Jason Blatt, MD, FAANS, FAAP The Core of Medical Advancement
Medicine is not a perfect art, and even the most dedicated clinical teams face challenges that can impact patient care. Without consistent and accurate reporting of Quality Improvement (QI) data, specialties lose the opportunity to learn from these challenges, refine techniques, and improve the patient experience. Reporting your QI work is far more than an administrative task; it is the foundational engine that drives medical advancement. It ensures that the immense trust patients place in their care teams—especially when undergoing vulnerable procedures—is continuously earned through a commitment to perfection and safety.
Effective QI reporting transforms isolated clinical outcomes and patient self-reported metrics into actionable big data. By systematically tracking how procedural tweaks impact patient recovery and well-being, we elevate not just our own departments, but our entire medical fields. In the resources below, Jason Blatt, MD, FAANS, FAAP, Associate Professor of Pediatric Neurosurgery and Physician Director of Quality (PDQ), shares his firsthand experiences to guide you through the impact, communication, and practical realities of reporting your QI work.
Resources
This collection of video resources is designed to help you understand the real-world impact of Quality Improvement and the mechanics of reporting your work. By learning from clinical leaders, you will see how tracking our outcomes helps us deliver on the promise of better patient care.
Why QI Matters: A Neurosurgeon’s Personal Journey
In this foundational video, Dr. Jason Blatt shares his personal and professional journey into the world of Quality Improvement. Drawing from his early career experience helping to launch a national patient data repository and a deeply personal experience as a trauma patient, Dr. Blatt illustrates the profound importance of capturing outcomes. He explains how prioritizing both clinical metrics and patient self-reported data allows a specialty to become nimble, continuously improve surgical techniques, and ultimately send more patients home safely with a higher quality of life.
Transcript: Why QI Matters: A Neurosurgeon’s Personal Journey
My name is Jason Blatt. I’m an Associate Professor of Pediatric Neurosurgery here. And I’m also the Quality Director for Neurosurgery on both the adult and pediatric sides. I’ve been here for nine years now.
So I was fortunate to spend almost a year of my residency in a program where a thing called N2QOD was founded that stands for the National Neurosurgery Quality and Outcomes Database. One thing I really like about my field of neurosurgery, is that it’s very small, and that makes us kind of nimble. There’s only about three thousand of us in the country. And so when big data started becoming a thing in medicine, neurosurgery was very quick to adopt that. And so they founded a thing called N2QOD. And that was essentially a national patient data repository for our outcomes data. And the guy that sort of started that was named Tony Asher. He was a neurosurgeon in Charlotte, and I spent nearly a year working with him, not just doing surgical training, but also got exposed to that work and helped him write one of the first abstracts from that that got a national plenary talk at a big meeting. And so that was kind of my, my first exposure to the ways in which outcomes and quality data can drive, how the field moves forward, getting better at the care that we provide and also how it can reflect meaningful changes for patients. Because a lot of what that database focused on was not just outcome metrics, but also quality of life metrics from patients. And that was the first time that neurosurgery in a big way, cared about patient self-reported outcomes. And so it was great to see that the things that we thought mattered to patients also delivered on quality of life for them.
I think ultimately medicine is about helping people, right? That’s what I hope most physicians would say. And the way that we get better at doing that is making sure that we have information about how well we do. Does this surgery help people? If we tweak that surgery, does it help people more? I think that really ultimately, that’s what we’re here for. And we want to make sure that when someone submits to an operation, goes under the knife. That’s a lot of trust that they’re putting in you. And I think that we earn that trust by making sure that the outcome for that patient is going to be as good as we can possibly get it. Medicine’s not a perfect art. I wish it was, but the reality is that we should strive for perfection every time we take care of a patient. And the way that we know we’re achieving that is through key.
