Tuesday, June 21, 2016

The Appearance of Callousness Revisited

GBMC is an outstanding healthcare system. We have made such great progress in improving the health outcomes of our patients. We have many, many great examples of care and caring. Just a few weeks ago we celebrated our compassionate caregivers and the stories of love and kindness abounded. But, we are not perfect and our HCAHPS scores (The Hospital Consumer Assessment of Healthcare Providers and Systems survey), the first national, standardized, publicly reported survey of patients' perspectives of hospital care, are just about average. https://www.medicare.gov/hospitalcompare

A few years ago I got myself into trouble when I wrote a blog called “The Appearance of Callousness.”  Although I did not mention where the upset patient was treated, the staff in that area got upset.  They thought that I did not appreciate their hard work or their intentions. I sincerely did appreciate how hard they worked and that no one intended to get the patient upset. I was just trying to get them to reflect on what the patient was upset about. If we truly believe that we are here to treat everyone, every time the way we want our own loved ones treated then we have to be big enough to reflect on our behavior…even if it was a one-time lapse on our part or even if we had the best of intentions. So today, I received a letter from a man who began by praising GBMC and three staff members in particular for the great care given his wife, but, then he added:
“However, there was one problem. One evening during her stay I was returning to visit her. Forgetting the location of my wife’s room, I approached the desk on the unit and asked a person seated there where she was. Before I could even speak, he/she said ‘wait a minute’ while he/she leisurely worked on some sort of report. I stood there five minutes while he/she ignored me, slowly filling out both sides of a sheet of paper. Exasperated, I finally left, asked someone else where my wife was and found her room. I was concerned about my wife’s condition and this person’s rude behavior did not help matters.”

What do you think? I bet the staff member who this man interacted with was doing his or her job and may have felt pressured to get some important work done. He/She may have treated the previous 50 family members that approached with kindness and respect but this husband felt disrespect.

What can we do as the GBMC family to minimize the chance that someone thinks we have been rude to them? I would love for you to comment on this blog...but I would like even more if you would discuss this with all in your department, unit, or office.

As I am asking this question, I know that there are many, many wonderful interactions with patients and family members but as caring adults, we must still reflect on the few perceived negative interactions. Thank you very much!


This past Sunday, I spent part of Father’s Day running the 28th annual GBMC Father’s Day 5K. It was a beautiful day and it was great to see so many families on our beautiful campus.

This event has been helping to raise much-needed funds for GBMC’s Neonatal Intensive Care Unit (NICU). Over the years, funds raised through this event have helped purchase lifesaving technology and services for our NICU babies and their families.

I want to thank the close to 900 participants who spent part of their Father’s Day with GBMC and helped raise approximately $140,000. In 28 years, the 5K has raised close to $2 million for critically ill and premature babies.

Let me also thank the amazing volunteers as well as GBMC’s NICU doctors, nurses, technicians and others who dedicate their lives to the health of babies.  I also had the opportunity to meet some of the “graduates” of our NICU and their parents and so many other wonderful people. I also want to congratulate the more than 100+ weight loss patients, a.k.a Team #COMPto5K , that completed in their first Father's Day 5K and to Cody and Selena Staab, 8-year-old twins and 2007 NICU graduates, who gave back to GBMC by selling their bracelets during the Father’s Day 5K.

Lastly, I want to thank everyone involved in our community Wellness Fair which featured health-related vendors. Additionally, MIX 106.5 Radio was on-site with its Friends and Neighbors van playing music and sharing prizes. The Maryland Zoo in Baltimore was also present with fun animal friends in the kids’ area. Great work everyone!!!

Thursday, June 16, 2016

Support for Our Tiniest Patients

It’s that time of year again for one of our biggest annual events for the GBMC HealthCare system.  This coming Sunday we’re holding the 28th Annual GBMC Father’s Day 5K  & 1 Mile Fun Walk at the GBMC campus to benefit the hospital’s Neonatal Intensive Care Unit (NICU).

