On Monday, I was proud to accompany several GBMC HealthCare colleagues to San Diego where GBMC’s geriatric and palliative medicine practice Gilchrist Greater Living and Gilchrist Hospice Care were recognized with the prestigious 2011 Circle of Life Award from the American Hospital Association (AHA). The Circle of Life Awards, given to only three organizations in the country, were created in 2000 to recognize programs that have found innovative ways to deliver the best and most timely palliative and end of life care possible. Circle of Life Award winners are considered role models for other communities.
In choosing Gilchrist for the national honor, the AHA selection committee noted the organization’s unique role in creating the Gilchrist Greater Living (GGL) geriatric and palliative medicine practice, which follows its mostly elderly patients throughout the healthcare continuum – from office visits, to the hospital, to nursing homes, assisted living and rehabilitation facilities and ultimately, to hospice. GGL is overseen by Cathy Hamel, Gilchrist’s executive director, and Tony Riley M.D., medical director, and is designed to ensure that the frailest of patients receive care that is compassionate, coordinated and comprehensive.
When I read in the award brochure, “Because the geriatricians at Gilchrist Hospice Care monitor patients and oversee patient care in multiple settings, ranging from home to skilled nursing facilities to hospital to hospice, their patients benefit from the greatest possible coordination”, I realized what a wonderful gift it is to have Cathy, Tony, and all the Gilchrist staff as part of our GBMC family. Our strategic plan is about coordinating care for the patient and this part of our family is already doing it exceptionally well.
The day began at 7 a.m. with a “sunrise session” in which Dr. Riley and representatives from the other recognized organizations discussed how they met the needs of patients and families and continually worked for even better care for the elderly. I then went to a plenary session where Dr. Atul Gawande, the noted Harvard surgeon and writer for the New Yorker, spoke about his work to improve health care in America (and across the globe) by the use of the checklist.
Dr. Gawande noted that there are three new values that health care providers needed to embrace to improve care. The first was humility. We should celebrate the intelligence, training, hard work and dedication of our physicians and nurses. But these professionals (especially physicians) must understand that they too are human and the practice of medicine has gotten way too complex for any individual to be able to deliver the care as a “lone ranger” that we would want for our own loved ones. The second new value required was discipline, required in complex endeavors to do things the same way every time according to the evidence of what works best. Gone are the days of allowing professionals to do things in whatever way feels right to them if the evidence shows that one way is best. Dr. Gawande suggested that the third required value was teamwork. Because healthcare is now too complicated for any one provider to be able to meet the needs of the patient, providers must value the input of all of their teammates. I found it interesting that he said that studies now show that the most powerful element of the use of checklists is not the checklist itself, but the teamwork required to use the checklist correctly. While he was speaking, I was thinking that Gilchrist displays these values daily.
We had a great lunch with the Circle of Life Award Committee and the other honorees and then went to the award ceremony. When Cathy received the award on stage it was another proud moment for me and our organization.
We then heard a presentation by Chip Heath, a Stanford University professor, who with his brother Dan wrote the best-selling book: Switch: How to change things when change is hard. Chip is an outstanding speaker. He presented a “change methodology” that was quite compelling (and again got me thinking about all that we are asking our people at our health system to change at once.) Chip said that research from the field of psychology has shown that humans have an internal conflict between their analytical self that thinks about and plans change and their emotional self that does the change. He offered as an example that the analytical self knew that he had to exercise to maintain his weight but the emotional self wanted to hit the snooze button rather than get up and go to the gym. The planner knew to count calories but the doer wanted to eat the Oreo cookie. He used the analogy of the rider as the analytical planner and the elephant as the emotional doer. The rider of an elephant can plan, think and analyze but sometimes the elephant has a mind of his own that overwhelms the rider’s plan.
Chip pointed out that the research literature had generated three surprises about change. The first is that what looks like resistance to change is often a lack of clarity about the change. You need to direct the rider. In this case, if you want to make change happen, rather than repeating the time honored dictum about “people just don’t want to change”, you should provide clear direction …and simple steps. The second surprise about change is that what looks like laziness is often exhaustion. People can’t do too many changes at once. “The rider can’t get his way by force for very long.” You need to motivate the elephant. Mr. Heath added that telling moving stories is generally better than giving data to get people in action. The data are needed but the stories ignite the fire. The third surprise about change, Mr. Heath said, is that what looks like a people problem is often a situation (or process, or path) problem. When things go wrong, or not as we would like, we have a tendency to attribute the problem to a fundamental flaw in the people involved rather than to the situation they are in. By blaming the people for the difficulty with change, we make the solution impossible. How do you make a stubborn person not stubborn? Chip said to try making the change easier and forget trying to change fundamental characteristics of the people involved in the change. He called this shaping the path.
Again as I was listening to Mr. Heath, I thought of Gilchrist and their work to eliminate the pain typically experienced by a patient new to the hospice service. The national standard is 48 hours but Gilchrist has made a commitment to reduce it to 24 hours. Cathy, Tony and the Gilchrist Hospice team motivated the elephant by telling stories of new patients and their families and got team members charged up to make major improvements. They directed the rider with a clear message about the goal and they made it easier to achieve that goal by shaping the path with daily conference calls and small tests of change. Now greater than 75 percent of patients are pain-free within 24 hours!
For inpatient end of life care, Gilchrist offers a unit on the GBMC campus, which recently was expanded to offer 34 beds, and a 10-bed center located within Harmony Hall Assisted Living in Columbia, the first acute care inpatient hospice facility located in Howard County's borders, which opened in May. This center ensures that terminally-ill individuals in Howard County and their families will have access to the full spectrum of the finest in end of life care, close to the homes they cherish. In addition, meeting a long unmet need, last summer Gilchrist Kids began providing comfort at home for terminally-ill infants, children and teens in Central Maryland, as well as care and support for their extended families.
I am so proud of Cathy, Tony and the entire Gilchrist Greater Living and Gilchrist Hospice team. Please join me in thanking them for making our care better! And please congratulate the Gilchrist staff when you see them. We can all learn from them.
UPDATE: Be sure to take a few minutes to watch this "Circle of Life" video. Dr. Riley and Cathy Hamel do a nice job of explaining Gilchrist palliative medicine and end of life services that help the patient and their family make the best decision for their situation.
Can you relate to Dr. Gawande’s three values required for improving our health care system? Do you have examples of how you have used Chip and Dan Heath’s change model or some other model to improve care? Please share your thoughts by commenting below.