Friday, April 20, 2018

Thank You to Our Volunteers!

This week, we're celebrating National Volunteer Appreciation Week and it is a special opportunity for GBMC HealthCare to pay tribute to the volunteers who devote their time, energy, and talent to serving the patients and associates at our hospital. We cannot achieve our mission of health, healing, and hope without them.

Volunteering is a great way to give back to the community and help those in need. With more than 900 volunteers in the hospital and at Gilchrist, GBMC has one of the largest volunteer auxiliaries in Maryland.

Our volunteers give selflessly to others, and they understand the value and importance of a friendly smile and the comfort of kind words in the healing process. The efforts of our volunteers are rewarding for them, in addition to being of great service to our patients and our employees. I’m extremely grateful for their dedication and hard work and for the wonderful job that they do.

This week, I was able to attend a few of the volunteer appreciation lunches to serve food, have a bite to eat and to say, “thank you” to them. I really enjoyed myself and was reminded again that at GBMC we are truly blessed to have such a fantastic volunteer auxiliary.

To all our volunteers, you’re a critical part of our healthcare team and I thank you for dedicating your time to make our health care system better.

How Good is GBMC as a Place to Work? Hearing from Our People
Among my responsibilities as the Chief Executive, I must ensure that GBMC is constantly in action to improve as an organization to work for. Our fourth aim is to exhibit our joy in serving others. This is not possible if our people are not feeling the support of our company. If they do not feel supported, they cannot fully engage in the other three aims of delivering the best health outcome with the best care experience and the least waste of resources.

So, every year we ask our people to complete our Employee Engagement Survey.

The survey is open through this coming Monday, April 23, and it should only take a few minutes to complete. I ask that all our employees complete the survey honestly. We need to know what you think to make the GBMC HealthCare system an even better place to work.

The survey is administered by Press Ganey, who compiles the data for us. We at GBMC never see individual responses. Your responses to the survey will remain CONFIDENTIAL. If you do, however, choose to include additional comments, these will be shared with your manager, but your name will not be given.
This summer, all employees will receive feedback on the survey results and action plans will be developed based on these results. Many of you last year asked for a shorter survey so this year the survey has 11 fewer questions!

Thank you so much for taking the survey.

If you have any questions about the survey, please call your Human Resource Business Partner.

Put on Your Red Shoes and Let’s Go for A Walk!
April is Sexual Assault Awareness Month and the statistics are quite alarming. Did you know that on average, there are over 320,000 victims of rape and sexual assault, a year, in the United States and in 8 out of 10 cases of rape, the victim knew the person who sexually assaulted them?

Our Sexual Assault Forensic Examination (SAFE) and Domestic Violence programs do so much for our community and we are grateful for their work in helping the victims of sexual assault and in educating the community to reduce these attacks. The assessment and treatment of victims of sexual assault are very complex. Expertise and caring are required not only to address the medical and psychological needs of the patient but also to complete the forensic work necessary to aid law enforcement in the identification of the perpetrator and to see that justice is served.

GBMC also serves survivors of domestic violence, including survivors of Intimate Partner Violence (IPV). Our domestic violence program includes providing 24/7 in-house victim advocacy.

Sexual assault and domestic violence patients not only get quality medical-forensic treatment but also receive much-needed crisis intervention and safety planning. Under the leadership of, Laura Clary, our SAFE program is growing and expanding in new directions helping us to better meet our mission of health, healing, and hope for those in our community and our vision of serving everyone the way we want our own loved ones served.

Registered nurses in GBMC’s SAFE program are specifically trained and certified by the Maryland Board of Nursing to provide care for victims of sexual assault and domestic violence of all ages in a confidential, non-judgmental atmosphere. At no cost to the patient, these nurses focus on re-empowering survivors to begin the healing process, in addition to working toward ending sexual assault and IPV in the community.

To date, GBMC’s Domestic Violence Program has provided services to approximately 1,000 individuals and our SAFE program sees close to 200 patients annually. We come nowhere close to covering the cost of these programs with health insurance billing, so we require the financial help of the community.

So, tomorrow, Saturday, April 21, I encourage everyone to grab their friends and family and come out to the GBMC campus for our third annual Walk A Mile In Her Shoes®: The International March to Stop Rape, Sexual Assault, and Gender Violence. Men, women, and children will walk a mile around GBMC’s campus with many in red high heels (or red Converse). All proceeds from the event will benefit GBMC’s Sexual Assault Forensic Examination (SAFE) and Domestic Violence programs.

To learn more about how you can continue to help victims and this critical program that supports the health and wellness of our community click here. I hope that you will come out and walk with us and/or financially support the event.

