By Elizabeth Landry
As the only academic medical center in Central New York, and the region’s largest employer, Upstate Medical University is a pillar of the area’s healthcare resources as well as a key component of the community at large. Intertwined with the organization’s continued growth is its focus on pursuing quality as the best measure of how it serves its patients.
“Something that’s been made clear to all by our hospital CEO, Dr. Robert Corona, is that quality is the priority at Upstate. He emphasizes that quality is our brand, that it’s what we want to be known for, and we are laser-focused on that,” said Amy Tucker, MD, MHCM, Upstate’s Chief Medical Officer. “Our leadership team is investing in the resources required to drive quality and patient safety.”
Dr. Tucker explained that as a complex academic medical center, quality is part of the education as well. With learners including medical students, residents, fellows, graduate students, nursing students and other health professional trainees, quality-related priorities are embedded at every step of their education.
“It is an expectation that students participate in quality from the very first stages of their education and it is a major part of their curriculum. It is part of what they see on wards and in clinics, so in the development of these future health professionals quality becomes a part of the culture,” she said.
Utilizing Quality Ratings and Metrics
Along with quality leaders at Upstate, including Matthew Glidden, MD, Upstate’s Chief Quality Officer, and Harvir Gambhir, MD, Upstate’s Associate Chief Quality Officer, Dr. Tucker and the Upstate leadership team look to several quality rating entities to understand how Upstate performs within the wider healthcare landscape.
Dr. Glidden shared that Upstate looks to scorecards from three benchmarking entities: CMS (Centers for Medicare and Medicaid Services), Vizient, and the Leapfrog Hospital Safety Grade. While these organizations rate hospital quality in different ways – some use older data while others use newer data, and some release the ratings publicly while others do not – each generally looks at data including patient readmission rates, patient experience, safety, mortality rates, and timely and effective care.
“Our overall goal is to provide the highest-quality, evidence-based care in a safe manner that reduces potential harm to patients and provides care they value, along with the best experience possible,” said Dr. Glidden. “Until you benchmark yourself to other hospitals, you don’t really know how you’re performing.”
Upstate’s quality score from Vizient, the largest leading healthcare improvement organization in the country, is particularly useful because the hospital is compared with other comprehensive academic medical centers, rather than smaller hospitals. The ratings also are often related; for example, the Leapfrog score, which primarily focuses on patient safety, uses a lot of metrics from the CMS scorecard, Dr. Glidden explained.
When looking at the overall metrics, there are many data points that show how Upstate’s focus on quality has paid off to benefit patients. In recent years, Upstate achieved a 20.7% relative reduction in overall risk-adjusted mortality, meaning that fewer patients died t
han would be expected based on their sickness and medical complexity.
“In terms of safety, we’ve been able to drive a significant improvement in our outcomes measure over the last four or five years. The data suggests that Upstate saves more lives when compared to expected among our academic peer group” said Dr. Tucker. “When we look at our mortality rate, it’s considerably below the national benchmark and has been sustained over a long period of time. That’s something we’re very proud of.”
Dr. Glidden shared that patient safety has improved significantly at Upstate during this period of intensified leadership commitment. Also, over the last two years there are additional specifics: accidental punctures and lacerations were reduced to zero. Patient falls resulting in serious injury were reduced by 87.4%, and there was a 54.5% reduction in serious pressure injuries, which are also known as bedsores.
“Taken together, these results demonstrate meaningful progress in outcomes that matter most to patients,” said Dr. Glidden. These include surviving serious illness, avoiding preventable complications and infections, and recovering safely after surgery. “They reflect Upstate’s continued focus on improving care while serving patients who have significant illness and medical complexity.”
A Strategy for Success
The metric categories that rating organizations use to grade hospitals relate to the six pillars of healthcare quality Upstate embraces to aim for high scores: safety, timely, effective, efficient, equitable, and patient-centered care. A big part of how Upstate strives to achieve top-performing quality for patients is the concept of high reliability, which is underscored by Dr. Corona.
Originally used by the airline industry and the nuclear power industry — fields that are highly resilient to stresses on the organization and the imperative to continuously keep their customers satisfied — the five concepts of high reliability are: preoccupation with failure; commitment to resilience; sensitivity to operations; reluctance to simplify; and deference to expertise.
To put these concepts into action, Dr. Glidden uses the mnemonic of SOAP: Structure, Oversight, Accountability, and Processes. “When we have to clean something up, we look at questions like: How can we improve? What is the quality and operational structure? How do we maintain oversight of quality and operations? How do we hold people accountable, and what are our processes?” he said.
A strategic innovation that’s shown positive outcomes is the opening of the Care Connect Clinic across the street from University Hospital. The clinic allows patients to receive immediate walk-in care when they have an acute problem but don’t need to go to the emergency room.
