They will never forget how you made them feel.

Donna Sollenberger, EVP & CEO, UTMB Health SystemI remember one year growing up in Springfield, Illinois, my uncle developed a chronic illness which, I believed and was wholeheartedly convinced, required a specialist. I attempted to persuade him to see a physician who specialized in his chronic condition. It would be easy, I told him, because I could arrange the appointment. However, my uncle declined. He wanted to stay with his current physician.

Not one to let things lie, I probed more closely. Why would he prefer to stay with his current physician and decline seeing the doctor that specialized in the chronic condition? His response interested me. He said that his current physician delivered a great quality of care for him. Why would he change now? So, I continued my probe.

How did my uncle know that his physician delivered great quality of care? His multi-faceted answer was even more insightful. It seems my uncle assessed the quality of care he received from his doctor in a way that most non-clinical people do, even today—they base it on the quality of their experience. To my uncle, a quality patient experience was about the following:

  • My doctor and his staff know me, so I can always get through when I contact them and get my questions answered or my needs met.
  • They always call me back within the day.
  • They are close to my home, so it is easy for me to drive there.
  • If I am sick, they always work me in that day.
  • Parking is easy and free.
  • My doctor’s office is new and pretty.
  • My doctor always has time to listen to me.

For a health care professional, it might seem odd that there is nothing in the above assessment regarding the training and experience of the physician, the access to other physicians for consultation, the way in which the chronic condition is managed so that it is under control—even in remission. There is nothing in his preferences about access to the best equipment, use of evidence-based guidelines in the patient’s treatment, or about the outcomes of other patients. My uncle’s entire assessment of the quality of his care was based solely on the experience he had as a patient visiting his physician. And yet, my uncle believed the quality of his care was outstanding.

Over the years, I have come to learn that the value of the patient experience cannot be underestimated. As a provider, we can do everything well in terms of the patient care delivered and the care interventions we make, but if the patient does not feel that they were treated with compassion and respect, or if they do not feel that we were responsive to their needs, or if they have trouble getting access to an appointment time that was convenient or timely for them, or if they felt they were not being listened to because the physician and/or staff never made eye contact with them or the conversation was rushed, the patient will not perceive that she or he is getting the quality of care s/he deserves. In short, the patient experience is crucial to the patient feeling as if they are receiving quality care.

In the past months, we have been focused on Best Care, which means we are upholding our unwavering commitment to deliver the right care, at the right time, in the right way, for the right person – and achieve the best possible results – for every patient, every time. One of the components of Best Care is patient-centered care, which means “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Institute of Medicine, 2001).

Every employee at UTMB in some way impacts how well we perform in the areas mentioned above—whether that contribution is direct or indirect in terms of the patient. It is true, sometimes in a large organization like UTMB, an individual who doesn’t directly “touch” a patient might not immediately realize how what one does truly helps or impacts the patient. If you feel that way, just think of a line of people passing buckets of water from one to the other from a source of water to be poured into a large water tank. An individual in the beginning or middle of the line may not be able to see the end result (i.e., the water being thrown into and filling the water tank), but the contribution of the individual is indispensable to the final outcome.*

Every interaction a patient has with our system influences their experience!

At UTMB, we are dedicated to providing an exceptional experience with excellent outcomes to all patients, no matter who they are, what their background is, what age they are, what their gender, race or ethnicity is, or how much insurance coverage or ability to pay they may have—this is equity of care, another focus of Best Care.

So, what can each person at UTMB can do to contribute to the patient experience? The following are just a few easy things we can all do, but there are ultimately countless actions we can take, and I encourage you to think about how you make a difference in your own important role:

  • Always warmly greet and assist patients and visitors—and one another.
  • Treat all patients and visitors with respect.
  • Be aware when someone looks lost or confused and offer to help them to their destination or point them to someone who can assist.
  • Assure equipment, supplies and medications are available for all patients at all times.
  • Conduct timely equipment inspections.
  • Provide language interpreters and interpreters for the hearing impaired; you can receive certification to assist in this endeavor through language services.
  • Attend training to increase ability to care for diverse groups of patients.
  • Work in teams and as a team.
  • If your personal finances permit, contribute to programs like the UTMB Good Neighbor program.