I think in my own career, it’s been very meaningful to be part of QI because I think it helps all of us, not in our department, but in our field, get better at what we do and feeling like you’re helping your entire specialty advance. Learning about things that we could do better, I think is, is very meaningful for me personally. I’ve been a patient as well. I had a bad car accident when I was in medical school and got a helicopter ride and had surgery, and some not very quality things happened to me during my hospital stay. You know, this was elsewhere, but I learned a lot about doctoring from that experience and knowing that we aren’t perfect, and knowing that medical teams make mistakes is a really personal thing for me. Having gone through something like that. And so it has really been, um, a productive but also very deeply meaningful thing in my career to, to be part of making us better in terms of patients. I think that the proof is in the pudding, right? We want every patient to have a perfect outcome. We know that we’ll never achieve that in medicine, but the closer we get to that, the more patients go home safely. The more people have surgery without complications, the more quality of life we can give back in terms of years and also mobility, um, you know, comfort, things like that. And so I think that seeing people come back to the office who have had good outcomes that maybe had newer procedures that you didn’t know how to offer ten years ago, you know, is really makes you feel good about yourself at the end of the day.
Speaking Truth: Communicating QI Findings to Staff and Patients
In this video, the focus shifts to the delicate but essential skill of discussing quality improvement findings and adverse events with both hospital personnel and patients. For colleagues and leadership, the video emphasizes the importance of acting as an honest, non-judgmental “truth-teller.” It outlines how to effectively speak truth to power while partnering with frontline staff to foster growth rather than assigning blame. When addressing patients and families following a quality incident, the video highlights the necessity of swallowing pride to share the unvarnished truth. You will learn actionable steps for rebuilding broken trust by clearly explaining what happened, detailing the institutional changes being made to prevent future occurrences, and providing a concrete path forward for the patient.
Transcript: Speaking Truth: Communicating QI Findings to Staff and Patients
I’m going to break that into two separate questions, if that’s okay. Um, I would say, how do you communicate key findings with hospital personnel? I think that everyone who works in the hospital, from low frontline staff to high C-suite administrators, really needs you to be blunt and open and honest about your findings, because if you’re a busker or you don’t share full truth, then I don’t think anyone can act on that information. And I think that part of what makes you a good quality director, if you’re in that role, is an ability to sort of just say, hey, I’m not going to sugarcoat this or hide half of it. I think everyone just needs to know, here’s what’s going on. I’m presenting this data in a non-judgmental way. I’m not pointing fingers at people. I’m here to say, hey, we all need to be aware of of what’s going on here. And here’s this issue that I’ve discovered, or here’s a place where I think that we can do better as a team or as an institution. I think that you get more buy-in from staff, you know, at any level in the hospital, if they know that you are a truth teller, right? If they know that they can come to you for information that’s going to be honest and open and just say, here it is. I think that you get more political capital working that way. Your ability to solve problems that you discover is better. If people know that you are reliable and honest about that sort of work. And so I think that you have to be willing to speak truth to power a little bit. You also have to know how to go to people below you in the institutional hierarchy and share problems with them in a way that doesn’t feel like my boss is yelling at me, right? You have to be able to say, hey, I’m your friend here, but this is an issue and I want to help you solve it because all of us hopefully are here again to make patients better. And I think there’s a way that we can help you improve at that. And I think that you also get more buy-in from people below you in the hierarchy if they feel like you aren’t, um, you know, there to fire them or to lay blame at their feet if you’re there to help them grow.
