We Earned An "A"

Last week, we got a report card of sorts and I am happy to report that we received an “A” grade! We achieved this high mark in The Leapfrog Group’s Hospital Safety Grades for fall 2018, which rates how well hospitals protect patients from errors, injuries, and infections. The survey assessed more than 2,500 hospitals across the nation, including 40 in Maryland. GBMC was one of only five hospitals in the Baltimore region and one of eight in the state to get an “A”! To see the grades, click here.

The Leapfrog Group, which launched its first hospital survey in 2001, began when a group of business leaders wanted to accelerate the improvement of hospital safety and worked with the Business Roundtable to review the evidence. If you would like to learn more about the survey, click here. The hospitals were given a letter grade from “A” through “F” based on several factors, including medical errors, accidents, injuries, and infections. The goal of the rankings is to determine a patient's risk of further injury or infection if they visit a particular hospital.

We should all be proud of this accomplishment. It is a measure of how well we are doing on our first Aim: the best health outcomes. We cannot be delivering the care we want for our own loved ones if patients are not safe from harm under our care. This “A” grade is another piece of evidence showing that we are moving towards our vision. We still have work to do but we have made great strides towards zero harm! I want to thank our entire team for all that you have done to move us to this point. I also want to thank Laura Hines, RN, SCNR, Director of Clinical Quality Outcomes and Carolyn Candiello, our Vice President for Quality and Patient Safety for their tremendous work in culling the data for the survey. Great work!

We are so fortunate to have Gilchrist in our system of care!

November is National Hospice and Palliative Care Month and I think It’s an appropriate time to recognize the Gilchrist team, led by Cathy Hamel and Dr. Tony Riley, who have designed an exceptional system of elder care and pediatric end-of-life care. Gilchrist has outstanding programs to keep elders well and to serve them as they develop illness and progress through to end of life. Our geriatricians assess patients in consultation, serve as medical directors in over 30 extended care facilities, manage the Gilchrist Rehabilitation Unit at GBMC, work with advanced practitioners to deliver in-home primary care, handle symptom management and palliative care for patients with terminal disease, and of course, they work with the fabulous Gilchrist nurses to deliver end-of-life care through Gilchrist Hospice. The work continues with families after the death of their loved one with bereavement support and counseling.

Recently, Gilchrist launched a new Integrative Medicine program that’s available to patients receiving treatment at our Sandra & Malcolm Berman Cancer Institute. Leading the initiative is the program director, Delia Chiaramonte, MD. In the program, cancer patients receive evidence-based interventions to alleviate the symptoms and the stress of cancer to improve their quality of life. Integrative treatment planning covers symptoms such as sleep problems, anxiety, depression, pain, nausea, and fatigue. Thank you, Gilchrist and welcome, Dr. Chiaramonte!

Last month, I had the pleasure of attending Gilchrist’s Taste of Howard County. This year’s theme was Merriment in Masquerade and the event featured food from more than 20 of Howard County’s premier caterers and restaurateurs. It also included more than one hundred bid items as well as a cash raffle. Over $200,000 was raised and all proceeds from the event will support Gilchrist Center Howard County, the only inpatient hospice in the county.

Over the last 24 years, Gilchrist has done so much to help so many people. We are so grateful for all that the Gilchrist team does every day.

Don’t Forget to Get Your Flu Shot!!

Immunization against influenza is the best way to prevent this illness. GBMC employees and volunteers are required to be immunized (those few who are not required to be immunized are required to wear masks during the flu season) to protect ourselves and our patients.
Currently, approximately 82% of GBMC employees and staff have gotten their flu shot. Our next FLU VACCINE EVENT is this Friday, Nov. 16, in the ED concourse, from 7AM - 7PM; or, you can receive your vaccine in Employee Health any Mon-Fri, from 7AM - 4PM. Thank you for getting your immunization.

Celebrating Nurse Practitioner Week

Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NPs) 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. They help us reach our vision of a patient-centered system of care every day. Please join me in thanking them this week!

Baltimore Magazine Excellence in Nursing

It's that time again - Baltimore magazine is collecting nominations for its Excellence in Nursing issue. Please vote for the colleagues you most respect! The survey, which ends on November 30, may be found here.

