Friday, January 18, 2019

Moving Patients and Equipment Around Our Campus is a Very Complex System

Recently, I spoke with Anthony Anderson, GBMC’s newly appointed Director of the Service Response Center and Patient Transport. 

Anthony, who worked at GBMC for three years as our Assistant Director of Food and Nutrition, now oversees daily transports and Service Response Center (SRC) calls. Anthony’s leadership team includes Destini Washington, Dominique Eaddy, and Gaurav Vasson.

Moving patients safely and efficiently requires standard processes and synchronization, which is the coordination of events to operate a system in unison. For example, when a patient needs to move from an inpatient unit to the radiology department for a study, the nursing staff must align its work to have the patient ready when transport arrives to move them. If either the patient or transport team is not ready on time, the system is “out of sync.” In a highly reliable hospital (one in which what should happen, happens, and what should not happen, doesn’t) patients are where they need to be when they need to be there.

This is a very complicated process because it’s impossible to predict exactly when and where patients will need to be moved at the beginning of the day. Anthony will be working closely with other leaders, especially our inpatient nurse managers, to make sure that we have standard work that is synchronized.

Anthony and his team also have the added complexity of moving equipment (stretchers, beds, wheelchairs, etc.). Our transporters are key players in keeping our facility clutter free and assuring that everything is in its place so that our staff will have what they need when they need it. They follow our 6S principles: sort, separate, shine, standardize, sustain, and safety. When things are not where they belong, it is hard to get them to the people who need them and clutter in the hallways is a safety hazard. Imagine if we had to move a patient quickly but the corridor was obstructed by a stretcher!

Anthony has created a new initiative with his people that we should all be following. It’s called “if you see something, say something.” It is everyone’s responsibility not to ignore something that is not in a 6S condition. For example, if a transporter sees trash overflowing, a stretcher in the hallway, or a wheelchair that is not in its proper place, he or she will rectify the situation or call ext. 6800. The transport team is trained to say something when they see something. If they see a stretcher, they will ask the unit if they need the stretcher. If they don’t, the transport team will ask them to log the equipment, run it in Epic, and take the stretcher to its proper destination.

Anthony told me that he and his team believe building relationships with leaders throughout GBMC will build the trust that patient transport will arrive on time. This will encourage others to do their part in making sure the patient is ready when the transporter arrives.

Please join me in welcoming Anthony to his new role and committing to help him create an even more reliable transport system. I would also like to thank Stacey McGreevy and David Brierley for their leadership in this area.

Kudos to our cleft lip and palate team!

Our cleft lip and palate team recently received approval by the American Cleft Palate-Craniofacial Association (ACPA). This recognition makes us one of four hospitals in the state to receive this endorsement.

The ACPA is an international nonprofit association of more than 2,500 healthcare professionals who are involved in the treatment and research of cleft lip, cleft palate, and other craniofacial abnormalities. The ACPA sets industry standards and optimizes the interdisciplinary care of persons affected by craniofacial abnormalities.

This approval is only given to teams with the highest level of training. The ACPA approval is a well-deserved recognition for Dr. Tonie Kline and the rest of the team. It is also recognition of the leadership and hard work of our recently deceased medical director of the program, Dr. Randy Capone. Congratulations to all!

Remembering Dr. Martin Luther King, Jr.

On Wednesday, we hosted our 4th annual Martin Luther King, Jr. Day celebration, which commemorated Dr. King’s life and vision. This year’s program, titled “Songs of Our Soul – We Shall Overcome,” featured our keynote presenter Richard Maurice Smith, Ph.D., associate professor of Sociology at McDaniel College and Lead Pastor of The Movement Church in Howard County, along with live music from the City Neighbors High School Choir.

I am grateful to Jennifer Marana, Ph.D., our Director of Diversity and Inclusion, and my colleagues on the Diversity and Inclusion Council for their hard work on this event and helping to bring us closer together. I also want to thank Dr. Smith, members of the City Neighbors High School Choir, and our Black History Month committee that put together this year’s magnificent celebration!

I encourage you all to send in your nominations for our GBMC Spirit of King Award. This award recognizes an individual who embodies the spirit and life's work of the late Rev. Dr. Martin Luther King, Jr. and who is dedicated to serving their local community, place of worship, child's school, etc. All nominations must be submitted no later than Thursday, January 31. The winner will be announced at the Black History Month celebration in February. Click here for more.

