Monday, May 20, 2019

National Hospital Week: Time to Thank Those Who Care for Others

Last week was National Hospital Week, and it was a great time to celebrate our hospital and acknowledge those that serve our community. Hospital Week, which dates to the early 1920s, according to the American Hospital Association, “celebrates hope and healing, and the hospitals, health systems, and the women and men who support the health and well-being of their communities through dedication and care from the heart.”

We use continuous improvement and Lean principles in our healthcare system, and we focus on key processes to improve clinical outcomes and the patient care experience, while driving out waste and creating more joy for those providing the care.

Lean Daily Management (LDM) has been a huge success for us, and through our daily rounding, we’ve also narrowed the gap between the “front office” and the “front line.” I have had the opportunity to get to know many of our front-line team members throughout the system who are studying problems and testing changes, allowing us to have open conversations with one another about how we can continue to move toward our vision. I am constantly reminded that we need everyone on the team in order to achieve our vision, from parking lot attendants, grounds crew, patient access reps, and billing staff, to transporters, environmental services workers, food service workers, security personnel, social workers, care managers, physicians, nurses, clinicians, volunteers, and all other non-clinical and administrative employees. Each member of the GBMC family is a very important part of our work.

Last week, we celebrated Hospital Week with an ice cream social day and other observances, and I want to sincerely thank all the members of our staff, our Board of Directors, volunteers, and everyone else who has helped us improve our designs and make our system of care more reliable to move us closer to our vision: to every patient, every time, we will provide the care that we would want for our own loved ones.

Second ”A” In a Row!!!

Last Wednesday, it was announced that GBMC received its second consecutive ”A” grade from The Leapfrog Group.
 
The Leapfrog Group is a national hospital safety organization that grades hospitals twice a year on how well they protect patients from errors, injuries, and infections. The grades range from A through F based on safety measures in place and the hospital’s actual performance in preventing harm. The goal is to give the community a tool to use in selecting a hospital.

The Leapfrog Group rates over 2,600 general acute care hospitals across the country, including 40 in Maryland. Earning an “A” is not an easy achievement –  we are one of only 10 hospitals in the state to receive this high mark.

This recognition validates our strong commitment to the vision of providing our patients with the care that we would want for our own loved ones. While we are proud of this consecutive honor, we will not stop our improvement work until we achieve zero harm. I want to thank our entire team for all that it has done to move us to this point. I also want to thank Laura Hines, RN, SCNR, Director of Clinical Quality Outcomes, and Carolyn Candiello, Vice President for Quality and Patient Safety, for their tremendous work in culling the data for the survey. Great work, everyone!

Oh! What A Night!
I had the privilege of attending our recent annual Art of Nursing celebration on May 9. This was a special evening for our nursing staff. It was a great opportunity to thank our nurses for all they do for GBMC and its patients every day, and to have some fun!

Caring for sick patients who have many needs requires physical and mental stamina. Our nurses are smart, well-trained, and resilient. Their work is not predictable. I am so grateful for their ability to adapt to the variability in demand for their services from day to day and sometimes, from minute to minute.

I would like to thank everyone involved in the very successful Art of Nursing celebration, especially our Marketing and Communications team and our Philanthropy team.

Thank you!
The Kahlert Foundation recently agreed to endow The William E. Kahlert Research and Discovery Fund to support oncology clinical research with a $1 million pledge.
 
This fund was created by the late Bill Kahlert, for whom the William E. Kahlert Physicians Pavilion North was named in 2018.

Bill developed a strong relationship with Dr. Ronald Tutrone and Dr. Paul Celano during his battle with cancer.  To demonstrate his gratitude to Dr. Celano and the oncology team, he established a fund to promote multidisciplinary medical research. The fund has helped GBMC increase enrollment in oncology clinical trials by 25% and endowed a Urologic Research Fund to support research efforts under the direction of Dr. Tutrone, which was the first endowment of its kind at GBMC.

Although Bill and Yvonne have passed away, their son Greg, his wife, Roberta, and their children, Heather and Scott, have continued their family’s support of GBMC and giving in honor of the great care they have received at GBMC. 

I want to thank them for their recent endowment and I am extremely grateful for the ongoing support from The Kahlert Foundation. Thank you, Greg, Roberta, Scott, and Heather, for continuing your family’s support of our work in the community.

Friday, May 10, 2019

GBMC Nurses Recognized for Their Excellence

This week is National Nurses Week, a time to reflect on the many talented nurses throughout the GBMC HealthCare System. Through their expertise and dedication, they drive us closer to our vision every day.

Nursing requires selflessness and commitment. The more than 1,400 nurses in our hospital, in Gilchrist, and in GBMC HealthPartners give of themselves to make the experience better for those they serve.

We have been able to retain our experienced nurses and recruit new nurses due to the vision of JoAnn Ioannou DNP, MBA, RN, NEA-BC, our Senior Vice President of Patient Care Services and Chief Nursing Officer. JoAnn, who recently appeared on our Facebook Live program, To Your Health, does an excellent job in assuring that our nurses are recognized for their value to our system. JoAnn has overseen the creation of a professional development model for nurses that helps them choose their career direction and grow and develop their skills. Please take some time to watch the interview below.



Nursing has always been a marvelous profession and it is exciting to see so many young people choosing nursing as a career. I’d like to take this opportunity to extend my gratitude to all of our dedicated nurses for bringing health, healing, and hope each day to our patients and to our community. Thank you!

Congratulations are in order
In case you haven’t heard, SEVEN GBMC nurses were recently recognized in Baltimore magazine's 2019 “Excellence in Nursing” issue!
Nominations were submitted from across the region and 50 winners in 21 specialties were selected by a panel of nurse advisors. This is truly great recognition for GBMC HealthCare and our exceptional nursing staff. Please join me in congratulating the following nurses:

Mark Fisher, BSN, RN, CEN, TCRN – Emergency Department
Kristine Baker, RN – Neonatal Intensive Care Unit
Kenneth Griffith, CRNA – Anesthesia
JoAnn Parr, MS-HCM, BSN, RN – Care Management and Continuing Care Services
Elaine Dougherty, RN, WCC – Wound Center
Kristin Trawinski, MSN, RN – Neonatal Intensive Care Unit
Jennifer Spahn, MSN, RN, NEA-BC – Nursing Education

The fifth annual “Top Nurses” issue is already on newsstands. Get it to learn more.

Also, it's that time again when Baltimore magazine is collecting votes from area physicians for its “Top Doctors” issue. Docs, please vote for the colleagues you most respect! The survey may be found here.

Thank You, Readers, of The Sun
Our healthcare system was recently recognized by readers of The Sun as Best in Audiology Services and Best Hospital. I want to THANK all who voted for recognizing the hard work and dedication of our clinicians, other staff, and volunteers, as well as for your confidence in our ability to treat every patient, every time, the way that we would want our own loved ones treated.

GBMC Health Partners LDM Celebration
Earlier this week, I attended the GBMC Health Partners Lean Daily Management (LDM) celebration, which showcased more than a dozen poster presentations from 14 multispecialty practices. Each practice highlighted an improvement that they achieved using LDM problem solving to generate improvements in one or more of our four aims. The clinical teams used the Model for Improvement with Plan, Do, Study, Act (PDSA) cycles. Additionally, the Neurosurgery and Perinatal Associate practices gave a presentation that focused on the teamwork in their departments with both metric selection and the creation of sustainable standard work. I want to congratulate Dr. Harold Tucker, our Chief Medical Officer and President of GBMC Health Partners, Evelyn Bowmaster, BSN, RN, CPHQ, CBN, Director, Quality and Patient Safety for Physician Practices at GBMC, Carolyn L. Candiello, Vice President of Quality and Patient Safety, and all the event volunteers for putting together such a wonderful celebration!

