Wednesday, November 22, 2017

Gratitude for Everyone in the GBMC Family!

I would like to wish a happy Thanksgiving to all of my GBMC colleagues. I want to thank you all for your expertise, hard work, and compassion that helps us move closer to our vision of being a community-based health system where every patient, every time is treated the way we would treat our own loved ones.  

This morning at the meeting of our Department Chairs, we were discussing the future of our HealthCare System. I was reminded of how wonderful our people are and how committed they are to serving others. I also reflected on how good we have become at change. I am so grateful for everyone’s commitment to studying our systems and learning from them so that we can deliver on our four aims. We are not perfect, but GBMC has really become a model for delivering patient-centered care. 

I also want to extend a special “Thank You” to all who will work on Thanksgiving, or who are working during the extended holiday weekend, caring for our patients and helping support their loved ones and visitors. 

What are you thankful for during this time? Please share your thoughts.

Please join me in congratulating Monica Goetz, RN, our clinical nurse manager for the Medical Intensive Care Unit (MICU — Unit 57), who was recently honored with the “Advocacy and Service Award“ by the Living Life Legacy Foundation, the non-profit organ procurement organization for the state of Maryland.  Monica was nominated for her initiative in creating awareness for organ, eye & tissue donation.

Organ donation saves countless lives and improves many others, and these gifts were celebrated at the GBMC HealthCare system earlier this year. Monica was instrumental in the creation of the ‘Tree of Life.’ This is a permanent art installation close to the Emergency Department Concourse, that memorializes the selfless act of organ and tissue donation and represents the legacy created by those who give the gift of organs, and tissues at GBMC.  

Congratulations Monica!!!

Joint Commission Survey
Thanks to all who helped us learn from our Joint Commission unannounced survey last month and worked hard over the past 30 days to make our systems even more reliable. Yesterday’s follow-up survey validated the strength of our processes. 

Friday, November 17, 2017

Welcome to the New Members of Our Senior Leadership Team

I’d like to extend a warm welcome to our new Executive Vice President and Chief Financial Officer, Laurie R. Beyer, BS, MBA, CPA, who recently joined us. Laurie is an accomplished, results-oriented executive with more than 25 years of experience. She came to our HealthCare System from Union Hospital of Cecil County, where she served as Senior Vice President and Chief Financial Officer for 11 years. During that time, she developed high-performing finance and revenue cycle teams, facilitated the conversion to the HSCRC’s Total Patient Revenue System, and led the successful implementation of the hospital’s electronic medical record.

Please join me in extending a warm welcome to Laurie!

Congratulations to Stacey McGreevy 
Stacey McGreevy, CPA, was recently named Vice President of Support Services at GBMC HealthCare. During her more than 20-year tenure at GBMC, Stacey has held a number of important roles including Manager of Finance and Regulatory Compliance, Director of Internal Audit and Compliance, and Chief Audit, Compliance and Privacy Officer. She developed GBMC’s first Internal Audit Department and Compliance Program and facilitated the establishment of an independent Audit and Compliance Committee of the Board of Directors. Most recently, she served as GBMC’s Administrator for Ancillary and Support Services, a position that oversees a $50 million annual budget and is responsible for oversight of construction management. Her leadership in GBMC’s strategic deployment process resulted in over $2 million in savings in purchased services and pharmaceutical expenses over the past year and she has been instrumental in overseeing a vast array of major construction projects. In her new role as Vice President, she will lead the design of a new supply chain system and facilitate the updating of GBMC’s Master Facility Plan. 

Celebrating Nurse Practitioner Week

Nurse practitioners (NPs) offer vital and reliable care and from November 12-18th,  which marks National Nurse Practitioner Week, we are given the opportunity to reflect on the roles of nurse practitioners whose tireless efforts often go unrecognized.

Please join me in celebrating GBMC’s outstanding Nurse Practitioners this week. Across our nation, there are more than 200,000 NPs who provide care to millions of Americans. We have excellent Nurse Practitioners working in our hospital, in our physician practices, and at Gilchrist. They help us move closer to our vision of a patient-centered system of care every day. 

Another Successful Nearly New Sale
I’d also like to take a moment to recognize all of those involved in making the Fall 2017 Nearly New Sale an outstanding success.

For those of you that don’t know, there is much that has to happen to make this event a success. Twice each year, GBMC employees, volunteers, and the general public get an opportunity to buy everything from furniture, clothing, and jewelry to appliances, sporting goods, toys, and much more — all at nominal prices. Under the leadership of our Director of Volunteer Services, Carmen Baeza, the team collects donations, sorts and prices them, and stocks them on the shelves. As soon as the fall sale ends, volunteers begin preparing for our next sale in the spring. GBMC volunteers devote hundreds of hours to these events that benefit the programs in our HealthCare System.

I am proud to say that the fall sale raised approximately $144,000 in proceeds! I want to extend a heartfelt thank you to the co-chairs for Nearly New, Joanne Lynch and Dirck Ten Broeck, as well as Sarellen Levine, the Nearly New representative on the Auxiliary Board, and all of the volunteers at Nearly New who work so hard to prepare for each sale!

Turkey Distribution...
Thanksgiving spirit was in full swing during GBMC’s annual employee turkey distribution on November 9 and 10. About 3,500 turkeys were given out to staff as tokens of appreciation for the hard work you do daily to ensure that ”to every patient, every time we provide the care that we would want for our own loved ones.” Thank you!

Monday, November 13, 2017

Named Top Performer...

Congratulations Gilchrist!
Last week, it was brought to my attention that the Gilchrist Sub Acute Unit (SAU) was recently named a “Best Nursing Home” by U.S. News & World Report 2017-18. According to U.S. News & World Report, only 15% of nursing homes in the United States achieve the “Top Performing” status of 4.5 or higher. Gilchrist achieved a perfect 5.0 rating and we are truly honored that they were chosen and that they achieved the highest score possible.

U.S. News uses existing federal nursing home rating information and federally reported healthcare data to determine their rankings. Criteria such as annual state survey results, medical quality measures, staffing levels and rehabilitation outcomes are all considered in the scoring process.

We are truly honored to be in the top tier of providers in both the state and the nation.  Congratulations to Leana Hoover and our Gilchrist SAU staff!

During the past few weeks, the news has been filled with allegations of inappropriate workplace behavior at other organizations. While this news is disheartening, it serves as a call to remind us of our GBMC value of Respect. It is important that we continue to work together to foster a safe work environment and to comply with our Harassment and Discrimination Policy. This Policy can be found on the InfoWeb. Please contact our Human Resources department should you have any questions or concerns. I am grateful for the respectful behavior, teamwork, and camaraderie that I witness every day in the GBMC HealthCare System.

Recognizing Colleagues: Radiologic Technology Week & Forensic Nurses Week
Last week was both “Radiologic Technology Week” and “Forensic Nurses Week” and I would like to thank all of our registered technologists (RTs) and our forensic nurses for their very important roles in providing care and serving our patients.

RTs perform diagnostic imaging examinations and administer radiation therapy treatments. They are educated in: anatomy, patient positioning, examination techniques, equipment protocols, radiation safety, radiation protection and basic patient care. They are the teammates of our radiologists and radiation oncologists.

Forensic nurses are specially trained and certified examiners who care for adolescent and adult victims (ages 13 and older) of sexual assault. They complete a full assessment of the patient, obtain potential forensic evidence and provide antibiotic therapy, emergency contraception and resources for crisis counseling and support services.

