Success is the sum of small efforts…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThe famous artist Michelangelo once received a visit from a friend as he worked diligently on a sculpture. After a brief chat, the friend left but returned later to find Michelangelo working on the same statue. Thinking the statue was nearly completed on his last visit and seeing no visible change, he exclaimed, “You haven’t been working all this time on that same statue, have you?”

“Indeed I have,” the sculptor replied. “I’ve been retouching the facial features, refining the leg muscles, polishing the torso; I’ve softened the presentation of some areas and enhanced the eye’s expression.”

“But all those things are insignificant,” responded the visitor. “They are mere trifles.”

“That may be,” replied Michelangelo, “but trifles make perfection, and perfection is no trifle.”

Even today, painter, sculptor, architect and poet Michelangelo is still widely regarded as the most famous artist of the Italian Renaissance. Among his works are the “David” and “Pieta” statues and the Sistine Chapel frescoes. His work demonstrated a blend of psychological insight, physical realism and intensity never before seen.

The moral of the story? People and organizations who pay attention to the “little things” produce excellence in larger matters. As American entrepreneur, businessman and founder of the Marriott Corporation J. Willard Marriot said, “It’s the little things that make the big things possible. Only close attention to the fine details of any operation makes the operation first class.”

UTMB’s Best Care initiative is composed of many “moving parts”. There are a number of focused efforts in each area in which we are working to make significant improvements: reducing our observed mortality rate, improving effectiveness (doing or using the right things to achieve the desired patient outcome and best experience of care) and increasing efficiency (doing or using the right things to achieve the desired patient outcome and best experience of care). There is a tremendous amount of work in progress, and I am truly excited about the collaboration and teamwork taking place to make Best Care a reality.

Many of you are a part of the teams conducting this focused work, but everyone in every role at UTMB Health contributes to making our organization the best place to receive care and to have an excellent patient experience. I know you are all dedicated to this endeavor and have a desire to stay informed of our progress and the projects underway. That’s why this week, I would like to give you an update on some of the work that is taking place, as well as the work that will be conducted in the time to come.

Reducing UTMB’s Mortality Rate

At UTMB, all patient deaths are reviewed within 48 hours of the event, as generated in the Epic electronic medical record (EMR). Each death is then classified based on how likely the patient’s death was to occur—some patient’s illnesses are severe and they were expected to pass away, while other patients who passed away were not expected to. This is why detailed and specific clinical documentation is important when it comes to predicting mortality, because it illustrates how sick our patients are and it helps identify any additional illnesses or complications that may make care delivery more complicated. To aid in this documentation effort, an enhancement known as a “smart phrase” will be made in the EMR is forthcoming.

Another way we have improved our mortality rate—and more importantly, improved end-of-life situations for patients and their families—is to consult with patients and their families when the patient is expected to pass about moving into hospice care. This helps give them a choice about how to spend their last days and honors the patients’ preferences. So far, we have been able to transition 14 patients into comfortable end-of-life care. These efforts will continue and remain ongoing in the future.

Diagnosing, Treating and Preventing Sepsis

Sepsis is a leading cause of mortality. It is a bloodstream infection that results in tissue damage and organ failure. Sometimes patients arrive in the hospital with sepsis; at other times, they can develop it after a surgery (if this occurs, it is considered a patient safety event).

Recent work to improve our performance in this measure has focused largely on placing a workflow in the electronic medical record (EMR) to help providers follow the evidence-based care recommended for testing and treatment of sepsis. A report has also been developed to help monitor all patients with sepsis on their problem list—this helps ensure that if sepsis is initially documented as “suspected” or “probable”, it is eventually also documented as “confirmed” or “ruled out” and the final diagnosis is clearly documented.

Clinical documentation guidelines for the diagnosis, documentation and coding of sepsis and septic shock have now been posted to the Best Care website, and clinical documentation specialists and inpatient coders continue working closely with physicians on this area for improvement.

Clinical Documentation Improvement

After physicians document the care they provide in the medical record, it is later translated into codes which are used not only to determine the cost of care and reimbursements, but to help illustrate how sick patients are and to track disease trends. The documentation/coding process is fairly technical and detailed, but one important factor is to identify not only the primary diagnosis, but also identify and document any complications or co-morbidities (aka, secondary, co-existing illnesses). It is also important to note whether or not the secondary illness was considered “major” (meaning it required more resources to treat and was at the highest level of severity) or “simple” (meaning the condition resulted in some increased resources, but at a much lower rate).

When ICD-10 was implemented in October 2015, it changed how some conditions and procedures were classified. That is one reason why specificity of clinical documentation was strongly emphasized. However, it was predicted that on a national level, some services that are considered “procedural-heavy”, like general surgery, general medicine and cardiac services would be more susceptible to the impact of this shift than other areas of care.

At UTMB, clinical documentation improvement is focused in all services, but project teams are also particularly focused on Cardiology. To help providers make the best possible diagnosis choices, Department Chair Dr. Ken Fujise has requested that a template be developed for use in the EMR, and this work is in progress.