GBMC is a community-based system of care. We enjoy a lot of support from those we serve and because we are seen as the best place to have a baby in our region, we deliver more than 4,000 babies a year! About 1 in 10 of those babies spends some time in our NICU. We are very fortunate to be able to provide tertiary care to neonates at a high level for those babies born too small, too sick or too soon.  The equipment and staffing required to provide this care is expensive and our annual Father’s Day Run raises funds for the NICU and creates greater awareness of the strengths of our program and the wonderful expertise and commitment of our Team.

The annual event, presented by the GBMC Volunteer Auxiliary, has raised more than $1.75 million for the NICU over the past 27 years and offers GBMC employees, volunteers and the general public an opportunity to support the program. We are well equipped but there are always new technologies to incorporate and other things that need updating.

This year’s event will again feature a Wellness Village, open to not only race participants, but the entire community.  The Wellness Village will be open from 7 a.m. – 10:30 a.m. in the South Chapman parking lot and will include health-related vendors.  Additionally, the Maryland Zoo in Baltimore will also be present with fun animal friends for the kids’ area.

Though we never wish for babies to need our NICU, GBMC is grateful to be able to provide outstanding care to these precious infants and their families. Again, all proceeds from the event will benefit the GBMC NICU to help support specialized equipment, excellent facilities and experienced clinical staff.  It’s still not too late to pledge, and you can do so by visiting www.GBMC.org/5K

…also, Happy Father’s Day to all of the Fathers in our GBMC Family!

Monday, June 13, 2016

Making it Easier to Work as a Team on a Hospital Unit

It is easier to accomplish complex work involving multiple people when those people routinely work closely together. Teams that get to know one another generally do better than people who rarely work together and don’t know each other. At GBMC, it is no accident that Units with a close knit team of doctors, nurses, other clinicians and support people get better outcomes and generally have better employee, physician, and patient engagement scores than those who don’t work and reflect together daily.

On units where nurses work routinely but physicians, care managers, and others come and go because they have patients on many units it is very hard to get the communication- and therefore the care- right.

In order to achieve our vision of the care we would want for our own loved ones delivered to every patient, every time, we need an environment that supports optimal collaboration among clinicians, as well as multidisciplinary team member inclusion in daily care-planning.

So earlier last week, on the GBMC medicine inpatient units, we started using the Patient­-Centered Care Team (PaCT) model of care. Work spaces on each unit will offer physicians and care managers private areas to tend to documentation, while still being within reach should a patient care need or question arise. Having nursing, physicians and care managers located together on every medicine unit will allow for easier scheduling of multidisciplinary rounds and will enable additional care providers a chance to gather with the team to improve patient health outcomes.

Dr. Neal Friedlander, our Chairman of Medicine, has been a champion of “collocation.”  He has been concerned about how physicians were spending hours each day walking to different units and because of this not being readily accessible to their patients, nurses or other care team members. He has been concerned that there were preventable rapid responses called, and discharge planning was difficult because care managers and physicians were not in geographic proximity.

In order to accomplish keeping a patient with one team more commonly, we had to make telemetry available on most units to eliminate unnecessary patient transfers; physicians and case managers will now join their nursing colleagues on a single unit; multidisciplinary rounds will include all members of the care team by unit (simultaneous rounds); medical directors and their partner nurse managers are now accountable for the care on each unit.

Over time, other support services may be assigned to individual units. JoAnn Ioannou, DNP, MBA, RN, NEA-BC,our Senior Vice President of Patient Care Services and Chief Nursing Officer, told me how thrilled she is to witness some of the early benefits of the PaCT Model on our units, for both our patients and staff. case.

I am very grateful to Neal, JoAnn, Cathy Hamel, our Vice President for Post- Acute Care and to everyone who has helped us implement this change!

What’s on your mind about EPIC?
Last week, in my blog I discussed the production, B’MORE EPIC, and how It gave attendees a comedic perspective on how EPIC will help clinicians assist patients through the care continuum and make it easier for us to achieve our vision.

This week though, I want to hear from you.  If you have a question about EPIC or its implementation, please enter it here and we will address them in the last blog post for June. Thanks!