Golfing for A Cause
The annual GBMC Golf Classic was held this past
Monday at Turf Valley Country Club. The sun made an appearance and the weather was just right as more than 180 golfers “hit the links” to help raise funds for continuing education in the GBMC HealthCare system.

Countless hours were spent by the entire golf tournament committee preparing for this great event that grossed more than $192,000. I’m very grateful to everyone who helped us raise the money and to those who came out to play. Kudos to the entire golf committee, co-chaired by Laurie R. Beyer, MBA, CPA, Executive Vice President and Chief Financial Officer, and David Brierly, Client Executive for Sodexo, as well as Jenny Coldiron, the GBMC Foundation staff, and all who volunteered at the event.

Friday, May 3, 2019

A Word of Caution in Overriding at the Electronic Drug Dispensing Cabinet

In December 2017, a nurse in a prestigious academic medical center used the “override” function in an electronic medication dispensing cabinet to get a medication to sedate a patient who was anxious about going into an MRI scanner. The nurse had been sent to the radiology suite to quickly administer a medication to calm the patient and get the study done. The nurse used “override” because the nurse did not find the medication on the patient’s profile. The nurse typed “Ve” into the search function and removed vecuronium, a paralyzing agent, from the cabinet and gave it to the patient. It was only later when the patient’s condition deteriorated in the scanner and the patient subsequently died that it was learned that vecuronium had been administered when the nurse had intended to give Versed, the trade name for midazolam, a sedative.

This is obviously a very sad case, but it was made even worse in January of this year when the nurse was indicted for murder. Following the notion of the Just Culture, punishing the nurse for this error would only be justified if his/her action was intentional or if there had been a reckless disregard for the standard procedures that other nurses in the same situation would have followed. Assuming there was no malicious intent, imagine how the nurse feels. He or she is clearly a second victim.

I don’t know all of the facts of the case, but none of the news reports suggest the nurse was trying to harm the patient. They all suggest that the nurse did not realize she had taken the wrong drug. I don’t know if another nurse in that particular hospital would have used the override in that situation, but I am concerned that in many hospitals, it would have been. Why do I believe this? Because all too often, we are concerned about speed and efficiency and we give our people the message that they need to move quickly to get the job done. We do not spend enough time coaching staff about our safety systems and making it clear with both our words and actions that safety is more important than speed. 

In the typical hospital case, there are 4 steps in the process to administer a medication to a patient (by the way, neither in my medical school education, nor during my pediatrics residency did anyone fully explain this sequence to me and the importance of all the steps). First, the licensed physician or advanced practitioner orders the medication. Next, the pharmacist checks the patient’s record for allergies and incompatibilities, as well as the dose and route of administration. He or she then verifies the order. Next, the pharmacy dispenses the medication. The drug dispensing cabinetry saves time because the drug does not need to be transported from a central location. The act of verifying the order in the computer tells the machine what to dispense. The nurse then does a final check that the patient, drug, dose, route, and time are correct and administers the drug to the patient. The drug dispensing cabinet has an override function because the manufacturer wants to allow the medication to be removed and administered quickly, if necessary, before ordering and verifying have been done.

In a true clinical emergency, time is of the essence. Think of a patient coming into the ED in full cardiac arrest. In this case, the provider running the code is giving verbal orders and other team members are getting the drugs (generally from a code cart) and administering them without the verification step. But what do you think about the case of the anxious patient? Is this truly an emergency? It is easy to see retrospectively that if the nurse had not used the override or if it was not even an option, and instead the nurse had waited for an order for Versed and its verification, this tragedy would not have happened.

At GBMC, we have some emergency medications in some drug dispensing cabinets, and therefore, we do not want to eliminate the ability to override. However, we do want to eliminate non-emergency overrides.

Our pharmacy leaders study the use of the override function at GBMC. Vaishali Khushalani, PharmD, GBMC’s Medication Safety Officer, has shared with me the insight gained by our daily medication override reviews. Most overrides that are occurring before a provider has entered the order are not for emergency medications; rather they are for acetaminophen (Tylenol), amoxicillin, and ibuprofen (Advil). In addition, there are many overrides within a minute or two of the order being entered. This does not give the pharmacist enough time to review and verify the order. The provider can order a medication “STAT” and the administering nurse can ask for a drug as “high priority.” In the month of April, there were 3,609 STAT/high priority orders and the average time to verify high priority/STAT medications was 6 minutes. There were 78,415 total medication orders in April and the average time to verify all medications was 12 minutes. While I am sure the mean performance includes some outliers, I believe that these are reasonable times to wait for the extra protection of the pharmacist verification step.

Vaishali and her colleagues are working closely with our nursing leaders to learn more about the reasons for the use of the override. They want to assure there are no significant delays in the verification of ordered medications so that we can eliminate non-emergency overrides. This ensures that patient needs are met without compromising patient and staff safety.

Our physicians, nurses, advanced practitioners, and pharmacists work extremely hard to get our patients what they need. We must all work together to make our system even safer than it is today. What do you think?

Way to go, Gilchrist!

Gilchrist was recently awarded the 2019 Health Care Hero Award for “Advancements and Innovation in Health Care” by The Daily Record. This award honors organizations and individuals who have played a major role in improving the quality of healthcare in Maryland. Recognized for “its professional achievements, community involvement, and inspiring change,” Gilchrist was applauded for its innovative patient care programs, which focus on meeting the needs of the seriously ill in our community. This includes home-based elder medical care for those who have difficulty physically making it to the doctor’s office.

Congratulations to all our Gilchrist colleagues for their hard work and for getting the recognition they so rightfully deserve!

Above and Beyond…

I want to extend my appreciation and gratitude to James Wilkins, a GBMC security officer, who was instrumental in helping a patient of ours reunite with his family.

Officer Wilkins was at home when he recognized a photograph from an Endangered Missing Person alert as a GBMC patient. The patient, who suffers from dementia and other medical conditions, was unfortunately separated from his family.

When James saw the alert on Facebook, he immediately notified the Aberdeen Police Department. The police positively identified the missing man, who was eventually reunited with his grateful family.

I want to THANK Officer Wilkins for his quick thinking to ensure this patient's safety and for doing his part, outside of his place of employment, to reunite this man with his family.

GBMC Employees Helping Our Community…

It’s no secret that we have some amazing GBMC employees who freely volunteer their time and do wonderful work in the community.

I was recently made aware by David Vitberg, MD, Division Chief of Medical and Surgical Critical Care Medicine, that GBMC NICU Nurse Manager, Kristin Trawinski, and Labor & Delivery Nurse Manager, Rachel Farbman, graciously volunteered their time for a very important training session with Baltimore County Fire Department's (BCFD) EMS providers. The event was attended by both career and volunteer EMS personnel.

Two BCFD paramedics presented during the training session a case of a complicated neonatal delivery. Although neonatal resuscitation is a rare call in the EMS world, EMS providers must be prepared for these low frequency, profoundly high-acuity emergency calls as the first link in the emergency medical system.

After the presentation of the case, a roundtable conversation took place between the two EMS presenters, Kristin, Rachel, and the audience. The lecture was also live-streamed to providers around the county.

The training, according to Dr. Vitberg, who is also Deputy Medical Director for Baltimore County Fire Department, was incredibly well-received by all in attendance, and as Kristin’s and Rachel’s colleague, he was extremely grateful they joined him at this event.

Thank you, Kristin and Rachel, for being stellar representatives of our Maternal Child Health Services and of GBMC!

Friday, April 26, 2019

Orthopaedic Care that You Would Want for Your Loved Ones

GBMC recently earned The Joint Commission’s Gold Seal of Approval® for Advanced Certification for Total Hip and Total Knee Replacement.

We are only the third hospital in Maryland to earn this distinction. The advanced certification is for Joint Commission-accredited hospitals and ambulatory surgery centers seeking to elevate the quality of their care.

