Friday, April 24, 2015

Recognizing Our Leaders: The Celebration Continues

This week we continued our 50th Anniversary Celebration with our Because of Leadership Event A Tribute to our Visionaries, Founders, Leaders and Benefactors. At the event were representatives of our founder organizations, members of our Virginia Sherwood and Kroh Societies, current and present HealthCare and Gilchrist Board members, members of the Philanthropy Committee and many other people from the community who have been important in the history of GBMC. We recognized three acts of leadership: service, innovation and philanthropy. Jamie Costello the nightly anchor of ABC News 2 –WMAR served as the master of ceremony and Cal Ripken, Jr. gave an excellent address on leadership.

Among the highlights of the evening were the playing of the tape recording of the invocation given by Reverend Richard H. Baker at the dedication of the hospital in 1965 and a video celebrating GBMC’s founding that included the voices of Milton and Dwight D. Eisenhower, the former President of the United States. The evening was a wonderful event and a great opportunity to celebrate our leaders past and present.



Central Sterile Processing

Last month we began the work to protect our operating rooms and central sterile processing from electrical outages like the ones that caused the cancellation of numerous surgeries last summer. The first step was to relocate the central sterile operations to a temporary location in order to rebuild the department and to add heating, ventilation, and air conditioning (HVAC) upgrades to improve the temperature and humidity controls.

Since then, temporary CSP trailers, compliant to The Joint Commission (TJC) and Centers for Medicare & Medicaid Services (CMS) standards, have been stationed in the Bluebell parking lot.  These trailers are equipped with similar state-of-the-art equipment to what we have had in the main department to assure that all of our surgical instruments are processed according to our high standards.

As most folks may or may not be aware, the CSP department plays a vital role in reprocessing reusable devices (primarily surgical instrumentation) for GBMC. Currently, the construction is on target with an estimated completion date of Friday May 3, 2015. CSP staff will be able to reoccupy the space beginning Wednesday May 6, 2015.

Please join me in thanking Steve Adams, the Manager of Central Sterile and his Team for their outstanding work. 

Thursday, April 16, 2015

GBMC has the Top Nurses!

On Wednesday evening, I had the privilege of attending Baltimore magazine’s dinner reception saluting 50 of the region’s top nurses for their contributions to healthcare.  I am proud to say that the GBMC family was well represented with SEVEN of our registered nurses being recognized by their peers for outstanding care in FIVE of 18 different specialties.  Having our nurses represented (7/50 = 14% of the winners!) on this list is evidence of what we already knew – our HealthCare system has the best nurses!

Please join me in congratulating the following nurses:
Cynthia Arnold, CRNP Pediatrics/Neonatal
Amanda Hindle, RN Pediatrics/Neonatal
Jaclyn Mueller, RN Emergency Department
Marla Newmark, RN Pediatrics/Non-neonatal
Ganotong Tongprom, RN   Medical-Surgical Nursing
Carol Hay, RN – Gilchrist Hospice Care Hospice/Home Health/Palliative
Kristin Metzger, RN – Gilchrist Hospice Care Hospice/Home Health/Palliative

I’ve been at GBMC for almost five years and I have learned how talented and hard working our nurses are.  I’ve also had the opportunity to see, each and every day, their true dedication to our patients and our vision.  Our nurses and nursing support technicians are the face of GBMC. They spend the most time with our patients and are critically important members of the healthcare team. Their untiring work in improving patient safety and redesigning systems to improve care has been remarkable.

Once again, congratulations and thank you for your hard work and dedication!

The inaugural “Top Nurses” issue will hit the newsstands soon.  Please make sure you grab your copy!

This week we are celebrating National Volunteer Appreciation Week. As you may know, with more than 900 volunteers in the hospital and at Gilchrist Hospice Care, GBMC has one of the largest volunteer auxiliaries in Maryland.  Over the last 50 years, our volunteers have donated more than 2.4 million hours of service and raised more than 20 million dollars to support patient care at GBMC.

