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Organizational Action Projects

During their Organizational Action Project (OAP) PEMBA participants design a project that will improve both patient and organizational outcomes. They work with a faculty advisor and their own corporate team to implement it, with deliverables scheduled throughout the program year.

Similar to a thesis, the project is graded independently of all other assignments, and our students report significant impact to efficiency and patient care through through their OAPs.

Charting a Future Course for a Regional Family Clinic

Michelle Steele Rebelsky, MD, Physician Executive MBA, Class of 2017

CHALLENGE: A family practice located in a small, south central Iowa town was formed in 2011 as a Virtual Private Practice (VPP) within a larger health care system. Since the practice’s primary mission is meeting the total health needs—including preventive, acute, chronic medical care, and obstetrics—of the underserved, the VPP model was an ideal way to quickly get the clinic up and running. A VPP outsources the business side of the practice, freeing clinicians to do what they do best: provide personalized patient care. Faced with the realities of the ever-evolving local, state, and national health care industry landscape, however, it quickly became clear to the family practice clinicians that the VPP model wasn’t sustainable. Handling the volume and complexity of increasing regulations while continuing to provide the same level of patient care, would require a solid administrative structure and a new, financially viable model.

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Post-Anesthesia Care Unit Process Improvement to Increase Patient Throughput

Pankaj Kumar, MD, Physician Executive MBA, Class of 2017

CHALLENGE: The high-stress environment of post-anesthesia care units, or PACUs, commonly leads to staff burnout and dissatisfaction. Stress levels are particularly high on days when a PACU reaches the point of over-capacity, known as a “surge” in patient census. Having a surge plan in place can help mitigate problems (such as staffing shortages), however, frequent surging can lead to surge “fatigue” or “numbness” among staff. While working in a PACU is inherently stressful, process improvements could increase patient throughput (the cycling of patients through the department), resulting in higher patient and staff satisfaction. As processes become more complex, however, individual hospital departments—including PACUs—tend to display the Fiefdom Syndrome, which is tendency of groups to isolate from the larger organization to protect their own turf and preserve the status quo.

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Evaluating the Potential Benefits of Acquiring a Skilled Nursing Care Facility

Richard Harp, MD, Physician Executive MBA, Class of 2017

CHALLENGE: In the world of skilled nursing and rehabilitation facilities, a one-star rating from the Centers for Medicare & Medicaid Services (CMS) is akin to a scathing Yelp review. CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers to easily compare nursing homes (also known as skilled-care facilities) and come up with questions—and things to look for—when touring a facility. Nursing homes with five stars are considered to exceed expectations for above average quality, while facilities with one star are deemed to have quality much below average. Such was the case at one-star Woodruff Manor, a privately owned, 88-bed skilled nursing and rehabilitation facility serving the Woodruff, South Carolina, community since 1987. Elevating Woodruff Manor from a one-star to three- or four-star facility would require significant upgrades and additional staffing. For the non-profit Spartanburg Regional Health System (SRHS), acquiring Woodruff Manor presented the possibility of increasing net income—if the due diligence process proved the acquisition to be financially and strategically sound.

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Leading Change in Emergency Department Chest Pain Care

CHALLENGE: Chest pain is a common reason people seek emergency medical care, resulting in about eight million emergency department (ED) visits in the United States each year. Many of those patients are hospitalized for comprehensive—and expensive—testing, even if they are at very low risk for life-threatening acute coronary syndrome (ACS) based on their history, electrocardiogram (ECG) findings, and cardiac biomarkers. Over-testing of ED patients with chest pain can lead to hospital crowding and inefficiency, while harming patient outcomes.

PROJECT: Leon Adelman, emergency medicine physician and director of clinical operations at the Inova Alexandria (Va.) Hospital (IAH) Emergency Department recognized that a standard, evidence-based approach to chest pain evaluation was needed to accurately determine whether a patient was at very low risk for acute coronary syndrome (and thus, safely could be discharged without further cardiac testing). Using the modeling tools learned in the PEMBA program—and the input and guidance of his UT PEMBA mentor and advisor Jody Crane—Adelman focused his Organizational Action Project on designing and implementing a ED Low Risk Chest Pain Initiative (LRCP) at IAH. He led an IAH LRCP team charged with improving the quality, consistency, and efficiency of the process for chest pain evaluation at the hospital.

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Restructuring a Growing OB/GYN Practice

CHALLENGE: Expanding any medical practice involves more than a few growing pains. While the addition of new physicians typically produces long-term benefits—such as lightening patient loads for current providers—short-term challenges can sabotage success. For Women’s Specialty Care (WSC), a Knoxville, Tennessee, obstetrics/gynecology practice located at the main University of Tennessee Medical Center campus, the decision to add four new physicians in 2015 was made, in part, to adopt a variation of the laborist, or obstetrics hospitalist, model.

The OB/GYN hospitalist approach ensures that a fully trained OB/GYN will be physically available—with no assigned tasks or responsibilities elsewhere—to manage patients who present to labor and delivery. Since WSC is aligned with a teaching hospital (the University of Tennessee Graduate School of Medicine) the laborist-like model also made it possible for four physicians in the practice to incorporate academic goals with the Department of Obstetrics and Gynecology.

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Connecting rural community hospitals to advanced critical care expertise.

CHALLENGE: Small community hospitals in rural South Carolina offer personalized, close-to-home care, yet commonly don’t have specialists on staff to meet the needs of critically ill patients. Physician specialists, such as intensivists (board-certified physicians who provide special care for critically ill patients) and pulmonologists, primarily are located in the state’s larger suburban and urban population centers. Lack of local access to critical care expertise often means that patients requiring intensive care-level treatment have to be transported to hospitals outside of their communities. The distance between home and hospital creates an extra financial burden (due to factors such as transportation and lodging expenses and lost work days) for patient families and can be stressful for patients who are receiving treatment in unfamiliar surroundings.

PROJECT: Dr. Tallulah Holmstrom, Chief Medical Officer of CMO of Carolina Pines Regional Medical Center in Hartsville, S.C. and KershawHealth in Camden, S.C., and her leadership team recognized that existing telehealth technologies could provide the connection needed to help patients in a rural community hospital receive critical care close to home. Using the modeling tools learned in the PEMBA program—and the input and guidance of her UT PEMBA mentor and advisor Dr. Erin Atchley—Holmstrom focused her Organizational Action Project on establishing a Tele-ICU program at KershawHealth. A Tele-ICU uses an off-site command center in which a critical care team (including intensivist physicians and critical care nurses) is connected with patients in distant intensive care units (ICUs) to exchange health information through real-time audio, visual, and electronic means. The initial goals of Holmstrom’s project included increasing successful outcomes for critically ill patients, reducing length of stay, and improving hospital financial performance.

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