Key Takeaways
- Leverage 'small data' to pinpoint specific patients needing intervention rather than relying solely on aggregate metrics.
In a world where healthcare systems strive to be more patient-centered, data-driven, and outcome-focused, quality improvement has become an art as much as a science. When done right, it can transform organizations, empower healthcare professionals, and, most importantly, save and improve the lives of the very people at the heart of it all: the patients. The integration of patient data analysis in hospitals has become crucial in this transformation, allowing for more precise patient analytics and informed decision-making.
Recently, we had the pleasure of hosting a conversation with an industry veteran, Tannasia (aka T) Gonzalez, MBA who serves as the Deputy Chief Quality Officer at the Jewish Board of Family and Children's Services. She has more than 20 years of experience as a continuous improvement analyst, using data and kaizen principles to optimize patient (or client) outcomes. Over the course of our talk, T. delved into her team's approach to "small data," the challenges of driving a culture of quality, and how organizations can mine for their own "diamonds" by focusing on what matters most to enhance patient experience.
Below is a deep dive into some of the key lessons and best practices that emerged from our conversation.
When T. first started her career, the notion of "quality improvement" in healthcare primarily revolved around meeting certain regulatory benchmarks and ensuring services were compliant with basic standards. Over the years, however, the emphasis has shifted toward a more holistic approach: reducing variation, improving patient experience, adopting evidence-based practices, and using actionable data in a proactive rather than reactive way.
At the Jewish Board, T. and her team have embraced this transformation by integrating clinical performance analytics into daily decision-making. Through dashboards and scorecards, her department tracks a wide range of metrics—everything from mental health outcomes and social service utilization to daily operational processes. While capturing large datasets has become commonplace, the real trick is in knowing how to translate "big data" into actionable insights through data-driven decision-making.
A term T. championed during our conversation was "small data." She explained that this process goes beyond just counting the number of visits, procedures, or service interactions. It's about identifying the exact clients, patients, or members who need targeted interventions. By doing so, quality improvement teams can help shape a culture that prioritizes personalizing care, rather than simply recording it.
T. recounted her experience overseeing an HIV/AIDS clinic in a large Manhattan-based health center. In that setting, the organization already had a proprietary database that captured the unique metrics associated with HIV/AIDS care, from regular lab work to medication adherence rates. Armed with these data points, T. and her team created a centrally accessible system that showed the status of each metric, down to the level of individual providers and patients.
For instance, if a provider's retention rate (number of patients who had at least one visit in the last 12 months) fell below the target, the system generated a list of patients who were overdue for appointments. The provider could then focus on those specific individuals, reach out to them personally, and troubleshoot barriers to care (like transportation, stigma, or misunderstanding of treatment plans).
This approach of pinpointing exactly where the problem lies—rather than making broad, sweeping changes—helped the clinic improve several key performance indicators by 50% or more. That's the essence of small data: letting the numbers lead you to real humans whose lives can be changed for the better. This method of data improvement has proven to be a powerful tool in driving patient experience trends and achieving patient experience goals.
Data alone, T. pointed out, cannot paint the full picture. Sometimes, you need to physically step into your patient's or client's journey to grasp their experiences—pain points and all. This approach is crucial for gathering valuable patient experience statistics.
One of the most powerful initiatives T. led at her HIV/AIDS clinic was called "Walking in Patient Shoes." Over a two-week period, quality improvement staff asked each patient for permission to accompany them through their entire clinic visit. This allowed the QI team to observe and record every step:
Check-in Process: Was it intuitive, or did patients struggle with paperwork?
Wait Times: Were patients left in the waiting area with insufficient information?
Care Environment: Did they feel comfortable and respected while speaking with clinical staff?
Follow-up: Were next steps clearly communicated once the appointment was over?
What emerged from this exercise was an immediate insight into barriers the data had not previously revealed. For instance, many patients complained about difficulties getting through on the phone. Staff discovered that voicemails weren't being returned promptly or that call routing was confusing, leaving patients frustrated. This had a direct impact on retention and adherence.
Armed with this "customer voice," T. and her team spearheaded improvements:
They centralized the call center so that every incoming patient call could be monitored, and call response times could be tracked.
They also recommended that doctors block off a specific window each day to return phone calls.
These changes may sound straightforward, yet they had a transformative impact on patient satisfaction and retention in care. Another discovery from the "Walking in Patient Shoes" initiative was that many patients were unaware of the clinic's walk-in policy. Through a "Did You Know?" campaign, staff posted informational flyers and explained to patients that they could come in for urgent appointments without a scheduled time. This eliminated a crucial barrier, and again, retention metrics began to rise.