I must admit, we have the best group of volunteers in the state.  I am always struck by how, to the average person, they seem so joyful in their service to our patients.  I meet them in our hallways and by the front desk, but, no matter where I walk within our hospital, I am proud to say that I am always greeted by at least 3 or 4 smiling volunteers.

I am so grateful for all that they do, from the smiles they share, to their dedication and commitment to our health system and our patients. Please take the time to say “thank you” for all they do.


Speaking of Baltimore magazine:  That’s right! It's that time again - Baltimore magazine is collecting votes for its best selling TOP DOCTORS issue.  Please vote for the doctors you most respect!  Remember, Top Doctors voting is done by physicians only.  The survey may be found at: http://www.baltimoremagazine.net/about/top-doctors-survey

Join the GBMC 50th Team for the Baltimore Aids Walk & Run on Sun., May 3rd
I am still looking for GBMC colleagues to join team GBMC 50th.  This squad is slated to participate in the AIDS Walk & Run on Sun., May 3rd.  The walk and 5K run is taking place at the Maryland Zoo in Baltimore to raise money for AIDS awareness and testing.  Again, please consider coming out and walking or running with me as another fun way to celebrate our 50th Anniversary and give back to our community.  If you want to get some exercise that morning or lend financial support (or both!), click on this link and follow the directions under “Join a Team”: https://www.kintera.org/faf/teams/registerTeam.asp?ievent=1112368&lis=1&kntae1112368=C5F4F766B96543009F1092421D8EC1D9&teamAction=join

Friday, April 10, 2015

Gaining Recognition for Excellence

About a year ago, I was speaking with Mark Lamos MD, the Medical Director of Greater Baltimore Medical Associates, and the heart and soul of our advanced primary care strategy, and I was concerned that we would not be able to attract outstanding primary care physicians, nurse practitioners and physician assistants fast enough. To truly be able to coordinate care across our community we needed more outstanding clinicians to add to the ones we already had, both as employed and private practicing doctors and mid-levels. With a new recognition of the value of primary care, how would we ever be able to do this with everyone looking for these providers?

Was I ever wrong! What I did not realize was that since we were building patient-centered medical homes that helped the physicians and mid-level providers do what they were trained to do and loved to do, they would flock to us. This week, there were a bunch of news stories about other companies opening new primary care offices. But their model had not changed…limited hours of operation, no embedded care managers and no hope for the providers to truly have a team to help them get the job done. Providers running as fast as they can where the goal is to churn as many visits as they can is not attractive to those looking for a job these days.

Our model, on the other hand, which is focused on the measurable outcomes of better health, better care experience, and less waste, thereby allowing the provider to have more joy in their day is what primary care clinicians are looking for. They want the help of the care managers and the rest of the team to do things like improve the diabetes composite score of their patients to make them live longer and healthier lives! They want to work in a system that is available for people when they have a need and doesn’t use the emergency department as the pathway of least resistance. An example of how attractive GBMA advanced primary care now is to physicians can be found in the fact that all 3 current Chief Residents of the University of Maryland Family Medicine Residency Program will be joining us this summer! They are: Janna Becker, MD who will be joining our Hunt Valley practice; Peter Burkill, MD who will be joining Family Care Associates in the North Pavilion; and Margaret Sass, MD who will be joining our Perry Hall team. One of their mentors, Dr. Kevin Ferentz, recently joined us as the lead physician at our Owings Mills practice. And we have other great new colleagues either recently arrived or coming:

Lisa Carey, DO Medicine/Pediatrics (Hunt Manor)
Deanna Shapiro, PA (Hunt Manor)
Elizabeth Shemin, NP (Texas Station)
Kevin Carter, MD (Owings Mills)

I am also excited that our Greater Baltimore Health Alliance colleagues from Jarrettsville Family Care, Linda Walsh, MD, Mary Elizabeth Craig, MD and physician assistants Bridget Diehl and Kristen Jubb, have decided to become employed by GBMA as well!

So, if you need a primary care provider or if you know someone who does…you have a lot of great choices! It is wonderful to be recognized as the system of choice for outstanding primary care physicians, nurse practitioners and physician assistants.