There is a quote attributed to Maya Angelou (and a few others) that says, “They may forget what you said—but they will never forget how you made them feel.” This can certainly be applied to the patient experience—whether you deliver patient care, respond to the patient’s concerns, ensure supplies and lab samples are delivered, help patients access our system, help them find the resources they need, or you create a warm, welcoming environment, you all contribute to the feeling of being well cared for at UTMB Health. I appreciate everything you do to create an excellent patient experience and to contribute to Best Care.

*Concept adapted from Grant Bright, Former Project Lead, IBM

**In addition to patient-centeredness and equity of care, the remaining areas of focus for Best Care include effectiveness of care, efficiency, patient safety and mortality, as measured by the Vizient Quality & Accountability Study.

Best Care Update

Donna Sollenberger, EVP & CEO, UTMB Health SystemAs you all know, we experienced a fire in John Sealy Hospital last week. Although some of our teams are now working in temporary locations until the hospital can be restored, we have resumed normal operations. So this week, I am again looking ahead to Best Care and what we need to do to assure that we will rank in the highest quartile of performance as measured by the Vizient Quality & Accountability Study.

We have done much work since June when we began working in earnest to improve outcomes of care for our patients. As a result of that work, we are starting to see improvements in our performance. We all remember that when we began the Best Care initiative, we ranked in the top 20 out of 102 academic medical centers in both equity of patient care (this means that our patients get the same care, regardless of their race, ethnicity, sexual orientation, economic status, etc.) and in patient-centered care.

Moving forward, we needed to remain a top performer in both of these categories, and to date, we have accomplished this. For example, our goal in patient-centeredness for the first quarter of the fiscal year was to have 76.4 percent of our patients rate us on the patient satisfaction survey as a nine or ten (on a scale of one to ten) for their overall experience of care. And there’s good news—for the first quarter of FY17, 81.6 percent of our patients rated us at the top of the scale! This is excellent work, and we need to keep it up!

Our work to increase patient safety has also been exceptional. For this measure, we use a rating called the Patient Safety for Selected Procedures Composite Score (a measure developed by the Agency for Healthcare Research and Quality), otherwise known simply as PSI-90. Patient Safety Indicators (PSIs) reflect the quality of care inside hospitals, but focus on potentially avoidable complications and adverse events following surgeries, procedures and childbirth. These types of events include, but are not limited to, the rate of pressure ulcers, falls in the hospital resulting in hip fracture, the rate of hemorrhage or hematoma after surgery, and the rate of postoperative sepsis (a severe bloodstream infection resulting in decreased organ function). We are doing exceptionally well with this measure. Our target score for the first quarter was 0.91 and we scored 0.65 (lower numbers are better, in this case). Our target for next quarter is 0.80, so we need to keep up this excellent work and do all we can to do even better!

For preventable readmissions within 30 days of discharge, we exceeded our first quarter target of 13.6 percent—our performance was 12.5 percent (again, lower numbers are better). This means that we did a good job of managing our patients once they left the hospital, we followed up with them to make sure they were following their care plan, and/or we managed their health in our clinics so they did not come back to the hospital within the 30-day time frame. While this is excellent work, we increase the challenge to meet our targets each quarter so that we have to continually improve. For the next quarter, our goal for the 30-day all-cause readmission rate is set at 12.58 percent or less, so we have to keep improving!

We also met our goal to reduce our mortality rate, which is described as a ratio that compares how many patients passed away, in total, compared to how many were expected to pass away while in the hospital based on how sick they were. A significant part of the effort to improve our rate has been rooted in clinical documentation improvement, because the more specific the documentation is, the more accurately the patient’s severity of illness is reflected. Additionally, if we do not document the care we deliver to our patients well enough, our performance appears worse than it actually is—even if the care was excellent and the patient had a good outcome. To help support our providers in this endeavor, we have been working to optimize our electronic medical record (Epic), and we are also offering documentation training to physicians on our inpatient units—for example, providers should not use symbols when documenting, and it is important to use special and specific wording when describing the patient’s condition.

For the mortality score, a score of less than 1 means that more patients survived than were predicted to. A score of more than 1 means that more patients passed away than were predicted to. So, a lower score is better. This quarter, our mortality observed/expected rate was 0.91, where our target was 0.99. Since lower numbers are better, this means we met our goal. For the next quarter, however, our target is 0.90, so we have some more work ahead of us.

