Wednesday, March 30, 2016

A Day to Celebrate the Dedication of our Physicians

Today is National Doctors’ Day, when we reflect on the knowledge, skill, hard work and most importantly, the dedication of our physicians.

My first remembrance of doctors is, as a little boy, hearing my mother speak of our pediatrician and her obstetrician in Paterson, New Jersey. I remember being amazed at the complete trust that my mom had in these two physicians. She was almost reverent in her words about them. It was apparent to me even at that early age that they had earned my mother’s trust. They were learned, caring and always there when she needed them.

As a teenager, I remember our family general practitioner making house calls. This man was also the father of my sister’s friends. This fact gave me new insight into the meaning of a physician’s dedication to his or her patients.  He, too, had a large family and was clearly devoted to his wife and children, but, if my mother called him, it seemed that he always figured out how to meet our needs either by seeing us in his office or coming to examine us in our home.

Being a physician myself, I have had the incredible good fortune to meet and work with hundreds of outstanding physicians, men and women who have been exemplary in their care and compassion. We are blessed to have so many wonderful physicians at GBMC. A marker of their excellence is that more than 160 of our physicians, in 80 unique specialties, were named in Baltimore magazine’s “Top Doctors” listings last year, the most for any community hospital in our region.

Doctors’ Day was first celebrated on March 30, 1933, in Georgia. It was started by Eudora Brown Almond, the wife of Dr. Charles B. Almond, and occurred on the anniversary of the first administration of anesthesia by Dr. Crawford W. Long in 1842. In 1990, March 30 was officially designated National Doctors’ Day. Today at GBMC, we are continuing this tradition.  We had a Breakfast-to-Go earlier this morning, and physicians in attendance were given ear-buds and card-holders for their smartphone. Later this afternoon we are holding an ice cream social in the physicians’ lounge as another way to show our appreciation for all that they do.

As we celebrate National Doctors’ Day, please take a moment to recognize all of our outstanding physicians, from the surgeons and hospitalists to the Emergency Department physicians, primary care doctors, geriatricians and other specialists all throughout GBMC. Thank you for caring for patients and families from every walk of life, through all types of illnesses and injuries, and for helping GBMC move toward our vision: To every patient, every time, we will provide the care that we would want for our own loved ones.

In honor of Doctor’s Day and your physician, please share your thoughts and stories of the dedication of physicians here:

Tuesday, March 22, 2016

Patient Safety Becomes Pedestrian Safety

I had a real fright last Friday morning. I had been invited to attend a lecture at the annual meeting of the Maryland Patient Safety Center in downtown Baltimore at the Hilton. I was listening to Joan Lunden, who used to be the co-host of Good Morning America, give her plenary address. While I was sitting there, I got a text message from JoAnn Ioannou our Chief Nursing Officer. JoAnn’s text said that two of our nurses, who were crossing Pratt Street on their way to the meeting that I was at, were hit by a car!

My heart was racing as I made my way to Shock Trauma. When I arrived at the Family Waiting Room, I was told that I would have to wait awhile to get more information. The staff  at the University of Maryland Medical Center immediately welcomed me and tried to allay my fears. A wave of panic went through me and I worked hard to control my emotions. We then got word that the two nurses were stable . I was told that a driver allegedly had gone through a red light, which caused the nurses’ injuries.

When we talk about the “Just Culture” we speak of human error, at-risk behavior, and reckless behavior. I want to remind everyone to be cautious for their own safety, and carry the “preoccupation with failure,” that we exercise in patient care at GBMC to our lives outside of the work environment.

