The way David Posch, CEO of Vanderbilt University Hospital and Clinics, described the health care industry’s current landscape to members of the Patient and Family Advisory Council at the group’s August meeting Tuesday night was by quoting the opening line of Charles Dickens’ “Tale of Two Cities” — “it was the best of times, it was the worst of times.”

Evolve to Excel (E2E), a comprehensive initiative designed to strengthen operational practices throughout Vanderbilt University Medical Center to ensure long-term success of the organization, is moving ahead.

With a desire toward process improvement that will result in lasting change, and in response to ongoing financial pressures from declining reimbursements for the treatment of Medicare and Medicaid patients along with reductions to federal research funding due to the nation’s ballooning deficit, Vanderbilt University Medical Center is embarking on a comprehensive program designed to sharpen operational practices throughout the institution to better meet the economic realities facing the future of health care delivery and research.