While quality improvement teams might be excited by metrics, dashboards, and new methodologies, frontline clinicians and staff often have their own priorities and workflows. Resistance to change is natural, and T. noted that her strategy to tackle these objections is twofold:
Find a Champion – Identify at least one staff member or leader within the clinical department who already embraces the change. It could be the medical director or a highly respected physician. Let them serve as a spokesperson and mentor for the rest of the team. Hearing the case for change from a respected peer rather than an external data analyst can make all the difference.
Communicate Non-Punitively – Emphasize that dashboards and metrics are not there to punish or single people out. They exist to highlight opportunities, standardize best practices, and, ultimately, provide better patient care. Celebrating small wins, according to T., is essential to building trust and enthusiasm for improvement projects.
At the HIV/AIDS clinic, some providers initially pushed back, arguing that patient relationships couldn't be reduced to numbers. However, once they saw how a colleague's personal touches—such as a caring word, a shoulder pat, or a simple follow-up call—dramatically improved retention rates, they were eager to adapt. Data confirmed that these human interventions actually worked. In essence, the numbers validated the power of empathy.
Quality improvement can often stumble when organizations treat it as a one-time project rather than an ongoing practice. T. believes deeply in training staff at all levels in Lean Six Sigma methodologies, from entry-level personnel to department heads. She encourages everyone—particularly those who seldom see themselves as "leaders"—to think critically about how to enhance the patient experience.
Front-desk staff, T. pointed out, are a perfect example. They are often overlooked but serve as the gateway to any clinic or hospital. As the first point of contact for patients, they have a front-row seat to everyday challenges. By involving front-desk staff in brainstorming sessions and giving them simple tools to track issues (like a basic spreadsheet of how many complaints or compliments come in about wait times), leadership can glean valuable insights on where to direct improvement efforts.
This approach fosters a continuous improvement platform where every team member contributes to data analysis adaptability collaboration. By establishing feedback loops and implementing robust data validation processes, organizations can ensure that the information collected is both accurate and actionable. This focus on employee engagement is crucial for measuring continuous improvement success and developing effective performance improvement plans.
The phrase "from data to diamonds" is apt because data, like raw diamonds, need refining. It is only by sifting through, analyzing, and polishing that we uncover the precious insights needed to drive real, human-centered change. Here are key takeaways from T.'s experiences:
Define Excellence – Start by articulating what good looks like for your organization. Identify key performance indicators (KPIs) aligned with evidence-based practices, including metrics like Net Promoter Score and Customer Satisfaction Scores. Consider incorporating industry-standard metrics such as Overall Equipment Effectiveness, First Pass Yield, Cost of Poor Quality, and Defect Rate to provide a comprehensive view of performance.
Embrace Small Data – Use dashboards and scorecards not just to collect big numbers, but to drill down to the individual who needs help. This involves a combination of descriptive analysis, prescriptive analysis, and predictive analysis to gain a comprehensive understanding of patient needs and drive improvement over time.
Engage Champions – Team up with well-respected clinicians or staff who can help build buy-in and spread best practices organically. This approach can significantly boost employee engagement in continuous improvement efforts.
Listen to the Patient Voice – Conduct "Walking in Patient Shoes" sessions or similar real-world observations to see where gaps exist. No spreadsheet can replicate that kind of first-hand insight. These exercises can provide valuable patient experience board ideas and help in collecting meaningful patient experience statistics.
Foster a Culture of Continuous Improvement – Encourage everyone from senior leaders to front-desk staff to adopt a mindset of "quality never stops." Provide the training and resources needed to evolve as a united team, focusing on process improvement and implementing changes based on data-driven insights. Consider implementing Cycle Time Reduction initiatives to streamline processes and improve efficiency.
Quality improvement in healthcare is a relentless journey of learning and adaptation. While large datasets and advanced analytics platforms are critical tools, they must be paired with empathy, direct feedback from patients, and a culture that embraces change. As Tannasia (aka T) Gonzalez, MBA so aptly demonstrated, even a small data point—like a single patient's unanswered voicemail—can open the door to transformative system-wide improvements.
Organizations that commit to an ongoing conversation between data, patients, and staff stand the best chance of turning raw information into the brilliant "diamonds" of improved clinical outcomes, seamless experiences, and flourishing communities. By setting measurable objectives and consistently monitoring progress, healthcare providers can ensure that their efforts lead to tangible improvements in efficiency data and overall patient care.