Please join me in thanking Phil Komenda, our Director of Imaging and Cardiac Services, and Laura Clary, RN, FNE-A/P, SANE-A, CPEN, our Clinical Program Manager for the SAFE Program, and their teams for all their hard work and for their important roles in caring for our patients.

National Medical Staff Services Professionals Awareness Week
“National Medical Staff Services Awareness Week,” just concluded and I would like to acknowledge and thank all of our medical staff services professionals (MSPs) for playing a critical role in our healthcare system. MSPs credential and monitor ongoing competence of physicians and other practitioners who provide patient care services in hospitals managed care organizations, and other healthcare settings.

MSPs are dedicated to making certain that all patients receive care from practitioners who are properly educated, licensed, and trained in their specialty. They are experts in provider credentialing and privileging medical staff organization, accreditation and regulatory compliance, and provider relations.

Please join me in thanking our MSPs for their hard work and for their important role in helping us achieve our vision.

Thanking Our Veterans on Veterans Day and Every Day
On Saturday, we commemorated Veterans Day and took the 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. My sincere gratitude to all members of the U.S. armed forces and their families who have served and made the tremendous sacrifices to preserve our freedom.

Thursday, November 2, 2017

Recognizing Three New Physician Titans of Care

It was with great honor and gratitude that GBMC HealthCare announced the selection of three new Physician Titans of Care during Monday evening’s recognition dinner. Melissa Sparrow, MD, GBMC Chief of the Medical Staff, presided over the event and presented the awards.

GBMC physicians provide a great service to the community every day as we move closer to our vision. The new titans are just three phenomenal examples of giving through their expertise and hard work. The new Physician Titans of Care are:

-John Boscia, MD
-Karl Diehn, MD
-Alan Tapper, MD

Let me just tell you a little bit about each new Titan.

John Boscia, MD
He was the first physician to open a pediatric practice at GBMC, and served the community’s children for more than 20 years: treating extended families, children of parents he had also treated in their youth, and some folks well into their 20s, because they didn’t want to go anywhere else. Dr. Boscia dedicated his career to caring and advocating for some of the most medically-challenged patients and he did it because of his sense of justice. He also experienced some physical challenges of his own and had a special place in his heart for these patients. He was a deeply compassionate pediatrician with outstanding clinical skills and impeccable character. He was loved by his patients and deeply respected by his peers. He was known as a “true pillar in the department of pediatrics” and “a fountain of knowledge when it came to pediatric medicine.” A kind, compassionate and generous pediatrician, Dr. Boscia was respected throughout the hospital for his ability to work with other departments in a positive and collaborative manner. He was chosen as a titan for being the embodiment of GBMC’s vision of treating every patient, every time, as you would your own, loved one; and for being the kind of physician every parent wishes for their child. GBMC suffered a great loss earlier this year with his passing but the legacy of his work is still felt in our hospital to this day.

Karl Diehn, MD
Dr. Diehn has been a cornerstone of GBMC’S Otolaryngology Department for more than 30 years. Upon graduating from the University of Maryland Medical School in 1975, and finishing his residency at Johns Hopkins Hospital, Dr. Diehn became one of the earliest members of Ear, Nose & Throat Associates, and helped to forge the practice’s reputation as the preeminent provider of pediatric otolaryngology care. During his tenure at GBMC, he also served on the GBMC medical board and the GBMC HealthCare board of directors. He is admired for his consistent availability, his accountability, and his kindness. His skill, thoughtfulness and calm demeanor have inspired physicians, students, patients and families throughout his professional career. He was also known for making many personal sacrifices and spending many long hours at work over the years. Despite Dr. Diehn’s complete dedication to his professional life, his children always saw him as “the best dad” and when speaking to Dr. Diehn’s myriad of patients, one often hears, “he took care of my kids too,” and “he’s such a wonderful doctor.” Really it seems that almost anyone you ask in the community knows of Dr. Diehn, a quiet and humble hero, and now a GBMC Titan.

Allan Tapper, MD
Dr. Alan Tapper is known to be a physician of remarkable vision and foresight. In the 1970s, he sensed the changing demands of obstetrics in the region and began advocating for family-centered obstetrical care long before that approach was acceptable or popular. In 1978, against very strong objections, Dr. Tapper established the first birthing room at GBMC. Dr. Tapper was also well known for consistently promoting progressive changes that improved patient care and was part of a team that elevated GBMC’s position as the preeminent institution for women’s healthcare. He has loved the profession and thought of his patients as people first, patients second. From simply asking questions to get to know them better, to attending funerals for patients and their families, he invested in their lives. He is known by the community to be a brilliant, gregarious, extremely funny, and profoundly dedicated individual and Dr. Tapper’s work ethic, and focus on patient and family-centered care was a clear representation of GBMC’s vision long before it was established. His unique character, affability, trustworthiness, and sense of humor make him one of the outstanding physicians in our community. We are truly lucky to have been the hospital where he chose to dedicate his work.

We salute the exemplary contributions to the growth and success of our organization and to the practice of Medicine of these newly named Titans. We applaud their outstanding skills, service, and commitment, and thank them for their instrumental roles in building GBMC HealthCare’s reputation in our community and beyond!

TOP DOCS 2017!...
We’ve always known that one of GBMC’s incredible strengths is the quality of its medical staff and I’m proud to say that many doctors agree!

Nearly 13,000 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. It’s with a great deal of pride that I share with you that 139 GBMC physicians, covering 76 specialties, were recognized as a “Top Doctor.” Several of these medical staff members were recognized in more than one category, and some have been recognized many years in a row!

In addition, the magazine also highlighted our chairman of Radiation Oncology, Robert K. Brookland, MD. He was one of six eminent doctors, from a pool of over 700 physicians in the Baltimore area, selected to be profiled in the current TOP DOCS issue.

Being recognized as a “Top Doctor” is an extraordinary honor, because it is a selection by peers. We are so fortunate to have outstanding surgeons, internists, pediatricians, family physicians, and other wonderful specialists. Congratulations to Dr. Brookland as well as all others who were named 2017 Top Docs.

To view a listing of our “Top Doctors” and to learn more about who they are, please visit GBMC's Top Doctors 2017 webpage.

Sunday, October 29, 2017

Why Can’t Electronic Medical Records Communicate Easily with One Another?

Recently, the GBMC Chesapeake Regional Information Sharing for our Patients (CRISP) governance team got together. This meeting provides us with an opportunity to meet with our CRISP colleagues to improve our use of the network, to connect with other providers of care, such as private practicing physicians, hospitals and nursing homes that don’t use Epic so that we can better serve our patients and reduce the time spent searching for information, which frustrates clinicians.  We have also made so much progress in the use of the network. An example is that every morning our patient-centered medical homes get a report from CRISP on each of our patients who were seen in any Maryland hospital in the preceding 24 hours. This allows our care managers to check-in with them and make sure they have what they need.

But during the meeting, I became frustrated on more than one occasion because of the incredible complexity of getting one company’s record to “talk” with another company's record. The medial record companies keep their source code secret to maintain the value of their investments and this is understandable, but the net effect is that even in the 21st century it’s really hard to have all of one patient’s record available for clinicians who need the information. We are dealing with a real “Tower of Babel” where no two vendors' records talk easily with one another. In addition, the U.S. has not created a “unique patient identifier” (such as a social security number) to make sure that we are truly connecting records of the same person.

I am concerned that the citizens of the U.S. have no idea that this is happening. If they did, I believe that they would advocate for better planning and some stronger rules about cooperation around the goal of better information sharing. Market forces are not working and our country’s doctors and nurses and their patients are paying a very high price in safety and efficiency while billions of dollars are being spent to work through the confusion to try to make these records talk to one another.

