Friday, December 8, 2017

“Brand” vs. “Evidence”

Recently, I’ve been thinking a lot about a big dilemma in the U.S. healthcare system. Patients are generally unaware of facts and rely instead on reputation when they choose a hospital or healthcare provider. They often don’t know if they’ve chosen a hospital of lesser value because they’ve assumed quality based on common wisdom or “brand.” Unfortunately, this can lead to patients receiving subpar treatment because they were unaware of facts when they were choosing their provider.

At their meeting this week, The GBMC HealthCare Board Quality Committee was reviewing the phenomenal performance of our orthopedics and spine surgical teams. Under the leadership of Joy Reynolds, RN, the Unit 58 nurse manager, Lee Schmidt, MD, the chief of orthopedics, and Bimal Rami, MD, the chief of neurosurgery, they’ve improved everything from evidence-based pre-op care in the physician offices, to outstanding performances in the operating rooms and phenomenal immediate post-op rehabilitation with GBMC’s sensational physical therapists. 

This improvement work has led to outstanding outcomes as evidenced by near-zero wound infection and readmission rates and the patient engagement scores for Unit 58 (where patients go from the operating room). These are among the highest in Maryland (with the best care experience). GBMC’s prices for the procedures are significantly lower than many, if not most, other hospitals in our region (with the least waste).



Our teams serve many patients but we would like to grow our programs. I would love to hear your ideas about how to get consumers to choose value over a brand.

In The Spirit of the Holidays, Please Donate ...
This year, we are a proud sponsor of the Fill the House for House of Ruth initiative to collect everyday necessities for this partner in care. This is the first year of the campaign and the items collected will help thousands of women and children to recover from abuse and to rebuild their lives. The work that the House of Ruth performs is closely aligned with our SAFE program.

Please don’t forget to donate items at various drop-off locations on the GBMC campus, including Family Care Associates and at each of our 10 off-site primary care locations. Some of the House of Ruth's greatest needs include diapers, women's and children's undergarments, pillows, twin-sized sheets, comforters, and blankets. The drive will run through Friday, December 15. All items must be new and unopened. An additional way to donate is through our Amazon Wishlist. All items purchased through this link will be shipped directly to GBMC Marketing so you don’t have to worry about dropping anything off.

Thursday, November 30, 2017

Waste

When experts talk about our country’s health care delivery system they usually begin by stating that the U.S. spends 40 percent more on health care per capita than any other country in the world. This is usually followed by the claim that a large amount of this spend is wasted on things that don’t actually benefit patients’ health.

This is a big statement, so let’s try to bring it down to the level of someone actually working in health care. What does waste look like to them? This morning I learned of a situation in our medical center. One of our employees collected information about a patient, loaded it into the electronic health record, and then printed out some of the information. This paper later reached a co-worker who scanned the information back into the very electronic system that it was originally printed from! (I suspect that this occurred because no one redesigned the work during the Epic implementation and it used to be going from one computer system to another). In the language of Lean production, this is called overprocessing and is one of the seven key wastes. The others are:
  • Overproduction (making more of something than necessary or before it is needed)
  • Production defects 
  • Movement or transportation (taking a material farther away from the process and requiring it to be moved back)
  • Inventory (the storage of overproduction)
  • Waiting
  • Unnecessary motion
The efforts of our colleagues who printed from a computer and then scanned the same information back into the computer were wasted. It added no value to the patient or to GBMC. I am sure that these colleagues were well-intentioned, but it raises the question of how many other tasks are being done that do not add value to the patient. Our people have so much to do that actually does add to the patient, but how much of their energy is spent on wasteful steps?

Our leadership system requires that our managers teach their employees about these wastes and empower them to test changes to our processes to get rid of waste. Lean Daily Management is just one tool to help eliminate waste. Value stream mapping and kaizen events are other tools that can be used. In the example of scanning information into the computer when the information is already there, we should just stop doing it!

I have a challenge for everyone in the GBMC HealthCare System. There are things that are scanned that do add value in healthcare, like outside medical information brought to us on paper or insurance cards, but are there things that we are scanning that don’t actually add value? Are we overprocessing this information? Please study all scanning and let me know what you find by commenting on this blog. Thanks! 

Holiday Decorations
Don’t the holiday decorations on our campus look beautiful?  I wanted to say thank you to Stacey McGreevy and her team for transforming our hospital into an eye-catching winter wonderland.

Let’s Fill Up The House!
This year, we are teaming up with WMAR-TV (ABC 2 – Baltimore) as a proud sponsor of the Fill the House for House of Ruth initiative to collect everyday necessities for this important non-profit organization. I am hoping that I can count on your help!