Effectiveness and Efficiency

Building on work already accomplished, Orthopaedics continues work to reduce patient length of stay and preventable 30-day readmissions through revised order sets (order sets are standardized lists of orders for specific diagnoses that help physicians follow evidence-based guidelines for care), conducting risk assessment for patients (that is, understanding what might put a patient at risk for readmission), and improved patient education and physical therapy training. Sometimes, a patient may need advanced care after a surgery, such as a knee replacement, but their condition isn’t serious enough to actually be admitted. By placing them in observation instead, which is a less expensive care environment, a 30-day readmission can be avoided.

Other areas of focus that are helping to improve the data for our readmission rate overall is ensuring that elective surgeries are clearly distinguished from non-elective surgeries and that inpatient procedures are accurately coded as planned or unplanned.

Last but not least, throughout the inpatient arena, patient care teams continue conducting progression of care rounds and using the “8 Ps” (an assessment of preventable risk factors for readmission). Teams also continue conducting and documenting “Teach Back”, which helps ensure that patients understand their condition and how to care for themselves at home. Care managers remain focused on following up with patients after they are discharged to ensure they are following their plan of care. Particular attention is being given to caring for hospital-dependent patients.

“Success is the sum of small efforts – repeated day in and day out.”

As you can see, there is a lot of work going on! Although I mentioned a couple of weeks ago that we slipped in our rankings in the most recent Vizient Quality & Accountability Study, all of the amazing work I described above was not included in the data submitted for that study’s time period. Therefore, I am confident that if we continue these efforts and maintain a steadfast focus on Best Care, including maintaining our performance in patient-centeredness and equity of care, we will be successful in our endeavor to become a top 20 academic medical center in the next study.

Thank you all for your diligence and hard work! And remember, it’s the things we work hard for that have the greatest worth. We have a tremendous opportunity to prove that UTMB Health is the best place to receive patient care!

Quote attributed to Robert Collier

Lifting People Up

Donna Sollenberger, EVP & CEO, UTMB Health SystemEach day at UTMB Health, people’s lives are touched in positive ways by our employees. Last week, I heard a story I wanted to share with you about an employee who went the extra mile to lift a patient’s spirits.

Nurse Keith Sumrall was working on the Pediatric Unit in John Sealy Hospital. One of the patients for whom he was caring had just been through a tough surgery; he also had an intellectual disability which made him feel especially anxious about the entire experience. One evening, as Keith left the patient’s room, he asked if there was anything else he could do. Kyle* had his heart set on one thing: a Kit Kat bar.

There were no Kit Kat bars on the unit to take to the young patient. The next day, Keith decided to buy something sweet for his patient. However, he didn’t return to the room with just one candy bar—he arrived with 60 Kit Kat bars, which he poured onto the bed cover in front of Kyle. The expression on the young man’s face was priceless. The moment was captured by his father, who videotaped the encounter.

Who would have thought that Kit Kat bars could bring that much joy to a patient who had been through so much that week? Kyle was so appreciative, he decided to name his new teddy bear after Keith.

I received another story on Wednesday from Dr. Joan Richardson, Chair of Pediatrics. It was an article that appeared in the New York Times (click here to read the article) about the experience of a family at CHA Cambridge Hospital in Massachusetts. Although the story did not take place at UTMB, it very easily could have.

The article featured the letter from the patient’s husband, who wrote about the professionalism of the staff, their kindness and compassion, and their consideration for the patient’s dignity and the family’s comfort. The staff also made it possible for the husband to have one last tender experience with his wife. These are all the types of things I hear about almost daily from our patients and their loved ones here at UTMB.

These two stories are examples of people who took delivering Best Care to a whole new level. Best Care is more than medicine. It is showing compassion and kindness for people who truly need our care. We should always ask patients and their loved ones if there is anything else we can do for them, and if there is something we can do to help (even if it is not within our scope of responsibility) we should find a way—we can always lend an ear, and we can always treat our patients and their loved ones with the same care and respect with which we would want to be treated.

Best Care is about understanding our patients’ needs and then doing what we reasonably can to meet them. It’s about living our values. The employees in these stories did exactly that as they demonstrated what exceptional patient care is all about.

Thank you to all of you who work together to truly work wonders for our patients and deliver Best Care, every patient, every time!

John Holmes

* The patient’s name and video above are shared with permission of the patient’s family.

SECC Don’t forget! The State Employee Charitable Campaign (SECC) is underway! SECC is a chance to give back to our communities and the important causes that are near and dear to us.

To all who have already committed to SECC, thank you!  To those who have not yet given, please give this every consideration. No amount is too small, and giving could not be easier. One-time contributions can be made via cash, check or online, or pledges can be made through payroll deduction (monthly or a single gift).

Please visit the SECC website at  to begin the process of making your donation today. The deadline to contribute to the campaign is November 14, 2016.

Remember Why You Started

Donna Sollenberger, EVP & CEO, UTMB Health SystemHave you ever worked really hard to improve at something, only to find that after dedicating a lot of time and attention to it, you did not get better? Or worse yet, that you didn’t even do as well as when you started? Did you give up, or did you make adjustments and work even harder?

When I was in my early 20’s, I decided I would take up golfing. Many of my friends played, and I thought it would be a good skill to have, especially if I were going into business. Everyone in business plays golf, right?

