What would your ideal primary care office look like?

I have been both a provider of care and a patient in many primary care offices. As a provider, I often thought that the way things were laid out could be improved to make us more efficient. As a patient, I have often reflected how similar all physician offices are – front desk, with or without a glass window, relatively large waiting room and exam rooms arranged along corridors.  I can remember as a physician, coming out of a room and walking down the long corridors to find another member of our team, to ask for help with something. As a patient, I was once “forgotten” in an exam room over the lunch hour (I didn't complain too much because I had back pain and lying on my side on the exam table felt comfortable).

GBMC has embraced the patient-centered medical home concept. We have taken our existing primary care offices and have used them in a new way. On a recent visit to our Hunt Valley site at mid-afternoon I noticed that the waiting room was empty….the way we want it to be because we don’t want people waiting….and I realized that the waiting room was now just a lot of wasted space.

So I am very excited to tell you about a 3P going on this week on the ground floor of the North Pavilion on the GBMC campus. A team, led by Sarah Whiteford MD, and Ben Hand MD are designing the new home of Family Care Associates, one of our GBMA practices! Drs. Whiteford and Hand spent some time last month in Seattle at the Virginia Mason Institute, part of the Virginia  Mason Health System. Virginia Mason is a national leader in patient centered care and one of the first healthcare companies in the country to fully adopt Lean as a business model. A consultant from the Institute is guiding our team’s work this week.

Dr. Sarah Whiteford (left), Bryan Niles, construction project manager (center),
 and Dr. Ben Hand (right) work at designing a more efficient office that
 will not only enhance the patient experience but create more joy for the staff. 

Do you remember what a 3P is? We discussed the concept in What’s a 3P, the blog installment of October 26, 2012, when we talked about the process for designing our new inpatient pharmacy.

3P is a lean tool that stands for production, preparation, and process. The tool helps us invent new designs that follow lean principles and drive out waste. In this case, waste is defined as anything that the customer would not pay for. Most patients will pay for time discussing their problems with their doctors but are not excited about paying for waiting rooms or filling out forms.

Most physician offices use “batch” processing and move the patient from point A to point B to point C throughout the process. You come in and you wait. You are called to register and you wait. You are then called to have your vital signs and height and weight taken, you are brought to a room and you wait. Your physician or nurse practitioner comes in and deals with you and you wait to then be checked out of the office. The time waiting is nothing more than a characteristic of the design for patient flow.

If you were going to design the process that would be used for you as the patient how would you design it? I would like to arrive, be welcomed, brought to a room, my vital signs taken if necessary and then have my physician begin the visit with me. When he or she was done, I would like to leave with my instructions for the future.

Drs. Whiteford and Hand, along with medical assistants, care managers, and other members of their team now have the wonderful opportunity of designing a space that is better able to deliver care with less waste of time, effort and resources for all - I will be excited to see what they come up with! Stay tuned.

Much to be Thankful For

Thursday is Thanksgiving and I have a lot to be thankful for. I am very grateful that I will be with my wife and children on Thanksgiving – they are the loves of my life.

I have a lot to be thankful for at GBMC, too. Last Friday, I was on a panel sponsored by the Baltimore Business Journal, discussing health care reform. While I was on the stage and listening to the conversation, I reflected on how lucky I am to have so many people in the GBMC family focused on our vision of being the healthcare system where everyone, every time, gets the care that we would want for our own loved ones. Our system has embraced the need to change. We are focused on our four aims because they are what we want for everyone getting care and for everyone delivering care – better health, better care, and lower cost with more joy for those providing the care. We are not lamenting change or struggling to hold on to the status quo. We are in action because that is what our community and our country need us to do! 

I was also very proud on Monday of this week when we hosted Carmela Coyle, the President of the Maryland Hospital Association and other leaders of the MHA at our GBMA Hunt Valley office. Our colleagues had come to learn about the transformation of our company, our accountable care organization, and how we were implementing the patient-centered medical home concept.  With the State’s new Medicare waiver, the MHA will be convening hospitals to help them transform toward managing the health of a population.  I again realized how much I had to be thankful for. 