Opening Day Fun!

It would not be an Opening Day in Baltimore without Orioles gear at GBMC. Please check out pictures from today's celebration at the Sandra and Malcolm Berman Cancer Institute!


Thursday, April 2, 2015

Our Culture of Safety: A Colleague Speaks Up

In last week’s blog, I used the example of our volunteers in the GOR waiting room reminding me to wash my hands as an illustration that our culture of safety was improving. The fact that volunteers or others would feel comfortable stopping a senior executive is a great example of people feeling secure to do the right thing.

Well, one of our colleagues read the blog and sent me an email. Her message was clear (although she did not use these precise words): “Not so fast! We still have those that abuse their position on the authority hierarchy. Our safety culture needs more work”. She told me of instances where a very few physicians were still getting angry when a staff member, usually a nurse, stopped them if they were going to deviate from a procedure designed for safety. Our colleague was concerned that even a manager who confronted a physician who didn’t want to follow the rules would be at risk for retribution by administration.

I met with our colleague directly to reassure her that no one would suffer retribution if they “stopped the line” to get the safe practice followed. I also met with the manager who reassured me that she believed that she was safe in confronting anyone who wouldn’t follow a safety procedure but she was getting a bit tired of confronting a very small number of individuals.

I again thanked the manager for her hard work and I reassured our colleague that we would get all of our leaders involved and if individuals persisted in acting up, that there would be further action.

I know that almost all of our physicians and nurses are marvelous collaborators who treat their colleagues with respect every day. And I also know that the evidence is not always crystal clear and that there is room for honest debate about some of our safety procedures. We want our clinicians to speak up if they think a rule needs to be changed. But everyone needs to know that we shouldn’t debate the rule at the bedside of an individual patient (unless of course we have evidence that following the rule will hurt that patient). The correct approach is to follow the rule in the moment and then meet with the leader who can change the procedure. Those leaders are usually our clinical department chairs, our physician service line leaders and our nurse managers and directors working together as a team.
 
I did not intend last week to suggest that our culture of safety is now perfect – it clearly is not – but we have made progress. Now, we must unite as a family to make the culture even better to protect our patients and ourselves. We must respect those with differing opinions and channel them to effective forums where their voice can be heard and when appropriate, the procedure changed. But we must simultaneously stop abusive behavior even if the abuser believes that their intent is pure. We must always make it safe and comfortable for people to speak up.

National Doctors’ Day
This past Monday (Mar. 30th) was National Doctor’s Day. This is the one day of the year that we reflect on the many contributions made by our physicians. I want to thank all the doctors on the GBMC medical staff who work extremely hard to care for patients as they would want their own loved ones cared for. We have physicians throughout our healthcare system that are making a tremendous difference in the lives of patients every day.  From the surgeons and hospitalists to the ED physicians, primary care doctors and specialists all throughout GBMC, thank you for caring for patients and their families.

Town Hall Meetings
Starting next week, through the end of June, we will be holding a series of Town Hall Meetings. These meetings present an opportunity for direct and provide an opportunity to ask questions, raise issues and share ideas.  All are encouraged to attend a meeting!  The value of these meetings is directly related to your participation so we look forward to seeing you there! For more information please visit http://infoweb/body.cfm?id=23&action=detail&ref=614

Happy Holidays
On a final note, the GBMC HealthCare family sends its best wishes to everyone celebrating Easter this Sunday and the eight-day festival of Passover.

Friday, March 27, 2015

Evidence of an Improved Culture of Safety

A marvelous thing happened on Lean Daily Management rounds today. My LDM Team is “Team A.”  Deloris Tuggle and I are the senior leaders on this team. Deloris was away today, so Kevin Creaby, our Manager of Benefits, was standing in for Deloris and we were accompanied on the walk by Ishmel Fulton, our new Lean Facilitator. We were on our way to the PACU board, rounding the corner, passing the family waiting room desk for the General Operating Room, when we heard: “Gentlemen, stop! You must clean your hands before entering the PACU!” I turned to see that this message had been delivered by one of our superb volunteers. She and a colleague were looking at us with smiles on their faces, but, they were not kidding. We thanked them for the reminder, cleaned our hands, and proceeded into the PACU.