Friday, January 11, 2019

Missing Medications Revisited

It’s been a while since we discussed “missing” medications in this blog. When a nurse goes to administer an ordered and verified medication to a patient and it is not there on the unit, we have a system that is not 100% reliable (reliability = what should happen, happens and what should not happen, doesn’t). Physicians and advanced practitioners order medications and pharmacists verify the order. The verification step is a protection that the medication is of the correct dose, that the patient is not allergic to it or has contraindications to its use, and that it will fit in with the other medications the patient is taking without untoward drug interactions.

We have made huge progress in reducing “missing” medications since 2013, when we first started studying the causes and testing changes to our delivery system. The pharmacy has a two-hour window from the time a medication is ordered to verify the order and deliver the medication to the unit if it is not already stored there. We saw considerable changes once we began studying one unit at a time and looking at each case of missing doses in real time. It’s difficult to tell what happened when looking back in time at an event. It is much easier to do the 5 Whys as soon as a miss occurs. Remember, the 5 Whys process is asking the “why” question FIVE times before you get to the fixable cause of a defect.

Prior to working on improving our system, busy Medicine units could have 30 or more missing medications per day. This has been reduced to 0-3 per day. The most recent work between our pharmacists and units 34 and 35 has resulted in many days with zero missing medications! This is a great achievement.

There are several Pharmacy leaders who oversee this work: Julia West, Assistant Director of Pharmacy, Julia McDonnell, Pharmacy Operations Manager, and Vaishali Khushalani, Pharmacy Medication Safety Officer. The Pharmacy Lean Daily Management (LDM) lead team also communicates with Pharmacy Director, Yuliya Klopouh, and the observations from LDM are used to make practical improvements in the pharmacy. These leaders are also in close communication with the nurse managers to study the defects and, when necessary, change the standard work.

A recent example of improvement involves the transfer of medications between the Emergency Department and inpatient units. The previous process was to send all the patients’ medications with them on transfer. The Pharmacy team worked with Emergency Department Manager, Mark Fisher, Assistant Nursing Director for the ED, Monica Goetz, and Unit 35 Manager, Temitope Oseromi, to create a better process for expanding the stock of medications on the inpatient units and in the Emergency Department. This allows for fewer medication transfers and improves access to and visibility of patient-specific bins. After this change, medication tracking became significantly easier and there was higher accountability between emergency and inpatient units. Now, there are fewer medications missing during the transfer process.

An added benefit of the daily improvement work is the better relationship and collegiality between pharmacists and nurses!
Congratulations Gilchrist!
Gilchrist Care Choices (GCC) is a national test program which allows qualified Medicare beneficiaries who qualify for hospice to continue receiving curative treatment simultaneously. This is being tested under the belief that many people forego hospice fearing their providers will “give up” on them. The idea of the program is that allowing patients to continue curative treatment will allay their fears and encourage many people to choose hospice care sooner. This has certainly been the case with GCC! The program has grown exponentially — since 2017, with referrals increasing by 100 percent. GCC, the fourth-largest program in the country, is one of the first to focus on continually improving internally-developed quality measures. This major achievement in growth from outpatient providers, was highlighted by the Centers for Medicare and Medicaid Services (CMS) in a recent publication. Congrats to Rene Mayo, MSW, GCC program manager, and her colleagues for this recognition!

Friday, January 4, 2019

What will 2019 bring?

I would like to wish you all a very Happy New Year. I hope your holiday season has been filled with good health and joy.

Our healthcare system continues to improve and grow. We have great people who work very hard and we are getting pretty good at designing systems to move us faster towards our vision. We still have work to do, but almost everything we measure under our four aims improved during 2018.

2019 will bring the next iteration of Maryland’s waiver with the federal government and the State has committed to reducing the total cost of care for Medicare beneficiaries. We will have a new tool to help achieve this…the Maryland Primary Care Program. This is part of the plan to create incentives for providers to coordinate their patients’ care.

