioned earlier on, the challenge is that now we’re at the point where, hey, you know what? Once you get to 90, 92, 94% bundle reliability, how much is getting to 96% bundle reliability really going to bring us the rest of the way down to zero?
(19:02):
It’s not going to happen. And so a few years ago, we were really fortunate that we started to learn a little bit more outside of the healthcare industry from the safety space in many other industries, areas like oil and gas, aviation, lots of different industries, where we started to appreciate that we really could lean into learning differently from the people who do the work, thinking differently about safety where it’s really, we’ve got to learn about successes and the positive adaptations that folks are making to be able to intervene early to keep kids safe rather than just learn when we don’t keep them safe. And so we applied, we said, “You know what? We’re going to try something out.” And we invited network hospitals if they wanted to join in this effort to try out a new proactive safety tool to our network called Proactive Safety Huddles.
(20:00):
We decided that we were going to focus on NICU patients, our sort of highest-risk population, and we were going to apply these Proactive Safety Huddles to those highest-risk NICU patients, of which I just want to make a note that Black and African American patients also were experiencing unplanned extubations at a disproportionately higher rate. And so this also became a targeted area to focus our Proactive Safety Huddles. And in less than a year, the group of 70 hospitals that volunteered, raised their hands, said, “Hey, we want to be a part of trying something new.”
(20:43):
And, less than a year, that group achieved a statistically significant 20% reduction in unplanned extubations in this extremely high-risk population. So super exciting to see how we’re going from the strong foundations of standardization around best practice bundles and not stopping there, not resting. We still have a lot of work to do. There’s still a lot of kids that are being harmed by these events. And this was a really great sort of case example, proof of concept that you know what? We can apply some new strategies and tools to learn differently to drive improvement. And I will say, not only did we see that 20% reduction, but we also are seeing a narrowing of the disparity that existed. So super exciting to see that progress.
Carol Vassar, podcast host/co-producer (21:25):
It is so wonderful that the bottom line of helping to make sure that children are extubated or not extubated properly is being raised in terms of safety levels. This is just amazing stuff. And I’m wondering what you’re focusing on right now in terms of quality and safety; you’re all leaders in this area. As you said, Lara, there is still work to be done. What else right now are you each working on to improve the complex, dynamic, and deeply human systems that our children are going to be part of? Dr. Godambe, I’m going to go to you first.
Sandip Godambe, MD, Rady Children’s Health (22:12):
I’m chuckling mainly because a lot of the things we’ve said, but so I’ll reiterate some, but they are important and a lot of it we can attribute to our collaborations. But we are focusing on, say, our frontline, how work is really done at the frontline, understanding through observations and learning from, I call, local experts and engaging them. For instance, recently we’ve learned a lot about our basic system peddling and rounding in the morning has some opportunities for improvement. But it’s interesting as a trainee, as an attending physician, I’ve always taken it for granted. That’s just the way we’ve always done things. And so we continue, and now we’re asking the question differently because our families want to be there. Sometimes our nurses are not present during rounding because they’re overwhelmed or overtasked. Similarly, I think Lara and Jared have both talked about our shift from reactive to proactive safety and using that language. So people, to me as a frontline provider, sometimes it means my system cares.
(23:18):
Suddenly my opinion matters. And [inaudible 00:23:22] in all of that, I’m also talking about better ways of communicating and care coordination and how we talk to each other, the culture of safety, the culture of our frontline teams, and also their relationship with senior leaders. We want workforce wellbeing. We want to reduce burnout and psychological safety so they can speak up. We have some efforts involving, and I’m just using an acronym, but there’s a lot more to it, but BETA HEART or CANDOR, and getting our families engaged. So when there are events that are stressful to not only families, but to our frontline team members, they have a way to call an expected response from senior leadership within 30 to 60 minutes.
(24:04):
And then Lara said, at best, the focus in equity, we want to make sure that the care we deliver is focused on not the average of the population, but on the different populations that we do serve, and then creating learning systems. I think the learning system concept was mentioned in To Err is Human, but I think largely ignored because the focus was, let’s try to quickly reduce harm while at the same time not understanding we have to have a culture and a learning system that we can learn from harm and do better.
Carol Vassar, podcast host/co-producer (24:37):
Lara, anything to add?
