University Strategic Plan: clinical services draft

On June 29, 1996, a ãUniversity Planning Committeeä (UPC) was created and charged with developing a comprehensive long-range University Strategic Plan.

The UPC has worked diligently to complete its charge by October of this year. Last fall, several working groups began focusing on the goals, objectives, and strategies for each of our three mission areas: education, research, and clinical care. During the past few weeks, draft reports on education and research have been published in The Catalyst for comment. Similarly, this clinical services report is published with the hope that faculty, staff and students will critique the draft and forward comments for review prior to its presentation to Presidentâs Council and the Board of Trustees.

Please send your written comments via e-mail (higerdtb@ MUSC.edu) of fascimile (792-2967) by Aug. 29.

--Thomas B. Higerd, Ph.D. Chair, University Planning Committee

Clinical Services Prologue

The Medical University of South Carolina (MUSC) provides state-of-the-art health care to South Carolinians through its network of primary and specialty care providers. Health promotion and disease prevention are integrated into direct patient care as well as to population-based programs. The Medical University through its faculty, staff, and students strives to provide care that is sensitive to individual and population differences and appropriate for patients from diverse social and cultural backgrounds. As the university strategic plan indicates, MUSC promotes patient-and community-centered clinical care systems. To provide the most effective care to South Carolinians, the Medical University must strengthen its ties with other community-based health care providers, both locally and statewide.

In 1997, the exemplary care it provided earned the Medical Center recognition through two national rankings of hospitals. Clinical ãCenters of Excellenceä in areas of organ transplant, cancer, heart disease, and digestive diseases have helped establish the Medical Universityâs outstanding reputation. These Centers of Excellence are integrated into the broad spectrum of health care provided by the Medical University and its affiliated hospitals÷ the Ralph H. Johnson Medical Center (Department of Veterans Affairs) and the Charleston Memorial Hospital. Not only can partnering institutions benefit from each otherâs existing strengths, but such alliances also provide a broader and more relevant academic base for MUSCâs educational and research programs.

One of the greatest challenges facing the university is that of responding to the changes in financing and delivery of health care, specifically the expansion of managed care systems. To respond to community health needs and succeed in this new environment, MUSC must explore a variety of avenues to build patient-centered and population-focused practices. One such avenue is the promotion of clinical services that are comprehensive, coordinated, interdisciplinary, and intercollegiate. The ãinterdisciplinary practicesä heavily referenced in this document involve both ambulatory and hospital service and foretell the nature of tomorrowâs health care. Several current MUSC practices are recognized as interdisciplinary practices, e.g., Adult Primary Care Center at McClennan Banks, MUSC Family Medicine Center, and South Carolina Diabetes Initiative. Other programs, like the Center for the Study of Aging and Womenâs Health Care Center, provide opportunities to build additional interdisciplinary practices. Furthermore, as the focus moves from hospital-based to outpatient care, increased attention must be paid to comprehensive Emergency Services.

The university is committed to being a responsible steward of State resources. In the clinical arena, this includes providing cost effective hospital and ambulatorypatient care, reducing or eliminating marginally beneficial clinical services, and addressing the prevalent health care needs of South Carolinians. Regarding the latter, the Medical University is committed to using its resources to reduce risk factors of leading diseases that shorten the lives of many of South Carolinaâs citizens: cancer, heart disease, stroke, diabetes, and chronic obstructive pulmonary disease head the list.

To extend the excellent clinical services of MUSC, the plan asserts that South Carolina health needs should be reassessed. This plan proposes university-wide systems to address the identified but unmet health needs of the community, evaluate new and existing clinical practices, remove barriers to effective interdisciplinary practices, enhance education and research at clinical practice sites, and promote a comprehensive, secure electronic medical record.

The Medical University of South Carolina is dedicated to providing health care in an environment that respects others, fosters excellence, adapts to change, and is accountable for outcomes.

Clinical Services Goals

• To serve the health care needs of South Carolinians by promoting health and preventing disease while achieving the highest standards of patient-centered, interdisciplinary, and cost effective, state-of-the-art primary, specialty, and advanced care.
• To ensure that clinical service sites are available to enhance education and research.