The first thing I set out to do was purchase a set of golf clubs. I am left-handed, so borrowing clubs was out of the question, and no one I knew had left-handed clubs that I could borrow. I had even tried playing a round of golf using right-handed clubs, but wow, was that a mistake! I didn’t even get through three holes before I realized it simply wasn’t going to work.

So, I set out in search of some left-handed golf clubs. I had been saving up for a new car, but I decided since my car was running fine, I would use the money to buy my clubs instead. I would love to say that they helped my performance, but they did not.

Despite family members who tried to teach me and despite the lessons I paid for with more of my car savings, nothing helped. In my entire life, I have played nine holes of golf twice. I am sure it was entertaining to those accompanying me—I would miss the ball and hit the grass with the club, knocking up a chunk of earth, or I would swing repeatedly at the air while trying to tee off. Then, it would take me about 10 strokes just to get to the green. While I was a pretty good putter, it did not make up for the rest of my performance.

Ultimately, I decided that golf was not my game; so, I invested my time in playing other sports I was good at like volleyball, softball and bowling. (I ended up being pretty good at bowling!) However, I have often wondered how good I could have become at golfing if giving up hadn’t been an option. I guess I will never know…

This experience made me think about Best Care. Last week, we received our results from Vizient for the quality and safety data we submitted in parts of 2015 and 2016. While we are still generally in the top 20 for equity and patient-centeredness, and we are almost at the top 20 for patient-safety, we have fallen in our overall ranks for mortality, efficiency, and effectiveness. As a result, our overall score fell from being 58th to 76th out of a little more than 100 academic medical centers. While we are still in the three-star category, our results within that range slipped.

What happened? There are several things to point out:

  • The 12 months of data we submitted did not include most of the last four months of effort we have given to the Best Care initiative. This means that some of the great progress we have made so far was not captured in this set of data. This was particularly evident in the category of mortality; for example, we know we have made considerable progress by converting patients who were expected to pass away to hospice care at the right time.
  • As we had already anticipated, several items were also added to the survey this year which affected the scores. For example, length of stay (LOS) was previously calculated according to the date of inpatient admission and the date of discharge. Now, patients who are being observed but are later officially admitted are also included in this count, and the time they spent in observation is included in their length of stay, thus increasing UTMB’s overall length of stay performance.
  • We have identified issues that are creating the need to keep patients in observation, such as limited availability of some weekend services in the hospital (other than what is needed for emergency services). The Health System has started working with affected departments to help improve patient access for those services on a routine basis.
  • It should be noted that several services have improved their performance by reducing their length of stay, as well as the direct cost of care for the patient. So, there was some positive news in the latest results.

We will be looking very closely at the data this week and developing the additional action plans we need to meet our Best Care goals, but we need everyone to stay focused on what we need to do in our individual roles—and most importantly as part of our teams—in order to be successful.

They say, “When you think about quitting, remember why you started.” Unlike my decision to give up on golfing, quitting Best Care is not an option for us. We have to double down on our efforts—we owe it to our patients and their families and we owe it to ourselves to show the world that the care and service delivered at UTMB is the very best. When the Vizient Quality & Accountability Study comes out next fall, and we are in the top 20, our efforts to “Be the Best” will not end. Maintaining that position will be as challenging as achieving it. It is hard work to always deliver Best Care, but it is also highly rewarding.

I am convinced with the many good people we have working together on Best Care, that we will achieve our goals. Thank you for all of your contributions to and work on behalf of our patients to assure that they receive Best Care – every patient, every time.


Everyone Can Help Someone

Donna Sollenberger, EVP & CEO, UTMB Health SystemAs you may recall from previous Friday Flash Reports, I am the oldest of three children. When I reflect on my childhood growing up in Springfield, Illinois, I have many memories of my mother. She was, by any measure, a very busy woman—she had three kids, worked part-time, and took care of most of the “homemaking” responsibilities that were common in the 1950’s, like cleaning the house, doing laundry, getting kids to and from school and after school activities, and cooking three meals a day. To me, this was nothing short of amazing.

One day, she was particularly harried, trying to set the table and get dinner ready. My dad, who the three kids called “Stormin’ Norman” when he was out of ear shot, saw me in the dining room and told me to go into the kitchen and help my mother get dinner ready. Being the rebellious first child, I did not like to be told what to do, so I nonchalantly told my dad that helping mom with dinner was “not my job”.

This statement…was a mistake.

Stormin’ Norman took me firmly by the shoulders, made me look straight into his eyes, and he said, “When you see someone who needs help, you help them. That is always your job.”

I could feel my response to him building up inside me, but I decided it would not be in my best interest to talk back, so I went into the kitchen to help my mom. As I started to set the table without her asking me, tears ran down her face. I asked her what was wrong. She told me that she was just really tired and appreciated my help.

That wasn’t the most memorable moment of my life, and it was not particularly dramatic, but that experience became a defining moment in my life. Seeing my mom react so appreciatively to my efforts to help her out made me realize that I needed to be more in tune with what others were feeling so that I could do my part to help out.  I remember as I responded to my mom, “It’s no problem,” my dad’s eyes locked with mine.

