BSc, MD, MPH
Wayne State University School of Medicine
Chicago, IL | United States
Main Specialties: Anesthesiology
Additional Specialties: Anesthesia, critical care
Dr Barach is an academic scientist and educator, board-certified in Anesthesia and Critical Care, who leads initiatives across clinical departments and support services, spearheading multiple projects and achieving physician alignment with strategic initiatives. Dr Barach advises and consults to academic medical centers and hospitals on the science of clinical practice improvement; acoustics and alarm fatigue; evaluation of practice transformation in diverse settings, and enjoys promoting the implementation of evidence for practice improvement. He has conducted a great deal of work over two decades on clinical and organizational performance, health systems improvement and patient safety.
Dr Barach is Clinical Professor at Wayne State University School of Medicine, Senior Medical Director at the Advisory Board Company, and Principal and founder of J Bara Innovation. Paul is double board-certified in Anesthesiology and Critical care, from the Massachusetts General Hospital affiliated with Harvard Medical School. He is a formally trained health services researcher, with advanced post graduate training in quality improvement and lean techniques at Intermountain Healthcare, and in advanced medical education and assessment methods from the Harvard Medical School Josiah Macy Program.
• Driver of change and manager of complex processes, content knowledge and experience in large-scale quality improvement/transformation with talent management and organizational development/change strategies to accelerate and sustain achievement of population health/ accountable care, patient safety, and patient wellness outcome goals.
• Improve access, quality and affordability of hospital health and community-based care including working with top-levels of state, local and international governments.
• Advance integration of quality improvement and organizational development/change science through research, teaching, publications, and national partnerships.
SUMMARY OF QUALIFICATIONS
• Extensive clincial experience in academic acute, ambulatory and community settings, double Board certified in Anesthesia and Critical Care.
• Over 15 yrs. leading large-scale quality improvement/transformation initiatives at delivery system, regional, national and international levels.
• Applied human factors expertise, acoustics, alarm fatigue, user centered research, design thinking and systems analysis.
• Dedicated to coaching and mentoring leaders of large-scale quality improvement and health information technology initiatives.
• Committed to professional development and quality implementation science knowledge teaching to clinicians, faculty, management, fellows, residents, and graduate students.
• Advancing quality improvement science through teaching, research, publications, journal peer review, and contributions at national level.
• Extensive GME curriculum design, deployment and evaluation focused around CQI, Patient Safety, Human factors, implementation science
• Lead development of integrated delivery systems linked to community based services, which offer high quality care for families, older adults, and people with disabilities, recognizing the value and need for population health, and other drivers to achieve the aim of improved health, higher quality and more cost-effective care.
He has published over 400 publications/8500 citations and has presented at international and national conferences on more than 500 occasions, including over 60 keynote addresses. His research appears in journals such as British Medical Journal, Analgesia and Anesthesia, Annals of Internal Medicine, Annals of Thoracic Surgery, Medical Care Journal of the American Medical Association, BMJ Quality and Safety, and many other prestigious journals. He co-authored the WHO report Exploring patient participation in reducing health-care-related safety risks, and co-edited a 2-volume book with Professors Lipshultz, Jacobs and Laussen (Safety and Quality in Pediatric and Congenital Cardiac Care, Springer 2014, and another book with Professor Johnson and Haskell on Patient Stories (Case Studies in Patient Safety Foundations for Core Competencies, Bartlett, 2015. His book on Surgical Patient Care: Improving Safety, Quality and Value: Theory and Practice, with Professors Sanchez, Johnson, and Jacobs, was published in 2017, and a book on hospital design and acoustics is scheduled for 2018 publication.
Further details can be found at: https://www.linkedin.com/in/paulbarach and https://uio.academia.edu/paulBarach and at https://www.researchgate.net/profile/Paul_Barach/publications/?pubType=article&ev=prf_pubs_art.