Congratulations Harry!!
Harry S. Johnson, Esq., previous Chair of the Board of Directors and current member of our GBMC HealthCare Inc. Board, is being recognized with a lifetime achievement award by the Daily Record publication. This award recognizes attorneys and judges whose body of work over their careers makes them stand out. They are well respected in their profession, active in their community, and dedicated to growing the next generation of legal leaders.

Harry’s been involved with GBMC since the mid-1980s as a lawyer handling medical negligence cases on behalf of GBMC and its physicians. He was an inspiring and strong leader as Chairman from 2011 to 2014.

For those of you who know Harry, you know he is a very passionate man who has also accomplished a great deal in his life. As a partner at the law firm of Whiteford, Taylor & Preston, he has become one of the most distinguished attorneys in Maryland and is a past President of the Maryland State Bar Association. He serves on many prestigious committees of the American Bar Association and has served a myriad of community organizations through the years.

I can’t think of anyone who is more deserving of this award than Harry Johnson!

Wednesday, April 4, 2018

Proud of What We Have Accomplished Together

Last week in Chicago, I did a little bragging about the GBMC HealthCare System and what we have accomplished under our four aims (the areas that best describe the care we want for our own loved ones): Best health outcomes; Best satisfaction; Least waste; Most joy for those providing the care. I gave a workshop along with my friend and colleague, Keith Poisson, our executive vice president and chief operating officer, at the annual congress of the American College of Healthcare Executives.

The title of our workshop was “A Community Health System Manages the Health of a Population.”

We described our work over the last eight years creating our vision and delivering on it. We talked about how strong our hospital has been for more than 50 years, and how we have built upon the excellent work of our hospital, hospice, employed physicians, and private practicing physicians to create a system of care that the patient would experience as a system. Keith presented the work with our service lines and how we have used continuous performance improvement tools such as Lean Daily Management to move closer to our vision every day. I presented about our development of advanced primary care using the patient-centered medical home and how this work has been aided by Maryland’s waiver and the global budgeted revenue system.

As we were presenting, I couldn’t help but reflect on how many of our people have worked hard on redesigning our systems to get us to where we are today, and how lucky I was to be associated with each one of them. Thank you!

Dr. Robert Ferguson recently received the 2018 Dema C. Daley Founders Award from the Association of Program Directors in Internal Medicine (APDIM).

Dr. Ferguson, an attending physician and valued member of the teaching faculty for our Internal Medicine residency program, was recognized by APDIM for his dedication to exemplary teaching and innovative educational program management.

APDIM is the professional organization of accredited internal medicine residency programs whose core mission is to support program directors in the pursuit of excellence in graduate medical education for internal medicine.

The APDIM Dema C. Daley Founders Award is the organization’s highest distinction and honors a member of the internal medicine community recognized nationally as an educator, innovator, and leader. Congratulations, Dr. Ferguson!

Friday, March 30, 2018

Improving Parking on Our Campus

We've recently started communicating with the GBMC family about changes to our traffic flow and parking on our campus. We have begun to put gates on our garages and lots. In June, we will remove the gatehouse and install ticket dispensers and “tap and go” readers at six locations: Rose Lot (Visitors Only), Daffodil Garage, Iris Garage, Lily Garage, Tulip Garage, and South Chapman.

These changes are needed to make the entrance to our campus safer for vehicular traffic and to reduce delays when entering and exiting from our grounds during peak hours while also improving parking accessibility for our patients. Stacey McGreevy, our Vice President of Support Services, and her team have been working hard to make the transition as easy as possible for our people. As we implement this decentralized parking model, we are conducting periodic studies of our parking capacity to make changes in employee assignments. Our goal is to allow employees to park as close to their work site as possible with the caveat that capacity for patients and visitors is our number one priority. If there are changes to your parking assignment, employees will be notified in May.

All GBMC employees will receive an assigned home lot or garage and will be able to “tap and go” their badges to enter and exit our medical campus. Your GBMC ID badge will be automatically programmed to function at your assigned parking lot or garage’s reader and stickers will still be issued to monitor compliance at free parking areas such as the Bluebell and the Labor and Delivery parking lots, that will remain as patient-only parking. We will not be erecting parking gates at these lots as parking will be free for our patients. Any employees found parking in these lots will be towed. Employees who work at locations other than the GBMC Main Campus, such as Gilchrist employees and our primary care off-sites, will have open access to park in any garage due to the infrequency of visits to the campus.

