Collective Voices

Donna Sollenberger, EVP & CEO, UTMB Health SystemEvery year is challenging when you’re a physician, staff member or leader at an essential hospital. But the good news is that in this ever-evolving health care environment, essential hospitals are better prepared for change than others: We have a long history of using limited resources to achieve good outcomes for complex patients who face many social and economic challenges. UTMB has truly demonstrated this since we began the Best Care initiative last June.

Yesterday, I was officially inducted as board chair of America’s Essential Hospitals (AEH), the nation’s leading association and champion for hospitals and health systems dedicated to high-quality care for all, including the most vulnerable. It is truly an honor to assist AEH in preserving and strengthening America’s safety net hospitals, and to assure that the health care needs of vulnerable populations are addressed for years to come.

The following are some examples of collective achievements of essential hospitals each year:

  • We provide 16.9 percent of all uncompensated care.
  • Half of the patients we serve are uninsured or Medicaid beneficiaries.
  • We run approximately 34 percent of all Level I trauma centers, 42 percent of burn centers, and 25 percent of pediatric intensive care beds nationwide.
  • We train nearly three times the number of physicians as other U.S. teaching hospitals – on average, that’s 228 residents per hospital versus 78 per hospital.
  • We deliver approximately 395,000 newborns; nearly 39 percent of those births are paid for by Medicaid.
  • We treat approximately 13.8 million patients in our emergency rooms.
  • And we achieve all of this, spending slightly less per Medicare beneficiary than the average hospital.

Our margins are stretched thin by this work, and for some hospitals, there’s no margin at all. Overall, AEH members operate with only a 3.2 percent margin – that’s less than half of other hospitals. Essential hospitals would lose 3.6 percent of that margin without government funding provided to hospitals that treat indigent patients, known as Disproportionate Share Hospital payments.

It is this work, and our daily struggle to make ends meet, for which America’s Essential Hospitals advocates. The association gives essential hospitals like UTMB a strong, collective voice that’s hard to ignore. Standing alone we risk failure, but standing with one voice we have every chance to succeed. Most important, we give a voice to our vulnerable patients, who might otherwise be overlooked or left without care. We have a collective responsibility to work with our communities, within our states and our nation to be that voice for patients and create access to equitable care for all.

While the numbers speak for themselves, they come alive best through stories that speak to the complexity of care and to the needs of patients we manage every day. I am excited to share with our essential hospital peers the innovative work we are doing at UTMB in support of our mission. We all have stories that can help people who are not entrenched in health care understand the problems we juggle every day.  I hope you will send me your experiences (protecting patient confidentiality, of course) so we can share the story of how, working together, we make a difference in the lives of so many!

Working together in concert not only helps us move more quickly; it changes the nature of what we can undertake. When we have the confidence that we can orchestrate the group effort required to realize them, we dare bigger dreams.

― Justin Rosenstein

We’re sorry, your appointment has been delayed!

Donna Sollenberger, EVP & CEO, UTMB Health SystemHave you ever boarded a flight and only moments after getting settled in and buckled up, the captain announced a mechanical issue? Thirty minutes later, still sitting on the tarmac, your frustration starts to mount as you realize you’ll have trouble making your next connection. Have you ever experienced a cancellation that forced you to wait hours for the next flight, and upon arrival at your destination in the Continental United States, you learned your baggage was on its way to Hawaii? I’m sure most of us have been there in some form or fashion at least once, and the more you travel, the more you’re bound to run into the occasional cancellation or delay. Airlines use checklists to ensure every safety measure has been taken before passengers board the airplane, but with tight schedules and high demand, there are sometimes operational issues that can’t be avoided.

From my perspective as a customer, I can’t help but wonder what is really going on behind the scenes when these inconveniences occur. Was it genuinely something that couldn’t be avoided, or was it poor planning or ambivalence? For many of us, when there is an unexpected or unreasonably long wait, it tends to influence our impression of the service we receive. We might even tell others about the quality of our experience. It may also cause us to reconsider our choice of airline the next time we book a flight. I recently read an article in H&HN Magazine that says among the 12 largest airlines, one airline ‘gets it right’ (via flights that leave on time, arrive safely and without deplaning incidents or baggage mishaps) 76 percent of the time. That means one in four flights will have a disappointing result. Whether it’s the fault of the airline or a complication of how the aviation system operates, passengers who are stranded in airports, delayed, inconvenienced or put on hold for hours when trying to reach a customer service representative blame the airline.

Health care is often compared to the airline industry when it comes to safety, high-reliability operations and customer service. Just as with airlines, in health care, customers (our patients) are watchful of our performance. Experiences like a long wait for an appointment can be frustrating. A last-minute rescheduled appointment is most often an inconvenience. It might make a person wonder why their health care provider cannot answer their phone in a reasonable time, or take weeks – or even months – to get them an appointment. Don’t they care about their patients’ time? Why is it taking so long to get a return phone call? Do they make mistakes? Our patients also rely on us to quickly resolve problems. Their experience, whether positive or negative, has the potential to influence their perception of us as a provider and as a result, has the potential to affect our reputation.