Thanking Our Veterans on Veterans Day and Every Day

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

A GBMC Giant is Retiring

This week, we began celebrating the outstanding career of Bennett J. (Ben) Beres. Ben joined GBMC HealthCare in February 2012 as Chief Operating Officer for Greater Baltimore Medical Associates (GBMA). He has made a huge difference in the functioning of our physician company in the almost seven years that he has been with us.

Ben and I previously worked together at Boston Medical Center. So, when we were looking for a new operational leader for GBMA in late 2011, I called him. I remember being ecstatic when Ben agreed to interview for the position.

I called Ben because I knew that he was a phenomenal physician practice manager and leader. He always started from the perspective of the patient, but he also looked out for those providing the care. It was important to him that physician leaders worked in partnership with practice managers. Ben was just the right person to oversee the implementation of our patient-centered medical homes. He completely embraced our vision of becoming an accountable system of care that the patient would experience as a whole. He championed extended office hours to include evenings and weekends and he led our work for better office throughput. Ben sent Sarah Whiteford, MD, and Ben Hand, MD, to the Virginia Mason Institute in Seattle to learn office flow science. They returned to work with our architects to design our Family Care Associates office in the Kahlert Pavilion. A hallmark of this office is that there is no patient waiting room. Patients go from the greeter station directly to the exam room. 

Ben first partnered with GBMA Medical Director Dr. Mark Lamos and then with Dr. Harold Tucker, with whom he constructed the rebranding and relaunching as GBMC Health Partners. Ben has also done excellent work with our specialty practices. 

In addition to being an incredible manager and leader, Ben is also an incredible human being. He is dedicated, hard-working, and always focused on making things better. Perhaps Ben will be best remembered for being the consummate friend. I have never seen anyone make as many friends and make them so easily as Ben. I believe that this occurs because he treats everyone with respect.

Ben has lived apart from his dear wife, Ellen, as she has continued her career as an internist at Dartmouth. They have each spent a lot of time traveling between Manchester, New Hampshire, and BWI and we, the GBMC family, have benefited from their sacrifices.

GBMC has been so fortunate to have Ben as a friend and colleague, as have I. We will miss him dearly, but we wish him the best in his well-earned retirement!

We will never forget Ben or his dedication to patients and his work at empowering physicians to lead. Therefore, we have decided to name the library at Family Care Associates, the Ben Beres Library. Please join me in thanking Ben for all that he has done for GBMC and our patients. 

Thanking our Medical Staff Services Team
Each year, during the first week of November, we recognize the important role that our medical services professionals play in our healthcare system. During National Medical Staff Services Awareness Week, we thank all our staff who work behind the scenes to ensure our providers are properly credentialed, licensed, and trained in their respective specialties. Often called the “gatekeepers of patient safety,” the work our exceptional medical staff professionals do contributes to our system’s high safety and quality standards. We thank you for your efforts and dedication this week, and every week of the year.

I’d also like to celebrate the NICU’s recent recognition from the Maryland Patient Safety Council (MPSC), which awarded the GBMC NICU with a banner of excellence in the care of infants with Neonatal Abstinence Syndrome. This accomplishment is the culmination of two years of implementing best practices and compassionate care to our most vulnerable patients. As you can imagine, caring for newborns experiencing drug withdrawal because of in-utero exposure requires ongoing diligence and expert care. It’s an emotional and often difficult job seeing these infants through withdrawal while also helping to educate and support the mothers and families. I am extremely proud of the work being accomplished by our neonatal team.

Finally, GBMC will be kicking off the season of giving by participating in #GivingTuesday. Giving Tuesday is celebrated each year on the Tuesday following Thanksgiving (this year it’s November 27th) and will benefit GBMC’s Child Life Program. Supporting our #GivingTuesday campaign means you’ll help provide toys, games, and other tools our Child Life specialists use to help ease the stress our pediatric patients often experience during their hospital stay. There are two ways to give this season – through the CrowdRise page and by gifting a donation through the Amazon Wish List. It’s amazing to watch our Child Life specialists help our young patients cope with the anxiety brought on by hospitalization, and I know they will appreciate the support.

Working Smarter, Not Harder

Our hospital is a very complex system. What happens in one area of the hospital can have a major effect in what happens in another unit or department. Because of this complexity, it is difficult to maximize our efficiency such that no one is waiting to move to the appropriate place.