Patients will use pay-on-foot stations, which will be installed at high-volume pedestrian locations or pay from their vehicle using cash or credit at garage gates. To ensure a smooth transition there will be attendants stationed at gates during the initial rollout. Patients and visitors will have four payment options:
1. Pay with cash or credit at a pay station, receive a ticket, and put the validated ticket in the ticket reader at the gate from their vehicle.
2. Pay with cash or credit at the gate pay station from their vehicle.
3. Pay the gate attendant with cash or credit.
4. Use a discounted or free parking ticket, if they received one, at any of the above payment location options.

Thank you for complying with our parking rules so that parking spaces are always available and accessible for our patients. All existing passes will be used during the transition. The booths will be staffed, and the existing passes will be accepted. Once existing passes have been exhausted, new passes will need to be purchased.

Doctors' Day
Today is National Doctors' Day across the United States. Because this year March 30th is a holiday in multiple religions, we are celebrating on Monday, April 2. We are very fortunate to have a wonderful medical staff, who work very hard and do marvelous things. Our physicians throughout the healthcare system make a tremendous difference in the lives of patients every day. I am glad that at least one day a year we reach out and thank physicians for all the things they do 365 days a year.

In honor of Doctors' Day and your physician, please share your thoughts and inspiring stories of patient care here… 

Happy Holiday
On a final note, the GBMC HealthCare family sends its best wishes to everyone celebrating Passover and Easter this Sunday.

Tuesday, March 20, 2018

The Calling of Gilchrist Kids: End of Life Care for Children and Support for Their Families

The recent rebranding campaign for Gilchrist was designed to inform the community that it is more than hospice. Gilchrist provides outstanding elder care for fully active seniors, patients with chronic disease and frailty, and those nearing end of life. Annually, Gilchrist delivers elder medical care to 7,500 individuals, hospice care to 5,400 patients, and grief counseling and bereavement services to 6,500 people. The organization also counsels people on advance care planning, guiding them through decisions about their treatment and helping them make informed choices about their end-of-life care. They truly are living up to being “more than hospice.”

What many people do not realize is that Gilchrist also has a pediatric hospice program, which provides all-inclusive end-of-life care for infants, children, and young adults with life-limiting illnesses. It is the only facility in the state with inpatient children’s hospice beds. Gilchrist Kids cares for children dying from cancer, cardiac disease, untreatable infectious disease or blood disorders, life-limiting genetic or congenital diseases, and other conditions. The program also offers perinatal support for parents-to-be who have learned that their unborn child may have an incurable illness, as well as respite care, which is critical in improving the quality of life for terminally ill children and their families.

Gilchrist opened over 20 years ago as a small hospice organization serving a few dozen people It has grown to now serving thousands of individuals throughout Central Maryland—in homes, in skilled nursing and residential care facilities, and in three inpatient hospice centers in Towson, Howard County, and Baltimore.

To find out more about Gilchrist kids, I encourage you all to watch the following two interviews with staff members from Gilchrist Kids from the shows “To Your Health” and “Greater Living,” which were broadcasted last week on the GBMC Facebook page. I think you will find them very enlightening and you will be very proud of all that they do.

To Your Health

Greater Living

Thursday, March 8, 2018

Learning Together with Our Colleagues from the Centers for Medicare and Medicaid Services

On Monday, we were delighted to host my dear friend and colleague, Dennis Wagner, the Director of the Quality Improvement and Innovation Group at the Centers for Medicare and Medicaid Services (CMS), and several of his colleagues from CMS on our Lean Daily Management rounds.

I worked with Dennis and learned so much from him when he was the director of  The Health Resources and Services Administration (HRSA) national initiative to increase organ donation and I was the national co-chair. Dennis is an expert in social marketing and leading groups to attain bold goals. He co-leads CMS’s Partnership for Patients collaborative, which has been incredibly successful in improving care in U.S. hospitals and in which GBMC participates. I previously visited CMS and participated in their LDM walk, so I was grateful that Dennis came to see ours.

We got some great insights from Dennis and his team that will only make our rounding better. Dennis was very impressed with the spirit of improvement that he found throughout our healthcare system.

Thank You to Our Social Workers!
March is Professional Social Work Month and I would like to thank the devoted group of social workers who serve GBMC. Our social workers help inpatients and outpatients navigate the complexity of the medical care world and prepare them for discharge along with our care managers. They’ve helped GBMC maintain one of the lowest readmission rates in the state. Please thank our social workers for all that they do to move us closer to our vision.

Left to right: Chris Greenawalt, MD &
Rekha Motagi, MD
New Director of our Hospitalist Program
Chris Greenawalt, MD, has been named as our new Director of the Hospitalist Program. Dr. Greenawalt has been a leading member of the GBMC hospitalist group since 2003.