Improvement is a continual process, and we are always looking at ways we can enhance the patient experience at UTMB. As far as access improvement, a great deal of effort has been put into improving our processes from an overall health system perspective. We are continuing this work with a focus on specialty services, where we sometimes have longer waits for appointments. To help improve access, we have decentralized specialty care appointment scheduling during regular business hours to make it easier for clinics to work patients into available appointment slots. We also created the ability for patients to view and make appointments online in primary care and selected specialty services via MyChart.

We know that in each specialty, patients have unique needs. We also realize patients sometimes have preferences, such as which provider they would like to see and on what day and time. As a result, even though we can implement broad solutions to improve access, each department will also need unique solutions for their area and their patients. We have a lot of possibilities at our finger tips. It is important to keep in mind, there is no one-size-fits-all approach to making major access improvements in each specialty, so it will require a combination of strategies, like exploring the use of telemedicine for consultations where it makes sense logistically and partnering with primary care to provide certain screening services. As we all strive to make these improvements, we will find that some of those solutions end up being so effective, they will work on a wider scale, improving the patient experience for all.

Through teamwork, collaboration and exploring the use of technology and the data we collect, we will find many great opportunities to take patient service and access to the next level. There is a saying, “Ideas won’t keep. Something must be done about them.” I know those of you who work directly with our patients and work within our systems have great ideas, and I believe in the talent and innovative spirit of everyone at this organization. Let’s demonstrate once again the kind of ingenuity we have at UTMB. If we can move the needle in our Best Care initiative from a rank of 76th place to 19th place among 102 academic medical centers in just nine short months, we can move the needle in any area we choose! Let’s make a difference this year in access, providing Best Care to each patient, each time, when they expect it!

“The man who moves a mountain begins carrying away small stones.”
– Confucius

Engage our patients in their care by asking, “What matters to you?”

Donna Sollenberger, EVP & CEO, UTMB Health SystemOn Tuesday, June 6, “What matters to you?” Day was celebrated globally. The observance first began in Norway in 2014 and became more widespread after Healthcare Improvement Scotland got involved. The day is intended to build support for more meaningful conversations between health care providers, social workers and the people, families and caregivers who receive such services. I think this is a wonderful effort, yet I couldn’t help but wonder why we devote only one day to recognizing the importance of asking our patients what matters to them?

In 2001, the Institute of Medicine, now known as the National Academy of Medicine, defined patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs, and values” and that ensures “patient values guide all clinical decisions.” Providing patient-centered care is important because it results in better outcomes for patients and greater patient satisfaction with the care they receive. With the patient’s voice at the center of their care team, it also helps assure the patient and family that members of the health care team are all talking to one another, and everyone knows what everyone else is doing. Additionally, it promotes shared decision-making, which emphasizes the importance of clinicians and patients working together to produce the best outcomes possible. In short, it helps the team deliver care that is focused on what matters most to the patient.

In an article published in Becker’s Hospital Review, Maureen Bisognano, president emerita and senior fellow of the Institute for Healthcare Improvement, explains, “What you’ll find is that what matters deeply to people often is different from what we might clinically diagnose them, but it expands our view, our sense of what is really important in these peoples’ lives.”

This concept was explored by Michael Barry, MD, in an article on shared decision-making published in the New England Journal of Medicine in 2012. He explains, “For some decisions, there is one clearly superior path, and patient preferences play little or no role — a fractured hip needs repair, acute appendicitis necessitates surgery and bacterial meningitis requires antibiotics,” for example. “For most medical decisions,” he continues, “more than one reasonable path forward exists (including the option of doing nothing, when appropriate), and different paths entail different combinations of possible therapeutic effects and side effects.” In such cases, patient involvement in decision-making adds substantial value.

In the namesake campaign launched by Healthcare Improvement Scotland last year, several examples of things that matter to patients were highlighted:

  • “I like to receive the medication that manages my Alzheimer’s at the time I always take it at home, rather than at drug rounds.”
  • “It’s really important to me that my granddaughter is involved in any discussions about my support. She’s the main person in my life!”
  • “Getting outside is really important to me. When I’m having a difficult day, getting outside helps me to find space to think more clearly.”

Most of you will recall the direction of Sir William Osler to treat the patient, not the disease. Dr. Berry says, “If we can view the health care experience through the patient’s eyes, we will become more responsive to patients’ needs and, thereby, better clinicians.” The question of “what matters” can be approached in a variety of ways, such as:

  • “What are the things that are important to you at the moment?”
  • “What are some of the things you would like to achieve as a result of this support?”
  • “When you have a good day, what are the things that make it good?”

