We Will Break the Record!

This coming Saturday, Sept. 24, we will have our 16th annual Legacy Chase steeplechase event at Shawan Downs in Hunt Valley.  This year’s event will again benefit GBMC’s oncology support services at the Sandra and Malcolm Berman Cancer Institute.

Legacy Chase has become a signature event for GBMC HealthCare combining the excitement of steeplechasing with a celebration of our patients and the services we provide to the community. There’s more to the event than great horse racing and there is something for everyone.  Past events have attracted more than 7,000 equestrian fans, friends, and families from across the region who’ve enjoyed the rail-side tailgating, live music, great food, and family-friendly activities. Many of the crowd-pleasing traditions continue this year—such as the kids’ Stick Pony Race, — and we have added some exciting new components to help make the event another memorable success.

This year we will celebrate our commitment to fight all cancers with an attempt to break the Guinness World Record for the longest cancer awareness ribbon—right in the infield of Shawan Downs.  Stretching a mile and a half long, the lavender ribbon is a symbol of GBMC’s commitment to continually reduce the scourge of cancer.  I’m really excited about this and I am sure with everyone’s support we are going to make it happen!

GBMC HealthCare has worked to perfect cancer care over the last 51 years.  The only comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer in the Baltimore region, GBMC has invested in talent and technology to provide the best for oncology patients. Whether they are in need of outpatient, inpatient, home care, hospice or survivorship services, the more than 2,000 people with newly diagnosed cancer that GBMC diagnoses and treats annually receive the best care possible. 

I want to thank all those who’ve donated time or treasure and to the GBMC Philanthropy and Marketing Departments who’ve worked so hard in putting together the event and for taking a run at the record!

So, make this year’s event a family affair and come and enjoy a day in the country.  I hope to see you there!

Working Very Hard to Get Ready for October 1

We are less than THREE weeks from our Epic go-live date of October 1. Last weekend, I was really impressed to see so many of my GBMC colleagues working in our command center in the North Pavilion and also at our Owings Mills site to enter appointments from both the hospital and our physician practices into Epic. Our team worked very hard on the schedule and registration conversion from Meditech and eCW. They posted 6,881 original Meditech Appointments into Epic and an estimated 21,052 appointments from eCW. The team also completed an estimated 10,000 total registrations! Gilchrist Hospice began manually converting the records of approximately 750 patients yesterday.

These phenomenal efforts are only the most recent example of the many hours of hard work that literally thousands of our people have done to move us to one patient, one record.  It clearly has not always been easy and we are not yet done, but, I am humbled by the efforts of our family. They have collectively worked through many barriers and completed countless hours of training to get us to this point. The transition will be hard, but once the hospital, our hospice, and all of our employed and GBHA affiliated physicians and other providers are using this system, it will be easier for us to move towards our vision faster. Please let me thank all of our physicians, both employed by GBMC and in private practice, all of our nurses, all of our nurse practitioners and physician assistants, all of our other clinicians, patient access representatives, billing personnel and every GBMC family member who has helped build the system, test it and get us to this point of readiness. I know how hard you have all worked and I am very grateful for all of your efforts. I am also grateful for the hard work and expertise of our colleagues from Epic. Thank you all!

Healthcare Environmental Services Week
This week is Healthcare Environmental Services (EVS) & Housekeeping Week (Sept. 11—17) and I am proud to acknowledge the dedication and professionalism of our EVS staff as we celebrate them.

Cleanliness is everyone’s job at GBMC, but, our EVS staff are the experts in cleaning who work tirelessly to get the job done. They spend countless hours in their vital role in preventing infections, patient safety, and patient satisfaction, maintaining sustainable buildings, lending a helping hand and working to ensure that our healthcare facilities are always presentable and ready for business.

There are over 100 EVS associates working “around the clock” at GBMC in a variety of roles servicing over 1.2 million square feet of facility. Their work is vitally important to the health and safety of our patients, so, please join me in honoring all the men and women of EVS.