I never told my mother that my gesture was really less than magnanimous and Dad had basically forced me into helping, but he never told on me either. Until she passed away in 2010, she always thought I was actually a better person at that point in my life than I really was. It was a great lesson to learn at a relatively young age, and ever since, I have always tried to take time to try to help others when I see the need.

A story that recently took place at the UTMB Health Multispecialty Center in League City illustrates that helping others out in times of great need comes naturally to Patient Services Specialists Vanessa Romero and Donna Papa. One evening, as they were leaving work a little later than usual, they were approached by some of the landscape workers. Two of the men were carrying their unconscious co-worker.

Vanessa and Donna immediately went into action—they called 911 and stayed with the men until the paramedics arrived. They knew that there still was a physician, Dr. Kevin Merkley, in the clinic, who was able to get the automated external defibrillator (AED) ready for the paramedics (an AED is a portable device that checks the heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm). Throughout the experience, Vanessa was able to speak to the workers in Spanish and served as a translator between them and the paramedics.

The actions of Vanessa and Donna exemplify our Best Care motto, “Every patient, every time,” because no matter what, we should always be ready to treat those who come to us for care with the same respect and compassion as we would like to be treated, and as we would also want the most cherished of our loved ones to be treated.

Our opportunities to help those in need from day to day may not always be as dramatic as Vanessa and Donna’s story, but each and every one of us has a chance daily to be a light in someone’s world and to help them out. You might be on the team who helps make sure our phones work so patients can reach our hospitals and clinics, and through your work, you play a role in Best Care (I’d like to extend a special thank you to the Information Services team who helped out with a phone problem at the Angleton Danbury Campus earlier this week!). You might help ensure supplies are quickly unpacked and delivered to our inpatient units, and you play a role in Best Care. Or, you may simply help someone find their way to their destination—and YOU play a role in Best Care.

There are things we all can do each and every day, both big and small, that impact the experience of care at UTMB Health. Thank you, Vanessa and Donna, for modeling the way for Best Care!

Donna Papa and Vanessa Romero

Donna Papa and Vanessa Romero

Never get tired of doing little things for others…

Donna Sollenberger, EVP & CEO, UTMB Health SystemThere is a saying, “Never get tired of doing little things for others. Sometimes those little things occupy the biggest part of their heart.”

This week, I would like to share a story about a couple of teams at UTMB who went above and beyond to deliver Best Care to one our patients. This story was submitted by Dennis Santa Ana, patient care facilitator in the Cardiothoracic Surgery/Vascular Surgery Unit. It was originally published in this month’s issue of Nursing News, but I thought it was such a wonderful and touching example of how two departments worked together as a team to make a special wish come true for one of our patients, I wanted to share it with you all in today’s Friday Flash Report.

During the latter part of May, a 46-year-old female was admitted to the Intermediate Specialty Care Unit in Jennie Sealy Hospital with a diagnosis of end-stage heart failure. She was placed on the highest priority waiting list for a heart transplant. However, this meant that she would need to remain hospitalized until a suitable heart donor was found.

During a casual conversation with her nurses, she mentioned the upcoming wedding of her son. She said she would love to attend the wedding, but she had dismissed the idea because of her current condition. Her nurses toyed with the idea that maybe they could have another wedding in the hospital chapel so she could be there, but planning it seemed extremely complicated.

However, the nurses in the unit were persistent about finding a solution. They had a meeting with their nurse manager, Dell Roach, and came up with a plan. In collaboration with the Information Services Department, they were able to stream the wedding live using an app so the patient could view the wedding on the big projection screen in the 9th Floor Jennie Sealy Hospital Conference Room.

The patient was so excited to hear the news. On the day of the wedding, she put on an elegant dress and two of her friends came to watch the wedding with her. Dell Roach and her staff brought food and refreshments, including a wedding cake. She was so thrilled to see the whole event unfold on the big screen.

I must admit, I had tears in my eyes by the time I finished reading this story. I think, as we focus on Best Care over the next year, sharing stories like this one demonstrates that no matter what your role—whether you deliver direct patient care or work in support of those who do—everyone at UTMB contributes to Best Care. Even if you work from behind the scenes or in areas such as Revenue Cycle Operations, the Access Center, or Business Operations & Facilities, you help create an exceptional care experience for our patients and their families.

These two teams were able to give a mother and her family the chance to share a very important life moment—and that is priceless.

Thank you for everything you do to deliver Best Care at UTMB Health!


Achieving Uncommon Success through Teamwork

Donna Sollenberger, EVP & CEO, UTMB Health SystemA couple of things happened this week that (once again) made me realize what an incredible group of people we have working at UTMB. It also made me realize that when we work together as a team, we truly are able to work wonders.

On Wednesday afternoon, UTMB received a phone call notifying us that a number of patients were being transported to our trauma center, all of whom were in critical condition after having suffered a chemical exposure. Our team in the Emergency Department (ED) did an incredible job supporting these patients (and many others) that day. Their work was nothing short of extraordinary, both in effort and in outcome.