That blend of compassion and precision lies at the heart of healthcare's future—and it's how we turn data into true diamonds of care.
<p>we realized that to get the best experience we needed to hear directly from our patients and we decided to do this project called Walking in patient [Music] shoes hello everybody this is Cole from the American Journal of healthc care strategy joined by a special guest today many years of experience in improving quality and outcomes improving experience uh tenasia T please introduce yourself and your role a little bit about your background thank you Cole thank you so much for having me on the show today really excited to talk to the audience and to you about my experienceing client experience and um quality improvement over the years so my name is tanasia Gonzalez but I do go by T it just it's a little easier for folks and it's it's actually my preferred name it's a little more fun um So currently I serve as the deputy chief quality officer at the Jewish Board of Family and Children Services uh we serve close to or over 35,000 clients um I oversee the data analytics team within the agency and we help people keep the posts on their work and understand in a descriptive way what they're doing and also in a predictive way what they could be doing better and also in a diagnostic way why what has happened in their workplaces and just we create tools to help folks understand where they are and specifically where they need to Target uh for improvement in addition my team is called the quality and transformation team and we work alongside the project management office which oversees the quality improvement um activity across the agency which is leanix Sigma so we train tons of folks across the agency and lean Six Sigma uh quality improvement methodology and there's quite a shift going on within the agency right now and is a more of an appreciation for data and being more data driven and taking that quality improvement methodology placing it on those challenging areas or processes that require tweaking for improvement and there's a shift right now and we are striving for excellence and it's beautiful to be a part of the team helping us get there um you know our mission is to be the best Mental Health and Social Services organization not just in the country but on the planet and um I'm making that my personal mission and my team every day they are so excited to just pull the data work with everyone across the agency all four divisions that we have and we have a close to we have over 2,000 individuals that work at the Jewish board and because we're at the corporate level we get to touch on all of the programs across the agency and see the whole uh body of work holistically yeah great work that you're doing yeah I'm a fan of the Jewish Board of course uh but I one of the reasons we wanted to bring you on is because of your experien a long period of time right near when I was born as you were uh working as a Managed Care analyst so I think uh long time um which is great right uh that depth of experience you've also seen a lot of transformation in terms of the technological changes over the years right and so um there's also a lot of things in your profile that that key words that might be interesting to people you know healthc care small data Ambassador um you know you mentioned Six Sigma as well and implementing that in the organization I just got my green belt currently finishing my black and so these things that that interest to me but it's also interesting to a lot of organizations right that transformation process um I have to ask what is small data it's mentioned a few times on your profile yeah and actually I forgot to mention that I am also um the host of the let's talk small data with t podcast and it actually is has a a global audience so it's been seen across six continents over 35 countries and basically talking about Smalls data it's so funny because my husband goes oh is small data like itty bitty numbers and I said no that is not what small data is small data is more so like an action so you know we have big data which is big and sexy everybody knows about big data but it's about diving into that big data to really zero in and really find those individuals with those individual issues that need to be tweaked and tracked over time and improved um and those types of activities help you really redesign the processes and the systems that you have at play uh impacting clients lives and giving you key learnings on you know what you need to do to change the systems and the processes you have in place to give you the actual outcomes um that you need like those evidence-based uh outcomes that you want to see come about like and a lot of the work that I've been doing I've been in the game maybe about 20 25 years and thank you for that out coold that you were in high school when I was starting out so basically I'm old I know um but um it's all about understanding what your kpis are or your key performance indicators and keeping the pulse like these kpis or key performance indicators um let me know that I am following evidence-based practices and I'm doing well at them you know there's a certain Target for each metric if if I'm at or above that Target then I'm fulfilling the evidence-based process here if I'm not meeting those targets I need to dive in I need to see who those clients are and how exactly are they falling out of the numerator and I need to focus on those clients and that activity will help Drive the metrics up or get us towards excellence and basically the small data is all about diving deep I say on my podcast it's about diving into the data and really drilling down to the individual client member or patient it depends on where you're serving so I've been on the Managed Care space which is where I started and we were talking about members right and then I've been in the hospital space then we're talking about patients I did a lot of time at the HIV aids clinic at a very large Center in Manhattan it was the largest one in the state at the time then here at the Jewish board we serve clients um because we're not Hospital based so even though we do have clinics we have doctors we have pcps but or Primary Care Providers I do speak in alphabet suit I apologize I will try and spell it out as we go along um but yes so basically it's customers like our customers across the board it's what are you doing to really know what good looks like what does excellent look like Define that by way of your key performance indicators build your scorecards in your tools so that you can keep the pulse and I do this because my team says you always do that t keep the