Friday, December 2, 2016

The Front Office and the Front Line

There is often a huge gap between what the people doing the work of an organization know and what the senior executives know. We implemented Lean Daily Management in part to narrow this gap and I really believe that we have been successful. However, we still have work to do. This morning, I was reminded how hard it is to keep everyone “on the same page.” I was in a clinical area and the team there was very down. They were struggling with new workflows created by our Epic implementation, many “glitches” in the new system, and the inability to fill some positions on their team as the economy heats up. The net effect of this was making it much harder to perform their jobs at the high level to which they had become accustomed to while treating everyone the way that they would want their own loved ones treated.

The team in this clinical area got up the courage to tell me that they thought that no one was really listening to them. They had been reporting the problems, outside of their control, correctly and respectfully, but did not see much improvement and they thought they were getting lip service from people like me.

After the interaction this morning, I began to think of when I first started my career as a pediatrician in a large, complex organization. I remember experiencing the same feeling as my colleagues this morning. But when I was in their position, no senior leaders had ever come to my clinic. It was very easy for me to conjure up the notion of a bunch of executives who really didn’t care and were not looking out for my best interests and the best interests of my colleagues and my patients. At GBMC, we are a lot more “visible” than the executives had been when I was on the front line of care. But this morning I realized that this is not enough. I was truly grateful for how hard they were working and we clearly were in action to fix problems beyond their control but we had to do better.

Identifying the fixes, beginning to implement them and communicating to everyone where we are in the process is… very, very hard in a large complex organization. Some things are easier to fix than others and some take a very long time. I know for a fact that many excellent people were working on the myriad of problems that the clinical team this morning were concerned about…but how could I help the clinical team understand this?

One thing that I have learned the hard way is that it is a fool who believes that complex problems have simple answers. So, the best thing that I can do for my colleagues that are down is to commit to getting the right people in a room, listing the issues, creating reasonable timelines for them to be fixed, making the timelines visible, and holding ourselves accountable to meeting those timelines. I want them to know that we really do care about them and that I know that we must and we will fix these issues.

The Art of Nursing on WMAR-TV
As we bring our formal celebration of the year of nursing at GBMC to a close, I am really looking forward to seeing our nurses spotlighted on television for the great work they do every day.

The community at-large will get a first-hand look at the life of nurses in the GBMC system and understand how exceptional they truly are by watching The Art of Nursing, a 30-minute TV special, on Wednesday, December 7th on ABC 2 Baltimore (WMAR-TV) at 7 PM.  If you want a sneak peek at the special, please watch by clicking here.

I promise you that after watching it you will not want to miss this program!

Congratulations…
Kudos to our very own, Barbara P. Messing, M.A., CCC-SLP, BCS-S, who was one of 19 fellows across the United States recently honored by the American Speech and Hearing Association (ASHA). She received this prestigious recognition for her research, teaching, and clinical service.  Barbara is the Administrative-Clinical Director of the Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery and Johns Hopkins Voice Center at GBMC. She is also recognized as a Clinical Specialist in Head and Neck Rehabilitation and is a Board Certified Specialist in Swallowing and Swallowing Disorders. Her clinical and research interests are in the area of head and neck cancer rehabilitation, dysphagia and voice disorders.  Again, please join me in congratulating Barbara on her recent achievement!

Wednesday, November 23, 2016

So Much to Be Thankful for...Especially Some Unsung Heroes

We all know that Thanksgiving is a day for reflection of all that we have and cherish. I am a very fortunate man and I have so much to be thankful for starting with my loving family. I am so lucky to be the President of GBMC and I am very grateful to have thousands of phenomenal colleagues who give of themselves every day to help others and especially those who work on Thanksgiving and all the other holidays. I am truly blessed.

This year, I have a special group of dedicated people to be thankful for. Let me tell you a story….

I was the Senior Team member on call for the weekend of November 5th and 6th. Being “on” entails coming in for Lean Daily Management Rounds each day and being available to the administrative coordinator if any issue comes up that they cannot handle on their own. The administrative coordinators are a blessing in themselves; they are so good at what they do that we hardly ever get called. So I was surprised when Michelle Patchett, RN, called me on Sunday evening with a problem.