Yes, we do have one patient, one record for patients served by our hospital, our employed physicians and Gilchrist and to the extent that the records are coming from the same EMR (Epic at other hospitals) we are okay, but when they are not, it’s a mess.  The American people need to think about this, decide what they want and make their opinion known to those in power.

We must all be united around the quadruple aim: The best health outcomes with the best care experience, with the least waste and the most joy for those providing the care. None of these four aims are truly possible without the efficient movement of information to those with a legitimate need to know.

Thank You!
Mother Nature was cooperative for the recent Baltimore Running Festival. Thousands of people participated in this year’s event including approximately 90 runners who joined team #RunGBMC to raise funds in support of the Gilchrist Center Baltimore – Joseph Richey House. The 19-bed inpatient center has been serving patients in Baltimore City for more than 30 years by providing residential, acute and respite care. We’re still counting, but so far we have raised more than $10,000. The money raised by team #RunGBMC will help cover Joseph Richey House’s operating expenses not covered by insurance or patient payments.

I’m very grateful to all of the employees, volunteers, patients and supporters of GBMC Healthcare who helped us raise money and awareness of the outstanding work at Joseph Richey House.  I hope you all had a great time in support of this fabulous part of our system of care.

Thursday, October 19, 2017

What’s in a name? Gilchrist rebrands itself

Over the last 23 years, Gilchrist Hospice Care has done so much to help so many people at the end of life, and their families. A few years ago, we changed the name to Gilchrist Services to show the community that Gilchrist was more than excellent end of life care. Annually, Gilchrist provides elder medical care to 7,500 individuals, hospice care to 5,400 patients and grief counseling and bereavement services to 6,500 family members. The organization also counsels individuals on care planning, guiding them through decisions about their treatment and helping them make informed choices for their advanced chronic disease. We were still concerned that “Gilchrist Services” was not working as a name.

Earlier this week, Gilchrist launched a new branding and advertising campaign that aims to educate the public that Gilchrist is “more than hospice.” I've asked Cathy Hamel, President of Gilchrist and our system’s Vice President for Continuing Care, to talk about it in this week’s blog.

What triggered the new brand and advertising campaign? Why now?
The mission of the “new” Gilchrist is to provide quality compassionate care, counseling and support to people at every stage of serious illness, so that they may live life to the fullest.  Although a lofty goal, at no time in history is this work needed more than now.  As medicine continues to advance, people are living longer.  And as the population ages, more and more people are struggling to cope with a serious illness or caring for an aging parent.  We want people to know that today’s Gilchrist is here to meet their needs, whether guiding them through treatment options, providing medical care in their home or residential care community or helping them to navigate the often complex, health care system.

What’s the primary goal of the campaign?
We hope that this campaign will allow us to better communicate the broad range of services that Gilchrist offers for people with serious illness.  Our new campaign aims to educate people that “even before hospice, there’s Gilchrist.”  From elder medical care to grief counseling to volunteer assistance and more, Gilchrist will provide clear information and loving care at every stage of serious illness, so people can live life to the fullest, on their own terms.

Are you hoping that through this campaign you can address some of the public misconceptions or stigma surrounding hospice and end-of-life care?
Gilchrist will always be known for the compassionate end-of-life care and services that we provide.  And believe it or not, although most Americans are still afraid of dying, the use of hospice has grown exponentially in the past 20 years.  But that is really not what this campaign is about.  It’s about communicating the point that today’s Gilchrist extends services to individuals with serious illness who need our care and support well in advance of hospice care.

Can you describe the programs that Gilchrist offers? What new services are you thinking about?
We have reorganized our programs into three main service lines: Counseling and Support, Elder Medical Care and Hospice Care.  By clearly defining our services under this continuum of care, we believe that we can more effectively communicate the breadth of services we offer to those with serious illness—through every stage—so that they may live life to the fullest.  Our physicians, nurse practitioners, and social workers provide medical care for people who can no longer safely access their care in medical offices by going to their homes. We provide palliative consultations in nursing homes and assisted living facilities in addition to acute care hospitals.  We provide the care in the GBMC rehabilitation unit, (previously known as Unit 54), and we, of course, continue to provide nationally recognized hospice care for children and adults.  We are also the only hospice in Central Maryland who offer Medicare patients on-going treatment for their disease and hospice care concurrently for select diagnosis.

In summary, we are deeply committed to giving people the clear information and loving support they need to make informed choices about their care.

I would like to invite you to visit our new website, to learn more about the new Gilchrist.

I sincerely thank Cathy and the entire Gilchrist team for all that they do every day for elders and patients at the end of life. I applaud them for their person-centeredness and their excellence!

Wednesday, October 11, 2017

How Reliable is Our Care?

As I write this blog, we are a couple of hours into our triennial unannounced Joint Commission survey at GBMC. Think of it as a checkup. The surveyors are going to check to see how reliable our care is.

I was thinking back to 2011, when I first touched on the concept of reliability in this blog: To reduce the concept to its simplest definition, reliability means “what should happen happens and what should not happen….doesn’t.” To get to very high reliability, or error rates close to zero, an organization must find the potential causes of failure, the so-called “holes in the Swiss Cheese”, before they can line up to cause a miss, that might lead to patient or staff harm. Being vigilant about filling in those “holes” is also called preoccupation with failure. Are we zealously looking for problems and fixing them when we find them?  When we see people drifting from our designs for safety are we calling it out or are we looking the other way? We know we are not perfect but it’s good to have outside eyes looking at our processes and to see just how reliable we have become and where we can still improve.

During LDM this morning, I learned of a phenomenal success that took place in Family Care Associates, one of our patient-centered medical homes, on Tuesday. They received 271 phone calls and answered every one within their 20-second standard! This is an incredible accomplishment after having implemented the phone call redesign that was created during the recent Kaizen led by our Lean facilitator, Farrukh Kidwai. What should happen…the phone gets answered efficiently…happened without a failure! An example of a 100% reliable process! Congratulations to Family Care Associates for achieving the President’s Four Aim Recognition. Family Care is now the third advanced primary care practice, along with Owings Mills and Hunt Manor to have implemented the new standard design for telephone calls.

National Physician Assistant Week
Please join me in celebrating all GBMC physician assistants (PAs). This week is National PA Week (Oct. 6-12) and is a time when PAs celebrate their profession and showcase the value they bring to today’s healthcare team.

The physician assistants at GBMC practice in many areas from the outpatient offices to the inpatient units in a wide variety of specialties. A PA is a nationally certified and state-licensed medical professional who begin their careers with rigorous education in a highly competitive field.  Upon completion of a bachelor’s degree, prospective students must then attend an intense three-year program and complete at least 2,000 hours of supervised clinical practice.  They then must pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).

Please join me in thanking our PA’s for their hard work and for their important role in caring for our patients.

2017 Healthcare Security and Safety Week
I want to thank all the members of our GBMC security staff as this week is Healthcare Safety and Security Week (Oct. 9-15).

The GBMC security team can be seen walking or stationed throughout our medical center from the emergency department to labor and delivery. Our security and safety officers meet the challenge every day to keep all of us safe at GBMC. They are vital members of the healthcare team and we cannot be successful without them.

Please join me in thanking our security staff for their hard work and for their strong commitment and the diligence they display in the practice of their profession.

Help Support The Joseph Richey House
Later this month employees, volunteers, and patients will be participating in the Baltimore Running Festival and fundraising for GBMC HealthCare's Gilchrist Center Baltimore – Joseph Richey House.

