Wednesday, November 26, 2014

If Your Mom had Diabetes Wouldn’t You Want Someone Reflecting on and Improving her Care?

One of the most enjoyable parts of my job is meeting with teams who are improving patient care. Last week I visited our patient-centered medical home (PCMH) at Hunt Manor. Drs. Robin Motter-Mast and Joe Connelly led a meeting focusing on improving the team’s diabetes composite score.  Also participating were Diana Mantell, the Administrator for Population Health of the Greater Baltimore Health Alliance (GBHA), Yvonne Latchaw, RN, the care manager at Hunt Manor, and Amanda Harris, one of the team’s medical assistants. The diabetes composite measure is made up of a number of evidence-based elements in the care of diabetes. The diabetes composite score is the first measure of population health on our system-wide scorecard.

The Hunt Manor team explained to me that it is not easy to get this diabetes composite score right. Either all of the elements are present for an individual patient or it is considered a miss. The five things that they must be achieved are:

•    blood pressure needs to be less than 140/90measured in the normal range
•    LDL cholesterol less than 100 in range
•    Hemoglobin A1c level less than 8
•    daily aspirin or anti-platelet medication in patients with diabetes and ischemic vascular
     disease (IVD)
•    and non-tobacco use 

Dr. Motter-Mast explained to me that the team has worked on engaging patients 18-75 years of age with diabetes that were missing lab values. Some of these patients were also seeing endocrinologists, so the Hunt Manor team worked with those offices to gather the values.  Other patients had not been seen recently so members of the team began contacting those patients to schedule visits.  The team also reviewed their Diabetes Disease Registry to find the patients who needed to be on aspirin, and contacted them to start if appropriate.

The GBMC data warehouse, built a few years ago, now gives us the ability to create reports like the Diabetes Disease Registry. These reports show performance at the level of the system, the practice and the individual provider and are used to find the patients who are deficient on one or more measures. PCMH teams then decide which metric to work on based upon the scores for their practice.

Most primary care offices in our country don’t have such reports and are not holding themselves accountable for helping the patient achieve measurable improvement with their chronic diseases. The GBHA, with the Hunt Manor office as an example, practices advanced primary care and is holding itself accountable for maximizing the health of each patient it serves. I am very proud of them and grateful for all of their hard work.

While at Hunt Manor the rate of success on individual metrics within the diabetes composite varies from 44 percent (LDL cholesterol) to 87 percent (aspirin use in IVD and non-use of tobacco), the overall rate of patients with all five measures met is currently 20.58 percent compared to 15.9 percent in late August of this year. Although it will be very difficult to get to 100 percent, the Hunt Manor team won’t quit until they get there!

Linda A. Walsh, MD, a GBHA board member and family physician at Jarrettsville Family Care, was recently awarded the 2014 Humanitarian Award by the American Academy of Family Physicians (AAFP) at its annual meeting. The Humanitarian Award honors extraordinary and enduring humanitarian efforts by AAFP members, both within and beyond the borders of the United States.  As the medical director and chair of the Steering Committee for the Dominican Republic Medical Mission, Dr. Walsh has led annual medical missions to the Dominican Republic since 2003. Over the years, she has been instrumental in addressing the immense medical needs of the community and its lack of access to basic health care. In 2014, Walsh’s team held 13 clinics, treated more than 700 patients and initiated and oversaw the installation of a water purification system in Esperanza, a Haitian refugee village. Please join me in congratulating Dr. Walsh on her recent achievement and for her efforts to help the people of the Dominican Republic.

In my previous blog, I congratulated our Chairman of Radiation Oncology, Dr. Robert K. Brookland, for winning the Martin D. Abeloff Award for Excellence in Public Health
and Cancer Control.  This week I want to applaud him and his department for being awarded a three-year term of re-accreditation in radiation oncology as the result of a recent review by the American College of Radiology (ACR).  Re-accreditation is given to health facilities that meet specific ACR-developed practice guidelines and technical standards, following a stringent peer-review evaluation by board-certified radiation oncologists and medical physicists who are experts in the field.  This designation is an honor and reflects GBMC’s ongoing commitment to excellence in cancer care. 

Finally, I want to wish everyone in our GBMC family a Happy Thanksgiving.   I have much to be thankful for.

Friday, November 21, 2014

Synchronizing to Start the Day on Time

Imagine if only 30 percent of BWI’s first flights of the day took off on time.  Commercial aviation is a large complex system. If 70% of flights from Baltimore arrived at their destinations late, it wouldn’t be long before the whole country was getting behind. Imagine how many upset travelers there would be. Imagine, also, the pressure on the air traffic controllers as they had to delay other flights to allow late flights to land.

We know that the hospital is also one large, complex system. If the operating room is sending cases out late, the PACU (Post Anesthesia Care Unit) will be delayed and cases will arrive to their inpatient beds (or outpatients to their homes) behind schedule. The downstream staff will be overwhelmed and people will have to stay longer than anticipated. The hospital will have to pay overtime to many or ask more staff to come in to handle the load. Subsequent operating room cases will start and end after their scheduled timeslots and some patients who have been fasting since the previous midnight will need to fast longer. No one is happy. 