pulse you know are we still breathing you know just keep the pulse where are you how are you performing in the minute you know you come inside you see that dashboard you see all your metrics you see one is red meaning you're using the stop light mechanism if your your result is green you're good if it's red you need to focus you need to drill in and that's what I mean by small data and small data tools and I actually when I was in the Hib Aid Center I had the pleasure of working with an executive director that gave me creative freedom to just build the reporting and Reporting and data infrastructure for the HIV aids clinic and I built the whole team we created a lot of reports we were supporting the staff of the clinic which we're about to 250 folks um sending data externally as well as for use internally and I was actually to build able to build an actual system that helped us track how we were doing on our key performance indicators about 25 or so so for our specific population which was HIV AIDS individuals individuals with and affected by HIV and AIDS um and we were able to able to build a system that was centrally located um and everyone in the clinic could see how we were doing compared to our peers on those kpis in New York state also how our three clinics were doing compared to each other and also how our 26 Primary Care Providers are doing against their peers within our Clinic you could click drill get down to a patient action list list of patients okay he listen Dr Jones you're not doing too good on retention here because these 10 patients need to get in for a visit now and so the client the the the providers going in and taking action is what drove those metrics up like this and this system became the the center of our quality improvement program for a little bit really highlighting projects that we needed to implement things that we needed to to to pay attention to and one example was really cool that and it really does impact client experience so one of these metrics was retention and care so it's important for an HIV AIDS individual anybody really um to get into the PCP or the primary care doctor's office at least once within 12 months because you have to have specific labs done you have to have a spec specific review of your medication yada yada um and we released this report and we saw some of the the primary care providers were doing really well on this metric others were not so good needed some improvement but we could see who along the Spectrum and where you were so what we did was we put those doing well and those not doing so well in the same room said okay we're going to talk and share what you're doing share some best practices what is happening and really it came down to human touch so the providers the pcps or primary care providers who were doing really well really engaged in human touch with their patience placement on the shoulder a hug treat me like a human being especially for uh a population that's usually stigmatized um you know and marginalized you know I mean so it my time at the HIV Aid Center was like really it was fun that was a good that was a fun time in my career because I was able to develop so much and I used to speak with the clients the patients themselves and I could see how this work impacted their lives um and we made it better uh indirectly but so when the the pcps who weren't doing so well started applying some of these interventions or these actions that these guys were doing we saw the metric go up across the board we were able to increase all of the quality improvement metrics by over 50% wow that's impressive did you did you not receive any push back because that's one of the things we talk about a lot is we teach someone Six Sigma we get them ready to go we send them out to be a practice manager or something like that and they're like H nobody likes these ideas nobody wants to listen they're all really angry at me they think I'm trying to be a doctor you know even I'm not we've heard a lot of these things and they struggle with that did you face that at all oh yeah you know that's going to happen I mean we're dealing with human beings and it's going to happen we got a lot of why do we need to do this we've always been doing it this way this works why are we doing that way and so and I'm not a doctor although that was my initiative uh initial uh idea was to become a doctor but that did not happen so they needed to hear it from someone like them so the first thing I did was I got a cheerleader on my side was a doctor was a medical uh director of one of our three clinics who was the champion and said listen guys I'm one of you and this works well for me and this is how let me show you how to do this and we had to really train people or really repeat this is not punitive this is not for punishment this is so that we can get better as a team and I mean it didn't happen overnight but slowly with us coming together me and this doctor data and the medical uh Department coming together um to move us forward it it worked out over time and it was really it was it was it was really enjoyable and a learning experience in people management as well as you know technical expertise and eventually and we were working at the time we were working with an EHR which was a proprietary database um that was built by a doctor that had been there like a decade before I got there and it was specific for the population of the clinic so it was built specifically to capture those key things that are needed um for the best uh care for an HIV AIDS individual um and it was just you know fun time to be and also we develop in terms of client experience um we realized that that to get the best shoes so basically we took two weeks and with every client that walked in the door or patient that walked in the door someone on the QI team was there with a tracking tool and once they got agreement from the client they followed that client through every step and including into the doctor's office that was you know obviously you'd have to get um ackn not acknowledgement but um approval from the client that it was okay to join them along their journey and we learned a lot about what their experience is traveling through our clinic and what we learned from that was that individuals were really unhappy with the telephone service they couldn't reach people the doctors not calling them back no one's answering voicemails I mean this is a common thing that happens in clinics so what we decided to do was uh create a centralized call center um and there were some challenges with that but also what the client start there the patients the providers started doing was putting into