As you recall, since 2014, our state has paid hospitals via global budgets to dis-incentivize the provision of services that don’t lead to better health or better care. Maryland has lowered the rate of increase in the total cost of care by doing this. Now to reduce the total cost of care, it will be necessary to bring others to the waste reduction table. This new program will provide resources to primary care physicians to improve health and the care experience. Primary care offices will work with Care Transformation Organizations (CTOs) (Greater Baltimore Health Alliance being one of them), to better coordinate care. The CTOs will provide care managers, behavioral specialists, and others to help the primary care team accomplish this. You will recognize that we’ve been doing this in the GBMC HealthCare System for quite some time. The inclusion of primary care practices allows the focus to be more on population health, including other settings of care in communities, rather than relying only on hospitals.

Under our new total cost of care agreement, the State has also committed to work on six high-priority areas: substance misuse, diabetes, hypertension, obesity, smoking, and asthma. So, 2019 should be a year of change towards better care leading to better health for the citizens of Maryland. Thanks to all my colleagues for working hard on this agenda.

The Passing of an Outstanding Physician
I was saddened to hear that Dr. Randy Capone passed away last week. Dr. Capone was an outstanding plastic surgeon who served as the medical director of our Cleft Lip and Palate Team. He worked tirelessly at his craft and under his leadership, the team changed so many lives for the better. He will truly be missed.

Wednesday, December 26, 2018

Validation From A Patient

Readers of this blog know that from time to time, I interview a patient to check in on how we are moving towards our vision of being the community-based true system of care that can deliver on our promise “to every patient, every time we will provide the care that we would want for our own loved ones.”

Recently, I interviewed an inpatient, Deborah Copeland, who is acutely ill and has chronic disease. I had the opportunity to get her perspective on how we are doing to care for her on Unit 34. As you watch the video, you will hear Ms. Copeland validating that her nurses and doctors are going above and beyond in providing the care she needs.

What she did mention to me, though not in the video, is that her patient room is too small. This is a major reason why we are planning the construction of a new 3-story tower that will contain a medicine inpatient unit with state-of-the-art rooms, which will allow us to re-do our older medicine units that have very small rooms. This is all part of our master facility plan.

I want to express my gratitude to Ms. Copeland for allowing me to interview her and share the interview with our readers. I also want to thank all the GBMC team, especially the physicians, nurses, technicians, therapists, and the rest of the staff on Unit 34 who were involved in her care. Great job!


Friday, December 21, 2018

IN THE SPIRIT OF GIVING

This past Tuesday, we hosted an emotional and heartwarming ceremony to announce a generous donation from the Presbyterian Eye, Ear and Throat Charity Hospital Board of Governors that will allow us to expand our Cochlear Implant Center’s services to a larger population of people who need assistance with their hearing loss. 

Our Center is one of the largest community-based programs in the United States and the only community-based program within a one-hundred-mile radius. Led by Dr. Brian A. Kaplan, Chairman of our Department of Otolaryngology, and Dr. Regina Presley, Senior Cochlear Implant Audiologist, our Center does excellent work. This was quite evident when listening to patient stories and watching videos of patients being able to hear sounds that they couldn’t hear before their procedure. Since 2002, the Cochlear Implant Center has helped 900 patients with their hearing loss and has brought the world of sound to more than 500 individuals through cochlear implantation.

The financial support from the Presbyterian Eye, Ear and Throat Charity Hospital will allow us to significantly improve the care to patients and to provide a unique setting for their evaluation, diagnosis, and treatment. The Center, under the new name, The Presbyterian Board of Governors Cochlear Implant Center of Excellence at GBMC, will also provide enhanced treatment options for all patients, from infants to seniors, diagnosed with moderate to profound sensorineural hearing loss, with the highest quality of clinical care, cutting-edge technology and research, and increased staff resources.

We are so grateful for this generous gift and for partners like the Presbyterian Eye, Ear and Throat Charity Hospital Board. Their financial support will help us to make our fabulous program even better.

HOLIDAY SPIRIT
For those of you who attended this year’s annual Employee Holiday Meal, I hope you enjoyed the good food and festivities. This is a GBMC HealthCare system tradition that brings us together. Music filled the air as the members of the GBMC Holiday Choir put on a wonderful lunch-time concert. Thanks to all who did their part to make this year’s event a success!


