Patient care is what David Roberts, MD, is most passionate about. From practicing family medicine to training residents in family practice, delivering high quality patient care has been his focus. While his role in healthcare may have shifted more to the administrative side rather than medical, high quality patient care and safety is still at the forefront. As Vice President/Chief Medical Officer for West Tennessee Healthcare may mean his direct contact with patients is limited, Roberts still impacts the lives of hundreds of patients each day.
As a pastor’s son, Roberts moved around the Southeast but spent his high school and college years in Tennessee. Watching his father help people in the rural South deal with health issues spurred his desire to be a doctor. At the time he entered medical school at the University of Tennessee Health Sciences Center in Memphis there was a great need for primary care physicians throughout the country but especially in the southeast. In response to that need, a three-year grueling accelerated primary care program was offered at UT and Roberts entered that program.
After completing his residency in family practice through the UT program in Jackson, Roberts got his certification in geriatrics and geri-nutrition. He remained on staff at UT as a faculty member for a year before entering private practice in Gallatin, Tenn. He left private practice after a year and a half. He returned to Jackson and the UT residency program faculty as an assistant in the Department of Medicine and ultimately became program director.
“As a part of the residency program faculty, I practiced family medicine as well as had teaching, administrative, research and writing responsibilities,” said Roberts. “During my 27 years as program director, I had the honor of receiving the Thomas K. Ballard-Oscar M. McCallum Professorship in Family Medicine. But what I am most proud of are the 160 family medicine physicians I helped to train.”
Fifteen years ago Roberts’ role shifted further into administration when he was recruited to be Vice President/Chief Medical Officer at West Tennessee Healthcare which requires him to wear several hats. “As VP for Medical Affairs, I am responsible for such things as credentialing providers, physician governance, peer review and case review,” he said. “On the quality assurance side, we have QA nurses that work with each department to ensure good outcomes. We aggregate data from 14 departments within the hospital in an effort to constantly improve patient care and safety. As a member of the Quality Council, I work with the board on strategies for the operation of the organization.”
Roberts is quick to point out that it is a team effort that requires communication. “We have a patient safety huddle every morning that brings together more than 70 people from within the hospital,” he said. “We look at what is happening, what needs to be looked at, as well as what communication needs to occur. Patient safety and quality of care starts with those who deliver the care. It is an extraordinary process that is always about the patient.”
Three priorities Roberts focuses on are to decrease patient morbidity and mortality to the lowest point possible; to design processes of care that are reliable and consistent so the patient gets the best care possible each and every day; and to have what he deems a culture of patient safety throughout the organization. “This is a vague term but people identify with it,” he said. “In everything we do here, patient safety is top of mind. Given the fact that we do lots of complex things, which is the nature of the practice of medicine and the complexity of the environment in which we provide care, there is always an increased need for us to look to improve.”
With reimbursement changes looming overhead, Roberts says finding the right balance can be difficult. “Tougher to show a return on investment for safer higher quality care as it is the event you prevented from happening that you cannot count. You can only look at the cost of the ones that do happen,” he said. “A good high quality safety program costs money in terms of training, but it is the right thing to do because it is about one person taking care of another.”
One major part of the quality improvement program, in which Roberts has been a driving force, has been the aggregation of data from within the hospital and its analysis. “We developed a whole system of how we look at our own data,” said Roberts. “Then we have used that data to recognize opportunities to improve and design processes to make those improvements.”
Process programs and protocols have been developed and implemented that are having a positive impact on patients. For heart attack patients, as well as stroke patients who come into the emergency room, protocols have been developed that have received national attention for their effect on decreasing the mortality rates of these patients. The hospital has also received recognition for a program developed that improved the care of total hip and knee replacement patients. And across all areas, hospital acquired infection rates have decreased.
Continuous improvement means there are always new things to work on. “We are using data to design a system of care that reduces medical errors that will have an IT component,” said Roberts. “We are very interested in integration of care transitions for patients from our facilities back to their primary care physicians. Poly pharmacy is an area we are investigating. Recent data indicates that patients can be on 12-15 medications when they leave a hospital so we think there are ways we can help a patient manage complex medicine regimes. We also are trying to get a better understanding and handle on social determinants of health for patients such as smoking, literacy, access to care, insurance and support systems as well as what percentage of the population are affected by those.”
Roberts feels very blessed both in his professional and personal life. Many of his peers, colleagues and former residents he counts as friends. He has been married for 44 years to Nancy, whom he calls a phenomenal lady and great partner. Their two sons and their families live in Jackson. At the end of the day, Roberts says he just tries to stay focused on making a difference in the world in some small way.
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