blocks in their schedule to make sure that they would get back to clients and like they started tweaking how they do things and that improved that metric over time like how happy clients are with the telephone service um a lot of clients didn't know that we had a walk-in policy they were like I needed to see the doctor and I couldn't get an appointment and they're like well you could have just walked in so we started a did you know campaign did you know we have a walk-in policy and a lot of clients were like oh okay and that that improved that metric um it was a couple other things we put on the did you know campaign but it was just like people just didn't know what's already existing and what they could take advantage of so it was great what's the first step in doing these things because that's where people struggle a lot is they hear these great ideas they take again they take the Six Sigma course they get certified they do a practice project but then they're put out on their own to start these projects and it's that getting started point so you know any of your examples are excellent but what is the thing that you are doing first interesting interesting question that's a big one um yeah I hear a lot of people on understand ask the same question like well T where do I get started so like here at the Jewish board we have such a wide range of services and when I'm talking at the new higher orientation because I I welcome folks every two weeks into the Jewish board and tell them about the quality and transformation Department our Mantra is you know challenge status quo you know our issue our main thing is we're solving complex problems um and really it's be become very aware of what your area does and how you serve the clients and listen to the clients see if you can identify issues in the systems and areas where things are not quite working well um see if you can create some some data put together a simple track sheet to track okay on this day we had x amount of clients come in for x and x amount of complaints came out and they were these complaints and started categorizing What complaints or What observations you're getting and once you start putting together those simple track sheets you'll see some Trends pop out um that will illuminate like where you can focus to start digging in diving in to the data and um let the data tell you um where you need to focus and that's always my recommendation for folks you know like just open up a simple spreadsheet and say you know like if you're at the front desk for instance front desk people first of all I love the front desk folks those front desk folks they're usually thought to be a not not essential role but those folks tell you what's working well and what's not and you need to listen to your front desk people my call to to action or anybody listening to this podcast please value your front desk folks because they could tell you they're they're the face of the organization first of all they could tell you what the clients are saying firsthand and what issues they're having um right there at the beginning of the journey and um they're also have access to registration system and the billing system and they speaking to the doctors so they can connect the dots across the journey um they're real key they're really key to really understand we may need to tweak this in our system for instance clients are coming in when they check in XYZ happens if we had them do this beforehand it would eliminate this issue happening over here so you know that would just be my recommendation based on where you are yeah who do you serve and how and how how is how do you quantify the services that you're providing and how do you measure what Excellence looks like are you fulfilling them based on those metrics that would be my advice and like you said it comes back to that voice of the customer the GMO walks right you want to actually be there to see what people are valuing because how can you set a quality metric for a lot of these things if you don't know what the customer cares about um you said that you like to speak with people when you were in the clinic there you like to to speak with them I think that's one of the greatest things that I've seen practice managers do as well is take time to to speak with them but as a non-clinician what do you say to them the the the patients or the clients uh when you go up to them what does that conversation look like you know what it's interesting so at the Hib AIDS clinic that's where had the opportunity to really engage with the c the patients on a ongoing basis and it's because different things were set up in a way that made that possible or easier so we had a cab or the consumer Advisory Board and those were clients those were patients of ours those are a different type of patients because they are very proactive they want things to change they're leading the charge they're change agents which is great but what I would do and what I would encourage my data analytics team to do is get from the computer go downstairs to the clinic and actually start talking to people in the waiting room go into the clinics and just walk through and talk to the to the to the the the clinicians and the nurses the social workers get to know everybody along the stream just you know just get out of your cubby hole um and just talk to people you know and just gather feedback um and people are always happy to share their story so I think we should leave that with our audience as maybe an assignment is get up from the desk and go talk to members go talk to patients uh maybe if you can't speak with your leadership at least on on wanting to get some more feedback regardless of really your position because I think that that's really the only way that you can actually find out what's going on right is by actually you know the data tells I think the number part of the story like you said drilling down into it you need to actually speak to the people who are create you know who are the points in that data right so that's excellent advice um don't want to take up more of your time uh than scheduled but please check out the the podcast there we're going to link it in the description for everyone I encourage all all the guests to do that and thank you so much for coming on T I hope that we can stay in touch and have you on again this has been a really great conversation and uh I've enjoyed it ditto ditto Cole so nice chatting with you and you know I always tell people lean into that small data it's a powerful asset</p>
Want to reach healthcare executives and decision-makers? Join industry leaders like HealthMap Solutions on our podcast.
Become a Guest