Category: Clinical Transformation
Clinical Transformation Despite Hurricane and Fire
In 2016, the University of Texas Medical Branch (UTMB), which includes four hospitals and is a member of Texas Medical Center, ranked a dismal 76th out of 102 other academic medical centers in a quality and accountability ranking study. The study looked at mortality, efficiency, safety, effectiveness, patient-centeredness, and equity measures. Gulshan Sharma, MD, chief medical and clinical innovation officer, knew that Galveston, Texas–based UTMB could do better and helped lead a successful transformation in the face of multiple challenges.
In 2017, Sharma and UTMB's senior leadership team launched an initiative to accelerate five years of earlier work aimed at improving UTMB's performance from mediocre to outstanding. The goal: Move from a 3-star performer in the Vizient Quality and Accountability Study to a top 20 academic health center in the United States. Through a concerted effort across the entire organization, this goal was realized, despite the fact that during that year UTMB endured a major hospital fire and a hurricane.
(Gulshan Sharma, MD, chief medical and clinical innovation officer, University of Texas Medical Branch. Photo courtesty of University of Texas Medical Branch.)
The fire, which occurred in January 2017 at UTMB's John Sealy Hospital in Galveston, caused the evacuation of 110 patients, their visitors, and the staff caring for them. Many areas of the hospital suffered smoke damage. As a result, major service areas, such as the cardiac catheterization/electrophysiology lab, women's and infants' services (which performs 6,000 deliveries a year), an adult burn unit, and other services were unable to return to the hospital for several months.
In August 2017, the hospital was also impacted by the catastrophic Hurricane Harvey. During the hurricane, UTMB accepted patients who were evacuated from surrounding areas. Impasses created by the storm, however, led to serious challenges in obtaining critical supplies, such as lifesaving blood products. Meanwhile, a number of clinical staff lost their own homes and possessions.
Nevertheless, UTMB continued its clinical transformation and learned at the end of 2017 it had exceeded its goal in the new Vizient Quality and Accountability Study. UTMB moved from 76th to 9th place among 107 peer academic medical centers. In addition, the organization met its budget for the fiscal year. As efforts continued in 2018, UTMB continued on a positive trajectory in the same study. Today, UTMB ranks 4th in the nation among 99 comprehensive academic medical centers.
UTMB also experienced other significant achievements, including improving patient experience and mortality goals. In the HCAHPS patient satisfaction survey category of "Rate the hospital a 9/10," UTMB climbed from the 59th percentile (with 73.7% of patients ranking the hospital 9/10 at the end of calendar year 2015) to the 90th percentile (with 82.8% of patients ranking the hospital a 9/10 at the end of calendar year 2017). UTMB also improved in the mortality domain of the Vizient Quality and Accountability Study. UTMB moved from 94th place in 2016 to 55th in 2017—and finally to an impressive 5th place in the 2018 study.
Dr. Sharma played a key role in these successes, working closely with UTMB's CEO, executive vice president, and the system chief nursing and patient care services executive, among other members of the health system executive leadership team, to ensure that the system and medical staff were closely aligned to achieve quality and patient experience goals. "Dr. Sharma spearheaded initiatives aimed at improving mortality and safety, which accounted for 50% of the Vizient Quality and Accountability Study. A considerable amount of work went into reducing potentially preventable 30-day readmissions and length of stay," says David Marshall, system chief nursing and patient care services officer.