September 25, 2009

Meeting explores culture of caring, accountability

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Jeff Balser, M.D., Ph.D., talks about VUMC’s culture at last week’s Leadership Assembly. (photo by Susan Urmy)

Meeting explores culture of caring, accountability

Caring and accountability were the themes for a presentation given last week at Langford Auditorium by Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of Vanderbilt University School of Medicine.

The occasion was the Leadership Assembly, a quarterly affair drawing some 800 managers and faculty leaders from across the clinical enterprise. Balser also presented this year's clinical enterprise goals.

Balser said accountability begins with caring and concern and the willingness to recognize and deal with mistakes. He sees this combination of caring and transparency as the core of VUMC's organizational culture.

He used hand washing to illustrate accountability for evidence-based patient care protocols.

“A physician walks into a room without washing his or her hands, and a nurse sees that person walk into that room and says, 'Doctor, you forgot to wash your hands.' Does the nurse actually say that? And if not, why not?” Balser said.

“And if the nurse does say that to the doctor, does the doctor say, 'Oh, thank you for reminding me,' and go out and wash their hands? Well, if not, why not?

“And if the doctor says, 'You know, I don't really need to do that, I'm too busy,' does the nurse report that? … And does that work its way up the chain until somebody is held accountable?

“And if not, why not?”

Balser warned against confusing accountability with an organizational chart.

“Nobody working in this organization should have the slightest reluctance to politely say to someone, 'I think you're making a mistake here.' … We all need to hold one another accountable.”

Innovation has become a new, fifth pillar of the VUMC management strategy — alongside quality, service, finance/growth and people. Balser mentioned diabetes and high blood pressure as two targets for clinical program innovation this year.

VUMC will continue to leverage its strengths in clinical information technology as it seeks to improve prevention, detection and management of these increasingly common patient problems.

This year's target for risk-adjusted inpatient mortality is 70 deaths per every 100 expected deaths. Balser predicted VUMC will exceed this mark.
“We're going to become the safest medical center in the United States. We were No. 5 or 6 this year — we're going to be No. 1,” he said.

In the face of continued tremendous demand from the community for Vanderbilt outpatient services, practices will try to see new patients within 15 days of the request for an appointment.

Bill Stead, M.D., left, John Manning, Ph.D., Marilyn Dubree, M.S.N., R.N., and Wright Pinson, M.D., M.B.A., speak at last week’s Leadership Assembly. (photo by Susan Urmy)

Bill Stead, M.D., left, John Manning, Ph.D., Marilyn Dubree, M.S.N., R.N., and Wright Pinson, M.D., M.B.A., speak at last week’s Leadership Assembly. (photo by Susan Urmy)

More specifically, this year's target is to meet this new standard at least 60 percent of the time.

“There is nothing that says to people, 'I don't care about you,' more than having them call us and hear that it's going to be two or three months before they can get an appointment,” Balser said.

The Medical Center will also seek to improve communication with patients regarding their health conditions and treatment.

“A lot of people we can't cure. But we care about everyone, and we can communicate that care effectively,” Balser said, implying that new importance will be given to the ongoing evaluation of communication in patient surveys.

In fiscal 2009, the hospitals and clinics returned a very healthy $80.7 million gain, but VUMC lost $9.4 million due to investment losses of $87.8 million. Over the next five years, as a buffer against any future financial calamity, VUMC will aim to put away $250 million in savings.

Balser said the willingness of employees to forgo this year's annual salary increase helped VUMC avoid mass layoffs.

“The response [from the organization] was unambiguous, 'I would much rather go without a raise than see my colleagues laid off.' I'm proud to work at Vanderbilt because of you and what your values are. It's put us in an incredibly strong position for the future because we handled this the way we did,” Balser said.

Balser, who became vice chancellor in June, said three main requirements were used in selecting his senior leadership team: leaders had to share the organization's core values, had to be able to put the team before themselves, and had to be admired by their organization.

At the assembly, three members of the senior leadership team — Deputy Vice Chancellor Wright Pinson, M.D., M.B.A., Associate Vice Chancellor Bill Stead, M.D., and Associate Vice Chancellor John Manning, Ph.D. — took the stage to answer questions about their roles and about the year ahead.

The day's program also featured a presentation of “What's Right at Vanderbilt.”

Mike Waterman, Ph.D., chair of Biochemistry, talked about the emergency cardiac care he received recently at Vanderbilt University Hospital, and about the culture of cooperation and caring that he found here. A medical student, Adam Wegner, talked about the Shade Tree Clinic, a student-run program that coordinates charitable care in an underserved area of Nashville.

And Marilyn Dubree, M.S.N., R.N., executive chief Nursing Officer, extolled a number of VUMC employees and programs, including Project Opportunity, which provides career development for adults with developmental disabilities.