Jan. 22, 1998

A recent University HealthSystem Consortium (UHC) meeting for board members, CEO’s and other clinical enterprise leaders focused upon the topic of “Competing in a Maturing Marketplace: A Midcourse Review.” Two MUSC Board of Trustees members, Dr. Stanley Baker and Mr. Robert Lake, and I attended the meeting. I would like to share with you the highlights of the meeting and more specifically how the Medical Center has fared with its strategic initiatives compared to other peer institutions. During the meeting, we revisited strategic initiatives formulated by leading academic health centers three years ago. Key strategic initiatives embraced by many UHC members at that time included: primary care development, infrastructure development, network development, cost reduction and development of insurance products. The MUSC strategic plan, which was kicked off in 1993, was closely aligned with those adopted by other UHC members, except for the development of insurance products.

The presentations at the meeting underscored that development of a primary care network and referral base continues to be very important and we have high marks in this area. The consensus among the UHC members also was that much emphasis needs to continue to be placed upon development of infrastructure . . . which to us means improvement in information systems, operating systems (such as the “Oversite” outpatient scheduling system) and facilities. While our progress with infrastructure development has been difficult and time consuming, we continue to make headway.

Regarding network development, we heard updates from a number of academic health centers that have merged with community hospitals. This suggested that MUSC’s affiliation proposal, while delayed, was conceptually sound. It was also emphasized that much attention needs to be devoted to cost reduction. We have made progress with reducing costs, but clearly we must continue our efforts to be more efficient and reduce costs.

MUSC did not pursue development of insurance products as did some of our peers. It appears that we were fortunate not to have included insurance among our strategic initiatives, since many academic health centers have experienced poor results in this area. I came away from the meeting feeling very good about our progress with most of our strategic initiatives. We started with a good plan, and we followed it. As we near the end of our planning cycle, our board and leadership team will revisit our strategic initiatives in view of the dynamics of our health care environment.

I am convinced that with the dedication of our employees and the strong support of our leadership we will continue our success.

W. Stuart Smith, Interim Vice President for Clinical Operations CEO, MUSC Medical Center

Announcements

• John Franklin, director of Support Services, announced that the results of a Request for Proposal for a new environmental services company are in and that Crothall Healthcare, Inc., received the contract, effective Feb. 1. At the Jan. 20 communications meeting, Franklin introduced Harry Webster, a district manager from Crothall Healthcare, Inc., who will be in charge of start-up for the new contract. Webster has 17 years of experience in the field of health care environmental services. Franklin and members of the new Environmental Services management team will be visiting departments in the Medical Center to discuss individual needs for each area. (MUSC Environmental Services staff will remain.) He also thanked the core group responsible for facilitating the RFP process: Gene Boyd, John Cooper, Carol Dobos, Sue Pletcher, Peggy Simmons, Marc Summerfield and Karen Weaver. He said this group also is helping with the RFP for linen and food services.
• Carol McDougall, coordinator of Clinical Services Education, distributed flyers on two upcoming seminars.
• April 8: Legal Issues in Health Care, for health care staff members.
• April 9: Supervisory Issues in Nursing and Health Care, for health care managers.

The seminars, presented by the Medical Center’s Clinical and Patient Education area, and cosponsored by the Low Country Area Health Education Center, will be held at the Francis Marion Hotel on King Street. Both feature the speaker Patricia C. McMullen, M.S., J.D., N.P., RNC. McDougall said that McMullen is a dynamic and energetic speaker and urged all who can attend to do so. The cost for MUSC employees and students is $25 per person, per seminar. Flyers with more information can be obtained by calling 792-2409.