Gilchrist Hospice has helped so many individuals and families through the end of life.  The Gilchrist team not only delivers world-class medical care to patients in their final days, but they also provide the emotional and spiritual support needed through the bereavement process. One of the founding principles of the Joseph Richey House is to provide services to everyone, regardless of their ability to pay. Joseph Richey is a 19-bed residential hospice designed to care for terminally-ill patients and serves 150 of these individuals each year, 80 percent of which are Baltimore City residents. The GBMC system and our community are very lucky to have Gilchrist to help individuals complete their lives with dignity and on their terms.

I want to thank all of our employees, volunteers, patients and supporters of GBMC Healthcare who are running during the Festival and helping to raise awareness of the great work at Joseph Richey.

Unfortunately, registration for running to support the Joseph Richey House is closed, BUT, you can help still support RunGBMC in other ways. Please consider being a volunteer the day of the race, by contacting Morgan Cook at or click here to join us in raising money for The Joseph Richey House and giving back to our community. Thank you!

Friday, October 6, 2017

Proud of a Wonderful Accomplishment

Last week, I went to Verona, Wisconsin, for the annual Epic Users Group Meeting. Healthcare companies that have installed Epic from all over the country gather to hear what is new and to share information about how to use the software to improve care.

I took a bus, with others, from the hotel to the Epic campus and walked into the building outside the large theater where the opening address from the CEO of Epic, Judy Faulkner, was about to begin. I was delighted that the first thing I saw upon entering the building was a banner announcing our achievement of HIMMS Analytics Stage 7. I can’t tell you how proud I was to see that banner. Being the first healthcare company in the state to achieve Stage 7, the highest stage, on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) for both our hospital care and ambulatory services shouldn’t be taken lightly. HIMSS Analytics developed the EMR Adoption Model as a tool to benchmark information technology maturity in healthcare organizations. Less than five percent of hospitals in the United States have achieved Stage 7 certification.

The award is recognition for operating in a paperless environment and representing best practices in implementing electronic health records. Make no mistake this accomplishment is due to the commitment and the hard work of the GBMC staff which includes our highly-skilled team of physicians, nurses, other clinicians and IT professionals. Our achievement was not without its challenges but the resiliency of our people in working through glitches has been impressive. Within our hospital, our physician company, and Gilchrist we have now achieved ‘one patient, one record’ and we continue to work with our private practicing physicians, nursing homes and other providers to connect with them through the Chesapeake Regional Information Sharing for Our Patients (CRISP) network. Without this, we cannot achieve our vision of being the community-based health system where every patient gets the care that we would want for our own loved ones.

Earlier this week, here at home, we celebrated our one-year anniversary of being live with Epic during EPIC 2017: CELEBRATE THE EPIC ADVENTURE. This star-studded, fun-filled event gave us a peek into the future of our clinical and administrative information system. As part of our continuous improvement efforts to ensure we have the most current technology infrastructure, next week we will upgrade to Epic 2017. This upgrade will include enhancements to the overall look and feel of Epic, have simpler and more consistent icons, and improved wayfinding for navigating the system. New functionality will also be available to optimize workflows and assist with improving end-user efficiency. There are many projects underway which will further leverage Epic’s functionality such as electronic prescribing of controlled substances and electronic pre authorizations. MyChart continues to grow with added features and functionality. Later this month, we will begin releasing ambulatory history and physical notes to MyChart and eventually progress notes. These initiatives will continue the push for empowering our patients with their information and encourage participation with their care.

Two years later…
You know, it’s been two years since our 50th Anniversary Gala. I can’t believe how time has flown by. Our 50th Anniversary celebrations were a wonderful recognition of GBMC’s rich history and its bright future. The community’s philanthropic support during the anniversary year was phenomenal and has aided our ability to continue with our transformation by supporting our patient-centered medical homes and tools like Epic.

October is National Cyber Security Awareness month 
The sharing of electronic information in all aspects of care delivery is important but is not without its risks. Through the Internet, health systems and other industries are under attack from criminals who look to profit from stealing information that should be private. You’ve probably all seen the headlines regarding the Equifax breach which impacted over 100 million people. It has been proven that the highest vulnerability for data breaches is not with the software itself but is through us, the users. Criminals know this and set out to trick us into opening our systems to them so that they can do their dirty work. We must all be vigilant and own the security of our information systems. Please bring the same questioning attitude that you use when delivering patient care to your use of e-mail, the electronic record, and other applications. Don’t click links unless you are sure it’s safe, don’t go to websites you aren’t familiar with and ask IT for guidance if something doesn’t quite “seem right”. Together, using simple internet safety precautions, we can help keep GBMC safer from cybercrime. I want to thank Dave Hynson, GBMC’s Chief Information Officer, and his team for all their hard work in addressing the issues and keeping us on normal operations. Also, don’t forget to look for our IT Security team’s educational materials and tips throughout the month and throughout the year.

Monday, October 2, 2017

Another Wonderful Celebration in the Sun

The 17th running of Legacy Chase at Shawan Downs was a huge success. Mother Nature was kind enough to provide us with nice weather, allowing us to enjoy the beautiful horses, a picturesque countryside setting and fun with family and friends – there were approximately 8,000 attendees this year – coming together for a fabulous time.

Stretched across 300 acres of green meadows at Shawan Downs in northern Baltimore County, Legacy Chase attracts visitors of all ages for a day of steeplechase races, railside tailgating, live music, great food and family-friendly activities. Many of the crowd-pleasing traditions continued this year—such as the G. Leslie Grimes Memorial Stick Pony Race for kids— and GBMC added some exciting new components to help make this year’s event a success. Brand new this year, was the Survivor Shuffle, a unique and exciting dance aimed to draw attention to the fight against cancer. I want to thank the more than 150 volunteers who took part in this fun and new effort which ultimately was a great way to show support for our Oncology services. Hats, Horses, and Hope was the theme to celebrate cancer survivors. Each of the symbols create a sense of comfort and strength for cancer patients. Children also came dressed as their favorite superhero or received a free cape on-site to show their support for the fight, while some guests boasted their best hat to show support for oncology patients, as funds raised benefit oncology support services at the Sandra & Malcolm Berman Cancer Institute at GBMC. In the 2017 calendar year, at the end of Legacy Chase we raised $1.25 million for Oncology Services from 435 community supporters, including fundraising and sales from Legacy Chase.

Legacy Chase also gives us an opportunity to engage with the community, employees, donors and local businesses in the work of our healthcare system. We are proud to receive tremendous support from the community-at-large and our family here at home. 

Despite no incentive of a world record to break like last year – a record which we still hold by the way – we continue to receive great community and employee support. There were 35 GBMC departments that participated in activities throughout the summer to engage the community, promote the event and encourage fundraising. And they had some fun too! Special recognition goes to the GBMC Epic team, which raised almost $3,000 through a car wash and other activities.

The Sandra and Malcolm Berman Cancer Institute is able to provide patients with the best treatment and care possible thanks to continued annual support. The Institute is the only comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer in the Baltimore region. GBMC has invested in talent and technology to provide the best for oncology patients. Whether they are in need of outpatient, inpatient, home care, hospice or survivorship services, the more than 2,000 new cancer patients annually at GBMC get the best care.

