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.

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.

Thursday, June 25, 2015

Leadership and Better Health Outcomes

This week the GBMC Obstetrics team was recognized by the March of Dimes for having eliminated pre-term (before 39 weeks gestation) elective births.

No one questions inducing pre-term labor or doing a pre-term cesarean section for good medical reasons. But if you induce enough pre-term vaginal births or do enough pre-term cesarean sections for the convenience of the family or members of the care team, you will eventually harm a baby who has retained lung fluid and must receive intensive care. This has never been a big issue at GBMC but under the leadership of Dr. Victor Khouzami, GBMC’s Chairman of Obstetrics and Director of the Women’s Service Line, it has now been many months since we had a pre-term elective birth.

This achievement was recognized through the presentation of a banner from the March of Dimes, the Maryland Patient Safety Center and the Maryland Department of Health & Mental Hygiene.  The banner will be displayed within the hospital – indicating our strong commitment to improving the quality of care for moms and babies.

We are honored to receive this recognition AND I am extremely proud of our obstetrics team of physicians and nurses for this wonderful accomplishment.


This past Sunday, I spent part of Father’s Day running at the 27th annual GBMC Father’s Day 5K. It was a great day and I was fortunate again to have my daughter, Caroline, running with me.

I was humbled to see so many dedicated members of the community and the GBMC staff come out and run for this terrific cause – raising money for the Neonatal Intensive Care Unit.  I want to thank the more than 800 participants and I am proud to report that this year’s event helped to raise more than $160,000 to help support the NICU babies and their families.  

I also had the opportunity to meet some of the “graduates” of our NICU and their parents and so many other wonderful people.  I was thrilled to hand out awards to the winners as well.

I must admit that the outpouring of community support was incredible and I truly felt so much pride for the wonderful volunteers as well as GBMC’s NICU doctors, nurses, technicians and others who dedicate their lives to the health of babies.  In 27 years, the GBMC Father’s Day 5K has raised more than $1.9 million for critically ill and premature babies and that has helped us over the years purchase lifesaving technology and services for our NICU babies and their families.  GBMC’s NICU is one of the largest in the area, caring for over 400 babies annually.  In honor of GBMC’s 50th anniversary celebration, this year’s race fundraising goal was $200,000 to mark the 200,000 babies born at GBMC since 1965, the year it was founded. So, if you want to contribute it’s still not too late to give – you can go to and click on the "Register" link. Donations can be made this week and will close July 1.

I also want to thank everyone involved in our community Wellness Fair which featured health-related vendors, as well as a "Baby Doll/Stuffed Animal Hospital" for injured dolls and bears to receive loving treatment and repairs as needed. 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 for the kids’ area. Great work everyone!!!

Friday, June 19, 2015

Running for GBMC’s Tiniest Patients

One of the biggest annual events for the GBMC HealthCare system is coming up.  On Sunday, June 21st, we’re holding the 27th Annual GBMC Father’s Day 5K & 1 Mile Fun Walk at the GBMC campus to benefit the hospital’s Neonatal Intensive Care Unit (NICU).

In honor of our 50th anniversary celebration, this year’s race fundraising goal is $200,000 to mark the 200,000 babies born at GBMC since 1965, the year it was founded.  Since 1965, approximately 20,000 babies have slept in its incubators, used its Human Milk Bank, warmed in its Giraffe beds and snuggled under its blankets.  Our NICU, under the direction of Howard Birenbaum MD, and Eva Stone, RN, provide outstanding care to premature and sick newborns. Not only is the event a great fundraiser but it is also a wonderful opportunity to see so many thriving children and adults who are NICU graduates.
As part of the 50th anniversary celebration with the community, this year's GBMC Father's Day 5K race will feature a Wellness Fair, open to not only race participants, but the entire community!  The Wellness Fair will be open from 7 a.m. - 12 p.m. in the South Chapman parking lot featuring health-related vendors, as well as a "Baby Doll/Stuffed Animal Hospital" for injured dolls and bears to receive loving care treatment and repairs as needed. Additionally, MIX 106.5 Radio will be on-site with its Friends and Neighbors van playing music and sharing prizes.

I encourage you to sign up today and visit I’ll be out there running, come join me! Your support will touch more than 500 critically ill and premature babies cared for every year in GBMC’s NICU and help us during our 50th anniversary year, in celebrating the healthcare system GBMC has become!

…also, Happy Father’s Day to all of the Fathers in our GBMC Family!

Friday, June 5, 2015

The World is One Village

Last weekend, I participated in the 3rd annual Middle East Forum for Quality Improvement in Health Care in Doha, the capital of Qatar on the Persian Gulf. The conference was sponsored jointly by the Institute for Healthcare Improvement (IHI) and Hamad Medical Corporation (HMC). The IHI was started more than 25 years ago by Drs. Donald Berwick and Paul Batalden. It is currently involved in projects in the Americas, Europe, Africa and Asia and is the world’s foremost organization for health
care improvement. Hamad Medical Corporation operates eight hospitals in Qatar and provides most of the care in that country. I gave a plenary address to the 2,500 delegates and also taught a workshop on patient flow with, my friend and colleague, Dr. John Boulton. John directs quality improvement at Hamad General Hospital in Doha. He visited GBMC as an IHI fellow in 2013.