I have written in this blog before that we are students of flow. We are designing our systems and matching the demand for services with the supply of caregivers throughout our organization. When we design our systems, hold ourselves accountable to the design, and match capacity to demand, our patients move one at a time in beautiful choreography. This is called single patient flow. On the other hand, when we have no design or don’t follow our designs and rely on hard work alone, we frequently have patients stuck in a bottleneck.

Humans can overcome bottlenecks by working around them or exerting more pressure or influence to get through them. This is known as expediting. An example of expediting is when we take someone away from their usual work to complete a task that the people who normally do it cannot accomplish. An example would be having a housekeeping manager race to clean a room because many dirty rooms have been called in for cleaning at once in the early evening. Rather than fixing the root cause of the problem, in this case the batching of discharges, we send someone to work around the problem in the moment to get the patients what they need. We have improved patient flow, but we will need to fix it again the next day because the batching of discharges has not been fixed. Smart leaders will learn the cause of the bottleneck, redesign the system, and not become complacent with the short-term success of expediting.

We know about the Hawthorne Effect as well, that when a problem gets focused on, it usually gets better without anyone redesigning anything. This is generally because the people involved, knowing that their work is being studied, work harder and faster to overcome the poorly designed process. This is the reason why we are so focused on getting the work redesigned first before we celebrate what looks like an improvement. If the gains are due only to shining the light on the problem, we lose the gains as soon as the light is turned off.

Our flow team and our Emergency Department leaders have been spending time studying and redesigning our processes to move admitted patients out of the Emergency Department to an inpatient bed as soon as possible after the decision to admit has been made. This system is very complex, and it has many sub-systems. The ED physician must enter the admitting order, a bed must be identified as empty on the appropriate unit, and then it must be cleaned. The ED nurse must communicate with the receiving nurse, as does the ED physician with the receiving physician. Transport must be notified and arrive to move the patient.

The number of patients waiting in the Emergency Department to be moved to an inpatient bed at 7 p.m. is a metric on the Executive Lean Daily Management Board. Every morning, we review this metric to learn the reasons that patients are waiting. Much progress has been made through system redesign and I am so proud of all involved. And while we still have processes in need of further improvement, we are working smarter rather than harder. Take a look below at the results of their hard work.

Patient Engagement Question — Wait Time in ED Before Admitted (Quarterly)

TOP DOCS 2018….

GBMC has always been known for having outstanding physicians. This was again confirmed when more than 130 of them, in 81 specialties, were named in Baltimore magazine's “Top Doctors” list for 2018.

For more than 30 years, the magazine has annually recognized the excellence of the region’s physicians. Being recognized as a “Top Doctor” is an extraordinary honor, because it is awarded by their peers. In preparing its annual list of “Top Doctors,” Baltimore magazine surveyed 13,000 area physicians in Baltimore City and seven surrounding counties and asked to whom they would send a member of their family for care in a wide variety of specialties. This question mirrors GBMC’s vision phrase of providing each patient with the care we would want for our own loved ones. The annual Top Doctors recognition isn't, therefore, another popularity contest – the list is chosen by people who really know about the quality of care being delivered.

This year, the magazine also highlighted, Dr. Jose E. Dominguez, our director of pediatric anesthesiology. He was one of six physicians, from a pool of over 700 in the Baltimore area, selected to be profiled.

We are so fortunate to have such a talented and dedicated medical staff. Congratulations to Dr. Dominguez as well as the others who were named 2018 Top Docs.

To learn more about our “Top Doctors,” please visit GBMC's Top Doctors 2018 webpage.

Another Well-Deserved Award
Congratulations to members of our Child Protection Program and our Sexual Assault Forensic Examination (SAFE) and Domestic Violence teams, who were recently awarded a Victims of Crime Assistance (VOCA) grant for more than $243,000 from The Governor's Office of Crime Control and Prevention (GOCCP). The award will help offset the cost of these programs as we grow our capabilities in child protection after the elimination of the pediatric emergency department and inpatient pediatrics at Franklin Square Medical Center earlier this year. Please join me in thanking these colleagues for their hard work and dedication to the protection of children and adult victims of sexual assault and domestic violence.

Our Sympathies...
I want to express our collective condolences to Dr. Gary Cohen, former medical director of the Sandra & Malcolm Berman Cancer Institute, and his family on the passing of his beloved wife, Charlene. Charlene was always an advocate for our healthcare system. Many of you will remember that Charlene was the chair of GBMC’s 30th Anniversary celebration, which raised over $140,000 for the Gilchrist Center for Hospice Care in 1995. She also is the artist behind the many paintings hanging on the walls of the Women’s and Outpatient Surgery Center, Oncology Support Services, and other areas within our hospital.