This wonderful event (highlighted in the below video) would not have been successful without the support of our loyal volunteers, who helped us make this year’s event very special. I thank all those who attended and all those who donated time or treasure. Special thanks to the GBMC Philanthropy and Marketing Departments, who worked so hard in putting the event together. There’s still time to support the cause by visiting

Friday, September 22, 2017

MyChart Bedside and the Era of Consumerism in Healthcare – We Need Your Feedback

We live in the age of technology and an era of consumerism in healthcare where everyone is connected and bombarded with enormous amounts of information on a daily basis. But how do we use technology to keep people interested and engaged? At GBMC, we’re always looking for ways to improve patient care and better meet the needs of our patients.

Toward that end, in our hospital we have begun testing a new tool that is part of the EPIC system called MyChart Bedside. Some of you may be familiar with MyChart at GBMC, a way to connect to your personal patient records through an app or online. The MyChart Bedside tool is an extension of this technology that two units – U25/26 postpartum and U48 surgical – are testing with inpatients. Patients on these units are being presented with an iPad that has the tool loaded. Nurses are encouraging patients to explore the app, login to their existing MyChart account or create a new account. Through the iPad, patients can participate in their care by accessing education and information, what to expect when they’re discharged, find test results, and even watch movies.

So, what we really want to know from patients who have used the MyChart Bedside tool at GBMC is:

How did you like it?

Did you use it?

Did you dislike it? If so, why? And…

What should we add to MyChart Bedside that would really add value for you?

On the Postpartum unit, Jodie Bell, BSN, RNC, IBCLC, Clinical Director, Postpartum and Newborn Nursery, explains that more than 90 percent of patients are presented with the MyChart Bedside iPad upon admission. They have started documenting this program on their LDM board to hone in on how patients are using the MyChart Bedside tool during their stay. What they have found is that patients on this unit are using the program for:

  1. Obtaining health metrics such as vital signs and lab results.
  2. Looking up information about the medication they are taking and when doses are due.
  3. Accessing education topics such as recovery, care at home, and caring for the baby.
  4. Creating a MyChart account. Jodie says that they rarely see patients leave the hospital without having an existing MyChart account or creating a new one. 

Jodie adds, “MyChart Bedside can also be used for fun. Patients and family members can use the iPads to access movies, for example, which also helps occupy older kids when mom and dad are caring for the new baby. Patients can use social media, browse online or even put in non-urgent requests for things like blankets or ice.

Ashley Dickenson, RN, shows the MyChart Bedside app on an iPad on U25/26.
The nurses are also really good at providing iPads to all of our patients and encouraging them to use the tool. And while we’re seeing that most patients like the technology, some patients find they don’t have time to use the tool while caring for themselves or a new baby, or have not found the technology particularly useful. Overall, however, it’s been well received and we are looking to optimize the iPads based on feedback from patients. This includes adding a breastfeeding app and an app where people can order meals directly from Food Service instead of calling in orders by phone.”

The usefulness of this technology for our surgical patients, however, is still in question. On U48, we are seeing mixed results with MyChart Bedside. Some patients love it. Others don’t use it at all.

Ceil Gayhardt, RN, BSN, Clinical Manager on U48, explains:

“The challenge for us is to get our short stay patients engaged with the tool since they come to us sleepy and often have narcotics or anesthesia still on board, making them less than receptive to engage with MyChart Bedside. The bariatric service is focused on telling their patients about it ahead of time and encouraging them to interact, so that helps.

On the surgical unit, our goals are to give patients a means in which to be more interactive with their care.  It can be a way for patients or their families to access information about their procedure, medications, real time vital signs, or upcoming tests. Patient education is also at their fingertips. Education that was traditionally done one-on-one with the nurse is loaded onto the iPad so patients can view the information when it’s convenient for them. This also allows for multiple presentations of the material since the nurse reviews the information with the patient as well.  This is important since it often takes multiple presentations of material for patients to absorb or retain the information as they are in an altered state of health.”

Dr. Elizabeth Dovec, Medical Director of the GBMC Comprehensive Obesity Management Program, took a quick poll of some of her bariatric surgery patients on U48 to see what they thought of MyChart Bedside. Special bariatric surgery videos are preloaded onto the iPads for these patients to watch post-surgery. Here is some of the feedback she received:

  • “I really enjoyed it. It allowed me to take my time and go through each slide so I didn’t have to feel rushed into obtaining a lot of information all at once the day after my procedure.”
  • “Very informative and it was seen at the right time while recovering in my room. Convenient. You can learn and feel more confident of the process going forward.”
  • “I watched them and I was able to look at my relevant patient information. It was more valuable on the day of discharge. I was out of it the day of surgery.”
  • “I loved the videos. Being tired from surgery and anesthesia, I found the videos to be a positive affirmation and a way to solidify key points, briefly and succinctly. Very useful. Thumbs up!”
  • “I received an iPad but I was so out of it when they told me what it was for that I didn't remember and forgot to use it when I was there.”


It’s been an interesting test of a program that is designed to be innovative, interactive, and convenient for patients.  But, how well is this tool working for patients?

This is your opportunity to share your experiences with MyChart Bedside or even if you have not yet used the tool to give your ideas of things you would like to see added if you were to be a patient. How can GBMC better utilize this tool for inpatients? Did you love it, hate it, or even ignore it? I’d love to hear from you on this topic. Leave your comments and experiences below in the comments section.


On a final note, this Saturday, September 23rd, is the 17th annual Legacy Chase at Shawan Downs, which benefits GBMC’s oncology services and patient support programs. This is always a wonderful community and family event. Be sure to join us on Saturday – get all of the information here:

Friday, September 15, 2017

A Conversation With GBMC HealthCare’s Director of Diversity and Inclusion

The GBMC HealthCare System is committed to having a workforce that mirrors our community. In order to achieve our vision, we need to be welcoming to all. We need to celebrate our racial, cultural, and other differences to help us become more unified as a team. GBMC recognizes the need for it to be more deliberate in its actions to achieve inclusivity. Towards this end last year, we hired a new Director of Diversity and Inclusion, Jennifer Marana, MS, PhD. Jennifer has been leading our Diversity and Inclusion Council and I asked her to guest author this blog.

Jennifer has over 15 years of experience in diversity. Her primary responsibilities, in her previous places of employment, have included diversity and intercultural communication training, facilitating focus group discussions and data analysis that help to develop diversity initiatives and strategies. I believe that Jennifer’s skills and experience are just what we need to help us become even more inclusive. Jennifer believes our commitment to providing a Just Culture and developing an inclusive community resonates with her personally and professionally.

Please join me in welcoming Jennifer if you haven’t already!

Can you tell me a little more about your background?
I have worked as a diversity and inclusion professional for more than 15 years, directing strategic diversity initiatives at institutions of higher education such as McDaniel College, Claremont McKenna College, and Bard College. One of my most poignant experiences related to diversity and inclusion has been raising a child with special needs. My 13-year-old son has cerebral palsy among other health-related challenges. While I was already steeped in diversity work before he was born, my experience with him brought a new meaning to my work. My empathy for those who are different from myself has deepened and I have become more fervent about teaching and training to assist others with expanding their understanding and connection across difference as well.

What brought you to GBMC?
I was interested in bringing my knowledge, skill, and experience with diversity and inclusion into a new environment.  When I learned more about GBMC’s needs related to diversity and inclusion, I knew I could make a difference.

As the director of Diversity and Inclusion, what is your role and primary focus?
The diversity and inclusion mission of the GBMC HealthCare System is to create a more diverse workforce and foster an inclusive workplace. This will allow us to better achieve our vision by providing culturally competent care. This mission guides my work as I develop training, multicultural programming, dialogue facilitation, and provide overall leadership and support for GBMC’s strategic diversity goals.