In terms of for patients and families, I think, um, you know, the question, I would phrase it as how do you communicate adverse quality incidents or information with patients and families? I think that when a problem happens for a patient or their family in the hospital, and that’s going to happen plenty. They are hurt, right? Not just physically, but I think trust sometimes is broken or at least damaged with those patients and families. And I think that they also rely on you to deliver that information truthfully to them. The only way that you rebuild that trust for those patients is to come to them and say, hey, very honestly, here’s what happened. But I think that you have to go one step beyond that to rebuild that relationship, right? If you want to have a therapeutic relationship with someone, they need to know that you’re looking out for their best interests. And the way that you get there from a trust breach is saying, hey, not only do I have the information for you now, but here’s how we’re going to grow from that. I want you to understand that this isn’t going to happen to someone else in the future, because here are the changes that we’re going to make, and here’s how I’m going to help you through this particular situation, because it’s either not the first time I’ve seen it or if it is, I can at least engineer a way out for you. And I think that’s kind of how you build back up with patients. They are smart. And they also know if you’re telling half truths or being sneaky about things. And that’s the way that you further damage that relationship. So you have to be willing to swallow your pride and kind of perk yourself up and just go in the room and say, here’s what’s going on and here’s how we’re going to help with it. That can be very uncomfortable. It’s even more uncomfortable, I think, when you have to do it on behalf of someone else on the team. You know, a patient that’s upset about something. And as a quality person, you have to go and speak with them because it’s a person you may have no rapport with at all. You’re meeting them for the first time in a situation where they’re already upset at the institution. And so that can be a real challenge. But I think when you come with information and sort of a calm effect about you and say, hey, here’s how we’re going to help you and here’s how we’re going to grow, I think they come very quickly to trust you as someone who’s here to help solve problems, and not someone who’s here to deflect their anger somewhere else.
Building a Culture of Safety
In this video, the discussion turns to overcoming resistance and fostering psychological safety among clinical teams. Not all medical professionals come from environments that encourage the open discussion of errors; many carry defensive habits from previous workplaces characterized by blame and accusation. This resource explores how to help colleagues lower their defenses, overcome institutional trauma, and build trust within a new department. You will learn the importance of creating protected, safe spaces—such as Morbidity and Mortality (M&M) meetings—where clinicians can honestly discuss adverse events. By normalizing this vulnerability, you can transform a defensive environment into a collaborative one where the entire team learns and grows from shared mistakes.
Transcript: Building a Culture of Safety
I’m going to phrase that as. Tell us about a time that you had resistance from colleagues when reporting quality data. One thing that I’m really grateful for in my department is that everyone that I work with really buys into QI as an important part of what we do, not just, again, at this institution, but as a specialty. That being said, I do have a number of colleagues that we’ve hired from other institutions where perhaps they didn’t have that culture of being very open about mistakes or problems that arise, and maybe they had a culture of accusations or blame laying. And that really kind of carries trauma forward with them into their next place of employment. And so I think one of the real challenges that I have is when we hire faculty from elsewhere, is getting them to lower those defenses a little bit. It takes time because they may have been somewhere else for many years. And sometimes, you know, in a, in an M&M meeting or something like that, they can feel very defensive. And it shows in the way that they talk about mistakes or problems that they sort of don’t want to be blamed for this. And so I’m going to only reveal part of the issue. Um, I think it takes a while for them to realize, okay, I’m in a new place and the people here have my back in general. They’re not here to, uh, you know, point fingers at me. They’re here to help everyone learn from problems and grow. And I think it’s actually really nice to see sometimes the way that they gradually calm down and the way that they present information at those meetings becomes more open and honest. And it’s because they sort of have built trust with us as a group that they can do some soul baring, you know, and we want someone if they feel like, you know, maybe I shouldn’t have done this surgery or maybe I would have done it differently on this patient. We want people to be able to say that in a protected, safe space, because that’s how we all learn. And I’ve learned certainly from other people’s mistakes. I’m sure people have learned from mine. But the only way we achieve that is if everyone can be very honest and open about it.
From Problem to Solution: QI’s Most Impactful Work
Dr. Blatt shares his most impactful QI project, demonstrating how quality data can directly drive educational innovation. By analyzing adverse outcomes, his team identified that surgical complications often stemmed from a lack of confidence in a specific “crux move” within a complex procedure. Rather than relying on expensive, high-fidelity computer simulations, they developed low-cost, targeted manual simulators to repeatedly train residents on these high-stakes maneuvers. You will learn how they meticulously measured the intervention’s success, which ultimately led to a measurable drop in complication rates. This video illustrates how a targeted, grassroots QI project can not only improve local patient outcomes but also scale globally to assist resource-limited hospitals.