We underwent a rigorous onsite review in late January 2019, when Joint Commission experts evaluated compliance with advanced disease-specific care standards and total hip and total knee replacement requirements, including orthopaedic consultation, and pre-operative, intraoperative, and post-surgical orthopaedic surgeon follow-up care.

Valid for 24 months, this advanced certification is evidence of the high standards of GBMC and our commitment to continually improve. Led by Leroy Schmidt, MD, our fabulous team of orthopaedists, advanced practitioners, nurses, physical therapists, occupational therapists, primary care providers, and other clinicians has generated outstanding outcomes with an excellent care experience.

In the past, joint replacement surgery meant a possible hospital stay of 1 to 2 weeks with significant post-operative pain, a significant risk of infection, and a lengthy recovery. Advances in joint replacement surgery have substantially reduced post-operative pain and complication rates, enabling us to discharge most patients after an overnight stay. I am happy to report that the risk of infection has been significantly reduced. In the past six months (September 2018-February 2019), we had 117 hip surgeries with 0 infections and 222 knee surgeries with 0 infections.

Our Enhanced Recovery After Surgery program (ERAS) allows for outpatient joint replacement surgery in selected cases. And, now we’ve started the Episode of Care Improvement Program (ECIP) to further improve the care experience and reduce waste. This innovative approach allows us to better prepare the patient for surgery and to eliminate the need for inpatient rehabilitation. Members of the care team educate joint replacement candidates about medical conditions that can negatively affect the outcome of their surgery and how to better manage these pre-existing conditions. In addition, the patient's functional mobility and support system is assessed to assure that they can receive their physical therapy in their dwelling rather than in a skilled nursing facility.

In addition to Dr. Schmidt, I want to thank all the members of our Joint & Spine Program for helping us attain this major achievement, especially April Asuncion Higgins, RN, BSN, CMSRN, Joint & Spine Program Coordinator, and Joy Reynolds, RN, Nurse Manager U58, and Joint & Spine Program.

It’s Medical Laboratory Professionals Week!
This week is Medical Laboratory Professionals Week. Medical laboratory professionals play a vital role in the diagnosis of disease and are key members of our healthcare team. These colleagues work out of the limelight and don’t often get the credit they deserve. I am so proud of our lab team, which has always demonstrated excellence. We are truly blessed to have an outstanding team of pathologists, technicians, phlebotomists, and staff.

Make Sure Your Voice Is Heard!
Please complete the employee engagement survey! This is a tool to make GBMC an even better system in which to work. The April 29 deadline is quickly approaching.

The survey is administered by Press Ganey, which compiles the data for us. So far, 63% of our colleagues have responded. The survey is anonymous and confidential. If you choose to include additional comments, these will be shared with your manager, but your name will not be given.

If you have any questions about the survey, please contact Angela Wilson, at anwilson@gbmc.org

Remember, we need your opinion! And thank you to those of you who have already taken the survey!

Friday, April 19, 2019

Beautiful Voices at GBMC!

This past Tuesday was World Voice Day, a day which serves as a reminder of the value and significance of vocal health in everyday life and encourages the public to act to improve or maintain good voice habits.

Last Friday, I enjoyed the second annual World Voice Day vocal showcase with special guest
performances by members of Technicolor Motor Home, a Steely Dan tribute band, in the Civiletti Conference Center!

This employee-only event, allows members of the GBMC family to display their singing talents. The concert showcased 15 incredibly talented performers, who sang songs from multiple genres. I was really impressed with the great vocal talents from across the GBMC system.

I want to congratulate Dan Sherwood, MS/CCC-SP, HSE, our clinical vocologist at the Johns Hopkins Voice Center here at GBMC and his colleagues for their hard work in putting this great event together. I’m looking forward to next year!


GBMC Is Again Represented in the Daily Record’s Top 100 Women
I am proud to announce that three members of the GBMC family were honored by The Daily Record as Top 100 Women.

Heidi Kenny-Berman, Esq., HealthCare Board of Directors member and Philanthropy Committee Chair, Elizabeth Dovec, MD, FACS, FASMBS, bariatric surgeon and Medical Director for the GBMC Comprehensive Obesity Management Program, and JoAnn Z. Ioannou, DNP, MBA, RN, NEA-BC, Senior Vice President of Patient Care Services and Chief Nursing Officer for GBMC Healthcare, were all honored for “outstanding achievement in professional life, community leadership, and mentoring.”

Congrats to all three of these GREAT  leaders!




Happy Holidays
On a final note, the GBMC HealthCare family sends its best wishes to everyone celebrating the start of Passover and Easter.

Friday, April 12, 2019

We are Grateful for Our Volunteers – National Volunteer Appreciation Week 2019

This week we are celebrating National Volunteer Appreciation Week and we are so grateful for all that our volunteers do to help us meet our mission of health, healing, and hope.

With more than 1,100 volunteers serving the hospital and Gilchrist, we have one of the largest volunteer auxiliaries in Maryland. Every day, our volunteers share their talents and spread kindness throughout our hospital. They are all accomplished members of our community and we couldn’t achieve our vision of providing to every patient, every time the care that we would want for our own loved ones without them. 

Over the last 50-plus years, our volunteers have donated approximately four MILLION hours of service and raised more than 25 million dollars to support patient care at GBMC!

So please, when you meet a GBMC or Gilchrist volunteer this week please take the time to say, “thank you” for all they do.

Donate Life Month

April is Donate Life Month, which brings awareness to the need for organ and tissue donors and honors those who have already donated. Earlier this month, I was privileged to be part of a very special ceremony at GBMC. We and The Living Legacy Foundation of Maryland held a flag raising ceremony to honor the memory of donors as we celebrated their gifts of life to others.

Today is the National Donate Life Month Blue and Green Day. The goal is to bring awareness to the importance of organ, eye, and tissue donors and to celebrate those that have saved lives through their donations. I hope that you all wore blue and green!

Every ten minutes, a person in the United States is added to the national organ donation waiting list, which has approximately 114,000 people on it. One person’s donation can make a huge difference for the people on this list. A single tissue donor has the potential to improve the lives of 50 people and one organ donor can save up to eight lives!

Please remember that you have the power to save lives. April is the perfect time to register as a donor if you haven’t already. Those wishing to register as an organ, eye, and tissue donor can do so at the MVA or at www.donatelifemaryland.org.

Helping our SAFE & DV program…
I want to thank everyone who participated in our fourth annual “Walk a Mile in Their Shoes” event. We had close to 500 participants and we raised more than $90,000 for our Sexual Assault Forensic Examination (SAFE) and Domestic Violence (DV) program! Last Saturday, under beautiful sunny skies, participants walked a mile around GBMC’s campus to shed light on and show support for an extremely important issue for women and men of all ages. Click on the image (left) to watch a video summary of our event.

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 empowering survivors to begin the healing process, in addition to working toward ending sexual assault and intimate partner violence in the community.

This year, our team decided to change the name of the event to “Walk A Mile in Their Shoes” to reflect that our healthcare system, and our SAFE and DV program, treats patients of all ages, genders, and ethnicities. When MedStar Franklin Square Medical Center’s pediatric program closed last year, GBMC immediately decided to create a child abuse team to fill the gap in services for children. It was the right thing to do. We couldn’t walk away from the need to care for and protect the most vulnerable segment of our population…children.

Prevention is key to putting an end to sexual assault and intimate partner violence. Our SAFE team has worked hard to expand across our healthcare system and into the community, and our primary care and emergency department teams have been trained on the signs of abuse and the steps to take when they see red flags.

The success of this year’s event would not be possible without the support of our generous sponsors, donors, and walkers. I was really impressed to see many of the football players from Stevenson University came out to support our program.

We understand the necessity of our Walk a Mile event and I am proud that GBMC continues to be a leader in helping the victims of sexual assault and domestic violence and in educating the community to reduce these attacks. I want to thank Dr. Fred Chan and Bonnie Stein and our committee members, along with the GBMC Philanthropy Department, Marketing Department, our Volunteer Auxiliary, and all parties, who worked together to make this year’s event another success!