Clinical Services objectives listed

Objective 1: To serve the health needs of South Carolinians, MUSC must:

• identify by July 1, 1998 those needs;
• evaluate by July 1, 1998 the ability of existing services, from health promotion and disease prevention to advanced specialty care, to meet those needs;
• respond with one or more interventions by Jan. 1, 1999, that address unmet health care needs of the community.

Strategies:

A. Charge the Center for Health Care Research (CHCR) to report on:

• health needs of South Carolinians. Assessing these needs may encompass a variety of definitions and should be done in collaboration with public and private agencies to maximize the usefulness of statewide data;
• access to health care services, including availability of types of health care providers. This assessment should include identification of existing programs and recommendations for needed programs.

B. Charge a task force of a diverse group of consumers, providers and payers to recommend to the university-wide clinical policy group the role MUSC should play in addressing the needs of underserved populations and other inequities identified in the CHCR reports, including mechanisms to provide clinical services and information (Reference: Education Section, Objective 7, Strategy B) to the public and advice to policymakers.

Objective 2: To have integrated health care delivery systems, emphasizing intercollegiate, interdisciplinary practices at all MUSC affiliated sites.

Strategies:

A. Charge by Jan. 1, 1998, a university-wide clinical policy group to advocate, advance and coordinate the integration of health care delivery by MUSC faculty and staff. This group will be composed of the vice presidents for academic affairs, clinical operations, and medical affairs and others appointed by these three vice presidents. This group will establish a system that is responsive to the needs of:

• patients (e.g., centralized and timely appointment scheduling);
• community health service and support groups;
• health care providers (e.g., consultation guidelines, accompanying clinical data);
• referring parties (e.g., timely clinical reports).

B. In conjunction with existing and newly appointed institutional committees charged with parallel subjects, this clinical policy group will establish university-wide guidelines, policies, and standards for:

• current and proposed interdisciplinary practices;
• unified patient scheduling and billing;
• electronic medical record that supports all health care providers and the academic medical center;
• revenue and expense sharing among departments, centers, institutes, and colleges;
• incentive plans submitted by each practice.

C. Every new or existing clinical practice must have:

• operational and strategic business plans that recognize the importance of ongoing data collection for evaluation;
• a continuous quality improvement plan.

In addition, practices should consider clinical practice guidelines developed in collaboration with appropriate health care providers. Educational/training programs must be offered to faculty and staff by respected clinical leaders with expertise in the practice area to enhance implementation of the practice guidelines.

D. This university-wide clinical policy council will review the business and strategic plans of each practice to maximize the integration of health care delivery, consistent with the University mission. It is anticipated that all new clinical practices will submit their plans upon application, and all existing clinical practices should have their plans submitted and reviewed by Jan. 1, 1999.

Objective 3:

To expand the numbers of interdisciplinary practices and other clinical sites serving the educational and research needs of the university.

Strategies:

A. Charge the provost with appointing by Jan. 1, 1998, a university-wide task force representing clinical, educational, and research interests to:

• assess the amount of student/resident training being conducted at all clinical sites;
• determine the financial resources required to support this training;
• formulate a plan that fosters cost effective student/resident training at selected clinical sites;
• develop mechanisms to promote research at clinical sites.

B. Each clinical practice must assess their ability to serve the educational and research needs of the university. These reports should be submitted to the university-wide clinical policy council by Jan. 1, 1999, or upon application for new practices.

Objective 4: To have a comprehensive, secure electronic medical record, 90+percent complete by Dec. 31, 1998. This record should have a single medical chart system suitable for inpatient and outpatient services, thereby eliminating the need for shadow medical records.

Strategies:

A. Continue university-wide support of the approved electronic medical record implementation plan, and provide the resources sufficient to satisfy the objective.

B. Ensure that the electronic medical record meets the fundamental needs of all MUSC health care providers, clinical practices, educational activities, and research endeavors, as well as external regulatory and accreditation agencies.

C. Charge the university-wide Information Technology Steering Committee to assess progress in the introduction of the electronic medical record and its suitability to the delivery and exchange of clinical, educational, and research information at distant sites.

D. Establish university-wide policies that are attentive to patient privacy and respectful of informed consent, while not unduly encumbering effective patient care, efficient delivery of health care, and access to clinical and research data that advance biomedical knowledge.