Thursday, June 2, 2016

Recognized for Their Compassion

On Wednesday, GBMC held its annual Dr. John Adams Compassionate Caregiver Awards. It is very important that we take time annually to recognize those who are outstanding at demonstrating their compassion. Remember that John Adams, MD, deceased former chief of pathology, started the Compassionate Caregiver Award at GBMC after losing a friend to cancer. His vision and philanthropy have created an endowment to underwrite the cost of the rounds that bear his name.

This year’s 15 nominees (Departments) included:
Cynthia Arnold, CRNP (NICU); Clara Anizoba, MD(Internal Medicine), Joanna Baird (Gilchrist), Lynn Beaver (Palliative Care), Nicholas Davenport (Care Management), Brittney Davis (Care Management), Daniel Fink (MICU), Cyril Gatewood (Emergency Department), Amanda Henderson (MICU), Donna Naslund (Gilchrist), Patty Nicholls (GBMA—Internal Medicine), Maria Pane, MD (Pediatrics/NICU), Mona (Eman) Soliman (Gilschrist), Zonda White (Environmental Services) and Brian Wilson (Gilchrist—Howard)

The winners were:
4th Runner Up - Donna Naslund, Gilchrist Volunteer
3rd Runner Up - Patty Nicholls, GBMA-Internal Medicine
2nd Runner Up - Nicholas (Nick) Davenport, Care Management
1st Runner Up - Cynthia Arnold, CRNP, NICU
Winner - Maria Pane, MD, NICU

We should all be very proud of all the nominees because they embody our second Aim of Better Care. In my remarks at the event, I pointed out that we move towards our first Aim of Better Health when we deliver evidence-based care. This is rather mechanical for scientist-clinicians. The second Aim is much harder to deliver. It requires that we get in the shoes of the patient and her family in the moment. This is very hard for clinicians to do always because we get caught up in the work of healthcare along with its stresses. It’s easy to come across as not caring when we are focused on our tasks. The nominees are special people who stay focused on the patient as a person with needs beyond the medical care.

After the large event in the Civiletti Conference Center, I attended a celebration at the NICU in honor of Dr. Maria Pane and Cynthia A. Arnold, CRNP for being nominated and winning their awards.
The celebration also highlighted our NICU Team for being nominated for this year’s Schwartz Center National Compassionate Caregiver Team of the Year (NCCY) award. The NCCY award recognizes health care professionals from across the country who exemplify extraordinary compassion in caring for patients and families. Winners of these national awards will be announced in November.  I would like to congratulate our NICU Team now even if the judges make a mistake and they don’t win the national award. They are outstanding examples of compassionate caregivers!

The Passing of Elsie Mildred Arnold
Speaking of compassionate caregivers, I was saddened to hear about the passing of Mrs. Elsie Mildred Arnold at the age of 94.  Arnold, a 1947 nursing school graduate, helped relocate patients from the Women’s Hospital to GBMC in 1965.  She continued to provide excellent care to our patients until her retirement in 1987 and subsequently served on the Women’s Hospital Foundation Board.
I believe in the old saying “work hard, play hard” and I know since March 2015 the EPIC team members have been working hard in the preparation for the implementation of EPIC.
The EPIC implementation is a strategic move for the GBMC HealthCare System. “One patient, one record” is critical for us to deliver the kind of care we want for our own loved ones to everyone. EPIC has wonderful tools to make communication between patients and caregivers easier as well.

I know how hard the EPIC team has been working.  Last week though, the EPIC Team showed their theatrical talents with their production called “B’MORE EPIC.”

Tickets were almost as hard to come by as tickets for Hamilton, but, I managed to get one and attended the sold-out matinee showing and I really enjoyed it.  It gave attendees a comedic perspective on how EPIC will help clinicians assist patients through the care continuum in our system.  Cindy Ellis, Project Director for EPIC, did an outstanding job as the producer of the performance and she did it with her usual outstanding style and exuberance.