I had never been to the Middle East before, so I was not sure what to expect and the trip was quite an adventure. I arrived in Doha after a 13-hour flight from Dulles. The Doha airport is very new and has all the amenities. The city has an incredible skyline with many 20 to 30-floor skyscrapers most of which have been built in the last decade. There is a sprawling landscape with homes for the 1.8 million inhabitants of the country, 300,000 of which are Qataris and the others are immigrant workers. Being in the desert, all of Qatar’s water comes from desalination. It is amazing how much green space there is in the city as it must all be irrigated by Doha’s complex system.

I stayed in a beautiful hotel in the center of the city that was attached to a very large indoor shopping mall that was complete with an ice skating rink! When I told a Qatari that I was surprised to find an indoor skating rink, he told me that since it was so hot there during the summer people stayed inside where it was air-conditioned or they went to the mall. While I was in Doha, it was above 100 degrees every day and it did not go below 80 at night. 

John gave me a tour of the sprawling campus that contains both Hamad General and the Women’s Hospital, where they deliver 12,000 babies per year. The two hospitals see a combined 1,500 emergency department patients per day! There are almost no primary care offices so everything goes
to the ED.

The amount of construction going on was incredible. There were cranes everywhere building schools, universities, hospitals, homes and office buildings. Since this was going on in the desert, sand was blowing everywhere. Qatar is scheduled to be the site of the 2020 Soccer World Cup Tournament, so the country is working hard to have its infrastructure in place by then. Outside of my hotel, an elevated metro line was being built. Transportation lines will be necessary for the World Cup and also to move Qatar’s growing population.

The Middle East Forum for Quality Improvement in Health Care meeting was at the Qatar National Convention Center (QNCC). The Center was completed a few years ago and it was huge. Disney on Ice was also performing at the QNCC while we were there. It was amazing to see families from all over the world with little children going to see the show.

The conference focused on patient safety, clinical quality, patient engagement and patient flow. Some of the highlights were the 200 posters presented mostly by teams from Hamad, a plenary by ex-astronaut, physician, diver and now hospital executive in Canada, Dave Williams, and one by Mark Gallagher, a Formula One racing executive. This presentation was a fascinating recounting of how Formula One had gone from having on average one driver death per year to no fatalities over the last eight years by studying the root causes of all mishaps and by applying human factors analysis to make the racing much safer.

I used the theme “The World is One Village” in my plenary address on flow. I wanted to leave the delegates from HMC with the message that the science of patient flow applies everywhere and we all struggle with the same issues (although the magnitude of the problem may be quite different.) There is a great need for dialogue and understanding in the world, and discussing how to solve the healthcare dilemmas of a country was a great opportunity for beginning this dialogue. I was also honored to be presenting as a plenary because my friend and mentor, Dr. Berwick, was presenting the day’s other plenary.

I learned so much during my trip and made many new friends. I was glad to have been a part of the conference, but I am also happy to be back home with a reinvigorated sense of pride for all that we do in our healthcare system at GBMC. I have greater appreciation for all that we have going for us.

Tuesday, May 26, 2015

Celebrating Our Resident Physicians

Last Friday, I had the great pleasure of attending the GBMC annual dinner dance to honor the house staff. Once every year, we take time to celebrate the accomplishments of our trainees and to thank them and their faculty for all that they do for our system and our patients.

Dr. Brian Kaplan, the Chair of our Graduate Medical Education Committee, served as Master of Ceremonies. After I welcomed those in attendance and thanked them for all that they do, John Saunders, MD, our Chief Medical Officer and DIO (while dio means “God” in Italian, here it signifies Designated Institutional Official- our senior representative to the Accreditation Council for Graduate Medical Education) made some comments and reminded us that one of the reasons for the creation of GBMC in 1965 was because the two predecessor organizations were at risk of losing their residency programs because they were not general acute care hospitals.

Dr. Paul Foster, the program director for Internal Medicine, presented the resident award to Sarah Finn, MD, the categorical intern award to Gurkeerat Singh, MD, and the preliminary intern award to Laurel Cummings, MD. The Internal Medicine faculty award went to Rudolf Pullmann, MD.

Next, Dr. Mary Louise Collins, the site program director for the Department of Ophthalmology, recognized our out-going Chair, Dr. Pat Wilkinson, for his many years of outstanding service. Dr. Collins then presented the resident awards to Angelique Pillar, MD and Roomasa Channa, MD. Dr. Pillar then presented the faculty award to Dr. Collins.

Dr. Kaplan then presented the Department of Otolaryngology resident award to Marietta Tan, MD. Dr. Kenneth Fletcher received the teaching award in Otolaryngology.

