What is our personal responsibility for living our values at GBMC?

Let me share a story that happened recently here on campus. 

It was an early weekday morning. As I walked through the Lily Park garage toward the Main Hospital thinking about the day ahead, I encountered three employees in scrubs who were standing in the ramp, clearly smoking cigarettes. As you know, for the health of our patients, visitors and employees, GBMC is a smoke-free campus. It has been so for more than five years. This rule comes from our value, respect. Out of respect for our patients, visitors, and our colleagues, we don’t smoke on our campus (and we don’t toss cigarette butts on the ground for others to clean-up).

Now, I realize it is hard for us as employees to approach individuals who are violating our smoke-free policy, but I decided to do so and ask them to put out their cigarettes. As I got closer, it became evident to me that one of them had also parked in a space that was clearly marked as “Patient and Visitor Parking Only.” We reserve some parking spots close to the door so that our patients, especially the sick and the elderly, don’t have to walk so far. I think this rule also comes from our value, respect.

As they saw me coming towards them, they quickly tried to hide and extinguish their cigarettes. But I still asked, “Are you aware that our policy states you cannot smoke cigarettes here?” I also asked the person who had parked her car in a “Patient and Visitor Only” spot, “Do you work here? Because you are not supposed to park there.” Her response was “Yes, but I am only part-time!”

I know that cigarette smoking is an addiction for many, but what if it was your child with asthma or your mother with chronic lung disease who was about to walk by?

I also know that there are times when you may be running late and are just in a hurry to find a parking space so you can get to your work station on time. But, what if you were a visitor to our campus, and you were looking for a parking space so you could visit your mother? You are anxious, nervous and scared – all of the emotions one may have when a loved one is in the hospital. Those emotions can be elevated when you have to drive around and around to find an open parking space. Then, on top of that, when you do find a space and get out of your car, there is a strong odor of cigarette smoke (or worse, a cloud of recently exhaled smoke), and you need to step over discarded cigarette butts! It’s not reassuring to know this is the kind of environment where your mother is being treated.

I am confident that most employees park where they are supposed to and follow our smoke-free campus policy. But, when those rules are broken, I ask the following:

1) Does the individual member of the GBMC family have a duty to not park in spaces reserved for patients and visitors?

2) Does the individual member of the GBMC family have a duty to not smoke on our campus except in his or her vehicle?

3) Who should say something to those few employees who violate these rules?

4) “I will foster a healing environment” is one of the behaviors associated with our value of respect. What does this value of respect mean to us in these situations?

I ask especially that employees who park in spaces reserved for patients and who smoke outside of their vehicle on campus reflect on these questions. I also encourage all employees to provide ideas on how we can better enforce the smoke-free policy and assure our employees do not park in spots designated for our patients and visitors.

On another note, I read a comment to last week’s blog in which a reader asked if the Medicare Shared Savings Program would ultimately lead to providers withholding necessary care.

This is a valid concern that we need to stay vigilant about. But, please know that the writers of the Affordable Care Act built in measures to prevent that very thing from happening. The Act includes 33 different quality parameters designed to assure better care. If we do not meet the quality parameters, even if we save money, we will not share in the savings.  We will add care that helps as we eliminate services that don’t. 

Under the Affordable Care Act, providers will wind up investing a lot more time and money on outpatient care. Let me give an example that I frequently use:

In the fee-for-service world, since no one pays for coordination, when we discharge a diabetic patient we don’t have a well-designed system for making sure that the patient takes their insulin correctly and stays on their diet. If the patient gets sick again and gets re-admitted, we get paid (well) again. The hospital and the doctors benefit financially from this second admission. However, if the patient was your mother, you wouldn’t want her readmitted for diabetes again. It is the second hospitalization that the Medicare Shared Savings Program is going after.

With the Affordable Care Act, we will be spending money (in the Patient-Centered Medical Home and with care coordinators) to keep the patient healthy, building a much more sophisticated system of care to keep that patient from getting sick again due to diabetes mismanagement. This is what you would want if it were your mother with diabetes. Yes, there is an opportunity for the unscrupulous to withhold necessary care but we will not let that happen.

Lastly, we held a very successful “Medical Staff and Employee Meet and Greet” last week. Approximately 200 employees came to the event, held in the back of the Dining Room, where they interacted with many of our physicians and their office staff members both from our GBMA employed group and from private practice. I want to personally thank Deloris Tuggle, Dione Harrison, Debbie Chilaris, Dr. Harold Tucker, our colleagues in the medical staff office and everyone who was involved in organizing the event; the 52 physician practices and their staff who participated; and those employees who attended. The feedback has been very positive and we are planning to hold similar events in the future.