Clinical Excellence

To the YSM and Alumni Communities:

A couple of weekends ago, several people sent me this column by our faculty member and NY Times writer Lisa Sanders. There is so much to love about this story. In its telling, Dr. Sanders captures what it means to be a teaching hospital and academic health system. She celebrates the commitment of our faculty, staff, and trainees to the value of human life and the tenacity with which they ask questions and apply their diagnostic acumen in the pursuit of saving lives.

This story further reminds us of the centrality of our clinical work to the realization of all our missions. I do not simply mean that revenue from the clinical enterprise supports our education and research missions, although this is true. Rather, the story highlights the critical role of the hospital and clinic in teaching analytical thinking as well as diagnostic and therapeutic strategies to our undergraduate and graduate medical trainees. Clinical observations inform discovery, and the partnership between Yale School of Medicine and Yale New Haven Health System enables us to offer our patients access to cutting edge diagnostics and therapies made possible by research.

Another thing that I loved about this story was how many people forwarded it. I imagine that was in part because the story reminds us that what differentiates the academic health system is our ability to attract committed and curious people. The ways in which our faculty and trainees save lives are not always as dramatic as in this case, but no less worthy. Indeed, the celebration of heroic saves should not detract attention from the need to attend to the day-to-day tasks that routinely prolong life. To provide the highest level of care and optimize the health of all, we must standardize routine tasks and introduce systems that minimize error across the Yale New Haven Health System. As our clinical mission statement reads, “We care for patients with compassion, and commit to improving the health of all people.” We need to apply the same commitment and energy that we devote to the care of our individual patients to the endeavor of optimizing health across the system and our community.

Achieving this level of care requires that the chairs of our clinical departments, as physicians- and surgeons-in-chief, have authority and responsibility for standards of practice across the system. It requires that chairs work closely with nursing, service line, and delivery network hospital leaders to operationalize best practices across our operations. It requires that each of us is invested in realizing these best practices. To this end, a task force of Yale New Haven Health System and Yale School of Medicine leaders, chaired by Murat Gunel in collaboration with Chris O’Connor, spent the better part of the last year developing a document that codifies the role of chairs across the system. It was particularly meaningful to me that one of the people who forwarded the Sanders column was a participant in the task force—Patrick Green, president, and CEO of L+M Healthcare.

Achieving the highest level of care also requires that our patients can access us. We must address barriers to timely appointments in the clinic. Under the leadership of Dr. Paul Taheri, Yale Medicine made progress in this area, and under interim CEO Babar Khokhar, we will work with the system to advance this work. In the hospital, we must address inefficiencies that prevent us from discharging patients who are ready for release. In the last few weeks, high occupancy rates and staffing shortages have prevented us from providing access to some patients in a timely fashion. What would have been the outcome if we had had to deny transfer of the patient in the story because the hospital was too full? To address this crisis, we must employ the same creative strategies and teamwork that we utilized during the pandemic. With this in mind, we are reconvening the group of school and hospital leaders that met weekly during the height of COVID-19 to tackle these challenges.

To provide the very best care of which we are capable and to make clinical research more accessible, we must also align strategic planning and decision-making across our academic health system. This will require careful delineation of responsibilities and elimination of duplication between the school and the health system and within each of our institutions. This in turn will require that we reimagine our coordinated leadership structures. Over the last 18 months CEO of Yale New Haven Health Marna Borgstrom and I began early work in this area. Chris O’Connor, recently designated as the incoming CEO of Yale New Haven Health, and I are committed to continuing this work and will be engaging many of you in the months to come.

The case described by Dr. Sanders gives us hope and reminds us of the fundamental reason we are here—to care for and sometimes cure individual patients and to advance human health. Let us carry that with us as we do the work with which we have been entrusted each day.

Sincerely,

Nancy J. Brown, MD
Jean and David W. Wallace Dean of Medicine
C.N.H. Long Professor of Internal Medicine