The Science and the Art of Medicine

This past week, I have done a lot of reflecting on the balance of standardization in healthcare processes and allowing experienced physicians and nurses to make decisions “in the moment” for their patients. My reflection was prompted by several conversations I’ve had with my colleagues about their challenges with creating this balance. While standardized processes are incredibly valuable, it’s difficult to standardize certain aspects of care, like the frequency of going into a room to check on a patient. We talked about the role of experts in healthcare and how they have to make decisions based on each individual patient.

In the early 20th century, when modern healthcare was still in its infancy, healthcare leaders began to realize that it was inappropriate for professionals to make treatment decisions that went against rigorously-researched best practices. Patients needed the assurance that their healthcare providers would follow scientific evidence and give them the best chance of recovering from their disease or injury. The Flexner Report of 1910 created standards for medical education and was seminal in creating a workforce of physician and nurse scientists, who were able to read the literature and distinguish facts from conjecture. The so-called evidence-based medicine movement began in the 1980’s and has continued to steer the industry away from autonomous experts making decisions however they saw fit.

At a meeting this week, a colleague was articulating the fact that some physicians are unclear in their role now that we have shifted towards becoming more standardized and protocolized. He also raised the concern that we may have gone too far in undervaluing experience.

My belief is that when we standardize what should be standardized, we create time for professionals to think about more complex decisions that cannot be standardized. When done correctly, standardization should be liberating for professionals, giving them the opportunity to use their experience as they search for answers to more complicated problems.

What do you think? Please let me know by responding to this blog.

Healthcare Security and Safety Week

Please join me in recognizing the GBMC security staff as this week is Healthcare Safety and Security Week (Oct. 13-19). This is a great time to thank those who keep us safe every day!

It is no easy task to protect the GBMC family on our campus, but it’s one that the GBMC security team does well, around the clock. They can be seen walking or stationed throughout our medical center from the emergency department to labor and delivery. Thank you to our security staff for their hard work and commitment, and the diligence they display in the practice of their profession.

National Cyber Security Awareness Month

I want to thank Dave Hynson, GBMC’s Chief Information Officer, and his team for working hard to educate us about the threat of attacks on our computer systems and for continually working to minimize the harm from a potential attack.

Our ITS team has made great strides in defending our networks while preserving the efficient delivery of healthcare services. As technology and threats change, they are continually adjusting.

Remember…Don’t click links unless you are sure they are safe; don’t go to websites you aren’t familiar with, and ask IT for guidance if something doesn’t quite “seem right.” Let’s work together to keep our healthcare system safer from cybercrime. Thank you!

International Infection Prevention Week

This week is also International Infection Prevention Week (Oct. 13-19) and it’s a time to highlight the importance of infection prevention and raise awareness of everyone’s role in protecting the public from healthcare-acquired infections. Because of the significant rise in measles cases nationally, this year’s theme is: Vaccines Are Everybody’s Business.

Our Infection Prevention team members are healthcare professionals whose mission is to protect patients, visitors, volunteers, employees, and providers from healthcare-associated infections.

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

Maryland and Our Nation Lose a Leader

On behalf of the GBMC HealthCare family I want to extend our condolences to the family, friends, and all of those touched by Congressman Elijah Cummings. He was a leader for Baltimore, Maryland, and our country. His advocacy on behalf of our community is irreplaceable.

GBMC: A Leader in Breast Care

October is Breast Cancer Awareness month, so it’s fitting that I write about the Sandra and Malcolm Berman Comprehensive Breast Care Center at GBMC. Since its inception, the Center has provided evidence-based care with kindness and compassion. Led by Director, Lauren A. Schnaper, MD, and Associate Director, Sara P. Fogarty, DO, the Breast Center team uses education and support to take some of the fear out of a breast cancer diagnosis. Aided by their colleagues, Angela M. Murrell, CRNP, and Barbara Raksin, RN, they have been delivering multidisciplinary care since before it was the standard for breast centers. The Center was designed with breast imaging capabilities and radiologists, who are experts in diseases of the breast, co-located within the breast surgeons’ office space. This facilitates quicker diagnoses through same-day needle biopsies and expert second opinions on abnormal imaging.