He received his medical degree from Wake Forest University School of Medicine and is board-certified in Internal Medicine. He not only has vast experience in working as a hospitalist, but also in helping hospitalist programs flourish.

“Hospitalists” are physicians who specialize in hospital medicine and devote their time exclusively to caring for inpatients. They communicate during admission and discharge with the primary care physicians, assuring continuity of care.

During Dr. Greenawalt’s time at GBMC, he served as the Assistant Director of the Hospitalist Group for six years and participated in multiple committees, including the Credentials Committee. In addition to his new leadership responsibilities, Dr. Greenawalt will continue to care for patients in the hospital as an attending physician. I would also like to thank Dr. Rekha Motagi, who is stepping down as Director of the Hospitalist Program for her years of outstanding service. Rekha will continue to see patients in the Hospitalist group.

Thank you to Dr. Motagi and congratulations to Dr. Greenawalt!

Friday, March 2, 2018

Pulling the Andon Cord

It’s been two years since we discussed our work to assure that nurses always have the medication to give to patients when they need it. In January of 2016, we reviewed the tremendous reduction in “missing medications” that had been achieved because of the improvement work in the pharmacy and our inpatient nursing units.

This week, on Lean Daily Management rounds, Maxine Lawson, our Assistant Pharmacy Director, explained to us that there had only been one missing medication to Unit 34 out of the last 400 medications dispensed! Only one defect in the system for that unit. How did they accomplish this? Redesigning the system to get to high reliability has taken some time. We suffered a significant setback after Epic implementation as many sub-systems had to be recreated. Today, we have now returned to our pre-Epic implementation state by studying the misses as they happen, during the day, to find the root cause and fix it so it doesn’t happen again.

Toyota gets credit for being the first company to perfect the study of defects as they happen to learn the cause of the issue. Before that, auto manufacturers would either find defects as the cars came off the assembly line or when their customers found the problem. Toyota implemented the Andon cord (now a button that can be pushed), that immediately stops the assembly line and brings managers to the person who pulled the cord, so they could study what happened and find a fix.

Now when the nurses on Unit 34 are “missing” a medication they need, they do the equivalent of pulling the Andon cord…they call the pharmacy. Maxine and her team immediately (during the day) go to the unit and study what happened. They then use what they learned to test changes to their system to assure that the miss doesn’t happen again. What Toyota learned and what we now know is that it is much better to study one defect well when it happens than to get sophisticated reports of many defects over time before scheduling meetings to figure out what happened and what we should do about it. I am very proud of our outstanding pharmacy team and our smart and hard-working nurses. Together, they are driving us to ever higher reliability! They are happy to help any group learn how to use the immediate Andon cord technique to make things better.

A Wonderful Friend and Colleague Heads to Retirement 
This Thursday was George Bayless’ last day at GBMC.

George joined GBMC’s Executive Leadership team about 11 years ago as Vice President of Finance.  With more than 30 years of corporate financial experience in the public accounting and healthcare industries, he was responsible for the development, implementation, and maintenance of accounting systems that provide for the financial control of the entities of GBMC HealthCare. George was also responsible for system-wide financial planning and the annual operating and capital budget processes.

George recently assumed additional responsibilities when he took over as Interim Chief Financial Officer prior to Laurie Beyer’s arrival. That’s the George everybody knows. He’s a person who will do whatever it takes to help his colleagues and our healthcare system. George is great learner and teacher.

Congratulations, George, and thank you for everything you have done through the years for your colleagues at GBMC, for our healthcare system, and for our patients!

Kudos to Laura Clary (again!)

I want to also congratulate Laura Clary BSN, RN, FNE-A/P, SANE-A, CFN, CPEN, Clinical Manager of our SAFE program, who was recently named Baltimore County Woman of the Year by the Baltimore Commission for Women. This program honors female residents of Baltimore County who have made significant, unique, and lasting contributions to their community. I echo Dr. JoAnn Ioannou’s words that it’s no surprise that Laura is repeatedly given accolades because she is an extremely knowledgeable nurse, scientist, and phenomenal team leader. Congrats again, Laura!

Friday, February 23, 2018

Honoring a Staunch Supporter of GBMC

On Monday, we held a dedication ceremony to officially rename the Physicians Pavilion North (PPN) to the William E. Kahlert Physicians Pavilion North. The naming was made possible by The Kahlert Foundation’s $5 million pledge during GBMC’s 50th anniversary celebration.

