January 17, 2003

Great to Greater — Fall retreat begins to bear fruit at Medical Center

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Norman Urmy addresses the crowd at the fall retreat.

Great to Greater — Fall retreat begins to bear fruit at Medical Center

Over the next eight months Vanderbilt University Medical Center leaders will test ideas and launch initiatives to improve clinical and operational performance.

Forty or so improvement projects received tentative approval two months ago at a three-day retreat that brought together some 12 dozen leaders and experts from across VUMC.

The agreed projects, some of which had already been under discussion well before the retreat, are now queued up for testing and final consideration in four executive team decision rounds that began in December and will conclude in August.

“Think of the initiatives as coming in three phases,” said Norman B. Urmy, executive vice president for Clinical Affairs and CEO of Vanderbilt University Hospital. “The first two phases are designed to free capacity to work on things that will be transformational. Having first created breathing room, we can work on goals such as reducing variation in health care — using evidence-based medicine to improve clinical outcomes, remove unnecessary costs and improve patient satisfaction. That’s the ultimate payoff that we’re after.”

“The purpose going into the retreat was to identify initiatives that the assembled group could agree were important to improve operating and clinical performance,” Urmy said. “Along the way another theme arose — the notion that we’re operating at full tilt, that it’s hard to get people into the hospital, that people are working a lot of overtime.”

There was general agreement that clinical capacity can’t be operated at the current level indefinitely. Along with focusing on performance, the people at the retreat began looking for ways to bring relief, particularly for the large and diverse Vanderbilt front line.

The first round of steering team decisions was concluded Jan. 3. Though most of the first-round initiatives had been previously approved at the executive level, they received added impetus at the retreat. The following is a partial list of projects approved for round one:

• To help ease inpatient access, 24 beds will be added across Vanderbilt University Hospital inpatient units.

• To ease the outpatient mid-week bottleneck, clinics will work to make better use of Thursday and Friday afternoons and certain clinics will consider expanded hours.

• To take off some pressure on weekdays, the OR will begin routine weekend operation on a limited basis.

• The ED will evaluate extending the hours of its fast-track program, which allows patients with minor injuries to be seen more quickly.

• The budget process was simplified to keep managers from having as many meetings to defend their budgets.

• Various measures were approved to help Vanderbilt strike a more fiscally manageable balance between under-reimbursed care for TennCare patients and care for patients with commercial insurance.

• Several first-round information technology initiatives deal with measuring and expediting patient throughput.

• Retreat participants also agreed to cut down on the number of standing meetings at Vanderbilt. Urmy, who has already reduced his meetings by half, has sent an e-mail to administrators encouraging them to reduce their standing meetings. “If we’re going to do these projects, we can’t be spending all day in standing meetings,” he said.

The retreat, held Nov. 20-22, was sponsored by Urmy, Chief Nursing Officer Marilyn A. Dubree, School of Medicine Dean Dr. Steven G. Gabbe, Chief Medical Officer Dr. John S. Sergent, and Associate Vice-Chancellor Dr. William W. Stead. The five retreat sponsors have become a steering team. Each initiative approved by the steering team has (1) a champion on the steering team, (2) an executive sponsor, someone with the necessary clout to bring the initiative to conclusion, and (3) an initiative leader who is close to the work in question.

Martha Miers, executive director of Diagnostic Labs, has temporarily left her job to become the full-time facilitator for the steering team, and Bret Perisho, director of Finance, has rearranged his duties to focus on measuring the impact of the initiatives.