Patients learn about their therapeutic options and the incumbent risks and benefits. The team works to remove cancer and leave the smallest and least obtrusive scars possible, helping patients heal more quickly and mentally move forward after their treatment. The Center is proud of its cure rates and cosmetic results. Breast conservation is very important at our Center and the team’s mastectomy rate is less than 30 percent.

The Breast Center collaborates with other members of the GBMC Sandra and Malcolm Berman Cancer Institute, including social workers, integrative care providers, and oncology support staff. They also collaborate with medical and radiation oncologists and pathologists to diagnose, treat, and follow hundreds of women with new diagnoses of breast cancer every year. This group of talented professionals has an extremely collegial working relationship that allows them to provide outstanding and compassionate care to every patient. Let me thank them for all that they do for GBMC and for our patients.

Thank you!!!
This week, I would like to express my gratitude to the men and women who work hard to keep the patients and staff fed. This group of employees does much of its work “behind the scenes,” but the impact on our hospital and patient care is truly vital. So, as part of Healthcare Foodservice Week (Oct. 6-12), when you see members of our food service staff, please thank them and tell them what a great job they’re doing!

Please join me in celebrating all GBMC physician assistants (PAs) this week during National PA Week (Oct. 6-12). This is the week when PAs celebrate their profession and showcase the value they bring to today’s healthcare team. Let me thank our PAs for their commitment to their patients and for all their hard work every day.

This week is also Healthcare Supply Chain Week (Oct. 7-13), which celebrates resource and materials management professionals for their important contributions to healthcare. During Lean Daily Management (LDM) this week, I visited with our materials management team, led by Kendrick Wiggins, Kevin Edwards, our Supervisors of Materials Management, Brian Riemer, our Director of Materials Management, Ginger Brooks, our Clinical Manager of Value Analysis, and Michelle Bunty, our Purchasing Manager. I am so grateful for their work and that of those who work with them. We all benefit from the work of our entire supply chain team. Thanks for everything you do every day to assure that we have the supplies we need to get the job done.

Congratulations Dr. Semenza!!
I would like to congratulate Dr. Gregg Semenza, Director of the Vascular Research Program at the Johns Hopkins Institute for Cell Engineering. He was one of a trio of researchers who, on Monday, was awarded this year’s prestigious Nobel Prize in Medicine. Dr. Semenza and his colleagues won this award for their pioneering work into how human cells respond to changing oxygen levels. Their research has been instrumental in understanding the mechanisms of disease, especially in anemia, stroke, myocardial infarction, and cancer. Congratulations Dr. Semenza!

A Well-Deserved Recognition

Earlier this week, I met with a few staff members from the Maryland Hospital Association (MHA) and talked about some of the major issues facing our state’s healthcare system. Toward the end of our conversation, one of the MHA employees congratulated me on all the transformation work that the GBMC HealthCare System is doing. We talked about many specific redesigns like our patient-centered medical homes and our most recent opening at the Helping Up Mission, as well as our Elder Care in the Home program and Gilchrist Center Baltimore. The MHA staff was particularly interested in learning about our Sexual Assault Forensic Examination (SAFE) and Domestic Violence (DV) program. I told our colleagues how proud I was of this team and how much their work means to our community.

October is National Domestic Violence Awareness Month. Our domestic violence program, led by Valerie Weir, BSN, RN, FNE-A/P, CMSRN, Domestic Violence Coordinator, provides 24/7 in-house victim advocacy and serves more than 350 patients annually. Under the leadership of Laura Clary, BSN, RN, FNE-A/P, SANE-A, CFN, CPEN, our SAFE program is also a key resource for victims of sexual assault and survivors of intimate partner violence (IPV). At no cost to the patient, our SAFE and DV nurses focus on empowering survivors to begin the healing process, in addition to working toward ending sexual assault and IPV in the community.