The Kahlert family has become part of the GBMC family and has been supporting us for the past 18 years. Bill and Yvonne were both GBMC patients and began giving to our healthcare system in gratitude for the care they received.During Bill’s battle with cancer, he developed a strong relationship with Dr. Ronald Tutrone and later with Dr. Paul Celano. Bill and Yvonne first supported GBMC HealthCare in the year 2000, four years before Bill developed a relationship with Dr. Tutrone, with a $250,000 to name the William E. Kahlert Cystoscopy Suite. This gift was soon followed by a $500,000 gift to secure the daVinci Surgical System that allowed GBMC to provide robotic urologic surgery. Three years after that, Bill personally made the bold step to endow a Urologic Research Fund to support research efforts under the direction of Dr. Tutrone. The Kahlerts also endowed the William E. Kahlert GBMC Chair in Urological Research which was the first of its kind at GBMC and has inspired a host of others to honor physicians and the great care they provide.

In 2009, to demonstrate his gratitude to Dr. Celano and the oncology team who cared for him as his cancer battle continued, Bill established a fund to promote multi-disciplinary medical research, which has helped GBMC to increase enrollment in oncology clinical trials by 25%.

Bill and Yvonne’s son Greg and his wife, Roberta, as well as their children, Heather and Scott, have continued the family’s support of GBMC. In 2014, The Kahlert Foundation gave $1 million to name our chapel in honor of Yvonne and to fund a second chaplain position. With the latest $5 million gift, their family and the family foundation have donated more than $13 million to our system!

Please go see the beautiful plaque and inscription in the Kahlert Pavilion lobby and the wonderful new signage on the exterior of the building.

I was honored to help commemorate Bill’s life through this dedication and we at GBMC are extremely grateful for the ongoing gifts from The Kahlert Foundation. We applaud Greg, Roberta, Scott, and Heather for continuing their family’s support of our work in the community.

Vanta Brewster
Celebrating Dr. King!
Yesterday, we hosted our annual Black History Month celebration. This year’s program, titled Black History Month and Spirit of King Awards Celebration, started off with a keynote presentation by Patrice Sanders, co-anchor of WBFF-TV’s weekday morning newscast, along with live music from the Dunbar High School Jazz Band. The winner of the inaugural Spirit of King award was Vanta Brewster. Congratulations Vanta and to all the nominees!

I am grateful to Jennifer MaraƱa, our Director of Diversity and Inclusion, and all of my colleagues on the Diversity and Inclusion Council for hosting this event and helping to bring us closer together. Thanks also go out to members of the Dunbar High School Jazz Band and our Black History Month committee that put together the outstanding celebration.

Random Acts of Kindness…
Last week, we celebrated “Random Acts of Kindness (RAK) Week” and this year, more members of our GBMC family helped to spread kindness throughout our healthcare system.

Dee Brown               Samantha Gendler

Kindness Kits were distributed to each hospital department, GBMC Health Partners practices, and Gilchrist units, so the GBMC family could display kindness to each other. This year had a new twist, as representatives from KIND also came to the hospital last Wednesday to hand out KIND bars and Valentines to passersby.

We also awarded our annual Random Acts of Kindness Ambassadors. The RAK Week planning committee received many worthy submissions and choosing the winners was extremely difficult. Congratulations to Dee Brown (Gilchrist Subacute) and Samantha Gendler (Marketing) for being selected as the co-recipients of our second Random Acts of Kindness Ambassador Award.

Thanks to everyone who helped with this event for making it such a success.

Book Drive…
Sticking with acts of kindness, just a reminder that we’ve been accepting donations of new and/or gently used books for the Reading Partners “Take Reading Home” program that will help provide support to children from kindergarten through fourth grade. Donations will be accepted until Wednesday, Feb. 28. Please consider leaving your books at our drop-off locations which include the main lobby of the hospital, the Human Resources department, the Marketing office (South Chapman building (Suite 102), Family Care Associates in the William E. Kahlert Physicians Pavilion North, or at any GBMC Health Partners primary care office.

Wednesday, February 14, 2018

National Tissue and Organ Donor Day

Did you know that this year today is not only Valentine’s Day but it is also National Donor Day? National Donor Day is a time to reflect on the gift of life that comes to many when they receive an organ, eye, tissue, or blood from another human being.

We all know that Valentine’s Day is a day to celebrate love and giving an organ or tissue is a remarkable way to demonstrate love. Currently, there are over 120,000 people nationally who are waiting for a life-saving organ and each day 110 people are added to the national waiting list. One tissue donor has the potential to improve more than 50 lives and one organ donor has the potential to save up to eight lives. If you need more proof of the power of organ donation, I welcome you to stop by and visit our ‘Tree of Life.’ This permanent art installation, close to the Emergency Department Concourse, memorializes the selfless act of organ and tissue donation at GBMC. What’s great is that if you stop by The Tree of Life, there is a kiosk where you can designate to become a donor. Please consider doing so!