Readers of the blog may remember my posting: A Just Culture Fosters a Safer Culture (Dec. 11, 2013) http://ahealthydialogue.blogspot.com/2013/12/a-just-culture-fosters-safer-culture.html. In that blog post, I spoke about the Tenerife crash, the worst disaster in the history of commercial aviation, where the belief is that the two co-pilots could have prevented the event, but they were afraid to say anything that might upset the captain. The unwillingness of “subordinates,” people lower down in the organizational hierarchy, to speak up is a detriment to safety and a sign of a poor safety culture. So, as we were entering the PACU after having cleaned our hands, I was really delighted that volunteers felt comfortable speaking up to the President and CEO of the organization. I was very proud of them and happy that we are making progress towards our vision!

Continually Improving Lean Daily Management

Lean Daily Management (LDM) has been a huge success for GBMC HealthCare. But there is always room for improvement. The Senior Team has been studying the groups that make the most improvement to find ways to help others. When the local manager and his or her team understand that LDM is about problem solving, much more improvement happens as opposed to groups that act as if telling the story of “red” or “green” is the end. We on the Senior Team now see that in our zeal to “help” by asking questions about the specific problem, we may actually be slowing down the problem solving.

On the LDM walk, some teams are celebrating when a metric is “green” even though they have not changed anything since it was last “red” and they apologize when the performance is “red.” We frequently have to remind them that if something is “green” but nothing in the process was changed that it is likely to return to “red.”

I have written before in this blog (http://ahealthydialogue.blogspot.com/2014/04/red-is-not-badge-of-dishonor.html) about how “red” should not be looked upon as being bad – it is merely an opportunity to problem solve so there is no need to say that they are sorry or feel that they have to defend themselves.

The job of the Senior Team is to hold managers accountable and ask questions to generate problem solving, NOT to offer advice to fix the specific problem.  The Senior Team must make sure that the manager and the unit or department have what they need to get the job done and then say thank you.

So, we on the Senior Team have committed to ask questions like “What have you learned?” and “What are you going to try next and when?” and not get involved in suggesting fixes. This should help us get more out of a tool that has already been immensely helpful! What do you think? I would love to hear your thoughts.

Friday, March 20, 2015

It Takes The Whole Team to Meet Our Patients’ Needs

I recently had an experience with a loved one in a hospital in another state that really bothered me. I went to visit my family member who was a very sick inpatient, and he told me that earlier in the day he had had a very acute need. He had pushed his call button to get help, but unfortunately, no one came to his aid for more than an hour.

It wasn’t that the staff in that hospital didn’t care. My relative’s nurses were very polite and hard working, but, they were also very busy. It was clear to me that there was no real sense of collaboration. The unit secretaries, housekeepers, nursing support technicians, other nurses and even the occasional administrator who came to the unit did not see responding to the call light as part of their job descriptions. I also got the sense that there was no attempt to anticipate my relative’s needs. When someone came into his room, they had one thing in mind. They did that one thing and that one thing only, and then left the room. In that hospital, my loved one did not get the care that I wanted him to get.

I wondered if this could happen at GBMC? I know how hard our nurses and support technicians work and that our patients – especially the very sick and elderly – have many needs. I asked myself the question, “Did I always go to answer a call light when I was a practicing physician on the unit if the staff was busy doing other things?” The answer was clearly that I did not.

I was very happy to hear of the rollout this week of the GBMC “NO PASS ZONE” (NPZ), a new hospital policy regarding how our clinical and non-clinical staff respond to our patients in need. If an alarm goes off or a call bell light is seen and/or heard, someone – even a nonclinical employee – will respond immediately. The concept of an NPZ has helped prevent falls and aid workers in responding more quickly to patients in need when it has been implemented elsewhere.