The House of Ruth provides services to nearly 9,000 women annually who are victims of intimate partner violence. Donations are needed to help women and children recover and rebuild their lives. The work that House of Ruth performs is aligned with our SAFE program. 

Earlier this week, various drop-off boxes (see picture) were set up throughout the GBMC campus including the GBMC Pediatric Group, Human Resources, Oncology Support, Spiritual Support, Volunteer Services, Family Care Associates and at each of our 10 off-site primary care locations.

All items donated must be new and unopened. The items of greatest need are:
--Diapers (all sizes) – House of Ruth uses 1,000 diapers each month
--Women’s and children’s undergarments – Underwear, bras, and undershirts (all sizes)
--Pillows, twin-sized sheets, comforters, and blankets

Other needed items include:

--Air mattresses
--Washcloths
--Gender neutral infant clothing
--Socks (all sizes)
--Children's coats
--Children's shoes

Another way to donate is through our Amazon Wishlist, where the most-needed items can be purchased straight from your computer. All items purchased through this Amazon link will be shipped directly to GBMC and then will be delivered with all the other items to ABC2 for distribution. 

Please don’t forget to donate at any GBMC drop-off location.You have until Friday, Dec. 15th! Thank you in advance for your generosity and Happy Holidays!

Wednesday, November 22, 2017

Gratitude for Everyone in the GBMC Family!

I would like to wish a happy Thanksgiving to all of my GBMC colleagues. I want to thank you all for your expertise, hard work, and compassion that helps us move closer to our vision of being a community-based health system where every patient, every time is treated the way we would treat our own loved ones.  

This morning at the meeting of our Department Chairs, we were discussing the future of our HealthCare System. I was reminded of how wonderful our people are and how committed they are to serving others. I also reflected on how good we have become at change. I am so grateful for everyone’s commitment to studying our systems and learning from them so that we can deliver on our four aims. We are not perfect, but GBMC has really become a model for delivering patient-centered care. 

I also want to extend a special “Thank You” to all who will work on Thanksgiving, or who are working during the extended holiday weekend, caring for our patients and helping support their loved ones and visitors. 

What are you thankful for during this time? Please share your thoughts.

Congratulations!!!
Please join me in congratulating Monica Goetz, RN, our clinical nurse manager for the Medical Intensive Care Unit (MICU — Unit 57), who was recently honored with the “Advocacy and Service Award“ by the Living Life Legacy Foundation, the non-profit organ procurement organization for the state of Maryland.  Monica was nominated for her initiative in creating awareness for organ, eye & tissue donation.

Organ donation saves countless lives and improves many others, and these gifts were celebrated at the GBMC HealthCare system earlier this year. Monica was instrumental in the creation of the ‘Tree of Life.’ This is a permanent art installation close to the Emergency Department Concourse, that memorializes the selfless act of organ and tissue donation and represents the legacy created by those who give the gift of organs, and tissues at GBMC.  

Congratulations Monica!!!

Joint Commission Survey
Thanks to all who helped us learn from our Joint Commission unannounced survey last month and worked hard over the past 30 days to make our systems even more reliable. Yesterday’s follow-up survey validated the strength of our processes. 

Friday, November 17, 2017

Welcome to the New Members of Our Senior Leadership Team

I’d like to extend a warm welcome to our new Executive Vice President and Chief Financial Officer, Laurie R. Beyer, BS, MBA, CPA, who recently joined us. Laurie is an accomplished, results-oriented executive with more than 25 years of experience. She came to our HealthCare System from Union Hospital of Cecil County, where she served as Senior Vice President and Chief Financial Officer for 11 years. During that time, she developed high-performing finance and revenue cycle teams, facilitated the conversion to the HSCRC’s Total Patient Revenue System, and led the successful implementation of the hospital’s electronic medical record.

Please join me in extending a warm welcome to Laurie!


Congratulations to Stacey McGreevy 
Stacey McGreevy, CPA, was recently named Vice President of Support Services at GBMC HealthCare. During her more than 20-year tenure at GBMC, Stacey has held a number of important roles including Manager of Finance and Regulatory Compliance, Director of Internal Audit and Compliance, and Chief Audit, Compliance and Privacy Officer. She developed GBMC’s first Internal Audit Department and Compliance Program and facilitated the establishment of an independent Audit and Compliance Committee of the Board of Directors. Most recently, she served as GBMC’s Administrator for Ancillary and Support Services, a position that oversees a $50 million annual budget and is responsible for oversight of construction management. Her leadership in GBMC’s strategic deployment process resulted in over $2 million in savings in purchased services and pharmaceutical expenses over the past year and she has been instrumental in overseeing a vast array of major construction projects. In her new role as Vice President, she will lead the design of a new supply chain system and facilitate the updating of GBMC’s Master Facility Plan. 