Remembering a Friend and Trusted Colleague
On Friday afternoon at the Sheppard Pratt Conference Center, GBMC and Sheppard Pratt held a memorial service for Darin Lerner, MD. Darin died suddenly of a myocardial infarction a few weeks ago. He was the Chair of Psychiatry at GBMC and an employee of Sheppard Pratt. The service was beautifully orchestrated by our Chaplain Joe Hart and attended by Darin’s widow, Dr. Laura Seidel, his brother Lane, and many members of the GBMC and Sheppard Pratt families. I said a few words of remembrance and thanksgiving for Darin’s hard work and marvelous devotion to his patients. Dr. Bob Roca, the Sheppard Pratt Chief Medical Officer, also spoke and commented on Darin’s career both as a resident in Psychiatry at Sheppard and also since then as an attending psychiatrist. Carolyn Keller, our interim nurse manager of Unit 36, told the crowd how much our nurses miss Darin as a friend, colleague and teacher. Other friends and colleagues added their thoughts at the loss of such a trusted healer. A search committee has been formed to find our new Chair of Psychiatry, but, we will not be able to truly replace Dr. Darin Learner. We will work hard to make his legacy be even better behavioral health care at GBMC and Sheppard Pratt.

Kudos to our maternity care staff
I am proud to announce that we recently received the Blue Distinction Center+ for Maternity Care designation, a new designation under the Blue Distinction Specialty Care program.

Blue Distinction Centers+ for Maternity Care, an expansion of the national Blue Distinction Specialty Care program, is awarded to hospitals recognized for delivering quality, cost-effective specialty care safely and effectively, based on objective measures developed with input from the medical community.  To receive a Blue Distinction Centers+ for Maternity Care designation, a hospital must also meet requirements for cost efficiency.

This is an important achievement because hospitals that receive a Blue Distinction Center+ for Maternity Care designation agreed to meet requirements that align with principles that support evidence-based practices of care, as well as having initiated programs to promote successful breastfeeding and it evaluates hospitals on overall patient satisfaction, including a willingness to recommend the hospital to others.

We are truly pleased to receive this recognition. This acknowledgement was made possible by the dedicated staff who work tirelessly to care for our community and provide quality services to our patients and their families.  Congratulations to everyone involved who help to make our maternity care one of the best in the region!

Happy Holidays
On a final note, the GBMC HealthCare family sends its best wishes to everyone celebrating Easter this Sunday and the Jewish holiday, Purim, on Thursday.

Friday, March 11, 2016

Reducing Hospital Acquired Infections – GBMC is a Leader

The Centers for Disease Control and Prevention, the CDC, recently released their progress report on hospital acquired infection rates for calendar year 2014 and on changes in these rates from those reported for calendar 2013. You can see how an individual hospital (including GBMC) performed on the Hospital Compare website:

Hospital infection control leaders collect data and report to the National Healthcare Safety Network (NHSN) at the CDC and the NHSN then severity adjusts the data and converts the raw rates into standardized infection rates so that hospitals and states can be compared one to another.

Among national acute care hospitals, the highlights of the report include (taken from the CDC website):
 --A 50 percent decrease in CLABSI (central line associated bloodstream infections) between 2008 and 2014.
--No change in overall CAUTI (catheter associated urinary tract infections) between 2009 and 2014.  But there was some progress in non-ICU settings between 2009 and 2014, progress in all settings between 2013 and 2014, and even more progress in all settings towards the end of 2014
--A 17 percent decrease in surgical site infections (SSI) related to the 10 select procedures tracked in previous reports.
--A 17 percent decrease in abdominal hysterectomy SSI between 2008 and 2014
--A 2 percent decrease in colon surgery SSI between 2008 and 2014
--An 8 percent decrease in C. difficile infections between 2011 and 2014  
--A 13 percent decrease in MRSA bacteremia between 2011 and 2014

So it is clear that American hospitals are safer and more infection free than they have ever been. This is excellent news for patients.

GBMC has made outstanding progress in all of the measured infections. We have a statistically better than the national average performance in CAUTI’s (catheter associated urinary tract infections) and continuing to improve and as good as the national average in all of the other infections.

This is not the case for Maryland as a state. When the performance of all Maryland hospitals is averaged together, Maryland has plenty of room for improvement compared to many other states. 

