Q&A: Yancy credits ‘team-based approach’ for Northwestern University's improvement in cardiology

After going from No. 25 to No. 6 in a U.S. News and World Report ranking in just six years, Northwestern University’s cardiology department and cardiothoracic surgery programs have grown increasingly competitive among leading cardiovascular centers across the country.

Healthcare and civic leaders in Chicago, the health system’s hometown, and others around the nation have grown curious about what kind of leadership, skills and innovation could lead to such a leap.

The department is run by Clyde W. Yancy, MD, who has been at the helm of Northwestern’s cardiology department since 2011.

Northwestern’s division of cardiology comprises of 60 faculty members, an additional 50 associated cardiologists, 34 fellows and 11 research staff, according to a recent report by the health system. It performs 6,500 invasive cardiac procedures and 22,000 imaging procedures while receiving more than 56,000 annual ambulatory patient visits. Additionally, it maintains a $15 million research portfolio, managing 50 clinical trials annually. Just recently, the cardiology department served as investigators on the ABSORB trials, testing the efficacy of Abbott Vascular’s bioresorbable coronary stent.

To get better insight into the department and what makes it work, Cardiovascular Business spoke with Yancy about successes in his division, what consequences could be looming in light of MACRA and what advice he has for his peers.

Cardiovascular Business: What is going well in your department?

Clyde W. Yancy: It falls in three specific domains. Outcomes really begin the conversation. We have the lowest heart failure mortality measured over 30 days from the point of admission and beyond in the country. This is only one of several leading outcome metrics housed here at Northwestern.

The second part of this has to do with quality, and if one looks at the usual quality initiatives, particularly patient safety, we again are performing at an exemplary level and this has been through major efforts to develop teams that have focused on targeted objectives, like catheter-associated infections and on urinary track infections in the ICU.

The third piece of this has been reputation. And even though that seems somewhat nebulous, we’ve done a very good job of bringing together an excellent team of leaders. The fellows that are attracted to our center come from other leading medical centers.

How do these qualities help Northwestern stand out?

These kinds of initiatives that are successfully executed have really contributed nicely to the awareness that others have of who we are. We do this humbly because our goal is not to have accolades per say, but our goal is to achieve excellence in everything we do—in education, research, discovery science and clinical medicine. When we do that, we believe we’re making the best contribution to the cardiovascular discipline that we can.

MACRA is one of the most significant looming challenges for healthcare professionals right now. What is the best way for cardiology departments to handle it?

This will be a change that won’t be quite iterative. It will be more abrupt and may call for a very different profile and business practices. Part of our success has been through the active engagement of those with sophisticated business expertise. We will rely on that expertise even more now.

Throughout the cardiovascular domain and probably throughout all of healthcare, there is some uncertainty about what will emerge as new leadership at the administrative level and the federal government take over different domains of healthcare. So whether that is the leadership of the U.S. Food and Drug Administration, National Institutes of Health, CMS, the Department of Health and Human Services or the surgeon general, all of those individuals and their vision for the space that they oversee remain an incomplete sentence right now. All of these things have a domino effect, and all we can do is continue to practice the best medicine, always be mindful of the importance of high quality initiatives for being cost effective, continue to move forward and remain flexible.

Based on experience in your department, what are some limitations of electronic health records? How could they be better?

The electronic health record (EHR) is an element of contemporary medicine that is here to stay. It clearly is an imperfect model, and there’s a necessity to develop a more efficient system. It requires an inordinate amount of time for data entry, and it’s largely being done by physicians. Having user-friendly, efficient EHRs will be a necessity. How this will evolve over time is not really clear to us, but it must evolve. Everyone needs to be at the table, particularly the EHR vendors. There needs to be an open discussion about interoperability between different platforms. There needs to be an open understanding about data use and the protection of privacy for patients. We’re still in the formidable stages of the usage of these tools and much, much more work needs to be done.

What is your advice to other cardiology chiefs?

The key to success for each of the things you brought up today has been having a team-based approach. We have benefited from having all the right people in a room, having open and transparent conversations, and being committed to work through new opportunities that will yield the best possible outcome. It’s very difficult to lead by fiat. It’s much more important to lead by consensus. For some, that is a major shift in how cardiovascular models work, but for others, it is an evolutionary development of what has already been done.