Marathon:
Mount Sinai's Roadmap to Sustainable Excellence in Healthcare Quality
This talk is brought to you by shared purpose, global partnerships, and institutional support. No industry ties, no hidden sponsors—just a commitment to safer, better care.
As leaders representing Mount Sinai International, our attendance at this conference is supported by our home institution. We have no other financial or relevant disclosures.
Tao Xu, MD
Associate Professor of Medicine
Icahn School of Medicine at Mount Sinai Medical Director, Mount Sinai International Division of Hospital Medicine
Department of Medicine
Eric Barna, MD MPH
Professor of Medicine and Medical Education
Icahn School of Medicine at Mount Sinai Director of Education, Mount Sinai International Director of Education, Division of Hospital Medicine
Associate Residency Program Director Department of Medicine
Pop Quiz: This Dish Is on the Menu in…?
Crepes
Bulgogi Burger
Grilled Halloumi
Cheese Muffin
McFalafel Wrap
Chicken McDo McAllo Tikki
Know…
Local context matters. Successful global health partnerships in quality and safety respect microcultures, prioritize cultural transformation, and avoid one-size-fits-all approaches.
Do…
Engage in dialogue—share your local challenges, and think creatively about scalable, culturally attuned solutions.
FeelEmpowered to be an agent of cultural change, whether you’re leading a team or supporting one.
9,000+ Physicians
7
48,000 Employees
8,500+ Nurses
Mount Sinai Health System: Global Recognition
Newsweek World's Best Hospitals 2025
The Mount Sinai Hospital was ranked by Newsweek/Statista as No. 19 in the world, No. 7 nationally, No. 1 in New York State, and No. 1 in New York City on its The World’s Best Hospitals 2025 list.
Newsweek World's Best Smart Hospitals 2025
The Mount Sinai Hospital ranks No. 1 among full-service hospitals in New York City and No. 6 in the United States by Newsweek on its World’s Best Smart Hospitals 2025 rankings.
U.S. News & World Report Best Hospitals
The Mount Sinai Hospital is listed on the U.S. News & World Report® “Best Hospitals Honor Roll” for 2024-25 for the 9th consecutive year. The Honor Roll commends the country’s top 20 hospitals, out of approximately 4,500 evaluated by U.S. News.
Newsweek World's Best Specialized Hospitals 2025
The Mount Sinai Hospital has earned positions in the fifth edition of the World’s Best Specialized Hospitals 2025 by Newsweek.
Mount Sinai Ranks as No. 1 Health
Care Institution in the World (Nature AI Index)
Mount Sinai Health System is No. 1 on the new Nature AI Index 2024 list of “Leading 10 Healthcare Institutions,” and among the world’s “Leading 200 Institutions” for AI across all fields, Nature.
The Mount Sinai Hospital received top20 rankings in the following specialties: Cancer, Cardiology/Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Geriatrics, Neurology/Neurosurgery, Obstetrics & Gynecology, and Urology.
Mount Sinai International: Who We Are and What We Do
Grenada
Source: Jha, Ashish K, et al. “The Global Burden of Unsafe Medical Care: Analytic Modelling of Observational Studies.” BMJ Quality & Safety, BMJ Publishing Group Ltd, 1 Oct. 2013, https://qualitysafety.bmj.com/content/22/10/809.short.
No One-Size-Fits-All:
Embracing Local and Regional Microcultures
The Path to Sustainable Operational Excellence
Companies must continuously improve to outpace rivals amid volatility. Sustainable continuous improvement charts this route— enhancing outputs substantially while weighing eco-friendliness and community-friendliness, fueling growth.
-Six Sigma
"You can mandate compliance, but only culture sustains excellence.
Cultural transformation is the bridge between improvement efforts and enduring quality across settings, systems, and continents.
Cultural Transformation Strategies
Which spice, often used in holiday desserts, creamy sauces, and eggnog, is so central to Grenada’s identity that it appears on the national flag?
