March 21, 2003

VCH launches improvement program

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Dr. Jay Deshpande

VCH launches improvement program

Barbara Walczyk

Barbara Walczyk

The Institute of Medicine has issued a general appeal for new health care quality improvement efforts to ensure that care and services are “safe, effective, efficient, equitable, timely and patient centered.”

Vanderbilt Children’s Hospital leaders heard this appeal when they designed the hospital’s new Performance Management and Improvement Program.

“The focus of the program is improving the way we deliver health care, with efforts keyed both to the vital dimensions of care highlighted by the IOM and to the stated values and vision of VCH,” said Dr. Jay Deshpande, professor of Pediatrics and Anesthesiology and medical director of the new program. “The program will ensure that we have ways of both assessing and modifying the way we take care of patients so that we can continuously improve.”

As the founding leader of both the division of Pediatric Critical Care and the division of Pediatric Anesthesia, Deshpande has longstanding working relationships with specialty programs across VCH. He is currently completing work toward a master’s degree in public health.

Deshpande’s partner in leadership is Barbara Walczyk, administrative director of the new program. Walczyk said the program will bring systemic improvement across the hospital.

“While various areas of the hospital have long worked to identify opportunities and make improvements, there hasn’t traditionally been a process to carry changes forward at the organizational level,” Walczyk said. “We have a lot of opportunity for improvement, but if we continue to go department-by-department we’re not going to make the big changes we need to become a nationally recognized children’s hospital.”

The scope of the program includes the clinical encounter as well as underlying processes from patient reception and transport to follow-up communication. The program has oversight for the transition to the new building later this year, and Walczyk said a number of clinical and operational process improvements will be made in anticipation of the move.

The program places within Deshpande’s and Walczyk’s leadership an amalgam of resources from VCH, Health Services Research and the Center for Clinical Improvement. Quality Consultant Pat Throop heads the support team, which includes two clinical quality consultants, a statistician, a safety consultant and a statistical programmer. Funding for the program will come from VCH and from future grants to study and improve patient care.

The three main components of the program are clinical services and effectiveness, operational services and effectiveness, and comprehensive outcomes measurement, including clinical outcomes, organizational functional status, patient satisfaction and cost/revenue. A Performance Management and Improvement Council, co-chaired by Deshpande and Walczyk, brings together clinicians and administrators from across the hospital as well as private pediatricians; the council is an umbrella for 10 quality task forces at work in clinical areas across VCH.

“My hope,” Deshpande said, “is that most of our projects won’t be conceived and driven by the people in our program. The idea is that health care providers will be able to come to us with questions and ideas and problems that need improvement.”

As outlined by Deshpande, the program’s improvement strategy is a familiar one at Vanderbilt: define the problem, gather people who already have a stake in the issue to discuss and design improvements, implement changes, and measure the effects of change within a reasonably short time. Walczyk emphasized the need when designing improvements to consider any related policies, identify all accountable parties and understand the current tools and practice.

Deshpande expects to expand clinical outcomes measurement beyond the immediate inpatient episode to include post-discharge patient function/quality of life. As for modifying the way VCH cares for patients, Deshpande said, “Our individual physicians and nurses want to do the best they can and deliver state-of-the-art care, and to support them we need continually to ensure that systems are in place to allow that to happen. We need to ask: Is the staffing appropriate? Is the equipment appropriate? Is the administrative structure appropriate? We’re concerned not only with the quality of clinical care, but with providing a concerned and caring patient care environment.”

To accept the new position, Deshpande has left his post as chief of the division of Pediatric Anesthesiology (a national search for a replacement is under way); he will continue as chief of Pediatric Critical Care, and will also assume the post of department vice chair for Academic Affairs in Anesthesiology, where he will foster faculty development and health systems research activity.

Deshpande’s role was made possible through collaboration of Dr. Jeff R. Balser, James Taloe Gwathmy Professor and Chair of Anesthesiology; Jim Shmerling, CEO of VCH; Dr. Robert S. Dittus, professor of Medicine, chief of the division of General Internal Medicine and director of Health Services Research; and John Bingham, director of the Center for Clinical Improvement.