Diversity is a very broad subject. Do you have a simplified definition of diversity?
Diversity is the combination, inclusion, and acceptance of the identities, experiences, and knowledge that make us who we are.

What is the most common mistake in our thinking about diversity?
I believe that some people think too narrowly about diversity.  They see it solely about the numbers – the racial/ethnic demographics.  As a diversity practitioner, I am intentional about coupling the word diversity with inclusion so that we address diversity in terms of race/ethnicity, sexual orientation, religion, and other aspects of our identity while creating spaces for mutual respect, learning, and understanding that comes with bridging the divides that may result from these differences.  

What does the role Director of Diversity mean at GBMC Healthcare and how do you see your role enhancing the GBMC community?
The role of Director of Diversity & Inclusion is a testament to GBMC’s commitment to its diversity and inclusion mission.  In some organizations, diversity and inclusion work is assigned as an additional task for the Learning & Organizational Development Director or other professional.  In these cases, diversity and inclusion work is not given the attention it deserves.  There is great value in having someone spearhead diversity and inclusion efforts.  This requires dedication and work from all employees, it requires a leader to guide the way.

Last month, your department facilitated an “Inclusivity Learning Forum” that you were particularly excited about, can you tell us who showed up to your forum and what the outcome was?
I have actually been excited about every single one of the Inclusivity Learning Forums (ILF) that the Diversity & Inclusion Council has hosted.  The Inclusivity and Learning Forums (ILF) are monthly educational seminars on topics that foster, promote and facilitate dialogue about diversity and inclusion.  Up to this point, we have addressed topics related to our Muslim, Jewish, LGBTQ (lesbian, gay, bisexual, transgender, queer) communities and even hosted a discussion on how to “Teach a Child about Diversity.” They provide a vehicle for learning about the diverse cultures, religions, and experiences that make up the GBMC employee and patient population.

The August Inclusivity Learning Forum was on the topic of “Judaism and GBMC.” panelists shared what it means to them to be Jewish and practice the Sabbath (if they do so), how their faith influences their work, and what we can do to make GBMC a more inclusive place to work.  Their responses illustrated the commonalities they shared in their faith as well as the diversity of their practices. We discussed what resources employees can access on the Sabbath and/or Jewish holidays if serving a Jewish patient who may refuse specific care.  Because many of our Jewish friends and colleagues may not be accessible on these days, Dr. Frankel shared a related story and taught attendees the term “Vechai Bohem,” words from the old testament that basically mean "to live by them."  Therefore, if someone comes to the hospital on the Sabbath or on a Jewish holiday and they refuse specific care, all we need to tell them is..."Vechai Bohem,” conveying that life is of utmost importance.

What is the WISER movement?
WISER is Working In Sync to Enhance Resiliency at GBMC.  Resiliency is the ability of employees to recover and remain engaged even in challenging work environments.  It is the opposite of burnout. The WISER team is made up of a group of GBMC colleagues who care for others while caring for themselves.  The team develops resiliency initiatives to support GBMC employees’ ability to engage patients and others as individuals and derive intrinsic value form work (at work) and disconnect and “recharge” (outside of work).  

What are some other programs or workshops your department has started and how can GBMC Healthcare employees get more information?
In addition to the monthly Inclusivity Learning Forums and WISER program, you will find the “Diversity & Inclusion Corner” of monthly cultural and religious observances and holidays on the Infoweb.  We have expanded the annual Black History Month celebration to include weekly activities throughout the month of February.  For more information, email

What would you like people to know about the council and future initiatives for employees?
The Diversity & Inclusion Council is committed to creating a framework that reflects our vision of creating an organization that attracts, retains, and leverages the diversity of our staff to meet the needs of our workplace and the populations we serve.  Future initiatives include religious and cultural celebrations, holidays, and upcoming GBMC diversity and inclusion events, a talk Line that employees can call if they feel as though an event, interaction, or encounter has left them feeling uneasy, disrespected or excluded from a diversity and inclusion standpoint.  Professional development opportunities related to developing inclusive work environments and engaging in bold conversations about diversity and inclusion.

Friday, September 8, 2017

Lights! Camera!....

On Thursday morning, you might have seen a video crew following our teams during the daily Lean Daily Management (LDM) walk. They were here filming LDM because of our national patient safety award, from the American Society for Healthcare Risk Management and Datix, that we received last year.

We were honored with the inaugural ASHRM Patient Safety Award for our use of LDM to improve health outcomes for patients and reduce preventable harm such as infections, falls with injury and hospital-acquired pressure ulcers.

Since we started LDM, we have seen a significant reduction in not only patient harm but employee injuries as well. We have also used this technique to reduce waste and improve patient satisfaction. We measure our progress towards achieving our vision by our results in each of our four aims of the Best Health Outcome and the Best Care Experience with the Least Waste of resources and the Most Joy for those providing the care.

In winning the award, we demonstrated how LDM principles, applied in a health care setting, improved patient safety. Some examples of the improvements through LDM included a reduction in catheter associated urinary tract infection (CAUTI) of 92 percent, surgical site infections (SSI) by 85 percent along with a reduction in readmissions rates for patients, fewer instances of missing medications, fewer employee injuries, better hand hygiene and an overall improved patient experience as measured by HCAHPS.

The ASHRM Patient Safety Award recognized our organizational excellence in patient safety and celebrated our efforts in risk management and in promoting patient safety across our health care system. Receiving this recognition from an external authority, like ASHRM, is a confirmation of the work we're doing to move us towards our quadruple aim.

This award was the result of the hard work and dedication of the entire GBMC family. I am so grateful that the crew was here to document LDM so it can be shared during this year’s ASHRM annual meeting next month in Seattle. We will also receive a video that we can use to teach new employees about our process.

We should all be very proud of our achievements in moving closer towards our vision.

Friday, September 1, 2017

The Summer is Ending

I hate the winter. When I tell people this they often point out to me that I moved to Baltimore from Boston where it is much colder. I am very grateful that I now live in a warmer place but I still wish that summer lasted all year long. I guess I just have to get over it.

But the change of seasons is a good time to reflect. I’ve been thinking recently about how much we have changed over the past seven years. I was reminded this morning on Lean Daily Management Rounds of one big change that we have made. When we were at the LDM Board in Family Care Associates, I asked the team if everyone had plans for the weekend and Dr. JoAnne Wills said: “I’m working”. Why will Dr. Wills be working as a primary care physician this weekend? Well, what if your daughter was sick and needed to be seen for something that wasn’t an emergency? Wouldn’t you want her to be seen in a timely way by a team that knows her and has her medical record, will treat her with kindness and won’t generate a very large bill? This is why Joanne will be working and it shows that we have changed and become truly more patient-centered in our advanced primary care offices. Thank you Dr. Wills!

We all know that just about every clinical outcome that we measure has improved over the last seven years because of our adoption of continuous performance improvement as the way we do our work. We are not perfect, but we get better at getting better every day. So maybe it’s good that the summer is ending and I will be spending less time outside…I’ll have more time to work on helping our healthcare system move faster towards our vision.

Labor Day
As our country celebrates the hard work of the American people, this Labor Day holiday, many of us will enjoy a three-day weekend.  But, many of my colleagues (like Dr. Wills) will be working. Please let me thank all of the phenomenal people of the GBMC HealthCare System for their labor towards our vision. Let me thank all of them for what they will do this weekend and every day to serve our community. Let me give a special shout-out to everyone who works in the Emergency Department for all that they do especially dealing with the opioid and mental health crises in the face of a nursing shortage. What makes a healthcare system truly outstanding is not the technology or the facilities, but the people.  I want to thank all of you who make our health system strong because you go to work every day and work hard serving others. Thank-You!

