Four of the University of Texas System’s six medical schools —those located in Dallas, Galveston, Houston and San Antonio— offer cardiac surgery care, and all four are rated highly by independent third parties including U.S. News & World Report, The Leapfrog Study and the Vizient Quality and Accountability Study.
To improve patient outcomes and increase revenue, the centers wanted to better leverage their strengths, which include an extensive, established cardiac surgery infrastructure; public trust in the University of Texas; a geographical span covering nearly 270,000 square miles; and, at $31 billion, an endowment second in size only to Harvard University’s. The obstacle to better performance? Data was not shared between institutions.
“We didn’t have a mechanism for sharing data or a forum where leaders could see the data and look at our processes across the system,” Patrick Roughneen, professor of cardiovascular and thoracic surgery at Galveston’s UT Medical Branch, says. “We saw our own data and filed it away in our individual institutions. But when you see the schools’ data in aggregate, we compare favorably with large institutions across the country that perform high-volume cardiac surgery.”
Staying separate, Roughneen believed, made all four institutions vulnerable to local competition in tumultuous times for healthcare. That includes a trend toward care based on service lines, an innovative, patient-centered approach.
Getting the Green Light
Before Roughneen joined the University of Tennessee, Knoxville’s Haslam College of Business Physician Executive MBA (PEMBA) program in 2020, senior leadership already supported combining the University of Texas medical schools into a unified system. “The blood, sweat and tears of putting it together hadn’t been done yet,” says Roughneen, who proposed starting with the cardiac surgery departments.
John Zerwas, the university system’s executive vice chancellor for health affairs, saw the potential and gave the go-ahead. All four medical schools’ provosts and deans embraced the idea. Roughneen says starting at the top was the only way the effort would work – otherwise, there would have been too much resistance to the idea. His proposal became his PEMBA Organizational Action Project (OAP), and that project became the UTCSQC, or the University of Texas Cardiac Surgery Quality Collaborative.
In PEMBA, Roughneen developed common metrics that could be used for cardiac surgery across institutions. With colleagues at the University of Texas Health Intelligence Platform (UT-HIP), he created a methodology for assessing quality and cost effectiveness on a risk-adjusted basis, using UT System data submitted to the Society of Thoracic Surgeons (audited by Duke University) and comparative hospital data from Vizient. Roughneen’s methodology provides an independently verified, reliable measuring tool for all interested parties to assess the newly formed alliance’s quality of cardiac surgery care.
First Wins and Found Opportunities
After the data was compiled under Roughneen’s new methodology, the collaborative held an inaugural meeting in January 2021. “Even on our first pass, things looked good in the aggregate,” he says.
Through reviewing each institution’s data, the group discovered that each center performs well – perhaps even in the top 10th percentile nationally – in at least one area. However, each also fell into the lower 25th percentile in some areas.
The data suggested that if each center shared processes in which it excels, they might achieve excellence in all areas. The group also discovered significant variability in dollars spent for the same operation at different institutions, highlighting an opportunity to streamline costs by sharing best practices.
Roughneen was surprised at how transparent surgeons were for the sake of improving as a group. “We all have a little bit of dirty laundry, and people are hanging it up,” he says, and then focusing on improvement.
UCSQC will hold quarterly meetings, expanding to include cardiologists as part of the data-sharing team to cover the group’s spectrum of care. Its next goals are improving patient care through resource and purchasing optimization, creating a common brand for the new system, engaging collectively in cardiac surgery research and capitalizing on the system’s geographical positioning to serve diverse populations. Reaching those milestones will provide a model for other departments and service lines.
In pulling together the collective, Roughneen was guided by PEMBA’s emphasis on building a repertoire of tools to persuade people in a given organization to support a mission. “The most powerful lesson for me was learning how to get buy-in – sharing ownership and not claiming something for yourself,” he says.
Noting that collegial relationships at work can lead to great opportunities, Roughneen says, “Those are the kinds of relationships you have to cultivate to implement a major change in a healthcare system – and they’re also incredibly enjoyable professionally.”
Scott McNutt, business writer/publicist, email@example.com