Celebrating Nurse Practitioner Week

Nurse practitioners (NPs) offer vital and reliable care and from November 12-18th,  which marks National Nurse Practitioner Week, we are given the opportunity to reflect on the roles of nurse practitioners whose tireless efforts often go unrecognized.

Please join me in celebrating GBMC’s outstanding Nurse Practitioners this week. Across our nation, there are more than 200,000 NPs who provide care to millions of Americans. We have excellent Nurse Practitioners working in our hospital, in our physician practices, and at Gilchrist. They help us move closer to our vision of a patient-centered system of care every day. 

Another Successful Nearly New Sale
I’d also like to take a moment to recognize all of those involved in making the Fall 2017 Nearly New Sale an outstanding success.

For those of you that don’t know, there is much that has to happen to make this event a success. Twice each year, GBMC employees, volunteers, and the general public get an opportunity to buy everything from furniture, clothing, and jewelry to appliances, sporting goods, toys, and much more — all at nominal prices. Under the leadership of our Director of Volunteer Services, Carmen Baeza, the team collects donations, sorts and prices them, and stocks them on the shelves. As soon as the fall sale ends, volunteers begin preparing for our next sale in the spring. GBMC volunteers devote hundreds of hours to these events that benefit the programs in our HealthCare System.

I am proud to say that the fall sale raised approximately $144,000 in proceeds! I want to extend a heartfelt thank you to the co-chairs for Nearly New, Joanne Lynch and Dirck Ten Broeck, as well as Sarellen Levine, the Nearly New representative on the Auxiliary Board, and all of the volunteers at Nearly New who work so hard to prepare for each sale!

Turkey Distribution...
Thanksgiving spirit was in full swing during GBMC’s annual employee turkey distribution on November 9 and 10. About 3,500 turkeys were given out to staff as tokens of appreciation for the hard work you do daily to ensure that ”to every patient, every time we provide the care that we would want for our own loved ones.” Thank you!

Monday, November 13, 2017

Named Top Performer...

Congratulations Gilchrist!
Last week, it was brought to my attention that the Gilchrist Sub Acute Unit (SAU) was recently named a “Best Nursing Home” by U.S. News & World Report 2017-18. According to U.S. News & World Report, only 15% of nursing homes in the United States achieve the “Top Performing” status of 4.5 or higher. Gilchrist achieved a perfect 5.0 rating and we are truly honored that they were chosen and that they achieved the highest score possible.

U.S. News uses existing federal nursing home rating information and federally reported healthcare data to determine their rankings. Criteria such as annual state survey results, medical quality measures, staffing levels and rehabilitation outcomes are all considered in the scoring process.

We are truly honored to be in the top tier of providers in both the state and the nation.  Congratulations to Leana Hoover and our Gilchrist SAU staff!

Respect
During the past few weeks, the news has been filled with allegations of inappropriate workplace behavior at other organizations. While this news is disheartening, it serves as a call to remind us of our GBMC value of Respect. It is important that we continue to work together to foster a safe work environment and to comply with our Harassment and Discrimination Policy. This Policy can be found on the InfoWeb. Please contact our Human Resources department should you have any questions or concerns. I am grateful for the respectful behavior, teamwork, and camaraderie that I witness every day in the GBMC HealthCare System.

Recognizing Colleagues: Radiologic Technology Week & Forensic Nurses Week
Last week was both “Radiologic Technology Week” and “Forensic Nurses Week” and I would like to thank all of our registered technologists (RTs) and our forensic nurses for their very important roles in providing care and serving our patients.

RTs perform diagnostic imaging examinations and administer radiation therapy treatments. They are educated in: anatomy, patient positioning, examination techniques, equipment protocols, radiation safety, radiation protection and basic patient care. They are the teammates of our radiologists and radiation oncologists.

Forensic nurses are specially trained and certified examiners who care for adolescent and adult victims (ages 13 and older) of sexual assault. They complete a full assessment of the patient, obtain potential forensic evidence and provide antibiotic therapy, emergency contraception and resources for crisis counseling and support services.

Please join me in thanking Phil Komenda, our Director of Imaging and Cardiac Services, and Laura Clary, RN, FNE-A/P, SANE-A, CPEN, our Clinical Program Manager for the SAFE Program, and their teams for all their hard work and for their important roles in caring for our patients.