It is said that this approach to conversing with patients helps us build a relationship with them, allowing us to better understand the person in the context of their own life and the things that are most important to them. Because diversity is one of our core values at UTMB, we try to recognize and understand the many different backgrounds, beliefs, traditions and preferences of our patients. With this crucial insight, we are in a much better position to work with our patients to find the best way forward for them, and we are in a much better position to provide them with the very Best Care.

When was the last time you asked a patient, “What matters most to you?” What was the outcome? Please send me your stories.

Are you prepared for hurricane season?

Donna Sollenberger, EVP & CEO, UTMB Health SystemAbout a month ago, an old friend reached out to me. I had not heard from her for several years, so I wondered if something important was going on. She told me she had recently been in the process of cleaning out her mother’s home when she found something that made her think of me. It was a newspaper from June 13, 1957 with the headline, “Two Dead, 46 Hurt in Storm: Tornado Hits City, Leaving a Path of Death, Destruction.” She wanted to know if I remembered the day of the storm, June 12. Did I remember? That was the time a tornado directly hit Springfield, Illinois. It was as vivid in my mind as yesterday!

Illinois State Journal – June 13, 1957

I remember riding in the car that day with my mother, younger brother and little sister. We had just stopped by my friend’s home to give her a ride to our swimming lesson. We had only made it about two blocks down the road from her house when it suddenly started raining. It was pouring down so hard that you couldn’t see anything beyond the front of the car’s hood. The wind whipped at our car, making driving even more difficult. Between the wind and the rain, my mother was having a difficult time seeing the road, so she immediately turned around and headed back to my friend’s house. My friend’s mother was in the driveway ready to help all of us into her house and down to the basement. I cannot recall if there were tornado sirens that day, but we all sat in my friend’s basement, huddled together and hoping that the tornado would spare us. Fortunately, it did.

This was my first experience with a tornado, but it would not be my last. Once, I remember waking up to the sound of sirens and having to take shelter under a mattress in the room that my sister and I shared. I also remember huddling in school hallways with my fellow students as sirens wailed. Another time, while driving, I saw a funnel cloud headed right toward me. I have sat in bathtubs in homes without basements (advice that meteorologists recommend because it is supposedly one of the most sturdy areas of your home), listening to the transistor radio for news. Each time, thankfully, I have been safe.

When you live in the Midwest, you learn to always be prepared for a tornado, which can come out of the sky at any time. There is not time to prepare, like stocking up on water and gathering other provisions. There is only time to react and to act on what you have been taught. Unlike a tornado, however, an approaching hurricane does allow us some time to prepare. That being said, as anyone who has ever attempted to purchase hurricane supplies in the days before a storm can tell you, now is the time to prepare!

Yesterday, June 1, marked the beginning of the 2017 Atlantic hurricane season, which will last until November 30. This year, forecasters predict a 45 percent chance of an above-normal season, a 35 percent chance of a near-normal season, and only a 20 percent chance of a below-normal season. Regardless of whether the odds of a storm in our area are high or low, continual readiness is important. Not sure where to begin in making preparations? Websites like offer a number of checklists to get you started, and UTMB’s Emergency Operations website offers information specific to emergency plans at UTMB.

Because some emergencies can come without notice, you should develop a communication plan with your family. Does your family know how to get in touch with one another? It may be that as employees, we are asked to stay for an extended time at UTMB. Or, we may not be at work or home at the time of an emergency. Lines of communication could be temporarily down or unavailable due to high call volumes. It’s important to have a family discussion to determine how you will contact one another, where you will go in case of emergency and to make arrangements for the care of dependents and pets.

Just a reminder, as a UTMB employee, there are some important actions you should take to prepare for an emergency:

  • Complete the 2017 Emergency Classification and Acknowledgment Form by June 30, available in a new online format (login required).
  • Consult your supervisor or faculty advisor if you have any questions about your emergency responsibilities or reporting to work/school during an emergency.
  • Become familiar with UTMB’s Institutional Emergency Operations Plan (login required).
  • Enroll in Direct Deposit and MyChart, to ensure access to your paycheck and/or your UTMB medical records in an emergency.
  • Update your general UTMB Directory information—particularly your work location (L-code) and departmental mail routing number. Go to Employee Self-Service/Personal Information/UTMB Directory Self Service. This information is vital to our ability to determine who is affected by a particular emergency and will support our efforts to better target emergency-related messages in the future.
  • Update your contact information in the UTMB Alerts emergency notification system. From the Directory tab on iUTMB, search your name and click the “Edit My Alert Info” button. Add mobile or other contact information as needed, and ensure at least two contact methods are listed for you.
  • Keep computer security in mind. Never reveal your UTMB login information to anyone, and be suspicious of emails asking you to enter your login information.
  • WEAR your ID badge every day at all UTMB locations, so emergency responders will know you belong.
  • Develop an emergency plan for your home that takes into account care and safety of dependents and pets.

Steven Cyros may have said it best: “Remember: when disaster strikes, the time to prepare has passed.” Let’s all commit to doing our part to assure that we can respond in any situation to assure our safety and the safety of our patients.