Give Blood, please!!!
This year, the extreme winter weather and a deadly influenza season have adversely impacted both donors and blood drive coordinators, resulting in the cancellation of many important drives across the U.S. This has created a shortage of blood. To add, many of us also, unfortunately, take the blood supply for granted. If your loved one had just had a serious injury or needed blood because of a significant disease, you would expect that blood would be available for them. We are very fortunate that blood is available when our loved ones need it…but it doesn’t magically happen.

At GBMC, it happens because of the American Red Cross, our community partners, and the many, many members of our dedicated and caring staff. It is because of those who take the time out of their very busy schedules that we often meet or exceed our blood donation goal each time we have a drive. We also have community members who come to GBMC to donate because they want to support their community hospital and health care system!

So, I am asking the GBMC family to help in our next blood drive slated for Thurs., February 15 in the Civiletti Conference Center from 5:30 a.m. to 4:30 p.m. Please click here to schedule your life-saving donation! By the way, members of the community who come specifically to donate blood will receive a FREE meal ticket to the GBMC Dining Room, FREE parking and cookies. Employees will also receive the FREE meal ticket and cookies along with a special "Jeans Day" pass for Friday, February 16!

I am so proud of the teamwork displayed through these drives, helping GBMC to be a leader in blood donation. I hope you all consider coming out and helping us with this very important endeavor.

Protecting GBMC
About a month ago, two healthcare facilities in the U.S. experienced separate ransomware cyberattacks that compromised their patient files, patient portals, and their datacenter. This attack ultimately compromised the personal information of their patients and made it difficult to deliver care. To make sure that this doesn’t happen at GBMC, we need your help.

We all know that ready access to information on 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. The unfortunate situations, mentioned above, should serve as a reminder not to click links unless you are sure it’s safe, not to go to websites you aren’t familiar with and to ask IT for guidance if something doesn’t seem quite “right.”

You all recently received a notification from our Cybersecurity team with an important message regarding safeguards that were recently installed in our e-mail system.  All email is now subject to GBMC’s security filters and any mail that has characteristics of a phishing or other attack, will now be sent to the Junk folder. Unfortunately, this includes some internal emails. Please check both your outlook inbox and your junk folder daily.

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. Remember that it takes all of us to keep GBMC safe from cyber attack.

Thursday, February 8, 2018

Amazon, Berkshire Hathaway, and JP Morgan Chase Unite to Purchase Better Healthcare Value

Last week, the news headlines included a story that got my attention! The CEOs of Amazon, Berkshire Hathaway, and JP Morgan Chase decided they would no longer tolerate the high cost of healthcare in the U.S. These corporate leaders know that we spend 40 percent more per capita on healthcare than any other country in the world and that despite higher spending, health outcomes are often the same or worse than in other countries. They also know that the U.S. has the best trained and most hardworking doctors, nurses, and clinicians in the world. The CEOs know people aren’t the problem.

The cost of healthcare varies dramatically from place to place — frequently from hospital to hospital. These CEOs are aware that sometimes there are differences in clinical outcomes between providers, but it doesn’t make sense to pay higher prices when the clinical outcomes and care experience are the same. They want to buy higher value.

Value= clinical outcome + care experience

It seems these corporate leaders believe they can use their clout as the purchasers of healthcare for more than one million employees to find the highest value. They want the best health outcomes with the best care experience at the lowest cost. They want to send their employees to the providers that can deliver the highest value. After all, if they know that hospitals X and Y will both do a great job at removing your gallbladder, but it will cost 50 percent more at hospital Y, shouldn’t they be sending everyone to hospital X? If, on the other hand, hospital Y’s outcomes and care experience are better, paying more makes sense.

I think they have a great shot at reducing their expenses while giving their people better healthcare. I have argued that the individual patient cannot drive value and actually has a hard time figuring out who has the best outcomes and who has the lowest prices. But moderate and large size employers know what they are paying and can demand data from hospitals and physician groups and use it to buy healthcare in much the same way they buy everything else. Of course, there is a fear that healthcare providers will just lower prices for those with clout and make the prices even higher for everyone else. (But in Maryland, since we are a rate-regulated state, this “cost-shifting” won’t be possible for hospital care.)

I applaud this initiative and I hope to see more business leaders demanding this in our market. We will all be better off. What do you think? Will it work?

Tuesday, January 30, 2018

Always Having the Supplies That the Team Needs…and not too many!

