UMH Makes Tremendous Progress on Its Journey to a Top-Tier Academic Hospital
Every morning, University of Miami Hospital’s leadership team gathers in a second-floor conference room for the daily “huddle.” The health and wellbeing of patients are uppermost on everyone’s mind. The Chief Executive, Medical, Operating, and Nursing Officers, the supervisors of the ORs, the ER and all the clinical and support service lines review staffing patterns, patient admissions, emergency room visits and a variety of metrics from the previous 24 hours, and year-to-date trends, to ensure the Miller School’s teaching hospital is delivering optimum care to its patients.
Monitored on a daily basis, the “dashboard” numbers provide a snapshot of the hospital’s performance on a given day, but viewed collectively over time, they create a montage of the extraordinary progress UMH has made since embarking on its journey to transform a community hospital into the best university teaching hospital in the nation, and the world.
“Yes, that is a lofty vision,” acknowledges UMH CEO Dan Snyder, who led the hospital’s staff and Board of Directors to adopt that goal after assuming the reins of the University of Miami’s flagship hospital in February 2012. “But if you are not the best, you are just part of the rest. As the only university-owned teaching hospital in Florida, our mission is to provide exceptional patient care, groundbreaking research, world renowned teaching and meaningful community service, and every day we are making tremendous strides to further that mission.”
“It is an exhilarating experience to walk through the halls of University of Miami Hospital, and literally see the transformation taking place – in both our employees and our patients,” said Pascal J. Goldschmidt, M.D., Senior Vice President for Medical Affairs and Dean of the Miller School, and CEO of UHealth. “With care at UMH delivered through integrated service lines that group patients with similar conditions or needs, and physicians and other caregivers by specialty, patients are receiving high-quality, integrated, timely, cost-effective and evidence-based care not available anywhere else in South Florida.”
Now operating at a near-optimal 85 percent of capacity and with a respectable 9.6 percent operating profit margin (based on earnings before interest, taxes, depreciation and amortization, or EBITDA), the hospital’s progress is evident in every state, federal and private barometer of clinical and operational excellence – an achievement Snyder attributes to the collective leadership of Rafael Campo, M.D., the hospital’s Chief Medical Officer, David Zambrana, D.N.P., M.B.A., R.N., the Chief Operating Officer who until recently doubled as the Chief Nursing Officer, and the experienced corps of clinical service line administrators who coordinate and integrate the care patients need across the UHealth system.
Among the top quality indicators are how well physicians and clinical staff meet the core performance measures the Centers for Medicare & Medicaid Services track to ensure hospital patients receive the treatments proven to improve clinical outcomes and reduce mortality and morbidity, disability, length of hospital stay, and readmissions.
Today, UMH routinely provides at least 96 percent, and often 100 percent, of all patients who arrive with a heart attack, congestive heart failure, community acquired pneumonia, or in need of surgery with all of the recommended treatments, a phenomenal record Snyder attributes to Campo’s diligence in putting the processes in place to ensure compliance with all protocols.
Also under Dr. Campo’s leadership, the average length of stay for patients admitted to UMH has dropped from an average of 6.1 days over the preceding four years to a more appropriate 5.3 days in the month of February, a reduction that not only reflects good stewardship of hospital resources, but also better outcomes for patients. As Snyder notes, when patients remain in the hospital beyond what is medically necessary, there is an inefficient and wasteful consumption of resources and patients may be at greater risk for hospital-acquired complications.
UMH also stands out as a national leader in preventing the four healthcare-acquired infections that, nationwide, account for more than 80 percent of the costly and often deadly infections patients too often contract while receiving treatment for another condition.
Since the second quarter of 2012, not a single ICU patient at UMH acquired a case of ventilator-associated pneumonia, a record that has continued into 2013, and is attributable to nurses and other staff rigidly following prescribed protocols involving many simple rules, such as elevating the head of the bed, for preventing infections. By adhering to the protocols, UMH caregivers not only exceed the national benchmark of fewer than 2.7 cases of ventilator-associated pneumonia per one thousand days on a ventilator, they surpass the more stringent internal benchmark UMH adopted for such infections.