National Medical Staff Services Professionals Awareness Week
“National Medical Staff Services Awareness Week,” just concluded and I would like to acknowledge and thank all of our medical staff services professionals (MSPs) for playing a critical role in our healthcare system. MSPs credential and monitor ongoing competence of physicians and other practitioners who provide patient care services in hospitals managed care organizations, and other healthcare settings.

MSPs are dedicated to making certain that all patients receive care from practitioners who are properly educated, licensed, and trained in their specialty. They are experts in provider credentialing and privileging medical staff organization, accreditation and regulatory compliance, and provider relations.

Please join me in thanking our MSPs for their hard work and for their important role in helping us achieve our vision.

Thanking Our Veterans on Veterans Day and Every Day
On Saturday, we commemorated Veterans Day and took the time to remember and pay tribute to the brave men and women, of the U.S. armed forces, who have served in the past and those who are serving today. My sincere gratitude to all members of the U.S. armed forces and their families who have served and made the tremendous sacrifices to preserve our freedom.

Thursday, November 2, 2017

Recognizing Three New Physician Titans of Care

It was with great honor and gratitude that GBMC HealthCare announced the selection of three new Physician Titans of Care during Monday evening’s recognition dinner. Melissa Sparrow, MD, GBMC Chief of the Medical Staff, presided over the event and presented the awards.

GBMC physicians provide a great service to the community every day as we move closer to our vision. The new titans are just three phenomenal examples of giving through their expertise and hard work. The new Physician Titans of Care are:

-John Boscia, MD
-Karl Diehn, MD
-Alan Tapper, MD

Let me just tell you a little bit about each new Titan.

John Boscia, MD
He was the first physician to open a pediatric practice at GBMC, and served the community’s children for more than 20 years: treating extended families, children of parents he had also treated in their youth, and some folks well into their 20s, because they didn’t want to go anywhere else. Dr. Boscia dedicated his career to caring and advocating for some of the most medically-challenged patients and he did it because of his sense of justice. He also experienced some physical challenges of his own and had a special place in his heart for these patients. He was a deeply compassionate pediatrician with outstanding clinical skills and impeccable character. He was loved by his patients and deeply respected by his peers. He was known as a “true pillar in the department of pediatrics” and “a fountain of knowledge when it came to pediatric medicine.” A kind, compassionate and generous pediatrician, Dr. Boscia was respected throughout the hospital for his ability to work with other departments in a positive and collaborative manner. He was chosen as a titan for being the embodiment of GBMC’s vision of treating every patient, every time, as you would your own, loved one; and for being the kind of physician every parent wishes for their child. GBMC suffered a great loss earlier this year with his passing but the legacy of his work is still felt in our hospital to this day.

Karl Diehn, MD
Dr. Diehn has been a cornerstone of GBMC’S Otolaryngology Department for more than 30 years. Upon graduating from the University of Maryland Medical School in 1975, and finishing his residency at Johns Hopkins Hospital, Dr. Diehn became one of the earliest members of Ear, Nose & Throat Associates, and helped to forge the practice’s reputation as the preeminent provider of pediatric otolaryngology care. During his tenure at GBMC, he also served on the GBMC medical board and the GBMC HealthCare board of directors. He is admired for his consistent availability, his accountability, and his kindness. His skill, thoughtfulness and calm demeanor have inspired physicians, students, patients and families throughout his professional career. He was also known for making many personal sacrifices and spending many long hours at work over the years. Despite Dr. Diehn’s complete dedication to his professional life, his children always saw him as “the best dad” and when speaking to Dr. Diehn’s myriad of patients, one often hears, “he took care of my kids too,” and “he’s such a wonderful doctor.” Really it seems that almost anyone you ask in the community knows of Dr. Diehn, a quiet and humble hero, and now a GBMC Titan.

Allan Tapper, MD
Dr. Alan Tapper is known to be a physician of remarkable vision and foresight. In the 1970s, he sensed the changing demands of obstetrics in the region and began advocating for family-centered obstetrical care long before that approach was acceptable or popular. In 1978, against very strong objections, Dr. Tapper established the first birthing room at GBMC. Dr. Tapper was also well known for consistently promoting progressive changes that improved patient care and was part of a team that elevated GBMC’s position as the preeminent institution for women’s healthcare. He has loved the profession and thought of his patients as people first, patients second. From simply asking questions to get to know them better, to attending funerals for patients and their families, he invested in their lives. He is known by the community to be a brilliant, gregarious, extremely funny, and profoundly dedicated individual and Dr. Tapper’s work ethic, and focus on patient and family-centered care was a clear representation of GBMC’s vision long before it was established. His unique character, affability, trustworthiness, and sense of humor make him one of the outstanding physicians in our community. We are truly lucky to have been the hospital where he chose to dedicate his work.