Managing the supply chain for a health system is no easy job. Last summer, I commented on the outstanding work of our materials management team led by Kendrick Wiggins and Kevin Edwards. Click here to see where we were last summer.

I recently met our new Director of Materials Management, Brian Reimer. In his role, Brian will oversee the entire supply chain from purchasing to procurement and distribution. Our goal is that our clinicians (and the rest of us!) always have what they need, when they need it, so that we can serve our patients well and move closer to our vision.

Brian has many years of experience as an engineer and supply chain manager in several high volume, fast-paced, technical environments.  He comes to GBMC after a nine-year career at Cardinal Health, a healthcare services company, where he was responsible for the operations of a major medical-surgical distribution center serving customers in the U.S. and overseas. He also possesses years of experience in establishing and executing supply chain solutions that helped to reduce waste and improve efficiency for the Cardinal Health distribution centers.

Brian’s job is far from easy. In the ever-changing healthcare world where new products constantly come on the market, Brian needs to make sure that we get what we need and do not waste resources through unnecessary purchasing. Brian’s most important customers are our clinicians. A couple of weeks ago a number of our units did not have enough face masks to care for patients. Brian needs to own the system for supplying the face masks but he also needs to own the system for learning why we didn’t have enough of them on certain units so we can make sure it doesn’t happen again. 

We have locked, computerized, supply storage cabinets on our inpatient units. They were purchased believing that the technology could help us with assuring that we knew precisely when supplies were getting low to prevent “stocking out." The system requires the user to enter the exact number of things removed every time they use the device. This is difficult to achieve in the hustle and bustle of a busy clinical unit so what the computer thinks is often wrong. A less sophisticated system, called a Kanban two bin system, is used in our physician practices. A necessary supply, let’s say 2- inch gauze pads, are stocked in the cabinet in an exam room in two bins. When the first bin is emptied, the clinician pushes it to the back (or to the front depending on how the cabinet is designed). The person doing the re-stocking then has the visual cue to refill the empty bin. The computer and the counting are then not necessary.

I am delighted to welcome Brian as a new colleague and expert in supply management. He knows that the most sophisticated (and expensive) system is not always the best system. Brian will help us get to a better-designed system by collaborating with the people actually using the system. I really look forward to working with him. Please join me in welcoming Brian to our family!

Monday, January 22, 2018

What if it was your mother?

I have been reflecting this week about an incident that made it to the national news; a woman wearing a hospital gown was left by hospital personnel at a bus stop in our city. We don’t know all of the facts, but this has been reported not to be an isolated occurrence. Could this happen at GBMC?

Emergency departments are frequently under siege. I have been in healthcare for more than 30 years and through those years, I have seen how we frequently use the emergency department as the pathway of least resistance. Primary care office closed? Send the patient to the ED. Specialist unable or unwilling to deal with a problem in the moment? Send the patient to the ED. Hospital leaders not able to create a smooth system for admitting a stable patient to the hospital? Send the patient to the ED. No way to get an infusion done on the weekend? Send the patient to the ED. Mental health system is broken? Send the patient in crisis and his or her family to the ED. I have worked in the emergency department when it seemed that we were overwhelmed with many problems beyond our control. And of course when the emergency department is overcrowded, people wait and they get upset.

What if we assume for the sake of discussion that there is a patient for whom the emergency department has done its job of treating an acute problem? The staff believes it has done all it needs to do and the patient is not happy. The patient begins to act in a belligerent manner after being told that she is being discharged. Let’s also assume that the first reaction of the staff is to try and reason with the patient and calm her down. But what if the patient escalates her behavior and starts yelling and screaming and even threatening the staff? And what if this is the third angry patient of the evening who has gotten confrontational? Can you understand the urge of a physician, nurse, or security guard to have this patient leave the ED? Of course, you can.

And what if the patient in this not atypical situation was your mother? What should happen next? There is no perfect answer in this hypothetical situation, but of course, you want your mother treated with respect and kindness, even if she is out of control.

As the leader of the GBMC HealthCare System, it is my job to make sure that the ED staff members believe that we will not leave them on their own when they are confronted with problems beyond their ability to fix. They must also believe that people like me mean it when we say that everyone must be treated the way we want our own loved ones treated. But we can only hold people to this standard if we are ready to give them the help and support that they need to carry it out.

Could this happen at GBMC? It is my duty to assure that our incredibly hardworking physicians, nurses, advanced practitioners, other clinicians, and support staff teams have the equivalent of a safety button that they can push which will bring other leaders to help when they feel overwhelmed. I have shared this commentary with Dr. Jeff Sternlicht, medical director of our ED, and Monica Goetz, assistant nursing director, who oversee the emergency department, to have them assure our staff members that we will not leave them to deal with episodes like these on their own. What do you think?

