Health Systems initiative
stresses service, high-quality care
By Kathleen D. Valenzi
Jones is concerned. Results from medical tests taken by her primary
care physician suggest a possible serious health problem. Shes
traveling to Europe in two weeks and would like to know conclusively
whether she has anything to worry about before she goes.
physician refers her to a specialist at the University of Virginia
Medical Center. While shed prefer to be seen right away,
she is also reasonable. She tells the specialists 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.
Tim Garson Jr., (left) dean of the School of Medicine,
and R. Edward Howell, chief executive officer of the U.Va.
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.
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.
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.
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.
the biggest hurdle in improving patient service is
making sure that all systems work in concert...
find that a number of elements in the Decade Plan were contained
somewhere in those other strategic plans, so in some sense, you
wouldnt call everything that were 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.
has coined the expression Models for all of US for
the Decade Plans 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.
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.
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.
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.
fifth cross-mission team was also assembled to study
issues like the relevance of departmental structures
that cut across all mission areas.
We want to be able to leverage the science that we
do so well here in order to make our own patients better...
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.
suspect that if you polled private-practice specialists throughout
the country, you would find that many of them dont see patients
within two weeks, so this is a tremendously high bar we are setting,
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. Thats why the collaborative
approach to formulating the Decade Plan is so critical.
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
...wed like to be a model for a
health system that gives back to the community in a number
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 thats all about
yes rather than about no or not
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.
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 were 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
weve learned with other institutions.
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.
...each of our residents will have to demonstrate
competency in areas... in order to practice medicine.
our vantage point at the Medical Center, were 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. Were 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
final model centers on community service. This is an easy
one to understand, Garson said. We have said that
wed 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.
this joint planning effort is important, neither man doubts.
and I were recruited here to focus on setting a new direction
for the Health System, Howell said. Weve already
done a number of one-time things. The Decade Plan reflects our
ongoing commitment to keep moving forward.