June 1, 2007

Quality, satisfaction initiatives making strides

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C. Wright Pinson, M.D., M.B.A., at last week’s elevate Leadership Development Institute. (photo by Susan Urmy)

Quality, satisfaction initiatives making strides

Care quality and employee satisfaction were twin themes for the tenth Leadership Development Institute, held over two days last week at Memorial Gymnasium.

The meetings are the Medical Center's quarterly series of day-long elevate management seminars, attended by some 800 managers and faculty leaders.

Harry Jacobson, M.D., vice chancellor for Health Affairs, began by reviewing several ongoing building projects, then announced there are more in the pipeline, including an expansion of the Monroe Carell Jr. Children's Hospital at Vanderbilt, to be located across the street on the current site of the Kim Dayani Health Promotion Center, which will move off campus.

Jacobson also said a lease agreement for space at 100 Oaks Shopping Mall is still under negotiation.

Over the last five years, ambulatory visits have risen 11.4 percent per year, emergency visits 6.5 percent per year, and surgical cases 7.7 percent per year.

VUMC's mission is sustained in large part through hospital and clinic operating surpluses. Jacobson forecast a $42.3 million surplus this year and said the goal next year is $65 million.

“I feel really good about how we're doing and I hope you do too. You don't find these kinds of numbers in most other places,” he said.

Associate Vice Chancellor for Clinical Affairs C. Wright Pinson, M.D., M.B.A., spoke about quality.

“In the U.S., health care is in a crisis, according to many people. Some speculate that quality is only half to one-third as good as it could be,” he began.

“I think there is a moral imperative for us to improve our quality vision and strategy.”

Pinson spoke about the increased outside scrutiny being brought to bear on health care, and about the increasingly palpable insistence on safer and more effective care that's coming from payers and consumers. He noted the recognition VUMC has received from groups that monitor health care, and he presented some key VUMC statistics, ranging from decreased mortality to increased adherence to evidence-based medicine.

“I know there are days when things happen, when you're disappointed and you think, 'This place drives me nuts.' But we are up there, we are doing very, very well.”

Pinson forecast yet more reporting requirements in regard to quality and safety, more media attention and higher patient expectations.

He said the themes he'll pursue in the next few years include clinical process reliability and teamwork, in addition to a continued focus on all measurable aspects of clinical quality.

“We want to be the very best in quality and we know quality has to be first. This message has to be relentless.”

Associate Dean for Clinical Affairs Drew Gaffney, M.D., elaborated on teamwork and process reliability. Patients suffer effects of medical error to one degree or another in somewhere between 1 percent and 3 percent of U.S. hospital admissions, he said.

When it comes to systematic quality improvement, a focus on individual performance is apt to be misplaced, because the solution is more a matter of reforming the underlying processes of care. Gaffney set out a number of proven tools for creating high reliability processes, supporting evidence based medicine, and improving team communication.

“People are fallible. It's the system that has to protect us,” he said. “I have absolutely no doubt that VUMC has well trained caregivers and staff. But it's processes and systems that make the difference.”

Chief Human Resource Officer Kevin Myatt announced overall results of the recent VUMC employee satisfaction survey. Scores improved across the board. VUMC exceeds the survey vendor's current national averages in every category, and scores improved on 94 percent of the questions repeated from the previous survey.

Myatt set out a process managers can use to communicate results to their work groups and develop improvement strategies. Work group satisfaction reports will be available to managers over the Web beginning June 29.

Slides from the seminar are available on the elevate Web site, www.mc.vander-bilt.edu/elevate.