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Assembly outlines VUMC’s fiscal path, plans for growth

Jun. 20, 2019, 9:23 AM

A panel discussion at last week’s Leadership Assembly focused on the importance of talking with patients about uncomfortable but crucial topics. From left are Marilyn Dubree, MSN, RN, Julie Burton, LCSW, David Raiford, MD, and Martha Reeves, RN.
A panel discussion at last week’s Leadership Assembly focused on the importance of talking with patients about uncomfortable but crucial topics. From left are Marilyn Dubree, MSN, RN, Julie Burton, LCSW, David Raiford, MD, and Martha Reeves, RN. (photo by Anne Rayner)

by Holly Fletcher

Patient experience and facilities expansion are the touchstones of the upcoming fiscal year strategy to align Vanderbilt University Medical Center’s growth with financial strength.

Top executives praised the task of working through the “EpicLeap” transition to get patient volumes back to, and in some departments above, pre-transition levels at the June Leadership Assembly that recognized the quiet resonance of dedication to tasks — ranging from patient parking to solving a tech conundrum — that polishes the daily experience of patients and employees.

Three years into legal and financial independence from Vanderbilt University, the Medical Center is concentrated on maintaining its stride of investing in its people and facilities, putting cash into reserves and burnishing how patients interact with technology and staff at various access points.

“We are focused on efficiency and prudent financial strategy so our investors continue to see us as strong and stable and associate the Vanderbilt Health brand with financial strength. Our major financial challenge for fiscal 2020 is to manage our labor costs as we balance the complexities of staffing for growth while we finish bringing new inpatient and outpatient spaces online,” said Jeff Balser, MD, PhD, VUMC’s President and Chief Executive Officer and Dean of the Vanderbilt University School of Medicine.

The next two years will see about 200 new inpatient beds while a variety of outpatient facilities open around the region. The acquisition of Tennova Healthcare-Lebanon is slated to close on Aug. 1, immediately adding licensed beds in Wilson County about 32 miles east of the main campus.

“The Wilson County Hospital has a strong leadership team and capable staff, and we have enjoyed working with them. The acquisition is one of several expansion initiatives of which the Vanderbilt Health community can be proud,” said C. Wright Pinson, MBA, MD, Deputy CEO and Chief Health System Officer.

Moving into the next fiscal year, Medical Center leaders will increasingly be looking for process improvements designed to increase productivity without increasing workload through efficiency and workflow improvements and better synchronizing systems.

For instance, a cardiac surgery pilot that increased the number of discharges before 11 a.m., is one of dozens of projects in the last year that “put design thinking into action to imagine what should this process really look like,” said Balser.

“We want to nurture and encourage creativity in improving work flow to make it easier for patients and staff to accommodate the growing patient volume we’re experiencing.”

The Medical Center made significant improvements in the number of patients seen within 14 days and online scheduling as well as length of stay and meeting pay-for-performance benchmarks, said Pinson. “More than half of the Pillar Performance goals are on track to be at threshold. Readmissions, patient experience and patient harm index will be priorities in the coming year,” Pinson said in his quarterly Pillar update.

In continuing efforts to eliminate sexual harassment in the workplace — a major concern for health systems nationwide — Balser updated the assembly on actions announced earlier this year by Employee Relations to facilitate reporting of these incidents. To further support employees who wish to discuss a situation confidentially, the Medical Center will in late summer open the SHARE Center, a confidential resource designed to support VUMC employees who are experiencing sexual harassment. Additional details about the SHARE Center will be announced closer to opening.

Leaders at VUMC are encouraging as many employees as possible to discuss their goals of care at the end of life with their family, and to document their goals in an “advance directive,” as a step toward encouraging all adult VUMC patients to do so. Guidelines and support for preparing an advanced directive have been updated in the My Health at Vanderbilt portal, under the My Record tab.

Advance directives, and the weighty discussions they spur for people and their families, are central to helping people receive the level of care that meets their preferred quality of life.

“We care for people throughout their lives, and that includes listening to and respecting their wishes at the end of life. We are increasing our efforts to talk to patients about their end-of-life goals, as well as documenting our own,” said Balser.

Executive Chief Nursing Officer Marilyn Dubree, MSN, RN, moderated a discussion among Julie Burton, LCSW, Pediatric Cardiology at Monroe Carell Jr. Children’s Hospital at Vanderbilt; David Raiford, MD, chief of Clinical Staff; Martha Reeves, RN, Medical Intensive Care Unit, Vanderbilt University Adult Hospital about the emotional burden of talking with patients about uncomfortable but necessary topics to ensure the right care is delivered.

“We need to understand ‘I want everything done’ means and what is their definition of quality of life,” said Reeves, who talked about her own advance directive and her attempts to get her father-in-law to put one in place.

Burton said the medical advancements bring hope to people in tough situations, yet sometimes reality necessitates comfort, not hope.

“Sometimes we hold onto that hope longer and harder since medicine has improved so much. Families trust us. They have so many struggles and they should never feel like they are doing it singlehandedly. It’s out of respect to our patients and our families that we have to have those hard discussions with them — it is our privilege and it is our duty,” said Burton.

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