 | Exposing patients to the healing power of the arts is the goal of the Yale Physicians Building Art Place initiative, in which creative works from various media -- many by members of the medical community -- are exhibited throughout the facility. |
Faculty practice blends scientific expertise,
Shirley Ray, 79, of Avon, was cold, her joints ached, and she felt depleted. She hoped a parathyroidectomy, surgery to remove one of four small endocrine glands in the neck, might relieve her symptoms. Her doctor in Florida, however, was hesitant to go ahead with the procedure.
"He felt I might have a rare genetic syndrome and not primary hyperparathyroidism," she recalls. "My internist in Connecticut had watched my calcium levels for three years and felt I needed the surgery." (The parathyroid gland secretes a hormone that acts to maintain normal levels of calcium in the blood and normal neuromuscular function.)
Ray's daughter mentioned the situation to a physician at Yale, who referred her to Dr. Robert Udelsman, chair of surgery at the School of Medicine and chief of surgery at Yale-New Haven Hospital. He looked at Ray's blood tests and other test results and agreed to perform the procedure.
Udelsman's assistant, Patricia Donovan, a registered nurse, took care of all of the arrangements. She even gave Ray her own home phone number in the event she needed anything after the surgery. Ray was spending the night in a local hotel, to spare herself the hour's drive home. The procedure took place under a local anesthetic without any complications.
"Everyone was very caring," Ray says. "I wasn't used to that type of treatment. I was very impressed from the aides right up through Dr. Udelsman."
Patient-centered care is a hallmark of the Yale Medical Group (YMG), which is the name of the practice organization of the School of Medicine.
The YMG includes more than 650 full-time and 117 part-time Yale physicians representing 17 clinical departments and over 100 specialties. Last year, the medical school's clinicians logged 400,000 patient visits and more than $160 million in collections. The YMG also provided over $2 million in uncompensated care for patients who have no health insurance and/or cannot afford to pay for medical care.
The patient care is provided at the Yale Physicians Building, Temple Medical Building, Yale-New Haven Hospital, the Yale Sports Medicine Center, and other offsite locations.
Dr. David Leffell, professor of dermatology and surgery, was appointed director of the YMG in 1999. His assigned task was to oversee all of the YMG's clinical and business activity and define the YMG as an efficient organization that facilitated the research and educational missions of the school. The complex organization also is responsible for negotiating contracts, marketing its services, and planning strategically in a changing health care environment.
"The major challenge is running the YMG in a way that provides the highest quality medical care and service while managing it like a health care business with marketing, billing and collections, auditing and compliance. All of this must be accomplished within a system that is structured for academics," Leffell says.
"The academic purpose of the YMG is served by the research, and an influx of patients who present clinical challenges -- both of which are the bedrock of this facet of YMG. You can't expand into new scientific frontiers in medicine without patients," he adds.
Because of the research interests of faculty physicians, YMG doctors and their patients have access to the most advanced medical care resources available. Some researchers are involved in developing new medications, vaccines or other treatments. Others intensively study the human genome to better understand how disease develops and how it might be cured. Still others study the effectiveness of current treatments or conduct clinical trials of innovative treatments not yet widely available to the public.
The top to bottom improvements at the YMG were driven by Practice Standards, which the physicians' group adopted in 1998. The standards include guidelines for telephone access; information for patients; patient experience; human relations; clinical productivity; appointment availability and scheduling; patient registration; appearance of facilities; medical records; and billing and collections systems and services.
Clearly defined targets were identified for important aspects of clinical service and YMG developed projects to systematically address each target and develop measurable performance metrics.
The first problem addressed was the billing and tracking function of the YMG. Marianne Dess-Santoro, executive director of the Patient Financial Services Office, managed the project and phased out the flawed APS computerized billing system and implemented a new IDX system. According to Dess-Santoro, "The key to successful IT implementation was streamlining the business processes and centralizing key aspects of the practice, including patient registration." The first year after the system's implementation, YMG realized a 14% increase in cash collections. The new tracking system also includes auditing and compliance functions.
Another initiative undertaken by YMG and led by Dess-Santoro was the substitution of the manual method of tracking patient complaints with a streamlined, electronic system to support the YMG Office of Patient Advocacy, which is an interdepartmental entity focused on patient satisfication.
Under the YMG system, when a patient complaint is received, it is immediately logged into the database, and then triaged to other departmental team members according to the type of issue addressed. Most importantly, the patient is contacted that same day to inform him or her of the steps being taken to resolve the problem.
Janine Evans, associate director for clinical affairs, who reviews all complaints monthly and directly oversees the Office of Patient Advocacy, says the process allows YMG to identify and correct problems within practices, and promptly respond to everyone involved.
"Our quick and informed response to the patient has a very positive impact on their perception of Yale," Evans says.
Mary Hu, director of strategic development and marketing for YMG, has been the lead person in developing YMG's new website, which is the cornerstone of its marketing initiative.
Located at www.yalemedicalgroup.org, the website includes an on-line searchable physician database, consumer health content, clinical department descriptions, and information about registration and billing.
"The YMG website serves as a portal to the school's clinical practice. It is positioned to be the preeminent provider of information and services, demonstrating our commitment to the health and well being of the community," Hu says.
The YMG's Practice Standards also address the patient experience when visiting or communicating with the YMG. Attention was paid to improving phone response time and being consistently courteous to callers. Paging systems and telephone trees were enhanced. Even the manner in which staff speak to patients was altered. Instead of the impersonal and commanding "Come in at 2 p.m.," staff now inquire: "Do you prefer a particular day or time?"
The YMG also worked to create more pleasant waiting areas for patients. For example, YMG supports two annual art shows in the Yale Physicians Building with an ever-evolving array of works in all mediums -- sculpture, painting, photography, quilts and pottery. This program, called the Yale Physicians Building Art Place, seeks to use the healing power of the arts to enrich the experience of the hundreds of patients who visit the building each day.
"As medical science advances the opportunities for health, the YMG is uniquely positioned to combine world renowned expertise in basic science with clinical care," Leffell explains.
"Our vision," he notes, "is to maintain the infrastructure and create an environment in which our patients are cared for in a superb fashion, our clinical experience both drives basic research and benefits from it, and the next generation of physicians are educated and trained in a way that values the patient as an individual."
-- By Jacqueline Weaver
T H I S
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