September 11, 2009

Balser charts Medical Center’s new course

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Jeff Balser, M.D., Ph.D., talks about his goals for VUMC at Tuesday’s State of the Medical Center Address. (photo by Joe Howell)

Balser charts Medical Center’s new course

Innovations in research at Vanderbilt University will have a transformative impact on the country's health care system as it relates to the quality and cost of care.

In his first State of the Medical Center Address, Jeff Balser, M.D., Ph.D., provided a focused vision for the future and a fresh perspective on the strengths of the Medical Center and University.

As the newly appointed vice chancellor for Health Affairs and dean of Vanderbilt University School of Medicine, Balser delivered the address on Tuesday to a large crowd, including Chancellor Nicholas S. Zeppos, at Langford Auditorium.

“We have a remarkable culture here. We care about one another,” he said. “The Medical Center is an enterprise with persons interested in very different things, but which functions together effectively as a whole.

“We are a player in health care, with a real opportunity to be a dominant national leader, and I want us to think about what it means to be one of the most influential places in the country.”

Balser focused on the direct link between clinical care, education and research and the impact that relationship can have on the quality of health care throughout the world.

He also shared goals that hit a little closer to home, such as reducing new-patient wait times at Vanderbilt to 15 days. One patient service already implemented and successful at Vanderbilt Health at 100 Oaks, and unique in the region, allows women to have screening mammograms without an appointment.

The patient demand for Vanderbilt services is “staggering,” Balser said, but the addition of a third bed tower to be completed in November and the first full year of 100 Oaks should contribute to increased outpatient visits and reduced appointment wait times.

Langford Auditorium was packed for Balser’s first address as vice chancellor for Health Affairs. (photo by Joe Howell)

Langford Auditorium was packed for Balser’s first address as vice chancellor for Health Affairs. (photo by Joe Howell)

Balser, who assumed his new responsibilities on June 1, said he wanted to touch on things important to every one of the 22,000 people working at the Medical Center.

Elevate will continue with changes, including an enhanced focus on the pillars of People, Service and Quality and the addition of an Innovation pillar.

The new pillar is aimed at goals such as reducing the cost of health care per person in the United States, while attaining better results.

Balser noted a difference of $3,500 per person spent on health care during 2007 in the United States when compared with Europe, the U.K. and Canada.

“We spend more than other developed nations, and their statistics are far better,” Balser said. “Clearly there is room for improvement and there is a lot of low-hanging fruit.”

With Vanderbilt treating 300,000 unique individuals each year, small improvements can add up quickly.

By focusing its unique resources and strengths in innovation toward increasing the use of evidence-based medicine and reducing variability in practice that exists in America due to overuse, misuse and underuse, Balser said Vanderbilt can reduce health care costs.

He demonstrated the effectiveness of a systems approach to care, showing a drastic reduction in the number of ventilator acquired pneumonia (VAP) cases each year at Vanderbilt. Many of the care protocols are based on the work of VUMC investigators.

The number of ventilator acquired pneumonias dropped from over 300 a year to about 140 per year with the VAP project.

The impact of this project alone was prevention of 16 deaths per year, more than $4 million in savings per year, more than 100 hospital days per year avoided and more than 400 ICU days per year avoided.

“The real issue in finding the dollars to pay for health care reform isn't insurance reform,” he said. “It is how we function differently to innovate and improve quality.”

Balser said there are thousands of opportunities across the Medical Center to produce results similar to the VAP project.

VUMC is now leading the country with the lowest ventilator mortality rates, length of stay and cost for patients ventilated for more than four days, according to the UHC.

The Medical Center has strategic advantages to grow as a national leader in health care.

Vanderbilt is one of a small handful of Medical Centers with a fully integrated system of clinical care, research and education (only 25 out of 130 in the country). And even fewer are fully integrated with a university — fewer than 10 of the top 20 US News best hospitals. Even fewer are co-located on the same campus.

Balser said Vanderbilt's discovery enterprise is a key driver to success throughout the Medical Center, with NIH research funding still on the rise despite an unprecedented economic crisis.

“Progress in discovery is a big reason we are becoming recognized,” Balser said. “In addition, our informatics strength is helping us move discovery to the bedside and is unprecedented in the country.”

Balser noted that nearly 25 percent of the Medical Center workforce is rooted in research.

VUMC has also been the recipient of nearly $25 million in funding from the federal stimulus package during the first two months of awards.

Balser wants Vanderbilt, which now has one of the largest DNA resources in the world, to be known as the place that solves problems targeted at the unique characteristics of individuals, from their genomic makeup to their cultural background, and then spreads those answers across the world.

“Personalized medicine is one area where we can be a definitive worldwide leader,” he said.

In the pillar area of Growth and Finance, Balser is focusing one-third of his time on philanthropy, which he believes will help Vanderbilt compete for students and faculty with peer institutions such as Stanford, Yale and Harvard.

“The biggest difference is no longer our size and scale, but rather the larger endowments of our competitors,” he said. He wants a renewed focus on philanthropy to be visible to the Vanderbilt community.

He said financial support from the University kept the Medical Center afloat during last year's economic downturn, which is an example of how the University and Medical Center function together as one university.

A target of $51.3 million in savings to be generated in FY 2010 was reported by Balser, with net results projected at $72.6 million.

Under the Quality pillar Balser noted that VUMC's expected mortality rates are among the best in the country, with 378 fewer deaths than expected last year and a goal for FY 2010 to improve on that number, meaning there would be 480 persons who were expected to die due to their conditions, but lived because they received care at Vanderbilt.

Under the pillar of People, Balser said that VUMC turnover rates are very good in all areas, especially nursing.

Vanderbilt was the first university named to Fortune 100's Best Companies To Work For and is also ranked by The Scientist magazine as one of the top 10 places for job satisfaction in research.

The 2009 Staff/Faculty Community Survey opened Tuesday and continues through Sept. 25. It has been simplified and improved from last year's survey and should take about 15 minutes to complete.

Balser said his participation goal is for 99.99999 percent of VUMC employees to complete the survey. “It is extremely important that we hear from you,” he said.

Under the Service pillar he noted that the Medical Center primarily serves two distinct groups — patients and students.

Students say they are among the most satisfied with their medical education in the nation, although those percentages are still only around 70 percent and leave room for improvement.

Graduate students are 95 percent satisfied, nursing students scored Vanderbilt a 3.8 out of 4.0 and residents had a satisfaction rate at 90 percent.

Balser applauded the School of Nursing and Dean Colleen Conway-Welch, Ph.D., for the school's ascent up the rankings to 19th in the nation and the School of Medicine for its slot at 15th in the country.

The Monroe Carell Jr. Children's Hospital at Vanderbilt ranks among the best in the country just six years after opening its doors, placing in the US News top 25 in six specialties.

The Bill Wilkerson Center's Department of Hearing and Speech Sciences is the gold standard for academic excellence and service to patients with its long run as the nation's top-ranked Audiology program.

“Something extraordinary happens nearly every single day at this Medical Center,” Balser said, citing examples of scientific discovery with profound, worldwide impact, and astonishing patient care that improves the lives of individuals and families.

“I am deeply honored to serve as your vice chancellor.”

A Suggestion Box for Medical Center employees to comment or provide ideas is now available online at