Last week, several members of the GBMC SAFE and DV program presented at the 13th Annual Baltimore County In Plain Sight Domestic Violence Conference. This year’s event had approximately 250 attendees, which included representatives from several county offices, along with the Baltimore County Office of the States Attorney, Family Crisis Center of Baltimore County, and the Baltimore County Domestic Violence Coordinating Committee. Joining Valerie at this conference were her colleagues Roz Berkowitz, BSN, RN, FNE-A/P, Lisa Brengle, BSN, RN, FNE A/P, Evelyn Kim, BSN, RN, FNE A/P, SANE-A, and Ashley McAree, RN, FNE-A/P, SANE-A. They presented on the topics of the neurobiology of trauma, non-fatal strangulation, and forensic nursing and human trafficking.

Let me thank them for their hard work and expertise, and for educating our community. Their work is being noticed and held up as an example for others to follow.

Another Great Legacy Chase

The 19th running of The Legacy Chase at Shawan Downs last weekend was a major success. Nice weather, beautiful horses, a scenic countryside setting, and many family and friends – there were more than 6,000 attendees this year – coming together created a spectacular event.

It was all for a good cause, as the more than $225,000 raised will go toward Oncology Support Services at the Sandra & Malcolm Berman Cancer Institute.

I thank all who attended and all who donated time or treasure. Special thanks to the GBMC Philanthropy and Marketing Departments, which worked so hard in putting the event together.

Congratulations, Dr. Ioannou!
I am proud to announce that JoAnn Ioannou, DNP, MBA, RN, NEA-BC, our Senior Vice President of Patient Care Services and Chief Nursing Officer, was recently named a 2019 Woman to Watch by The Baltimore Sun.

Dr. Ioannou was one of 25 women selected by the newspaper. She was chosen because she has “positioned GBMC HealthCare at the forefront of a nursing revolution in which we celebrate nursing as an art form — the art of science, knowledge, and caring – and because of her passion for nursing.” Congrats JoAnn!

Thank you!

This week, we were very fortunate to host nine examiners from the Malcolm Baldrige Performance Excellence Program. The Commerce Department’s National Institute of Standards and Technology (NIST) manages the Baldrige National Quality Award. Over the past few years, GBMC has been using the Baldrige criteria to improve and to move us faster towards our vision. In the spring, we submitted a 50-page application responding to questions about our deployment of systems in the categories of leadership, strategy, customer, measurement and knowledge management, workforce, operations, and results. Out of the 26 organizations across multiple industries that applied (16 were in healthcare), only 12 received a site visit. GBMC was one of only 5 healthcare organizations that got chosen!

The examiners came to validate what we put in our application and they also looked for best practices to highlight on a national stage for others to follow. One example of an exceptional business practice at GBMC is Lean Daily Management (LDM).

There has been a buzz in the air all week. From the opening session, where we got to tell the examiners a bit about who we are and about our vision to become the community-based healthcare system where every patient gets the care we want for our own loved ones. There has been a tremendous sense of pride on display for all that we have accomplished.

The examiners visited all three of our work systems: Greater Baltimore Medical Center, Gilchrist, and GBMC Health Partners. Everyone went out of their way to tell them our story. I am so proud of all of you!

I cannot name all of those who worked so hard to make the examiners visit a huge success, but I would be remiss if I didn’t name a few. Carolyn Candiello, our Vice President for Quality and Patient Safety, and her whole team in the Quality Department worked tirelessly, as did Lisa Groff, RN, our Clinical Director of the Women and Children service line. Keith Poisson, our Executive Vice President and Chief Operating Officer, and all our operational leaders did a fabulous job as well. Let me also thank the rest of the Senior Team and all my clinical colleagues and support staff in the hospital, at Gilchrist, and in our physician practices.

So now that the visit is over, the examiners will file a report that will be reviewed by the Baldrige judges, who will determine if we have achieved the award. We will learn of their decision before the end of the year and receive a thorough feedback report from which we will learn and continue to make our system even better than it is today! Regardless of the outcome, we have so much to be proud of and it really showed this week!

All I can say is thank you, thank you, thank you! We will be doing some celebrating. Stay tuned.

Legacy Chase is this Saturday!
What better way to relieve the stress of the work week than by coming to this year’s Legacy Chase at Shawan Downs  THIS Saturday, September 28! Legacy Chase is our signature fundraising event benefiting Oncology Support Services at the Sandra and Malcolm Berman Cancer Institute.