Transcript: From Problem to Solution: QI’s Most Impactful Work
Um, so, um, the question I guess is, um, what has been your most impactful key project and how did you achieve it and measure it? I’m going to actually answer that from an educational standpoint, because I think one of the biggest powers of key work is the way that we can teach others from our mistakes or from our problems. And so when I was a resident, we actually had some adverse outcomes that occurred in some patients in specific types of surgery. And it turns out that in many cases, the reasons for that were that that surgery had kind of a crux move, if that makes sense. You know, a single technique within the larger surgery or a single portion of that surgery, that kind of has the biggest impact on whether the patient’s going to have a good outcome or not. And often the residents were deeply involved in that sort of that part of the procedure. And so we found that a lot of them felt uncomfortable doing that part of the procedure. Um, I’ve had a long standing interest in resident education and what we developed as a sort of response to that was a series of surgical simulators. And what was different about that work was that most surgical simulators involve really expensive computer graphics simulations, and try to simulate the entire procedure from start to finish. But when we had the insight that there’s really just one part of this surgery that has the biggest impact on outcome, why don’t we just build something really cheap that makes them do a similar thing with their hands? Right? So if the problem is, it’s hard for me to sew this patch in really deep in the neck on a Chiari operation. Well, we can simulate that pretty easily with a PVC pipe that just makes you sew in a deep hole. Or if the problem is that I don’t know how to quite drive the endoscope during this other procedure, well, let’s just build something out of either clay or wood or something that makes someone drive an endoscope through a maze. You know, that has sort of the same shape, even if it’s not visually high fidelity to the operation. It’s really more about the manual skill. And we did a whole bunch of work with residents and medical students, basically teaching them how to use these simulators. And we videoed each of their attempts and had them graded by independent observers and timed them as well. And the change between first attempt and say, tenth attempt or twentieth attempt was astonishing. You look at the final picture of what they were able to do, and it was night and day. And so it turned out that a lot of the problems we were having with. Oh, the patch broke loose after the surgery and the patient had a spinal fluid leak. Really just boiled down to how confidently that person could perform that manual task that they were being trusted to do. And so we actually saw our complication rates go down among residents who had completed all of the simulator training. And then we shared that in a paper that went into an international journal for neurosurgery and has been used in not just the US, but in a lot of low income countries, because it turns out that cheap simulators that only do sort of crux moves are two orders of magnitude less expensive than surgical simulators that, you know, are commercially available in the US. So that’s been something that reached not just US audiences, but but around the world.
The Practical Reality: Data, Time, and Measuring What Matters
The final video addresses the everyday logistical hurdles of QI work. You will learn about the challenges of “data brokering” within heavily siloed hospital systems and the importance of shifting from reactive reporting to proactive, real-time data sharing. Dr. Blatt also candidly discusses the reality of balancing administrative QI tasks with clinical duties, emphasizing that patient care must always come first and that clinical teams must extend flexibility and grace to one another. Finally, the video explores how to evaluate success by watching 30,000-foot metrics—like mortality indices, length of stay, and infection rates—to ensure your department’s various QI initiatives are collectively moving the needle for patient safety.
