Technology, leadership and the willingness to be humble make this operation one of the best.
While technology is an important factor in healthcare excellence, other ingredients are equally important. They include a bold vision, capable leadership to attain that vision, teamwork and intelligent data mining.
UMass Memorial Medical Center in Worcester, Mass., is a superior example of blending leadership and technology. In 2005, the hospital voluntarily stopped performing elective cardiac surgery after data indicated its CABG mortality was above the state average. The experience was humbling for UMass, but the organization rose to the challenge and has since been recognized as a national leader in quality and cardiovascular outcomes.
“Being humbled by the closure of our cardiothoracic surgery program provided the catalyst for this major shift in cardiovascular performance,” says Robert Phillips, MD, senior vice president of UMass and director of its Heart and Vascular Center of Excellence.
Two major organizational shifts propelled the transition. Primarily through the leadership of Walter Ettinger, MD, president of UMass, the hospital established the Clinical Performance Council in 2006, in order to focus exclusively on quality and patient outcomes. The second important piece was the development of an integrated clinical, operational, financial and quality program for CT surgery, cardiology and vascular surgery under the organizational structure of the Heart and Vascular Center of Excellence.
The focus on quality is now ingrained at the highest levels of the organization, says Phillips. The clinical performance council is a bi-monthly meeting that includes all clinical chairs, key administrators and members of the board of trustees. This committee regularly reviews, gathers, analyzes and acts on quality assurance data. The performance council review system includes quality walk-a-rounds from senior leadership that focus on strict adherence to processes and procedures.
This focus on outcomes helped UMass identify other opportunities and areas for improvement. A focus on door-to-balloon (D2B) times for MI, for example, helped UMass garner the No. 2 spot nationally and the No. 1 spot in Massachusetts for heart attack survival from the Centers for Medicare & Medicaid Services.
“We began to drill down and analyze every aspect of the process,” says John Keaney Jr., MD, chief of cardiovascular medicine. Keaney notes that identifying the components of the process was a critical first step. Once these segments were identified, individual time goals were established to help clinical leaders improve overall D2B times.
“Our intent wasn’t to change clinical practice, but to change how we coordinate the process of care and its impact on patient outcomes,” Keaney said. “Each step in the process was examined for inefficiencies, duplication and standardization. We partnered with our colleagues in the emergency department and with local and regional EMS to create the most efficient system. The results are impressive: D2B times now average less than one hour, while the national standard is 90 minutes.”
Local ambulances now are equipped to send ECGs wirelessly to the emergency room and to the on-call physician’s phone, which helps to activate the cath lab in a timely manner. The hospital has adopted the use of cooling helmets, initially for use only in the cath lab, but now they are applied in the ER, says Craig S. Smith, MD, director of the coronary intensive care unit at the Heart and Vascular Center of Excellence. In the process, the UMass team has created a new metric: door to cooling-core-temperature time.
The Heart and Vascular Center of Excellence has its own monthly surgery executive committee that advocates for the needs of its surgical program. “The strength of our integration is illustrated by the decision-making process to build a hybrid vascular operating room,” says Louis Messina, MD, chief of vascular and endovascular surgery.
The performance also has had an impact on finances. “From 2006, the first year that the cardiac surgery program reopened, to 2008, profit in the Heart and Vascular Center of Excellence has increased by 260 percent,” says Jay Cyr, vice president of the Heart