Bing Grumbine, MD, our Chair of the Department of Gynecology, then presented the OB/GYN resident award to Stephen James Martin, MD. The Gynecology teaching award went to Robert F. Pegues, MD.

It was a beautiful evening in all respects. The weather was perfect but the affection and admiration for their attending physicians by the residents, and for the residents by their teachers, was a thing of beauty as well. Having a teaching hospital is a significant reason for GBMC being the great care system that it is and we must never forget this.

Wednesday, May 13, 2015

It’s Hospital Week! Reflecting on the Value of Our Hospital in the Community

For 50 years, Greater Baltimore Medical Center has been serving the healthcare needs of our community. From the moment we opened our doors, our people have worked hard to meet our mission of health, healing and hope.

This is National Hospital Week. It’s a wonderful time to celebrate our hospital and acknowledge all that it means to the people we serve. In a two-week span this winter, we had two emergencies in our family and I was so grateful that GBMC was close and our team was so well prepared, hard working and caring.  On those two occasions, I was reminded that it takes the whole team, from parking lot attendants, grounds crew, patient access reps, and billing staff, to transporters, environmental services workers, food service workers, security personnel, social workers, care managers, physicians, nurses, clinicians, volunteers, and all other non-clinical and administrative employees. All of the GBMC family is very important to get the job done.

As GBMC celebrates its 50th anniversary caring for our community, this week is a great time to reflect on some of the things that make our hospital a great place to come to for care and a great place to work.

So, as we observe National Hospital Week, I want to sincerely thank all the members of our staff, Board of Directors and volunteers and everyone who has helped us improve our designs and make our system of care more reliable to move us closer to our vision: to every patient, every time, we will provide the care that we would want for our own loved ones.

I invite all employees to take part in the Hospital Week celebrations planned this week including:

Wednesday, May 13 - Ice Cream Social Event – Enjoy a delicious ice cream today:

  • 12 p.m. - 2 p.m. at the Emergency Department (ED) Entrance and in Civiletti Conference Center
  • 6 p.m. - 7 p.m. at the ED Entrance Only
  • 11 p.m.-12 a.m. at the ED Entrance Only

Thursday, May 14 - GBMC Mug Giveaway – Each employee and volunteer will receive a commemorative GBMC 50th Anniversary mug as a token of our appreciation.  Managers will receive an email with the location to pick up mugs for their staff.

Thursday, May 14 - Employee Wellness and Information Fair -- I know you are very busy caring for our patients and healthcare system, but please take some time to focus on your own health and wellbeing by joining us for the fair anytime from 11 a.m. - 3 p.m. in the Civiletti Conference Center.

Thursday, May 7, 2015

Honoring our Nurses During National Nurses Week

Each year, GBMC celebrates National Nurses Week and National Nurses Day (celebrated this year on May 6th). During this week, we reflect on the tireless caring that our nurses demonstrate daily in their work with our patients. I often write in this blog about how we at GBMC are transforming to fix the main issues affecting our national healthcare system.  I can assure you that nursing is not one of those issues.  This country has the best prepared and hardest working nurses in the world.

Our nursing staff is a phenomenal group – well-trained, smart and resilient. In fact, the resiliency of our nursing staff never ceases to amaze me.  Nurses are at the bedside 24 hours per day, 365 days of the year. They deal with whatever problems come their way and are the face of our healthcare system to thousands of patients annually. Nursing requires self-sacrifice and dedication. Through major snowstorms and other calamities, our nurses are there for our patients, whether they have to sleep on cots in the hospital so that they don’t miss a shift, or come in early to make sure shifts are covered. We in the GBMC HealthCare system are blessed to have phenomenal nurses in our inpatient units, in our operating suites, in our outpatient areas, our physician practices and in our hospice.

One of the hallmarks of nursing is compassion but over the last 50 years nursing has become a very technologically and scientifically challenging field. During my time at GBMC, I have seen just how talented our nurses are and how good they are at problem-solving. Through Lean Daily Management (LDM), I have had the pleasure of getting to know many of our nurses and have observed directly their dedication to improving care and moving us closer to our vision.

Last evening, as part of our 50th Anniversary Celebration, we held a reception for all of our nurses who had served GBMC for 10 years or more. I addressed the group and reminded them how GBMC had always been known for outstanding physicians and outstanding nurses. I thanked them for their dedication to our patients and for their efforts to continually improve our care. This beautiful power point presentation (below), displayed during our event, clearly demonstrates the value of our nurses and what they mean to GBMC and our patients.

Our Board Chair, Bonnie Stein, told them of how GBMC had become her hospital and health system even though she lives some distance from our main campus. She had initially been referred to a prominent GBMC physician who treated her very well, but it was the nursing care that helped convince Bonnie that she should get all of her care at GBMC!

Our CNO, Dr. Jody Porter recognized each of the nurses in attendance and also thanked them for their commitment and excellence. It was then fitting for us to also recognize Jody for her outstanding leadership as she prepares for her retirement. It was a great occasion!

So during Nurses Week, please take a moment to thank our nurses for all of their care and caring.