medical center strategic directions process 2016 …...vumc strategic directions process page 1...

VUMC Strategic Directions Process 2020-08-07

Medical Center Strategic Directions Process 2016-2020

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 chose the compass as a metaphor for the strategy 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:

• Be inclusive of all missions of VUMC

• Tighten connections to generative academic strengths

• 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

• Deliver an initial draft in August 2016; iterate over fall

The Strategic Directions Team sketched a “straw person” strategy framework to catalyze the conversation and engaged ten workgroups to develop the initial draft over June and July 2016. The team envisioned the workgroups as “nodes” that would connect to create strategic capabilities. The workgroups were:

• Fundamental Discovery

• Translation

• Technology

• Design

• Learning

• Patient Care and Experience

• Efficacy, Effectiveness and Reliability

• Engagement

• Entrepreneurship

• Diversity and Inclusion


Each group was comprised of 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 (Appendix I)

• Identifying the top three goals in that scope, one each from the perspective of three biologic scales – the molecule, individual and population (Appendix II)

• Doing a Strengths, Weakness, Opportunities and Threats analysis on each goal (Appendix III)

• Identifying the key connections to other work groups (Appendix: IV)

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. 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. In addition, 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 Medical Center academic and clinical enterprises came together in a retreat format to share the reports, identify common themes and discuss next steps. We began by affirming our mission did not change with the transition into two affiliated organizations.

We coalesced around three strategic targets (Appendix V) and a mandate to identify key areas for fundamental change; drive to the change; and lead by example.

The top six candidates for change were: expand the parameter space and time scale of data/analytics; create the ecosystem to link research and learning to patient experience; improve access to continuous engagement; reconfigure the platform for technology; design VHAN as a platform to change care for populations; transform how we innovate.

Next steps included identifying the top six areas to preserve and the top areas to discard to free-up bandwidth & resources.

During the fall, the Strategic Directions Team distilled this input into a strategy framework to chart paths toward our aspirations as a Medical Center. 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.


The strategy framework capitalizes on “distinctive capabilities” - capabilities we have because we are an academic medical center comprised of a team of over 25,000 people, bi-directionally engaged with the community, and leveraging Vanderbilt’s assets. The capabilities we will leverage, and grow are:

• A collaborative culture

• Leadership in clinical care

• Basic and translational research

• Learning as a core competency

• Personalized medicine

• Population health

The strategy framework identifies “strategic directions” or themes. It allows us to adapt as we learn or as things change. It allows us to measure – and accelerate – our progress. The 2016 strategy framework focused on four strategic directions:

• Design for Patients and Families

• Make Diversity and Inclusion Intentional

• Discover, Learn and Share

• Amplify Innovation

In 2016, we committed to an annual “refresh” of the Strategic Directions to adapt our strategy as we evolved year-to-year. This commitment led to StrategyShare – an annual 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 is 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 workstreams (Appendix VII).

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


We picked “Defining Personalized Care” as seen from the perspectives of our patients and our teams as the theme of StrategyShare 2020. The strategic directions team paired a physician scientist and a nurse leader to co-chair the program committee. They assembled four track committees with paired faculty and staff co-chairs for each strategic direction. The track committees met and held listening sessions to harvest exciting examples of efforts to advance the directions. They came together at the beginning of March to converge on a program to highlight how the directions work together to define personalized care. We paused work on StrategyShare2020 as everyone focused on COVID-19.

In June 2020 we elected to simplify our strategic message to better connect with our internal and external constituencies. Our vision statement captures our aspiration, what we want to be. Our mission describes what we try to do each day. Both statements are short and easy to remember.

Vision

The world leader in advancing personalized health

Mission

Personalizing the patient experience through our caring

spirit and distinctive capabilities

We distilled the strategic directions to three, strengthening Discover, Learn & Share by integrating Amplify Innovation into Share.

In July, the StrategyShare2020 program committee reconvened. Originally scheduled for June, StrategyShare2020 will now be presented through a series of three, 90-minute, virtual sessions. Content will build from one session to the next and each session will include presentations on topics related to all of the Strategic Directions. In light of current events, the agenda has been expanded to include topics related to COVID-19 and issues of social injustice our country is facing. We will take advantage of a virtual format to make the event much more diverse and inclusive.


Appendix I: 2016 Strategic Direction workgroup topics and scope

Work Group Scope

Fundamental Discovery Fundamental discovery is the study of how things work. This type of activity is not compelled to achieve translation; but it provides a framework for the medical center to translate new knowledge into actionable processes. Not limited to laboratory-based, molecular studies, also encompasses population, behavioral, implementation and other sciences.

Translation Bi-directional translation facilitates the discovery process by moving novel therapeutic applications to pre-clinical validation through interventional trials; and by taking clinical observations and phenotypes back to the laboratory. Translational investigation engages patients at multiple steps and ultimately improves the health of the population.

