Design for Patients and Families logo: stylized human head and shoulders inside a magnifying glass

Design for Patients and Families

We will care for people in a compassionate and personalized way,
wherever they are, whenever they need us. 

Statement of Importance:

I Want graphicHistorically, the processes of health care have been designed around the health care enterprise. It is clear that engagement and outcomes improve when the processes of health care are designed around the needs of patients and their lifestyles. We will iteratively redesign health care to touch our patients and their families continuously, whenever or wherever they need us, with the aim of addressing their needs within the flow of their daily lives. Furthermore, defining personalized care offers us a clear competitive advantage—it builds a reservoir of positive memories that over time can generate loyalty.

  • Our collaborative culture to be inclusive and to express empathy and compassion in all interactions
    • Incorporating empathy mapping into VUMC lean events.
    • Training VUMC community in unconscious bias (UCB) and added UCB-sensitive metrics to patient satisfaction surveys.
    • Developing VUMC-wide climate policies and processes on uncivil behavior and how to respond. Programs rolled out and in process include sexual harassment and Patients’ Rights and Responsibilities.
  • image of patient with care provider. Text reads: Team-based care, right set of pros collaborating and coordinating care; patient and family at center. Coordination of clinical teams and systems to close gaps in care and set a new bar for safety, reliability, and effectiveness 
    • Developing and scaling consistent processes to improve quality, experience, and cost for defined patient populations. Examples include population health pay for performance (P4P) metrics and adult enterprise value bundles.
    • Developing processes to identify and communicate the patient’s health team, their role in the team, their relationship to one another, and their status (on/off).
    • Developing processes to 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 My Health at Vanderbilt (MHAV).
    • Developing processes to create shared care plans collaboratively 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.
    • Developing processes to leverage predictive analytics and artificial intelligence to embed validated, predictive process and decision support into VUMC workflows to improve safety, efficiency, and alter the course of disease or preserve health.
    • Developing process to leverage pragmatic effectiveness trials to design, test, and deploy interventions in real-world operational settings with feedback and update loops.  
  • The structure of the Patient Care Centers (PCCs) to coordinate multidisciplinary care for conditions managed by VUMC
    • Refining the PCC structure, decisions rights, and management processes.
    • Convening stakeholders to develop a strategy and structure for adult Davidson county primary care. 
    • Developing a VUMC standard for integrated practice units, patient-centered structures to care for a cluster of conditions that require a multi-specialty team to improve outcomes and reduce cost. Examples include Medicine PCC - Eskind diabetes center; Women’s Health PCC - Fetal Center, Maternal Cardiac Clinic, Coagulopathy Clinic, Polycystic Ovary Syndrome, DNA Diagnostic Center.
  • Opportunities for community stakeholders and patients to participate in research and learn how to improve their health and engage as partners in their care
    • Developing the Person-centeredness of Research Scale to assess the degree to which research reflects the needs, values, and priorities of patients, families, and communities. 
    • Developing the Community Engagement Studio Toolkit (pdf).
    • Launching the NIH’s All of Us Research Program Engagement Core to include participants as partners in the oversight, governance design and implementation to ensure it is inclusive, relevant and culturally sensitive to diverse communities and everyday people.
  • Image, fingers holding pill capsule filled with DNA graphic. Text: Precision medicine. The right care the first time. Care that considers the whole person, their prefs, their individual characteristics. Personalized medicine to integrate social, behavioral and environmental factors with the full range of molecular characteristics
    • Framing the concepts of The Vanderbilt Inventory, a repository of all data sets needed to support whole person precision medicine, and Whole Person Visual Risk Displays to help clinicians and patients assess options.
    • Convening the Clinical Genomics Strategy Session to identify the path forward toward a vision where all clinicians at VUMC have the ability to counsel and, as needed, refer their patients regarding germ-line risk and drug selection.
  • Population health by engaging in cross-sector community partnerships to improve community health and well-being
    • Convening the Community Health Worker Collaborative, a group of organizations focused on advancing the Community Health Worker (CHW) profession in Tennessee facilitated by the Meharry-Vanderbilt Alliance (MVA).
    • Engaging with health departments and other non-profit hospitals, federally qualified health centers and community organizations for collaborative Community Health Needs Assessment.