A Collaborative Effort for Better Care

GBMC is a fabulous place to have a baby and everyone knows it. Our clinical outcomes for mothers and newborns are excellent!  While our patient satisfaction scores for maternal and newborn are always among the best in inpatient units in Maryland, there is always room for improvement especially if we compare ourselves to hospitals in the Midwest and West. In these comparisons, we are still very good as we find ourselves in the top 25 percent.

Recently, Jodie Bell, RNC, BSN, IBCLC, Clinical Director, Postpartum and Newborn Nursery, got together with leaders from food and environmental services, Kelly Bechtel, General Manager of Food & Nutrition Services and David Fatokun, Quality Assurance Manager with Sodexo, and through Lean Daily Management started studying the mothers’ beliefs about their care, how their room was being maintained and their thoughts about the food.  As a team, they have been working on courtesy and friendliness and auditing their performance. They have begun to study things like how a food tray does not always have what the patient ordered or why the food that is supposed to be hot is not always hot when it is delivered.

This new higher level of collaboration and inquiry has already begun to yield results! 

In August, patient surveys scored the courtesy of the person serving their food at 92.9 (99th percentile in MD and the 80th percentile nationally) and their room cleanliness score at 90 (97th percentile in MD and the 70th percentile nationally). On the so-called “overall” HCAHPS score, where patients are asked to rate their hospital stay on a scale from 0-10, where 0 is the worst hospital ever and 10 is the best, the Maternal and Newborn Health team, so far, are now scoring 86.7 (99th percentile in MD and 94th percentile nationally)! 

I am so grateful for all of their hard work and their learning and tests of change. When you see Jodie, Kelly, David or anyone on their team please congratulate them.

Designing Patient Flow

Patient flow in healthcare continues to be a daunting challenge. It is not the same as building a car. All patients are different and their clinical needs and rate of improvement vary. The hospital doesn’t get to choose how many patients it will serve in a day. It serves all who need care. Because of the variability in these inputs, it is very important that we approach patient flow the way an engineer would. We study the patient demand and try to have just the right number of clinicians and support staff to serve them. And we design the system of patient movement to minimize the waste of time and energy.

Previously in the blog, I have discussed the concept of synchronization.  It’s a change concept that brings the players or processes in a design into “harmony.”  When we synchronize processes in patient flow, we allow the operators to organize their work so they can be ready to act at a specified time. In order for success, all parties involved must align their work to be ready for the chosen time.

People do not like to feel overwhelmed in their job. When we don’t synchronize, we run the risk that the “downstream” function isn’t ready to accept the patient when we want to move them. An example of this is the emergency department calling an inpatient unit to move a patient to them but there is no nurse ready to accept the patient. The emergency department gets upset because they want to get the patient out so that they can see the next patient. The inpatient unit gets upset because they feel they are being ‘jammed’. Both groups feel that the other doesn’t respect them.

Synchronizing flow from one unit to the next begins with a conversation before the patient moves. Information is shared about the patient and a time is chosen with the input of the sender and the receiver with enough advance notice for both to be ready.

Monica Goetz, our clinical nurse manager for the Medical Intensive Care Unit (MICU -- Unit 57) and her team felt that the previous process for moving patients out of the MICU was leading to many challenges as well as dissatisfied and frustrated staff on both ends of the transfer.  This is why they redesigned the process and are now studying it during LDM rounds, helping them to focus on how best to complete the transfer they redesigned the process.

The MICU team redefined the term “ready to move” as when both the sending and receiving nurse could safely perform a patient inclusive bedside handoff. Now, when the patient’s room is ready, the ICU nurse calls the new unit to identify a time, within the hour, that they both will be prepared to meet.  This allows both nurses to plan their work to be ready. At the agreed upon time, they meet in the new room, perform bedside handoff, review the patient’s belongings & share the “getting to know you” form. The “getting to know you” form is a tool used by the MICU team to learn about who a patient is as a person; their hobbies, things they enjoy when they are not in the hospital, fun facts, and things they want us to know about them.  

