Friday, August 28, 2015

Make Sure Your Voice is Heard

With the August 31st deadline quickly approaching, I wanted to kindly remind you all to do your part and complete our annual Employee Engagement and Safety Survey.  The survey can easily be accessed through the icon on any GBMC desktop computer (see pic on right) or by clicking on this link http://survey.confirmit.com/wix/p3074660416.aspx

This year, the survey company, Press Ganey, will know who completed the survey so that your response can be assigned to the appropriate unit or department. But Press Ganey will not give any identifying information to anyone at GBMC. Your individual responses to the questions will not be shared! If you do, however, choose to include additional comments, these will be shared with your manager, but, your name will not be given.  Again, identifying yourself is important to ensure that your responses are appropriately linked to your department.

If you want to be included in a weekly drawing for a $100 prize, be sure to enter your name after you complete the survey.

Please complete the survey.  We use the information to see what we can do to make GBMC a better organization in which to work and a safer healthcare system for our patients. Thanks!

Tuesday, August 25, 2015

How Do You Want Your Mother’s Care to Be?

We are working towards our vision of becoming the healthcare system where everyone, every time, is treated the way we want our own loved ones treated. The most important thing that we want when our loved one is sick is the best possible health outcome. But the second most important thing we want is the best possible care experience. We want our loved ones to be well informed by people who care; we don’t want long waits and delays; and we want the care in a clean, respectful environment.

About a decade ago, the federal government began requiring hospitals to ask their patients a standard set of questions after discharge so that patient satisfaction could be compared across hospitals. This system is called the Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS. http://www.gbmc.org/body.cfm?id=2216

The HCAHPS survey asks discharged patients 27 questions about their hospital stay. The survey contains 18 core questions about critical aspects of patients' hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and would they recommend the hospital).

So, the HCAHPS scores are the answer to the question “Are we getting closer to our vision under the aim of better care?” Another way to look at it is “Would you bring your mother to GBMC rather than another hospital because the evidence was that she would be always treated with respect and kindness?”

Some people argue that we should not pay attention to patient satisfaction scores because they are not often correlated with outstanding clinical process and health outcome measures. I think that this is silly. Health outcomes and care experience are two separate dimensions. If for a given hospital they are not both excellent, it just means that the hospital is not effectively working in one or the other or both. It clearly does not mean that being excellent in patient satisfaction causes worse clinical outcomes!

So where do we stand? Well, our overall score has been about average over the course of the last fiscal year. We clearly have work to do because we don’t want our loved ones going to an average hospital. But it is not because our people don’t work hard or don’t care. Our staff works very hard and they do care. When our scores are not excellent it is because our systems need some work. One of our dis-satisfiers is waiting for discharge. Why do patients wait so long after being told that they are ready to go home? It is because we have not designed a system to get the work done expeditiously. The doctors and nurses are working very hard doing other things.

I don’t think that we have done a good enough job enrolling our people in this care improvement work. We have not clearly stated what we are trying to do and given our staff time to discuss it and declare after the discussion that they will be fully engaged in this work. This is our biggest obstacle to improving the care….having the staff not see it as a burden but as a way to not only make the patients happier but to also make their work easier.

We have begun to hold focus groups in our departments and units to foster the enrollment process. The staff is being asked questions like:  “What are the barriers you find when you are trying to provide care to the patient that you would want for your own loved one?”

It doesn’t take long in these discussions before someone raises the question about staffing. It is unreasonable to think that we can do the work well if we are overwhelmed. We must make sure that we have the right number of workers to get the job done. But, we also need to make sure we get rid of wasteful steps to make sure that we are not bringing in more staff to do rework. An example of this is the “missing medication” problem that we have made such great progress on. I am still concerned that nurses are spending too much time looking for medications that they need. If they are spending a lot of time on this, it is not a good idea to bring in another nurse so that we can get all of the nurse work done. It is much better to unburden the nurse of the rework of calling the pharmacy multiple times and then giving the medications late.

Please get involved in improving our care to patients. It isn’t about the HCAHPS score, it’s about giving everyone what you want for your loved ones. Thank you for your hard work and please let me know what you think.

