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!

“THERE IS NO EXERCISE BETTER FOR THE HEART THAN REACHING DOWN AND LIFTING PEOPLE UP.”
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 https://www.utmb.edu/secc  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.

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