A man had come to the Emergency Department very sick and he needed to be admitted to the Intensive Care Unit. But the man had a “service dog” who I will call “Fluffy”. The man said that he had no friend or family member who could care for Fluffy. The intensive care unit is not a place for animals so our problem was what to do with Fluffy? This was clearly a “special cause” in quality improvement parlance, because most people with a dog will have a friend or neighbor who will be willing to care for their dog for a day or two but this man did not. GBMC did not have a procedure in place for this situation. Michelle called the Baltimore County Animal Control people but they had no answer for us.

I knew of the Maryland Society for the Prevention of Cruelty to Animals (MDSPCA), but I had no idea if they would be able to help. We got in touch with the Board President of the MDSPCA, Elizabeth Drigotas who asked us to call their Director of Community Affairs, Katie Flory. While it was clear that they too did not have a process in place specifically for this issue, Katie did not hesitate to offer her help. She essentially dropped what she was doing (at the dinner table with her family on a Sunday evening) and drove to GBMC and picked up Fluffy. Nichole Miller, the MDSPCA Director of Operations, met Katie and Fluffy at the shelter. The MDSPCA treated Fluffy with tender loving care at their shelter for one night until the patient was released from the ICU. Fluffy was then reunited with him the next day on an inpatient unit. But the work of the MDSPCA did not end there! Katie brought food, bowls, treats, blankets, and toys for Fluffy. For the next 9 days, Katie travelled to GBMC and walked Fluffy in the morning and Nichole came and walked him in the afternoon. They were aided by Amy Gonzalez, a GBMC employee, and an MD SPCA volunteer who walked him on the last couple of days. My wife, Tracey, and my daughter, Caroline, walked Fluffy every evening (They love animals and they really loved Fluffy! I see a dog in our future to go with our cats, Bonnie and Clyde).

So I have so much to be thankful for, but this Thanksgiving I am asking you to join me in thanking some “unsung heroes,” Katie, Nichole, Amy, Tracey, Caroline and all of the Team at the MDSPCA, who truly helped us and Fluffy’s owner and who help thousands of animals and people every year. The mission of the MD SPCA is to improve the lives of pets and people in the community by fostering healthy animal-human relationships.  The Maryland SPCA is a private, non-profit, independent organization which operates primarily in the Greater Baltimore Metropolitan area.

My family will be making a donation to the MDSPCA in honor of Katie, Nichole, and Amy. Please consider making a gift as you are able to this wonderful organization. You can do it at http://www.mdspca.org/give Thank you and Happy Thanksgiving to all!

Thursday, November 17, 2016

Continuing Our Work Towards a Better Healthcare System

The GBMC HealthCare system has been transforming itself for more than 6 years to deliver better health and better care at lower cost with more joy for those providing the care. We have been very successful so far. The health outcomes of our care have improved. Our patient engagement scores are up, especially in our advanced primary care sites. We have reduced the total cost of care for the Medicare beneficiaries served in those sites by more than 7 percent, and our people are delighted to have the support they need to better manage those with chronic disease.

Over the last week, I’ve been asked many times, “What effect will the presidential election have on our work?” Truthfully, I don’t really know. What I do know is that every American wants a healthcare system that is less costly, delivers better health outcomes and is more focused on the patient. Republicans and Democrats realize that we cannot return to a system that only financially rewards the number of services provided without regard to whether or not those services actually helped the patient and were provided in the most efficient manner possible. The move toward value is well under way and payers are not reverting to the old ways that had healthcare costs rising by 7-10 percent annually. Also, Republicans and Democrats know that even though we have made progress, we are still spending 40 percent more per capita on healthcare than any other country in the world and our industries are less competitive because of this.

