The Vanderbilt University Medical Center is representative of many health care delivery systems in the United States today. Even with its long history of success, Vanderbilt faced a $250 million shortfall in 2012. This resulted from a variety of operational issues, it resulted from the changing healthcare landscape in the United States, changes that demand new approaches from leaders, changes that result from policy changes, changes that result from a more consumer-driver health care economy. Vanderbilt, to regain its position, acted with purpose and direction, it reevaluated its organization and structure, it analyzed its sources of income, it refocused its attention on targeted areas. This term we have considered the health care delivery system and how services are offered and accessed. We have weighed the impact of insurance and of policy, always considering the impact on those who need care. Focusing on one part of our Vanderbilt case study, "Neurosciences" (p.10) as below, use the work from our term so far and answer the four questions that follow the excerpt.
Neurosciences
The Neurosciences PCC [Patient Care Center], including core departments of neurology and neurosurgery, had been reconstructed after 2012. The Executive Committee consisted of Beauchamp who oversaw the Section of Surgical Sciences (including Neurosurgery), Dr. Robert MacDonald, the Chair of Neurology, and Dr. Reid Thompson, the Chair of Neurosurgery. The PCC Leadership Team consisted of the Vice-Chairman of Neurology, a nursing director, and an administrative director.
The Neurosciences PCC had also established a "critical relationships" committee which consisted of Chairs of other departments as well as Directors of other PCCs (such as cancer) that played a role in the care of certain conditions. For example, the chair or orthopedic surgery was included because neurologists and neurosurgeons, and other orthopedic surgeons all treated certain spinal conditions. The relationships committee also coordinated oversight of finances, quality of care, and research.
The Neurosciences PCC was not co-located, and had not yet moved to pods for individual conditions. Leadership was currently focused on integrating and improving care for patient in three areas: spine, pituitary tumors and skull base surgery. It was working on standardizing care pathways and order sets across all services, and enabling discharge of all patients prior to 11:00 a.m. toensure adequate time to confirm that they returned home without difficulties. Also under development were transparent service-specific dashboards which included quality information and cost information (based on charges). Outcomes and process measurement remain limited except in neurosurgery, where VUMC hosted National Neurosurgery Quality and Outcomes Database.
1- White andGriffiths (authors of textbook for the term) discuss the need for Health Care Organizations (HCOs) to design for excellence. They identify 3 foundational elements for excellence. Identify these 3 elements, define them and discuss how the Neurosciences Division of Vanderbilt is attempting to achieve excellence through these 3 elements.
2- In our second class, we considered the need to organize, to structure health care delivery to achieve targeted outcomes. Identify how Vanderbilt's Neurosciences Division has made or not made needed changes in structure and organization to meet achieve success. Consider, for example, how it is developing work with multi-disciplinary teams, how it has not co-located services for easy access and flow (or select other area(s) from the case study excerpt that answer this question). What impact might their actions have on outcomes?
3- As our health care system transitions from a volume-based system to a value-based system, many changes are needed. As leaders we need to evaluate how work is done, evaluate the processes and the skills and competencies of the people doing the work.
a- Compare and contrast the volume-based and value-based system and its implication for the Neurosciences Division of Vanderbilt (hint: value to customer)
b- Discuss the need to become more efficient in health care. Why must we seek to reduce waste in the system (in general; you may choose to use Vanderbilt here or not)
c- Identify the 2 foundational principles of Lean (Toyota Production System ((TPS)). How is Vanderbilt Neurosciences embracing this concept by including other services in their work?
4- Policy underpins our work in health care leadership. As leaders, we must ensure compliance with law, regulation and work closely with the accrediting agencies too. We must, through our actions, comply with health policies that hold "The competing interests [which are] at the heart of public health [that] are mainly addressed through two types of policies and laws: those that define the functions and powers of public health agencies and those that aim to directly protect and promote health" (3rd class presentation). Vanderbilt attempts to do this through reorganizing its services, by making changes that will allow it to draw income/reimbursement in the new health care finance environment; Neurosciences develops a dashboard so that it display its data and performance data. Neurosciences is enforcing a policy for all its patients to be discharged by 11:00 a.m. so that they can "ensure adequate time to confirm that they returned home without difficulties".
a- Define "value" in terms of lean/Toyota Discharge system. Who defines "value" in the Lean methodology?
b- Post-surgery discharge call: Identify and discuss one reason it is good for the patient (hint: quality of care) and one reason it is good for the Vanderbilt Medical Center (hint: utilization, finance)