A)Clove
B) Cardamom
C) Nutmeg
D) Allspice
Grenada is one of the worlds top nutmeg producers ( 2030% of the worlds supply) so much so that its nicknamed “The Spice Island.” Nutmeg isn’t just a crop its part of the culture, the economy and the aroma in the air.
Learning as a Catalyst for Cultural Change: Introduction of Process Improvement Methodology to Develop an Interdisciplinary Team Huddle at the General Hospital in
Grenada.
Tiered Huddle/Unit Based (Tier 1)
Purpose: A brief, unit-based daily meeting that brings together all interdisciplinary staff to surface immediate concerns, review key announcements, share unit metrics, and identify workflow barriers.
Format:
• 5-10 minutes, daily
• Unit based
• Standardized agenda
• Led by a Consistent facilitator
Benefits:
• Improved communication
• Enhanced patient safety
• Increases operational efficiency
• Empowers frontline staff
Laying the Foundation: Education and Local Context to Build a Tier 1 Huddle
Educate
Analyze
Introduction of LEAN fundamentals, core change management concepts, and practical tools like visual boards
Build
Observation of existing huddle structure, stakeholder interviews and team driven process mapping
Develop future state process maps, define structure, pilot and create a scalable model
Find the Thread, Weave the Change
Identify consistent cultural practices (prayer and motivational quote)
Highlight strengths
(A&E Team lead and consistency)
Anchor in Familiar Language (match the rhythm of A&E)
Empower champions to sustain change (A&E physician lead)
Unit-Based Huddles: A Platform for Learning, Insight, and Action
Launch May 2025
What We’ve Achieved
• Successful launch of tier 1 huddles on all target units
• Enhanced awareness of unit level concerns
• Improved front-line problem solving
Sustained Engagement
What's Changed
• Staff feel heard and supported
Quicker resolution at the unit level Program expansion
• Stronger sense of team cohesion and collaboration
• Fewer escalated issues
What’s Next
• Continued unit expansion
• Implemented ongoing LEAN methodology education to support culture change
Which of these dishes is considered
Nanjing’s most famous specialty?
A.Kung Pao Chicken
B.Xiaolongbao (Soup Dumplings)
C.Salted Duck
D. Peking Duck
Measuring What Matters: Aligning Data, Leadership, and Culture to Improve Handoffs, Communication, and Staffing at Taikang Xianlin Drum Tower Hospital in Nanjing China.
Source: “Hospital Survey on Patient Safety Culture.” AHRQ, https://www.ahrq.gov/sops/surveys/hospital/index.html.
China: Metrics and Feedback
What dessert in Guyana is soaked in alcohol for days before it's served?
A.
B.
Rum Trifle
Black Cake
C. Tiramisu
D. Cassava Pudding
Georgetown Public Hospital, Guyana: Building Safety Culture Through Leadership Alignment
Daily Safety Huddle: A Streamlined Communication Tool
Purpose:
A brief (15–30 minute) daily meeting that brings together senior hospital leaders and key departmental reps.
Format: Consistent and standardized across the hospital Benefits:
•Promotes a safe and efficient environment
•Builds shared situational awareness
•Streamlines communication across departments
•Fosters accountability and responsiveness
Guyana: Three Steps to Safer Care
Look Back
Look Ahead
Addresses significant events from the past 24 hours
Highlights anticipated disruptions or safety risks in the upcoming 24 hours
Reviews the progress of previously identified action items Follow
Daily Safety Huddle:
Driving Engagement, Insight and Action
Launch September 2022
What We’ve Achieved
• Over 400 weekday huddles completed
• Cross-departmental engagement (clinical + non-clinical)
• Improved response flows (weeks → days → hours)
Sustained Engagement
What's Changed
• Staff feel heard and supported
Improved Response Flows
Tracking Follow Up
• Issues escalate with clearer resolution pathways
• Fewer disruptions through early interventions
What’s Next
• Tracking issue escalation patterns, resolution outcomes, and the modalities used to address them
From Local Innovation to National Transformation
2022 Launch
Launched at Georgetown Public Hospital Corporation (GPHC) as a leadership-driven safety initiative, focusing on improving clinical outcomes through enhanced communication. 2
2025 Expansion
Ministry of Health to integrate the initiative into national healthcare policy. Structured implementation across 6 regional hospitals begins Fall 2025.