“The clinic helps a timely flow of care and helps with access for patients, making it more convenient for them. It’s been a nice resource for the patients in our community and reduces the load on our ED,” said Dr. Tucker.
Another strategy Upstate has utilized to improve quality has been what Dr. Tucker termed the “clinical flash mob.” This strategy has increased immediate communication among care providers when there’s a difficult problem that requires input from experts across the organization.
“During a ‘clinical flash mob’ we get together over an emergency virtual meeting, discuss the problem together, and come up with an agreed-upon solution,” explained Dr. Tucker. “We’ve found this really helps with decision making and provides support for our clinicians.”
Staff on the Front Lines of Patient Care
When facing challenges and determining solutions, Dr. Glidden said leadership places great importance on listening to those who are caring for patients on hospital floors. Through a safety alert system, Upstate employees are empowered to report quality concerns and mistakes without a fear of retribution — an important part of the just culture and psychological safety found at Upstate, shared Dr. Glidden.
“It’s really the nurses, techs, managers—the ‘boots on the ground’ – who are telling us where we can improve. Upper-level departments process the information, but we always go back to the people on the front lines because they’re the ones that know how to solve the problem,” Dr. Glidden explained.
Beginning in November 2025, Upstate employees have come together to focus on quality through the Co-Elevate program. A series of monthly meetings that center on diverse topics, all related to quality, Co-Elevate brings senior leadership and frontline employees together to share their voices and help solve problems. The meetings include nurses, physicians, residents, fellows, pharmacists, environmental services workers, patient advocates and others.
“Co-Elevate is a link between the frontline workers who take care of patients and see quality concerns and the senior leadership,” said Dr. Gambhir. “We didn’t want another meeting to talk about quality metrics – we wanted a meeting to discuss the story behind what is happening and to work together to improve patient safety.”
Although the topics range widely, each one is always patient-centered, Dr. Gambhir said. All Upstate employees are invited to the meetings, which are held both in-person and virtually. Patient advocates and family advisors are also welcome as Co-Elevate panelists.
Despite being a relatively new program at Upstate, there are already tangible success outcomes. Dr. Gambhir highlighted new patient care huddles, an idea that came out of Co-Elevate meetings, in which all physicians and residents involved in a patient case will gather at the patient’s bedside together at the same time, helping to keep everyone on the same page. Another byproduct of the Co-Elevate program has been the implementation of Lean Six Sigma strategies in operating rooms for improved workflow efficiency. Overall, Dr. Gambhir said, Co-Elevate has helped create a more proactive culture at Upstate at all levels of the organization.
“We want to close the gap between how the work is imagined, and how the work is actually done,” stated Dr. Gambhir. “That’s where we’re heading. We want everyone to feel that we are all working together as a team.”
The Future of Quality at Upstate
Built upon guiding principles from leadership, it’s clear that Upstate’s focus on quality is steering the organization into the future. CEO Robert Corona, DO, MBA, continually presents quality as the “operating system” for the hospital, coordinating and connecting the functions of the entire enterprise. He also builds quality specifically into the strategic pillars he established when he first started as CEO: Quality, the Upstate Experience, Innovation and Sustainability and Growth.
“We can ask a quality question for each aspect of our strategy,” Dr. Corona added. “Are we delivering exceptional outcomes? Would we want this care for someone we love? Are we finding the best ways to operate? Are we building an organization that can fulfill its mission for generations? These are the questions that drive quality in every part of our system.”
Related to the strategic pillar of the Upstate Experience, the conversations are happening. “The goal is that we keep on speaking up, and we develop an interdisciplinary collaboration in a psychological safe space,” said Dr. Gambhir. “No matter if it’s a nurse or a resident who is on their first day at work, or a physician who’s been with us for ten years, we can talk freely in front of everyone. It is proactive culture, every day we try to improve, and things get better and better.”
Dr. Tucker also emphasized teamwork and open communication as some of Upstate’s priorities related to quality.
“We know when teams get together and focus on a common goal, and everyone’s helping one another, we see better outcomes,” said Dr. Tucker. “To increase the robustness of our communication pathways, we’ll be rolling out some new technology to make it even easier to connect with people in the moment.”
Looking toward the future, perhaps the most central goal for quality at Upstate is making sure patients are aware of the quality that’s available to them at the hospital.
“We really provide quality care here at Upstate. We want to provide the best care we can for the people here in Central New York, and it’s important to us that our public face reflects this, and people feel comfortable and secure when they come to us,” said Dr. Tucker. “We want that reassurance for patients. We want them to have the peace of mind that if they need care, Upstate is the place to come.”