Technology The use of science to invent useful things or solve problems related to healthcare, the adoption of healthy lifestyles, and the diagnosis and management of patients. Technology includes the application of scientific knowledge for practical purposes.

Design Our definition of the design is that it is an intentional, iterative, research-based, and human-centered process to realize value through discovery, development, and transfer of knowledge between the research lab, individual, and community.

Diversity & Inclusion Diversity is an ever-expanding tent, filled with new members added to expand our cognitive diversity, i.e., broad ideological and intellectual points of view generated by the presence of patients, families, faculty, staff, and trainees of all ages, races, ethnic groups, religions, genders, gender identities, sexual orientations, socioeconomic status, veteran status, disabilities, national origin, immigration status, and insurance status & payer. Inclusion insures a person of a varied community has an opportunity to engage in their appropriate loci such that their combined identities, experiences, education, health literacy, sense of common community, perspectives, and varied learning styles contribute to the community.

Learning Learning is a complex and dynamic process of acquiring the knowledge, skills, attitudes, habits and behaviors that result in improved performance within many cognitive, procedural, interpersonal and systems-level domains. It is a social and collaborative process undertaken by individuals, teams and organizations and often happens organically in the context of the workplace.

Patient care & Experience

Patient is considered from the vantage point of a zoom lens. Our patients are not just the patients we currently have in our panels but reflect a greater population. We are also not just considering the patients of today but looking toward future patients and different expectations of delivery of healthcare. Care applies to ALL aspects of a person’s care: not just what we deliver in the moment but across a continuum, not just a single disease but overall health and well-being, and not just of the individual but the support team of that individual inclusive of community partners. Experience refers to all aspects of a person as they engage with VUMC— communication, attention to medical, cultural and spiritual needs of the person as they engage with us including as learners, research participants.

Efficacy, Effectiveness & Reliability

We define efficacy as how an intervention works in the ideal setting. We defined effectiveness as how the intervention works in the “real world” setting. We defined reliability as the consistency over repeated measures or interventions.

Engagement Engagement is an interaction for mutual benefit that involves commitment, loyalty, passion and/or emotional connection that is friendly, collegial and respectful. It can also include a collaboration between diverse groups to work together to achieve a common goal.

Entrepreneurship Reciting Harvard Business School’s definition, “the pursuit of novel opportunity beyond resources controlled.” Entrepreneurship is synonymous with risk taking, but the risk is a considered risk, not an uncalculated risk. Further, entrepreneurs have a sense of urgency that is uncommon in established companies – time is money to an entrepreneur.


Appendix II: 2016 work groups’ top three goals from the perspective of three biologic scales

Work Group Molecule Individual Population

Fundamental Discovery

Understand the molecular basis of biological function

Provide the conceptual framework for understanding an individual as a system

Provide a conceptual framework for understanding groups of individuals that form a system

Translation Discover molecular basis for variation in disease susceptibility, disease progression, and drug response and translate discoveries to novel therapies

Link individuals to information and resources that promote wellness, enable early identification of disease, and foster personalized interventions.

Acquire and integrate multiple data types across populations to drive discovery and translate those discoveries to promote individual health.

Technology Develop and implement state‐of‐the‐art technologies to accelerate the discovery of disease mechanisms and novel diagnostics and therapies.

Develop and support the use of state‐of‐the‐art technologies to empower individuals and caregivers to achieve improved wellness and personalized care.

Implement the widespread use of technologies for patient monitoring, point‐of‐care delivery and patient‐provider interactions that improve health and provide population‐based information.

Design To build the connection of basic discovery research infrastructure to clinical laboratory and care for rapid translation and application of discoveries to improve the delivery of care, and guide future research efforts.

To build connections across the institution to enable our significant discovery efforts and patient care experiences that inform our efforts in designing improved human‐centered individual health and community health and wellness initiatives.

To build robust and interlinked connections between basic discoveries and applied practices, and between researchers and clinicians with a goal of advancing learning and of improving the quality of our interventions in service of the health for individuals and populations.

Diversity & Inclusion Use knowledge of molecular diversity to promote health and understanding of ALL people

The VUMC community values, understands diversity & inclusion, and creates an inclusive personal experience tailored to each person’s diversity

ALL people serve ALL people well regardless of their personal identity groups, & according to their needs

Learning Understand the interactions between the basic science of learning and the environmental, behavioral, health and social factors, to enhance learning environments and effectiveness of learning programs.

Every individual who works, learns, collaborates or receives care at VUMC and its network will have the opportunity and individualized resources to optimize health, learning and livelihood across the lifespan.

Create an engaging and collaborative ecosystem for learning about health and disease for diverse populations, including providers, community members, patients and caregivers, so that the communities we serve will thrive.


