Tuesday, June 25, 2013

How Much Progress Did We Make Toward our Vision in Fiscal Year 2013?

Our fiscal year ends this week so it’s time to reflect on our accomplishments. We won’t have the final tally on our system goals until the fall after our financial audit is complete, but we can already see that it has been a great year for our system. We all know that we measure our progress toward our vision of becoming the healthcare system where every patient, every time, gets the care that we would want for our own loved ones by assessing our four aims: better health,  better care, with the least waste, and the most joy for those providing the care.

Better Health

Our work in standardizing care around the evidence has helped us achieve great things this year. Since fiscal year ‘11, we have reduced our serious safety events by 45%. We went from 20 events in FY’11 to 11 in FY’13. While we did not achieve our goal of 10 or less in FY’13, the knowledge that we have gained from studying our events and creating more reliable systems where care is delivered will serve us well for the future. We have made significant progress in healthcare acquired infections. In this year, two highlights are the dramatic reduction in catheter-associated urinary tract infections and the big improvement in hand hygiene, where we are now close to 10 points above the statewide average. See the charts below. These achievements were made by redesigning systems and monitoring the performance of the new designs.

We would have clearly reached our goal of reducing incidents of harm by 20% had we not uncovered the fact that we were not counting falls at home for Gilchrist patients in our overall falls reporting. Our reporting of near misses, great catches, and lower level safety events has also improved significantly and we achieved our annual goal.  Our Board Quality Committee continued to mature in its ability to drive meaningful change with the addition of our patient members. Our Board authorized the release of our quality indicators to the general public. We now update the data monthly for all to see at www.gbmc.org. The Greater Baltimore Health Alliance, our Accountable Care Organization, has successfully reported all of its required quality measures to the Centers for Medicare and Medicaid Services for our first year in the Medicare Shared Savings program. Our work with the outpatient medical record and standardized order sets with prompts has made our primary care much more reliable. The attainment of level 3 certification for our patient centered medical homes has increased our ability to manage chronic disease.

Better Care 

While we will not reach our goal in many of our patient satisfaction areas averaged over the entire year, last month, May 2013, we achieved the highest overall inpatient satisfaction score in the history of the organization. I attribute this to many things but most importantly to the increased study and testing of changes that are now happening on our inpatient units and other clinical departments fostered by Lean Daily Management. On many floors, our nursing teams are now asking patients on a daily basis about their care and then problem solving to fix defects in care like inadequate communication or responsiveness.  

Gilchrist Hospice Care has achieved a 96% success rate with making patients comfortable within 24 hours of admission. This is a phenomenal accomplishment. Our employed physician group, Greater Baltimore Medical Associates (GBMA), has now reached its goal for overall satisfaction rating by truly focusing on the patient’s needs. In this year, GBMA primary care offices have opened on Saturdays, greatly increasing their patients’ satisfaction with access to care.

Less Waste

It is too soon to tell if we will achieve our 1.2% operating margin for the year but we are at 1.6% through May. Many Maryland hospitals are currently operating in the red. Our system is in the black, even though we get lower prices than many of the other nearby hospitals. I am very proud of our ability to drive waste out of our system. Our redesign efforts in the arena of moving admitted patients out of the Emergency Department and to the inpatient units are starting to payoff. Our overall throughput time for admitted patients in the month of May was 6.23 hours, a 1.45 hour reduction over May of 2012!

More Joy

Our employee and physician satisfaction surveys will happen later this summer. We have been working to address issues raised since our last survey. We have worked hard to empower our people to make changes to make their work lives easier. We have gotten better at moving decision making to the people doing the work (although we still have room for improvement in this area). We have listened hard to concerns about our benefits and we have worked to improve them. We plan to give raises based on merit in the fall.
While we will not achieve our goal of reducing employee injuries by 20%, we will have had fewer in FY’13 than in FY’12. The number of employee injuries for the preceding day is now a Lean daily metric for the senior executive team. Every morning we hear of the injuries from the previous day and we are beginning a daily problem solving process to root these out.

Looking Forward

So, we are getting closer to our vision – the measurements bear this out. We are getting more and more recognition from outsiders about our work in creating a value-driven healthcare system. We must stay in action and generate continual improvement.

Fiscal year 2014, which starts next week, will be a pivotal year for our healthcare system. In October, the health insurance exchange created by the Affordable Care Act will create a new marketplace for health insurance. Insurance companies, like the Evergreen Cooperative and Cigna Health Care and others, are racing to create new offerings that will provide measurably better care at lower costs. These companies see what we are doing and are happy to collaborate with us as they construct their new products.  They want to work with GBHA and its 100 plus primary care providers driving value through our patient- centered medical homes. They know of our great surgeons and other specialists providing great care in our lower cost hospital. They also know of the phenomenal work of our geriatricians and their nurse colleagues in Gilchrist Greater Living and Gilchrist Hospice Care and how wonderful they are at patient-centered care in the later stages of life.

While some others are focused on getting much higher hospital rates even though their existing rates are already much higher than ours, we are working to lower costs and drive value…because this is what the community is desperate for us to do.

I am very excited about the future of the GBMC HealthCare System and the next steps in the attainment of our vision. I look forward to discussing this with many of you at our Town Hall meetings which will begin on July 8th.

Let me know what you think of some of the positive changes that have taken place over this past year - I welcome your feedback…

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