Thursday, August 11, 2016

Taking it to the street…

In the last blog post, I spoke of the great work of our patient-centered medical homes and how we have truly transformed care to become more patient-centered. It has been very difficult for us to get the word out about this transformation. I believe that the average member of our community does not know how we are innovating and what it means for individual patients, families, and the local economy. We’ve made progress, but, we still have a lot of work to do to “get the word out” to the community.

So, last week, I was the featured speaker at a “house party” with the folks at Quarry Lake Condo Association. The purpose of the meeting was to share GBMC’s vision and our quadruple aim—better health and better care with the least waste and the most joy for those providing the care. I was truly excited at this opportunity to speak directly to patients and prospective patients.

At the event, I had the pleasure of meeting the host, Mrs. Rozzie Brilliant, who received oncology support care at GBMC and whose own daughter also received life-saving testing and care at GBMC. During her presentation, Rozzie, a four-year survivor of ovarian cancer, explained her personal story and connection to GBMC and her oncologist, Madhu Chaudhry, M.D. Rozzie hosted the event out of her desire to give back to GBMC and to assure that all of her friends knew of our work.

I spent a few minutes speaking of our vision and our vision phrase: To every patient, every time, we will provide the care that we would want for our own loved ones. I told those in attendance that in America, it was clear that we have the best doctors, nurses and other clinicians in the world, who are working very hard, but, that the system they work in needs to be redesigned to help them get the job done. I told them that the biggest challenge was how to coordinate care for those with chronic disease and how we were redesigning just about everything at GBMC to become more patient-centered and to meet this challenge. They listened attentively as we discussed advanced primary care and our hours of operation. They were intrigued by our disease state registries and how we were working to assure that everyone had evidence based colon cancer screening among other things. I reminded them how good our specialists are, how we have outstanding surgeons and that surgery at GBMC costs much less than surgery at most other local hospitals and with outcomes that are at least as good if not better. The participants had many questions and we had a great dialogue. Greg Shaffer, Director of Marketing, and his team were there to help me answer questions and to provide more information about how to access our care.

I felt very good about this session where I was speaking directly to those who benefit the most from our redesign work…members of the community. We will do many more of these sessions. Do you have a group that you would like us to address?

Thursday, August 4, 2016

It Is Not What You Say, It Is What You Do

Marketing tag lines are pervasive in our society. If a concept is “in vogue,” organizations want you to believe “oh yes, we do that, too.” A good example of this in healthcare at the present is the term “patient-centered.”  The consumer should be wary of healthcare organizations who are using this term and they should check to see if the organization is really putting them in the center of what they do or are they just saying it.

To become patient-centered, you have to start by listening to what it is that the patient wants. Most patients want the care to be accessible when they need it. This is the reason that urgent care centers have sprung up.  Primary care offices were not open or did not have appointments when the patient had a need. Most patients, especially those with chronic disease, also want care from clinicians who they know and respect. They don’t want to have to keep introducing their problems to new people who will have a different treatment plan. Patients don’t want their time wasted. They want fast, but, first and foremost, they want the correct evidence-based care because they want to get well. Most patients would agree that getting an antibiotic that they really shouldn’t take just so the provider can get them out of the office faster is not an example of being patient-centered.

So what has GBMC been doing to be patient-centered?

A good example of true patient-centeredness is in our advanced primary care practices, our Patient-Centered Medical Homes. For these practices, it is no longer about the visit. It is about a relationship between a physician or advanced practitioner and a patient and a promise to that patient to help him or her stay well or get well when they are sick. The team is available when the patient has an acute need, but, moreover, the team studies the patient’s health and preventive care needs at regular intervals and works with the patient to assure that they get what they need. A good example of this is our work to assure that everyone who should have colorectal cancer screening gets it. We don’t wait for the patient to make an appointment. If we see that the patient is due for a colonoscopy, we contact the patient to help get it done.