Congratulations to our team at the Sandra and Malcolm Berman Cancer Institute, who under the direction of Dr. Gary Cohen, were among 20 accredited programs nationwide to receive the mid-year 2015 Outstanding Achievement Award (OAA) from the Commission on Cancer (COC) of the American College of Surgeons.

According to the COC, award criteria are based on qualitative and quantitative surveys conducted during the first half of the year and the purpose of the award is to raise the bar on quality cancer care, with a goal of increasing awareness about care choices for cancer patients and their loved ones. In presenting this award, the COC recognizes the outstanding quality of cancer services that the Berman Cancer Institute continues to provide to our patients.

Earlier this summer, our Sandra and Malcolm Berman Cancer Institute and Sandra and Malcolm Berman Comprehensive Breast Care Center along with its affiliated Advanced Radiology Breast Imaging Center were all given a three-year, full accreditation with commendation designation from the American College of Surgeons.

Please thank all of our team involved in the care of cancer patients and congratulate them on these deserved recognitions!

Friday, August 7, 2015

Making GBMC A More Diverse And Inclusive Company To Work In

Over the past nine months, a group of GBMC employees has been meeting to begin to discuss how to make our system an even better place to work. The Diversity and Inclusion Task Force, led by Deloris Tuggle, Vice President of Human Resources, Bonnie Stein, Chair of the GBMC HealthCare Board, and me, has been discussing how to make our workforce more diverse at all levels and representative of the community we serve. In addition, the group has been discussing how to make everyone feel “included.” The best companies not only hire people of diverse characteristics and backgrounds, they also work intentionally to make their people  feel welcomed and not isolated.

The Task Force has created a draft Diversity and Inclusion Plan for this fiscal year and is presently interviewing candidates for the Director of Diversity and Inclusion position within our Human Resources Department.

It is often said that an organization cannot achieve its vision without a fully engaged workforce. To get everyone fully engaged, everyone must feel included. You will hear more as we find our new Director and begin acting on the plan over the next few months.

We get what we tolerate.

I threw a temper tantrum on Monday morning. I was walking down the hall to our first stop in Lean Daily Management when I came upon a stained floor where something had clearly dripped from a trash bag or trash cart from Unit 38 all the way to a closet outside of Radiology. Many GBMC employees were walking on the dirty floor (and had walked on it for a number of hours from the looks of the stain). I was upset for two reasons: the first was that we have not learned to get rid of trash carts with holes in the bottom - or we were still transporting bags not in carts; and the second (and more concerning thing) was that many of my wonderful GBMC colleagues had walked on the floor after the spill but had not taken action to get the mess cleaned up. What if your mother was sick and you were escorting her to Radiology along that corridor and she had seen the filthy floor? How would you feel? How would she feel?

Whose job is it to get the floor cleaned up?

I went and found an environmental services worker who gave me a mop and I began to mop the floor. Within minutes many people came and told me that I should not have to clean the floor and an environmental services crew took over and made the floor look beautiful. I have no problem cleaning the floor and I don’t mind pitching in when everyone is busy. That is not the point. The point is that no one should walk by a dirty floor. The first action is to call housekeeping and expect that the floor is cleaned expeditiously. If it cannot be cleaned by EVS quickly, then I believe that everyone should be ready to grab a mop. If we look the other way when we find things that are not the way we want for our own loved ones, then we will get more of what we tolerate – in this case dirty floors. What do you think?

2015 Employee Engagement and Safety Survey
 

Please complete our annual Employee Engagement and Safety Survey.  The survey is open through Monday, Aug. 31 and can easily be accessed through the icon on any GBMC desktop computer (see pic on right) or by clicking on this link http://survey.confirmit.com/wix/p3074660416.aspx
And, if you want to be included in a weekly drawing for a $100 prize, be sure to enter your name after you complete the survey.

Identifying yourself is important to ensure that your responses are appropriately linked to your department. The survey is completely CONFIDENTIAL, and your individual responses to the questions will not be shared! If you do, however, choose to include additional comments, these will be shared with your manager but your name will not be given.

Please complete the survey so that we can learn what we can do to make GBMC an even better place to work. Thanks!