We salute the exemplary contributions to the growth and success of our organization and to the practice of Medicine of these newly named Titans. We applaud their outstanding skills, service, and commitment, and thank them for their instrumental roles in building GBMC HealthCare’s reputation in our community and beyond!

TOP DOCS 2017!...
We’ve always known that one of GBMC’s incredible strengths is the quality of its medical staff and I’m proud to say that many doctors agree!

Nearly 13,000 physicians in the region “voted” for the physicians, in a variety of specialties, that they would send a member of their own family to if they needed care. The Baltimore Magazine annual “Top Doctors” November issue was recently released and the votes are in. It’s with a great deal of pride that I share with you that 139 GBMC physicians, covering 76 specialties, were recognized as a “Top Doctor.” Several of these medical staff members were recognized in more than one category, and some have been recognized many years in a row!

In addition, the magazine also highlighted our chairman of Radiation Oncology, Robert K. Brookland, MD. He was one of six eminent doctors, from a pool of over 700 physicians in the Baltimore area, selected to be profiled in the current TOP DOCS issue.

Being recognized as a “Top Doctor” is an extraordinary honor, because it is a selection by peers. We are so fortunate to have outstanding surgeons, internists, pediatricians, family physicians, and other wonderful specialists. Congratulations to Dr. Brookland as well as all others who were named 2017 Top Docs.

To view a listing of our “Top Doctors” and to learn more about who they are, please visit GBMC's Top Doctors 2017 webpage.

Sunday, October 29, 2017

Why Can’t Electronic Medical Records Communicate Easily with One Another?

Recently, the GBMC Chesapeake Regional Information Sharing for our Patients (CRISP) governance team got together. This meeting provides us with an opportunity to meet with our CRISP colleagues to improve our use of the network, to connect with other providers of care, such as private practicing physicians, hospitals and nursing homes that don’t use Epic so that we can better serve our patients and reduce the time spent searching for information, which frustrates clinicians.  We have also made so much progress in the use of the network. An example is that every morning our patient-centered medical homes get a report from CRISP on each of our patients who were seen in any Maryland hospital in the preceding 24 hours. This allows our care managers to check-in with them and make sure they have what they need.

But during the meeting, I became frustrated on more than one occasion because of the incredible complexity of getting one company’s record to “talk” with another company's record. The medial record companies keep their source code secret to maintain the value of their investments and this is understandable, but the net effect is that even in the 21st century it’s really hard to have all of one patient’s record available for clinicians who need the information. We are dealing with a real “Tower of Babel” where no two vendors' records talk easily with one another. In addition, the U.S. has not created a “unique patient identifier” (such as a social security number) to make sure that we are truly connecting records of the same person.

I am concerned that the citizens of the U.S. have no idea that this is happening. If they did, I believe that they would advocate for better planning and some stronger rules about cooperation around the goal of better information sharing. Market forces are not working and our country’s doctors and nurses and their patients are paying a very high price in safety and efficiency while billions of dollars are being spent to work through the confusion to try to make these records talk to one another.

Yes, we do have one patient, one record for patients served by our hospital, our employed physicians and Gilchrist and to the extent that the records are coming from the same EMR (Epic at other hospitals) we are okay, but when they are not, it’s a mess.  The American people need to think about this, decide what they want and make their opinion known to those in power.

We must all be united around the quadruple aim: The best health outcomes with the best care experience, with the least waste and the most joy for those providing the care. None of these four aims are truly possible without the efficient movement of information to those with a legitimate need to know.

Thank You!
Mother Nature was cooperative for the recent Baltimore Running Festival. Thousands of people participated in this year’s event including approximately 90 runners who joined team #RunGBMC to raise funds in support of the Gilchrist Center Baltimore – Joseph Richey House. The 19-bed inpatient center has been serving patients in Baltimore City for more than 30 years by providing residential, acute and respite care. We’re still counting, but so far we have raised more than $10,000. The money raised by team #RunGBMC will help cover Joseph Richey House’s operating expenses not covered by insurance or patient payments.

I’m very grateful to all of the employees, volunteers, patients and supporters of GBMC Healthcare who helped us raise money and awareness of the outstanding work at Joseph Richey House.  I hope you all had a great time in support of this fabulous part of our system of care.