So let me list just a few of those things here:

• The GBMC HealthCare Board of Directors who had the courage in 2010 to set a new course for our company
• The incredible GBMC Volunteer Auxiliary that is celebrating its 50th Anniversary and is made up of people who give of themselves to help others 
• Our phenomenal medical staff – because of their capabilities (once again GBMC had the most Top Docs of any community hospital in Maryland), their hard work, and their dedication our system does many things that cannot be done by others
• GBMC’s wonderful nurses – they are the core of our organization. Our nurses are smart, tireless and giving. Their work in the last year at improving our patient safety and service has been remarkable.
• Our nursing support technicians who are the face and heart of GBMC to so many patients in our hospital
• The nurse practitioners and physician assistants that work so hard to deliver exceptional care to our patients
• All of the rest of GBMC’s fantastic clinicians: therapists, laboratory personnel, and other technicians who use their expertise to improve clinical outcomes
• GBMC non-clinical personnel: from managers to patient access reps to billing personnel to food service workers and environmental service workers and everyone else who goes above and beyond for those we serve
• Gilchrist Hospice Care – our hospice along with Gilchrist Greater Living set a very high standard for patient-centeredness and the rest of our system learns from them every day
• The GBMC Foundation and its staff – where would we be without our excellent fundraising team?
• The GBMC campus – we are blessed to have such a beautiful environment for healing
• Our patients – they come to us for help and they show their gratitude even when we don’t get it perfectly right
• The staff at Einstein Bagels on the third floor of the hospital who make me smile every morning

I could make the list much longer - we really have a lot to be thankful for. Please enjoy Thanksgiving with your families, and Happy Hanukkah to all those in our GBMC family who celebrate the Festival of Lights. 

OUR PEOPLE, GIVING BACK TO OUR COMMUNITY, IN MORE WAYS THAN ONE

As a not-for-profit organization, GBMC exists to serve the community. Our HealthCare system is “owned” by the community and a group of people from our community, the Board of Directors, oversee it and hold the CEO accountable for serving the mission every day. The directors give of their time and talent to help GBMC. The Chairman of the Board, Harry Johnson, Esq., has served on our board for more than 10 years and has been involved with GBMC since the 1980’s.

Harry Johnson, Esq.

This is why many of us within the GBMC family felt privileged to have attended the Boy Scouts of America’s Whitney Young Jr. Achievement Award ceremony last week, honoring our Chairman Harry Johnson.  It was a true honor to attend this ceremony and pay tribute to a great community leader.

The Whitney Young Jr. Achievement Award is presented to a member of the community in recognition of their involvement in the development of scouting opportunities for youth from rural or low-income backgrounds. In Harry’s brief acceptance speech he spoke about his dad, who was a Boy Scout leader in Maryland in the early 1960s when Maryland was still segregated. His father led an all-black troop and had to deal with many issues stemming from racial inequality. But Harry’s father was a leader and helped these young boys, including his son, Harry, become leaders and contributing members of their community.

Harry is an accomplished attorney and partner at the law firm Whiteford, Taylor and Preston, yet he finds time to volunteer and give back to numerous organizations. In addition to serving as Chairman of the Board at GBMC, Harry is also very active with the Maryland State Bar Association including the Maryland State Bar Foundation board of directors as well as many others. Harry is a shining example of someone who has dedicated himself to giving back to the community, and GBMC has certainly benefited from Harry’s service and leadership. We are very proud of Harry and grateful for all that he has given to GBMC.