UMH also exceeds the national performance benchmarks, as well as its own more stringent internal benchmarks, for central line-associated blood stream infections, catheter-associated urinary tract infections, and surgical site infections. Together with ventilator-associated pneumonia, these healthcare-acquired infections annually claim tens of thousands of lives and cost billions of dollars nationwide.
Since the University purchased Cedars of Lebanon Medical Center and established the UHealth brand in 2008, patient satisfaction scores also have soared, reflecting not only the positive perceptions UMH patients have of their experiences, but how committed physicians, nurses and other frontline staff are to exceeding their patients’ expectations for service as well as clinical care. For example, UMH now exceeds the state average in all but two of 10 patient satisfaction categories measured by the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) established by the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality.
In the latest HCAHPS survey, 75 percent of UMH patients surveyed said they would recommend the hospital to others. That compares to an average of 68 percent of patients at other hospitals in Florida and 70 percent nationally, and represents a 27 percent improvement since acquisition.
Not surprisingly, internal surveys of UMH employees likewise show a growing pride in working for Florida’s only university-owned hospital, which Susan Wasstrom, a labor management consultant at UMH, attributes to the collaborative vision management and labor have forged on improving patient safety, quality measures and efficiencies in the work flow. Those goals and incentives for reaching them are spelled out in UMH’s unique contract with the 1199SEIU United Healthcare Workers East, the first in Florida reached through interest-based bargaining.
“There is no question about it,” Wasstrom said. “The staff is very proud to work for University of Miami Hospital. They’re proud of the brand name. They are proud of the work we do here. They’re excited about the growth of this hospital. Now that hasn’t come without some pain over the rapid amount of change, but having a joint vision between the union and management on the future of this hospital and everybody working in the same direction is very fruitful.”
In addition to shared goals, the contract established a training and education fund, also a first in Florida, to provide employees tuition assistance for earning advanced degrees, as well as college preparatory courses, GED, ESL and other courses to help them move up the career ladder.
UMH’s historic investment in employees goes hand in hand with its other ambitious goal of earning designation as a nursing magnet from the American Nurses Credentialing Center (ANCC), which under the leadership of the new Chief Nursing Officer, JoAnn Trybulski, Ph.D., ANP-BC, DPNAP, is on target to conduct a site visit within the next 24 months. The ultimate credential for high-quality nursing, ANCC Magnet Recognition helps hospitals do exactly what UMH set out to do when it began its transformational journey – attract and retain top talent, improve patient safety and satisfaction, foster a collaborative culture, advance nursing standards and practice, and grow business and financial success.
While still burdened with inequitable contracts with private insurers, UMH is also financially out-performing many of its peers across South Florida and the country. According to the Premier Global Report Card, UMH’s 9.6 percent operating margin (EBITDA) last fiscal year was almost double the 5.2 percent median of its peer group.
Add UMH’s sound financial footing and all the barometers of clinical and operational excellence to its future plans, including the addition of a rehabilitation center to enhance The Miami Project to Cure Paralysis’s research efforts, and it is easy to see the metamorphosis surveyors with the Joint Commission saw when they last visited UMH. After spending five days at the hospital in December, members of the accreditation team said they had no doubt UMH, which had already earned teaching hospital status from the state, would become a top-tier academic organization – if it stayed on its current trajectory.
Snyder is confident that the University, his leadership team and the hospital’s employees have laid a strong foundation for the five strategic pillars – people, quality, service, finance and growth – that will ensure UMH remains on course.
“If you take care of your people, then your people can focus on clinical excellence, which is providing the highest quality, timely, consistent, cost-effective and evidence-based care possible,” Snyder said. “I am proud to say our numbers show we are doing that.”