There’s no doubt that we have a lot to do between now and October 1st, but, it was great to showcase the software and have some fun.  I want to thank all of those involved with this stellar production for bringing us some joy. If you didn’t see it, please visit http://infoweb/EPIC  Please share your thoughts of “B’More Epic”

Monday, May 30, 2016

Recognition for Our Work on the Triple Aim; Honoring Our Heroes

It is a great source of pride for me to attend a regional or national conference, seminar or symposium where our healthcare system is being recognized as a leader. Last week, I was in attendance at the Institute for HealthCare Improvement’s (IHI) Leadership Alliance spring meeting in Washington, D.C. with leaders from 40 other healthcare organizations in the country.

During the meeting, I was asked to be part of a three-person panel from the Alliance to present evidence that support from the Centers for Medicare and Medicaid Services (CMS) was helping us achieve the Triple Aim: Better Health, Better Care and Lower Costs for a population of people (….and we have added the fourth aim of More Joy for those providing the care). I presented our data at improving health and care while lowering cost through our patient-centered medical homes and the phenomenal work of all of our team members in the hospital. Also on the stage with us were Acting CMS Administrator Andy Slavitt and Acting Principal Deputy Administrator, Deputy Administrator for Innovation & Quality, and Chief Medical Officer, Patrick Conway, MD, MSc. The week before, Dr. Conway had come to GBMC to participate in our Lean Daily Management walk. When I told them about our accomplishments and how support from the Centers for Medicare and Medicaid Innovation had really helped us transform care it was clear that they were pleased. The don’t frequently hear words of thanks and praise. I was really proud when Dr. Conway told the 200 or so people in the room how impressed he was with all that the GBMC HealthCare was doing and when he thanked us for helping CMS to learn daily improvement.

Kudos to Our IT Department

I am very excited about implementing EPIC, our new clinical and administrative information system, because when we go live each patient will only have one record in our system and it will make it easier to treat everyone the way we want our own loved ones treated. We have a lot to do between now and October 1st when we go live. But, I want to take a brief moment to thank Dave Hynson, GBMC’s Chief Information Officer, and his team, for all their hard work in getting us ready to go live. This is such a huge undertaking, but, Dave and his team have been doing an incredible job not just with EPIC’s implementation, but, with the everyday issues that come up across the GBMC HealthCare landscape. Thanks to all in our IT department who are working on EPIC and beyond!

Thank You Beth and Albert!

I recently had the opportunity to visit the Sheila K. Riggs Department of Radiation Oncology to make a special announcement. One of our most tenured and beloved physicians, Dr. Albert Blumberg and his wife, Beth, had done a wonderful thing for the staff of the Department of Radiation Oncology, and it was my honor and pleasure to make the formal announcement.

Beth and Albert, in a magnanimous gesture of gratitude have established the Beth and Albert Blumberg Radiation Oncology Staff Development Fund.  For more than 30 years, Dr. Blumberg has cared for thousands of patients who have come to GBMC for their care.  This wonderful gift is one way that the Blumbergs have decided to say, “Thank you!” to the Radiation Oncology staff who have made possible the Department’s and Dr. Blumberg’s success in delivering life-saving treatment.

The new fund will allow the Department Chair, Dr. Rob Brookland, to allocate critical dollars in support of requests by staff who are seeking continuing education.

Dr. Blumberg summed up the genesis of their decision to create this perpetual endowment, “This gift is to reinforce to the people I care about how much I really care about them.”

As I made the announcement about the Blumberg gift to a gathering of the Department’s staff, many were drying their eyes or visibly fighting back tears of admiration and joy for the Blumberg’s generosity and desire to recognize and reward them.

This very special occasion highlights the power of an effective team – the staff of the Sheila K. Riggs Department of Radiation Oncology is an amalgamation of people from diverse backgrounds who share one guiding principle: they support each other to ensure that every patient is treated like a member of their family.

Beth and Albert, GBMC salutes you for your many years of service, the team that you have helped to build and your amazing gift that will continue to give back to our staff so that they can grow in their careers and help our patients for a long time to come.