Transcript: The Practical Reality: Data, Time, and Measuring What Matters
What are the biggest challenges I face in collecting and analyzing data for QI, and what are my workarounds for that? I would say one of the biggest problems facing QI folks in general, in most institutions is the siloing of information. There are about six million agencies that rate hospitals on their performance, whether it’s infection rates or mortality after surgery or discharges to home versus rehab. There are so many categories that these agencies want to look at and want to rate us on, and it makes it very challenging because each one of those agencies is getting data from perhaps different people in the hospital. Each group in the hospital may possess one little nugget of that. And so when we send, for example, the annual Vizient survey back to Vizient, it has input from probably two hundred people around the hospital. If you, as a quality director, want to get ahold of some of that data, you may have to find one of those two hundred people. That’s the one that supplied it to Vizient to figure out, okay, well, where in our computer system did you get that information from? And how can I have some of it halfway through the year so I can respond to it in a timely fashion? And so I think that one of our biggest challenges is data brokering, for lack of a better term. Um, the workaround is being in a position for a while as you have been a Quality Director or other person, the quality infrastructure for a year or two years, three years, you start to learn, okay, who possesses what and where do I go if I need certain information? But I do think that this is a place where Yusuf has a chance for real growth. And I’ve talked to the sort of c, o and quality office about this. Actually just in the last month or so is how do we move from a system that is merely reacting? You know, when I have to file a report, I go hunt that person down and get some information from them. How do we move from that into a proactive data sharing sort of system? Right? You know, can we generate a quarterly report that goes to the PDX’s that has information of their sphere of influence in it, so that we aren’t just finding out at the end of the year when a report is due, that, oh, our mortality index rose five percent, but actually seeing that in real time or semi-real time, so that we have a chance to modify it before the reporting period is over.
How do you balance the time demands of your quality work with your clinical duties and patient care responsibilities? You don’t always, or at least I don’t always. Um, I think that if you’re going to be a clinician at all, if any part of your work is clinical patient care, you have to accept that there are going to be some days or some weeks where patients come first. And the report that you thought you might have time on Monday to finish with somebody for the quality side, turns out, well, I had to do an emergency surgery that day. So we’re going to have to postpone. And so I think, um, you know, if you’re in the patient care space, you have to prioritize that first. Um, but there are still plenty of holes in the matrix there. And so you can usually find time to do both. Um, but I, I think that I’d be lying if I said there are weeks where somebody isn’t waiting for an overdue answer on an email that I thought I would have time to write for them and haven’t yet. I think that, you know, in a in a place like a big hospital, our expectations on folks should be flexible who have clinical roles. I think that it’s reasonable when someone tells me, hey, sorry, I can’t finish this thing because I am in the O.R. until ten pm tonight. I should try to be understanding with that person. And certainly, you know, I’ve been the person sending that kind of response before. And so I think that as long as we maintain the the sort of notion that, hey, we’re all on the same team here, we’re moving toward the same goal. If somebody needs some flexibility today or this week, it’s okay. I know they’ll get back to me. They’re not bad actors. I think that’s really, you know how we collaborate best.
What metrics and outcomes are the most meaningful to you when evaluating your own success? I and things. How I’d phrase that. I think every key project that I’ve done has its own set of metrics by which we judge its success. But I think if you look at the thirty thousand foot overview of what quality is all about, as I said before, I think it’s really about making sure that patients are safe, that our surgeries are accurate and gentle. To paraphrase Doctor Wroten, who was the founding chair of our department, um, I think that big picture items like mortality rate or mortality index, length of stay index are things that are meaningful to me, thirty day reoperation rates or infection rates. Those are the things that do the most harm to patients who have undergone neurosurgical procedures. You know, an infection can be life-threatening if it’s in your brain or your spine or function threatening, certainly. And so I think those are the big sort of big overview points that tell me, you know, are we doing an okay job in general? Is there a trend upward in our infection rate? Well, that’s something that bears investigating. Is the trend flat to slowly lowering over time, then, you know, we’re probably bearing fruit from the various efforts that we have, you know, eight irons in the fire. Usually in terms of infection rate, we’re working with sterile processing and our O.R. staff and our surgeons, and we’re doing new antibiotic protocols. So each big ticket item usually has multiple key projects that are active at any given point to sort of help with that outcome measure. But I think that the big ones are the ones that I value most because they tell me, are we at least moving the needle with all of these other smaller efforts that we’re making?