Zubin Damania, MD, is an internal medicine physician known for his ZDoggMD platform, where his music videos and parody inspire providers to think about health care in new ways and develop innovative solutions to tackle problems in the health care system. Damania will deliver the Ralph G. Brindis Keynote Lecture on Thursday at 8:30 a.m.

In his talk, titled "Healthcare Remixed," Damania will discuss some of the major issues facing health care teams and other emerging challenges in the health care space, including reimbursement structures, increased patient ratios and electronic health record (EHR) demands. In a recent interview with Inside Look, Damania shared his thoughts about quality improvement and the shifting health care environment.

The health care environment is constantly changing. How does that affect the path toward quality improvement?

It's a huge challenge to improve quality and safety, even in a static health care environment. As we transition from volume to value, it becomes even more challenging. We have to operate on an individual level with a collective aim. Every individual in the health care space has to realize they have tremendous influence within the overall environment. We have to inspire people individually. Then organizations need to coordinate and work together across institutions.

All of us have stories of patients or loved ones who have been harmed, and we have this great data we've been collecting in EHRs but not using. Let's take this data and make it actionable by finding patterns, processes and interactions. We can harvest that information to improve outcomes on the ground level.

You talk a lot about team-based care. Why is the team approach so important?

The team approach is crucial. When I talk about a team, I'm talking about a 'wholarchy.' This is very different from a hierarchy, which-is often one or more people at the top who-dominate the rest of the team. A true team-based-scenario is a wholarchy: everybody has something crucial to contribute, and everybody brings different pieces to the table.

The team provides the support that allows each person to have the tools, autonomy and resources to take care of patients. In the old days of medicine, the environment was more of a dominance hierarchy where people felt marginalized. Without a true team-based approach, you cannot have a system focused on quality and safety.

What role does patient-centered care play in quality improvement efforts?

Patients are the sole reason we exist. If we don't focus on their experience, outcomes and unique situation and how they fit into the bigger picture, we're going to fail. Our current system is so fragmented and siloed that each patient becomes a series of problems to solve before moving on to the next one. A team-based strategy that leverages technology and enables us to see the unique patient and also provides the time to witness their stories is a very holistic way that puts the patient's goals at the center.

How can clinicians balance the changing landscape and things like administrative burden without losing sight of the patient's experience?

It's hard because clinicians don't have a lot of time, but I think they need a bigger voice in the design of EHR systems. Most clinicians understand what they want in terms of EHRs, but they either don't know how to express it or don't feel like they will be heard. A lot of EHR vendors talk to clinicians or have physicians on staff, yet EHR products are tailored for billing or regulatory and compliance issues, not patient care.

No one is saying we should go back to a paper-based system, but everyone who has used a smartphone knows that technology can be integrated in a seamless way. Our EHR system is like an 90s-era car phone, and we need to transition it to a smartphone format. We know we can get there; we just need to have the will to do it and put in the work.

How does your ZDoggMD persona shed light on some of these issues? What do you want people to take away?

My hope is that the platform can catalyze transformation on an individual and collective level. When people approach me, sometimes they will say, 'Thank you for helping me get through residency.' But more often, people will say, 'I never thought about situation X in medicine in this way until I saw your video.' The idea with the ZDoggMD platform is to empower individuals by helping them understand these issues in health care and their personal role in catalyzing meaningful change.

Keywords: Quality Improvement, National Cardiovascular Data Registries, Quality Summit, Quality Improvement, Patient-Centered Care, Electronic Health Records, Patient Care Team, Physicians

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