The Berman Cancer Institute is a comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer. GBMC has invested in talent and technology to provide the best care for oncology patients. We care for more than 2,000 new cancer patients annually!

Make this year’s event a family affair and come to enjoy a day in the country. Don’t forget that GBMC employees and volunteers receive ONE FREE Founder's Hill parking pass for ONE carload of passengers! So, fill up your car with family and friends, pack a cooler and picnic basket and spend a day in the September sun. To obtain your free pass, click here - add the Founder's Hill parking pass to your cart and use promo code GBMC at checkout. I hope to see you there

Recognized (Again!) for Being at the Forefront of Information Technology that Aides Clinical Care

Just two weeks ago, I wrote in this blog about our achievement of being one of only nine Epic sites across the world to attain 9 Gold Star status. This week we have yet another information technology accomplishment to celebrate! I am delighted to announce that GBMC, for the first time ever, is a recipient of the Most Wired Hospital award from the College of Healthcare Information Management Executives (CHIME) for both our acute and ambulatory services. A total of 16,168 organizations were assessed in the 2019 Most Wired program. Organizations were rated on the adoption, integration, and impact of information technology.

GBMC achieved Most Wired Certified Level 8, receiving the Quality Award. The Most Wired program conducts an annual survey to assess how effectively healthcare organizations apply core and advanced technologies to improve health and care in their communities. This award recognizes hospitals and health systems that are at the forefront of using healthcare IT to improve the delivery of care, to maximize the benefits of foundational technologies, and to embrace new technologies that support population management and value-based care.

To achieve Most Wired Certified Level 8, we had to reach a score within the 71-80 percent range. This award recognizes that we have deployed technologies such as patient portals and population health/cost-of-care analytics to achieve clinical and efficiency outcomes.

Let me once again congratulate our information technology professionals and our clinicians on this fabulous accomplishment!

Last Sunday (9/15) was Neonatal Nurses Day. It’s a day to honor our nursing colleagues who care for babies and to celebrate their hard work and dedication. With more than 4,500 babies born at GBMC annually, we are very fortunate to have outstanding nurses in our nursery and in our NICU. Please join me in thanking them for all that they do.

This week is Surgical Technologists Week. Surgical technologists prepare operating rooms and equipment, ensure a sterile and safe environment for patients, and assist during surgery. The work demands attention to detail and knowledge of surgical procedures. It’s hard to imagine how an operating room would successfully function if there were no surgical techs performing all these very detail-oriented tasks. They are an integral part of an operating room team and have a tremendous impact on patient care and our hospital operations. Please join me in thanking our surgical techs!


Did you know that approximately 80 percent of all infections that cause illness can be prevented by hand washing? This week is also International Clean Hands Week. It’s a good time to remind ourselves of the importance of good hand cleaning habits. Wash your hands!

To move toward our vision: “To every patient, every time, we will provide the care that we would want for our own loved ones,” we must continually improve our systems. I thank the professionals throughout GBMC, such as our Neonatal Nurses and Surgical Technologists, for their work in improvement.

Welcoming Our New Colleagues and Enrolling them in our Vision

Every two weeks, I spend an hour welcoming our new people at employee orientation. My task at orientation is to begin to enroll our new colleagues in our vision.

I begin explaining who we are by introducing our THREE work systems of Greater Baltimore Medical Center, Gilchrist, and GBMC Health Partners and our very important partners, the 600 or so private practicing physicians who we work with. I then introduce them to our Mission (our purpose of bringing health, healing, and hope to our community) our Values (the behaviors we hold each other accountable to) and our Vision (where we want to go). I tell them that they may not remember our vision statement word for word, but that they should remember our vision phrase: to every patient, every time, we will provide the care we want for our own loved ones. 