Yesterday, I saw Christine Wade, director of Patient Care Services and assistant chief nursing officer of the ED. I thanked her for the great work that her team had done the day before. Without hesitating, she told me how incredibly proud she was of each and every person who works in her department. However, she said what struck her most about this incident was how everyone at UTMB had joined together to work wonders in a time of crisis.

The minute the team received the call, Christine said they immediately sprang into action. ED Manager Pam Cruz took control of operations and EMS Coordinator Chad Connally managed the arrival and decontamination process of the patients. Meanwhile, ED Techs Donnie Walker and Preston Huff donned full decontamination gear to assist with the arrival and care of the patients in outside temperatures of well over 95 degrees.

Christine told me about the many other teams who came to the aid of the ED staff. With one quick call, Respiratory Therapy was on site and ready to respond. With another call, the Blocker Burn Unit (BBU) staff, physicians and fellows were working seamlessly, side-by-side with Trauma Surgeon Dr. Carlos Jimenez and the other clinicians and members of the ED patient care team. Meanwhile, the pharmacy had ensured the needed emergency medications were delivered within minutes.

Then, just after the first patients, more arrived who had also suffered the same chemical exposure. In the midst of this, another serious trauma arrived. The team did not miss a beat; they remained calm and well-organized, and rushed the trauma patient to the operating room.

Josette Armendariz-Batiste, director Patient Care Services and assistant chief nursing officer for the Adult Medical/Surgical Intensive Care Units, quickly obtained assistance from the ICUs to help care for all of the incoming critical patients. At the same time, Mike Mastrangelo, UTMB’s institutional preparedness program director, and his team were also on deck to help Clinical Operations Administrator Jennifer Casso coordinate resources, help the Patient Placement Center team find available beds, and assist the ED faculty in managing the flow of regular patients.

Christine told me that Jason Sheaffer, nurse manager of the BBU, worked late into the evening checking on patients across the multiple units. She said there were countless other staff members who also selflessly worked extra hours to ensure that the patients had everything they needed. Throughout it all, everyone maintained a positive can-do attitude. The ED never stopped seeing regular patients and did not go on diversion. She credited ED Charge Nurse Darrin Radzinski with helping keep everything running smoothly during the course of these events.

It was clear to me that in this time of crisis, UTMB physicians, nurses and staff had a singular focus—to provide the best care and comfort to patients in their greatest time of need. How humbling it was to hear the stories of this incredible work!

One might think this would be the ending of my report this week, but I must tell you, my amazement did not end with this story! That’s because while I visited with Christine, we were both in attendance at the annual Good Samaritan Foundation’s Nursing Excellence Awards, a luncheon held each year in the fall to honor outstanding nurses from hospitals throughout the greater Houston area. Much like the Olympics, the awardees are given gold, silver and bronze medals for their outstanding contributions to nursing.

As with past years, UTMB Health had many nominees and many, many awards. In fact, 27 UTMB nurses were awarded bronze medals. Two of only six gold medal recipients were also from UTMB—Odette Comeau, from the Health System, was recognized for excellence in Clinical Education and Dr. Carolyn Phillips, from the School of Nursing, was recognized for excellence in Nursing Education (Faculty). Both Odette and Carolyn had videos that were shown during the ceremony in which colleagues told of the outstanding work and contributions each has made to the field of nursing. It was a moving tribute to two outstanding nurses!

The events of the past two days reminded me that the greatest successes are rarely achieved by individuals alone; rather, they are achieved by teams of people who are all committed to a common cause and to making an impact that will last for years to come. It also reminded me of the importance of preparation on an individual level so that we can give our very best and contribute to the success of our team as a whole.

Uncommon situations require uncommonly prepared and talented people to be successful. At UTMB Health, you all have demonstrated this excellence time and time again, and this was certainly demonstrated on Wednesday. Just as you have done in the past, when called to action, you rose to the challenge. Thank you to everyone who has contributed to the care of these patients and all of our patients, each and every day.

There is a saying, “Individually we are one drop, but together we are an ocean.”  When we focus individually on being well-prepared while working collectively as a well-orchestrated team, we truly do “work together to work wonders.”

'Teamwork is the secret that make common people achieve uncommon result.


Happy Labor Day!

Donna Sollenberger, EVP & CEO, UTMB Health SystemThis weekend, we celebrate Labor Day, which always falls on the first Monday of September. For those who are headed back to school or who have already hit the books, this weekend marks the end of summer, although the first day of fall is officially September 22. For many individuals at UTMB, this is a welcome holiday because it means they will enjoy an extra day off. For others, especially those who provide patient care or support those who do, it will be another day of exceptional and compassionate service as they remain on board in our hospitals, urgent care clinics and emergency rooms to ensure UTMB patients receive the Best Care. I’d like to especially thank you all for your service on this day.

Labor Day was established as a tribute to the contributions of employees across the U.S. to the strength, prosperity, and well-being of our country. At UTMB Health, we could not provide the best possible patient experience without the talent and expertise of all of our employees and physicians, working together to work wonders. So in honor of everything you personally do for our patients, their loved ones and your colleagues, I’d like to thank you for your service.