We want to hear from our employees…
Every year, we ask our people to complete our Employee Engagement Survey. This year, the theme is Let's Get Better Together, and our goal is to have 80% (or more!) participation.

We need to know what you think to make the GBMC HealthCare system an even better place to work. We know we have the best employees at GBMC, Gilchrist, and GBMC Health Partners and we can't wait to hear your feedback!

Earlier this week, you should have received the survey link in your employee email. The survey is open through Monday, April 29, and it will only take a few minutes to complete. I ask that all our employees complete the survey. Please respond honestly, as the survey is completely CONFIDENTIAL. If you include additional comments, these will be shared with your manager, but your name will not be given.

Thank you for helping us make GBMC an even better employer. If you have any questions about the survey, please contact Angela Wilson, anwilson@gbmc.org

Thank you so much for taking the survey.

Friday, April 5, 2019

Walking with a Purpose

The numbers tell the story. One in three women and one in six men in the United States have experienced sexual violence in her or his lifetime. These are not just numbers, though. They are real people – mothers, fathers, sons, daughters, grandparents, spouses, friends – whose lives are forever impacted. For this reason, our Sexual Assault Forensic Examination (SAFE) and Domestic Violence (DV) Program is expanding to care for more survivors, including a growing number of children.

I am writing about this in the blog this week to ask that you consider participating tomorrow and register NOW for the Walk a Mile in Their Shoes event! Online registration closes at 2 p.m. TODAY, but in-person registration WILL BE AVAILABLE tomorrow prior to the start of our event.

Learn more about the program by clicking the image below and watching Valerie Weir, BSN, RN, FNE-A/P, CMSRN, SAFE & DV Program Coordinator, discuss how to stop teen dating violence and sexual assault on BMORE Lifestyle.
Valier Weir Discusses Sexual Assault
Please click here to register before 2 p.m. today! I hope to see many of you walking with a purpose tomorrow!

Remembering Those Who Served
Last Saturday, Gilchrist held its second annual Welcome Home Vietnam Veterans Day Celebration honoring the brave men and women who served during the Vietnam War. Hundreds of Vietnam War Veterans attended the event, which provided a day of healing for them and their families. It also gave others in attendance the opportunity to thank those who served and give them the welcome home that they deserve.

Gilchrist is proud to honor and support those who have served in the United States Armed Forces and has honored thousands through their salute to service and pinning ceremonies. Over 10 percent of Gilchrist’s hospice patients are veterans. Gilchrist’s Welcome Home celebration honors the veterans in their care and in the community, recognizes the unique needs of these veterans, and thanks them for their sacrifice and service to our country.

In addition to Vietnam War Veterans, the Welcome Home Celebration had several extraordinary Iraq War veteran speakers who shared their messages of hope and healing. Captain George G. Forrest, a community hero who saved many of his soldiers’ lives when he served in Vietnam, was the emcee. Other speakers included: Cathy Y. Hamel, MA, President of Gilchrist, Lt. Diane Carlson Evans, USA-Army Nurse in Vietnam, Founder of the Vietnam Women’s Memorial Project, and the first woman in U.S. history to spearhead a campaign to place a national monument in Washington, D.C.; Senator John Astle, USMC-Marine, Vietnam veteran and sponsor of state legislation, and Governor Larry Hogan who signed a bill in 2015 that established March 30 as Welcome Home Vietnam Veterans Day in Maryland.

Congrats to Gilchrist for hosting this great event and thank you to all those in attendance for your service!

Let’s Go O’s!
Yesterday was opening day at Orioles Park at Camden Yards and I was graciously invited to the Oncology Services Opening Day Luncheon Celebration, which has become a wonderful annual event that brings joy to our oncology team and their patients. The food (hot dogs, mac and cheese, pretzels, salads, etc.) was delicious and I really enjoyed the singing of our National Anthem by Rocelle Feria, RN!


Friday, March 29, 2019

Connecting the Addicted to Treatment

GBMC has just completed its first year of the SBIRT program. SBIRT, which stands for Screening, Brief Intervention, and Referral to Treatment, is as an evidence-based, comprehensive, integrated, public health approach to the delivery of early intervention for individuals with risky alcohol or drug use, and the timely referral to more intensive substance abuse treatment for those who need it.

Over the last year, we have screened every adult who has come through our Emergency Department (ED) for addiction. If they screened positive, we have offered them a brief interview with a peer recovery coach; someone who has had an addiction and is in recovery. The peer recovery coach provides non-clinical services intended to aid patients with getting into treatment. The coaches work as part of the ED team to provide education about the risks of the unhealthy behavior and, if indicated, help the patient get to a recovery program with a warm handoff.
GBMC was asked by The Maryland Department of Health to participate because screening helps to identify those at-risk individuals who have not previously sought substance abuse services. Research has shown that a brief intervention helps some people change their behavior around substance use, even when they are not thinking about changing. Please join me in thanking our peer recovery coaches:

Daron (Ron) Brodie – Community Outreach Peer Recovery Coach
Latanya (Tanya) Hill- Peer Recovery Coach (PRC)
Jessica Pieper- Peer Recovery Coach (PRC)

Thanks to Our Physicians!
Today is National Doctors’ Day, when we reflect on the hard work of our physicians and thank them for their dedication.

To celebrate Doctors' Day at GBMC, we had breakfast earlier this morning and those physicians in attendance could visit several wellness stations. This afternoon, we are holding an ice cream social in the physicians’ lounge as another way to show our appreciation for their tireless efforts.

So, as we celebrate National Doctors’ Day, please join me in thanking our physicians for all that they do to drive us closer to our vision: To every patient, every time, we will provide the care that we would want for our own loved ones.

Friday, March 22, 2019

Improving Our Emergency Department

GBMC has an outstanding Emergency Department and the community knows this. While the region is seeing about the same number of ED visits as last year, our ED visits have increased by 10%! This is because people know the quality of our care and that we are working to become the healthcare system where every patient gets the care we want for our own loved ones. Emergency Medical Technicians and ambulance drivers know that we are welcoming to them and that we are actively working to improve our efficiency every day.

We also know that we need to make changes to our physical plant. From all the sounds coming from our Emergency Department concourse, you can tell that there are renovations taking place. We started this work a few weeks ago.

The changes are designed to reduce delays in admitting patients by improving flow. Stacey McGreevy, our Vice President of Support Services, Russ Sadler, our Manager of Capital Resources and their teams have been working hard to make the transition as easy as possible for our patients and employees.

The Emergency Department Entrance renovation will allow for wider hallways, greater patient privacy, a re-designed registration area, and improvements to overall workflow to provide better patient through-put during the registration process. By relocating the main registration desk, creating more efficient triage rooms, and adding a secondary waiting area for triage and registration, we will be better able to register patients without having long lines resulting in cramped hallways. The design team included physicians, nurses, and registrars.

I want to thank everyone involved with these renovations as well as our patients and employees for their patience while we improve.  The target date for completion of the project is June 30, 2019.

THANK YOU TO OUR SOCIAL WORKERS!!!
March is National Professional Social Work month and I want to extend my appreciation to our fabulous GBMC social workers.  I am always amazed by the resourcefulness and fortitude of this group. Our social workers deal daily with the many challenges that come with the social determinants of health and without them, our system would come to a near standstill.
They have helped GBMC attain low readmission rates and have designed a system that assures that our patients with advanced illness receive the continued support they need after they leave our hospital. Please take the time to say, “thank you” for all they do!

P.S. March 29 is Doctors’ Day – do you have a physician you’d like to honor or recognize for exceptional care? If so, please go to https://www.gbmc.org/doctorsday

Friday, March 15, 2019

Celebrating Patient Safety Awareness Week

This week is Patient Safety Awareness Week (March 10-16).  This annual recognition is meant to urge the public to learn more about healthcare safety and for hospitals to share their work on patient safety and safety culture. The goal is for healthcare systems to improve patient safety while developing lasting partnerships among staff, patients, and the community.