Primary Affiliation: Wayne State University School of Medicine - Chicago, IL , United States
PubMed Central Citations
Centre for Clinical Governance Research
Scientific Institute for Quality of Healthcare
University Medical Center Utrecht
Scientific Institute for Quality of Healthcare (IQ healthcare)
3 Center for Clinical Risk Management
Instituto Universitario Avedis Donabedian
University of Southampton
603PubMed Central Citations
Progress in Pediatric Cardiology 48 (2018) 82–92
Progress in Pediatric Cardiology
Quality improvement (QI) is becoming a central part of the work of clinicians throughout healthcare. Continuous quality improvement (CQI), Lean Management Systems (LMS) and Lean Six Sigma (LSS) are management phi- losophies as well as management methods. They offer an approach, a set of tools, and a way of thinking about how to more effectively assess and study clinical flow, including addressing variation in clinical process and operations. We define CQI as the daily use of QI methods as a regular part of practice engaging all practice staff, constantly measuring structure, processes, outcomes against effective practices (benchmarking), moving from one QI project to the next, pursuing the goal of “The right care for every child every time”. It is based on clear scientific principles, a valid way of measuring change and has theories of reliability and human factors that underpin the interventions. Significant variations in quality of care provided to pediatric patients leading to substandard care have been well documented. For example, in antibiotic prescribing for community acquired pneumonia; pediatric sec- ondhand smoke reduction; screening for diabetes in cystic fibrosis program; and, in depression screening in Type 1 Diabetes. Despite this, not enough pediatric practices are performing continuous quality improvement (CQI) as part of their daily activities. All health care professionals caring for children should consider incorporating quality measurement into their practice. However, we need to focus on what is the right approach to take and the right questions to ask and address the challenges of aggregating scientifically imperfect tests of change. Increasingly, colleagues, patients, payers and certifying agencies expect such measurement to achieve the Triple Aim of better health, better care and lower cost. In addition, new payment models increasingly pay providers for demonstrated value rather than volume, and they expect participation in continuous improvement. Quality Improvement (QI) is a critical component of the American Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part 4. This requires pediatricians to participate in a meaningful manner in two data-driven QI projects every five years. Pediatricians can select quality measures to evaluate whether patient outcomes and experience improve, and if not, identify and overcome barriers. In this paper we discuss performance improvement using CQI and related methods, suggest approaches to help pediatric cardiologists to ask the right questions when seeking to drive improvement, and consider the implications of measurement theory and complexity science for QI and CQI.
International Journal of Quality & Reliability Management, Vol. 35 Issue: 5, pp.1075-1092, https://doi.org/10.1108/IJQRM-02-2017-0027
International Journal of Quality & Reliability Management
Purpose – The purpose of this paper is to illustrate the systematic role played by Six Sigma methodology in improving the quality of healthcare. The literature review identifies the relevant opportunities for successful introduction and development of Six Sigma approach in healthcare sector. Design/methodology/approach – A systematic methodology to identifying literature on Six Sigma in healthcare is presented. Web of Science, Medline, Emerald Insight, ASQ and ProQuest databases (1998-2016) were searched, and 68 papers of fair methodological quality were identified. Findings – The findings of the systematic review reveal a growing interest in research on Six Sigma adoption in healthcare. The findings indicate that Six Sigma applications in healthcare have been focused on the entire hospital with no real focus on a particular department or function. The key findings on benefits, success factors, challenges and common tools of Six Sigma from the existing literature are also presented in the paper. Research limitations/implications – The papers included in the systematic review were peer-reviewed papers available in English. Due to these limitations, relevant papers may have been excluded. Moreover, the authors have excluded all conference and white papers for their inclusion in this study. Originality/value – This paper can serve as a guide on how Six Sigma approach can be applied to improve the quality of healthcare. The authors also believe that this is possibly the most comprehensive systematic literature review on the topic and will set the foundation for various research avenues based on the key findings of this study.
The Joint Commission Journal on Quality and Patient Safety 2018; 44:485–493
The Joint Commission Journal on Quality and Patient Safety
Background: Poor-quality handoffs have been associated with serious patient consequences. Researchers and educators have answered the call with efforts to increase system safety and resilience by supporting handoffs using increased communication standardization. The focus on strategies for formalizing the content and delivery of patient handoffs has considerable intuitive appeal; however, broader conceptual framing is required to both improve the process and develop and implement effective measures of handoff quality. Methods: Cognitive task interviews were conducted with internal medicine and surgery residents at three geographically diverse US Department of Veterans Affairs medical centers. Thirty-five residents participated in semi-structured interviews using a recent handoff as a prompt for in-depth discussion of goals, strategies, and information needs. Transcribed inter- view data were analyzed using thematic analysis. Results: Six cognitive tasks emerged during handoff preparation: (1) communicating status and care plan for each patient; (2) specifying tasks for the incoming night shift; (3) anticipating questions and problems likely to arise during the night shift; (4) streamlining patient care task load for the incoming resident; (5) prioritizing problems by acuity across the patient census, and (6) ensuring accurate and current documentation. Conclusions: Our study advances the understanding of the influence of the cognitive tasks residents engage in as they prepare to hand off patients from day shift to night shift. Cognitive preparation for the handoff includes activities critical to effective coordination yet easily overlooked because they are not readily observable. The cognitive activities identified point to strategies for cognitive support via improved technology, organizational interventions, and enhanced training.