Patient Care & Experience

To broaden and deepen the impact of discovery programs and to improve care across the region, we need to expand biomarker development, broaden biomarker testing, and link biomarkers to prevention and disease management, and to enhance our expertise in neuro-degenerative diseases, immunology, tissue engineering, and regenerative medicine.

To provide integrated and compassionate care to each patient and family, in a timely and efficient manner, sensitive to individual physical and environmental characteristics.

To leverage VUMC and VHAN resources ‐‐discovery, training, information sharing, and extensive partnerships‐‐to understand, prioritize, and improve the health of our community and region.

Efficacy, Effectiveness & Reliability

Expand focus on molecular research, including genetic research that is integrated into the health system and the community.

Expand the collaboration between research, health system, and the community to perform efficacy studies, comparative effectiveness research, and pragmatic clinical trials to expand our knowledge about optimal approaches to care to improve patient, family, and community well‐being, and incorporate systems to assure these approaches are consistently applied.

Expand the collaboration between research, health system, and the community to perform implementation and dissemination research, and to disseminate and reliably implement optimal approaches to care that promote well‐being at the patient, family and community level.

Engagement VUMC employees & patients actively improve their health & the health of their communities

Enable a person to easily find & connect with the appropriate level of care and the right health professional at any point in the person’s health & life

Provide the nation’s model system for engaging patients, families & caregivers in decision making and in supportive/preventive care across the life continuum

Entrepreneurship Devise a system to recognize, and stimulate disclosure, of design and methodologies that are developed to study molecules and molecular systems.

Reinforce a culture of entrepreneurship in which employees can pioneer truly innovative products; devising new business models in healthcare; and exploring and adopting novel disruptive solutions developed in the community.

Devise new business models in healthcare; and exploring and adopting novel disruptive solutions developed in the community


Appendix III: 2016 strengths, weaknesses, opportunities & threats – aggregate word clouds


Appendix IV: Connections between the 2016 workgroup topics

Fundamental discovery Design Technology

Fundamental discovery

How things work Processes to optimize core facilities and connect individual, smaller-scale science with bigger-scale team science

Tools to accelerate scale, speed and dimensionality of measurement (e.g., ion mobility mass spec; high-throughput screening)

Translation Basis for variation in health & wellbeing (susceptibility, progression & response to interventions)

Processes to optimize connections among phases of discovery and learning-based practice

Engineered model systems (e.g., organ on a chip). Precision phenomics.

Technology Basis for new technologies (e.g., advanced materials, energy storage, human technology interaction)

Processes to optimize the technology development/manufacturing/uptake life cycle

Technology development platforms (e.g., 3D printing)

Design How things create. How cyber-social-physical systems communicate

Design models (e.g., rational model, action-centric model)

Design and visualization tools (e.g., computer-aided design)

Diversity & inclusion Basis for variation related to demographic, social and behavioral, environmental and genetic factors

Designing experiences that benefit intended users (patients; families, employees) by addressing their own needs

Multimodality passive sensors and deep learning analytics

Learning How things learn (epigenetics, neuroscience, system dynamics)

Design systems to improve learning, (e.g., for applicants to VUMC training programs, existing faculty, or VHAN)

Adaptive learning tools and platforms to support assessment with feedback

Patient care & experience

How phenotypes and responses to interventions are expressed (e.g., biomarkers)

Create processes that enhance patient safety or systems that improve patient experience (e.g., in waiting rooms) using human-centered design principles

Tools to provide situational awareness, whole person classification, prognostic and predictive decision support

Efficacy, effectiveness & reliability

Basis for variation in application of knowledge to improve health

Design, build, test, and refine diagnostic and therapeutic algorithms

Platforms to optimize connections between discovery, knowledge and standard of care

Engagement How things make connections and decisions Human-centered design is based upon empathy, which fundamentally relies on understanding the needs of those to be engaged

Platforms to optimize community formation, communication, decision making & creative work

Entrepreneurship How things respond to risk and reward Business models to optimize uptake of innovation by society

Platforms to optimize IP creation & distribution (e.g. PaaS, Bitcoin)


Appendix V: Strategic targets chosen during the August 2016 retreat

Molecule: To enable discovery and learning that is inclusively based, leveraging institutional capabilities and strengths, and aided by creative technology and design. Some of this discovery will be developed into novel methods to improve health, education and quality of life of all people. In this process, the reputation of VUMC will be enhanced and business opportunities realized.

Individual: To provide personalized care and education to diverse individuals within an inclusive, creative, and advanced system that allows knowledge gained about individuals to be shared, real time, throughout the institution, community and world.

Population: To apply molecular- and individual-achieved objectives to improve the well-being and education of all populations, while at the same time designing methods to study populations in order to stimulate new discoveries, knowledge and learning opportunities to further enhance the health of all communities. Through this iterative process and collaborations between scientists, care providers, patients and community members, we will all develop an innovative approach – a national model – that can be leveraged for great return.