Whatever your role, from the moment you put on your UTMB badge, you are part of the patient experience at this organization. I’d like to share a letter recently received from a patient’s loved one that illustrates the impact you make on people’s lives each and every day. Even if you weren’t directly involved in this specific patient’s care, I’d like you to think about how you played a role in this couple’s experience at UTMB—whether you realized it or not:

“On Monday morning, May 2, my wife and I were returning to Galveston on a cruise ship when she was discovered unconscious for unknown reasons. Once docked, paramedics came to the ship’s infirmary and transported my wife to the UTMB Emergency Room facility. She was discharged the following Friday after spending several days in ICU while UTMB physicians and staff cared for her.

I wish to say “Thank You!” to the UTMB team. I was extremely impressed with both the quality of care and the compassionate disposition of the UTMB staff. During my wife’s most difficult medical procedures in the ICU, we received a level of treatment that FAR EXCEEDED any prior experience. I was greatly relieved to know my wife was in such capable and experienced hands.

In my opinion, the entire UTMB team went above and beyond at every opportunity and greatly eased my wife’s suffering during a very difficult situation. She made several remarks to me during her stay about how much she appreciated the professionalism in the staff and how she felt that her caregivers really considered her comfort and well-being. They took the time to explain to us what procedures were planned and the results of tests that had been conducted. They answered all of our questions and took the time to make sure my wife understood what was happening.

As a husband, I want to thank you and your entire team for all that was done to help in my wife’s recovery. I cannot convey how much it meant to me to know she was getting the best possible care provided by a staff who gave so much of themselves to their patients. Most importantly, we left Galveston much better than we had arrived as a result of the tremendous care we received at UTMB. Please extend to the team our grateful appreciation for their hard work and dedication.”

The gentleman who wrote this letter described an excellent patient experience at UTMB. While this is just one couple’s story, there are many other narratives we may not always hear about, although they happen every single day—someone who warmly greeted another person who, in that moment, really needed to see a friendly face, or someone who provided an anxious, concerned visitor with directions from the parking garage to the correct hospital entrance—the smallest gestures of kindness can make an impact.

I am pleased to share with you that our most recent patient satisfaction survey results reflect that our patient’s experiences are consistently good. In fact, for the month of July, 85.4 percent of patients from our Galveston campus hospitals gave UTMB the highest overall rating, according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. (Patients are asked to rate their experience on a scale of 0 to 10, where “0” means “worst hospital possible” and “10” means “best hospital possible”.)

The survey, which is administered by Press-Ganey, showed that for this rating, we performed better than 93 percent of 1,985 hospitals. Compared to other hospitals in our bed group (300-449 beds), only one percent of hospitals performed better than UTMB! Meanwhile, when compared to our academic medical center peers within this group, only five percent outperformed UTMB. This is outstanding!

Everyone at UTMB Health impacts the patient experience, and everything we do while we wear our badge represents our commitment to our patients, visitors and colleagues:

  • When you provide the right care to the right patient at the right time, you impact the patient experience.
  • When you help someone find their way or simply listen to their story, you impact the patient experience.
  • When you help a patient schedule the appointment they need when they need it, or when you help provide great customer service, you impact the patient experience.
  • When you document patient care or translate clinical documentation into codes that accurately reflect the patient care delivered, you impact the patient experience.
  • When you deliver or maintains materials, supplies or equipment to the individuals who deliver patient care, you impact the patient experience.
  • When you help ensure our facilities are operational and running efficiently, you impact the patient experience.
  • When your role is to find the right candidate for a certain job, you welcome them aboard, or provide training or educational opportunities, you ultimately impact the patient experience.
  • When you support information systems like the Epic electronic medical record, you impact the patient experience.
  • When you help transport test specimens to the laboratory or ensure the right medications are delivered to the right patient at the right time, you impact the patient experience.
  • When you serve a patient a delicious meal or you help keep our campuses beautiful, you positively impact the patient experience.
  • When you educate our future medical professionals or make medical discoveries through important research, you impact the patient experience.
  • When you quickly respond to and fix parking equipment to minimize delays in exiting our hospitals, you impact the patient experience.
  • When you promptly order and install way-finding and parking signage to reduce patient and visitor confusion regarding where they need to go to get to a clinic or pick up a discharged patient, you affect the patient experience.

From a patient’s first impression to their last impression of UTMB Health, you are all a part of the patient experience, and you all help deliver the Best Care to our patients. Thank you for everything you do at UTMB Health, and enjoy a safe and happy Labor Day!

If it doesn’t challenge you, it doesn’t change you.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI read online that viewership of the 2016 Rio Olympics is down. That was news to me, since I have been glued to the television during all of the swimming, diving and gymnastics events. I don’t read the spoiler alerts on the news and in social media, because I want to watch each event with nervous anticipation and hopefulness. I love to be surprised by the results!

As you know, swimming is a favorite sport of mine – more so lately because my grandson, Jack, participates in the sport. In my last two Friday Flash reports, I told the story of his most recent meet, as I watched him swim in adversity and finish his first race with his goggles lodged between his nose and mouth; then, I had a chance to see him finish in fifth place for his 100-meter backstroke event. He had told me all about his strategy to improve his time, and in his last race, the 200-meter freestyle, I learned even more about Jack as he once again put his strategy to work—he shaved a full 15 seconds off his personal best time and finished in fourth place!

