Q&A: AHRQ chief aims to help communities improve their health systems

The Agency for Healthcare Research and Quality has a low profile within the Health and Human Services Department. But its mission has big implications for hospitals and health systems.

Modern Healthcare spoke with with AHRQ Director Robert Otto Valdez about the agency’s goals and how it plans to engage providers. The following is an edited transcript.

Modern Healthcare: What’s your philosophy as the director of AHRQ?

Robert Otto Valdez: The role of AHRQ is really to focus on healthcare improvement, both at the clinical level and in the organizational and delivery side of things. While biomedical science is necessary, it’s clearly insufficient for doing that job.

What I’m trying to do is to get people to understand that AHRQ’s job and unique role within the federal government is to serve healthcare delivery systems and organizations everywhere across the country…[and] to be to those healthcare organizations the way CDC is to state and local health departments. Local and state health departments look to CDC for guidance, ideas, approaches to make their work better and more effective. And quite honestly, we’ve been doing that here for 25 years or more, but most of our work’s been hidden because we’ve been serving our larger regulatory and payment organizations.

For example, much of the [Centers for Medicare and Medicaid Services] decision-making around coverage and other kinds of payment issues [is] based on research activities that AHRQ staff contribute. [The Food and Drug Administration], for example, does a number of its medication and device decisions based on patient safety work that’s done fundamentally here at AHRQ. That background work has not often been recognized.

There’s such a proliferation of journal articles and journals where findings and discoveries are being published. No single clinician, no single administrator can go through all that. And that’s the work that AHRQ does now. We take all those things, we collapse it down to what are the real bits of knowledge that can be captured in the literature, or in the work or in the pilots that are being tested out on a real-time basis. That’s really what I’m trying to do here at AHRQ. It’s trying to make AHRQ the servant of health and healthcare so that we can improve care for all Americans in the country.

MH: How do you plan to work with providers and engage them in your research and your work at AHRQ?

Valdez: What we’re trying to do is embed our researchers in systems that then pursue questions of interest directly to the healthcare system decision makers, whether it’s the healthcare executives and the boards of those organizations or whether it’s at the clinic level, depending on whether we’re looking at a particular kind of treatment that’s effective or less effective.

It’s really a different way of looking at how we do research…. It’s a recognition that no single community faces exactly the same problem. You have to tailor your solutions using the best available knowledge to address them. And recognizing that we’re actually serving others to make those decisions. We’re not making [them], we’re not changing them. As a federal agency, we don’t have that kind of reach and we don’t really want that kind of reach because, quite honestly, it’s local communities that have to decide what they need and what they want. The best we can do is offer assistance, tools and consultations.

MH: Given that every community is so different, what do you see as the major quality and safety issues facing the healthcare industry as a whole right now?

Valdez: We’re focused on trying to implement the [National Action Plan to Advance Patient Safety]. AHRQ has co-led a coalition to develop actionable steps that every healthcare system can take to regain the patient safety that we’ve lost during the course of the pandemic. Central line infections, for example, increased by 28%. In the five years prior to the pandemic, we’d actually decreased central line infections by 32%. That’s basically saying: This pandemic has wiped out all the patient safety work that we’ve done.

When I talk to my colleagues in the healthcare industry, I ask folks running health centers, ‘What’s the biggest issue affecting you today?’ and they answer, ‘The healthcare workforce.’ I say, ‘Well, what’s the No. 2 item?’ ‘Healthcare workforce.’ ‘What’s the No. 3 item?’ ‘Healthcare workforce!’ It’s really at a critical situation across the country.

What I’m trying to do here at AHRQ is to provide some relief and support to my colleagues with at least additional ideas for how we can organize or reorganize, how we can rebuild a healthcare system that can be effective even though we face these other kinds of manpower shortages, supplies disruptions and the host of issues that that my colleagues are facing on a day-to-day basis.

MH: How has COVID-19 changed AHRQ’s work?

Valdez: We need to be able to communicate with people in other places and work together in teams in different spaces. It’s really also helped us recognize that this is potentially a way in which we can actually expand our reach into rural communities that historically haven’t had different kinds of technologies that allow us to do this.

Whether we can do this at high quality, particularly in the service industry, that’s one of the issues that we’re driving at here at AHRQ because that’s the ‘Q’ in our ‘AHRQ.’ We need to make sure that quality services are available in all patient care settings, and not just the historical focus on hospitals and institutions but also home care, home services and other arrangements. We need to think about what quality means in those contexts. We’re doing that kind of hard thinking here at AHRQ.