Friday, January 12, 2018

What if it was Your Loved One in the Bed? The Absence of Alarm Fatigue in our MICU!

Back in July, I wrote a blog about “alarm fatigue.” In that blog I discussed my experience as a pediatric resident in a Neonatal Intensive Care Unit with alarms that constantly went off. We had become oblivious to them, unconsciously assuming that they were false alarms. In that blog I also commented that in highly reliable high-risk systems, like in an airplane cockpit, the alarms are minimized to those that are critical and that in those systems everyone responds immediately to them.

This morning I was on our Lean Daily Management walk in the MICU. Stacey Klingler, RN, the charge nurse, was presenting the Board accompanied by her manager, Rachel Ridgely, RN. Stacey was in mid-sentence explaining something to us when a patient alarm went off. Stacey immediately stopped and started to move to the patient’s room as did Rachel. I turned and looked towards the source of the alarm to see that other staff members were on the move as well. A staff member gave a thumb’s up “all clear” and everyone went back to what they were doing. Without missing a beat, Stacey finished her explanation. I was so proud of Stacey, Rachel and the entire team. If it is your loved one who is a patient in our ICU, you don’t have to worry about an alarm being ignored.

We thanked Stacey and Rachel for exhibiting the “preoccupation with failure” that all high reliability teams exhibit and for not assuming that the alarm was false or would be dealt with by someone else. Afterwards, I reflected on how quiet the unit had seemed before the alarm went off even though the unit was very full. We are making excellent progress in eliminating alarms that are not helpful and in presuming that all alarms are real until proven otherwise.


Rachel also told us that she was meeting with the leaders of our equipment hub. A few years ago we created the hub to remove clutter (and eliminate blocked corridors in the event of a fire) from our patient care units and also to have a system where we always knew where our equipment was. This way it could be moved quickly to where it was needed. At that time, we realized that hard-working, well-intentioned physicians and nurses were hoarding equipment because they were afraid that they would not get it back when they needed it…in other words, they knew that the system for removing equipment from and returning it to the units was unreliable.  Well, our system has worked pretty well since we created it but Rachel was seeing some drift away from our standard work. The physicians and nurses were beginning to hoard things again after one or two episodes where they had called for things that could not be found.

It is not a surprise that workers in unreliable systems begin to work around the system. They are not doing it for malicious reasons. They do it because they believe it will help them get their work done. But, as students of systems, we need to point out that when a system starts to fail and people stop following the design, it actually makes the system worse! Rachel is taking the correct step to meet with the hub leaders and ensure that we continue to follow our standard work to make sure that everything is in its place and moves according to need.

What do you think? Do you see other examples of drift away from standard work? Please comment below.

Friday, January 5, 2018

On Becoming a Learning Organization: 8 Employee Injuries

Today, I met with Simon Freyou, our new Director of Occupational Health, and discussed the GBMC HealthCare System’s progress in making our environment safer. Back in 2011, as we started becoming aware of the magnitude of this problem, we had as many as 40 injuries per month, many of which were lifting injuries, injuries due to slips on wet floors and sprains.

Last month we had “only” eight injuries. I use the quotes because if you are one of our eight colleagues who was injured, you deserve to be annoyed if the CEO says “only eight injuries.” I was telling Simon that the good news is that there were no sprains, strains, slips, and falls or chemical exposures this year.

How did this improvement occur? Was it by wishing and hoping? Or by paying better attention? I am sure that paying attention to wet floors or to how we lift patients did help; but most of the improvement came from studying the causes of the injuries, learning from them and making real changes. We now have “spill stations” throughout corridors where we often have spills or wet feet. We no longer place full trash bags on the floor, instead, we place them directly into carts because many contain liquid and may leak. We have placed lifting devices in most rooms or near where the care is delivered to aid in lifting patients.

With “only” eight injuries we still have work to do. All eight were in the category of potential blood-borne pathogen exposure- needle stick or other sharps injuries and splashes of body fluids. This category is probably the worst for our people. It is very unlikely that someone will get a serious pathogenic exposure from a sharps injury or a splash, but can you imagine going home after your work as a physician, nurse or other clinician and telling your spouse that you just converted to Hepatitis C positive because you stuck yourself with a needle? We owe it to our people to learn from every injury to make changes to eliminate injuries from our workplace. While we will never achieve perfection, we must always be working to reduce harm to our patients and our workforce. I am proud to report that we are becoming a learning organization and we are making progress. Let’s keep learning and testing changes on the basis of what we learn.