Endorsed by GPHC staff after measurable improvements in patient safety. Ministry of Health officials conducted direct observation and assessment. 3
4
2024 Validation
Future Vision
National rollout will establish new benchmarks for healthcare leadership and communication in Guyana.
What began as a localized leadership initiative to strengthen hospital operations and safety has evolved into a broader cultural transformation—one that is shaping the standard for healthcare leadership and communication across the country.
Which of the following dishes is a staple breakfast item in Karnataka, often served with coconut chutney and sambar?
A) Poha
B) Dosa
C) Idiyappam
D) Paratha
Empowering Healthcare Teams: A CAUTI Reduction Initiative at Ramaiah Memorial Hospital
A quality improvement case study highlighting how nurse empowerment and multidisciplinary collaboration transformed catheter-associated urinary tract infection (CAUTI) prevention protocols at Ramaiah Memorial Hospital in 2025.
Autonomy as a Lever for Cultural Transformation in India
Identified Problems & Interventions
Documentation & Indication Standardization
Problem: Inconsistent physician documentation of catheter indications.
Interventions: Revised checklist with mandatory indication requirement and formed multidisciplinary QIP committee
Expanding Nursing Scope of Clinical Practice
Problem: Only physicians could insert urinary catheters, causing delays.
Interventions: Implemented formal nursing skills training and revised workflows for nurseinitiated catheter insertion.
Collaborative Decision-Making
Problem: Nurses excluded from catheter removal decisions, resulting in prolonged catheter use and missed early removal opportunities.
Intervention: Developed physician-nurse dyad process for daily catheter necessity review, empowering nurses in removal decisions per protocol.
Breaking the Silo: Empowering Our Teams
Eliminate Non-Added Value Steps in Workflows
Empowering Nurses
Delivery of Standardized Care Through Policies & Protocols
Reduction in overuse and Inappropriate use of catheters
Results
Reduction in catheter associated Urinary tract infections
Creation of multidisciplinary committee
From Empowerment to Impact: A CAUTI Success Story
Launch April 2025
What We’ve Achieved
• New Catheter Policy Rolled Out: Hospital-wide guidelines now define when catheters should be used and how they’re maintained.
Sustained Engagement
• Checklist in Daily Use: Nurses and scoring staff on the pilot unit use a daily checklist to reassess catheter necessity.
What's Changed
• Cultural Shift: Nurses are now involved with MDs in discussions about catheter insertion and removal
Catheter days reduction Program expansion
• Improved Communication: Interdisciplinary rounds and shared decision-making have become routine, improving continuity and reducing silos.
What’s Next
• Expansion to additional critical care environments with future hospital wide impact
• Scaling Beyond Our Site: The initiative and methodology have been shared with other Mount Sinai partners to support system-wide efforts to reduce unnecessary catheter use.
Know…
Local context matters. Successful global health partnerships in quality and safety respect microcultures, prioritize cultural transformation, and avoid one-size-fits-all approaches.
Do…
Engage in dialogue—share your local challenges, and think creatively about scalable, culturally attuned solutions.
FeelEmpowered to be an agent of cultural change, whether you’re leading a team or supporting one.
“Changing culture is the most critical—and most challenging—step toward improving healthcare systems. Without cultural transformation, policies and technologies won’t stick.”
— Dr. Don Berwick, former Administrator, U.S. Centers for Medicare & Medicaid Services and founding CEO of the Institute for Healthcare Improvement