Stroke Center Award

I also want to congratulate our rapidly growing Center for Neurology and GBMC’s Primary Stroke Center which, under the leadership of James Bernheimer, MD and Tracy Lamb, MSN, CRNP, CRN,   recently received the Gold Plus award from Get with the Guidelines®. The award is given by The American Heart Association and American Stroke Association in recognition to hospitals that have achieved 85% or higher adherence to all Get with the Guidelines Stroke Achievement indicators for two or more consecutive 12 month intervals. The award also recognizes hospitals with at least 12 consecutive months of 75% or higher compliance with five or more Get with the Guidelines Stroke Quality measures to improve quality of patient care and outcomes.

This award is the result of the hard work and commitment of our entire stroke team and demonstrates GBMC’s high level of commitment and expertise in caring for stroke patients. With an aging population, we are at the ready to provide superior care to all GBMC stroke patients day in and day out. Great work!

Are our Top Doctors Speed Dating?

Once again, GBMC had more doctors recognized in Baltimore magazine’s annual listing of Top Doctors than any other community health system or hospital in the region – a true accomplishment and a testament to the top notch physicians caring for our patients. In fact, 171 members of our medical staff were named to this year’s list in 71 different specialties – truly outstanding.

But, unlike many other healthcare surveys that poll people with very little knowledge or understanding of healthcare, Baltimore magazine’s Top Doctors list is actually compiled by surveying other doctors, nearly 10,000 area physicians, in fact.

The annual Top Doctors recognition isn't another popularity contest – it’s about people who really know about the quality of care being delivered by their peers. And, it’s clear that with 171 member of GBMC’s medical staff on this list, the medical community, as well as our patient population, recognizes this medical excellence. So, when we ask people, “What if it was your daughter?” the physicians surveyed for this year’s Top Doctors recognition feel confident enough in so many of GBMC’s medical staff to send their own loved ones to them for care.

I congratulate GBMC’s Top Doctors - we are extremely proud to have such excellent, caring clinicians on our team and very grateful for all that you do to care for our community.

Speed Networking Doctors

And speaking of GBMC’s great medical staff, I had the privilege of attending GBMC’s first ever Physician Speed Networking event on November 6. Just like speed dating, 140 GBMC clinicians – along with members of the GBMC senior leadership team, service line administrators, Physician Relations and GBHA representatives attended this special “meet and greet” event.

This speed networking event was one of the best medical staff events that I have ever attended! 

The idea was born out of general “meet and greet” sessions that our HR department has held over the past couple of years for our employees to meet with GBMC doctors. The creative idea of the physicians speed networking provided an enjoyable forum for our providers to put names with faces and become more acquainted with others’ styles of practice. PCPs met with specialists who could provide further care for their patients and the specialists had the opportunity to meet the PCPs who could refer their patients.

Physicians had the chance to kick back, enjoy some great food under the big tent and not only meet their peers, but have an entertaining time doing so. It was a win-win event for all who attended and I think we all look forward to the next event!

A Peaceful End-of-Life Journey with the Help of Gilchrist Hospice Care

The first of our four aims is to be the healthcare system where everyone, every time, gets the very best possible health outcome.

And, while we are focused on restoring patients to health, we also recognize that sometimes this is not possible. When patients have life-ending illnesses, it’s comforting to know we have the experts at Gilchrist Hospice Care to guide them through and to be there to support their families.

November is National Hospice and Palliative Care Month and I’d like to recognize the excellent staff and volunteers at Gilchrist who are devoted to ensuring a peaceful and respectful end of life journey. Gilchrist Hospice Care is the largest hospice in Maryland and is repeatedly recognized nationally for its work. In fact, Gilchrist is often referred to as the platinum standard for hospice care.

To commemorate National Hospice and Palliative Care Month, I've asked Cathy Hamel, the Executive Director of Gilchrist Hospice Care, to talk about hospice and the vital role it plays in caring for patients:

Cathy says:

“Every day in the United States, 10,000 people turn 65. Seven out of every 10 Americans die from a chronic illness. A century ago, our ancestors, more often than not, died suddenly. But today, many of us have the good fortune to live longer thanks to the wonders of technology and advances in medical care.