The Medical Homes have significantly improved their availability. They are open Monday through Friday 7AM to 7PM and have Saturday and Sunday hours. As a group, they have provided office hours on major holidays as well. It is much easier to close at 5PM and not be open on weekends and holidays….but that isn’t patient-centered nor is it patient-centered to send patients to emergency departments for non-emergencies or to urgent care centers for acute care because it isn’t convenient for the primary care offices to be open.
The Medical Home is a model that emphasizes care and communication and transforms primary care into ‘what patients want it to be’ – a partnership between patients and their doctors to improve health, to improve the patient’s satisfaction with the way the care is delivered and to reduce cost. So, at GBMC we are well on our way towards our vision and we are not just talking patient-centeredness…we are doing it!

Friday, July 29, 2016

Uniforms for the GBMC Team

We are building a culture in our healthcare system that values teamwork. Caring for patients is complex and it requires varied talents to get the job done the way we would want it for our own loved ones. The team is made up of physicians, nurses, advanced practitioners, therapists, housekeepers, billing people, food service workers and many others. There is great fun in being on a team. Anyone who has ever played sports knows that. I remember playing basketball in high school and how proud I was to put on our uniform and how close I became with my teammates. Uniforms unite people in a common cause. Just walk around Camden yards before or after an Orioles game and see how many fans are wearing Orioles gear.

Uniforms also identify people and their respective roles. In the hustle and bustle of today’s healthcare world, patients are often confused about who is who on the team. When everyone comes in wearing scrubs, it is difficult for the patient to figure out who is doing what and to whom they should address their questions. “Many times, patients don’t know who the nurse is versus the techs and even housekeepers who wear scrubs. So by moving to standard and different colored uniforms, patients will be able to identify their caregiver, along with their specialty, easier. It also gives our staff a more professional look,” explained Sue Bowen, RN, BSN, NE-BC, Administrative Director of Maternal Child Health.

So, GBMC is working to improve the sense of pride, purpose and team membership among our people and working to make it easier for patients and family members to identify team members by outfitting bedside staff with new uniforms. Sue is spearheading the uniform initiative and reports that most of the staff is quite happy with the new uniforms and many were involved in choosing colors and styles.

This week, clinical staff members have the opportunity to attend the GBMC Fit Line where they can try on scrubs and choose from a variety of styles and fits before orders are placed.

Which Color Are You?

GBMC’s clinical and bedside staff will be in the hospital-provided uniforms by November 1 so know who’s who by color:

Nursing staff – Navy blue
Technicians – Black
Pharmacy – Caribbean Blue
Respiratory – Gray
OT/PT – Galaxy blue
Radiology – Pewter
Laboratory – Eggplant
Advanced practitioners – Wine
Radiation Oncology – Teal
Sitters – Khaki

Welcome to GBMC’s New Chief Financial Officer

I’d also like to extend a warm welcome to our new Executive Vice President and Chief Financial Officer, Lisa Goodlett, CPA, MBA, who started this week in her new role. Lisa is an accomplished financial leader with more than 20 years in the healthcare industry, having previously served as Senior Vice President and Chief Financial Officer of the Dimensions Healthcare System in Hyattsville, Maryland. She also possesses in-depth knowledge of the Maryland waiver with Centers for Medicare and Medicaid Services (CMS) and also has significant experience in working with Maryland’s Health Services Cost Review Commission (HSCRC) in the all-payer rate setting system.

Lisa says, “I am excited to join the GBMC team.  I was drawn to the vision of GBMC with putting the patient first via the patient-centered care team, the work in population health and its bold steps to be a leader in generating value.  I look forward to working with such a strong team with the will for change.”

Please join me in extending a warm welcome to Lisa.

Thursday, July 21, 2016

Changing the Leadership Structure of Our Evolving Physician Company

GBMC has always had a very strong medical staff and this fact has set us aside as an outstanding community health care system. In the early years of GBMC, we employed very few physicians.  Back in the 20th century, most physicians were in private practice, but, as the medical care world has continued to evolve, it has become difficult to make small private practices work economically so like many other organizations, GBMC now employees a large number of physicians. We are delighted to still have many private practicing physicians who work very hard and are a very important part of our future, but, we are employing more and more doctors in areas where if we didn’t employ them, we wouldn’t be able to meet the needs of the community we serve.

