Q&A with Dr. John Brumstead

Fletcher Allen's CEO Reflects on 2013 and Looks Ahead to 2014

dr brumstedFor John Brumsted, M.D., President and CEO of Fletcher Allen Health Care and Fletcher Allen Partners, a significant highlight of the year 2013 was being named one of the top ten academic medical centers in the U.S. But he’s less focused on being an award-winner, and much more intent on talking about the accomplishments that the award recognizes, and the journey to reach this high level of achievement. 

Winners of the Quality Leadership Awards from UHC (University Health System Consortium -- the foremost alliance of the nation’s leading non-profit academic medical centers) must demonstrate one key attribute above all others: delivering high-quality patient care. In addition to Fletcher Allen, this year’s top ten include the Mayo Clinic, New York University and Rush University in Chicago. Winners are evaluated on six criteria: effectiveness, mortality, safety, patient-centered care, efficiency and equity, which means demonstrating that quality care is provided to all patients regardless of demographics, insurance status or any other factors. Fletcher Allen ranked #1 in patient safety, #2 in efficiency and #7 overall. Fletcher Allen has ranked in the top twenty before, but this was the organization’s first time in the top ten overall.

Q: Winning this award – being in the top ten of what are arguably the country’s most prestigious medical institutions – has to be very exciting for you.

A: It is – but what’s even more important to me is what the award is based on, which is quality. It’s all about quality in patient care, and that’s what we are all about.  Quality and patient safety are ingrained in our culture, and we’ve spent years with this focus. In every meeting, no matter what the topic, quality is on the agenda, and we engage all of our staff in this commitment. We’ve been at this for more than a decade, with our physicians in the lead. It’s the way we live and work, the core of what we do. The question is always: “What can we do differently and better?”

We have invested heavily in ensuring that patient care is of the highest quality. If you look at the work of Fletcher Allen’s Jeffords Institute for Quality and Operational Effectiveness -- measurement, patient safety, patient and family advocacy, infection prevention and regulatory readiness -- you can see what a significant and complex effort it takes to create a non-stop effort to always go beyond, to continuously improve.   Our staff at the Institute are a tremendous resource for us at Fletcher Allen in so many ways. For example, the analysts help us take reams of data that are generated every week, and look at what the data means – where are there areas we need to address, where are we making progress and learning things that should be instituted throughout the hospital.  

Representatives from the Jeffords Institute are integrated into every area of patient safety and quality. For example, the team from the Institute’s Infection Prevention Department worked with our environmental services team to find innovative ways to clean patient rooms – and test for cleanliness – and we’ve actually won national recognition for those efforts. 

Q: So can we say you’ve “arrived” in terms of being a national leader with this award?

A: Not at all. While we of course have celebrated the UHC award, our efforts don’t stop or even slow down. We look forward, asking how can we do better tomorrow what we did really well today.”

Q: The award was a highlight of 2013, but clearly there were other achievements of which you are proud.

A: I’m very excited about what we are doing in the area of patient experience. Delivering the highest quality medical care is the core of what we do – but we also have to make sure that every part of the experience of being a patient at Fletcher Allen is as excellent as the clinical care.  So we are taking a broad, multi-disciplinary approach in looking at every single facet of the patient’s experience at Fletcher Allen.  We are looking at every touchpoint, everywhere and every way the patient encounters us, and redoubling our efforts to make sure that while we are providing the highest quality clinical, medical care, we are also doing it in a way that makes it a positive personal experience for the patient.

Q: Is there a special way Fletcher Allen is going about this?

A: We’re doing our best to make it collaborative, by involving the patients and community in the process of considering and designing services, processes and facilities. I don’t mean just asking for input, or telling those we serve about what we are doing – I mean having them at the table, sitting with us while we make decisions. For instance, as we proceed with our planning process for the new inpatient facilities, we want past, current and future users of our services giving us their ideas, telling us about their needs. The era of hospitals developing plans and then announcing them to the public must give way to having the public, the community we serve, be part of the planning, right along with us.

Q: What else has happened in the past year that’s a success story for Fletcher Allen?

A: The ongoing development of Fletcher Allen Partners, our multi-hospital system in Vermont and northern New York, is an effort that is going to literally change health care delivery to better serve patients. Our mantra is right care at the right time in the right place – making sure that services that can be provided in the community setting, close to the patients’ homes, happens there, and conversely, that the services for which patients are sent to Fletcher Allen require advanced, tertiary-level care.

A good example of this is heart care. It doesn’t make sense to have two open heart surgery programs within Fletcher Allen Partners, so we’re consolidating the cardiothoracic surgery at Fletcher Allen.  At the same time, it doesn’t make sense for people in northern New York who need cardiac catheterization to drive past CVPH, which has an excellent cardiac catheterization program, to go to Fletcher Allen  - so we are establishing a northern New York Center of Excellence for cardiac intervention at CVPH.  

This approach will be better for patients and will certainly result in greater cost effectiveness, something that’s essential for businesses, government and individuals who pay the health care bills.     

That sorting out of what happens where is an integral part of Fletcher Allen Partners, as is creating a consistent, system-wide set of standards and procedures, so that, for instance, technicians doing an echocardiogram in a community hospital, a physician’s office or at Fletcher Allen do it in precisely the same way, to ensure the highest quality and outcomes.  

Certainly, making decisions about location of services and standardization of care is a deliberate and painstaking process, and it’s not always easy, because we’re unwinding a lot of things that have ‘always been done this way,’ but it’s a challenge we are mastering and the patients, payers and the communities we serve will benefit.

Q: So that’s both a success story and an ongoing challenge.  Other challenges ahead in 2014?

A: Clearly the big one will be managing the impact of health care reform, including expected declines in reimbursement. There were questions raised in a recent report by a Washington consulting group analysis about the financing plan for Vermont’s proposed single-payer system. The report concluded that the estimates of total funding needs may be too low. On a broader scale, some have suggested that we could see as much as 15 percent reduction in reimbursements for hospitals. That goes beyond bending the cost curve, to breaking the back of health care providers. Fortunately here in Vermont, we know that if we are open and honest, doing our best, making the best effort, state leaders will work with us to manage this situation in a way that’s in the best interests of the people of Vermont.

Q: What do you see as a key strategy to address the challenge of managing in a “reformed” health care delivery system?

A: We have to continue to work with and bring together all of the parties who have a stake in health care in Vermont. No one organization can go it alone in terms of making change. We don’t operate in a vacuum.  In the l990s, during the push for health care reform, providers each tried to fix things, independently. That didn’t work. Even with the tremendous resources of an academic medical center, Fletcher Allen cannot do it alone and it would be counterproductive of us to try. So we’ve opened up a dialogue here in Vermont among health care providers, payers, regulators and government on issues of care and care delivery. We are creating our own network in Fletcher Allen Partners; we’re partnering with Dartmouth in a statewide Accountable Care Organization and we worked on a network in New York State that has been approved as the Adirondacks ACO. It’s all about collaboration with like-minded organizations with whom we can work to advance our mission and common interests.