We’re also more likely to suffer from one or more chronic illness at some point in our longer lives. As a result, we now have more choices in both life and death, and both studies and practice have shown that hospice is a wonderful alternative -- I would argue the best alternative -- for terminally-ill patients as they seek to balance quality of life vs. quantity of life. It is the former that is the focus of hospice.

If you ask most Americans to envision a "good death," they would tell you they prefer to die at home, surrounded by loved ones. Few wish to spend their last days in a hospital room, and even fewer in an intensive care unit, surrounded by machines. However, as a society, we tend to avoid conversations about death. We avoid planning for the day when we will need a feeding tube or assistance with breathing. We don't tell our family, our caregivers -- our doctors -- our wishes for care at the end of life. As a result, when those last weeks and days arrive, so many patients find themselves headed to the ICU, and more invasive, often futile treatment, against their better wishes.

Every November, during National Hospice and Palliative Care Month, we applaud those who have had what we call "courageous conversations" with their families and physicians and have created a game plan, of sorts, for their death. Every November, we encourage those individuals who haven't yet had these discussions to begin thinking and talking about their wishes for care when they are terminally ill. And every November, we recognize the teams of hospice workers -- physicians, nurses, social workers, chaplains, hospice aides, volunteers, bereavement counselors and support staff -- who are able to transform an emotionally-wrought time into a celebration of life for our families, and who are there to ensure that patients are able to approach the end of life in comfort and with dignity, surrounded by their loved ones.

At Gilchrist Hospice Care, our staff and volunteers understand that building relationships and memories with our patients and their loved ones is of the utmost importance. They understand that terminally-ill individuals still have life goals, even if time is fleeting, and they go above and beyond to help their patients achieve those goals. Gilchrist has earned its stellar reputation because of our commitment to providing individualized, compassionate care to each and every patient. The death of a loved one is a lifelong memory and we’re committed to making that memory as positive as we can.”

***
I sincerely thank Cathy and the entire team at Gilchrist Hospice Care for their devotion to making the end of life journey a peaceful and positive one for so many families throughout the years.  You can also read more about Hospice care and Cathy’s insights into end-of-life issues in The Gilchrist Blog.

Have you or a loved one been touched by the care of a hospice or palliative care team member? I’d love to hear your personal stories of exceptional care…

Change is a Learning Process

Winning organizations recognize the importance of learning. Companies that don’t learn new ideas don’t change to meet the demands of those they serve. When an organization doesn't change to meet new demands, it eventually fails. That is why we set aside time for learning.

Last Thursday, GBMC leadership had a marvelous day of learning with our teachers from Next Level Partners who taught us about focused problem solving to get better execution of meaningful change.

The former President of the Institute for Healthcare Improvement, Dr. Don Berwick, says there are three important factors required for improvement:
1. The will to change
2. Ideas
3. Execution

I have no doubt that at GBMC our people want to change. They embrace our vision of providing the care that we would want for our own loved ones to every patient, every time. We have the will to change.

I know that GBMC has a workforce made of many intelligent individuals with great ideas to improve our processes. I also know that with the Internet, many solutions are just a few clicks away. So, there is no lack of great ideas.

Our dilemma is number 3: execution. Healthcare in general has not been particularly good at executing change. Many healthcare service processes haven’t changed much since the mid twentieth century. Many companies have unwittingly instilled the notion into their people to hold on to the status quo, and to learn to deal with systems that don’t work, rather than getting them the idea that not only is it their right to fix broken systems – it is their duty.

We are implementing Lean Daily Management to change this. Since we started this technique last April, our senior team visits departments and units every day. On our daily walk, members of the unit and department teams tell us about the performance of key indicators from the day before. They tell us about the reasons why goals were missed and about their problem solving to improve the process.

A great example of excellent problem solving can be seen in the work done by both the Emergency Department and inpatient unit teams, including doctors, nurses and techs, with the help of housekeepers and transport aides, to move patients more quickly from the ED and into a hospital bed. We have reduced the time in the ED of patients admitted to the hospital by more than two hours.

