Decade Plan
Health System’s initiative stresses service, high-quality care

By Kathleen D. Valenzi

Mrs. Jones is concerned. Results from medical tests taken by her primary care physician suggest a possible serious health problem. She’s traveling to Europe in two weeks and would like to know conclusively whether she has anything to worry about before she goes.

Her physician refers her to a specialist at the University of Virginia Medical Center. While she’d prefer to be seen right away, she is also reasonable. She tells the specialist’s appointment secretary that she can wait as much as two weeks if she has to, since the specialist is undoubtedly busy. She is told to come the next day; the specialist will work her in.

Arthur “Tim” Garson Jr., (left) dean of the School of Medicine, and R. Edward Howell, chief executive officer of the U.Va. Medical Center.

“We wish that scenario were true in every case today, but it is not,” says Arthur “Tim” Garson Jr., dean of the University of Virginia School of Medicine. Sometimes patients must wait several weeks to be seen by a specialist for the first time.

But not for long. Garson and R. Edward Howell, chief executive officer of the U.Va. Medical Center, are spearheading an effort to put patient-centeredness back into academic health care.

The two University vice presidents are co-chairing a major initiative known as the Decade Plan. This first-ever joint planning effort of the School of Medicine, the Medical Center, the Health Services Foundation and the School of Nursing intends to remedy documented problems and to create innovative models for improving human health in four mission areas. If successful, Garson and Howell believe they will be able to steer the U.Va. Health System to top status as a health care institution in less than 10 years.

A strategic effort that combines plans for the schools and the Medical Center has never before been undertaken at the Health System, although strategic planning has been conducted separately. Consequently, the Decade Plan — which got under way in September 2002 — does not attempt to reinvent the wheel entirely.

Patient Care “the biggest hurdle in improving patient service is making sure that all systems work in concert...”

“You’ll find that a number of elements in the Decade Plan were contained somewhere in those other strategic plans, so in some sense, you wouldn’t call everything that we’re doing ‘new,’” said Howell, “but you would call it ‘refocused’ and ‘collaborative.’ I think of the Decade Plan as both a coming together and a moving forward.”

Garson has coined the expression “Models for all of US” for the Decade Plan’s theme. As the double-entendre suggests, if these models are successful for the “us” represented by the Health System, they can be exported as models for the nation, represented by the double-capped “U.S.”

The theme also has a subtler third meaning, Howell said. “Because we intend to make the Decade Plan a living and breathing document by putting a budget behind it and doing what is necessary to support it, the plan serves as a model for us — for Tim and I — too,” in terms of setting priorities.

He and Garson made a conscious decision to develop and advance the Decade Plan internally, without the assistance of consultants. Why? “We wanted to put our money into the doing and not the planning,” Howell said.

As mentioned, the Decade Plan will create four models, one each for patient care, research, education and community service. Each of these areas was assigned to a team of faculty and administrators who gathered information, looked for solutions to identified problems and developed approaches to long-term goals.

A fifth “cross-mission” team was also assembled to study issues — like the relevance of departmental structures — that cut across all mission areas.

Research “We want to be able to leverage the science that we do so well here in order to make our own patients better...”

The patient care model will focus on improving customer satisfaction, particularly with respect to how long it takes a patient with a non-urgent medical problem, or a referring physician, to get an appointment. The ideal would be for non-urgent patients to be seen as soon as they would like to come in. Until the ideal can be achieved, the model will strive to get patients seen by a specialist within at least two weeks.

“I suspect that if you polled private-practice specialists throughout the country, you would find that many of them don’t see patients within two weeks, so this is a tremendously high bar we are setting,” Garson said.

“At the Medical Center, the biggest hurdle in improving patient service is making sure that all the systems work in concert,” Howell added. “By systems, I mean provider and patient communications, scheduling, patient feedback and so on. That’s why the collaborative approach to formulating the Decade Plan is so critical.”

At least 25 reasons have been identified for why a patient cannot be seen within two weeks, “and we have to fix every single one of them, from scheduling, to ‘no shows,’ to processes that take too long to get people through a clinic,” Garson said.

Community Service “...we’d like to be a model for a health system that gives back to the community in a number of ways.”

Is this doable? “I think the answer to that is, ‘yes,’” said Howell. “In fact, if you were to look down this list of things, the common theme that runs through them is the word ‘yes.’ We need to become a culture that’s all about ‘yes’ rather than about ‘no’ or ‘not yet.’”

The second model encompasses translational research — basically, the investigative work entailed in taking scientific discoveries from basic research labs and “translating” them into clinical solutions to patients’ problems.

“We want to be able to leverage the science that we do so well here in order to make our own patients better, and then we want to take that level of patient care to the rest of the country,” Garson said. “What we’re after is a model for how to facilitate this type of research — all the way from internal grants that would be given to different departments to encourage collaboration between investigators and clinicians, to facilities that promote interaction across the basic sciences throughout the University, to national conferences where we would share what we’ve learned with other institutions.”

Education serves as the basis for the third model, which includes enhancements to the curriculum; support for the clinical educator; creating a simulation center and medical education building in which students would learn, practice and maintain clinical skills and procedures; and a research program that would study the way medicine is taught to determine whether it is being taught as well as possible.

Education “...each of our residents will have to demonstrate competency in areas... in order to practice medicine.”

“From our vantage point at the Medical Center, we’re in the midst of ... a sea change away from learning that was largely experiential — meaning you would experience something either by observing or doing a number of things, and the accumulation of your experiences then qualified you in some way to practice the profession,” Howell said. “We’re now shifting in the direction of competencies, in which each of our residents will have to demonstrate competency in areas such as patient care, medical knowledge, communication, health system knowledge and lifelong learning in order to practice medicine.”

The final model centers on community service. “This is an easy one to understand,” Garson said. “We have said that we’d like to be a model for a health system that gives back to the community in a number of ways.” This model would not only encourage volunteerism at all levels but also would include the establishment of an Office of Community Outreach.

That this joint planning effort is important, neither man doubts.

“Tim and I were recruited here to focus on setting a new direction for the Health System,” Howell said. “We’ve already done a number of one-time things. The Decade Plan reflects our ongoing commitment to keep moving forward.”