Nearly seven years ago, when Johnson City, Tenn.-based Ballad Health was formed through the merger of Mountain States Health Alliance and Wellmont Health System, Amit Vashist, MD, a dual-boarded internist and psychiatrist, found himself contemplating a crucial question.

As the chair of the newly established clinical council, he recognized that while Ballad had already made strides in clinical and quality initiatives -- leading to safer care and improved patient outcomes -- there was still room for transformation.

"Despite excelling in numerous quality metrics, some of which ranked in the top decile nationally, how could we create and sustain a culture of clinical excellence and radical accountability across our facilities?" Dr. Vashist told Becker's. "How could we optimally leverage the trifecta of people, process and technology to break down silos, reduce fragmentation and standardize care delivery?"

Dr. Vashist identified several critical goals: advancing from incremental clinical improvements to the execution of bold, ambitious initiatives; and creating a unified system where evidence-based practices would be standardized and integrated across all Ballad Health facilities -- a concept he referred to as "systemness."

A year later, after transitioning to his current role as senior vice president and chief clinical officer, Dr. Vashist set these principles into motion. With the support of Ballad Health President and CEO Alan Levine, Dr. Vashist founded the Center for Clinical Transformation & Outcomes Optimization in 2022.

"Alan's immediate and unwavering support for this initiative was invaluable," said Dr. Vashist. "His belief in the potential of the center to enhance patient care and deliver superior outcomes helped shape its success from the start. I couldn't have asked for a stronger advocate for quality than our president and CEO."

The center, led by Preetham Talari, MD, a practicing internist and Ballad's vice president of clinical transformation and outcomes optimization, is staffed by a multidisciplinary team of 10 experts. Together, they focus on leveraging data, analytics and innovative technology to drive clinical improvements across Ballad's 20 hospitals. Dr. Talari oversees at least 15 clinical transformation projects at any given time, each tied to Ballad's objectives and key results framework. The system deploys a balanced scorecard methodology that incorporates clinical, operational, financial and experiential components to select the projects that will have the most meaningful impact on patients and communities, according to Dr. Vashist and Dr. Talari.

The center also works closely with Ballad's project management office and value-based care leaders to ensure that all transformation initiatives align with systemwide goals, fostering a unified approach to improvement, innovation, and clinical standardization.

"Our team spends a significant amount of time collaborating with regional and facility CNOs, CMOs, and data leaders," said Dr. Talari. "We provide data-driven insights, recommend evidence-based practices, identify existing gaps and guide teams toward improvements that directly impact the quality of care our patients receive. We consider ourselves catalysts for change."

Driving key clinical transformation projects

One of the center's earliest and most impactful initiatives was the standardization of diabetes care, a crucial area given the high prevalence of diabetes in Ballad's service area. Over the course of 11 months, Dr. Talari and his team developed and implemented a state of art, best evidence-based diabetes management system across the organization. This initiative included an EHR-integrated toolkit for monitoring blood glucose levels, as well as comprehensive training for physicians, nursing staff, dieticians, and other key stakeholders.

Another critical project has been addressing preventable harm, particularly falls leading to sentinel events such as hip fractures or head injuries. Since the height of the COVID-19 pandemic in 2022, Ballad Health has reduced fall-related sentinel events by an impressive 35%, demonstrating the effectiveness of systemwide best practices in fall prevention.

The center has also made significant strides in sepsis care by establishing a virtual sepsis monitoring unit. Modeled after an air traffic control center, virtual nurses monitor patients for signs of sepsis and alert front-line caregivers when intervention is required. From FY 2022 to FY 2024, this initiative contributed to a 27% reduction in sepsis mortality and a 17% improvement in compliance with CMS' sepsis bundle.

These initiatives highlight the center's focus on achieving "systemnes," reducing clinical variation and improving the overall quality of care across the health system. As part of Ballad's broader high-reliability journey, the system is currently rolling out high-reliability training to all 12,000 team members, with completion expected by June 2025.

Fostering a culture of psychological safety

In 2024, Ballad Health has also placed significant emphasis on fostering a culture of psychological safety, ensuring that all staff members feel empowered and supported when voicing concerns. A recent example of this occurred when a 17-year-old patient transporter reported concerns about a team member suspected of impairment. The quick response to remove the individual from care was an example of the safety culture in action.

"That 17-year-old exhibited the kind of courage we want to see across the organization," Dr. Vashist said. "We immediately recognized and honored that caregiver, making it clear to everyone that this is the standard we expect: 'Say something when you see something.'"

Conclusion

Ballad Health's Center for Clinical Transformation & Outcomes Optimization exemplifies the organization's commitment to creating a unified, high-reliability healthcare system that is grounded in best evidence-based practices, innovation and a relentless focus on improving patient outcomes. With the support of visionary leadership and a dedicated team, the center is paving the way for meaningful, sustainable improvements in clinical care and operational excellence across all 20 hospitals.