Safety is at the core of our vision. We owe it to our patients to keep them free from harm when they are in our care. We have come so far in eliminating error, but we still have so much to do.

We have worked hard to create a just culture, in which we begin from the premise that humans will make mistakes and they should not be punished unless they are consciously violating safe practices. We console those who make an error and we coach those who drift away from safe practices. We build systems to catch human error so that the mistake doesn’t reach the patient. A good example of this is scanning all medications to make sure that the drug has been ordered by a provider and verified by a pharmacist to prevent giving a patient the wrong medicine.

We are delighted to work in partnership with our patients. Patients and family members play an important role in preventing harm. At GBMC, we educate patients on their disease processes, we teach them about their medications, and we encourage them to ask questions. An informed patient, who is comfortable speaking up, is less likely to experience harm.

Here are some facts that the GBMC family can be proud of:
--We were one of only eight hospitals in Maryland to receive an ‘A’ in The Leapfrog Group’s Hospital Safety Grades in 2018. These grades measure how well hospitals protect patients from harm.
--We’ve only had ONE surgical site infection for hip and knee replacement surgeries since January 2016. Prior to that, we had averaged approximately one surgical site infection per month.
--Unit 36 and Unit 58 have been Central Line Associated Bloodstream Infection (CLABSI)-free for over four years.
--Unit 45 has not had a Catheter Associated Urinary Tract Infection (CAUTI) since 2012 and Unit 35 has been CAUTI-free since 2013.

These results did not happen by chance. We put evidence-based standard work in place to prevent these episodes and we hold ourselves accountable to follow the standard work. Whether staff members have direct or indirect contact with patients, everyone plays an important role in preventing harm. I want to thank all our GBMC physicians, nurses, advanced practitioners, and everyone in our system for their tireless efforts as we work towards zero harm.

Come Out and Walk for A Great Cause!
Did you know that one in three women and one in six men in the U.S. have experienced some form of sexual violence in their lifetime? To raise awareness on this very important issue, we are holding our annual Walk a Mile in Their Shoes event during Sexual Assault Awareness Month.

This powerful event, which takes place on Saturday, April 6, is hosted by the GBMC Foundation and presented by the GBMC Volunteer Auxiliary. It’s a great opportunity to educate the community about sexual assault and domestic violence. Participants will walk one mile around GBMC’s campus to shed light on this extremely important issue.

Walk a Mile in Their Shoes, which financially supports our SAFE and Domestic Violence Program, has continued to grow over the past four years. We are proud of the impact that this program is having, and we are grateful for all the community support that allows GBMC to provide these necessary services across the region.

I want all of you to consider walking with us and/or financially supporting the event. For more information, please visit: www.gbmc.org/walkamile

Advanced Practitioners Week
This year GBMC is celebrating advanced practitioners in a very unique way. The theme of the week was “The Resilient Practitioner: Wellness and self-care for those who care for others.” The theme was inspired by the book, “The Resilient Practitioner: Burnout and Compassion, Fatigue Prevention and Self-Care Strategies for the Helping Professions.” The week-included a variety of wellness and resilience-based activities such as: flower arranging, pet therapy, yoga, eating cupcakes, and making essential oil sprays. Today, we ended with a ceremony to honor advanced practitioners who exceed expectations in skill and professionalism. GBMC is the home to more than 150 advanced practitioners who apply their skill and hard work every day to move us closer to our vision. Happy Advanced Practitioner Week!

Friday, March 8, 2019

Someone Who Has Overcome

Last week, we hosted our annual Black History Month celebration. This event honors the culture and accomplishments of African Americans in our society and celebrates the spirit and life work of the late Rev. Dr. Martin Luther King, Jr. with the presentation of the Spirit of King award. This year’s program, entitled “Songs of our Souls: We Shall Overcome,” featured Maryland Delegate C.T. Wilson, along with music from the Milford Mill Academy String Orchestra and Honors Chorale.

After the opening musical numbers, Delegate Wilson began this year’s program with his keynote. C.T. is from Charles County, and was featured in the Netflix docu-series “The Keepers.” He successfully advocated for legislation to extend the statute of limitations in child abuse cases in Maryland. When I first met him a few years ago, I was immediately impressed with his passion to help those without a voice. C.T.’s personal story is one of true hardship and perseverance. Thrown out of his home at the age of 4 by a drug-addicted mom who explained to him, "It's time for you to be a man." His life went from bad to worse. Orphaned at a young age, he was moved from foster family to foster family, and then when he was adopted at age nine, he was sexually abused by his adopter. Somehow, he got through the pain and suffering to build a better life for himself, his community, and his family. Today he is the state's primary advocate in the fight against child abuse and he has sponsored legislation to give child victims more time to file lawsuits against their abusers.

Prior to the start of the event, Delegate Wilson and I spoke briefly about GBMC’s vision of being the community-based true system of care that can deliver on our promise “to every patient, every time we will provide the care that we would want for our own loved ones.” I told him of our work to help victims of sexual abuse and domestic violence. I also mentioned that since the closing of Franklin Square Hospital’s Pediatrics department about a year ago, GBMC’s SAFE (Sexual Assault Forensic Examination) program has seen an increase in childhood assault and sexual abuse cases. As a result, we recently created a Child Protection Team, comprised of a pediatrician and social worker, who evaluate and treat all children where abuse is suspected. The team serves as a liaison between GBMC and governmental agencies which investigate child abuse and they educate medical providers and families on the recognition, reporting, and prevention of child abuse. Dr. Michelle Chudow is the medical director of the Child Protection Team and she works closely with the SAFE program team, led by its clinical program manager, Laura Clary, RN, FNE-A/P, SANE-A, to make sure that adolescent victims of sexual abuse or assault get the care they need. Delegate Wilson praised us for our efforts and encouraged us to continue to work to protect children from abuse.

Delegate Wilson’s presentation (click here to watch) was very moving and served as a motivator for everyone present. We all fought back tears because his story is so hard to hear. In the end, however, we all realized his resilience and strength. He told those gathered that he was not looking for pity, but rather a commitment to work for justice for all. I am very grateful that Delegate Wilson came to our event in the middle of the legislative session and shared his story with us. We will not forget it and we will redouble our efforts to help the abused and to educate our community towards the goal of eliminating abuse.

After Delegate Wilson’s speech, we presented the Spirit of King award which recognizes an individual who embodies the spirit and life's work of the late Rev. Dr. Martin Luther King, Jr. and who is dedicated to serving their local community. The winner of this year’s Spirit of King award was Lisa Anglin, care coordinator at our GBMC Health Partners Primary Care – Perry Hall patient-centered medical home. Please join me in congratulating Lisa and all the nominees!

I am grateful to my colleagues on the Diversity and Inclusion Council for hosting this event and helping to bring us closer together. Thanks also to the Milford Mill Academy String Orchestra and Honors Chorale and our Black History Month committee for putting together the outstanding celebration.

Friday, February 22, 2019

A Grand Experiment

As readers of this blog know, Maryland is different from the other 49 states in the union because we don’t get reimbursed from Medicare for hospital services by the national prospective payment system. Instead, Medicare pays hospital rates that are set for all payers by the Health Services Cost Review Commission (HSCRC). The rates vary significantly from one hospital to another.

In the other states, Medicare and Medicaid generally pay below what private insurers pay and hospitals negotiate payment rates with the private insurers, trying to pass the costs not covered (by Medicaid in particular) on to the private insurers. In Maryland, hospitals don’t negotiate rates with private payers because they are set by the HSCRC.

Since 2014, Maryland hospitals have been working to improve health outcomes and the care experience of patients while keeping the annual increase in the cost of care for hospital services below 3.58% (the projected annual increase in our State’s economy). Maryland has succeeded in reducing hospital-acquired conditions and in keeping cost increases below 3.58% annually over the past 5 years.