The Affordable Care Act (ACA, Obamacare), in my opinion, has been very successful. More than 10 million Americans now have health insurance who did not have it before. People who were born with a disease now can buy insurance when they couldn’t before. Children can stay on their parents’ plan until they are 26 years of age. Medicare has seen the lowest annual cost increases in decades, and employers have benefited from lower increases to their plans.

The one area where the Act needs improvement is in controlling premium increases for individuals buying insurance on the exchanges. Before the ACA, people who were already sick (like someone I know who was born with epilepsy) could not get health insurance. Therefore, the price of insurance for individuals was lower than it is now because the insurance companies were only insuring well people. The ACA “mandates” that everyone not covered by their employer, Medicare, the Veterans Affairs or Medicaid buy insurance. You need the healthy people in the plan to spread the cost of the people with a disease over more policies to keep the price low. Well, too many healthy people are not buying the insurance and, therefore, the price has gone up significantly. This is the classic “chicken and egg” situation. People are not buying the insurance because the price is too high, and the price is too high because people are not buying the insurance. Medicare works pretty well for America’s senior citizens because it is paid for by the Medicare tax, and the younger beneficiaries don’t consume much while the older ones do. Medicare doesn’t make the sicker patients pay more. By the way, Medicare only spends about 8 percent on administration, the other 92 percent goes to pay for care. Before the ACA, private insurance companies were spending 70-80 percent on care and the other 20-30 percent was going for administration and profit. The ACA limits the percentage for administration and profit to 18 percent. If the act is repealed, this limit will go away.

Homeowners insurance wouldn’t work if you could wait to buy it until your house caught on fire. The same is true of health insurance. The risk must be spread over the entire population, including the healthy, for it to work. So it’s the “individual mandate” part of the Affordable Care Act that isn’t working well, and everyone agrees on this.

How will the new administration deal with this? No one really knows. But it is clear that we must continue to work to create a better system. We in the GBMC HealthCare system must deliver even better health and even better care at even lower cost by driving out the waste. We must educate citizens on the facts. We must make prices more transparent so it is easier to see one source of the waste in healthcare. We must recommit to working both in our state and with the new federal leaders to deliver better value to the American people.

Celebrating Nurse Practitioner Week
Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NP) this week. Across our nation, there are more than 220,000 NPs who provide care to millions of Americans.

We have excellent Nurse Practitioners working in our hospital, in our physician practices, and in Gilchrist Services. They help us reach our vision of a patient-centered system of care every day. Please join me in thanking them this week!

Friday, November 11, 2016

What a Great Party!

I would like to thank everyone involved in our very successful Art of Nursing celebration last week. The event’s emcee, Ron Shapiro, did a great job overseeing the event that featured presentations by our Board Chair, Bonnie Stein, our Chief Nursing Officer, JoAnn Ioannou, and a panel of physicians, which included Chief of Staff Dr. Melissa Sparrow, Chair of Surgery Dr. Jack Flowers and Chair of Emergency Medicine Dr. Jeff Sternlicht.  Each of them spoke about what nursing had meant to them in their careers. Two of our patients also recognized a nurse who had helped their families cope through the loss of their loved ones. This year’s winners of our nursing awards, Roxann Cavey, BSN, CCRN, RN, Samantha Clayton, MA, Alejandro Maynard, RN, Marcus Nicholson, MSN, MBA, RN, Nicola Wagner, RN, Delores Williams, AA, RN, Linda Young, CNOR, RN were all recognized.

When the formal program was over, Dionne Figgins, accompanied by our own Lisa Griffee, Director of Performance Improvement, Carolyn Keller, Nurse Manger of Unit 36 and Rachel Ridgely, Clinical Unit Coordinator of the MICU, got the place jumping with their rendition of “Stand By You.” This was followed by dancing to the tunes of DJ Mikey V.

It was a great opportunity to thank all of our nurses for all that they do for GBMC and our patients every day and to have some fun!

Recognizing Colleagues: Radiologic Technology Week & Forensic Nurses Week
This week is both “Radiologic Technology Week” and “Forensic Nursing Week” and I would like to thank all of our registered technologists (R.T.s) and our forensic nurses for their important roles in providing care and serving our patients as if they were their loved ones.

