Clinical Care

Overview

copyright 2013The Department of Pediatrics strongly emphasizes service to patients and families of North Carolina, and has a long history of providing excellent clinical care throughout the state and beyond.

A key goal for the department has been to ensure that it offers the full breadth of specialty care, an important responsibility as a state hospital and a distinguishing factor for UNC as an academic medical center. There has also been a concerted effort to address operational issues in the clinical enterprise in recent years.

While the clinical mission is said to have strengthened in recent years, the strategic planning process highlighted the following concerns:

  1. As with most academic pediatric departments, the Department’s financial standing is impacted by clinical volume, a dependence on Medicaid funding and level of philanthropy relative to benchmark institutions.
  2. The lack of a clear clinical vision makes it difficult to prioritize investment beyond the goal of offering the full breadth of specialty care.
  3. Faculty cited the absence of a single child health leader as an obstacle to coordinating with the North Carolina Children’s Hospital, along with insufficient administrative and clinical support.

Opportunities

The parallel effort to refresh the N.C. Children’s Hospital strategic plan has addressed many of the areas of concern raised by faculty, starting with the articulation of an inspiring clinical vision and a plan for growing clinical volume to ensure continued quality of care, academic opportunities for faculty and financial health. Reengineering key processes, and providing additional ancillary support to clinicians, will enable improved efficiency of care delivery.

Priorities and Initiatives

Strategic Priority 1: Seek greater alignment of Department of Pediatrics with N.C. Children’s Hospital and other non-Department of Pediatrics pediatric subspecialties

Optimal care for infants and children is best delivered when decision-making is efficient, streamlined and coordinated among the various departments and units that serve these patients, and when and physicians and administrators share leadership at all levels of the organization. Care providers and administrators are thus better enabled to focus on quality improvement through patient safety, exceptional provision of health care and patient and family satisfaction.

In order to create an integrated, patient-centered health care environment that effectively and efficiently produces better health outcomes and clinical program growth, the Department of Pediatrics must fully integrate itself with N.C. Children’s Hospital and other pediatric subspecialties.

Recommendations:

  • Support the shared leadership model captured within N.C. Children’s Hospital strategic plan by recommending a set of governance principles to ensure efficient, streamlined and coordinated decision-making.
    • Create a formal partnership between the Physician-in-Chief and N.C. Children’s Hospital executive leader.
    • Allow all physicians who care for children to have input into operational and budgetary issues of the N.C. Children’s Hospital.
  • Appoint a Vice Chair for Clinical Operations within the Department of Pediatrics who will serve as Pediatrician-in-Chief for N.C. Children’s Hospital. The Vice Chair will be responsible for overseeing the following aspects of the clinical activities in the Department of Pediatrics and N.C. Children’s Hospital:
    • Operational
    • Financial
    • Strategic planning
    • Quality improvement
    • Compliance
  • Maintain a full breadth of clinical services in order to provide the best care possible to the children of North Carolina and beyond.
  • Optimize the collaborative relationships within all pediatric subspecialties, both within and outside of the Department of Pediatrics.
  • Pursue inclusion of pediatric subspecialties not already located organizationally with the Department of Pediatrics.

Strategic Priority 2: Increase efficiency and standardization of clinical operations

Clinical operations sometimes struggle to meet capacity demands, leading to inefficiencies. Addressing these inefficiencies will have positive implications for quality of care and cost.

Recommendations:

  • Encourage innovation in clinic operations by gathering data about scheduling processes, flow, etc. and creating a rapid improvement team.
  • Create a Clinic Innovations Fund which will support these initiatives and others as they are identified.
  • Advance knowledge, clinical care and patient experience around adolescent transitioning by creating a task force to review best practices and make recommendations to the Department of Pediatrics and N.C. Children’s Hospital for policy updates.

Strategic Priority 3: Increase clinical volume

While the Department of Pediatrics and N.C. Children’s Hospital have achieved the goal of providing the full range of pediatric specialty care, some specialties experience low patient volume. The following steps are recommended to ensure continued opportunity for clinical research and financial health.

Recommendations:

  • Expand off-campus outpatient operations by better utilizing current off-site outpatient clinics, such as the UNC Pediatric Subspecialty Clinic on the Rex Hospital campus.
  • Support the recommendations of N.C. Children’s Hospital strategic plan regarding other off-site locations in which to build a Department of Pediatrics presence, and ensure support is available to sustain the clinics.
  • Expand on-campus outpatient operations by improving utilization of current clinic space, increasing availability to meet patient and capacity needs and expanding the current clinic space.
  • Improve system for ‘triaging’ inpatient beds to improve bed utilization and better align the Department of Pediatrics and N.C. Children’s Hospital missions by involving clinical attendings in all admission and placement decisions for inpatient referrals.
  • Improve the current inpatient capacity by increasing utilization of the Observation Bed unit.
    • Consider redesigning the space to include isolation capability and bathrooms.
    • Consider moving infusion to clinic space.
    • Explore relationship with off-site hospitals to admit previously well children with acute illnesses, staffed by faculty in the divisions of General Pediatrics and pediatric Hospitalists (eg, asthma, r/o sepsis, bronchiolitis, etc).