Tragedy in Texas
Our thoughts and prayers are with all those that have been affected by Hurricane Harvey. Watching the news, you can’t help but feel sorry for all the people who were harmed by the storm, lost loved ones or who had devastating property damage.  It is very sad to see so many homes destroyed. We Americans, the descendants of people who built this country often under adversity, are a resilient lot. I have no doubt that all the cities affected by Hurricane Harvey will rise up again.

Please join me in donating online using this link. You can also text “HARVEY” to 90999 to make a donation of $10. The GBMC HealthCare System is very good at helping those in need…let’s show the people of Houston and the other affected areas that we stand with them now! Thank you.

Wednesday, August 23, 2017

GBMC: the only healthcare system in Maryland to reach HIMSS 7 for both Inpatient and Ambulatory Care

Back in early June, we had representatives from the Healthcare Information and Management Systems Society (HIMSS) evaluating our healthcare system on the use of electronic health records. As you know, GBMC has been utilizing the Epic system since this past October.

I am very pleased to announce that GBMC HealthCare has achieved Stage 7 on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) for our inpatient care and ambulatory care! This award represents a lot of hard work to eliminate paper records and get all of our patients' information in one electronic file.

EMRAM is a methodology for evaluating the progress and impact of electronic record systems and includes eight stages (0-7) that measure a hospital’s implementation and utilization of IT to optimize the care that patients receive. Stage 7 represents the most advanced patient record environment. HIMSS Analytics developed the EMRAM as a tool to compare information technology maturity in health care organizations. Less than 5 percent of hospitals in the United States have achieved Stage 7 certification.

This accomplishment is due to the commitment and effort of the GBMC staff which includes our highly-skilled team of physicians, nurses, other clinicians and IT professionals. I want to thank all of my GBMC colleagues for this achievement especially Dr. Fred Chan, our Chief Medical Information Officer, Cindy Ellis, Epic Project Director, Dave Hynson, GBMC’s Chief Information Officer, Chase Roberts, Finance/Operational Efficiencies Manager and Mary Swarts, the Epic Nurse Champion, who all played an integral role in getting us to this point.

Achieving this recognition is something we all should be proud of.  It exemplifies our true commitment to ‘one patient, one record.’ Without this, we cannot reach our vision of being the community-based health system where every patient gets the care that we would want for our own loved ones.

Congratulations Dr. Kline!
Recently, I learned that Dr. Antonie “Tonie” Kline, the director of our Pediatric Genetics at the Harvey Institute for Human Genetics, will receive the RARE Champions of Hope in Medical Care and Treatment Award for her development of the Multidisciplinary Cornelia de Lange Syndrome (CdLS) Clinic Program. This award honors physicians for their notable efforts in rare disease advocacy, science, collaborative medical care, and treatment.

CdLS is a developmental disorder that affects many parts of the body. The features of this disorder vary widely among affected individuals and range from relatively mild to severe. An estimated 20,000 people in the U.S. have CdLS but remain undiagnosed and without support services.

Dr. Kline has coordinated free bi-annual Multidisciplinary CdLS Clinics for Adolescents and Adults at GBMC. During these small clinics, patients meet with Dr. Kline and a group of volunteer specialists. Patients and families are provided with behavioral plans, treatment protocols and valuable information on expectations for the individual’s current stage of life. This service helps families in knowing what to expect as their loved one with CdLS ages, and they are able to bring these protocols back to their personal physicians, educators, and caretakers.

As the medical director for the CdLS Foundation, Dr. Kline is also involved in both national and international research related to the condition. Over the years, she has established other clinics throughout the country; provided consults to roughly 300 children at biennial CdLS National Family Conferences; raised approximately $85,000 and has organized the Foundation's running group, Team CdLS Baltimore.

Please join me in congratulating Dr. Kline on her recent achievement and for her efforts to help people with CdLS.

Baltimore City Fire Department Gives To GBMC
Last Friday, Baltimore City Fire Department Chief Niles R. Ford and members of the Local Unions 964 and 734, visited our Sandra and Malcolm Berman Comprehensive Breast Cancer Center and kindly presented us with a generous monetary donation.

From the sales of a few hundred pink Baltimore City Fire Department t-shirts, they were able to raise $8,500 which will be used by our breast cancer center in providing holistic breast cancer support; such as breast surgery aftercare kits, therapy, and other recovery options.

We are truly honored that these men and women of valor chose us to be the recipients of their efforts to bring awareness and aid in our fight against breast cancer. I want to thank all the firefighters, not only for their generosity and caring but, for what they are doing for our community.

Thursday, August 17, 2017

Are we following the standard work…the design?

Earlier this week, at the executive Lean Daily Management board, we learned of three cases of patient falls at GBMC where the individual sustained minor injuries. Our people, especially our nurses and nursing support technicians, have done a remarkable job at reducing falls within our system. I believe that frail elders are now safer at GBMC than they are in their homes. Let me make the statement that I don’t think we will ever get to zero falls because to do this we would have to rob patients of their freedom and we will not do that. But as smart, caring professionals we need to always be learning from falls and changing our systems to move closer to zero.

So when three falls get reported what should our first question be? Our first question should be “did we follow our standard falls prevention work?” That standard work includes assessing the patient’s falls risk, educating high falls risk patients about how we will act and how they should act to protect themselves, and then implementing measures, like red socks, to alert others to the high falls risk, and using the bed and chair alarms.

The Swiss Cheese Model of error informs us that we should not expect to find one cause of a fall. In large complex systems, it is usually a series of factors that result in the bad event. One category of “holes” in the Swiss Cheese is that leaders need to be aware of managerial failure. One type of managerial failure is knowing that the standard work (in the case of falls prevention it is standard safety work) is not being followed and not doing anything about it.

If you are a very busy nurse on a medicine unit caring for a number of sick elderly patients, you have a lot to do. Setting up the bed alarm and making sure that it is turned on is one of your tasks. It should come as no surprise that a very busy nurse will sometimes get called away to urgently help another patient and forget to turn on a bed alarm. At GBMC we have, as part of our every two-hour rounds, a safety checklist that is done in part to check that the appropriate safety measures are in place and turned on. But what if we are not doing the safety checks as designed? If we are not, then that is a hole in the Swiss Cheese that is waiting to line up with a busy nurse getting distracted and forgetting to turn it on that might then lead to a patient fall.

So, as leaders at GBMC, we owe it to our patients, our staff and ourselves to assure that those safety checks are being done correctly. As we work to improve our care and get to even higher levels of reliability, we accept the fact that people will make mistakes and we must be preoccupied in catching the mistakes before they might result in harm.  So, we set up audits or checklists, but if we don’t follow the standard work of the check itself we miss our opportunity to find the mistake and fix it.

All leaders at GBMC have to unite NOT on ‘re-educating’ our staff on the importance of not forgetting, but, unite on ways of making sure that the standard work is followed when we are doing the safety checklist.  Only after enrolling all of their team members in the standard work should leaders decide how to hold their people accountable.  Leaders must take ownership as well.  If we know that the standard work is not taking place, as leaders we can’t wait until there’s an event, we must immediately work to close the hole in the Swiss Cheese and prevent the event from happening.

Please share your thoughts with me. 

Thursday, August 10, 2017

The Affordable Care Act was not repealed. What next?

In light of the vote against repeal of the Affordable Care Act (aka Obamacare) two weeks ago in the Senate, it’s a good time to continue the dialogue about the successes of the Affordable Care Act, its problems, as well as reflect on what the future may hold.

