University Staff Council

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University Staff Council

• Harry R. Jacobson, M.D.
• Vice Chancellor for Health Affairs
• February 13, 2007

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• Overview of Vanderbilt
• Bragging and Shameless Self Congratulations
• Let the Beatings Continue Until the Patients
  Smile -

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Overview of Vanderbilt
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Vanderbilt University
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Vanderbilt University FY 2007 Budget( millions)
University Administrative Infrastructure Cost
University Revenues
IDS Payments (non-tuition based)
University Central 19.9
University Central 21.4
VUMC 80.1
VUMC 78.6
2,434 Million Total University Budget
121.7 Million Total IDS Payments
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Total Employment
18,935 Employees
Univ Central 4,725
VUMC 14,210
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Vanderbilt Medical CenterFull-Time Faculty
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Class of 2010/2011
As of 02/05/07
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Vanderbilt University Medical CenterSummary of
Education Programs
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Vanderbilt University School of
MedicineRestricted Gifts, Grants, and
ContractsDirect and Indirect Recoveries(millions
)
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Strongest NIH research award growth rate
Source NIH, top 25 medical schools
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Vanderbilt Medical Center ResearchNIH Ranking by
Department
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Research Summary

• Research is the defining character of Vanderbilt
• Biomedical research has propelled our reputation
• Our research priorities are at the leading edge
  of science, and in-step with federal funding
  priorities
• Shared facilities and a culture that encourages
  multidisciplinary research differentiates
  Vanderbilt
• Imperatives faculty recruitment, faculty
  development and research space

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Vanderbilt Medical CenterLicensed Inpatient Bed
Capacity
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Vanderbilts Unique Services

• Highest Level Neonatal Intensive Care Unit
• Dedicated Pediatric Emergency Room
• Highest Level Trauma Center
• National Cancer Institute Designated Center
• Solid Organ Transplant Center of Excellence
• Pediatric Intensive Care Unit
• LifeFlight

• Angel Ambulance
• Burn Center
• Poison Control Center
• Quaternary Services
• High Risk OB
• Fetal Surgery
• Bone Cancer
• Seizure Ablation
• Retinopathy
• Pediatric Cardiovascular Surgery
• Head and Neck Cancer

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Vanderbilt University HospitalsDischarges
42,599
39,640
TOTAL 3.8 4.0
4.7 7.5 8.9
6.0


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Vanderbilt University Hospitals and Clinics
Clinic Visits
1,059,392
Total 7.3 1.5
17.9 14.1 8.3 4.1
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Vanderbilt University Hospitals and Clinics
Financial Results Available for
Capital Replacement

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Vanderbilt University Hospitals and
ClinicsUncompensated Care
Uncompensated Care ( millions)
Percent of Gross Patient Revenue
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Uncompensated Care Cost ShareBenchmarked against
Median Teaching Hospital
Vanderbilt University Medical Center
COTH Quarterly Survey of Hospital Operations
Financial Performance
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Braggingand Shameless Self Congratulations
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Consumer Hospital PreferenceComparative Rates
1996 2006
Hospital of Choice
Based on a survey of 1,900 households
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Consumer Hospital PreferenceComparative Rates
1996 2006
Quality of Care
Based on a survey of 1,900 households
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Consumer Hospital PreferenceComparative Rates
1996 2006
Physician Quality
Based on a survey of 1,900 households
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Vanderbilt Childrens Hospital ranked 14th in the
country
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Magnet Designation

• 1st in Nashville
• One of Only 223
• 2nd in Tennessee
• Covers all Aspects of Clinical Programs
• All Hospitals
• All Clinics
• Emphasizes
• Value of Nursing
• Importance of Shared Governance
• Role of Cross-Disciplinary Teamwork

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We are Nashvilles First
Congratulations !
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Major Differences Exist Between the Top
Performers and Others
For a 500-bed AMC performing at the median to
move into Group 1 would result in 150 fewer
deaths per year.
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Vanderbilt Medical School ResearchNIH Funding
National Rankings 2005
20 million away from Top 10
Vanderbilt was 24th in 2000
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Americas Best Hospitalsaccording
to7/17/2006 Issue
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US News World Report 2006 Honor Roll
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Recognition

• National Research Corporation
• Top Preferred Hospital in Nashville
• Measures Reputation and Quality
• 7 Years in a Row

• Solucient Top 100 Hospitals
• One of 16 Academic Centers
• Fifth Year in a Row
• Only Nashville Hospital
• Measures Clinical Quality, Profitability, Cost

• Americas Top Doctors
• Peer Selection of Top MDs
• 67 Tennessee MDs listed
• 46 are Vanderbilt Faculty