• Tom Keating, administrator for Finance and Support Services, said that the Department of Health and Environmental Control conducted a licensing inspection at the Medical Center last week. The Medical Center has been relicensed, but will be working on an action plan to resolve one violation noted by DHEC regarding improper storage. Keating reminded all managers to stress to staff members the importance of following the procedures and keeping the good habits we established during the Joint Commission on Accreditation of Healthcare Organizations’ survey in August.
• Laurie Zone-Smith, manager of Employee Health Services, distributed a handout of Workers’ Compensation information. The handout includes contact people and phone numbers for WorkMed Carolina (the Medical Center’s employee health services provider) clinics and staff members as well as MUSC employees who are responsible for medical claims management of work-related injuries or concerns. Copies of the phone list can be obtained from your manager or by calling 792-7769.

Reporting Sentinel Events

• At the Jan. 20 communications meeting, Pam Cipriano, Ph.D., R.N., administrator for Clinical Services, discussed sentinel events—the unexpected or unanticipated loss of life, limb or function—and the Medical Center procedure for reporting and investigating such events. Cipriano said regulations regarding reporting sentinel events are changing, and criteria defining such events is expanding. Categories of sentinel events now include (in addition to the unexpected loss of life, limb or function) the abduction of an infant, the discharge of an infant to the wrong family, rape by another patient or a staff member, hemolytic transfusion reaction, and surgery on the wrong patient or body part. “Near miss” events also are included in the regulations.
• Cipriano discussed the process that must occur after an event that may be considered sentinel. The event is reported to Risk Management, which uses a rating system to determine how an event should be handled and enters the information into a database. If the event meets the criteria for a sentinel event, certain reporting and review procedures must be followed.
• MUSC’s procedures include reporting sentinel events to the medical director, members of management staff and the Quality Council. Detailed information on sentinel events is recorded so that a thorough job can be done in determining the root causes of events and so that an effective action plan can be developed to respond to each event. (For example, if the council finds that an event could have been prevented if different procedures had been followed, it can assign a performance improvement project to the departments involved or institute hospital-wide staff member education.)
• A flow chart outlining the procedure for reporting and investigating sentinel events is being added to the current policy and will be included in the policy manual.

Work Station Support Update

• Dave Northrup, director of Healthcare Systems, and Bill Rust, manager of Healthcare Network Services, in the Center for Computing and Information Technology, gave the management team an update on efforts to improve service in the area of work station support.
• Northrup said he realizes there has been a good amount of frustration in the last year about the lack of enough work station support, periods of e-mail downtime and server difficulties. He said CCIT is doing its best to improve service levels. He also reminded managers of who the contact people are in CCIT for each area of the Medical Center.
• Rust explained how changes in the structure of CCIT have affected Medical Center work station support. In June 1996, the decision was made to combine work station support for the university, administration and health care functions into one area. This benefited some areas, as it gave them access to more staff members and resources. However, it resulted in a reduction in service to other areas.
• During this time of change, CCIT continued to operate with the same number of employees and the same resources, but with a dramatic increase in workload. For example, an average of 100 new PCs have been added each month for about three years. Rust said service levels reached a critical low, and the department struggled with finding a solution.
• Because of several funding issues, a decision was made to once again break up the PC support group. As of December 1997, the three areas (university, administration and health care) are again served by different work station support groups.
• Rust said Healthcare Network Services today has a better staffing ratio, a better focus and renewed energy and commitment to improving service in the Medical Center. The area includes system engineers, field engineers, client support specialists and a trainer. It maintains 55 file servers throughout the Medical Center, and receives more than 200 calls for service each week. Rust said the area’s goals are to reduce the backlog of calls for service to 150 (from 210 currently) and establish service level goals by March 1, and to fill its three vacancies by March 15.
• Rust also discussed plans to bring ClinLAN into “the next generation.” He said ClinLAN95 is being developed, with a roll out planned to begin in the second quarter of this year beginning with electronic medical record system users (such as those who use Oacis). Extensive training will be key in the roll out.
• Northrup added that although the original plan was to forego Windows/95 in favor of what will follow it, it now appears that Microsoft’s development of its next system, Windows/NT will not meet the Medical Center’s timetable. He said that some applications—most notably the electronic medical record—need Windows/95.