Friday, May 27, 2011

GBMC HealthCare System – Our New Vision, Our New Plan to Get There

Shortly after I joined GBMC HealthCare, Inc. as President and CEO just about one year ago, I was challenged by GBMC’s Board of Directors to answer, in what direction should we go to keep GBMC strong well into the future?
We have taken this question quite seriously and I want to share our answer with you.
We’ve just finalized GBMC’s three-year strategic plan (FY ‘12 – FY ‘14), a huge undertaking that solicited the input of many people throughout the system. A new vision for GBMC has been created and I’m pleased to share that our long-term strategic plan is quite different from past plans and is unique in our region. It’s not about edifices and how big of a new patient tower we can build. Rather, it serves as the foundation for a solution to what ails the current national healthcare system, focusing on what the people in our community truly need and want to stay healthy, or become healthier. 
In creating our plan, we first needed to assess where we were as an organization and identify the things we were doing well. We next needed to ask ourselves where we were missing the mark through the eyes of our patients.  This process started with our Board of Directors’ strategic visioning retreat where we began shaping the organization’s new path.  We discussed how America has the best trained doctors and nurses in the world, yet we are in a deep mire. Our system is very costly and is financially unsustainable. In addition, our care is frequently disjointed and the ever-increasing number of people with chronic disease is frequently not well served. The Board challenged themselves to think of a better system that they would want for their own family members. Thanks to the leadership of the Board’s strategic planning committee, led by Chairman Jim Stradtner, we developed a vision of a more patient-centric system where the patient’s needs could be better met.  
So today, GBMC is moving into the future with renewed energy and increasing insight with our new vision as our guiding light. The more lengthy vision statement is summarized in the phrase:
“To every patient, every time, we will provide the care that we would want
 for our own loved ones.”

[Read the full version of GBMC's new vision as well as the strategic plan summary on the GBMC website - ]

With our new vision taking shape, we forged ahead with creating the plan to get there, working with the clinical department Chairmen throughout GBMC to find out what they needed to get us to this vision. We took their valuable feedback and used it to begin developing the specific areas of focus and tactics of our plan. The process was guided by the strategic planning committee and overseen by John Ellis, Senior Vice President of Corporate Strategy and Business Development, and Colin Ward, who as part of the plan has been named Executive Director of the Greater Baltimore Health Alliance. Once the committee sanctioned the plan, we took it to our full Board earlier this month and they approved it.
So, as we begin to roll out our new vision for the future, I felt it was critically important for everyone to know where we are going and how we will get there, with the ultimate goal of providing the very best care for the people in our community.
 At the heart of our strategic plan are five pillars that encompass the work to get us to our new vision:
1.   Create an enterprise-wide IT solution, e.g. Information technology, specifically Electronic Medical Records (EMR), that will provide a seamless information network between outpatient and inpatient records
2.   Improve operational performance
3.   Improve clinical outcomes and the patient experience
4.   Build a provider network to achieve the mission of developing a model system for delivering patient-centered care
5.  Create new organizational capabilities to support our new strategies

What the Future Will Hold
Moving forward, GBMC will provide the kind of care that will keep people from getting sick, or sicker, rather than just taking care of someone episodically (like when they come in with a sore throat, infection, or even complications from a chronic disease that has not been managed correctly).  This type of comprehensive care requires much more attention on prevention and a greater focus on primary care as a way to mitigate disease. We see primary care physicians and their teams as the integrators of services across the continuum. This is why our primary care practices in our employed group, Greater Baltimore Medical Associates (GBMA), have undergone a significant transformation over the past year, moving toward a patient-centered medical home model that includes extended office hours to better meet the needs of our patients, as well as e-mail communication, patient registries, the electronic record, group education for specific chronic diseases and more – this is all part of the transformation of healthcare that GBMC is leading for our community.
In fact, we have a really good example of integrated care embodied by Gilchrist Greater Living, GBMC’s geriatrics group, led by Dr. Tony Riley. This team of physicians manages the care of frail elderly from their home, to the physician office, to extended living facilities, to nursing homes, to the hospital, to hospice and between these different sites.