Monday, July 27, 2015

Growing Surgery at GBMC

GBMC has always been a great surgical hospital. We have always had outstanding surgeons, nurses, physician’s assistants and technicians and they work very hard. Since the downturn in the economy and employers putting higher co-pays and deductibles in their insurance plans, there has been a reduction in the rate of many elective procedures. This, coupled with the fact that Maryland hospitals are now paid on the basis of a global budget, has given some people the impression that GBMC is not interested in attracting new surgical patients. Nothing could be further from the truth.

GBMC wants every patient in our community who needs surgery to have their procedure at GBMC if we are capable of providing it. Under the leadership of our Chair of Surgery, Dr. Jack Flowers, the Surgery Service Line has been strategizing to continue to improve the quality and efficiency of surgery at GBMC and to attract new surgeons and new patients.  Many will recall that last summer, after storms knocked out the electric power at both GBMC and St. Joseph’s, both institutions had to cancel surgeries. Since then, GBMC has spent close to $3 million to upgrade and reroute our ventilation and air conditioning systems and connect our generators to the systems maintaining cooling and humidity control to the operating rooms and our central sterile supply areas. We have had at least one power outage this summer but surgeries were not affected by the storm because we are now prepared.

We are beginning a study of our operating rooms to make them more efficient and make it easier for the staff to get the work done. We are also adding surgeons to our team in growth areas.

Just this month, a new bariatric surgeon, Gustavo (Gus) E. Bello, MD, hit the ground running in our Comprehensive Obesity Management Program.  Dr. Bello completed his residency at the Pennsylvania State Milton S. Hershey Medical Center where he served as chief resident in General Surgery.  Prior to joining GBMC Dr. Bello served as the Medical Director of the Uniontown Hospital Weight Loss Surgery Center.


Todd M. Melegari, MD, recently joined the Orthopaedic Specialists of Maryland practice at GBMC. Dr. Melegari earned his medical degree at MCP Hahnemann School of Medicine and he completed his residency at the University of Medicine and Dentistry of New Jersey.   Dr. Melegari is board-certified in Orthopaedic Surgery and was previously employed with Easton Orthopaedic Group at Coordinated Health in Pennsylvania.

Please join me in welcoming Drs. Bello & Melegari to the GBMC family.

New Physician Leaders at GBMC

Alex Munitz, MD, GBMC’s Chair of Radiology and Phil Komenda, the Director of Imaging and Cardiac Services have announced the appointment of Ethan Spiegler, MD, FACP as medical director for the Division of Nuclear Medicine and John Werner, MD, DABR, as medical director for Interventional Radiology.

Dr. Spiegler is a well respected and highly regarded physician in the Nuclear Medicine field.  He was instrumental in bringing PET CT imaging into the community setting by overseeing and directing the first units with Advanced Radiology and St. Agnes. He was co-author of the ERASE trial to risk stratify patients with chest pain with acute perfusion imaging in the emergency department.

Dr. Werner, who will be working to expand our Interventional program, has published numerous peer-reviewed journal articles and has many years of experience in the field of Interventional Radiology. While attending medical school, he was also working at the NIH’s Laboratory of Neurogenetics. Upon graduating from medical school he went on to complete his Radiology Residency at Albany Medical Center (that place sounds familiar to me) where he served as chief resident and then completed his Vascular and Interventional Radiology Fellowship at Johns Hopkins.

We are pleased that these outstanding physicians have joined the GBMC team and we look forward to the expansion of both programs under their leadership.

On a separate note, one of our beloved employees, Eric Melchior, earlier this month retired as our executive vice president and chief financial officer.  Eric’s 15 year GBMC career was stellar and highly impactful.  His dedication and insight were instrumental in GBMC HealthCare’s growth and financial success during his tenure.

Please join me in wishing Eric and his wife, Lynnette, all the best in their retirement.  Eric will truly be missed.

I am also pleased to announce that Robert “Bob” Thornton has assumed the position vacated by Eric. Prior to joining GBMC, he was the president of Patronus Healthcare Business Solutions in Tampa, Florida.  Thornton was also employed for 15 years as the executive vice president of finance and CFO for Bayfront Health System, a large, urban, multi-facility healthcare system in St. Petersburg, Florida.  Under Thornton’s leadership, Bayfront financed a campus expansion including a new women’s center, a heart center, 12 new operating room suites and a new eight-bed cardiovascular intensive care unit. He was able to deliver these projects, which greatly enhanced Bayfront's capacity in key clinical areas, while improving the system’s overall financial reserves and credit profile.