While I won’t go into the politics of healthcare, I believe it is important that the public remain educated and informed on how we arrived at this major crossroads in the American healthcare system.

The Two Main Components of the Affordable Care Act
First, did you know that there are actually two major bodies of work within the Affordable Care Act? The first has to do with health insurance. By far, covering Americans with health insurance was the biggest draw of this healthcare bill. Before the ACA was enacted, roughly 50 million citizens were uninsured. Since the ACA was passed, that number has been cut roughly in half.

The other component of the ACA focuses on the actual health care delivery system. As you know, even though we don’t cover all of our citizens with health insurance, we still spend 40 percent more per capita on healthcare than every other advanced nation and we don’t have outcomes for chronic disease that are as good as those other countries. So the ACA began changing incentives to meet the triple aim of improved health outcomes, better care delivery, and lower cost. This part of the ACA has been successful. We’ve seen annual Medicare cost increases lower than ever before and new programs set in motion that incentivize hospitals, physicians, and nurses to drive better health care value that has also kept employer-based health insurance cost increases relatively low. We’ve been experiencing the success of the ACA and the incentive programs at GBMC.

Of course, no bill, no matter how well designed, is without its problems. Yes, the ACA significantly increased the number of low-income individuals and families who qualified for Medicaid coverage to the tune of about 20 million Americans. It also made it easier for middle-class Americans to buy individual policies when they did not receive employer sponsored insurance, accounting for about 15 million more Americans who could purchase and choose their own plans on the newly created healthcare exchanges.

Why was this a big deal? Because prior to the ACA, people could buy individual policies from insurance brokers – if they were healthy. Because only healthy people could qualify, the rates for these policies were relatively low. People who were sick or had a pre-existing condition (such as epilepsy, diabetes, or even cancer), however, were deemed uninsurable. The pre-existing condition clause in the ACA opened up health insurance to a whole new pool of individuals who were no longer discriminated against by the insurers. This was a great win for millions of people.

But, once you create a market for sick people to buy insurance, the healthy people must also be required to buy insurance to balance out the costs.

This is the part of the ACA that is not working.
The incentives for healthy people to buy coverage were just not enough for many. Every time a healthy person decides to forgo health insurance pays the penalty, and takes their chances that they won’t wind up with a major illness or accident, the cost of insurance goes up…and up, and up.  And every time the cost of healthcare insurance goes up, more and more young and healthy people decide to roll the dice, take the risk, and not buy insurance, leaving a yet higher percentage of sick individuals in the insurance pool which drives costs up further. In some states across the country, this is causing insurance companies to stop selling policies to individuals. In these states, the exchanges are at risk of failing.

Going forward, we need to figure out how to make these exchanges work. We need a bipartisan effort to fix this part of the ACA, whether that means steeper penalties for healthy people who don’t buy health insurance, or more significant incentives for the healthy to enroll in coverage to keep costs lower for everyone. I am hopeful that the bipartisan work that started in Congress last week will come up with some good ideas to help fix this. Remember, the goal is better health outcomes with better care experience at lower cost. I don’t know anyone…Republican, Democrat or Independent…who is against this. 

As a result of this turmoil, many people are now considering a single payer system for the first time in our healthcare history. This would eliminate the problem of pre-existing conditions and differing policy costs because every citizen would be covered in the same huge pool of people.

This doesn’t mean socialized medicine or total government control of our healthcare system. This is the misperception that is hindering our efforts to even discuss this as an option.

Think about this: There is a single payer system in Canada. In Canada, it’s like Medicare for all, where Canada (like Medicare), is just paying all the bills, not providing the care. Actually, it is the U.S. government that provides more care than the Canadian government. The Veterans’ Administration is government-delivered care (is the VA socialized medicine?). Because of the single payer system, Canada spends about five cents on the dollar on insurance administration. In the U.S., we spend about  18 cents on the dollar on administrative costs and profit (which is actually lower than the previous 22 cents on the dollar the U.S. spent before the ACA). The difference between that 18 percent and five percent is billions of dollars! Many Americans believe this is pure waste.

A single payer system does not mean government provided healthcare. In all of the debates and discussions about the future of our healthcare system, Americans need to stay calm and listen to the dialogue about what single payer actually means.

There are pros and cons of all of the healthcare systems in the world. There is no perfect system…our goal as a nation should be to make our system better. We can make great progress even without a single payer system but we must come together to truly explore the evidence and our options.

We have a long road ahead of us to get to where we need to be with our healthcare system in this country. Staying educated and informed is vital to keeping a smart dialogue moving forward.

Thursday, August 3, 2017

Studying Defects to Learn and Improve at GBMC

I and other members of the senior team have really been impressed with what Kendrick Wiggins and Kevin Edwards and the materials management team have done to improve their work and make sure that our nursing units always have everything that they need to care for our patients. They have significantly reduced calls from nursing units for all types of supplies. Our nurses are spending much less time looking for supplies and calling to get things that they need that should already be present on the floor. At the same time Kendrick, Kevin and their colleagues have reduced the waste of having too much supply on the unit that can then expire and have to be discarded or reprocessed. Kendrick and Kevin have made their processes much more reliable.

This Tuesday morning on LDM rounds, Kendrick presented the learning on calls for missing linen from the day before. Kendrick had received a call that Unit 36 needed more linen. After directing the delivery of the needed things, he began to investigate. He asked the first why: Why did the unit run out of linen? He learned that the daily cart that replenishes the supply according to the predicted usage had not been delivered to the unit. He then asked the second why: Why had the cart not been delivered? And he learned that the vendor had not delivered the cart for that unit to GBMC. He then asked the third why: Why had the vendor not delivered the cart to GBMC to be brought to that unit? Kendrick called the vendor and found that they had not followed their standard delivery work. He asked them to problem solve and to create a final check of their delivery and to alert materials management when they did not deliver what was needed. The process that Kendrick followed is called the 5 Why process because it frequently takes asking the why question 5 times before you get to the fixable cause of the defect. Kendrick got all of the information that he needed in this case by asking just 3 why’s.

For LDM to be of value, the local leader must have a curiosity about how things are actually working. He or she must avoid the trap of assuming that they already “know” before going to study the actual event. On rounds when we hear people responding to the “what happened” question with “usually” or “sometimes” we know that the person has not actually investigated the event and done a 5 why’s. Tests of change that come from someone assuming what went wrong are not likely to be helpful. Engineers that are trying to improve something always start by going and watching the existing process. Only when they have observed and learned as much as they can about how a process fails do they test a change.

Another point that the leader must understand is to not stop the 5 why process too soon. On rounds we often hear “the chair alarm was not on.” The first ‘’Why was the chair alarm not on?” results in the answer, The nurse did not turn it on.” At this point we often hear that the leader has assumed education is the answer and that he or she is going to reeducate the nurse about the importance of turning on the chair alarm. If the leader had asked the second why, “Why didn’t the nurse turn on the chair alarm?” he or she may have gotten the answer that the nurse forgot. Very hard working and well trained people forget things from time to time, especially when they are under pressure and have many things to get done. Forgetfulness is better fixed by some kind of reminder in the moment (like a sign) or by some kind of constraint to make it impossible to get to the next step without completing the preceding step (you can’t order anything online until you have put in all of your credit card information) or by eliminating the step (like having the chair alarm reset itself). Leaders who stop the why process too soon don’t make as much improvement as those who learn as deeply as they can.

So the next time you see Kendrick, Kevin or anyone from the materials management team, thank them for being excellent learners and for helping us move closer to our vision faster!