Building a Strong Provider Network and Capitalizing on Our Historic Strengths is Essential
In addition to an emphasis on primary care, our plan will build on our wonderful areas of excellence in specialty care. We cannot lose sight of our historic strength in Surgery, Women’s Health, Cancer, and many others. In order to be a vibrant healthcare system we will no doubt need to do surgery even better, more efficiently and with greater patient satisfaction than ever before, which is why surgery (and the success of all of our surgeons) is another main focus of our strategy for the future. We will place even more emphasis on the measurement of outcomes – and recognize that there will be an increased need to document the medical necessity of procedures to ensure that we are practicing evidence-based medicine. Dr. Jack Flowers, GBMC’s Chairman of Surgery, is leading the charge to have us report and record data so that we can be ahead of the curve when it comes to documenting our superb surgical outcomes.
We must create a more integrated healthcare system from our existing model, which must include wonderful private practicing physicians in the community as well as those physicians who are employed by the system. This vision of building an alliance of physicians is now becoming a reality with the establishment of the Greater Baltimore Health Alliance (GBHA). GBHA will be a physician governed organization comprised of employed and private practicing physician partners tied together by a common commitment to better health, better care, and lower cost and a common electronic record system that will facilitate the exchange of health information, and  help coordinate care among the practices, the hospital, Gilchrist Hospice Care and other future community partners.
In building a strong provider group, we realize that GBMC doesn’t need to employ all physicians. Across the country, the organizations that seem to integrate care well have mostly employed physicians. At GBMC, we want to build on our historic strength of outstanding private practicing doctors by aligning them tightly with our employed physicians.  This type of combined medical staff has certainly served us well over the history of GBMC. We need to build up from this area of historic strength.  
Integration is a Key Tenet to our Strategic Plan
In order to integrate care through eyes of the patient, we must have a sophisticated electronic medical record system. All GBMA primary care physician practices now have the EMR in place. We will have all of our employed specialists on the record over the next few months. And our partners through GBHA will also be helped to implement the EMR technology. Patients often get nervous and frustrated when clinicians ask the same questions and don’t have access to tests they have already taken, which results in the waste of repeating tests. This type of fragmented care is a characteristic flaw of our existing system and GBMC is leading the way in eliminating this flaw.
Healthcare Reform in Our Own Backyard
What GBMC is looking to achieve is a true reform of our community’s healthcare system. We are doing the right thing to better serve our patients. We’re focusing more on the specific needs of each patient and the health of the community. Some may worry that we could find ourselves going down a path that causes us to lose money because the payment system may not be able to keep up with the rapid changes in the way we deliver healthcare. However, being an independent, community hospital makes it much easier for us to adapt quickly as change comes. And, we have time to make the transition because all of the change isn’t going to happen overnight. It is also helpful that we are beginning from a strong financial footing; we do not have the huge debt associated with large new buildings.
It’s so important to have this plan in place for the healthy future of our organization as well as of our community. And as you can see, we’ve adapted our vision and we are now ready to be the healthcare system that “To every patient, every time, provides the care that we would want for our own loved ones.”
I welcome your thoughts and comments as we move into this new era of healthcare at GBMC…


  1. Dr. Chessare, What you have failed to mention, and what has been a trend in your blog posts, is the other disciplines that will be the epicenter of these changes. Physicians are not the only healthcare professionals that are responsible for patient care or that deserve to be noted. Throughout your posts, physicians are routinely recognized and addressed by their title and full name in bold face font. Not one nurse was noted in your post celebrating nurses’ week. Nurses are implementing many of the changes you have described in this post however they are never mentioned. Each point you make recognizes, and unjustly glorifies, the physician.

    Management and documentation of patient outcomes has occurred on the unit level at GBMC for quite some time. However, this management is done by the nurses. Currently, every unit has a unit-based practice counsel who recognizes issues in practice and addresses them. These groups are organized and run solely by nurses. Nurses at the bedside recognize needs in patient care. They then bring these issues to the group, conduct research, and determine a solution. To date, GBMC has implemented a tight glucose control protocol, falls protocols, hyperglycemia protocols, electrolyte replacement protocol, and an eye care for ventilated patients protocol, to name a few. These protocols were all researched, written and implemented by nurses in response to issues they discovered in patient care. These counsels are responsible for keeping GBMC up to date with evidence-based practice and providing the best care for our patients.

    Nurses are also responsible for data collecting and reporting. Each unit has a CUSP (comprehensive unit safety program) team that develops and implements protocols regarding central line care, skin care, and hospital acquired infections. These nurses collect data on the aforementioned sentinel events and implement strategies to prevent them in the future. As a result of this, many units are several weeks or over a year without a central line associated bloodstream infection. The MICU has gone over five years without ventilator acquired pneumonia. These are just mere examples, and nursing is in the center of this process.

    The sophisticated electronic medical record system that you mention was developed by a staff nurse here at GBMC. Nurses make changes to the ordersets and address any discrepancies. Nurses developed, implemented, and educated on the new CPOE (computer physician order entry) program.

    Modern research has proven over and over again that nursing input and their assessments are crucial to improved patient outcomes. On the floors, it is often nursing who gets the ball rolling with patient mobility, nutrition support, and other comfort measures. It is nurses who are responsible for ensuring the patient leaves the hospital with as much functionality as possible.

    No, a hospital cannot run without doctors, but it cannot run without nurses either. Nursing is in the center of all of these changes you described and many, many more. What would a hospital do without nurses to advocate for the patient, address practice discrepancies, and provide this care? Physicians write orders, but what good would they be without a nurse to implement them and evaluate their effectiveness? Patients are hospitalized because they require daily care, hourly care, and sometimes constant, one to one, uninterrupted care. Patients are admitted to the hospital because they require nursing care. If you fail to recognize this, you have missed the mark.

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  3. Anonymous,

    Thank you for raising a very important issue. Nurses are the center of hospital care. They are present 24 hours per day as a constant guardian and aide to the patient. They bring science and the art of caring.

    I went back and counted the number of times that a nurse was "called out" in the blog in boldface. I have done this 9 times since I began my blog. Many of these callouts came in a single blog post on the Health Care Heroes. In comparison, I called out physicians in bold face 15 times (4 of those were to Dr. Saunders our CMO).

    I don't want to make excuses. I am very aware of the phenomenal work and commitment of our nurses. The blog is designed to move us forward as a Health Care system. We do very well once a patient gets admitted and a big reason for this is the hard work and caring of our nurses.

    A big opportunity for us is in managing care and keeping patients out of the hospital. Physicians are much more prominent in the redesign of outpatient care and that is why I have referenced them and their work so prominently recently and in discussions of our new strategic plan. It is understandable that I would spend more time discussing the areas that require bigger changes.

    Having said that, I will redouble my efforts to highlight the work of all of the members of our Team: physicians, nurses, nurse practitioners, PA's, therapists, technicians, other clinicians, and all non-clinicians. We need all of us to be fully engaged. Thanks for your comments.


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