Monica shared a recent story to illustrate how the new design is working;
We had a patient (87-year-old male), with many co-morbidities and more hospitalizations than he could count.  He has always hated hospitals, the feel of being in them, and how he is treated…until this hospitalization.  He went on to describe that the care he received was like a well-orchestrated symphony.  Everyone in tune and working in harmony.  From the conductor (manager) to the lead violinist (the charge nurse) ...all setting up to tune for the concert (the shift).  Everyone worked together to make the beautiful music that we call patient care.  

This story is a good example of the work that the MICU is doing with patient transfers…. moving our patients in “synchrony”.  Working together to find a time that is agreed upon (within the hour) and then performing the handoff at the bedside – making the transition not only safer but patient inclusive.  This design demonstrates improvement from the back and forth phone tag, impersonal phone report and leaving a patient in a room alone until someone on the new unit is able to greet them.   I am very proud of Monica and her team and all of the nurses and others who have designed this new system. Let’s hear it for synchrony!

A Story That Illustrates How GBMC is different

We have been building our system of care to drive towards our vision for six years now. In 2010, we put a stake in the ground that we would become the health care system where everyone, every time, got the care we would want for our own loved ones. Our vision statement talks about physicians leading teams to deliver this. We have had a dialogue among us in the GBMC family, that we want the best health outcome and the best care experience with the least waste of time and money with the most joy for those providing the care. We chose the patient centered medical home as a design to deliver this. We already had a great hospital with excellent physicians and nurses and a great hospice, but, the medical homes were required if we were truly going to maximize people’s health and not just wait until they got really sick and needed to be admitted. Our patient-centered-medical homes are different from typical primary care because they are no longer dependent on a visit to the doctor. This model is about a relationship between a physician, her team and a patient. It is about a promise to that patient to work with him or her to maximize his or her health. It is about having the time to reflect on a patient’s health between visits, to make sure that they are getting what the evidence says will keep them well.

On a bad day, I am concerned that many people in our community don’t know how we are different or don’t believe that we are different. So let me tell you a recent story in the words of Dr. Sarah Whiteford, of Family Care Associates:

“I wanted to share this wonderful letter from a very appreciative patient whose life was quite possibly saved by the efforts of PCMH and our population health outreach.  In brief, this lovely patient of mine received a call from our care coordinator, Shelly Deckelman (go Shelly!), who was going through the list of patients aged 50 and older in our practice who had not yet had a colonoscopy.   This day of Shelly’s call happened to be her 50th birthday and her name clearly “fell onto the list.”   She was quite surprised to receive the call but it prompted her to immediately schedule her colonoscopy (which she admitted would have likely been many months later if left to her own devices).  Much to everyone’s surprise, her colonoscopy revealed a large, ominous rectal mass.  She had no symptoms at all. Despite a negative initial pathology, she was sent for urgent surgery for removal of this mass as its malignant potential was quite high.  Fortunately, her surgery was successful and the mass was ultimately a very high grade polyp which most certainly would have become malignant if not removed in a timely manner.” 

Dr. Whiteford thanked all of her team and congratulated them for making the medical home concept a reality.

Physicians and other clinicians practicing in regular primary care are smart and care about their patients just like Dr. Whiteford and her teammates. It’s just that in regular primary care after the visit, it’s on the patient. If the patient never comes in for a visit, and they don’t know the evidence about care that can save a life, they are not likely to get that care unless someone is looking out for them. This story is one of many that shows how we are different. Without the patient centered medical home, this patient may not have had her mass found until it was too late!  Let me add my thanks to all of my GBMC colleagues who are moving us closer every day to our vision.

Taking it to the street…

In the last blog post, I spoke of the great work of our patient-centered medical homes and how we have truly transformed care to become more patient-centered. It has been very difficult for us to get the word out about this transformation. I believe that the average member of our community does not know how we are innovating and what it means for individual patients, families, and the local economy. We’ve made progress, but, we still have a lot of work to do to “get the word out” to the community.

So, last week, I was the featured speaker at a “house party” with the folks at Quarry Lake Condo Association. The purpose of the meeting was to share GBMC’s vision and our quadruple aim—better health and better care with the least waste and the most joy for those providing the care. I was truly excited at this opportunity to speak directly to patients and prospective patients.

