Cleveland-based University Hospitals Harrington Heart & Vascular Institute has more than 2,000 employees across 11 hospitals, 12 ambulatory health centers and multiple joint ventures. As president, Mehdi Shishehbor, DO, PhD, was tasked with standardizing vascular care across the institute through a newly established Vascular Center in 2017.
Within six years, the institute saw a “consistent and significant” increase in both the number of vascular procedures performed as well as in the number of patients treated for vascular disease at University Hospitals, according to an Endovascular Today article co-written by Dr. Shishehbor.
He spoke to Becker’s about the strategy and intent behind the new care model, which he said began with him and his team asking themselves two questions:
“One, how do you reduce variability in cardiovascular outcomes across different sites?” he said. “And two, how do you get cardiac surgeons, vascular surgeons, cardiologists, interventional cardiologists, etc., to all work together for a common purpose: the patient?”
The Heart & Vascular Institute first established a culture of quality, deciding it would pursue or invest only in activities that made sense for its patients.
“Anytime somebody wanted to pursue an initiative, honestly, we just asked this question: ‘Is this good for our patients?’ It’s that simple,” Dr. Shishehbor said.
The team then created a horizontally structured quality network across the entire system for cardiovascular disease, foregoing typical market- or hospital-based systems.
“If we have a complication at Hospital A, we’re all going to learn from it,” he said. “We’re all going to look at it and see where we can do a better job.”
The horizontal structure similarly bled into other areas of operations, with the team combining on-call schedules across hospitals. Shifting from having 10 teams to five teams on call each night resulted in such high satisfaction that Dr. Shishehbor called it the “feather in our cap in regards to ‘systemness.'”
As “systemness” increased in priority, it revealed areas where some physicians were not meeting quality standards. Enforcing those standards was not easy, Dr. Shishehbor said.
“We had three surgeons actually leave our program because of this,” he said. “They believed that they were doing a good job, that nobody could do better than them.”
For those who stayed, the institute committed to helping physicians elevate their technical and clinical skills.
“We are continuously investing in quality process improvement,” he said. “[Whether that] means working with others, bringing in external physicians, collaborating with or sending one of our doctors to another organization to learn for three months.”
Next, Dr. Shishehbor focused on creating formal processes that would bring together physicians from different specialties and service lines. This resulted in establishing multi-disciplinary teams that meet, often virtually, to discuss patient cases and care plans. The institute now has 11 teams for various conditions: from the Complex and High Risk Coronary Intervention Team and the Hypertrophic Cardiomyopathy Team, to the Limb Salvage Advisory Council and Acute Aortic Care Team.
“It’s amazing how people want to contribute, they will join the call even when they’re on vacation,” he said. “They show up and want to know what is happening with the case.”
Those 11 teams run across the institute’s 20 centers, which are each led by a physician-administrator dyad and are “completely patient-centric,” Dr. Shishehbor said. The centers include a vascular center, cardiac center, electrophysiology, advanced cardiac imaging, a clinical trials unit, prevention and other services.
“We have structured the 20 centers and 11 multidisciplinary teams to really bring everyone together,” he said. “We are really agnostic to the idea that if you practice on the east side, this is the way we do it and if you practice on the west side, that’s the way we do it. There’s only one way, and we call it the Harrington Heart and Vascular Institute way.”
Dr. Shishehbor and his team are confident this care structure can be replicated for a diverse range of specialities and system models. His advice to other systems looking to establish this framework boils down to three points.
“Number one, no player is bigger than the team. You have to be very clear about who is at the center. The purpose for us is the patient. It’s hard for me to imagine a health system where that’s not the case,” he said.
“Number two, you have to create systems and hold people accountable. There is no reason the quality of care should be different between Hospital A and B within the same system or Doctor A and B even in the same hospital. There has to be investment in improvement and in elevating everyone.
“Number three, there’s always going to be bumps in the road. Like anything else in life, we just have to get up and keep falling forward, do the right thing and keep improving.
“Don’t get me wrong, there’s so much work for us to do, too. It’s not like we’re done. We’re just getting started.”
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