December 11, 2009

Clinical enterprise takes center stage at assembly

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C. Wright Pinson, M.D., MBA, speaks during this week’s Leadership Assembly. (Photo by Anne Rayner)

Clinical enterprise takes center stage at assembly

First-quarter business results at Vanderbilt University Medical Center (July through September) present a positive financial picture, but the near-term outlook for health care finance in Tennessee is precarious, so everyone at the Medical Center needs to remain vigilant about costs.

As happens every three months at VUMC, on Tuesday morning some 600 managers and faculty leaders assembled to review progress and discuss plans for continued improvement across the Medical Center's five management “pillars”: quality, service, people, growth/finance and innovation. They gathered at the Student Life Center.

As always, speakers balanced their presentations between, on one hand, celebrating the Medical Center's continued positive trajectory, and, on the other hand, pointing out opportunities for improvement and rallying support for change.

“On an operating basis, year-to-date we're doing very well, we're ahead of budget. As you know, we had a tough year last year and we need to replenish our savings: we're on target to do that,” said Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of the School of Medicine.

Jeff Balser, M.D., Ph.D., addresses the audience at this week’s Leadership Assembly. (Photo by Anne Rayner)

Jeff Balser, M.D., Ph.D., addresses the audience at this week’s Leadership Assembly. (Photo by Anne Rayner)

Also in some doubt are future Tenncare funding levels and levels for government payments to medical centers to offset expenses for graduate medical education.

“Let's keep expenses down. We're doing really well now, but it could get tough in the last quarter,” Balser said.

As a dire alternative to layoffs, at the start of this fiscal year Vanderbilt reluctantly withheld annual salary adjustments for all employees.

“Barring some unforeseen catastrophe, we intend to do a salary increase in July,” Balser said. “We're unable to say right now how large that will be. We want to do as much as possible.”

C. Wright Pinson, M.D., MBA, deputy vice chancellor for Health Affairs, presented the first-quarter VUMC progress report.

Regarding employee satisfaction benchmarking, VUMC leaders are looking first at VUMC scores as compared with the 20 top-scoring health care organizations in the vendor's database. At 86 percent, VUMC overall job satisfaction matches the vendor's health care top 20. At the institutional level (as opposed to the work-group level), Pinson identified two leading areas for employee satisfaction improvement — pay satisfaction and human resources/personnel policies. A consultancy is reviewing these areas for Vanderbilt.

Vanderbilt Medical Group is setting out to give new patients an appointment within 15 days of the request. The target for this initial year is to meet this new standard 60 percent of the time. In the first quarter, VMG performance overall was 54.25 percent, up from last year's performance of 52.51 percent. Pinson sees a hopeful trend.

“Most importantly, the message is getting around: this is what is expected and is the norm; we are focusing on what patients need, not what is convenient for us,” he said.

Regarding Vanderbilt's wide-ranging patient safety and clinical quality improvement efforts, Pinson said, “We have made steady progress and we have gotten great results. And that's been going on for about four or five years — at least. But we do have work to do here to meet our necessary and ambitious pillar goals for this year.”

Hand hygiene drew repeated comments; frequent auditing indicates that compliance with hand washing standards is on target in the clinics, but below target in the hospitals.

“It's really amazing to me, when I think of all of the technology that exists today — all of the remarkable drugs that have come out, the databases we dig through, personalized care with genetics — what is the deal with washing your hands?” Pinson said.

He announced that VMG is beginning to test new outpatient care delivery models for hypertension and diabetes, and that in the years ahead findings from these pilots will be used to help reshape care delivery more generally across VUMC.

Marilyn Dubree, M.S.N., R.N., gives an update on the Community Survey. (Photo by Anne Rayner)

Marilyn Dubree, M.S.N., R.N., gives an update on the Community Survey. (Photo by Anne Rayner)

To conclude the morning's program, Pinson was joined on stage by Dubree; Monroe Carell Jr. Children's Hospital at Vanderbilt CEO/Executive Director Kevin B. Churchwell, M.D.; Vanderbilt University Hospital CEO Larry Goldberg; and Vanderbilt Clinic CEO David Posch. Pinson asked the panel: how their respective units contribute to VUMC; for their suggestions for working better together across the clinical enterprise; what their own plans were for using recent “pillar” results and employee satisfaction survey results; and what they think is needed to make VUMC successful in the long run.

Materials from the assembly are posted on the elevate Web site (employee log-in required).