New Chief of Plastic Surgery

Congratulations to Alyson Wells, M.D., F.A.C.S. who was recently named as the new Chief of Plastic Surgery.  Dr. Wells is the first female physician appointed as division chief within our Department of Surgery.  She is replacing the retiring William Crawley, M.D., D.D.S., F.A.C.S., who headed the division since 2009.  She has researched extensively and published many professional papers in the fields of facial plastic surgery, organ transplantation and cancer.
Dr. Wells, an active medical staff member at GBMC since 2003, will be overseeing the work of 30 board-certified plastic surgeons on staff with practices that cover the entire spectrum of plastic surgery.

2015 Employee Engagement and Safety Survey

Please participate and complete our annual Employee Engagement and Safety Survey, which starts on Monday, August 3.  Your participation in the survey is vital so that we can learn what we can do to make GBMC an even better place to work.

Last year’s survey responses were used to generate significant change across GBMC HealthCare.  A few of these improvements included:  The creation of many unit-specific action plans; Implementation of a comprehensive Talent Management system, which includes career development planning; the Four Aims Recognition Program and the Perfect Attendance Program; and many celebrations of our staff throughout our 50Th Anniversary year including last week’s Employee, Physician and Volunteer Barbecue!

So thank you in advance for completing the survey!

Tuesday, July 21, 2015

Celebrating in the Summer!

There’s no doubt that the work of healthcare is hard. We spend so much time working to achieve our vision, to provide the care to everyone, every time that we would want for our own loved ones  that we sometimes forget the importance of stepping back for a moment to reflect on and to celebrate what we have achieved, together as the GBMC team. So, the timing was just right last week for our annual physician crab feast and our employee and volunteer BBQ.  These two events were great opportunities for our physicians, staff and volunteers to come together to celebrate what we have accomplished together, while also having some fun and enjoying comradery!

On Tuesday evening, after the triennial medical staff meeting, 156 physicians gathered under the tent for the annual crab feast. It was a great time to get together with long time friends and also to meet the new members of our medical staff!


On Wednesday, our Philanthropy Team, led by Jenny Coldiron, and our Marketing and Communications Team, led by Greg Shaffer, put on a fabulous day-long barbecue! The festivities began very early in the morning. The Philanthropy Team delivered breakfast to the night shift on the inpatient units. Lunches were delivered to offsite GBMA practices and Gilchrist home care staff were given food coupons that they could use at their convenience.  At 11 AM, the barbecue began. Hamburgers, hot dogs, salads, ice cream and many drinks were served. There were spectacular karaoke performers and bean toss participants. It was a great opportunity to party a bit together and leave our work behind even if only for an hour or so.















It’s fun to let go occasionally and celebrate each other and all of our accomplishments together. I think we should make the barbecue an annual event. What do you think?

Thursday, July 9, 2015

Saving Medicare and Taxpayers (at least) $16,440,000 Annually While Improving Health and Care and Adding Joy


We formed the Greater Baltimore Health Alliance (GBHA) in 2012 so that our employed and private practicing physicians could participate in programs designed to help us reach our quadruple aim of better health outcomes and better care experience with less waste of resources and more joy for those providing the care. The first program with which GBHA contracted was the Medicare Shared Savings Program that came into being as part of the Affordable Care Act.

So how are we doing at making Medicare beneficiaries healthier and happier with their care? Are we saving any money? Are those individuals taking care of our patients any happier?

We now have more than two years worth of data and the results are pretty impressive. We serve roughly 12,000 Medicare beneficiaries in this program. In 2012, just before we started the program, Medicare costs for our patients were averaging $12,653 annually. In the first quarter of 2015, GBHA Medicare patients had an average annual cost of $11,283! Other accountable care organizations have also done well, but they have seen the average cost per beneficiary go up by approximately 1.4 percent (see the figure below).