Beginning on January 1, 2019, Maryland’s hospitals have committed to a new waiver extension. You can read the details by clicking here. The agreement commits Maryland to improving the health of our citizens while controlling the cost of care. A new element to the waiver will be Maryland’s need to reduce the rate of increase for the total cost of care to Medicare beneficiaries relative to the rate of increase in the total cost of care for Medicare beneficiaries in the rest of the country. By the fifth year of this new waiver, Maryland is required to generate $300 million in savings annually. Until this year, Maryland’s performance has been judged based on hospital costs only, but now it will include physician billing, nursing home billing, and all that is included in Medicare Part B billing.

Since hospitals are now responsible for charges outside of the hospital itself, it will be more important than ever to get physicians on board. For this reason, the new waiver will include THREE programs designed to incentivize providers of care to generate better health outcomes at lower costs. The first is the Maryland Primary Care Program (see my blog from Jan. 4 by clicking here). The Maryland Primary Care program will create more advanced primary care practices which are better equipped to keep patients with chronic diseases out of the hospital and as healthy as possible. The other two programs that involve physician leadership in improvement are the Episode of Care Improvement Program (ECIP) and the Hospital Care Improvement Program (HCIP).

The ECIP incentivizes clinical teams to improve outcomes and lower costs for an episode of care, like an artificial hip transplant. Medicare will ‘bundle’ the total costs for a hip transplant and if the team can reduce the total costs, the hospital that the team is associated with will keep a portion of the savings. For example, if the team can eliminate stays on a rehab unit and send the patient home from the hospital with physical therapy, thereby saving the cost of the rehab unit stay, the team will receive a percentage of the savings.

In HCIP, clinician-led groups work to improve clinical outcomes within a hospital stay by designing better processes, using care coordination, and creating better handoffs at discharge. Teams will work to drive out waste, resulting in reduced costs. Hospitals that reduce their costs will keep the savings, thereby increasing their profitability and making rate increases in subsequent years less necessary.

Everyone agrees that the current healthcare system in the U.S. is wasteful and unsustainable. The Centers for Medicare and Medicaid Services are using Maryland as a laboratory to see if changing financial incentives can help care providers to transform the system and drive better value to the people we are serving. It is a very exciting time to be in healthcare in our state! The GBMC HealthCare System is a key player in this transformational movement as we continue driving toward our four aims of the best health outcomes with the best care experience and the least waste of resources with the most joy for those providing the care – the definition of what we want for our own loved ones and for every patient, every time. Let’s use the new waiver to move us faster toward our vision. 

Friday, February 15, 2019

GBMC has the Best Grounds Crew!

Over the past couple of weeks, I’ve had several people stop me, most recently during this past Monday’s Lean Daily Management (LDM) walk, to let me know how grateful they are for the excellent work our grounds crew has done during the recent winter storm events. They’ve told me how “stunning” our facility looks after inclement winter weather. They reflected that they wished that the rest of the region could be as good at snow and ice removal as GBMC.

Every winter, our grounds crew does an outstanding job of clearing snow and ice on our grounds, and our facilities team makes sure that everything remains in working order. Over the years, there have been several stories about how all our staff members have rallied together during blizzards and ice storms to ensure the hospital remained operational to serve those in need of our care. Time and time again, the GBMC team has clearly demonstrated its commitment to our mission of health, healing, and hope for the community. I have witnessed the teamwork, camaraderie and “can do” attitude of our people firsthand many times since I arrived in 2010.

On Monday, our grounds crew did its usual phenomenal job of snow and ice removal to make our campus safe and passable. They were out all day, clearing ice from GBMC roads and walkways. GBMC ran like a well-oiled machine. I can’t think of anything that exemplifies teamwork more than this.

Let me take this opportunity to thank everyone for their commitment and effort to get the job done for our patients and our community during the recent storms. Special thanks must go to our beloved grounds team: George Dillon and Tony Weber. From early in the morning to very late at night, these guys worked collaboratively with our vendors, Bright View, to keep our campus safe and passable. Thanks also must go out to Jim Keyzer, Mitchell Scholtes and all of our facilities team!

Again, my appreciation to all who work so hard to get the job done for our patients and our community during the recent storms.

Thank you, everyone!

Friday, February 8, 2019

There is No Substitute for Compassion

This week, I have spent a lot of time thinking about the use of automation and technology in healthcare. Many are trying to sell us various products such as online primary care, remote monitoring, and decision tools using artificial intelligence, just to name a few. I have no doubt that we can use technology to improve the value of our care, but this week I was reminded that only humans can love and demonstrate their love for others, especially when the other is in a time of need. On Wednesday, we celebrated the winner of the annual Nancy J. Petrarca Compassionate Caregiver Award. This year’s winner is Carolyn Insley, the Executive Assistant to Jenny Coldiron, our Vice President for Philanthropy. Carolyn is an important player on our philanthropy team.

John Adams, MD, the deceased former Chair of the Department of Pathology at GBMC, started the Compassionate Caregiver Award after losing his friend, Nancy Petrarca, to cancer. His vision and philanthropy created the endowment that underwrites the rounds that bear his name.

I can think of no one more deserving of this award than Carolyn. While she is not a caregiver to patients, Carolyn cares for the GBMC Team every day. Carolyn is an outstanding example of a caregiver to the caregivers. She has overseen the Adams Rounds and its predecessor, the Schwartz Rounds, from their beginning. She treats everyone with care and she never says no when she is asked for help. Carolyn does an outstanding job supporting Jenny and she has been a wonderful colleague to me. She quietly and graciously does so many things to aide our efforts to raise funds and she is frequently the point person in our efforts to soothe the pain of someone who has lost a loved one or who is going through a difficult time.

So, please join me in congratulating Carolyn. We will see many new hi-tech tools in healthcare, but there is no substitute for the compassion that Carolyn displays every day!

I am also very proud of all 87 of this year’s nominees and the other four finalists: 
Tara Archer –  Gilchrist Kids Volunteer
J. Christopher Greenawalt, MD – Hospitalist
Kory Joyner – Security Officer
Lisa Brengle Krueger, RN –  SAFE Nurse

Thank you all for your caring and your leadership!

Help us reach our goal!!!

Our nation’s blood supply has been critically depleted because of multiple snowstorms, frigid temperatures around the country, and the recent government shutdown, which reduced the number of blood drives in our region. Blood drives help surgical patients, those who’ve suffered traumatic injuries, and patients who need blood because of illnesses such as cancer. I encourage you to watch our two Facebook Live shows “To Your Health” and “Greater Living Live, to learn more about the value of blood drives and why I am asking for your help!

This Valentine’s Day, GBMC is hosting its first American Red Cross Blood Drive for 2019. Currently, we have about 90 people registered to participate, but we really need to reach our goal of 120 donors. The drive is from 5:30 a.m. to 4:30 pm and will take place in our Civiletti Conference Center. To register, click here.

Please have a heart and sign up to donate. It’s easy, won’t take much time, and you will literally be helping to save lives. I am confident that the GBMC family will rise to the occasion and make this blood drive the best one yet! Thank you!

Friday, February 1, 2019

Healthcare Price Transparency

This week, I was made aware of the need to make prices more visible to patients. I received a letter from the Maryland Insurance Commissioner, Al Redmer, because a GBMC patient was stunned when he received a bill for more than $5,000 for a leg compression device to prevent blood clots. His insurance had paid $3,000, but since the durable medical equipment company was “non-participating,” he was left with a $2,000 responsibility. “Non-participating” means that the durable medical equipment company had not contracted with the insurer and reserved the right to charge anything the insurance company didn’t cover directly to the patient. Evidently, we had ordered this device without investigating how much it cost or how much the patient would have to pay out of pocket. I am sure that whoever ordered the equipment did so in good faith, trying to help the man. Mr. Redmer had also sent a letter to the president of the man’s insurance company requesting an explanation.