I then ask for a volunteer to help me identify what we mean by “the care we want for our own loved ones.” We always arrive at our four aims as the definition of that care: 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 explain that the GBMC HealthCare System is a not-for-profit company and that as such, we are owned by the community. The Board of Directors consists of 27 unpaid community members who oversee GBMC and determine its direction. They wrote the vision statement in the fall of 2010 during a time of turmoil regarding the topic of healthcare reform. The vision statement talks about truly focusing on the patient, coordinating care, and moving upstream to keep patients out of the hospital. This vision statement is the game plan that I, as the Chief Executive Officer, am held accountable to carry out. It is this vision statement that has brought us components like our patient-centered medical homes, the richness of our SAFE program, elder medical care in the home, and our palliative and integrative medicine programs, just to name just a few. I tell them that we have created these things using our core competency of redesigning care.

I explain to them that our business model is a continual improvement and that Lean Daily Management is an important tool to move us faster towards our vision. I show them our leadership system model (left) and explain that their supervisors will demonstrate how the work of their department fits in with our organization-wide strategic objectives.


I thank them for joining us and I encourage them to come forward with new ideas to be tested to help us improve even faster. I wish them a great career with GBMC.

If you would like to see any of this, click here to view a video of this week’s orientation. You don’t need to watch the whole thing, but it should provide a “refresher” on connecting our work to our vision.

It is important that all of us in the GBMC system understand why we do what we do, and we should each be able to connect the purpose of our work to where we are going as an organization. We should also be able to talk about how we are improving towards our vision.

Environmental Services Week 
This week is Environmental Services (EVS) & Housekeeping Week (Sept. 8—14) and I am proud to acknowledge the dedication and professionalism of our EVS staff as we celebrate them.

Cleanliness is everyone’s job at GBMC, but our EVS staff members are the experts in cleaning and work tirelessly to get the job done. They spend countless hours in their vital role of keeping us clean and helping to prevent infections.

There are over 100 EVS associates working around the clock at GBMC in a variety of roles servicing more than 1.2 million square feet of facility. So, please join me in honoring all the men and women of EVS!

We Scored 9 Stars Out of 10

Recently, I met with Dave Hynson, our Chief Information Officer, and Cindy Ellis, our Epic IT Application Director, who had recently returned from the Epic Users Group Meeting. Dave and Cindy shared with me the news that we achieved a score of 9 out of 10 on the Epic Gold Star program. The Gold Star program exists to incentivize Epic users to get the most out of the software’s capabilities. Dave told me that only one organization achieved a 10 this year and that out of 400+ Epic organizations, only 9 had achieved a 9! In Epic’s own words, those organizations that achieve an 8 or higher are at the cutting edge and are using leading practices in electronic medical record use. Congratulations to our Epic team and to all in the GBMC family who have helped us achieve this status.

Local Produce on Our Campus…Again
Many of you remember the GBMC Farmer’s Market. It was a good way to support our local farmers while also promoting healthy eating to our employees.

Well, we have reinstituted this practice, as GBMC is now partnering with SNAP produce (Hungry Harvest). This gives our patients, staff, employees, and community members an opportunity to purchase healthy produce at an affordable price. The markets will be held on the first and third Fridays of the month from 2 p.m. to 4 p.m. in the Civiletti Conference Center. The first community market took place on Friday and was a huge success!

I encourage you all to come and shop your local neighborhood market. For more information, please visit produceinasnap.com.

Join the Celebration!
Please bring your family and friends to Shawan Downs on Saturday, September 28th, where once again, we will host Legacy Chase. Legacy Chase has become an annual social event, marrying the excitement of steeplechasing with the beauty of the countryside. The Hats, Horses, and Hope theme returns, and children are encouraged to come dressed as their favorite superhero to help fight cancer. They are also invited to attend Kids’ Korner for games, face painting, pony rides, and more.

Proceeds from the event will benefit oncology services at the Sandra and Malcolm Berman Cancer Institute. The Institute is the only comprehensive community cancer program in the Baltimore region to be certified with distinction by the American College of Surgeons Commission on Cancer. GBMC has invested in talent and technology to provide the best for oncology patients. Whether they need outpatient, inpatient, home care, or survivorship services, the more than 2,000 new cancer patients annually at GBMC all get the care we would want for our own loved ones.

For more information, visit www.gbmc.org/LegacyChase

Hope to see you there!