Honoring Our Heroes

Today is Memorial Day and it’s a special day during which we honor those who have given their lives during military service to our country.  Many of our GBMC employees have family members in military service and some are veterans themselves. We all have friends or family members whose lives of service included the ultimate sacrifice. So, on this Memorial Day holiday let’s make time to honor all of our veterans and their commitment to safeguard our security and be mindful of our heroes — living and dead. Let this be a moment to recognize with appreciation and respect our nation’s champions.

Tuesday, May 17, 2016

Do You See the Clutter?

February 2015
Making It Easier (and Safer) to Get the Work Done on an Inpatient Unit
July 2013
It’s easier to get the job done when everything is in its place - 5 (or 6) S's revisited
August 2012
5 or 6 S: Having a Prepared Work Space to Get to Higher Reliability & More Joy on the Job http://ahealthydialogue.blogspot.com/2012/08/5-or-6-s-having-prepared-work-space-to.html

I have written about the concept of 6 S's in this blog three times previously. So last week, when I was returning a wheelchair, to a wheelchair storage area, I wondered how many of my colleagues had walked by that wheelchair and had not returned it to where it belongs. I began to reflect on the reasons why things get out of place.

When I walk through the halls of GBMC, I often find stretchers, chairs and other things where they don’t belong. We don't want to put clinicians in the position of having to do work-arounds to meet patient care needs because they cannot locate the proper equipment. Things get out of place for many reasons. Sometimes we are doing something and feel rushed to get on to the next task that we leave an item anywhere we can just to quickly get on with our work. In these instances, we sometimes tell ourselves that we will put the thing anyway later, and then we forget. Sometimes things need to be returned to a place off our unit or department and we need to call transport to retrieve it which takes time. Sometimes we don’t know where something truly is stored.

When something is already out of place, like the wheelchair I found, there are many reasons why they don’t get returned. Sometimes we are in a hurry and feel we don’t have the time to return something to its correct place. Some people believe that it isn’t their job to replace things that they did not displace. I also think that we get immune to clutter and we begin to not “see” it. It becomes the usual to have “stuff” everywhere. Then there is the concept of “hoarding”. Sometimes we keep things where they don’t belong because we are afraid that if we put it back where it belongs (especially if it is stored at a distance from our workplace) that we won’t be able to get it back when we need it. This, of course, guarantees that someone won’t get it when they need it if no one else knows where it is. This is why we created an equipment hub in 2012. When people don’t trust the equipment storage system and they hoard, they unwittingly make the system less reliable.

Why should we care? I think there is a true hierarchy of reasons why we should not accept clutter. The first is patient and staff safety. I told the story in this blog of being in a hospital that had a fire and patients needed to be moved quickly. Beds, stretchers and other things in the hallway were a true safety hazard that day. The second is patient engagement. No one thinks well of a cluttered hospital. The third reason is it makes it harder for us to get our work done if we can’t find what we need or have to work around things that don’t belong where they are.

We need to create better accountability for our facilities staying in 6S condition. So, in case you have forgotten the 6S’s, they are:

1. Sort: eliminating everything not required for the work being performed.
2. Separate: efficiently placing and arranging equipment and material.
3. Shine: tidying and cleaning.
4. Standardize: standardizing and continually improving the previous three.
5. Sustain: establishing discipline in sustaining workplace organization.
6. Safety: creating a safe work environment.

All managers must own their workspace and audit for clutter at some regular interval. They must enroll their people in keeping the department or unit clutter free. Our performance improvement colleagues will be happy to help managers create a system to make it easier to keep your space ready for business.

But we as individuals must avoid leaving things where they don’t belong and also help and remove clutter as we find it. If we all commit to this, it won’t be so hard because it will become much less frequent to find something that isn’t in its place.

What do you think?

Thursday, May 12, 2016


Sunday marked the beginning of National Hospital Week, the celebration of which dates back to the early 1920s. According to the American Hospital Association, the week is “a celebration of the history, technology and dedicated professionals that make our facilities beacons of confidence and care.”  This year’s theme is “Health Care from the Heart,” something that our committed GBMC staff – over 4,0000 employees across the system --does daily.