I was on a phone conference with other Maryland hospital leaders this week to consider how we can reduce Maryland’s CAUTI rate that is 35% higher than the national baseline and that has not improved between 2013 and 2014. We also discussed reducing multi-resistant staphylococcal bacteremia because Maryland’s rate is 22% higher than the national baseline and our clostridium difficile infection rate which is 20% higher than the national baseline. Both of these facts are a call to action to reduce the misuse of antibiotics, a main cause of multi-resistance and of c. difficile infections in general.

I want to thank all of our GBMC physicians, nurses and advanced practitioners for their great care and everyone at GBMC, but especially our environmental service workers, for keeping our clinical areas clean to reduce the spread of germs! 

March is Professional Social Work month and I want to thank our dedicated group of social workers who serve GBMC.  I am constantly impressed and humbled by the creativity and determination of this group. Our social workers carefully arrange for care of patients after they leave the hospital. Our social workers and care managers have helped GBMC reach the lowest readmission rate in the state and have designed a system that assures that our patients with advanced illness receive the continued support they need after they leave our hospital. Please take the time to say “thank you” for all they do!

Wednesday, March 2, 2016

What Can We Do to Excite Business Owners About Reducing Health Care Costs?

The Triple Aim (Better Health, Better Care and Lower Cost) movement is under way in our country. Many people now know that we have the best doctors and nurses in the world but they work in a system that spends at least 40% more per capita on health care than all other countries. Those in the Triple Aim movement are working to redesign this system.

The notion of value is well understood by the consumer –“What am I getting for my money?” The smart shopper doesn’t pay 40-50% more from one retailer when they can get the same or better quality product for less from another. But why is it that so few self-insured employers are on this value bandwagon?

Almost all self-insured employers (which is most employers with at least a few hundred employees) don’t differentiate between high cost and lower cost providers of care even when the outcomes are the same or even better at the lower cost provider. Instead, to try to make health insurance affordable for their companies, they have turned to high deductible plans which put a greater financial burden on their employees.

Health insurance companies have created “tiering” for drugs. The idea of tiering is that you pay less out of pocket if you pick the lower cost drug that will get the same outcome. So, if you take the generic, you pay less of a co-pay whereas if you take the higher cost “brand” name drug, you pay more. We are very proud at GBMC of our platinum health care plan because if you pick GBMC, a lower cost high-value hospital, and its doctors, you don’t pay anything out of pocket. You could still go to a much higher cost hospital for the same care and the same outcome, (Maryland hospital rates can vary by as much as 60%) but you have to pay more out of your own pocket to do that. It used to be that our employees paid the same deductible if they got their gallbladder removed at a hospital that charged $10,000 for the episode as they paid if they went to a hospital that charged $16,000 for the same quality outcome. We now use tiering and we have saved a lot of money that we apply to other things like annual salary increases. It puzzles me that the companies managing healthcare for self-insured employers don’t help them setup tiering the way we have for GBMC as an employer. It is a win-win – the employee has lower out of pocket cost and the employer saves money.

What are your thoughts? Why have employers not driven towards value-purchasing for health care like they have for everything else that they buy?

Helping those in need…
This year, as part of our first ever Random Acts of Kindness initiative, GBMC and our off-site locations, participated in a canned food drive to benefit the Bea Gaddy Family Center. I just want to thank the hundreds of GBMC staff and volunteers, who always rise to the occasion to help people, along with our patients and visitors, who helped contribute to the drive.  Over 1,200 lbs. of non-perishable food items were delivered to the Bea Gaddy Family Center that will be provided to children and families in need. Special kudos to the Black History Month Committee who for the the second year devoted time to collecting food donations for Bea Gaddy during Black History Month! This endeavor was so valuable because we all know that the hunger crisis in our state doesn’t disappear after the holiday season.  It’s a problem all year long and for this reason, I am also very grateful to our Philanthropy and Marketing Departments who ran the drive for us and for making it such a success!