HAPPY HOLIDAYS
On behalf of the organization, I want to extend best wishes for a safe, healthy, and happy holiday season for those celebrating Christmas or Kwanzaa. Enjoy your time with family members and think about the things that are important in your lives. For those staff members working during the holidays, a special “thank you” for taking care of those who can’t be at home during the holiday season. I am so lucky to be associated with so many wonderful caregivers. In this season of giving, my colleagues give a lot and we are grateful. Merry Christmas and Happy Holidays to all!

Monday, December 17, 2018

Helping Patients with a Rare Disease

On Friday, December 7, we announced the naming of a new center that will help patients with Alstrom Syndrome (AS). A rare disorder caused by a genetic mutation, AS has devastating effects including blindness, deafness, and ultimately multi-organ system failure, and premature death.

The Jan D. Marshall Center of Excellence at GBMC is the first center in the nation to focus on AS. It was created thanks to a gift from Alstrom Syndrome International, whose mission is to help those afflicted and to search for a cure for the disease. Clair Francomano, M.D., Geneticist and Director of Adult Genetics at the Harvey Institute for Human Genetics, was close friends with the late Jan D. Marshall, co-founder, long-time board member, and the first Chair of the Scientific Advisory Board of ASI, who imagined a better life for children battling AS.

Since 2015, GBMC has been the home of a semi-annual multidisciplinary clinic for AS. Children come from around the world with their families to seek treatment, learn about the disease, and meet others who are living through it. Our partnership with ASI has not only provided comprehensive clinical care for patients, but also professional education for physicians and research regarding the causes of this debilitating disorder. The Jan D. Marshall Center of Excellence will continue to focus on helping those affected and search for a cure for Alstrom Syndrome.

Please join me in celebrating the founding of the center and in congratulating Dr. Francomano for being named the new Chair of ASI’s Scientific Advisory Board.

Nurse Residency Program Recognized by the American Nurses Credentialing Center

GBMC HealthCare is proud to announce that our nurse residency transition to practice program is now accredited with distinction by the American Nurses Credentialing Center (ANCC). This is the highest level of recognition awarded worldwide for programs that demonstrate excellence in continuing nursing education. GBMC is the only hospital in Baltimore to receive this accreditation, the first in our Maryland state nurse residency collaborative, and only the 61st to earn it globally.

I would like to recognize JoAnn Ioannou, DNP, MBA, RN, NEA-BC, Senior Vice President of Patient Care Services, Chief Nursing Officer and the following members of her team for their continued dedication and for earning this recognition: Lynn-Marie Bullock, DNP, RN, NEA-BC, Director of Professional Practice; Jennifer Spahn, MSN, RN, NEA-BC, Clinical Program Manager-Nurse Residency, Theresa Di Seta, MSN, RN, Education Specialist-Nurse Residency, Roxann Hurkamp, BSN, RN, CCRN, Education Specialist-Nurse Residency; and Lauren Raynor, MS, RN, Education Specialist- Nurse Residency.

Friday, December 7, 2018

An Outstanding Colleague Leaves Private Practice and Joins GBMC HealthPartners

Earlier this week, I spoke with our new GBMC colleagues at employee orientation. I gave the opening welcome and talked about the parts of our organization and how they fit together as a community-based system of care. I explained our mission and our values, and how we are owned by the community. I explained to our new people that the Board of Directors are the members of the community who oversee me and the rest of our team in the fulfillment of our mission of health, healing, and hope. I told our new colleagues how the Board held a visioning retreat in late 2010 that created our plan and that we have been implementing this strategic plan ever since. We are now a system that is designed to provide the care that we want for our own loved ones as defined by: the best health outcome and the best care experience, with the least waste of resources and the most joy for those providing the care. I did this because it is important for our new people to be enrolled in this vision as they are beginning their careers with us.

Among the people that I welcomed at orientation was someone who is not a new colleague. He has been with our system for quite some time, but he is moving from the private practice of medicine to employment with GBMC Health Partners. He is Jon E. Simon, MD, a double board-certified physician in Pediatrics and Internal Medicine. He attended medical school at the University of Maryland and completed his residency training at the University of North Carolina Hospitals in Chapel Hill, NC. He has been practicing primary care in Baltimore since 1998 and will now be joining our advanced primary care practice at Hunt Manor.

