Julie Morath Breaks Glass Ceilings While Advancing Patient Safety and Healthcare Quality

Julianne M. Morath, a highly respected healthcare executive, has dedicated over three decades of her career to improving patient safety and healthcare quality. Despite her extensive achievements, she shows no signs of slowing down, continually raising the bar higher in her field.

"I was pulled toward it. It was gravitational. As a child, I was always drawn to the sciences and to service to others," Morath recalls.

Her family history, including a mother who was a teacher, a father who was a professor, and grandparents who served the community in various capacities, profoundly influenced her. Her maternal grandmother, a pioneer in nursing, worked fearlessly with the mentally ill before the advent of psychotropic drugs. This left a lasting impression on Morath, who admired her grandmother's courage and dedication.

"My childhood and early experiences were always directed to the development and support of others. That had a profound imprint on me and what I saw as possibilities," Morath said.

As she entered her clinical rotation, she knew she was on the right path and never looked back.

"Nursing for me had so many opportunities and is so versatile. I'm a restless person who is always looking for what's next, what would have impact, and how I can contribute. It kept me moving forward, even though I didn't always know what the destination would be," Morath said.

Morath was one of the first cohorts of advanced practice nurses in psychiatry and mental health in San Francisco. From there, she was recruited to be part of a community mental health team in Georgia, focusing on crisis intervention in the ER and ambulatory setting. This experience inspired her commitment to interdisciplinary, intersectional systems thinking, catapulting her into leadership positions.

She recalls that during a nurses' strike while she was in Georgia, she was called to help resolve the conflict.

"I didn't know what to do, but I knew how to listen," she said.

Her ability to facilitate communication between nurses and management led to a resolution and underscored her potential in clinical leadership roles.

In 1999, she joined Children's Hospitals and Clinics in Minneapolis and St. Paul. With a reputation for being a strong manager, she agreed to take the position, but only if she was given the opportunity to operate through the lens of quality and patient safety. If the results weren't favorable within 18 months, she agreed to leave of her own volition; she would go on to stay in that position for 10 years.

"I wasn't naïve, I knew people were harmed in care. But early on, it was seen as an inevitable byproduct of the complexity of care. I never believed that," she said. "At Children's, I began to work in earnest around patient safety. I was able to redefine the COO role where creating the conditions for safety and clinical outcomes were the top imperatives. Engaging patients and families as partners in care was pivotal to learning and improvement."

She introduced principles of the Toyota Production System as the management and improvement system for care delivery, emphasizing a culture of learning and open discussion of medical errors. This initiative included patient safety action teams, blameless reporting, and a full accident disclosure policy, significantly reducing medical errors and earning the hospital national recognition.

"People in health care are some of the people with the highest integrity, compassion, and skills that I know. I was certain that with common ground, common goals, and a common direction that we could make an impact and that it was worth the risk," she said.

These efforts not only reduced medical errors but also fostered a transparent and proactive approach to patient safety, earning the hospital national recognition. Morath's innovative work in patient safety earned her the inaugural John M. Eisenberg Patient Safety Award for Individual Lifetime Achievement, presented by the National Quality Forum and The Joint Commission. This prestigious award recognized her lifelong commitment to enhancing patient safety standards.

Her leadership also received the attention of Harvard Business School researchers who studied her leadership and management style, publishing a Harvard Business School Case Study in 2007, broadly used today in business management school programs.

"I am not interested in a rigid or power-based hierarchical organization of roles. I believe the locus of control and power is within an individual and their ability to influence. I did not simply defer to perceived power, but rather I call my leadership inquiry-based leadership because I always use questions to pull people together to find common ground. Whether you're a physician, pharmacist, nurse, therapist, there's a part for everyone to play that needs to be orchestrated when it comes to patient safety," Morath said.

Beyond Children's Hospitals and Clinics, Morath has held significant roles in major U.S. health systems, including chief quality and safety officer for Vanderbilt University Medical Enterprise and system vice president of Allina Health System in Minnesota. She has served as chief nursing officer, vice president of clinical services, chief operating officer, and was the President and CEO responsible for developing the Hospital Quality Institute of California.

"They say luck favors a prepared mind. I didn't go looking for these positions, they came to me, and I had a supportive family who were willing to move around so I could contribute," she said.

She is a founding and current member of the Lucian Leape Institute for Healthcare Improvement and has served on the Board of Commissioners of The Joint Commission. During her time serving on the Joint Commission Board, she was also chair of the National Nursing Advisory Committee of nurse leaders from academia, service, and nursing organizations.

She is also an affiliate faculty member in the Division of General Internal Medicine at the University of Washington School of Medicine and served as the board president for the Collaborative for Accountability and Improvement and remains on its board.

Of being a woman in places of power, she said the biggest challenge was getting people past categorizing and pigeonholing her with their own reference of what a nurse is and what a woman is in health care.

"Part of it is not blinking in the face of criticism but to step up to it and sort through it," Morath said. "It's also important to listen to what is said and unsaid; to fully engage with the process; gain the perspective of others always; and openly share your assumptions, concerns, and fears so that others join you. In doing so, people get a sense of your character, what's important to you, what you know and contribute and what you can do. Integrity is important for individuals but also for organizations."

She added that it is integral to recognize and create policies that recognize the interconnectedness of patient safety and workforce safety, whether its violence, infection, musculoskeletal injury, or lack of respect experienced by the workforce.

In recognition of her humanitarian efforts in patient safety, Morath received the Beau Biden Humanitarian Award from the Patient Safety Movement Foundation. She is also an accomplished author, with influential books such as Do No Harm and The Quality Advantage, and over 50 publications to her name.

Morath finds hope in the academic progression of nursing programs and the increasing number of nurses stepping into leadership roles. She is also encouraged by the potential of nursing to bridge public health and medical care, despite challenges like faculty shortages, and the potential in entering meaningful partnerships with patients and families.

"Nursing is in a great position to bridge public health and medical care, and we're seeing more of that in community-based practices," Morath said.

Looking ahead, Morath hopes for greater transparency, accountability, inclusion, and kindness. She added that greater focus on healthcare equity is overdue and will inform new and better systems of care.

Her passion for patient safety and quality improvement continues to inspire and mobilize others in the healthcare industry. In her own words, "The phrase 'inflection point' is used quite often, but I truly believe we are at one. The way the healthcare system has been operating is not sustainable. There's a lot of exciting work that is being done exploring new models of care."

A long-time friend of the Foundation and Board member of WHAMglobal, Morath said JHF's strength is in its boldness to break through old molds, find new models, and mobilize people and organizations to progress change. She lauded the critical work to establish a National Patient Safety Board and its recognition in President Biden's Council of Advisors on Science and Technology's recommendations for health care.

Of JHF's President and CEO Karen Wolk Feinstein, PhD, Morath said her superpower is bringing people together and elevating others.

"The passion (of the Foundation) is contagious. The candor and the energy that the Foundation puts forward is significant in creating change. The continual search and scanning the environment for areas we have gaps – maternity care, women as they age, teen mental health, HIV/AIDS – are all examples of where care processes and outcomes in care exist. The Foundation has taken those things on and is willing to help fund, support, and advance work in those targeted areas and the model they create is transferable to other areas of care and is action focused. It's exciting to be a part of."