R.T.’s perform diagnostic imaging examinations and administer radiation therapy treatments and may specialize in a specific imaging technique such as bone densitometry, cardiovascular-interventional radiography, mammography, MRI, nuclear medicine, sonography or general radiography.  They work closely with 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.  Forensic nurses 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.  Our forensic nurses, as part of our Sexual Assault Forensic Examination (SAFE) Program, are also an instrumental part of the Baltimore County Sexual Assault Response Team (SART) and work closely with local law enforcement agencies in cases of sexual assault in our community.

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 role in caring for our patients.

Thanking Our Veterans on Veterans Day and Every Day
Today, we honor the millions of American military veterans who have given of themselves to protect us. Let’s pause and salute all who have served and honor the tremendous sacrifices made by members of the U.S. armed forces and their families to preserve our freedom. I know that I speak for all of us at GBMC in offering our sincere gratitude for their personal sacrifices, past and present.

Thursday, November 3, 2016

In Grand Celebration of Our Nurses

It has often been said that nurses are the backbone of a hospital, and that is clearly true at GBMC. The more than 1,000 nurses, across the GBMC HealthCare system, work very hard to deliver to all the care that we would want for our own loved ones. Without them, we would have no system.

I often write in this blog of all of the things that we are working to fix in our national healthcare system but nursing is not one of them.  I am a firm believer that the United States has the best prepared and hardest working nurses in the world.

GBMC’s nurses have been known for outstanding care at the bedside, but now they’ve also become leaders in quality improvement. Just look at our patient falls rate, our CAUTI rate, or our patient satisfaction scores.


Our nurses have done an outstanding job collaborating marvelously well with their physician colleagues and others to help us achieve our four aims.  And we cannot forget all of their contributions towards making our Epic implementation so successful.

Caring for sick patients with many needs requires physical and mental stamina. Our nurses are smart, well-trained and resilient. Their work is not predictable. I am so grateful for their ability to adapt to the variability in demand for their services from day to day and sometimes from minute to minute.

I am so grateful for the commitment, compassion, and expertise that our nurses bring to their work.  We will be celebrating The Art of Nursing this Friday night and I look forward to seeing many of our nurses at the event.  I am very proud of all of them and honored to call them my colleagues.

Friday, October 28, 2016

ARE WE IN AN ECHO CHAMBER?

It is very difficult, in a large complex organization, to make sure that everyone knows what is actually happening. At GBMC, we have many ways to communicate, but none of them are perfect. We communicate by word of mouth from manager to employee down the chain of command; we send email newsletters; we invite people to lunch meetings; we put information on the Infoweb; we use social media and many other methods. But I am still amazed at how little our people know about some of the things that I know, and how little I know, about some of the important things that are confronting our people. Sometimes people know very well what is going on in their unit or department but have no idea or are misinformed about things going on in other parts of our system.

I recall discussing this communication difficulty with Dr. Don Berwick, one of my mentors and someone who I have learned so much from. Dr. Berwick began the “triple aim” movement some years ago. This movement has been very successful at creating better health outcomes and better care experience at lower cost but most Americans don’t know that the movement even exists.  I remember telling him how few healthcare workers know what the triple aim is.  I ask this question at every employee orientation, mostly comprised of people who have worked in healthcare in other organizations, and most of them have never heard of this movement.   So, when I told Dr. Berwick how bothered I was about this, he responded that it was because we are in an “echo chamber.” Meaning that everyone runs in circles with the same people and we begin to believe that what we know and discuss is what the average person knows. Instead, we think this because we are speaking directly with a small group of people and we are reinforcing each other’s knowledge.  Unfortunately, the conversation is not getting out to the people who are not “in the room” with us.