Lara Wood, MN, RN, Children’s Hospitals Solutions for Patient Safety (SPS) (24:39):
I think they’ve done a great job covering it; I would just highlight a couple of things that I think we so often have an infinite number of possibilities of things we can focus on. And so one of our greatest challenges in leadership is being explicitly clear on what our top priorities are, that there are a limited number of things that we can really drive breakthrough progress on. And so I think that that is first and foremost, identify what are the top problems we’re trying to solve, use good QI science, but I think points that both Sandip and Jared made multiple times is that one of the big ahas is that we need to slow down in the learning phase, learn more deeply about the current state, understanding work as it happens, appreciating the expertise of the frontline folks. So I think that’s just highlighting that same point. But for me, prioritization, learning deeply, and then staying true to quality improvement science, it works.
Carol Vassar, podcast host/co-producer (25:52):
I’m curious; I don’t think there’s any podcast I can get out of without talking about AI, and it’s part of the conversation across all of healthcare. Let’s talk about it if we can in the context of patient safety and quality improvement. How are you each beginning to use AI? Are you beginning to use AI or advanced data tools to detect patterns in terms of safety and quality and learn from events faster or support safer care? Dr. Capouya.
Jared Capouya, MD, Nemours Children’s Health (26:23):
Yeah, thank you. And to Lara’s point, this is one of those things we have prioritized this year in terms of doing some AI pilots within quality and safety. And I think there’s a huge amount of enthusiasm here, and we actually have some prioritization that we work through to think about. One, I think the learning, Lara mentioned learning deeper. So I think there’s also learning quicker. And I think some of the tools that we have in place to review some of our events that could be auto-populated through some of the automation tools that we have, which could then gain insights, which could then help drive proactive mitigation. I think that’s one of the things we’re really trying to focus on. The other one is we get an immense amount of information on a daily basis. So event reporting systems, other sorts of tools, and communication streams where we’re getting just flooded with information about our systems.
(27:12):
And I think these tools could actually help us categorize, trend, track, and really bring us better insights quicker that it would take maybe our teams a little bit of a longer time to put together. And I think we’re also experimenting with some of that. And then I think there’s some of the other things, like our systems doing, not so much within quality and safety, but like ambient listening and some of those other things to help drive documentation improvement. We actually do have a pilot related to that as well to try to learn about, are we documenting well to then drive better decision-making too and some models within an AI tool. So I do think this is wide open in terms of where we could go with these things. But I think back to Lara’s point, one of the things I’ve learned in this is we got to keep it really clear as to what those things are that we want to work on and then how effective are they? And then which ones do we go forward on and which ones do we not?
Carol Vassar, podcast host/co-producer (28:04):
Sounds like a very logical way to proceed. Dr. Godambe, are you doing similar work at Rady?
Sandip Godambe, MD, Rady Children’s Health (28:09):
Yeah, I think, and Jared and I have geeked out together, but I was fortunate when I arrived here in Southern California, we actually have an AI institute called Mi4. And so I’ve been fortunate to be, I guess, trained or learning from some of our leaders such as Anthony Chang and John Henderson, Steve Martel and others. And so we’ve actually been using AI; we’re fairly careful. We actually have a governance that we’ve set up, and it’s been in place for about four or five years now, but we’re very deliberate. I mean, we’re using AI to augment, and I think Jared brought it up, which is to detect patterns, to identify risk earlier, and also large amounts of data. I think our frontline teams are overwhelmed. So anything we can use to reduce that burden- AI would be one thought. We’ve always used AI for early risk and prediction, predictive modeling, say for sepsis, also some of our patients at risk for readmission. So we’re thoughtful, especially when there’s social drivers of health involved.
Carol Vassar, podcast host/co-producer (29:12):
It sounds like continuous learning is all a part of quality and safety. Lara, what are your thoughts on AI, especially from that SPS perspective when you’re in contact with so many hospital systems that are possibly incorporating AI?
Lara Wood, MN, RN, Children’s Hospitals Solutions for Patient Safety (SPS) (29:27):
Yeah, it is an extremely exciting space. And I think you’ve heard just a handful of examples. We are hearing new examples of how folks are learning and utilizing AI to really make some cool progress. And so, a very exciting space, I think in particular as we’re thinking about hospital-acquired harm reduction, predictive analytics, super helpful in terms of predictive modeling, being able to better identify, as Sandip mentioned, and intervene early. So lots of exciting stuff happening there. And I think that the one thing that sort of at a network level that we’re wrestling with a little bit, that we have to balance the excitement and enthusiasm with the recognition that as we are doing safety event learning in particular, in order to really understand the context in which an event occurs, we really have to dive pretty deep to understand why actions were made by folks doing the work leading up to the occurrence of an event.