Progress in Pediatric Cardiology 44 (2017) 57–61
Progress in Pediatric Cardiology
P-values are a common component and outcome measure in most every published observational or randomized clinical trial. However, junior faculty, fellows, and residents have little or no training in statistics and are forced to rely on the interpretation of results based solely on the authors or secondary sources. This education gap applies to an even larger audience including many physicians, researchers, journalists, and policy makers. That is a dangerous approach. Statistical analysis of data often involves the calculation and reporting of the p-value as statistically significant or not, without much further thought. But p-values are highly unreplicable and their definition is not directly associated with reproducibility. Findings from clinical studies are not valid if they cannot be reproduced. Although other methodological issues relate to reproducibility, such as statistical power to reproduce an effect, the p-value is arguably at the root of the problem given its wide variability from study to study. Many common misinterpretations and misuses of the p-value are practiced. It is essential to bring more awareness to this critical issue by providing a deeper educational understanding of the p-value to the proper interpretation of study re- sults. Recognizing this need the American Statistical Association (ASA) recently published its first ever policy statement concerning their proper use and interpretation of p-values for scientists and researchers. This policy statement addresses the misguided practice of interpreting study results based solely on the p-value, given that it is often irreproducible in subsequent, similar studies. To further educate and illustrate this issue we investigated the irreproducibility of the p-value by using simulation software and results reported from a published randomized control trial. We show that the probability of attaining another statistically significant p-value varied quite widely on replication. We also show that power alone determines the distribution of p, and will vary with sample size and effect size. The percentage of replication means which fell within the original confidence interval (CI) from each replicated experiment revealed that the 95% CI included only 85.4% of future replication means. In conclusion, p-values interpreted solely by themselves, can be misleading if interpreted devoid of context poten- tially leading to biased inferences from clinical studies.
Acad Med 2017 07;92(7):927-931
E.J. Warm is the Sue P. and Richard W. Vilter Professor of Medicine and categorical medicine residency program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. R. Englander is associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota. A. Pereira is associate professor and assistant dean for clinical education, University of Minnesota Medical School, Minneapolis, Minnesota. P. Barach is clinical professor, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
J Pediatr 2016 10 15;177:13-16. Epub 2016 Aug 15.
Carman and Ann Adams Department of Pediatrics Wayne State University School of Medicine Children's Research Center of Michigan Children's Hospital of Michigan Detroit, Michigan. Electronic address:
HERD 2008 ;1(2):27-38
Debajyoti Pati, HKS, Inc., 1919 McKinney Avenue, Dallas, TX 75201
Int J Med Inform 2015 May 22;84(5):355-62. Epub 2015 Jan 22.
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Social Work, Stockholm, Sweden; Karolinska University Hospital, Department of Social Work, Stockholm, Sweden.
Int J Med Inform.
Acad Med 2014 Oct;89(10):1416-22
Dr. O'Leary is assistant professor, Department of Anesthesia, University of Toronto, and staff anesthesiologist, Hospital for Sick Children, Toronto, Ontario, Canada. Dr. O'Sullivan is research fellow, Department of Anesthesia, University College Cork, Cork, Ireland. Dr. Barach is anesthesiologist and visiting professor, University College Cork, Cork, Ireland. Professor Shorten is professor of anesthesia and dean, School of Medicine, University College Cork, Cork, Ireland.
BMC Health Serv Res 2014 Sep 13;14:389. Epub 2014 Sep 13.
Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P,O, Box 9101, 6500 HB, Nijmegen, The Netherlands.
JAMA 2014 Aug;312(6):651
Department of Medicine, University of Chicago, Chicago, Illinois.
International Journal of Clinical Practice
HERD 2008 ;1(3):128
Progress in Pediatric Cardiology 33 (2012) 57–65
Progress in Pediatric Cardiology
There is growing recognition that risks and hazards of health care associated injury and harm are a result of problems with the design of systems of care rather than poor performance by individual providers. The convergence of cardiovascular surgery and interventional imaging has resulted in new models of cardiovascular surgical suite design and new configurations of specialized surgical procedure rooms. Hybrid cardiovascular surgical procedure rooms are designed to accommodate both “open” surgery and “closed” vascular access procedures. These new rooms incorporate a variety of image-guidance modalities, are configured for surgical sterile precautions, and are designed for the use of general anesthesia. Proper design of advanced cardiovascular surgical procedure rooms requires an understanding of room configuration, surgical and anesthesia work "ow, lighting and air handling requirements, surgical team culture and behavior, and human factors. Integrated medical equipment assemblies that amalgamate features of open surgical equipment, closed interventional imaging equipment and advanced medical information technology will further infuence the form and function of tomorrow’s cardiovascular operating rooms.