At the event, I had the pleasure of meeting the host, Mrs. Rozzie Brilliant, who received oncology support care at GBMC and whose own daughter also received life-saving testing and care at GBMC. During her presentation, Rozzie, a four-year survivor of ovarian cancer, explained her personal story and connection to GBMC and her oncologist, Madhu Chaudhry, M.D. Rozzie hosted the event out of her desire to give back to GBMC and to assure that all of her friends knew of our work.

I spent a few minutes speaking of our vision and our vision phrase: To every patient, every time, we will provide the care that we would want for our own loved ones. I told those in attendance that in America, it was clear that we have the best doctors, nurses and other clinicians in the world, who are working very hard, but, that the system they work in needs to be redesigned to help them get the job done. I told them that the biggest challenge was how to coordinate care for those with chronic disease and how we were redesigning just about everything at GBMC to become more patient-centered and to meet this challenge. They listened attentively as we discussed advanced primary care and our hours of operation. They were intrigued by our disease state registries and how we were working to assure that everyone had evidence based colon cancer screening among other things. I reminded them how good our specialists are, how we have outstanding surgeons and that surgery at GBMC costs much less than surgery at most other local hospitals and with outcomes that are at least as good if not better. The participants had many questions and we had a great dialogue. Greg Shaffer, Director of Marketing, and his team were there to help me answer questions and to provide more information about how to access our care.

I felt very good about this session where I was speaking directly to those who benefit the most from our redesign work…members of the community. We will do many more of these sessions. Do you have a group that you would like us to address?

It Is Not What You Say, It Is What You Do

Marketing tag lines are pervasive in our society. If a concept is “in vogue,” organizations want you to believe “oh yes, we do that, too.” A good example of this in healthcare at the present is the term “patient-centered.”  The consumer should be wary of healthcare organizations who are using this term and they should check to see if the organization is really putting them in the center of what they do or are they just saying it.

To become patient-centered, you have to start by listening to what it is that the patient wants. Most patients want the care to be accessible when they need it. This is the reason that urgent care centers have sprung up.  Primary care offices were not open or did not have appointments when the patient had a need. Most patients, especially those with chronic disease, also want care from clinicians who they know and respect. They don’t want to have to keep introducing their problems to new people who will have a different treatment plan. Patients don’t want their time wasted. They want fast, but, first and foremost, they want the correct evidence-based care because they want to get well. Most patients would agree that getting an antibiotic that they really shouldn’t take just so the provider can get them out of the office faster is not an example of being patient-centered.

So what has GBMC been doing to be patient-centered?

A good example of true patient-centeredness is in our advanced primary care practices, our Patient-Centered Medical Homes. For these practices, it is no longer about the visit. It is about a relationship between a physician or advanced practitioner and a patient and a promise to that patient to help him or her stay well or get well when they are sick. The team is available when the patient has an acute need, but, moreover, the team studies the patient’s health and preventive care needs at regular intervals and works with the patient to assure that they get what they need. A good example of this is our work to assure that everyone who should have colorectal cancer screening gets it. We don’t wait for the patient to make an appointment. If we see that the patient is due for a colonoscopy, we contact the patient to help get it done.

The Medical Homes have significantly improved their availability. They are open Monday through Friday 7AM to 7PM and have Saturday and Sunday hours. As a group, they have provided office hours on major holidays as well. It is much easier to close at 5PM and not be open on weekends and holidays….but that isn’t patient-centered nor is it patient-centered to send patients to emergency departments for non-emergencies or to urgent care centers for acute care because it isn’t convenient for the primary care offices to be open.

The Medical Home is a model that emphasizes care and communication and transforms primary care into ‘what patients want it to be’ – a partnership between patients and their doctors to improve health, to improve the patient’s satisfaction with the way the care is delivered and to reduce cost. So, at GBMC we are well on our way towards our vision and we are not just talking patient-centeredness…we are doing it!