The last major measure we are tracking is length of stay (LOS). This falls under the Vizient Quality & Accountability Study’s category of Efficiency, which measures how well we are using our resources compared to how ill the patient is. This measure is case mix index adjusted, which essentially means that it takes into consideration the diversity, clinical complexity and resources needed to care for our total hospital patient population. Our goal for this first quarter’s LOS at the Galveston campus was 2.85 days. At 2.96 days, we missed our goal. We have a significant amount of work to do, because for next quarter, our goal will be 2.81 days.

I know many of you have asked me how we are doing when it comes to achieving Best Care. If I were to summarize, I’d say we are on the right track and moving in the right direction. But to meet the goals we have for the end of this fiscal year, we have stay focused and maintain our absolute resolve to meet our Best Care goals.

I want to thank each of you for our improvements made since June. I know this requires a lot of work, but if we can make these improvements stick, ultimately, our work will become easier. And even more importantly, our patients will receive the Best Care.


*Lower numbers are better

Everyday Heroes

Donna Sollenberger, EVP & CEO, UTMB Health SystemMost of you already know that I was not here for Hurricane Ike. I arrived to work at UTMB one year and a day afterward. My first day of work at UTMB, I remember standing in the grassy area in front of John Sealy Hospital during the Hurricane Ike Commemoration Ceremony. Dr. Callender was surrounded by a small group of employees who listened to him talk about the progress the organization had made over the past year, and he reflected on the experiences of the first days after the storm. He recalled the extraordinary effort of some of our facilities colleagues who made sure the UTMB sign on John Sealy Towers was lit. Then, the ceremony ended, and the UTMB flag was raised by two of our students. I stood at the back of the small crowd, listening and watching the emotions of the people there. It was obvious that the memories of this experience were still quite vivid and emotions were still raw. There was still much healing to be done.

About two years ago, UTMB had the opportunity to host the University of Texas System Board of Regents and members of UT System leadership at a dinner reception. That evening, Dr. Joan Richardson, chair of the Department of Pediatrics, spoke of her love of heroes when she was a girl. She told us that she had always wanted to know a hero, but had not had a chance to know one—that is, until September 2008. As she described the work of hundreds of people who rode out the storm and the many others who came back to work tirelessly to reopen UTMB, she said that she realized she knew hundreds of heroes. They came from every walk of life, and they all had one thing in common—their resolve to reopen UTMB. UTMB stopped for no storm.

I remember the absolute silence that evening as the audience sat mesmerized at the story of the heroes at UTMB. There were few dry eyes in the room when Dr. Richardson finished her story. I remember thinking how lucky I was to work with people who made sure that UTMB, like the mythical phoenix, rose again from Hurricane Ike’s devastation.

Houston Fire Department to the rescue!

Houston Fire Department to the rescue!

This past Wednesday, I experienced what Dr. Richardson described. I was walking toward the Administration Building on the Galveston Campus when I saw a fire truck and two escort cars arrive in the front of John Sealy Hospital. It is not unusual to see an emergency vehicle or two in front of the hospital from time to time, and it generally is not a serious issue. But as I watched two of our police officers run past me and into the east entrance of John Sealy Hospital, I realized something serious was happening. Within minutes, we learned that a fire, yet uncontained, had broken out on the second floor and that smoke was in the stairwells and moving throughout the building. We declared an emergency at UTMB.

Transportation staff in action

UTMB Transportation staff in action, waiting in front of Jennie Sealy Hospital to transfer patients.

Working with local fire departments, a decision was made to evacuate the 110 patients, their visitors and our staff in John Sealy Hospital. Although this was an intense situation, our staff, physicians and managers remained calm and focused on getting everyone out of the building. As the patients were being safely transferred out of the building, we simultaneously needed to decide on where to place the patients. Administrators, doctors and managers worked together under pressure to identify the best places to continue care for our patients in our care facilities. I applaud every one of you who helped moved our patients to new locations, got them settled in, and worked to assure that their needs in these new areas were met. It was a challenging situation, but everyone problem-solved and worked together to get what was needed to help our patients.

A hero is defined as someone who makes a personal sacrifice in order to benefit others or someone who is noted for their courageous action. I now know from my own personal experience what it is like to work with hundreds of heroes. To everyone who made the safe evacuation of 110 patients possible on Wednesday, you are the heroes of UTMB! Thank you for the personal sacrifice and the risks that you took to benefit so many others!

Thank you to the Galveston Firefighters, the Galveston County Health District EMS, the Galveston Police Department, Island Transit, the Houston Fire Department, and Santa Fe Fire & Rescue for coming to UTMB’s aid!