Given Dr. Simon’s transition from private practice to an employed Health Partners physician, I thought it would be a good idea to get his thoughts on the transition, the joys, and challenges of private or employed practice and to learn why he chose employment with GBMC.

Q:  Prior to joining GBMC Health Partners, you owned your practice. What factors led you to switch to employed practice? Are other physicians faced with the same issues and how would you counsel them to proceed?
A:  "For years, I have enjoyed my solo private practice, which included seeing patients of all ages, as well as going to the hospital to see newborns and hospitalized adults. I read about so many of my primary care colleagues around the country experiencing burnout, and while I have never felt that in my career, I expect that many changes in healthcare in the next 5-10 years would add excessively to my administrative burden; I was looking for a way to help manage the administrative aspects of practice."
 
Q:  There are positives and negatives associated with being an employed physician and with being in private practice. Can you briefly describe the advantages, disadvantages, and similarities that you see in these roles?
A:  "The advantage of a private solo practice was in allowing me to have total control over my schedule, my employee wages, my office setting, etc. If I know that a certain patient needs an hour of my time, I can make that happen. If an unexpected number of patients need same day appointments, I can make that happen. I place a high value on making sure the patients have a good experience (are seen on time, don't feel rushed, get their phone calls returned, get same-day appointments, etc.). As an employed physician, I will need to rely on other people to make all those things happen. At the end of the day, being a primary care pediatrician/internist is about the experience of taking care of patients, regardless of the practice setting. The professional satisfaction comes from that experience in the exam room with the patient."

Q:  You’ve just described some of the advantages and disadvantages to employment versus private practice. I’m guessing that ultimately, it's up to the individual physician to decide what they want most. What did you want most and why did you decide to move to employed practice? Moreover, why did you choose GBMC Health Partners?
A:  "As a solo pediatrician/internist, I was the only doctor in the office. However, I was also responsible for administering all the immunizations, doing EKG's and spirometry, as well as managing the payroll, accounts payable, laundry, maintenance and repair, and IT support. Those secondary roles have been very gratifying, but that gratification can't last forever! In choosing to return to an employed group practice, I was looking for a way to keep the joyful parts of patient care and to lessen the burden of those secondary roles. I also am looking forward to having my patients benefit from the team-based approach of GBMC Health Partners. I have been on staff at GBMC for 18 years, and I trust the organization and respect the leadership. GBMC was not always skilled at running outpatient practices, but they have improved a great deal, and have committed to and invested resources in primary care practices especially."

Q:  The switch from private practice to a salaried position can be a complex decision. There were various factors that you had to consider. Are your colleagues in private practice dealing with the same issues? How might you advise them if they are considering making a similar transition to employed practice?
A:  "I can't really address what colleagues are going through, though I suspect that there are very few out there still in private (especially solo practice). For many years, I have noticed that there are few if any physicians younger than myself going into private practice. I am 51 and was still the youngest one I know of."

Q:  Whether a physician chooses to be employed or in private practice, what are a few tips you’d share on how to thrive in either work environment?
A:  "It is very easy to let the administrative hassles of your job get to you. There is a high degree of physician burnout in primary care, but it doesn't have to be that way. We should all recall that every day we come to work, we will make a difference in somebody's life. For me, whether it is seeing a newborn in the hospital, or helping patients in the office with complex or even simple problems, the patients are grateful to have a physician on whom they can rely. Keeping this basic fact in mind will help us all thrive as physicians, regardless of the practice setting.

Q:  What are you looking forward to the most in working for GBMC Health Partners and what will you miss the most in not working in private practice?
A:  "I will miss the intimate setting of my small office, the very personal, welcoming venue that allows me to be very close to my patients and close to the business as well. Though it sounds a bit crazy to hear myself say it, at times I enjoy answering the phones, making appointments, and running patient payments through the credit card machine. Having been in solo practice for the last 16 years, I wouldn't exactly say that it was lonely, but I can say that I am really looking forward to working with other physicians at Hunt Manor! There are a few physicians whom I already know and have great respect for, and there are others whom I do not know but am looking forward to getting to know."

I am so grateful to Dr. Simon for his willingness to give us his insights. Please join me in welcoming him in his new role! We are delighted that he is a teammate in our system of care.