Let’s thank…
I want to acknowledge the hard work and dedication of both our chaplains and medical assistants as we celebrate Pastoral/Spiritual Care Week (Oct. 21—27) and Medical Assistants Recognition Week (Oct. 22-28).

Medical assistants are incredibly versatile and are trained to perform clinical, laboratory, and administrative duties. They are truly vital members of our healthcare delivery team who help move us closer to our vision every day.

I want to thank Chaplain J. Joseph Hart and all members of our Spiritual Support team for their hard work and dedication to meet the spiritual needs of our patients. No matter the faith, our Spiritual Support team is always there to provide compassion and comfort to families as their loved ones face a serious illness or life-threatening injury. To learn more about our Spiritual Support Services, please go to their web page. Also, check out a recent “Day in The Life” segment, produced by our media partner ABC2 News, which focuses on Reverend Hart and his team by clicking here.

Partnering with our Community to Meet Needs Beyond Healthcare

We have built a community-based system of healthcare that we can be proud of, but we know that healthcare can only do so much to generate health. The GBMC HealthCare System must also become more involved with the social determinants of health: safe housing, food and clothing, education, and jobs. I would like to review some of our involvement with community partners to improve health beyond healthcare.

Since 2016, our Community Benefits Committee has been led by Cathy Hamel, Vice President of Continuing Care at GBMC HealthCare and President of Gilchrist, and Carolyn Candiello, our Vice President for Quality and Patient Safety. The committee recently updated our Community Health Needs Assessment (CHNA) and as a result, they’ve chosen three priority areas: Behavioral Health/Substance Use, Access to Care, and Obesity. The group studied the existing resources in the community for these priority areas, identified gaps, and created ideas for improvement. Their next meeting is before the end of this month and I look forward to hearing about our next steps. Stay tuned!

This year, GBMC teamed up again with ABC2 News to collect hundreds of needed items for the Fill the House initiative supporting the House of Ruth. Thank you to all who donated items for this year’s drive and to all who helped with the campaign.

We have partnered and will continue to partner with other community agencies as well. You may recall that a couple of years ago we collected thousands of pounds of non-perishable food items and delivered them to the Bea Gaddy Family Center and to the Assistance Center of Towson Churches (ACTC), a consortium of 50 churches that provides support to disadvantaged families in our community.  We also conducted a book drive for new and/or gently used books for the Reading Partners “Take Reading Home” program, whose main goal is to help provide support to children from kindergarten through fourth grade.

I am very proud of our involvement in the community and I know we can continue to do more!

Healthcare Security and Safety Week

I want to thank all the members of our GBMC security staff as this week is Healthcare Safety and Security Week (Oct. 14 — 20).

The GBMC security team can be seen walking or stationed throughout our medical center and at Gilchrist. The officers work every day to keep all of us safe at GBMC. They are vital members of the healthcare team and we cannot be successful without them.

Please join me in thanking our security staff for their hard work and for their strong commitment to keeping us safe.

International Infection Prevention Week

This week is also International Infection Prevention Week and it’s a time to highlight the importance of infection prevention and raise awareness of everyone’s role in protecting the public from healthcare-acquired infections.

Our Infection Prevention team members are all registered nurses with additional qualifications in Infection Prevention and Control, immunization, and HIV and Hepatitis Testing. They oversee our cleanliness, our use of antibiotics, and our use of protective equipment.

Under the guidance of our infection preventionists, here are a few of our accomplishments in FY18: reduced catheter-associated urinary tract infections to 4; reduced central line-associated bloodstream infections to 3; and improved hand hygiene compliance to 91%.

Please join me in thanking our Infection Prevention Department on a job well done!

52 Clicks

During this past Friday’s Lean Daily Management rounds, I learned that a nurse doing a complete neurological check on a patient after spine surgery had to click 52 times in the electronic health record to document his or her assessment. I was stunned by this assertion. I have been very concerned about creating unnecessary work for our nurses who already work so hard. This example made me concerned that in our zeal to get to high reliability (what should happen happens and what should never happen doesn’t) by creating standard work, perhaps we had created a system that is not sustainable.