(30:38):
And those things, nine times out of 10, probably more than that, are not documented in the EMR. And so we appreciate the fact that the why, in the context of people making moment-to-moment decisions in whatever’s going on in the world around them, it’s not going to be captured. And so we have a responsibility to really have the conversations to really make sure that we are understanding the context to the extent possible, especially as it relates to event learning. And so we want to make sure that we’re not replacing all of the dialogue that allows us to approach events with humility and curiosity in favor of using something that may not actually allow us to do as deep of learning. So I think that’s the sort of cautionary tale that we’re balancing in the midst of the exciting progress that’s being made.
Carol Vassar, podcast host/co-producer (31:43):
Very prudent way to proceed on all of this, and it makes so much sense. As we close out today, Dr. Capouya, I want to talk about Nemours. And at Nemours, we talk a lot about whole child health. Recognizing that children do best when the systems around them are working well. And all of what we’ve spoken about today is about system change when necessary. How does this work in safety and reliability really support that broader goal of healthier children, stronger families, and of course, better communities?
Jared Capouya, MD, Nemours Children’s Health (32:19):
Yeah, Carol, that’s a great question. And it’s really fundamental, I think. We talk a lot about this. We know most of health is driven by things outside of medical care, clinical care, but every child should have access to primary prevention. And some kids, fewer children, will need care all the way through quaternary care. So everything we’ve talked about today in terms of designing systems that build and create health for children and their families and do so in a manner where they can move through that system harm-free or free of harm- I think that’s really fundamental to them than being healthy. I think it goes back to the idea of improving physical health, emotional-social wellbeing. So if we harm somebody, so if there’s a diagnostic error or diagnostic safety event, as Sandip was talked to, or an unplanned extubation, there are consequences to that.
(33:19):
Patients or children may stay in the hospital longer. They may need to be away from school and their parents away from work longer. Obviously, we drive up healthcare costs in those situations. And I think if we develop these systems that are more aware and mindful and have the ability to really prevent some of these things from happening, which we’ve done a really phenomenal job with the methods and the tools that we have in place and the things that we’re layering now on top of that, we’re going to get kids home sooner. We’re going to get families home sooner. We’re going to get them back to school sooner, where they’re best able to learn and excel, where they can play. So I would say it’s really fundamental to maintaining and achieving the best health possible for the future of our children to be really healthy adults. I think all of us in pediatrics, our goal is to create healthy adults who can go out and excel in the world and be productive. And I think if we can really design these systems the way we’re talking about today, we’re going to do that hands down.
Carol Vassar, podcast host/co-producer (34:24):
Dr. Jared Capouya is the Vice President and Chief Quality and Safety Officer at Nemours Children’s Health. He was joined in conversation about quality and safety by Dr. Sandip Gadambi, Chief Medical Officer and Senior Vice President for Medical Affairs at Rady Children’s Health in Orange County, California, and Lara Wood, senior associate clinical director for the Children’s Hospitals Solutions for Patient Safety, or SPS.
MUSIC:
Well Beyond Medicine
It hasn’t even been 30 years since To Err Is Human, and the progress in pediatric safety is striking. But at its core, this work comes down to one thing: preventing harm before it happens. That’s exactly where quality, safety, and sepsis intersect, and that’s where we’re headed on our next episode. Recorded at the 2026 Pediatric Academic Societies meeting in Boston, our guest is Nemours Vice Chair for Research, Dr. Scott Weiss. We’ll sit down for a conversation about pediatric sepsis, where early recognition, rapid response, and the right systems in place can quite literally save lives. Thank you so much to Dr. Capouya, Dr. Gadambi, and Lara Wood for sharing their expertise and wisdom on quality and safety, and thank you for listening.
Our production team for this episode includes Cheryl Munn, Lauren Teta, Susan Masucci, and Alex Wall. Video production by Brit Moore. Audio production by yours truly. I’m Carol Vassar. Until next time, remember, we can change children’s health for good, well beyond medicine.
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Let’s go, oh, oh. Well Beyond Medicine.