It has been quite some time since we’ve seen new primary care private practices. GBMC now has close to 100 employed primary care physicians and advanced practitioners caring for patients in our patient-centered medical homes across Baltimore County and beyond.  And we are so fortunate to have excellent employed specialists from hospitalists and other internal medicine specialists to pediatricians, neurologists, physiatrists, surgeons in most specialty areas and others.


As the number of employed physicians in our organization grows, we must make sure that the leadership structure to support them in their work grows and adapts as well. To make our employed physician company, Greater Baltimore Medical Associates (GBMA), even stronger, we are appointing Harold J. Tucker, MD, as the new President of Greater Baltimore Medical Associates (GBMA). In order for Dr. Tucker to take on his new position, he has stepped down as GBMC’s Chief of the Medical Staff in the last year of his term. I think we can all agree that Dr. Tucker did an excellent job in advocating for both employed and private practicing physicians and will be missed in that role.

We are delighted to announce that Melissa Sparrow, MD, who was the Vice-Chief of the Medical Staff, has been elected by the medical staff to finish Dr. Tucker’s term and has therefore become the first female elected Chief of Staff of GBMC. Dr. Sparrow, the current clinical director for pediatric inpatient and emergency services, oversees the day to day operations of the both the pediatric inpatient unit and pediatric emergency department.

Dr. Tucker’s main charge, in his new position, is to make our employed physician company into a strong multi-specialty group that will make it easier for GBMC Healthcare to achieve our vision.  Hal will work to assure that all the employed physicians know what the leadership hierarchy is, and their role in it to not only meet the needs of the patient but, also their needs as well.  Hal will work with Ben Beres, the Chief Operating Officer of GBMA and Vice President for Physician Practice Management to further empower physicians at all levels to make improvements in how the company operates to generate better health and better care with the least waste of resources and to increase joy in the practice of medicine.


I would like to thank Mark Lamos, MD, for his leadership as President in helping to build a very strong primary care group within GBMA. Mark will continue in his role as Medical Director of Greater Baltimore Health Alliance (GBHA), our Accountable Care Organization (ACO), that also includes affiliated private practicing physicians. In addition, Dr. Lamos will assume the new role of Medical Director for the GBMC Employee Health Plan.  Annually, we spend approximately $20 million on the care of our own people and Dr. Lamos will help assure that the benefits are structured correctly and that they’re well managed to better serve our employees and members of their families. 

Please join me in thanking Drs. Tucker, Sparrow, and Lamos and celebrating them as they take on their new roles.

Tuesday, July 12, 2016

Summertime, Family Gatherings and Our Annual Employee and Volunteer Barbecue

I was on vacation last week and we had a Fourth of July barbecue. We invited many family members who we don’t see more than once or at most twice per year. One of my nephews who was “a little boy” the last time I remember seeing him was now as tall as I am. Everyone updated everyone else at the barbecue with the new things in their lives. This type of gathering is good for families to reminisce, support and celebrate.

The GBMC Family is having a barbecue this week as well. Last summer, during our 50th anniversary year, the barbecue was such a huge success, we decided to make it an annual event. This family, too, needs time to celebrate each other and have some fun outside of work  ̶  More Joy for those providing and supporting the care is one of our four aims. During our hectic work day, it is difficult to find time to display our joy. The barbecue gives us some time to do just that.  With all the terrible things going on in the world that are pulling the human family apart, I look forward to celebrating with all of my GBMC brothers and sisters at the barbecue.

I woke up in the middle of the night a few nights ago and began thinking about karaoke. Our communications team believes that I need to do a karaoke song to bring joy to our people (I guess they haven’t listened to my singing voice or maybe they have?) I have to come up with a song. Many people know that I am a big fan of Steely Dan, although many of our people don’t know who Steely Dan is. Should I sing another Steely Dan song or should I try to find something that more people will know? It’s good to focus on silly things when you spend so much time dealing with issues like clinical computer systems, the budget and making sure that everyone gets treated the way we want our own loved ones treated.