Last week, I used Jack’s story to talk about our own strategy for success when it comes to Best Care. Our vision is to not only deliver the safest care to every patient, every time, but we are also challenging ourselves to rank among the top 20 academic medical centers for quality and patient safety*. This week, something happened to reassure me that we can and will meet this very aggressive goal.

As a participant in the Medicaid program, which provides medical coverage for more than 4 million low-income Texans, UTMB takes part in its pay-for-performance program. Simply put, the program has two basic elements upon which we are rated: potentially preventable readmissions (PPR) and potentially preventable complications (PPC).

The penalties are not insignificant. When the program began three years ago, UTMB had $3.5 million of its Medicaid payments withheld due to unplanned readmissions and complications. We were astonished. But, as we looked into the data, it became clear that a good deal of the reimbursements were withheld not because of the quality of the care provided, but rather because our documentation and coding was not sufficient; therefore, it did not accurately reflect the degree of our patients’ illnesses or the specificity of their complications. In response, we set out on a mission to improve our documentation and coding, as well as to review every unplanned readmission.

The results the following year were incredible—instead of the $3.5 million figure being withheld, we had reduced the amount to a $2.5 million—all from readmissions. Following this significant improvement, we planned to further reduce this amount in FY16 by at least another million by sustaining our gains in reducing readmissions and focusing on preventing complications.

Because our Medicaid population is heavily represented by mothers and children, we talked to the department leaders, we rolled up our sleeves and reviewed OB charts with identified complications, brought in experts in the 3M PPR and PPC algorithms, and shared findings and recommendations with faculty and residents, informing them of the implications for their ongoing documentation.  As a result of that work, a physician leader reviewed each case forwarded by hospital coders. The physician then communicated clarifications to the individuals involved in that patient’s care and medical record, and provided any overall messaging that would be useful in guiding the entire department.

While documentation and coding were certainly high contributors to the outcomes, there were also some process changes that helped us turn the information into actions that improved our overall care. The team engaged partners in Information Services to make changes in the Epic EMR infrastructure that would better facilitate the identification of the complexity and co-morbidity of OB patients, and to guide the assignment of observation status as appropriate (thereby avoiding an inpatient readmission).

The result? This week, we received our report from Medicaid outlining our results for the 2015 performance period, which go into effect September 1, 2016. We had zero deductions for unplanned readmissions and zero deductions for unplanned complications of care. That’s right—we exceeded our plan, and we did not incur ANY of the potential $2.5 million penalty!

This outcome reinforced several things for me:

  • We need a plan that we follow without exception.
  • We need people to be engaged in this effort to help us identify problem areas, develop solutions to those problem areas, and be willing to assist in teaching and educating our providers and staff to help us achieve our goal.
  • We can achieve lofty, seemingly impossible goals, if we have a plan, execute it and stay singularly focused on achieving it.

While I would like to think that the large amount we retained will help our budget next year, we also learned that some of our funding from other various sources will be reduced more than we had anticipated. So while the latter is disheartening, it is another reason why we are so focused on Best Care—safer care is not only better for our patients, but it costs less, too.

If we remain focused on meeting the performance benchmarks for academic medical centers, increase our efficiency, reduce variation in care, and improve our quality, everyone wins. We lower our costs, see greater reimbursement, and most importantly, our patients get the best possible care—this is our ultimate goal.

We have a tremendous opportunity to showcase our talent and expertise through this endeavor. Thank you all for everything you are doing to help UTMB Health achieve Best Care for all of its patients!

*As measured by the Vizient Quality & Accountability Study.

Commit to Excellence

Donna Sollenberger, EVP & CEO, UTMB Health SystemLast week, I shared a story about my grandson, Jack, who recently competed in a swim meet. During one of his races, he swam four laps with his goggles between his nose and his mouth after they were dislodged upon diving into the pool. Despite this obstacle, Jack finished the race. I thought this story was a great example of the importance of staying the course to achieve our goals, despite the obstacles we may encounter along our way.

After this race, Jack had a little bit of time for lunch before he swam in his next two events. As the time approached for the 100-meter backstroke, he sat down next to me. Instead of asking him if he was nervous, I asked about his goal for his heat. He told me that he wanted to improve his time and finish in the top eight, which would earn him a ribbon.

“So, you have a plan?” I asked.

“Yes,” he said. (He is a boy of few words – or maybe it is just that he is 10!)

“How did you get that plan?” I asked. (Jack thinks his Nana asks a lot of questions, but I tell him I had many years of practice when his mom was young!)

“I worked with my coach.” He said. “She had me practice my dive into the water and my turns. My coach and I talked about what I needed to do to improve my stroke, and we talked about my plan for swimming the race.”

Then he told me about how he would try to get a good entry into the water, move under the water as long as he could, swim hard the first lap, pace himself, and then give it all he had toward the finish.

“Do you feel it is a good plan, one that will work for you?” I asked.

Jack nodded.

