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Adult hospital, clinics positioned for success: Posch

Nov. 8, 2012, 10:03 AM

David Posch discusses the state of Vanderbilt’s adult clinical enterprise during his address last week. (photo by Joe Howell)

Vanderbilt University Hospital and Vanderbilt’s adult clinics have achieved a strong position in the region and are poised for continued growth.

Like other health care providers across the land, VUMC’s hospitals and clinics face serious challenges, but with their unique resources, expert and dedicated staff and faculty and new affiliate network, the adult hospital and clinics are enormously capable of improving health care quality and lowering the cost of care.

Such was the gist of “Driving Value in Clinical Patient Care,” an annual talk on the state of Vanderbilt’s adult clinical enterprise, delivered Nov. 1 by David Posch, chief executive officer of Vanderbilt University Hospital and Clinics.

Posch spoke in the morning at the Marriott in Franklin, Tenn., and again in the afternoon in Light Hall.

According to Posch, three core problems underlie health care quality and cost issues: failure to apply known science reliably (in the form of evidence-based care standards); failure to engage patients and families; and poor continuity of care due to a lack of coordination between patient care settings.

“I would submit to you that government is not going to solve these problems. There is only one group of people that can solve these problems, and that’s us. And if we do, we will fundamentally change the quality outcomes our patients experience.”

Meanwhile, taxpayers and employers are finding the runaway growth in per capita health care expenditure to be unsustainable.

“That means that we’re going to get less money for what we do,” Posch said.

The upshot at Vanderbilt is increased emphasis on value, which equates to improved quality and reduced cost. For Posch, the route to value is through improved system reliability. The balance of his talk was a report on new and ongoing initiatives to increase reliability and value.

Front and center is the recent creation of an administrative structure and initial elements of an infrastructure to support improved patient transitions from the hospital to each patient’s home or other post-acute care setting. Standardization and measurement of these patient transitions is in the offing. This work will dovetail with large disease-management research projects being jointly undertaken by VUMC, three of its affiliated hospitals and certain skilled nursing facilities in the region.

A shift is afoot in health care, Posch said. “It’s going to population-based care. We will be controlling physiologic indicators in groups of patients, not just at the individual patient level but for populations.”

Other reliability and value projects include a burgeoning team-based approach to diagnosis of complex patient problems, use of information systems to deliver clinical decision support in outpatient areas, better use of nurse practitioners, new workflow and patient flow studies in the hospital and clinic, ongoing measurement against targets for quality and patient satisfaction, and outpatient access improvement.

Posch also introduced new leaders, acknowledged top performers in patient satisfaction and discussed other changes and achievements, including:

• Projected fiscal 2013 cost and revenue improvements;

• Refurbishment of the Vanderbilt Psychiatric Hospital and a new reliance there on team-based psychiatric care;

• Increased efficiency in surgical services, radiology services and clinical laboratory services;

• New and relocated VUH patient care units;

• Plans for a new facility to consolidate outpatient services in Williamson County; and

• VUMC’s renewed designation as a Magnet organization by the American Nurses Credential Center.

“I want to thank every single one of you for the amazing things that we accomplish in this organization for every patient, every day,” Posch said in closing.

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