This is a phenomenal accomplishment! Nationally, in the four decades from 1970 to 2010, Medicare spending per beneficiary grew at approximately the rate of growth of the Gross Domestic Product plus 2.7 percentage points annually, or in the range of 5.7 percent. . Not only are we not seeing the cost per beneficiary increase, but GBHA has actually reduced it by 10.8 percent over the past two years. With a $1,370 decrease per beneficiary and 12,000 beneficiaries served, we saved $16,440,000! That is not counting the projected five percent annual increase that was projected.
We have done this by reducing emergency department visits by 12 percent (see below),

and overall admissions to the hospital by 26 percent!


Our Patient Centered Medical Homes (PCMH) are doing an excellent job of improving the health of their patients. Our physician-led care teams are holding themselves accountable for delivering evidence-based care to everyone-not just Medicare beneficiaries. These care teams receive monthly “scorecards” to track their progress, and meet regularly to see how their patients are doing and decide what they could do next to move closer to perfection. GBHA is one of the few healthcare organizations in Maryland that is measuring its performance on the “diabetes composite score.”  The score is made up of tracking five items that, if present, have been shown to increase the health of diabetic patients (Hemoglobin A1c in range, blood pressure in range, cholesterol in range, non-smoking, and utilizing a daily aspirin or blood thinner). GBHA is now in the top 15 percent of organizations nationally in diabetes care, and we are working hard to see that all of our patients have evidence-based screening tests completed. For example, our care teams are working on “tests of change” to see that everyone who should have had a colonoscopy performance-based on demographics such as age, medical history and other factors – has had one.


Additionally, the patient satisfaction scores for patients of our employed physicians have never been higher.


What about the joy of those providing the care? This is the hardest thing to measure, but anecdotally, the primary care physicians are happier that they now have the support of a team to get the work done.  We are no longer judging our primary care physicians solely on the number of patients they have seen, but are now supporting them in their quest for value-driven care.

We have many more metrics of health outcomes and care engagement that show improvement and I am so grateful to everyone on the GBMC team that is driving us closer to our vision.

Our community is taking notice. We are achieving better health and better care at lower cost and our team is finding more joy in its work. We still have more improvement work to do but I am so proud of all that has been accomplished so far.  Thank you!

Thursday, July 2, 2015

Glass Ampules

We need more “both/and” solutions.

Everyone knows that serving the community’s healthcare needs and staying within GBMC HealthCare’s budget can be a challenge. We have committed to driving waste out of our care (it is one of our four Aims) because we owe it to the community and everyone’s loved ones to not squander their money. So it should not be surprising to anyone that when our pharmacists pointed out that we could save $50,000 annually by switching from pre-packaged Dilaudid syringes to Dilaudid ampules where nurses would have to break the ampule and draw the medication up in a syringe, that our leaders thought that this was a reasonable idea. But in the last year, a small number of our colleagues have gotten lacerations from breaking ampules. Adding more joy to our work is another one of our Aims (and we have significantly reduced employee injuries over the last two years by studying their causes and rooting them out). Certainly if our nursing staff is at higher risk for finger lacerations they are not going to be happier on the job or feeling more respected by our leaders. I think we may have fallen into an “either/or” trap. Either we would save money or we would keep our nurses safe.

While some argued that a few minor lacerations were not a big deal and that there were safe ways to break open the ampules, we reversed the decision and have gone back to using the syringes to keep our staff safe. But we still need to look for ways to both reduce waste and keep our staff safe. We must do more “both/and” thinking and not fall into the trap of either/or. I have asked my colleagues in surgical services to look for sources of waste to eliminate that won’t put our staff at risk.

What waste reduction ideas do you have? Please share them with us.

Recognition for Outstanding Care

Congratulations are in order this week for the Sandra and Malcolm Berman Comprehensive Breast Care Center and its staff, who under the direction of Dr. Lauren Schnaper, have once again earned a three-year full accreditation as a center of excellence from the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons.  Re-accreditation is given to health facilities that meet specific NAPBC-developed practice guidelines and technical standards, following a rigorous evaluation and review of its performance and compliance with industry standards. This designation is an honor and reflects GBMC’s ongoing commitment to excellence in cancer care.

HAPPY BIRTHDAY TO US!!!
Finally, I want to wish everyone in our GBMC family a safe and happy Independence Day. July 4th marks the birthday of our great country…the land of the free and the home of the brave. Let's take some time to reflect on what we can each do to make our country even better than it is today.