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Mission

• Educational Mission
• One of the Most Selective Medical Schools
• One of the Best Places for Doctoral and Post
  Doctoral Studies
• Residency Programs Improving
• Research Mission
• Fastest Growing Research Program in US
• 5th Ranked for Clinical Medicine Citation
• Investments on Target with NIH
• Clinical Care
• USNWR Best Hospitals
• Solucient Top 100 Hospitals
• Strong Growth Market Share and Preference
• Strong Financially Margins in Top Quartile
• Quality
• Customer Service GOOD BUT NOT YET GREAT
• Workplace of Choice

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Goals for the Medical Center

• strongest market share
• most preferred
• highest quality, highest severity
• 1 or 2 in all key service lines

• Be the dominant healthcare provider in Middle
  Tennessee

• Cancer, transplant, pediatric subspecialties,
  neurology/ neurosurgery, trauma, diabetes,
  cardiovascular disease, burn, orthopedics

• Become the top referral center in the Southeast

• Become nationally recognized as top 10 best
  medical center

• exceptional healthcare
• organized around the patient
• perfect customer service

• Earn Mayo-like brand

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Earn the Mayo-Like Reputation

• Exceptional physicians and nurses
• Excellent quality and safety
• Exceptional staff
• Care organized around the patient
• Flawless hand-offs
• High value on customer service
• Communication
• Coordination
• Kindness
• Quality
• Follow-up

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The Origin of Great Customer Service

• Customer satisfaction is driven by employee
  satisfaction (Harvard Business Review)
• Employee satisfaction is driven by trust (Gallup,
  Buckingham, Great Places to Work Institute)
• Elements that most effectively build trust
• Clear, effective and relentless communication
  with managers
• Personal relationships between managers and
  staffs
• Clear goals and expectations more objective the
  better
• Clear job scope of work and empowered to meet
  goals

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Balanced Goals

• Multi-year organizational development approach
• Focuses All Staff on Five Pillars
• - Clinical Quality
• - Service and Patient
• Satisfaction
• - Financial Performance
• - Growth
• - Staff Satisfaction
• Headed by Studer Group and Quint Studer
• - Former CEO Baptist/Pensacola
• - Only Malcolm Baldrige Hospital
• - Fortune 500 100 Best Places to Work
• - Clients Include University of Chicago and
• Cleveland Clinic

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Hardwiring Excellence

• Leadership Development Institute
• Its Who We Are Credo Value
• Thank You Notes
• AIDET Introduction to Patients
• HEART Customer Recovery
• Reward and Recognition
• Balanced Goals
• Performance Development Plans
• Tough Questions and Management Transparency

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Leadership Development Institute
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People Pillar

• Reduce turnover rate
• VUMC overall to 12
• VUMC nursing to 8
• Elevate our new hire employee retention after 18
  months to 80
• Elevate our staff satisfaction scores to 4.5 in
  all 4 Survey Domains
• Employee Domain
• Manager Domain
• Organizational Communication
• Commitment Indicator
• Elevate our physician satisfaction

VUMC is a great place to work and will be on
Fortune 100 Best Employer list by 2007.
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People FORTUNE 100 BEST COMPANIES TO WORK FOR
2006
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People

• 11,020 Responses
• (7,557 in 2004)
• (46 increase)
• 81 Participation Rate
• (63 in 2004)

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People

• Every item showed higher scores
• Average for all items combined was better(3.9 in
  2006 versus 3.7 in 2004)
• Consistency of responses was higher
• Domain Scores were above 4.0 for 3 domains

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PeopleAll Domains Improved
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Service Pillar

• Elevate rating of excellence for
• Overall service and medical care to 90
• AND
• Likelihood of returning for care and recommending
  Vanderbilt to 95

VUMC will continuously improve how we serve
others.
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ServiceQuality of CareJuly 2005 to December 2006
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ServiceLikelihood to Recommend Vanderbilt July
2005 to December 2006
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ServiceAdult ED Patient SatisfactionOverall
Quality of CareVanderbilts National Percentile
97.4
94.8
94.8
92.2
89.6
87
70.3
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Quality Pillar

• Achieve lowest mortality in nation
• Perform in top 10 on publicly reported quality
  measures
• Eliminate medication errors

VUMC will provide safe and high quality
preventive, acute, and chronic patient care.
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Quality
VUMC Monthly O/E Trend Line
UHC Expected Line 1.0
VUMC Cumulative O/E thru 5/06 .75
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QualityLeapfrog Top Hospitals 200659 hospitals
including

• Vanderbilt University Hospitals

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QualityWhat is the Magnet Award?