On Tuesday, I heard a speech from the Administrator of the Centers for Medicare and Medicaid Services, Seema Verma, who discussed how she and the Secretary of Health and Human Services, Alex Azar, were focused on driving healthcare costs down. She highlighted that, as of January 1, 2019, all Medicare participating hospitals were required to publish their chargemasters online to make prices available to patients. GBMC has dutifully done this. If you want to view the GBMC charge master link, click here. I would recommend that you visit other hospital websites and see if you can compare their prices. This will be challenging due to the variation in cost for procedures, so you may want to compare something like a Mumps Measles and Rubella vaccine. With some research, you will be able to find this because it is a vaccine that does not vary across hospitals making it an apple-to-apple comparison.


As in the case of the man referred to in the letter from Commissioner Redmer, the charges by themselves are not enough for a consumer to know what they will pay out of pocket because it will vary dramatically according to the insurance plan. For example, GBMC employees who have taken our platinum plan don’t pay anything out of pocket, no matter what the charge is, if they use GBMC. This is obviously not true for someone with a “high deductible” plan. (By the way, this is a reason why many think we should explore a single-payer plan, to simplify the rules and to spend much less on insurance administration. It would be as if everyone had Medicare and there was only one set of rules. The Canadians have a single-payer system and they save a lot on administration and spend 40% less per capita on healthcare with much the same outcomes as ours).

Maryland is the only state in the U.S. where hospital rates are set by a commission known as the Health Services Cost Review Commission (HSCRC). All payers pay the same price for a given service in Maryland. In the other states, hospitals set their prices very high on their chargemasters to be able to negotiate downward with Blue Cross and other insurers. The gap between what the chargemaster says and what individual insurers actually pay is not as big in Maryland as it is in the other 49 states. In all states, however, the person with no insurance is billed the full charge as found on the chargemaster. People who cannot pay these charges apply for discounts based on their means.
GBMC has some of the lowest hospital charges in the region and with our global budget and more patients coming, our prices have actually gone down. Making patients and employers (who could steer their employees towards high-value hospitals) aware of price differentials is a good start, but we all have so much more work to do to build a more value-driven healthcare system. If you want to know more, please visit a recent New York Times article on hospital prices here.

THANK YOU!!!
I would like to thank everyone who recently took time out of their busy schedule to email or speak to me in person and offer their thoughts about last week’s blog. I truly appreciate the feedback and it was nice to hear from so many of you. I encourage you all to please submit your remarks in the comment section of the blog and to help keep the conversation going about improving our nation’s healthcare system.

Friday, January 25, 2019

The Cost of Prescription Drugs

Earlier this week, I read an op-ed piece in The Baltimore Sun that focused on the life sciences industry in our state and the value that these companies bring to our economy. The author of the op-ed was making the case that regulations on the pharmaceutical industry are onerous and should be reduced.

As I was reading the article, I tried hard to keep an open mind. We should always be cautious in applying new rules or regulations to any industry to make sure that the benefit provided by the regulation outweighs any potential harm. We are well-served by the pharmaceutical industry in the U.S. in that we (usually) have a ready supply of high-quality drugs. But would the quality and efficacy of the drugs be so good without the manufacturing controls and tests required by the Food and Drug Administration? It is clear to me that the profit motive alone is insufficient to assure that we have the drugs we need. Recently, U.S. hospitals have had to scramble to acquire certain medications and intravenous solutions because they weren’t being manufactured due to low-profit margins.

GBMC works diligently to make sure that we are good stewards of the community’s resources. We are here to bring health, healing, and hope to those we serve and to do it as efficiently as possible. This year we are performing very well on our annual budget. We are serving many more patients than expected and our expenses are in line, with one big exception — we are overspending our pharmaceutical budget, especially in oncology drugs, by $3.2 million.

Why is this? Well, a small part of the overspend is because we are serving more patients, but the biggest reason is the dramatic increase in drug prices for both new and common drugs. A new report from The Health Care Cost Institute showed that the cost of insulin, which has been commercially available since the mid-twentieth century, has doubled between 2012 and 2016. By looking at health insurance claims, researchers also found that there was a 97% increase in the amount spent on insulin for people with Type 1 diabetes using employer-sponsored health insurance. Personal costs went from $2,900 in 2012 to $5,700 in 2016. For more on the report click here.

Recently, I heard a presentation from Aaron S. Kesselheim, MD, JD, MPH, Associate Professor of Medicine at Harvard Medical School and a faculty member in the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital. Dr. Kesselheim has made a career out of studying drug prices and he disputes the idea that new drugs are more expensive because of research and development (R&D) costs. Dr. Kesselheim’s work shows that only 10-15% of the cost of a drug comes from R&D and asserts that pharmaceutical companies are charging more to maximize their profits —sometimes more than one thousand times their cost of production. Dr. Kesselheim believes that this won’t change unless consumers and purchasers take action.

I think the American people need to first answer this question: “Is healthcare a right or a privilege?” If it is a privilege, then everyone must deal with the price of care in whatever way they can. If healthcare is a right, then we need a system with an oversight mechanism that checks the profit of individuals at the expense of the sick and the society at large. Pharmaceutical companies must make a profit but when is the profit too much?

The op-ed writer in The Baltimore Sun did not mention the protection afforded to pharmaceutical companies which block competition from generics for years after a drug comes to market. Nor did he mention their ability to maintain the protection significantly longer by creating minor changes to the drug formulation. Dr. Kesselheim explained government protected monopolies for drug manufacturers in his article in the Journal of the American Medical Association, which can be found here.

There is no simple solution to the dilemma of the cost of prescription drugs in the U.S., but it is time for citizens to learn the facts and weigh in. What do you think?

Bereavement Services for Our Employees
Over the last few weeks, I have highlighted various Gilchrist successes and initiatives, and this week I want to mention Gilchrist’s bereavement program led by Deb Jones, Bereavement Program Manager. The bereavement staff is well-trained in accompanying families through their grief journey.

The bereavement program is now open, not only to hospice families and friends, but also to GBMC and Gilchrist employees at no charge. The Gilchrist Grief Support Programs offer six-week and monthly support groups, workshops, and special events. For more information, please call 443-849-8251.

Friday, January 18, 2019

Moving Patients and Equipment Around Our Campus is a Very Complex System

Recently, I spoke with Anthony Anderson, GBMC’s newly appointed Director of the Service Response Center and Patient Transport. 

Anthony, who worked at GBMC for three years as our Assistant Director of Food and Nutrition, now oversees daily transports and Service Response Center (SRC) calls. Anthony’s leadership team includes Destini Washington, Dominique Eaddy, and Gaurav Vasson.

Moving patients safely and efficiently requires standard processes and synchronization, which is the coordination of events to operate a system in unison. For example, when a patient needs to move from an inpatient unit to the radiology department for a study, the nursing staff must align its work to have the patient ready when transport arrives to move them. If either the patient or transport team is not ready on time, the system is “out of sync.” In a highly reliable hospital (one in which what should happen, happens, and what should not happen, doesn’t) patients are where they need to be when they need to be there.

This is a very complicated process because it’s impossible to predict exactly when and where patients will need to be moved at the beginning of the day. Anthony will be working closely with other leaders, especially our inpatient nurse managers, to make sure that we have standard work that is synchronized.

Anthony and his team also have the added complexity of moving equipment (stretchers, beds, wheelchairs, etc.). Our transporters are key players in keeping our facility clutter free and assuring that everything is in its place so that our staff will have what they need when they need it. They follow our 6S principles: sort, separate, shine, standardize, sustain, and safety. When things are not where they belong, it is hard to get them to the people who need them and clutter in the hallways is a safety hazard. Imagine if we had to move a patient quickly but the corridor was obstructed by a stretcher!

