July 9, 1999

Improvement expert settles in as VUMC’s chief quality officer

Improvement expert settles in as VUMC's chief quality officer


Dr. Paul Miles

Dr. Paul Miles was recently named Vanderbilt University Medical Center's first-ever chief quality officer, charged with promoting quality improvement across the entire clinical program.

Miles, 56, is a pediatrician who says he gravitated to quality improvement in part out of frustration with various common defects of the health care system.

VUH and VMG quality consultants and quality technical staff have been consolidated under Miles' leadership, forming the Center for Clinical Improvement, located on the first floor of Medical Center North.

An Idaho native, Miles is former director of clinical research at Magic Valley Regional Medical Center in Twin Falls. His medical degree and resident training in pediatrics are from UCLA, his undergraduate degree is from Stanford.

Miles has been quick to acquire firsthand experience of Vanderbilt inpatient and outpatient care. Chest pains set in his first morning on the job, as he carried boxes to his new office. The pains subsided, then flared again at noon. As his lunch meeting broke up, Miles drew aside VMG Chief Medical Officer Dr. John Sergent and explained his situation. They walked to the Emergency Department, where an electrocardiogram indicated Miles was undergoing heart attack.

Forty minutes after entering the ED, Miles was in the heart catheterization lab under care of cardiologist Dr. Drew Gaffney.

Instead of settling in to his new office, Miles spent the next 48 hours settling into a bed on 7 north under the care of Dr. John Dixon. He was back to work in one week. The heart attack left his heart muscle undamaged.

"Taking this job at Vanderbilt probably saved my life. I feel embarrassingly well," Miles said. "People really are nice here and were very good to me as a patient. That's one of the elements of quality. Patients want someone who cares – they want technical expertise, too, but a caring atmosphere makes all the difference."

Quality driven

Miles confirms that significant system drawbacks are endemic in health care.

"Pick any medical problem and you can find system problems that affect the outcome."

Asked for his view as to why he was selected for this new post, Miles notes that his background combines both theory and practice. "I've not only done the work, I've taught it to physicians nationally and internationally. Also, I think they were specifically looking for a physician to take this job."

The core of his task is to use the Center for Clinical Improvement to impact patient care and the general health of VUMC patient populations. The center will help Vanderbilt clinical leaders – doctors, nurses and administrators – succeed in realizing clinical quality improvements. The center will also work on behalf of community health.

"We'll look at how Vanderbilt, as an academic center, can help promote community health through relationships with private practitioners and with the community itself."

Miles laid out a basic strategy – the Center for Clinical Improvement will focus first on five or six quality projects, with an eye to later introducing them as a model for the entire institution. They'll begin by identifying priorities based on mortality, morbidity, cost, and patient satisfaction and searching out front-line quality champions.

VUMC is already ahead, Miles said. He points to some examples: efforts underway to improve care for people with advanced cases of heart failure and chronic obstructive pulmonary disease, the pediatric asthma improvement initiative, the transplant program's thorough approach to data analysis.

"Vanderbilt has a lot of efforts already going. Many of the required components are there. We could become one of the top places for applying principles of quality improvement to health care."

The system problems Miles is concerned with tend to be deep rooted and require concerted effort to correct.

"We're basically talking about application of the scientific method, about collecting data, proposing hypotheses, making changes and measuring the results. We need an intense focus on patients, and an ability to measure what we do with every patient that comes through the system. What needs to change isn't individuals, but the system itself."

For more information, call the Center for Clinical Improvement at 2-3366.