  • Self-service tools for health improvement, access to care, and engagement in care.
    • Working to enroll all VUMC patients in MHAV to increase patient engagement with their care teams.   
    • Implementing online scheduling for return appointments.
    • Launching Vanderbilt Health On Call, a Medical Center innovation that uses a smartphone app allowing patients in Davidson County to order a $149 home visit from a Vanderbilt nurse practitioner.
  • Accessible regionally integrated patient-centered health care systems to bring Vanderbilt to people where they are
    • Operating and providing clinical services at 14 retail Vanderbilt Health clinics within Walgreens stores located across Middle Tennessee on Nov. 14, 2017 (more), and managing over 120 walk-in and urgent care centers in central Tennessee.
      Expanding the Vanderbilt Health Affiliate Network (VHAN) to more than 6700 clinicians in 13 health systems with 67 hospitals in five states, caring for over 350,000 people through partnerships with insurers.
      Implementing telehealth to provide access to care and consultation remotely. Programs include real-time unscheduled visits for acute illnesses or injuries, transmission of still images from the patient’s location to a specialist for diagnosis and treatment, clinician to patient encounter allowing the patient to be in a different location than the clinician, and system to system services for another entity that wants to buy VUMC services (more).
  • Image is a word map associated with Behavioral Health. Text, a system of team-based, tiered B H Services; a system of precision management of defined psychiatric cohortsSystems of care with the right levels of clinician, integration of behavioral health, and mode of interaction
    • Restructuring primary care teams and roles so that each member practices at the top of their license to improve clinician and patient satisfaction and throughput.
    • Gaining agreement to develop infrastructure to provide continuum of Population Health  Primary Care  Specialty Care, leveraging precision medicine and predictive services for automated risk assessment of early intervention. 
    • Engaging in strategic planning for behavioral health and gained agreement to embed behavioral health in 1° care, meet the millennial desire for “care now,” align incentives for patients and clinicians, incorporate technology, and practice an interprofessional and interdisciplinary approach to care and learning (more).
  • Clinical integration across VHAN, including quality improvement, information technology connectivity and contracting
  • Systems to measure and respond to social, behavioral and environmental factors; individual values and goals; and outcomes that matter to patients and families
    • Incorporating Patient Reported Outcome Measures (PROMs) into VUMC systems of measurement to include patients’ perspectives of their health, enhance real-time shared decision-making, and improve the quality, outcomes, and value of care. Medicine PCC piloted adult inflammatory bowel disease, Surgery PCC piloted advanced prostate cancer, and Childrens PVV piloted asthma. Each PCC will implement PROMS as part of the system of measurement for at least one condition by December 2021. 
  • Care systems engineered to provide a consistent high-value experience based upon understanding patient and family
    • Engaging in a collaborative patient-centered process to develop a vision and path forward to set a new bar for welcoming patients to VUMC wherever they touch us. The vision is that patients will feel as if each visit flows smoothly from access through the clinic visit, and will experience personalized care regarding technology, mobility and communication (including language, identification, relationships and goals of care), with maximal autonomy and preferences (including proximity); staff and providers will leverage technology, even if behind the scenes, maximizing efficiency and accuracy.
    • Image, holding  hands. Text, Goals for end of life. Compassionate care with shared goals and plans. Right balance between curative care and supportive care. Patient and family at the center.Working with the U.S. Centers for Medicare and Medicaid Services to implement an Oncology Care Model that incorporates extended hours to care for patients, patient navigators to help guide patients through the health system, palliative care, psychosocial support, and hospice counseling. 
    • Broadening the VUMC initiative to ensure dignified, personalized end of life care to include improving communication about goals of care, including goals for end of life.
  • Ways to engage all stakeholders to improve patient and family experience