So, our friends at Next Level Partners taught us more of the science of improvement to help us execute faster. It was a great day of learning for GBMC leaders. Such offsite trainings make us stronger as an organization and make our people more skilled. We all came back to work more inspired and better prepared to move us faster toward our vision.

Continuous Improvement – The Method that Will Get Us to Our Vision

GBMC HealthCare is using the management science that other excellent organizations use to provide ever-increasing value to those they serve. This way to manage, created by the likes of W. Edwards Deming and Walter Shewhart in the 20th Century, is what is helping us get closer to our vision every day. How are we doing at using this science? Well, we recently “took a test” when examiners from the Maryland Performance Excellence Awards program reviewed us. The examiners studied GBMC through the lens of the Malcolm Baldrige Performance Excellence criteria.

On October 15th, I attended the Maryland Performance Excellence Awards dinner with a group of my colleagues. GBMC received a silver award. Congress established the Baldrige Program in 1987 to recognize U.S. companies for their achievements in quality and business performance and to raise awareness about the importance of quality and performance excellence.

Forward thinking organizations like GBMC utilize the National Malcolm Baldrige Criteria for Performance Excellence to make themselves better, faster. This was GBMC’s first application for this distinction, and to be honored with the silver award recognizes the advances our organization has made in improving care to our patients. Our vision is a vision of perfection, and we won’t get there unless we use scientific management. We will apply for the award again next year, because it is a great way to learn and improve our management systems.

At the awards dinner, I had the opportunity to explain our vision to a large group of people assembled from other industries. I told them about our quadruple aim (Better Health, Better Care, with the Least Waste and the Most Joy for those providing the care) and I gave them some examples of the progress we were making. As I was speaking I realized how proud I was of everything that our people were accomplishing, but I also recognized how much work there still is to do to become even more patient-centered.

Our vision of perfection includes always delivering the correct medication at the correct dose to the correct patient. This is the definition of a highly reliable medication delivery system. Our Pharmacy team is using continuous improvement to build this highly reliable system. And, with this week being National Pharmacy Week, I asked our pharmacy team to explain their expanded role in patient care and safety.

Todd Jackson, Automation Systems Analyst, Pharmacy Informatics explains:

“In both the hospital and community setting, Pharmacists play an integral role in patient care by preventing medication errors, advising physicians on the best drug choices, safeguarding against medications allergies and drug interactions, and working with nurses to ensure that patients understand how to use their medications safely and effectively.

Several members of the Pharmacy team including (L-R):
Mahsa Mahmoudian, C.Ph.T, Nicole Garrison, R.Ph, Dana Hack, R.Ph.,
Heather Orach, C.Ph.T., Peter Furgiuele, R. Ph.
(Not pictured: Min Min Than, R.Ph., Pharmacy Director, and Todd Jackson)

Certified pharmacy technicians play an equally important role in the healthcare continuum. Incorporating a high level of multitasking ability, they are involved in compounding medications, packaging and labeling, and delivering medications.

Pharmacists and certified technicians have taken on enhanced patient care roles through the use of special technologies including DoseEdge, Medex, RobotRX, as well as the Acudose and Anesthesia RX stations.  Here at GBMC, technology is utilized at many points in the pharmacy workflow. 

Computers also help pharmacists monitor every patient’s medication therapy and provide quality checks to detect and prevent harmful drug interactions, reactions, or mistakes. But, it still takes a human being to evaluate what the computer says and to know what to do to prevent adverse medication events.”

*****

To move toward our vision of perfection: “To every patient, every time, we will provide the care that we would want for our own loved ones,” we must continue to have outstanding professionals who continually improve our systems. I thank teams throughout GBMC, such as our Pharmacy team, for holding themselves accountable for the attainment of our vision.

What are your teams doing to redesign systems and improve quality in your departments?