The barbecue comes in the middle of GBMC Spirit Week, a time for us all to show the pride we have in our organization and our caring about each other. I am honored to be a part of this family of caregivers and I am so proud that we are building a better system of care and are working hard to keep people out of the hospital. I am very grateful for all that our people do and I am delighted to show my spirit. I’m especially impressed with Family Care Associates (FCA), the winner of our cheer contest. FCA is a patient-centered medical home that is delivering advanced primary care with extended hours and sophisticated care management. FCA is a great example of how GBMC is different in the health care marketplace. It’s easy to tell when every member of a team is truly engaged, and FCA’s spirit is a true testament to our vision of the best health outcomes with the best care experience and the least waste of resources. And now that they have won the cheer contest….the most joy! Thank you, Family Care Associates and all of my GBMC HealthCare colleagues for your enthusiasm and hard work bringing us closer to our vision.

What brings you More Joy at work? For me, it’s getting a chance to show my appreciation and recognize the great work each and every one of you is doing. To celebrate, please join me at the Employee and Volunteer Appreciation BBQ today in the parking lot across from PPNorth from 11 a.m. to 2 p.m. and again from 6 p.m. to 8 p.m. Both time slots will include food, music, karaoke, and games as a way to say ‘thank you’ for your commitment.

New Physician Titans of Care

It is with great honor and gratitude that GBMC HealthCare announced the selection of three new Physician Titans of Care at last night's Medical Staff meeting:

-Rudiger Breitenecker, MD
-John E. Savage, MD
-Claire Weitz, MD

We salute their exemplary contributions to the growth and success of our organization, as well as to the ongoing evolution of the practice of medicine. We applaud their outstanding skills, service and commitment, and thank them for their instrumental roles in building GBMC HealthCare’s reputation in our community and beyond.

Friday, July 1, 2016

Redesigning at Light Speed

The GBMC HealthCare System is getting pretty good at redesign. There are days that I almost get dizzy just thinking about all that we are doing to drive closer to our vision. Let me highlight just a few of the myriad of major changes that we are in the midst of….

Epic
One patient- one record…this phrase has been on the tip of my tongue now for more than 15 months. This week I experienced the 90 days to go live three-hour session that was held in the recently opened Epic Command Center, in PPNorth, where Cindy Ellis and Dave Hynson oversaw the review of the entire design and operational. I was so proud of the literally hundreds of people both on the computer build side and on the operations side who presented where they were in being ready for go live! We have so many smart, hard-working people getting us ready for the “big bang” go live on October 1st when our hospital, our hospice and our employed and GBHA affiliated physicians will be on the same information system. I can’t wait!

Patient Centered Care Units
I attended the day two report out done by Dr. Jason Stein, an expert in patient-centered inpatient care, who commented on how well this initiative is going in its first month of operation. Getting nurses, physicians and other clinicians all co-located on the same units to better meet the needs of the patient as a team is a very, very exciting concept and we are making it happen.

Designing our new Endoscopy Center
This week a team led by Lindsay Cromwell-Rims, RN our Endoscopy Nurse Manager and Niraj Jani, MD, our Chief of Gastroenterology with the facilitation of Ishmel Fulton, our Lean facilitator used the 3P process (production, preparation, process) to begin designing our new endoscopy center. In the old days, a couple of executives would get in a room with an architect and lay out the plans. Not anymore. Now the people who will use the facility get together with experts to design a center that will work for them and their patients with the least waste of everyone’s time, energy and resources.

These are just 3 of the major redesign efforts underway. I am very proud of all of the people involved and very grateful for their hard work.

Gilchrist Hospice Accreditation
Also this week, I attended the exit conference of the examiners who reviewed Gilchrist Hospice for CHAP (Community Healthcare Accreditation Partner) accreditation. This organization now does for our hospice what the Joint Commission does for our hospital. Once again, I was present in a room when a set of reviewers said: “We have found no deficiencies.” This is an outstanding performance and extremely rare to have no deficiencies but why should I be surprised? Gilchrist is the best hospice anywhere, period. Cathy Hamel and her team are exemplars in healthcare management. I am so grateful for all that Gilchrist does every day.

Our Night at “The Yard” 
All of us who attended  GBMC Employee Night at Camden Yards last week really enjoyed it.  I was happy to see so many of our people come out and have fun with their colleagues. Having the Orioles win that night added more joy to an already festive event.


Closing Time….

