For many months, UTMB’s Chief Medical and Clinical Innovation Officer Dr. Gulshan Sharma has been living and breathing UTMB’s No. 1 priority goal—the Best Care initiative, which challenges UTMB to achieve a top 20 ranking among academic medical centers by 2018.
Mid-year performance rankings, measured by the national Vizient Quality and Accountability Study, revealed good news: UTMB improved from 76th place to 19th place out of 102 reporting academic medical centers. While that brings UTMB closer to its goal to rank among the Top 20 AMCs, Sharma said all employees need to remain focused on meeting the end-of-year ranking—and beyond.
“We should all be proud of the progress we’ve made and should celebrate the early gains,” said Sharma, who credits UTMB’s quick rise in the rankings to a shared vision and commitment among leadership, physicians and all employees. “However, a lot more work needs to be done. As we are improving, other institutions also are working hard to get where we want to go.”
The Vizient study measures six different domains, including patient-centeredness, effectiveness, mortality, safety, efficiency and equity. So far, results have shown UTMB is ahead of target in most areas, ranking first in equity, fourth in safety, and 13th in patient-centeredness. More work is needed for length of stay and cost of care (measures of efficiency), and mortality, but UTMB has been trending in the right direction in those domains, as well.
“When we first started this initiative, many people expressed to me that our Best Care goals were too far of a stretch,” said Donna Sollenberger, executive vice president and chief executive officer for the UTMB Health System. “Yet, after seeing our second-quarter results, I feel as confident as ever that if we maintain our focus, we will be successful.”
Thus far, improved clinical documentation has been a major factor in UTMB’s progress in several domains, including mortality. For example, by educating physicians on how to properly document the complexity of patients we serve, billing and coding staff has been able to more accurately report patients’ severity of illness. This has led to an improved and more accurate risk-adjusted mortality rate, which takes into consideration factors such as age, comorbidities and level of organ failure on presentation.
Looking ahead, Sollenberger said clinical documentation is very important, but there’s still more to Best Care.
“What we really have to do now is fundamentally change patient care processes,” she said. “That will be more of the heavy lifting because it is changing how people are providing care, not just how they are documenting.”
Sharma agreed.
“We won’t achieve top 20 by documentation alone,” he said. “While it is an important common thread that has helped us across the board, we still need to make changes culturally—where our approach to patient care is different. We can’t keep doing the same things and expecting different results. We have to look at things and say, ‘If it’s not working, let’s do it differently.’”
One area that’s doing things differently is Internal Medicine. Department chair Dr. Randall Urban has helped lead several innovative projects, including one focused on better managing frequently admitted patients and reducing the need for hospital admissions. Under a new approach to patient management, general medicine doctors are split into three distinct teams that each provide care to the same patients whenever they come to the hospital.
“Previously, a frequently admitted patient would see physicians from any of the three teams and they could get lost in the system,” said Urban. “Now, when the patient is admitted to the hospital, the same team cares for them each time and the doctors get to know that patient very well. This has been a really big change for us and a better way to provide continuity of care.”
Urban said UTMB follows about 40 percent of our frequently admitted patients in the outpatient setting, as well. In efforts to reduce readmissions, the inpatient teams were recently brought together with outpatient care providers for a two-hour lunch meeting. Members of each team sat at the same table and did team-building activities before discussing how they could develop better care plans for their frequently admitted patients.
“In addition to better managing frequently admitted patients, we want to figure out how we can identify patients who are on the cusp of being frequently admitted and prevent them from moving into that category,” he said. “We aren’t there yet, but in the end, I think that’s where we’ll make the biggest impact.”
UTMB will receive a final report card from Vizient in September, which will show whether the university achieved a top ranking for the year. In the meantime, Sharma encourages all employees to keep pushing ahead. He hopes Best Care practices become “hardwired” so the positive changes are sustained.
“I want us to be consistently in the top 20 for three years in a row—that will be a true testament that our culture at this great institution has really changed,”said Sharma. “Best Care is not only for one year—it is here to stay. We will continue to work on opportunities to improve every year. We have a clear path forward, which is a remarkable thing.”