Anthony has created a new initiative with his people that we should all be following. It’s called “if you see something, say something.” It is everyone’s responsibility not to ignore something that is not in a 6S condition. For example, if a transporter sees trash overflowing, a stretcher in the hallway, or a wheelchair that is not in its proper place, he or she will rectify the situation or call ext. 6800. The transport team is trained to say something when they see something. If they see a stretcher, they will ask the unit if they need the stretcher. If they don’t, the transport team will ask them to log the equipment, run it in Epic, and take the stretcher to its proper destination.

Anthony told me that he and his team believe building relationships with leaders throughout GBMC will build the trust that patient transport will arrive on time. This will encourage others to do their part in making sure the patient is ready when the transporter arrives.

Please join me in welcoming Anthony to his new role and committing to help him create an even more reliable transport system. I would also like to thank Stacey McGreevy and David Brierley for their leadership in this area.

Kudos to our cleft lip and palate team!

Our cleft lip and palate team recently received approval by the American Cleft Palate-Craniofacial Association (ACPA). This recognition makes us one of four hospitals in the state to receive this endorsement.

The ACPA is an international nonprofit association of more than 2,500 healthcare professionals who are involved in the treatment and research of cleft lip, cleft palate, and other craniofacial abnormalities. The ACPA sets industry standards and optimizes the interdisciplinary care of persons affected by craniofacial abnormalities.

This approval is only given to teams with the highest level of training. The ACPA approval is a well-deserved recognition for Dr. Tonie Kline and the rest of the team. It is also recognition of the leadership and hard work of our recently deceased medical director of the program, Dr. Randy Capone. Congratulations to all!

Remembering Dr. Martin Luther King, Jr.

On Wednesday, we hosted our 4th annual Martin Luther King, Jr. Day celebration, which commemorated Dr. King’s life and vision. This year’s program, titled “Songs of Our Soul – We Shall Overcome,” featured our keynote presenter Richard Maurice Smith, Ph.D., associate professor of Sociology at McDaniel College and Lead Pastor of The Movement Church in Howard County, along with live music from the City Neighbors High School Choir.

I am grateful to Jennifer Marana, Ph.D., our Director of Diversity and Inclusion, and my colleagues on the Diversity and Inclusion Council for their hard work on this event and helping to bring us closer together. I also want to thank Dr. Smith, members of the City Neighbors High School Choir, and our Black History Month committee that put together this year’s magnificent celebration!

I encourage you all to send in your nominations for our GBMC Spirit of King Award. This award recognizes an individual who embodies the spirit and life's work of the late Rev. Dr. Martin Luther King, Jr. and who is dedicated to serving their local community, place of worship, child's school, etc. All nominations must be submitted no later than Thursday, January 31. The winner will be announced at the Black History Month celebration in February. Click here for more.

Friday, January 11, 2019

Missing Medications Revisited

It’s been a while since we discussed “missing” medications in this blog. When a nurse goes to administer an ordered and verified medication to a patient and it is not there on the unit, we have a system that is not 100% reliable (reliability = what should happen, happens and what should not happen, doesn’t). Physicians and advanced practitioners order medications and pharmacists verify the order. The verification step is a protection that the medication is of the correct dose, that the patient is not allergic to it or has contraindications to its use, and that it will fit in with the other medications the patient is taking without untoward drug interactions.

We have made huge progress in reducing “missing” medications since 2013, when we first started studying the causes and testing changes to our delivery system. The pharmacy has a two-hour window from the time a medication is ordered to verify the order and deliver the medication to the unit if it is not already stored there. We saw considerable changes once we began studying one unit at a time and looking at each case of missing doses in real time. It’s difficult to tell what happened when looking back in time at an event. It is much easier to do the 5 Whys as soon as a miss occurs. Remember, the 5 Whys process is asking the “why” question FIVE times before you get to the fixable cause of a defect.

Prior to working on improving our system, busy Medicine units could have 30 or more missing medications per day. This has been reduced to 0-3 per day. The most recent work between our pharmacists and units 34 and 35 has resulted in many days with zero missing medications! This is a great achievement.

There are several Pharmacy leaders who oversee this work: Julia West, Assistant Director of Pharmacy, Julia McDonnell, Pharmacy Operations Manager, and Vaishali Khushalani, Pharmacy Medication Safety Officer. The Pharmacy Lean Daily Management (LDM) lead team also communicates with Pharmacy Director, Yuliya Klopouh, and the observations from LDM are used to make practical improvements in the pharmacy. These leaders are also in close communication with the nurse managers to study the defects and, when necessary, change the standard work.

A recent example of improvement involves the transfer of medications between the Emergency Department and inpatient units. The previous process was to send all the patients’ medications with them on transfer. The Pharmacy team worked with Emergency Department Manager, Mark Fisher, Assistant Nursing Director for the ED, Monica Goetz, and Unit 35 Manager, Temitope Oseromi, to create a better process for expanding the stock of medications on the inpatient units and in the Emergency Department. This allows for fewer medication transfers and improves access to and visibility of patient-specific bins. After this change, medication tracking became significantly easier and there was higher accountability between emergency and inpatient units. Now, there are fewer medications missing during the transfer process.

An added benefit of the daily improvement work is the better relationship and collegiality between pharmacists and nurses!
Congratulations Gilchrist!
Gilchrist Care Choices (GCC) is a national test program which allows qualified Medicare beneficiaries who qualify for hospice to continue receiving curative treatment simultaneously. This is being tested under the belief that many people forego hospice fearing their providers will “give up” on them. The idea of the program is that allowing patients to continue curative treatment will allay their fears and encourage many people to choose hospice care sooner. This has certainly been the case with GCC! The program has grown exponentially — since 2017, with referrals increasing by 100 percent. GCC, the fourth-largest program in the country, is one of the first to focus on continually improving internally-developed quality measures. This major achievement in growth from outpatient providers, was highlighted by the Centers for Medicare and Medicaid Services (CMS) in a recent publication. Congrats to Rene Mayo, MSW, GCC program manager, and her colleagues for this recognition!

Friday, January 4, 2019

What will 2019 bring?

I would like to wish you all a very Happy New Year. I hope your holiday season has been filled with good health and joy.

Our healthcare system continues to improve and grow. We have great people who work very hard and we are getting pretty good at designing systems to move us faster towards our vision. We still have work to do, but almost everything we measure under our four aims improved during 2018.

2019 will bring the next iteration of Maryland’s waiver with the federal government and the State has committed to reducing the total cost of care for Medicare beneficiaries. We will have a new tool to help achieve this…the Maryland Primary Care Program. This is part of the plan to create incentives for providers to coordinate their patients’ care.

As you recall, since 2014, our state has paid hospitals via global budgets to dis-incentivize the provision of services that don’t lead to better health or better care. Maryland has lowered the rate of increase in the total cost of care by doing this. Now to reduce the total cost of care, it will be necessary to bring others to the waste reduction table. This new program will provide resources to primary care physicians to improve health and the care experience. Primary care offices will work with Care Transformation Organizations (CTOs) (Greater Baltimore Health Alliance being one of them), to better coordinate care. The CTOs will provide care managers, behavioral specialists, and others to help the primary care team accomplish this. You will recognize that we’ve been doing this in the GBMC HealthCare System for quite some time. The inclusion of primary care practices allows the focus to be more on population health, including other settings of care in communities, rather than relying only on hospitals.

Under our new total cost of care agreement, the State has also committed to work on six high-priority areas: substance misuse, diabetes, hypertension, obesity, smoking, and asthma. So, 2019 should be a year of change towards better care leading to better health for the citizens of Maryland. Thanks to all my colleagues for working hard on this agenda.

The Passing of an Outstanding Physician
I was saddened to hear that Dr. Randy Capone passed away last week. Dr. Capone was an outstanding plastic surgeon who served as the medical director of our Cleft Lip and Palate Team. He worked tirelessly at his craft and under his leadership, the team changed so many lives for the better. He will truly be missed.