“Then go do it, Jack, because I know you can.”

As he dove into the water a few minutes later, I held my breath, hoping that his plan would pay off and he would meet his goal. A few minutes later, Jack had finished in the top five!

I thought about what Jack had done – how he had prepared for and swam his race. I realized how similar this is to what we are doing in the next twelve months to achieve our Best Care goal:

  • We have selected the races that will help us rank among the best. In other words, we have identified several areas of focus in quality and safety – mortality, readmissions, length of stay and patient safety – that will help us improve the most and place us among the best academic medical centers in the country, as measure by Vizient’s Quality & Accountability Study. We also know we must maintain our success in patient-centeredness and equity, as well as remain focused on clinical documentation improvements and enhancing the Epic EMR to be successful.
  • We have set challenging but achievable targets. Working together, Health System leadership, the Provost & Dean of the School of Medicine, and the Clinical Chairs identified measurable goals that we believe we can achieve within the coming year—as long as we work together and maintain our commitment, dedication and focus. Learn more about these measures on the Best Care website.
  • We will coach ourselves so we always know how well we are performing and where we need to increase our focus to improve. Teams across the Health System have created reports that can be accessed on the Process Improvement Dashboard to help us track our progress. Clinical Chairs and unit leaders can access these reports, identify areas for improvement on an ongoing basis, and help lead their teams to success.
  • We believe we can do it! Above all, we believe we can be the BEST, because know at UTMB Health, we have the talent and expertise – and most of all, we have the passion – to deliver a safe, reliable care environment and an excellent patient experience to every patient, every time.

“Desire is the key to motivation, but it is determination and commitment to an unrelenting pursuit of your goal – a commitment to excellence – that will enable you to attain the success you seek.”

—Mario Andretti

Just Keep Swimming: Facing Adversity and Finishing

Donna Sollenberger, EVP & CEO, UTMB Health SystemSeveral weeks ago, my grandson, Jack, swam in a large meet in the Houston area. Jack has been a swimmer for almost two years, and he swims in the 10-year-old category. This particular meet was very illuminating to me, because what happened to Jack told me something about his character.

This particular Saturday, Jack was scheduled for three events: the 100-meter freestyle, 100-meter backstroke and 200-meter freestyle. His first event, the 100-meter freestyle, should have been his best. However, as he dove into the pool for his heat, his goggles were not on tightly enough and they ended up just below his nose with his mouth partially covered by them.

I could tell from where I sat that he was upset and struggling. The same thing happened to another swimmer in the heat. Jack swam four laps in the 25-meter pool and finished in 14th place out of 53 swimmers. The other swimmer whose goggles had also slipped pulled himself out of the pool after the first lap, and in a fit of defeat, threw his goggles into the practice pool.

When Jack got out of the pool, he was also very upset. This was his best event, and he knew if the goggles had stayed in place, he would have placed in the top eight in this event—practice after practice, that had been his goal. Now, he did hadn’t even placed in the event.

A little later, as we were waiting for Jack’s next event, I talked to him about his experience and told him he should be proud of what he accomplished. While the other swimmer had given up, Jack finished his race despite the obstacle in his way.

What happened to Jack caused me to think about how many times we have to keep going despite adversity so that we can finish, and at times, finish strong. This is true in the workplace, in our personal lives, and it’s true for our patients and their loved ones. Every day, we each have a choice as to how we will meet our challenges. We have a choice as to whether or not we are willing to overcome the barriers that get in our way, or if we will give up, even despite all of the hard work we have put in so far.

When it comes to Best Care, we have set the bar high, and we have some tall orders ahead of us when we consider we have to simultaneously improve in mortality, readmissions, length of stay and patient safety events. At times, it may be tempting to throw in our goggles after one bad race, but that doesn’t mean giving up is the right thing to do—for ourselves or our patients. We make a choice each day to keep swimming and finish the race!

  • We may face adversity when it comes to helping a patient with multiple illnesses get well enough for discharge.
  • It may be a challenge to help patients who will require some level of care outside of the hospital setting; however, they may not have the resources to acquire that care.
  • It may be a challenge to help some patients learn about healthy lifestyle choices or to help them find the resources they need to avoid readmission.
  • We may do everything in our power to create a plan of care that meets all of a patient’s needs, but they may have trouble following their care plan or will simply not comply.
  • Not all patients and families begin at the same starting line—even though there may be a patient whose length of stay extends beyond what we hoped, we know we must stay the course until that patient is well enough to go home, because it’s the right thing to do.
  • We will face challenges on our own teams at times—perhaps there will be disagreement among team members or lapses in communication.

It is said that when beginning a journey, start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible. Whatever challenges may come, we must stay focused and remember to break these large areas of focus—readmissions, mortality, length of stay, and patient safety events—into effective and manageable tasks, like using the 8 Ps, working together during progression of care rounds, and improving our use of the medical record. All of these seemingly smaller efforts will begin to align and will get us to our goal more quickly than waiting for one big opportunity to come along.

Remember: Determination, patience and courage are the only things needed to improve any situation! Whatever our obstacles to Best Care may be, let’s continue to work together, focus on our goals, and finish our race strong!