• The highest level of recognition that the
  American Nurses Credentialing Center can accord
  to healthcare organizations which provide the
  services of Registered Professional Nurses.
• Dates Reviewed September 1316, 2006 
• Date Awarded November 16, 2006

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QualityResearch - Thomson Scientific Indicators
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Growth Pillar

• Volumes Exceed Plan
• Hospital admissions
• Clinic visits
• Total surgical cases
• Emergency visits
• Increase Sponsored Research 10 per year
• Increase Pool of High Volume Referring Physicians
  5

VUMC will be the leading provider of health care
services in the region.
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GrowthVUH Critical Care Tower Phase II

• 9 Story Addition (Floors 2 - 10)
• 5 New ICU Inpatient Floors 141 Beds
• 12 New Operating Rooms
• Begin construction January 2007
• Occupancy 2009

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GrowthMedical Research Building IV
MRB IV 385,000 GSF 221,900 NSF
Light Hall Addition Occupied 2005
Eight Floor Deck Framing
Langford Addition Occupancy Summer 2007
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GrowthVanderbilt Eye Institute

• Construction underway Fall 2006
• Occupancy January 2008

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GrowthVUH East Garage Expansion

• Project complete Fall 2007
• Adds 800 parking Spaces
• New Entry on 21st Ave.

New Garage Construction Looking South
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Growth Center for Experiential Learning and
Assessment (CELA) MRB IV 3rd 4th Floors
Simulation Room
CELA Entrance
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Growth Vanderbilt Institute of Imaging Science
Vivarium Construction Above

• Occupied October 2006
• 41,000 GSF
• 6 Magnets

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Growth Centralized Vivarium and Gross Anatomy
Lab at VUIIS

• Five Floor Addition of 42,500 GSF
• Gross Anatomy Lab 10th Floor
• Three vivarium floors
• One Shelled floor

View from 21st Avenue
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Growth Vanderbilt Ingram Cancer Center
Clinic Waiting Reception

• Multi-phased project
• Construction starts March 2007
• Completion December 2008

Clinic Entrance
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Growth Equivalent Patient Days
9.3 Average Annual Growth Rate
2007 Forecasted Volumes
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GrowthChallenge Constrained Capacity..VCH
Occupancy has been over 80since July of 2004
Average Daily Census VCHJuly 2003 September
2005
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Growth Targeted Growth Plan

• Realities
• Limited Near Term Capacity to Grow In-Patient
  Beds
• Clinical Space, OR Time and Parking Constrain
  growth
• Some Services and Procedures Produce Larger
  Margins
• Uncompensated Care Strains Financial Health

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GrowthTargeted Growth Plan

• Approach
• Demand in all Services Exceeds Bed and OR
  Capacity
• Develop Allocation Model That
• Maximizes Revenue
• Controls Excess Demand
• Diverts Appropriate Services Off Campus
• Ensures All Programs Meet Academic Requirements
• Some Services and Procedures Produce Larger
  Margins
• Uncompensated Care Strains Financial Health

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Financial Pillar

• Increase Net Revenue (Top Line)
• Hospital and Clinic by 10
• VMG by 8
• Increase Bottom Line by 18
• Save 5 of Cash Flow

VUMC financial resources attract world class
faculty, staff and students to heal, teach, and
discover in state-of-the-art facilities.
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FinancialVUMC Performance ResultsFiscal Year
2006 2007 (in millions)
Source VUMC Department of Finance
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FinanceVanderbilt University Medical CenterNet
Revenue Trend(billions)
Compound Average Growth Rate of 10.1
5.3
11.3
15.1
12.3
15.0
14.1
October YTD Actual
11.2
11.3
6.7
Forecast
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FinanceUncompensated Care
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• Where are we now?
• Established credibility of effort and management
  commitment
• Expanding program to residents
• Increasing focus on physician buy-in and
  satisfaction
• Building internal organizational development
  capacity
• Planning Phase II of Studer engagement
• Hiring Chief Learning Officer
• Extending customer service focus to internal
  customers
• Move low performers up or out
• Increase scope of performance incentive
  compensation

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State of the Medical Center2016

• Parking is Free
• Mayo Launches a Drive to Earn a Vanderbilt-Like
  Brand
• Vanderbilt Medical Center Holds a 2.5 Billion
  endowment
• Evidence-Based Medicine is Practiced Nation-wide
  with Tools and Approaches Developed at Vanderbilt
• Vanderbilt is the National Learning Lab for Team
  Approached Health Care
• Our Scientists and Physicians Have Invented New
  Diagnostic and Therapeutic Tools Geared to the
  Individual
• Vanderbilt is on the Fortune Top 100 Places to
  Work List for the 10th Year
• Vanderbilt is Recognized as a Top 10 Hospital, a
  Top 10 School, a Top 10 Research Center
• And Is In A Class By Itself

• Jacobson on Sabbatical at Pebble Beach

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