November 10, 2011

Focusing on quality key to improving value of care: Posch

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David Posch, CEO of Vanderbilt University Hospital and Clinics, speaks at last week’s update for the adult hospital and clinical enterprise. (photo by Susan Urmy)

Focusing on quality key to improving value of care: Posch

The outlines of the crisis are by now familiar. The United States is beset with runaway health care costs, while from all sides is heard an increasingly insistent call to make health care better, safer and more reliable.

Leaders at Vanderbilt University Medical Center like to point out that solutions to the problems in health care won’t come from outside observers, but from health care providers and workers themselves.

Last week, faculty and staff received an update from clinical leaders, who reconfirmed their focus on providing ever greater reliability and affordability in the delivery of health care and a more comprehensive approach to patient problems.

The annual executive update for the adult hospital and clinical enterprise was repeated on successive days in Williamson County, at Vanderbilt Health One Hundred Oaks and in VUMC’s Light Hall. The title was “Driving Value in the Adult Patient Experience, and the Role You Play.”

Leading the presentation was David Posch, CEO of Vanderbilt University Hospital and Clinics, who sees value as a lodestar, and whose basic prescription for health care can be summed up as follows: improve quality and reliability and you’ll markedly decrease the need for acute services, thus lowering overall costs.

“How do we move from taking care of episodic and acute disease to really think in terms of creating reliable, preventive systems in health and a focus on wellness? And how do we make sure that everything we do is in fact appropriate and reliable as we go forward?

“Really what we need to do is demonstrate that patients receive everything they need and nothing more,” Posch said. “When all is said and done, we have to become design engineers, every single one of us: we execute our work, but we also have to be thinking about how we can improve our work going forward. That’s what we’re going to be spending our time thinking about: trying to fix that value equation, improving our quality, reducing our cost.”

Allen Kaiser, M.D., chief of staff of the Vanderbilt Health System and interim chief operating officer of Vanderbilt University Hospital, set out a year of accomplishments by faculty and staff at VUH.

Teams are succeeding in lowering dangerous central-line-associated blood stream infections and readmission rates for certain high risk groups, including patients with heart failure; the Rapid Response Team has proven a successful strategy for preventing inpatient respiratory arrest; collaborative cost-cutting efforts are saving million of dollars in supply chain costs.

Marilyn Dubree, MSN, R.N., Executive Chief Nursing Officer, noted that consumers by a wide margin consistently rate VUMC nurses as the best in Nashville. She said nurse recruitment is healthy at VUMC, and education levels attained by newer recruits is rising.

Vanderbilt is posting excellent nurse satisfaction scores, indicating that ongoing efforts to lower turnover may be bearing fruit. Dubree also spoke glowingly about research activity among Vanderbilt nurses, which is undergoing a sharp rise.

Margaret Head, MSN, MBA, R.N., chief operating officer of Vanderbilt Medical Group, and Paul Sternberg Jr., M.D., assistant vice chancellor for Adult Health Affairs, took turns providing a VMG update. They noted that the agenda set out this year by the VMG Patient Safety and Quality Committee includes better medication reconciliation and management, better patient handovers, reliable results reporting and quicker patient access.

Through a variety of VMG patient access initiatives, clinics are getting better at providing appointments within 15 days of the request.

The ongoing improvement efforts at VMG also include increased electronic prescription writing, use of clinical summaries to be handed to patients at the conclusion of each visit, and better utilization of patient capacity on Friday afternoon.