Appendix VI: Key features of the medical center research portfolio, updated June 2020

1 . Diversified, robust and aligned with the scale of the health system

• Fundamental Discovery – foundation for progress, source for conceptual leaps, based in human disease, consequences sometimes unpredictable

• Translational/clinical investigation areas – aligned with scale of health system to provide opportunities for new diagnostics, risk reduction, treatments and cures (precision medicine) based on molecular knowledge from bidirectional translation with “Fundamental Discovery”

• Population health sciences areas – aligned with scale of health system to affect disease burden within and beyond our catchment area

2. Appropriately sized and sustainable 3. Outcome measured by the impact of discoveries and the application of VUMC-powered knowledge to enhance health, lengthen life, and reduce the burdens of illness and disability

• Paradigm-shifting

• Practice-changing

• Policy-shifting/changing


Appendix VII: VUMC Design for Patient and Families workstreams, updated June 2020

Welcome to Vanderbilt Health

MyHealth @ Vanderbilt Integrate MH@V into the Vanderbilt Health experience. Make MH@V the primary way our clinicians and staff communicate with patients between face-face visits and for telehealth appointments. Make MH@V the first-place patients turn for their health needs.

Virtual care, triage, direct schedule

Acquire or develop mobile apps and web tools that work with MH@V to help people manage their health goals and care plans in collaboration with their health team (e.g. Carium); connect with a clinician in the app to evaluate symptoms & receive prescriptions; connect to nurse-on-call; or direct schedule to a walk-in or a care team visit(e.g. AmazonCare).

Front desk of the future Design and standardize the ambulatory visit so each flows smoothly from access through the clinic visit, delivering the right personalized experience for the patient’s preferences, reliably and efficiently. Capture administrative and patient reported data digitally in the right workflow, from the right person, at the right time, and make them accessible with the right context in eStar and MH@V

Team-based care

Adult primary care model Develop a model of team-based, coordinated primary care including collaborative behavioral health. The role mix (MDs, APPs, RNs, LPNs, Mas, LCSW) and panel size will flex to match population risk, regional density. Establish a Primary Care PCC to oversee care management and culture change.

Integrated behavioral health Build institutional competency for accurate identification, safe care and efficient disposition of high-risk patients with mental illness and matching integrated care support to patient need across all care centers

Specialty IPUs Develop integrated practice units (IPUs) to care for clusters of conditions that require a multi-specialty team to improve outcomes and reduce cost. IPUs may be within a PCC or cross PCCs and will include a mechanism for coordinating care across multiple IPUs for a patient when required.

Care control center Operationalize a care control center spanning inpatient services to provide clear chain of command, aggregate and visualize data, and converge clinical and administrative monitoring. Initial priorities include patient throughput, capacity management, transfer center, and transport.

Visible team structure & shared care plans

Identify and communicate the members of the patient’s health team, their role in the team, their relationship to one another and their status (on/off). Create shared care plans collaboratively by clinical teams with the patient. Plans may include the patient’s goals, needs, and preferences, and track past challenges and future goals for treatment and well-being.


Personalized medicine

Goals of care & EOL Ensure patients with serious illness receive evidence-based, cost-effective care guided by patient-reported outcomes and preference. All Vanderbilt clinicians, staff and patients have advanced directives.

Clinical genomics Tailor decision support for VUMC clinicians, patients and families based upon individual characteristics including clinical phenotype, genes, social and behavioral determinants, and environmental factors. Focus on predicting risks and targeting interventions that improve an individual’s health care.

Health equity Incorporate health equity into the quality improvement strategies of the clinical enterprise by addressing systematic, avoidable and unjust distribution of social, economic, and environmental conditions needed for health.

Patient reported outcomes measures (PROMs)

Develop, pilot, evaluate and spread methods for measuring and incorporating PROMs into clinical care to enhance shared decision-making and improve the quality, outcomes, and value of care. Every Patient Care Center will manage at least one condition using PROMs as part of their system of measurement.

Predictive analytics & AI Embed validated, predictive process and decision support into VUMC workflows to improve safety, efficiency, alter the course of disease or preserve health. Standardize pipeline for designing, evaluating, implementing, monitoring and de-implementing AI-based interventions.

Aligned financing

Clinical integration Make VHAN the region’s preferred value-based clinically integrated network by delivering innovative solutions, learning opportunities, and strategic advantages to our partners, who are patients, providers, employers, and payors. Achieve an 8% premium differential by medical neighborhood in FY21 and achieve 500,000 attributed lives by FY23.

Direct to employer & consumer programs

Lead value transformation for VUMC & regional, national, and international purchasers by designing and delivering value-driven, comprehensive & specialty health care experiences directly to employers.

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