Checking on the neurological status of a patient who has just had spine surgery is very important to make sure that we do not miss a serious problem in the making. Documenting our check is important to our colleagues, in this instance especially the operating surgeon, can see the result of our neurological exam. But does it have to be so hard?

Before the reader races to blame the electronic record let me point out that the paper world left room for error as well. With a blank piece of paper, it was easy for the clinician to write Neuro: WNL, meaning the entire neurological exam was normal. This would always raise the question of whether an entire exam was done. We also had the problem of illegibility with some handwriting.

This is an instance where we healthcare leaders need to avoid the “either, or” trap. Either the documentation will be complete, or it will be efficient. We need “both, and” solutions that will allow for documentation that is both complete and efficient. Wouldn’t it be nice if as the nurse was doing the exam the documentation just happened? How about voice recognition software that would allow the nurse to speak the results of the exam as it was being done?

I am sure that we can come up with a system that would be better than the 52 clicks. Do you have an idea? Please share it.

A New Dynamic Dyad

The GBMC HealthCare System gets better every day at delivering on our four aims and the areas where we make the most improvement are where we have our best leaders. I have been teaching our leadership model in GBMC University classes a lot recently.

During our last GBMC HealthPartners meeting, Shannon Littleton, the Joppa Road Patient-Centered Medical Home Practice Manager, and Dr. James Baronas, the Physician Lead, presented some of their most recent results in patient engagement scores. This dynamic duo took over the leadership of the practice in the summer of 2017. Since then, they have reviewed the GBMC mission, vision, and values with their team and shared performance data. They redesigned their work to improve scheduling, the use of MyChart, phone answering, and office flow. At every step, they thanked their people and encouraged them to make further improvements.  Their results are remarkable!

We are so fortunate to have smart, caring, young leaders in our organization. Thank you, Shannon and James!

HELPING THE HOUSE OF RUTH…

This year, during Domestic Violence Awareness Month, we are teaming up with WMAR 2 News (ABC – Baltimore) as a proud sponsor of the Fill the House for House of Ruth initiative to collect everyday necessities for this partner in care.

House of Ruth provides services to nearly 9,000 women annually who are victims of intimate partner violence (IPV). The work that the House of Ruth performs is closely aligned with our work in the community. Our Domestic Violence (DV) Program has provided services to more than 800 individuals such as support, education, safety planning, referral to community resources and follow-up.

Various drop-off boxes (see picture) have been set up throughout the GBMC campus including the GBMC Pediatric Group, Human Resources, Oncology Support Services, Spiritual Support Services, Volunteer Services, and Family Care Associates. They are also at each of our 10 off-site primary care locations along with Active Life & Sports in Nottingham and Karma Consignment Group in Timonium. Another way to donate is through our Amazon Wishlist. All items purchased through this link will be shipped directly to the GBMC Marketing department, so you don’t have to worry about dropping anything off.

Some of the House of Ruth's greatest needs include diapers, women's and children's undergarments, pillows, twin-sized sheets, comforters, and blankets along with personal care products — deodorant, shampoo, conditioner, bar soap, etc...The drive will run through Monday, October 15 and all items must be new and unopened.

Again, your donations meet the basic needs of victims — things we often take for granted — so please help the House of Ruth and victims of IPV.

Fun in The Sun for A Great Cause

The 18th annual Legacy Chase at Shawan Downs was a huge success! Approximately 8,000 attendees came together for great weather, beautiful horses, and time spent with family and friends. The more than $200,000 raised will go toward oncology services at the Sandra & Malcolm Berman Cancer Institute.

Hats, Horses, and Hope was the theme again this year to celebrate cancer survivors. Many of the annual crowd-pleasing traditions continued— such as the G. Leslie Grimes Memorial Stick Pony Race for kids — and GBMC added some exciting new components to help make the event a success. Brand new this year, was the Archway of Hope, which allowed volunteers and friends of our Cancer Institute to decorate and personalize wide-brimmed hats, which they placed on the arch. Each of the hats create a sense of comfort and strength for cancer patients and their families. Children also came dressed as their favorite superhero to show their support for the fight, while some guests boasted their best hat to show support for oncology patients.

Legacy Chase gives us an opportunity to engage with the community, employees, donors, and local businesses in the work of our healthcare system. We are proud to receive tremendous support from the community-at-large and our family here at home. 

I also want to thank the more than 150 volunteers who helped make this such a great event.