We have excellent facilities and technology within GBMC HealthCare, but, a hospital is always more than a building and equipment.  It is made up of physicians, nurses, volunteers, therapists, food service workers, surgeons, analysts, counselors, and administrators — men and women who are committed to providing everyone with the care they want for their own loved ones. At all hours of the day and night, all year long, GBMC and its dedicated staff are there to serve our community in our mission of health, healing and hope.

I am very grateful for all that our hospital team does every day. Thank you to all!

I hope that all of my colleagues will take some time to focus on their own health. Please attend our Employee Health Fair in the Civiletti Conference Center TODAY (Thurs., May 12) from 11 a.m. - 3 p.m. Visit a variety of vendors, learn about health, wellness, and benefits, receive giveaways and be entered for raffle prizes. Winners will be announced on the InfoWeb.

This week, GBMC HealthCare is participating in Decision Health’s 8th Annual Care Coordination Summit.  The summit showcases new models of care and innovative processes that are transforming the healthcare system leading to improved patient outcomes and appropriate use of healthcare resources.

During the three-day summit, Dr. Robin Motter-Mast, chair of the family medicine department and who leads population health and our Patient Centered Medical Homes, Melanie Miller, manager of Population Health Coordination Services who manages and trains the care coordinators within all GBHA primary care practices, and Megan Priolo, chief operating officer of GBHA who has direct oversight of ACO and population health activities, all presented our work that has resulted in a better health outcomes, better care experience including better access and reduced healthcare expenditures for our community.  They did a fantastic job in representing our healthcare system and educating the public on our population health initiatives.

We were nominated as finalists for the Case in Point Platinum Awards for our exemplary work and aim to continue providing improved healthcare to the people we serve.  The Case in Point Platinum Awards recognize population health management programs that successfully deliver efficiency and effectiveness across a variety of disciplines and settings in the continuum of care. Now, I am proud to announce that GBMC won awards in the following categories:
Community Care Settings--Community Care Programs; Health Information Technology Systems and Transition Care Programs.

I want to extend congratulations to the Gilchrist Inpatient Care Management team, director Joanne Parr, utilization review manager Yanting Zhu and manager of care transitions Kathy Eiseman-Brock for their part in securing our Transition Care Programs award.

With the May 16th deadline quickly approaching, I wanted to kindly remind you all to do your part and complete our annual Employee Engagement and Safety Survey.  The survey can easily be accessed through the icon on any GBMC desktop computer (see pic on right).

So far, 42 percent of our colleagues have responded. We need your opinion.  The survey is anonymous to GBMC and confidential. We work with a third party vendor, Press Ganey, who compiles survey data for us. We at GBMC never see individual responses.

Please don’t be silent and complete the survey so that we can identify opportunities for further improvement, to judge the value of changes we made since the last survey and to make GBMC an even better place to work and a safer health system for our patients.

If you want to be included in a weekly drawing for a $100 prize, be sure to enter your name after you complete the survey.  As a thank you to completing the survey, Press Ganey also conducts a prize drawing each week.  For just providing your honest opinion, you could be entered to receive $100 extra in your paycheck or two tickets to GBMC Employee Night at Camden Yards.

I would be remiss if I didn’t mention the 28th annual GBMC Golf Tournament that was held on Monday at Turf Valley Country Club.  Hats off to the entire golf committee, the many employees who helped with the event and to Jenny Coldiron and the GBMC Foundation staff, all of whom worked together for a great event. We had over 45 foursomes sign up – that’s almost 200 golfers supporting our efforts.  It was clear that countless hours were spent preparing for this great day that grossed more than $180,000 to benefit GBMC. I had the opportunity to golf with Sam Heffner, the Chair of the HealthCare Board’s Philanthropy Committee and Delbert Adams, the Board member who along with his wife, Gina, oversaw our phenomenal 50th Anniversary Gala. Sam and Delbert carried our Team….I wasn’t much help but I had a great time!