Friday, June 20, 2014

What Do I Learn at Town Hall Meetings?

Over the past couple of weeks, I've met with large groups of employees as well as small groups in departmental town hall meetings. One of the goals of holding these town hall meetings is for our people to come away feeling informed about our health care system and what is going on around it. It is also an opportunity for me to get more people in action to help us reach our vision and to hear our people’s concerns and ideas on how we can continue to get better and meet our four aims.

Here are a few of the conversations that I had with our folks during the meetings thus far:

A staff member was upset that she didn't get a raise this year. I reminded the employee that indeed she did receive a raise, but she let me know that it was ‘so small that she didn't notice it in her paycheck.’ I had to remind my colleague that GBMC’s profit margin this year is budgeted at less than one half of one percent. This means that for every dollar that we take in, we are spending 99.5 cents already. This does not leave much room for raises. I asked her to help us continue to reduce waste and to attract more patients to create an opportunity for bigger raises. I was concerned that she did not see the relationship between her efforts to improve things and her salary.

At a town hall session for the GOR (general operating room) staff, a nurse asked me, “Why do I have to ask the patient for all of this information pre-operatively when the information is already in the physician’s outpatient electronic medical record?” To this nurse, it seemed this was a waste of her time as well as the patient’s time. I have to admit that I got upset when this question was raised because I agreed wholeheartedly, but I wondered why this hard working nurse had waited to bring this matter to my attention instead of turning to her boss the very first time she felt this frustration so that they could fix it together? Did she not feel empowered to fix it? When I asked the manager why the staff did not have access to the EMR, the manager did not know this was an issue or concern. We must have the whole team engaged in improvement. If it is within your control to fix…fix it. If it is not, bring it to your manager and work with him or her to get it improved. The manager, for her part, must be asking her team to bring forth ideas for improvement and she must be engaging them in problem solving on a regular basis. Our people need to believe that it is not only their right to speak up but it is their duty. All of our people at every level must not accept dysfunction or assume “that’s just the way things are done.”  We must all be in action to make things better. Our work with lean daily management has demonstrated what can be accomplished when many begin focused problem solving. But if everyone is waiting for me to fix things…we are not going to get very far.

A Gilchrist staff member who had her arm in a sling raised her hand to tell me about the care that she had received recently. She fell and injured her arm and went to the ED. At registration she was asked if she had a primary care physician. She said yes but she was a bit reluctant to say that she went to one of our patient-centered medical homes because she had not been seen recently. Her injury was addressed and she went home. She was surprised when the next morning, about 10:30 AM, she received a call from her practice’s care manager inquiring about how she was doing, if her pain was controlled and if she had a follow-up appointment with an Orthopedist. She told me that she was delighted to see that someone was looking out for her and trying to help coordinate her care. I told her that every morning at 10:00 AM our primary care sites in GBHA get a download from CRISP, the Chesapeake Regional Information Sharing Network for our Patients, that tells them if any of their patients were seen in the previous twenty four hours in any hospital in Maryland. Her practice had been notified of her visit to the ED and they wanted to make sure that she was doing OK and that she understood the plan for her care. Her story made me feel very good because it was evidence that we are making real progress on becoming a true community based health system through the eyes of the patient.

The lessons I learned from these encounters in this series of town hall meetings are these – we must all:

  • Be engaged, empowered and in action to improve the care we deliver
  • Never accept dysfunction and cynicism
  • Celebrate our improvements

I found myself wondering, ‘Why is it that most of our people are feeling empowered but some are not? What is happening at our department meetings? Why are some not engaged and don’t see that they can say, “I have an idea”?’

I urge our team not to accept the status quo but to continue to be in action to create positive change. Waiting to air grievances twice a year at a town hall meeting is not going to get us to our vision any time soon!

Department leaders have to take responsibility to keep lines of communication open between them and their staff. We need a free flow of ideas both ways. The boss must be all ears for questions and ideas from their team and employees must be ready to fix things within their span of control. This is not an issue unique to GBMC. Rather, it is an issue for all organizations that grows with the size of the organization. I hold our local leaders accountable for overseeing effective problem solving to generate positive change and for getting everyone engaged. Our tremendous progress in so many areas shows how well the majority of our local leaders are doing this. I am grateful for their hard work and for that of their teams.

So, my reflecting after the first few weeks of Town Hall meetings shows me that our culture is certainly changing for the better, but it has also made me ask myself what we could do to make it change even faster.

How can we get more people engaged, empowered and in action on meaningful change? As usual, I look forward to hearing your ideas.


  1. Thank you Dr. Chessare for listening in the town hall meetings and for asking all of us to be proactive. Recently I had a family member who had to visit the ED and who ended up having surgery. As an employee and a nurse, and closely related, I was unfortunately not very impressed with the lack of communication between the staff and the patient during his stay. For example, the room he was in had a white board in it which had the name of a nurse and tech, from 4 days prior. When I mentioned it to the clerk at the desk, she laughed. The patient was diabetic and hadn't eaten since that morning, but no one offered anything to eat, or checked regarding it. When I asked later, I was told that he was to be NPO since he might go to surgery. I asked if anyone had communicated that to him? When he asked for water, he was given a small paper cup with lukewarm water in it.I asked for and got a full cup of ice water for him. It is the small things we remember and overall this is not a great impression to leave with patients or their families. His surgery was phenomenal and so far the outcome is great, hopefully this is what his takeaway is from his stay. We all have the power to affect patient satisfaction, we all need to own it.

  2. I wanted to give another perspective concering the situation about the OR nurse bringing up information already being in a patient's EMR.

    While I agree that communication and a whole team effort is needed, there must be a reason why she felt she could only bring up the topic to the town hall meeting.

    Sure, the manager said he/she was not aware of this concern, but do we really know that? It's very possible in today's world that people can be making up things to cover for themselves.

    And let's be honest, there are managers that are unapproachable. There are managers that are not receptive to new ideas or changing things.

    I wanted to defend this OR nurse because that really could be the case, and this really hits close to home, especially considering the practice manager I currently have just a few days ago covered up an error she made and blamed the front staff to higher management. Our front staff here, repeatedly come up to her about ideas on how to change front desk operations and nothing gets changed.

    I think the OR nurse makes a good point. If the EMR already contains information they need, than I suppose it's redundant to collect the data again. Maybe there just needs to be a quick check list to make sure the information is accurate when the patient arrives to the OR.

    Maybe we can hear a followup about this to see if the OR nurse got a chance to have her ideas heard. That would truly be enpowering, and that would be a great example of whole team effort.

    1. Thanks, Anonymous. I want you to know that I am not blaming the nurse who raised the issue. There is no reason to "defend" the nurse. My blog comments were intended to elevate the importance of two way communication at huddles and meetings. It is clear to me that if managers are not holding effective huddles and meetings where our people are involved in problem solving than they will have no recourse other than to raise these issues with me or other members of the Senior Team. I believe that the nurses now have access to eCW but also that the dialogue raised other care design issues that are now being worked on.


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