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VUMC Strategic Directions Process 2019-08-20

In April 2016, faced with the rapid consolidation of the health care industry and the shift toward population health management and pay for value, the Vanderbilt University (VU) Board of Trust decided to transition Vanderbilt University Medical Center (VUMC) into a separate non-for-profit academic medical center tightly affiliated with the University. This shift created the flexibility in governance and financing to scale the health system, while strengthening the connections to the academic capabilities to drive transformation of the health system. In May 2016, Jeff Balser, CEO of VUMC and Dean of the Vanderbilt University School of Medicine (VUSM), charged Jennifer Pietenpol, Senior Executive VP of VUMC for Research and Director of the Vanderbilt Ingram Cancer Center, Reed Omary, Chair of Radiology and Radiological Sciences to co-lead a process to develop a unifying strategy framework with support by Bill Stead, Chief Strategy Officer of VUMC. We used the compass to describe the purpose of the framework. A compass is:

• A tool for assessing our progress • Tells us where we are in relation to our goals • Points us in the direction we want to go • Enables us to adjust our path forward • Can be recalibrated based on new information

Seven touchstones guided the process:

• Inclusive of all missions of VUMC • Academic strengths are generative • Include all School of Medicine and School of Nursing faculty • Work seamlessly with VU Strategic Plan • Measure and improve speed of execution • Engage executive leadership, faculty, students, staff, patients, partners and community

stakeholders • Initial draft due in August 2016; iterate over fall

The Strategic Directions Team engaged 10 workgroups to develop the initial draft over June and July 2016. The workgroups included:

• Fundamental Discovery • Translation • Technology • Design • Learning • Patient Care and Experience • Efficacy, Effectiveness and Reliability • Engagement • Entrepreneurship • Diversity and Inclusion

Each group was limited to nine members, including two co-chairs, a trainee (student/resident/post-doctoral fellow), a patient/community representative and persons bringing expertise relevant to three scales of biology (molecular, individual and population). The groups were charged with:

• Defining the scope of their topic (Table I) • Identifying the top three goals in that scope, one each from the perspective of three biologic

scales – the molecule, individual and population


• Doing a Strengths, Weakness, Opportunities and Threats analysis on each goal • Identifying the key connections to other work groups (Appendix: Table 2)

We augmented the work groups with an integration panel to scan these reports as they were developed and to provide cross-cutting feedback and advice. The workgroups and integration panel engaged 110 people drawn from 46 departments in four schools and from the community. Each workgroup met virtually and in person at least once a week and delivered iterative drafts of their final report at the end of each week. The workgroups engaged focus groups and a wide-variety of Medical Center and community advisory groups for input. In August 2016, the workgroups and leadership of the VUMC academic and clinical enterprises came together in a retreat format to share the reports, identify common themes and discuss next steps.

During the fall, the Strategic Directions Team distilled this input into the VUMC Mission Statement (affirming the mission did not change with the transition to a separate organization); six distinctive capabilities; and four strategic directions to double down on the distinctive capabilities. These drafts were vetted and refined through discussions with more than 2,500 people, including the

VUMC Board of Directors and the Biomedical Science Advisory Board.


In 2016, we committed to an annual “refresh” of the Strategic Directions to adapt our strategy as we evolved year-to-year. This commitment resulted in StrategyShare – an annual, half-day event that showcases and connects colleagues around the work being done across VUMC to advance the Strategic Directions. Using a variety of communications formats, StrategyShare was designed to engage people across disciplines, roles and power differentials through a series of TED-style talks, PowerPitch presentations, PosterShare sessions, panel discussions and more.

The first annual StrategyShare took place in June 2017, and served as an opportunity to communicate the Strategic Directions, share advances and tactics for each Strategic Direction, and forge new connections. More than 40 academic departments, and several administrative and clinical units, presented posters outlining their work as it related to each of the four Strategic Directions. Notable outcomes of StrategyShare17 PowerPitch presentations included the implementation of VUMC’S Food Truck Wednesdays, the launch of an electronic medical record interface start-up company by VUSM students, and affiliation of more than 150 faculty with the VUMC Institute for infection, inflammation and immunology. In 2018, StrategyShare focused on “Discover, Learn and Share.” The Strategic Directions team engaged two “next generation” workgroups comprised of new and emerging leaders. One group focused on education while the other focused on research. The groups were charged with:

• Proposing comprehensive programs that will create unique opportunities to improve health across populations

• Identifying key enablers, including aspects of operations, that will support these efforts

• Defining measures to incentivize research and learning that results in paradigm shifts, practice changes and policy changes

More than 400 people from across the Medical Center tuned into StrategyShare18, in person or via live stream, for presentations and panel discussions that highlighted:

• Opportunities to move toward mission-focused measures • Agile ways to develop people and sustain them through career changes • Opportunities to link discovery science and engineering


Outcomes and next steps that resulted from StrategyShare18 included:

• Identifying and testing metrics that align and connect our people to our mission

• Launching Discovery Scholars Program • Exploring programs that enable on-going

career progression and transitions • Developing comprehensive programs in

brain health • Developing comprehensive programs for

data science • Framing the opportunity for Vanderbilt

metabolic health

In 2019 StrategyShare focused on “Design for Patients and Families.” In preparation, more than 40 individuals comprised of members of VUMC clinical teams, patients, community leaders, VUMC administrators and others with a stake in patient care, formed two work groups – an Experience Workgroup and a Design Workgroup – to capture what patients want from experiences with other industries to suggest designs for health care. This work resulted in in five principles:

1. Listen to understand – What is the patient requesting? 2. Adapt – Who needs how much help? 3. Communicate – Real-time status updates 4. Coordinate – Coordinate across period of greatest need 5. Connect and activate – Social and community support

These principles are being embedded in VUMC’s Design for Patient and Family’s initiatives (Appendix: Table 3).

More than 500 members of the VUMC community participated in StrategyShare19 in person or via live stream. A diverse group of presenters representing many specialties and roles shared their knowledge and unique perspectives during TED talk-style talks, lightning-quick pitches, insightful panel discussions and posters highlighting:

• The connection between the work we do at VUMC and in communities to enhance the patient experience

• Examples of health care design to listen, adapt, communicate and activate patients, their families, the Medical Center and communities at large

• Transformational power within VUMC and the focus on our patients


APPENDIX Table 1: 2016 Strategic Direction workgroup topics and scope


Table 2: Examples of connections between the 2016 workgroup topics: Guided by the compass, we are free to change our plans as we work together to try new approaches.


Table 3: Design for Patient and Families Initiatives

Accessibility

MyHealth at Vanderbilt enrollment

Increase MyHeath At Vanderbilt (MHAV) Enrollment for all VUMC Patients while increasing patient engagement with their care teams.

Guided on-line appointments A patient-centered scheduling model that aligns the patient with the right provider at the right location the first time

Telehealth Provide access to care and consultation remotely through technology.

Behavioral health capacity

Provide timely access to high quality behavioral health services across VUMC, with BH integration woven into care decisions across the enterprise.

Coordination

Team-based primary care Align structure and roles within primary care teams so that each member practices at the top of their license

Integrated Practice/Prevention Units

An integrated patient-centered structure to care for a cluster of conditions that require a multi-specialty team to improve outcomes and reduce cost.

Visible Team structure

Identify and communicate the patient’s health team, their role in the team, their relationship to one another and their status (on/off).

Seamless data capture/paperless clinic

Capture administrative and patient reported data digitally in the right workflow, from the right person, at the right time, and make the data accessible with the right context in eStar and MH@V

Welcome to VUMC, aka front desk of the future

Each visit flows smoothly from access through the clinic visit, delivering the right personalized experience for the patient’s preferences, reliably and efficiently

Shared plans for care

Shared care plans are created collaboratively by clinical teams with the patient. They may include the patient’s goals, needs, and preferences, and track past challenges and future goals for treatment and well-being.

Knowledge

Goals of care including goals for end of life

Ensuring patients with serious illness receive evidence-based, cost-effective care guided by patient-reported outcomes and preferences

Precision medicine Tailor health care and health maintenance based upon individual characteristics

Patient reported outcomes

Develop and evaluate a system of measurement that includes patients’ perspectives of their health to enhance real-time shared decision-making and improve the quality, outcomes and value of care.

Predictive Analytics & Artificial Intelligence

Embed validated, predictive process and decision support into VUMC workflows to improve safety, efficiency, and alter the course of disease or preserve health.

Pragmatic effectiveness trials Design, test, and deploy interventions in real world operational settings with a feedback/update loop.

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