The Epic implementation has been raising this issue of how to communicate well. If you are in a department where things are going smoothly, you believe that they are going well everywhere. If you are in an area that is still challenged, you assume that this is the case throughout the system. The true message about Epic is that on the whole, the implementation has gone very, very well. Very few companies have gone live with such a broad scope of applications all at once and accomplished what we have. But in some areas, like our physician practices, because the data conversion from our old system to Epic could not progress without major human intervention, we are still challenged to get the job of patient care done without a lot of data entry, verification, and rework. We are fixing this and I believe that in a few weeks all areas will be operating smoothly and will be ready to begin optimizing the system to help us get to our vision faster.

TOP DOCS 2016!
I am pleased to announce the selection of Dr. Melissa Sparrow, our first female chief of staff and medical director of Emergency and Inpatient Pediatrics, as the physician cover of this year’s Baltimore Magazine Top Docs issue. This recognition is truly an indication of Dr. Sparrow’s clinical expertise and leadership.

For 30 years, the magazine has annually recognized the excellence of the region’s physicians. Each year, we eagerly await the edition’s release to see how many of our accomplished doctors are chosen for their talent and compassion by their peers. I am certain that the entire GBMC family will agree that Dr. Sparrow serves as an excellent representative of the many other GBMC physicians who are recognized within the pages of the issue.

I would also like to commend Dr. Neal Friedlander, chairman of the Department of Medicine, who was selected to be one of only seven doctors profiled in the issue, chosen from more than 680 doctors who were nominated for the honor.

Please join me in congratulating both Dr. Sparrow and Dr. Friedlander for their achievements as well as all others who are named 2016 Top Docs.

Wednesday, October 19, 2016

GBMC is a Learning Organization

I have spent my career in healthcare and for most of it I was on the frontline, taking care of patients. During our Epic implementation, I was reminded how little I actually know, or how little anyone actually knows, about how our healthcare system functions. I don’t mean that glibly –– our company has thousands of workflows in order to get the job of patient care done. Some of them are designed beautifully and work very well. Others are very complex, have fallen together over time, and are more like a Rube Goldberg contraption (a device that performs a simple task in a complicated fashion).

All of my GBMC colleagues will have their favorite examples of well-designed processes they are involved in daily and others that are in need of redesign. I can think of many processes that work well, but one of our most elegant is the check-in and rooming process at Family Care Associates. Patients are greeted, checked in and then immediately escorted to an exam room to be seen by a doctor. It’s a very smooth, generally reproducible process.

One of my least favorite processes in our company is the process for telling new patients how to get to the location of their visit (and where to park!). Prior to a patient’s first visit, some offices/clinics call and/or mail instructions while others give the name (e.g. North Pavilion) and/or address of the building. I wish I had a nickel for every patient I have found lost on our campus or parked needlessly far from where they need to be.

We should not be surprised that we have many processes that are too complicated and wasteful, nor should we be ashamed when we identify them. We should, however, be ashamed if we don’t learn from what we find and test changes to improve. This is the whole reason for doing Lean Daily Management (LDM). Maybe we should change the name of this practice to Learn Daily Management.

I was speaking with Radiology Quality and Patient Safety Coordinator, Brenda Schuette, on LDM this week. Brenda explained that she discovered a change in the process for ordering electrocardiograms, a result from the Epic implementation which created difficulty in getting ECGs read quickly by a cardiologist. The bad news was that the process had been slowed down, but the great news was that Brenda was part of a team that was studying the process and using their learning to test a fix! Having people learning about our processes every day is a requirement for getting to our vision of treating everyone, every time, the way we want our own loved ones treated. Let’s keep learning!

Thank You!
We couldn’t have asked for better weather during last week’s Baltimore Running Festival. Thousands of people participated in this year’s event including approximately 100 runners who joined team #RunGBMC to raise funds in support of 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 our $50,000 goal. The money raised by team #RunGBMC will help cover Joseph Richey House’s operating expenses not covered by insurance or patient payments.

I participated as part of a four-person marathon relay team with Lisa Baylin, a patient from our Comprehensive Obesity Management Program and teammate who so graciously hugged me when handing off the timer, along with Greg Shaffer and John Lazarou from our marketing department. We all had a great time in support of an important cause.

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.