How does the NO PASS ZONE work? If you see a call light on, you CAN do the following for a patient:

  • Reposition the call light, telephone, bedside table, chairs, trash can, tissues or other personal items within reach.
  • Assist with making phone calls or answering the telephone.
  • Change TV channels or turn the TV on or off.
  • Turn the lights on or off.
  • Obtain personal items such as blankets, pillows, towels, washcloths, toiletries, pens, pencils, books, magazines, etc.
  • Reduce clutter.
  • Perform and encourage hand hygiene.
  • Alert the clinical staff for all clinical needs.

We should always use AIDET communication standards (Acknowledge, Introduction, Duration, Explanation, Thank You) upon entering the patient’s room. If you need a reminder about the AIDET communication standards, they are listed and explained on the small Service Excellence and AIDET card behind your GBMC badge.When entering an isolation room, we must also follow the proper personal protective equipment (PPE) requirements which will be displayed outside of the room.  If you do not have an AIDET badge please contact Courtney Hendon in Service Excellence.  She would be more than glad to provide you with one.

I know that some of my non-clinical colleagues are nervous about assisting a patient, but there is no expectation that a non-clinical person do anything clinical. Everyone can help meet the patient’s other needs or get help from a clinician if the problem is clinical. It takes the whole team to work together to get the job done. Thanks in advance for making NPZ work!

Thursday, March 12, 2015

Gray and Son Construction and GBHA – A New Partnership for the Quadruple Aim

The United States has one of the most complex health insurance systems in the world. An individual could be covered through a governmental program like Medicare, Medicaid or the Veterans Administration; they could be covered because their employer buys a health insurance plan for them or they could buy their own health insurance policy. In addition, many of us are covered because our employer pays our healthcare bills directly. I get coverage through GBMC. GBMC does not actually buy health insurance for its employees….it pays the bills for care as they come in. We contract with a company that handles the payment and we buy what is called “stop loss” insurance for very large claims. So we are able to say that GBMC is “self-insured”. We are not alone in this practice. Most larger companies are self-insured.

It is in the interest of the self-insured company to get the most value for the healthcare dollar spent. But until now, most companies didn’t pay much attention to what they were paying for a service. It was almost as if the employer was assuming that all services were the same, no matter who the provider was and that the costs were about the same. Well we know that this is not true. Some providers of care can charge as much as 60% more for the same service and the quality of the care received is not always the same.

So a few weeks ago I was very happy to meet with many of the employees of Gray and Son Construction.   Gray and Son is a leading contractor in the Baltimore area for both private and public projects, specializing in paving, excavating, utilities, and soil stabilization. It is a family-owned business steeped in tradition that dates back to 1908. I learned that the company intends to remain independent and looks out for its people. I realized that GBMC HealthCare and Gray and Son had a lot in common-both are local, independent- and relatively small, giving both companies an agility that makes it easier to get the job done and provide greater value to those that they serve.

Gray and Son saw the value that the Greater Baltimore Health Alliance could provide. They understood that advanced primary care with a team of caregivers led by a physician that was available and accountable could help them with prevention and the management of chronic disease. They knew of the great specialists at GBMC and that our outstanding hospital is lower cost than most in the area. Gray and Son learned of GBMC’s success in keeping the healthcare of its employees within the GBMC family while lowering out-of-pocket costs to its employees and they decided to do the same. So, Gray and Son employees will now have a “GBMC tier.”  If they use GBMC doctors and GBMC facilities, they will pay less. We will deliver improved clinical outcomes and better care experiences, showing them that we believe providing healthcare is a joyful pursuit.

Please join me in welcoming the people of Gray and Son into this partnership for better health and better care with the least waste and the most joy for those providing the care….our quadruple aim!

THANK YOU TO OUR SOCIAL WORKERS!!!

March is Professional Social Work month and I want to thank our dedicated group of social workers (pic below) who serve GBMC.  I am constantly impressed and humbled by the creativity and determination of this group. Our social workers carefully arrange for care of patients after they leave the hospital. Our social workers and care managers have helped GBMC reach the lowest readmission rate in the state and have designed a system that assures that our patients with advanced illness receive the continued support they need after they leave our hospital. Please take the time to say “thank you” for all they do.