Prof. Paul Barach 

Paul Barach, BSc, MD, MPH, Maj (ret.)

 

Paul Barach, MD, MPH, has been a leader of Anesthesia patient safety, quality management and performance improvement, medical education, and systems change with over 15 years of clinical and administrative experience in academic medical centers and integrated delivery systems. Paul is a double boarded anesthesiologist and critical care physician-scientist, Clinical Professor at Wayne State University School of Medicine, and Children’s Hospital of Michigan. He is Lecturer and senior advisor to Dean, Jefferson College of Population Health. He trained at the Massachusetts General Hospital affiliated with Harvard Medical School. Paul is an elected member of the lead honorary society the Association of University Anesthesiologists. He leads the Patient Safety Commission for the World Society of Intravenous Anesthesia and is a member of the World Societies of Anesthesia Patient Safety subcommittee working group. He holds adjunct academic appointments and teaches in Universities in Europe, and Australia. 

 

Professor Barach was Chief Quality Officer for the University of Miami and Jackson Memorial Healthcare System, Associate Dean for Patient Safety, and Founder and Director of the Miami Center for Patient Safety and Simulation. Paul’s areas of experience include clinical strategy, clinical model development & redesign, physician leadership & engagement, performance & quality improvement, perioperative care, and anesthesiology. He led the Florida Patient Safety Agency creation and wrote the blueprint for the Betsy Lehman Patient Safety Massachusetts Center. Dr. Barach is deeply committed to translating research into public health strategies for ensuring safe patient care, systems strengthening, health protection and population health. Paul has more than 25 years of experience as a practicing public health physician and physician executive in the military and in academic medical centers and integrated delivery systems. He is a formally trained health services researcher, with advanced post graduate training in advanced medical education and assessment methods from the Harvard Medical School Josiah Macy Program medical education, lean six sigma, quality improvement and lean techniques at Intermountain Healthcare. He has had additional training in epidemiology and statistics including both methodological as well as applied HTA research. Prior to that he spent 5 years in the military in disasters preparedness work and was involved in leadership, team training, leadership and simulation training for disasters.

 

Paul has an extensive track record of improving interprofessional surgical training, health service and medical education delivery in US, Australia. GCC and Europe. He leads the Patient Safety Commission for the World Society of Intravenous Anesthesia. He is a board member of the International Academy for Design and Health focusing on innovation and facility design including for disasters. He has been a member of numerous ASA committees including holding leadership roles.

 

Theories and ideas he has helped shape and provided research findings for, are now in common use as a result of his work: TeamSTEPPS team training, early disclosure after patient harm, robust incident reporting, human factors tools, multi-method, triangulated approaches to research, governance of health systems, and interprofessional learning and culture change to achieve safe and reliable outcomes.  His work has led to over $14,000,000 in federal competitive grant funding including as Principal investigator from the US NIH/AHRQ, EC FP-7, Australian NHMRC and Norwegian Federal Agencies.

 

He served as Editor of the British Medical Journal Safety and Quality, has published more than 300 scientific papers and 5 books including Surgical Patient Care: Improving Safety, Quality and Value: Theory and Practice.His work has been cited over 10,000 time, H=50. He has presented at or chaired international and national conferences, workshops, symposia and meetings on more than 500 occasions, including over 60 keynote addresses.  

 

 

Further details at: www.linkedin.com/in/paulbarach and Academia profile  

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Critical Factors Essential for Understanding and Enhancing the Learning Capabilities of Organizations

 

Individual and organization learning in health and wellness represents a paradigm shift in how care is delivered and how changes in practice can be disseminated and implemented. These results rely on a new approach to meaningful teamwork, continuous audit, and support of data-driven change and improvement. The real challenge remains how to translate these findings into new settings. Introducing and implementing new practices is a complex challenge requiring what Deming calls the “profound knowledge” of improvement. This involves four key components: (1) a deep knowledge of the system through which care is delivered; (2) understanding system variation and the aspects of variation that can be tolerated or even required (as in adaptations) and those that need to be eliminated; (3) willingness to experiment to continually improve and be bold in advancing testable theories of improvement; and (4) engaging front line staff in the improvement process with transparency, truth telling, and trust building.

 

The nature of introducing complex systems is that small changes to inputs may produce large changes in results across the system. Therefore, thoughtful implementation with an eye on key system leverage points reinforced by engaged learning communities may result in rapid acceleration once a “tipping point” is reached. By the same token, negative feedback loops may result in rapid deterioration of uptake from which systems may find it difficult to recover. The implementation tools require thoughtful application: They are not a hammer that can be universally employed in all circumstances. They are not an end in themselves. Instead they provide a starting place for systematic reflection, staff engagement, deepening trust and staff support, and enabling a deep and meaningful culture of continuous improvement.

 

The process of implementing new knowledge is iterative and cyclical. It should promote engagement among clinicians, staff, administration, and patients. It is systematic and based upon measurement and consultation with all stakeholders involved in the process. Even if initial outcomes are achieved, the practice could determine how to produce an even better outcome or achieve it more efficiently and with less cost. Continuous quality improvement (CQI) is necessary and requires significant change in how surgical care is delivered. It explicitly seeks to be not only better but the best that a team can deliver under these circumstances. The process of learning is iterative and typically incremental, constantly being infused by every day work experience and hard-earned lessons by clinicians providing clinical care. The staff ownership for the improvement process and adaptability of the intervention to address future quality outcomes are considered essential and key strengths for sustainable gains.