October 28, 2005

Satisfaction drives success: Goldberg

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Larry Goldberg

Larry Goldberg joined Vanderbilt this summer as the executive director and CEO of Vanderbilt University Hospital. He was previously vice president for operations at Northwestern Memorial Hospital in Chicago, the primary teaching affiliate for Northwestern University Feinberg School of Medicine. He recently talked with Paul Govern about his new role.

How do you like your new job?

Mr. Urmy, Dr. Jacobson, my administrative leadership team, the leadership of the medical staff and many others have made me feel extremely welcome and all have been very supportive in assisting me through the transition.

Prior to accepting this role, I knew Vanderbilt was a great institution. However, since arriving on campus I've found that my expectations have been exceeded. Not only are we a top national medical center, relative to industry benchmarks and other comparative rankings, but there is a culture of collaboration and excellence that is unique and makes this a great place to work. And it's unusual in today's environment to be at a major teaching hospital that is not experiencing significant labor shortages, multiple vacant chair positions, inconsistent financial performance and an inability to invest in capital equipment or facilities needs.

In coming here, I recognized the great opportunity to build on the tremendous accomplishments already achieved. We have a strong research enterprise, the Medical School is unquestionably among the best in the country, the patients are well cared for, the hospital operations are efficient, departmental leadership is strong, the Nursing division is extraordinary and our strength in clinical informatics is unmatched. We're helping to define best practices for the nation in terms of evidence-based medicine, physician computer order entry, patient safety and financial performance. There are always ways to improve even more, but I am confident in our future.

What would you say elevate is all about?

It's doing the right thing. The most important thing we do is provide outstanding care to our patients; it's what we do better than any of our competitors. Having said that, I believe it is important to have a balanced approach to operating a hospital. Providing the best care in the context of safety, quality, employee and patient satisfaction, growth and financial performance is how we can build on our excellence and strive for the next level.

I am particularly pleased that our initial focus is on employee satisfaction. I firmly believe that if our employees feel good about working here, our patients will be the true beneficiaries. Satisfied and engaged employees are key to helping us create the basis for building on all of the elevate pillars. If you look at the current literature, the number one correlation of hospital patient satisfaction is the relationship of the patient with his or her nurse. The number one indicator for a nursing unit to have high patient satisfaction is the job retention rate among nurses and other staff members working on that unit, and the number one correlation of staff retention on a hospital unit is the satisfaction level of the staff and their relationship with management. So, if you consider the elevate activities that we have initially adopted, they are focused on understanding the needs of our workforce and helping our staff do their jobs better.

Our job vacancy rates are already much lower than the national average, and last year's employee satisfaction survey scores, as well as a recent R.N. satisfaction survey, indicate that we are doing very well. Another indicator, although not as scientific, is the incredibly large number of staff I meet while doing rounds through the hospital who have been with Vanderbilt for 20 and 25 years, or more. This says a lot about the strength of our culture.

Have you ever before been in an organization that was attempting a house-wide upgrade of service to patients?

I came from an organization that had a good service culture and we took it to the next level. What I learned is that it starts with your relationship with your employees and how you communicate with your workforce. This is a relationship business; we are people taking care of people. If our workforce feels good and has what they need to perform their responsibilities, then patients benefit.

A lot of organizations talk about providing a high level of service, but few can actually execute on their promise. There's clearly a firm commitment to continue to provide a “high touch” service level here. What is wonderful is that our improvements are beginning to be noticed. I have been encouraged by several medical staff members who have enthusiastically commented on the changes they are experiencing. This is very gratifying and is a testament to staff at VUH for their willingness to accept new ideas.

How do you know if you're successful in what you're trying to accomplish?

I will be evaluated based upon our continued improvement in each of the five elevate pillars: employee satisfaction scores, patient satisfaction scores, a series of quality initiatives we'll start to track this year, financial performance and growth targets.

Beyond that, are there specific opportunities or challenges that you've been asked to focus on in this initial period?

One of the most immediate challenges will be to expand our inpatient bed capacity in order to serve more patients and reduce patient wait times in our emergency department and other parts of our hospital. Our growth curve over the last five years is something that most institutions would covet. We've also been recognized as the most preferred provider in the area and the state in almost every discipline — it's pretty impressive. We are fortunate to be outperforming by two years our long-term operating and financial plan in respect to inpatient volume growth. It will take another two or three years before we complete the necessary planning and construction to open a third bed tower, to be located above the new ED. We are planning to open 10 additional inpatient beds over the next year, but that alone most likely will not be enough to meet our demand projections.

We're going to continue to improve our efficiencies through bed capacity management, while continuing to run our operating rooms at a high utilization rate. To create additional access to beds, we are going to have to use what I call “virtual capacity.” That includes implementing processes to assure we can discharge our patients earlier in the day, consistently reducing our room turnaround time, and ensuring that we utilize our observation beds to have more capacity to care for inpatients.

Why give so much attention to improving service if we're already riding so high in terms of consumer preference and patient volume?

Because we can always do better. And we know our patients deserve the very best care in the best environment possible. We also know that as our population continues to age, our patients' needs will also continue to grow. As a premier academic medical center, we will continue to provide exceptional, specialized care that is not available within our region. This is what we are known for and why our patients will continue to seek care at Vanderbilt.

Do you expect academic hospitals to change much in the coming 10 or 15 years?

Technology is going to become increasingly significant, and how it is managed — when to acquire which technologies — will be a challenge. For example, the cardiac hybrid operating rooms and state of the art clinical drug trials are going to continue to change the way care is provided, and I don't believe that many institutions can afford to continually stay current. I think we are well positioned to do this, because of our volume growth and expertise.

How fast are health care costs rising and what is driving the increases?

That goes back to the technology issue. It is costing hospitals more to provide the most advanced care. Many areas, such as some segments of the pharmaceutical industry, can have double-digit annual inflation. However, on the flip side, patients are benefiting from the many innovative treatments we are able to offer, such as minimally invasive neuro and vascular procedures. Plus, it will cost more to hire and retain professionals in the work force, unless we address the issue of attracting more people into this industry. Therefore, we will always be engaging in initiatives to offset these expenditures and looking for ways to keep our costs down.

Are hospitals going to be asked to tighten their belts?

Clearly the message from society — from government, insurance companies and the public — is that we have to become more efficient, more cost effective. At Vanderbilt, we're growing and can work to accommodate growth and become more efficient at the same time.

Information technology helps improve safety but it's also about creating more time for our workers so they can be more productive. There are a series of initiatives that we're going to start in the coming year, including automating nurse scheduling, using bar-coded wristbands on patients to aid safety and to reduce paperwork, and increasing automated collection of clinical outcomes data. So, we'll be expanding information systems in ways that help us work more efficiently. In the longer term, we'll have to look at productivity and identify ways to increasingly allow our workers to do more of the work that they've been trained to do.