October 9, 2009

Meeting reviews outpatient care plan

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David Posch talks about the performance of Vanderbilt’s outpatient clinics. (photo by Susan Urmy)

Meeting reviews outpatient care plan

Quicker patient appointments, better continuity of care as patients move from one setting to the next and new approaches to detection, prevention and management of chronic disease are among changes that will shape outpatient care at Vanderbilt over the coming years.

In his recent State of the Clinics address, David Posch summarized the strategic plan for Vanderbilt's clinics, extolled the accomplishments of staff and faculty and reviewed the performance and growth of the outpatient enterprise.

Posch, CEO of the Vanderbilt Clinic and Executive Director of Vanderbilt Medical Group, delivered his speech three times, from Sept. 23 to Sept. 25, for staff and faculty who work in Williamson County, at Vanderbilt Health at One Hundred Oaks and on the main campus.

“What we do is really all about the patient,” Posch said at the start, and to underline his point he wove into his presentation several video segments in which patients described what they've valued at Vanderbilt and what they would like to see improved.

When a patient in one segment said, “People here care and they strive constantly to do a good job,” approval from the audience was audible.

Posch individually commended nationally recognized nurses, doctors and specialty groups, top patient satisfaction score-getters, certain clinics that stick out for successful projects of quality and performance improvement, clinics that have undertaken concerted community service, Vanderbilt's Patient and Family Advisory Councils, and nurses and patient service representatives who've recently achieved career advancement.

In fiscal year 2009, VMG recorded 1.2 million patient visits, a 120 percent increase from 1999. Over that 10-year period annual revenue increased 266 percent (to $542 million in FY 2009); the general upkeep costs per visit decreased 18 percent; and, while consumer price inflation for the period came to 29 percent, costs per unit of billable service in Vanderbilt clinics grew only 12 percent.

Last year, care delivered in the clinics was rated excellent by 74 percent of patients who responded to ongoing surveys; in the national sample of clinics compiled by the survey vendor, that result placed Vanderbilt's clinics in the 77th percentile. Posch said the next interim goal is to reach the 90th percentile nationally.

“It's going to take more than just being friendly. … We do pretty good on the friendliness quotient. Where we need to do work is on our systems. If it's hard to get in, if it's hard to get around, we risk making patients unhappy and losing their business,” he said.

When patients, leaders, physicians and staff took up long-term strategy planning this year, better patient satisfaction loomed as only one of several requirements. Other elements include:

• VMG will undertake sweeping efforts to improve communication with patients regarding health conditions, treatment and procedures. This effort will include more use of Vanderbilt's patient Web portal, My Health at Vanderbilt.

• Vanderbilt will better balance its outpatient capacity and will standardize patient access across the clinics, including appointment setting and check in. Clinics will aim to accommodate new-patient appointments within 15 days.

• In terms of broad-based safety and quality efforts, Vanderbilt will be focusing on patient hand-offs, infection control and medication reconciliation.

• In terms of care delivery innovation, the initial focus will be on diabetes, hypertension and anticoagulant management. VMG will intensify use of electronic decision support technology as an aid to evidence-based practice.

• Use of electronic systems in the clinics will be reviewed with an eye to eliminating any pitfalls that may detract from customer service. Research regarding service improvement will intensify and new training will be available for leaders, clinicians and support staff.

• Management of individual clinics will be yet more closely aligned with organizational strategy, and managers will adopt new tools for value assessment and evidence-based management.

“There's no question about what we can accomplish together,” Posch said.

He concluded his address by urging staff and faculty to “Embrace change — it's constant, it's needed and it's exciting. Get involved. And keep our patients first — it's why we're here.”