by Holly Fletcher
Team building and efficiency are umbrella priorities over the coming year as leaders focus on strengthening patient flow through existing, and newly opening, inpatient and outpatient facilities and bolstering the spirit of culture, top executives said at the August Leadership Assembly.
After a strong fiscal 2019 rebounding from the “Epic Leap,” Vanderbilt University Medical Center is poised for success in the coming year as digital and efficiency initiatives bolster enterprise strategy, said Jeff Balser, MD, PhD, President and Chief Executive Officer of VUMC and Dean of Vanderbilt University School of Medicine.
Here’s what to know:
1. Financial independence requires constantly enhancing fiscal strength.
Keeping the health system on track to increase salaries while pursuing strategic growth in an environment of rising costs means all programs across VUMC are constantly seeking efficiency and productivity gains.
The Medical Center’s lenders — institutional bondholders — watch for budget management and growing cash savings as indicators of financial health. The end of fiscal year 2019 finished on our budget target, and with a milestone of 100 days of cash on hand of savings, or enough money in the bank to fund all VUMC salaries in the unlikely event of a major crisis without revenues for more than three months.
Recognizing this progress, the institution is doing across-the-board 2.5% salary increases on Oct. 1 for staff positions (Jan. 1 for most faculty), with additional adjustments for certain roles where compensation is below the local market. In addition, a two-year priority is to ensure no full-time VUMC employee is paid below the $15/hour “living wage” level. VUMC will invest nearly $20 million more in pay increases in Fiscal 2020 than in Fiscal 2019.
“Nationwide, the expenses we manage as a health system are growing faster than revenues, so the great work we are doing to improve efficiency, trim unnecessary costs and expand productivity is making these vital pay adjustments possible,” said Balser.
2. Make it local.
The purchase of the hospital in Wilson County is part of a long-term strategy to put care closer to where people live as well as alleviate overcapacity in the Adult Hospital and some clinics when possible.
The Vanderbilt Home Care Services team — which treats about 500 patients a day — drove more than a million miles last year as they cared for people at home for whom skilled treatment can reduce readmission.
3. Get Digital.
Telehealth services are offered in 87 areas, a convenience for patients and a key to alleviating overcapacity in some clinics. Additional uses are being rolled out and C. Wright Pinson, MBA, MD, Deputy CEO and Chief Health System Officer, encouraged people to try a telehealth service to better understand the technology, adding “it’s a very modern thing to do.”
Patient enrollment in My Health at Vanderbilt increased 37% year-over-year, bringing enrollment to more than 435,000 people. Online scheduling, a feature of the digital portal, is central to efficiency and patient engagement — and increased from 4,000 to 50,000 appointments in one year.
“I want us to be among the first major health systems where patients can schedule nearly all of their appointments online,” said Balser.
The My Health at Vanderbilt Advance Directive got a digital makeover from Neal Patel, MD, MPH, Chief Health Information Officer, to simplify the completion process. Forms can be completed online for your VUMC provider’s office to upload to eStar. Soon, an online self-submission functionality will be live at My Health at Vanderbilt.
Care teams are being re-designed in primary and specialty care clinics to free providers from some electronic health record documentation responsibilities, so they spend more time with patients and have less chart work to do after hours. These team-based care initiatives will be expanded to more outpatient practices as we gain more experience.
“We’re going to continue to work these models and scale them because the wellness of our clinicians is important to us,” said Balser.
4. The “I” in team is you.
Improving communication channels across the enterprise as well as between department leaders and employees is a priority in the coming year, said Balser. As the Medical Center expands, cultivating a deep sense of team spirit is key for patient experience and outcomes in addition to corporate cohesion.
“Our path forward is possible because of you and your team,” said Pinson.
5. Pillar Goals.
The Medical Center met or exceeded 14 of 18 goals for 2019, including seeing new patients within 14 days and shortening length of stay.
One milestone is a 0.86 observed-to-expected mortality rate — an industry risk-adjusted measure of a hospital’s mortality. At that rate, 234 more patients were discharged from VUMC than would have been from similar hospitals.
“Everyone worked together to achieve that,” Pinson said.
6. Mindful respect and confidence.
The unease and anxiety about the mass shootings happening all over the country is impacting people across VUMC, and it’s vital to be mindful of how the ever-increasing number of incidents impacts colleagues. VUMC handles heavy Emergency Department traffic daily that meets the definition of “mass casualty” volume and routinely prepares for single mass casualty situations.
“If violence like the mass shootings in El Paso and Dayton comes to Nashville, it will be terrible, but we are prepared. I want you to have the quiet confidence that when, and if, this happens in Nashville we will be ready to save people — and we will,” Balser said.