Prog Pediatr Cardiol (2011), doi:10.1016/j.ppedcard.2011.10.010
Progress In Pediatric Cardiology
Progress in Pediatric Cardiology 33 (2012) 25–32
Progress in Pediatric Cardiology
The safety, reliability, and stability of the pediatric cardiology workplace are continuously challenged. These factors include the complexity of patient care, keeping up to date with evidence based practice, harnessing the implications of innovations in technology, and adapting to changes in the structure of health services and facilities. The differences between individual clinical team perspectives and impressions formed by other teams across the organization produce divergent perspectives on clinical work. This paper makes a case for investing in a social science framework entitled ‘work domain analysis’ to better understand how health teams function reliably within the wider healthcare organization. Work domain analysis was developed to equip people in complex work environments with the skills and awareness to identify and adjust the margins for safety in normal work by making the boundaries between management imperatives, workload and safety (in this case, pediatric cardiac care) more apparent to a wider range of people. Healthcare can no longer afford to be precious about methods adopted from other industries due to the high complexity of the clinical workplace. The paper outlines an approach to work domain analysis that can greatly enhance the engagement and awareness of clinicians. The opportunities for practical applications of work domain analysis to pediatric care are discussed.
Prog Pediatr Cardiol (2011), doi:10.1016/j.ppedcard.2011.10.011
Progress in Pediatric Cardiology
Expectations of pediatric cardiac surgeons grow as the specialty evolves and yesterday's challenges become tomorrow's routine. The pioneering era of fast-paced major technical advances is behind us. Integration of surgery, cardiology and intensive care is nowthe basis of incremental improvements in perioperative and long termoutcomes. Surgeons can be natural leaders of this process because their skills, roles and experience are crucial in the preoperative, intra-operative and postoperative care of the patient and their family. However, the personality traits that draw physicians to the specialty and contribute to the drive to become a successful technical surgeon may be at odds with the collaborative aspects of this microsystem, both inside and outside the operating room. The potential for disruptive behavior on the part of the surgeon to impede the functioning of a large multidisciplinary teamproviding care of the upmost complexity raises fundamental questions about howto design reliable pediatric cardiac surgery teams. A new dynamic is needed to support team members, including the surgeon, in times of extreme stress and to help them avoid destructive,maladaptive responses. Focusing these efforts around the clinical microsystemrequires a detailed analysis of the teaminteractions, the underlying culture and support, and the clinical engagement of staff. Building and nurturing a resilient systemin a highly specialized environment where burnout, bullying and loss of staff exist remains a constant challenge.
ANZ J Surg 2011 Oct;81(10):659-60
BMJ 2009 Oct 13;339:b3949. Epub 2009 Oct 13.
Cardiol Young 2008 Dec;18 Suppl 2:215-21
The Congenital Heart Institute of Florida (CHIF), Clinical Assistant Professor of Pediatrics, University of South Florida, Florida Pediatric Associates, 880 Sixth Street South, Suite 370, St. Petersburg, FL 33701, USA.
World Hosp Health Serv 2008 ;44(2):15-21
Utrecht University, Netherlands.
Cardiol Young 2008 Dec;18 Suppl 2:271-81
Department of Pediatric Anesthesia, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
Stud Health Technol Inform 2008 ;132:14-22
University of Utrecht Medical Center, Utrecht, Netherlands.
J Clin Monit Comput 2007 Dec 1;21(6):353-63. Epub 2007 Nov 1.
Division of Trauma Anesthesia & Critical Care, Department of Anesthesiology, School of Medicine, University of Miami, P.O. Box 016370 (M820), Miami, FL 33101, USA.
Neurotoxicology 2007 Sep 15;28(5):1043-4; author reply 1044-5. Epub 2007 Aug 15.
Anesth Analg 2005 Oct;101(4):1135-40, table of contents
Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami School of Medicine/Jackson Memorial Hospital, R-C370, 1611 NW 12th Ave., Miami, Florida 33101, USA.
Mark Health Serv 2005 ;25(1):14-9
University of Miami, Florida, USA.
BMJ 2002 Feb;324(7333):363-4