It is not easy to make sure that everything is ready to go on time in all operating rooms in a surgical suite. Team members can arrive late, the patients can arrive late, there can be missing lab work that is required to assure that the surgery can be done safely, or the patient may be nervous and want to ask a few more last minute questions. But studying the reasons why cases are late and using problem solving to test changes will result in more on-time first cases. This is just what our Sherwood Outpatient Surgery Center Team has done under the leadership of its medical director, Dr. Aaron Wood, and its Clinical Unit Coordinators,  Holly Clevenger, RN and Kate Devan, RN3 BSN, CAPA.  This team selected first case on-time starts as one of their Least Waste metrics for Lean Daily Management and they have tested many changes and made great progress. You see from the run chart below that in March they had over 70% late first case starts and that number is now down to 34%. They have reduced the defect rate by more than 50% !

Team members understand that cases start late most frequently because of the system for getting ready, so they continue to study their system and ask the “why” questions when one does not start on time. I am so proud of them and I am very grateful for all of their hard work.

Congratulations to our Chairman of Radiation Oncology, Robert K. Brookland, M.D., who earlier this week was honored with the Martin D. Abeloff Award for Excellence in Public Health and Cancer Control by the Maryland State Council on Cancer Control.  For those who don’t know, this award is given annually to a Marylander who has contributed to reducing the incidence, morbidity and mortality of cancer through research focused on cancer control. Dr. Brookland is a great leader at GBMC and we are proud of him for earning this prestigious honor. Please congratulate him the next time you see him!

While on the topic of significant recognitions,
I am so pleased to announce that our hospital was named Top Performer on Key Quality Measures® for 2013 by The Joint Commission, the leading accreditor of health care organizations in America. 

This is a big deal because less than one-third of U.S. hospitals earn this distinction. According to The Joint Commission, we were chosen for “our commitment to assuring that evidence-based intentions are delivered in the right way at the right time – because it’s the right thing to do for your patients.” I want to thank the following individuals and teams for helping us attain this major achievement:  Carolyn Candiello, Vice President of Quality and Patient Safety, the executive sponsor for the Core Measure reporting, Michele Cave, BSN, RN (Director of Clinical Quality Outcomes), Laura Hines, RN, Sara Helman, RN, and Laura Wieber.

The following nurse leaders also contributed: Lindsey Cromwell-Rims, RN (Nurse Manager of IR and the Kroh Center), Stephanie Topscher, RN (Clinical Director ED/UC), Charlene Mahoney, RN (Nurse Manager PACU), along with physician champions: Jeff Sternlicht, MD (Chairman, ED), Reed Riley, MD (Chief of Cardiology), Jack Flowers, MD (Chairman, Surgery), and all of our outstanding physicians, nurses and other clinicians.  Thank you for all you do for our patients.

I am truly proud of this recognition as it clearly demonstrates that we are moving toward our vision of treating everyone the way we want our own loved ones treated.  We are pleased that the Joint Commission has recognized us as one of their “top performers” on key quality measures. 

Tuesday, November 11, 2014

Again! GBMC Tops the List with More “Top Docs” and Thank-You to our Veterans

Again!  GBMC Tops the List with More “Top Docs”

Last week, we voted in the 2014 Maryland general election and on referendum questions. But recently there was another “election.”

Nearly 10,000 physicians in the region “voted” for the physicians, in a variety of specialties, that they would send a member of their own family to if they needed care. The Baltimore Magazine annual “Top Doctors” November issue was recently released and the votes are in.

I’m proud to say that many doctors agree on who is best! Once again, GBMC had more members of our medical staff cited as a “Top Doctor” than any other community health system or hospital. It is with a great deal of pride and pleasure to share with you that 138 GBMC physicians, covering 60 specialties, were recognized as a “Top Doctor.” Several of those medical staff members were recognized in more than one category, and some have been recognized many years in a row! 

Being recognized as a “Top Doctor” is an extraordinary honor, because it is a selection by peers. To all of the “Top Doctors” at GBMC, congratulations from all of us! The rest of us in the family are very proud of you.

To view a listing of our “Top Doctors” and to learn more about who they are, please visit GBMC's Top Doctors 2014 webpage.

Let me thank Dr. Alexa Faraday, one of our general internal medicine physicians practicing on our campus, who was one of the three survey advisers (and thus was ineligible to be selected as a "Top Doc" by her peers).

Thanking Our Veterans on Veterans Day and Every Day

Millions of American military veterans have honored us with their service. Today, we set aside a special day to honor them and thank them for all they have done. We enjoy our freedom because these individuals were ready to make the ultimate sacrifice. Without their service, our daily lives might be very different.

Veterans Day is a time to remember and pay tribute to the brave men and women of the U.S. armed forces who have served in the past and those who are serving today. As Americans, we owe a tremendous amount of gratitude to our veterans who, during peace and war, have demonstrated a steadfast commitment to safeguarding the principles upon which our nation was founded.

Everyone in the GBMC family should pause today and reflect on the gift of our fighting men and women and our veterans.