BALTIMORE Magazine is wrapping up soon on collecting votes for its TOP DOCTORS issue. Docs, if you haven’t done so already, please vote for the colleagues you most respect by NO LATER than Thurs., July 7th! This year, the magazine will only utilize online voting for TOP DOCS and no hospital codes are being used. The survey may be found at: http://www.baltimoremagazine.net/about/top-doctors-survey  I am sure your colleagues will greatly appreciate your vote!  Thank you.



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.

Tuesday, June 21, 2016

The Appearance of Callousness Revisited

GBMC is an outstanding healthcare system. We have made such great progress in improving the health outcomes of our patients. We have many, many great examples of care and caring. Just a few weeks ago we celebrated our compassionate caregivers and the stories of love and kindness abounded. But, we are not perfect and our HCAHPS scores (The Hospital Consumer Assessment of Healthcare Providers and Systems survey), the first national, standardized, publicly reported survey of patients' perspectives of hospital care, are just about average. https://www.medicare.gov/hospitalcompare

A few years ago I got myself into trouble when I wrote a blog called “The Appearance of Callousness.”  Although I did not mention where the upset patient was treated, the staff in that area got upset.  They thought that I did not appreciate their hard work or their intentions. I sincerely did appreciate how hard they worked and that no one intended to get the patient upset. I was just trying to get them to reflect on what the patient was upset about. If we truly believe that we are here to treat everyone, every time the way we want our own loved ones treated then we have to be big enough to reflect on our behavior…even if it was a one-time lapse on our part or even if we had the best of intentions. So today, I received a letter from a man who began by praising GBMC and three staff members in particular for the great care given his wife, but, then he added:
“However, there was one problem. One evening during her stay I was returning to visit her. Forgetting the location of my wife’s room, I approached the desk on the unit and asked a person seated there where she was. Before I could even speak, he/she said ‘wait a minute’ while he/she leisurely worked on some sort of report. I stood there five minutes while he/she ignored me, slowly filling out both sides of a sheet of paper. Exasperated, I finally left, asked someone else where my wife was and found her room. I was concerned about my wife’s condition and this person’s rude behavior did not help matters.”

What do you think? I bet the staff member who this man interacted with was doing his or her job and may have felt pressured to get some important work done. He/She may have treated the previous 50 family members that approached with kindness and respect but this husband felt disrespect.

What can we do as the GBMC family to minimize the chance that someone thinks we have been rude to them? I would love for you to comment on this blog...but I would like even more if you would discuss this with all in your department, unit, or office.

As I am asking this question, I know that there are many, many wonderful interactions with patients and family members but as caring adults, we must still reflect on the few perceived negative interactions. Thank you very much!

THANKS TO ALL FOR PARTICIPATING in the FATHER’S DAY 5K

This past Sunday, I spent part of Father’s Day running the 28th annual GBMC Father’s Day 5K. It was a beautiful day and it was great to see so many families on our beautiful campus.

This event has been helping to raise much-needed funds for GBMC’s Neonatal Intensive Care Unit (NICU). Over the years, funds raised through this event have helped purchase lifesaving technology and services for our NICU babies and their families.

I want to thank the close to 900 participants who spent part of their Father’s Day with GBMC and helped raise approximately $140,000. In 28 years, the 5K has raised close to $2 million for critically ill and premature babies.

Let me also thank the amazing volunteers as well as GBMC’s NICU doctors, nurses, technicians and others who dedicate their lives to the health of babies.  I also had the opportunity to meet some of the “graduates” of our NICU and their parents and so many other wonderful people. I also want to congratulate the more than 100+ weight loss patients, a.k.a Team #COMPto5K , that completed in their first Father's Day 5K and to Cody and Selena Staab, 8-year-old twins and 2007 NICU graduates, who gave back to GBMC by selling their bracelets during the Father’s Day 5K.

Lastly, I want to thank everyone involved in our community Wellness Fair which featured health-related vendors. Additionally, MIX 106.5 Radio was on-site with its Friends and Neighbors van playing music and sharing prizes. The Maryland Zoo in Baltimore was also present with fun animal friends in the kids’ area. Great work everyone!!!