Dr. Richard Crowell says he was drawn to a medical career because he liked the idea of diagnosing and solving problems.
These days, he finds himself problem-solving on an epic scale in his new role as chief quality officer for the University of New Mexico Health System.
Crowell and his staff have the heavy responsibility of ensuring that UNM’s hospitals and clinics maintain their accreditation, while continually looking for ways to improve patient safety and quality of care – and he couldn’t be happier.
“This is exciting and I enjoy doing it,” says Crowell, who recently traded in his trademark ponytail for a more clean-cut look. Until late last year, he was the longtime chief of the Division of Pulmonary, Critical Care and Sleep Medicine in the Department of Internal Medicine, as well as the department’s executive vice chair.
Crowell says the need for a single quality control officer arose from the integration of the clinical services of the UNM Health Sciences Center – UNM Hospital, UNM Cancer Center, UNM Sandoval Regional Medical Center, the UNM Medical Group and dozens of clinics – into an integrated health system.
Quality management had been focused on focused on individual programs, with differing goals and criteria, Crowell says. “It was not an aligned agenda, and there was a lot of fragmentation,” he says. “They decided it would be best to have someone at the health system level to coordinate it and make it work.”
Crowell had accumulated plenty of on-the-job experience in quality improvement while serving in Internal Medicine. Six years ago, he tackled the vexing problem of sepsis-driven patient mortality.
Sepsis – a life-threatening systemic inflammation caused by severe infection – can be managed with antibiotics and intravenous fluids, but only if they are administered in time. Crowell collaborated with a team of physicians, nurses and pharmacists, with the support of Dr. Michael Richards, then head of Emergency Medicine (and now UNM HSC’s executive physician-in-chief), Dr. Pope Moseley, chair of Internal Medicine, and Sheena Ferguson, now UNM chief nursing officer.
Together, they devised detailed checklists with specific time points for starting different treatments, including antibiotics. The new approach worked. “We have really managed to decrease that mortality rate significantly – by more than half,” Crowell says.
Treatment checklists, based on extensive research, are “very potent tools” that exemplify evidence-based decision-making and reduce treatment variability, he says.
There is some tension, however, between attending to patients as individuals and the growing use of checklists and other standardized protocols that help practitioners who are coping with massive amounts of information.
“Healthcare is not a car-making company,” Crowell says. “It is infinitely more complex than that. Patients are not widgets on an assembly line, and they can’t be thought of that way.”
Crowell, who majored in zoology and comparative literature at The Ohio State University, has explored many facets of medicine in his career. He attended the University of Cincinnati College of Medicine, before taking an internal medicine residency at Baystate Medical Center in Springfield, Mass., a 1,000-bed hospital, where he became chief resident.
Crowell also spent a life-changing two-month rotation at a clinic in Chinle, Ariz., in the heart of the Navajo Nation. “I had never been west of Fort Wayne, Ind.,” he says. “I came out here and absolutely fell in love with the Southwest and vowed to return if I could.”
After finishing his residency in 1983 he did just that, coming to UNM as a fellow in pulmonary medicine to work with respected researcher Dr. Jonathan Samet, who was among the first to realize that Navajo uranium miners were suffering high rates of lung cancer from their exposure to radon gas in the mines.
As a UNM faculty member, Crowell became the pulmonary section chief at the Albuquerque Veterans Affairs hospital. There, he founded a multidisciplinary clinic for lung cancer patients that brought together oncologists, thoracic surgeons and pulmonologists to provide their patients with “one-stop shopping” consults.
Later, he took over as chief of UNM’s pulmonary and critical care division and increasingly assumed administrative duties. “I found that I liked the administrative stuff and enjoyed doing it,” Crowell says. “It seemed like a natural progression for me.”
In 2011 he took on the duties of Senior Vice Chair for Quality, Safety and Clinical Operations in the Department of Internal Medicine. Meanwhile, he had been gaining additional training in medical leadership with stints at the University of Michigan School of Public Health, the Alliance for Academic Medicine and the Harvard School of Public Health. Last spring, he completed the Advanced Training Program in Health Care Delivery Improvement at Intermountain Health Care Delivery Research in Salt Lake City.
Crowell sees quality improvement as a comprehensive ongoing process to improve patient care. “It’s necessary that you not only have feedback, but it’s necessary to collect data and then interpret it,” he says. “That came very naturally to me, with training in a basic science background.”
Going forward, Crowell wants to build a system-wide culture of quality improvement that encompasses all UNM physicians, residents and students. “This is going to be a part of their lives from here on in,” he says.