Important Insights for Breast Cancer Awareness

You may have noticed that the world looks a little more “pink” in October. This is because October is national breast cancer awareness month and to recognize the important strides GBMC’s Comprehensive Breast Care Center has made in diagnostics, treatment and overall care for our patients, I’ve asked Dr. Lauren Schnaper, Director of the GBMC Sandra and Malcolm Berman Comprehensive Breast Care Center, to be a guest blogger this week. Dr. Schnaper is nationally recognized for her breast cancer expertise and patient care and has been active in a number of national clinical trials. She was named one of Maryland’s Top 100 Women in 2010 and is passionate about sharing lifesaving information with women. I hope readers of this blog will find Dr. Schnaper’s observations on breast cancer screening and biases as enlightening as I did:

Dr. Lauren Schnaper

Dr. Schnaper writes…

The first mammograms were performed in Europe, as early as 1913.  They were not the high tech digital films we know today and did not catch on for many decades because surgeons treated all breast tumors, no matter the size or the behavior, with radical surgery.  Finding smaller tumors that might be treated with more limited procedures was a concept foreign to physicians. They believed, erroneously, that removal of as much tissue as possible was the only way of keeping breast cancer from “coming back.” That is a tenacious concept, still believed by many people.

By the early 1960s, when surgeons began to question radical mastectomy dogma, mammography was resurrected and the first screening trials began. Screening mammography was not widely performed until the 1980s.

The definition of a screening test for a population or an individual means that they are asymptomatic (no lumps or bumps, skin changes, nipple abnormality, etc).  The screening criteria also may not apply to individuals who are considered to be at high risk (strong family history or genetic mutation carrier, previous breast cancer).  The benefits (reduction in the risk of dying from breast cancer) must be weighed against the financial and non-financial costs (radiation exposure, additional tests and biopsies, anxiety, money per test).

There are two major problems with screening:  Underdiagnosis means that the mammogram failed to find a cancer that will eventually be discovered when it becomes a lump or presents with some other symptom. Overdiagnosis means: (1) that an abnormality is found that is not a cancer but is evaluated with multiple procedures as if it was a cancer or (2) a true cancer is found but one that would never become clinically significant during the indivdual’s life-time and would not influence how they are treated, how they live or die.

In America, we have trouble with the concept of costs vs. benefit.  We believe that if a million women need to be screened to save one life, then so be it.  We picture ourselves or our loved ones as that one life saved.

The non-financial costs of screening are influenced by several biases:

Lead time bias means two women develop a deadly breast cancer on the same day.  They die of that cancer on exactly the same day, five years after diagnosis.  They both have treatment but no treatment that they receive will change the behavior of their cancers or save their lives but they are not aware of that fact.  The first woman’s cancer is picked up on a mammogram in year #1 after the cancer is born.  She and her family believe that mammography has benefited her because she has had four additional years of life following her diagnosis.  The second woman never had a mammogram.  Her cancer is picked up as a lump in year #4.  Her survival appears to be shorter than that of the first woman, even though it is identical to the first woman’s.  To be effective, screening must decrease mortality from the disease, not just give the appearance of doing so.

Length time bias speaks also to the variable behavior of cancer.  More poorly behaved fast growing tumors do not lend themselves to screening as they often occur in between the screening test interval and have already spread before they are detectable.  Slow growing tumors are amenable to screening because they might hang around for a long time before doing any damage.

The concept of “early detection” is a simplistic view of a disease that has numerous and complex behaviors; no two cancers are the same.  In the extreme, a few are deadly from the day they are born but most require treatment and are ultimately curable.

Herein lies the controversy that waxes and wanes in the popular press.  Who should be screened and how often?  The United States Preventive Services Task Force (USPSTF) has reviewed screening mammography studies in 2002 and 2009.  The members took many factors into account.  In 2002, they recommended that the screening interval be changed to one to two years.  In 2009, they changed their recommendation to every two years because they saw the same decrease in the death rate in the annually screened groups as in the longer screening interval groups.  They also found that there was no difference in the chances of detecting an aggressive cancer between the one year and the two year screening interval.

The risk of developing breast cancer increases with age.  The “readability” of mammograms gets better after menopause when breast tissue goes away and is replaced by fat.  The average age of menopause in America is 52. The behavior of breast cancer is also less aggressive in older women.  The USPSTF recommend screening every two years between 50 and 74 and individualized screening for women over 74.

In women who are still menstruating, there is a lot of breast tissue which is referred to as “breast density” on mammogram – as if this is an abnormality or a disease.  It is not. The breast is a round object, compressed by the mammogram plate to be a flat picture.  The overlapping shadows of the tissue are white on the film.  Because all of the abnormalities – good or bad – are also white, they may not be seen if transposed on a white background.  Digital mammography has more contrast and is more sensitive to changes in mammograms of menstruating women or those on exogenous hormone therapy.  Again, the USPSTF recommends individualized screening decisions for women in their forties but at a two year, rather than a one year, interval.

It should be noted that the American College of Radiology, the National Comprehensive Cancer Network, and the American Cancer Society continue to recommend annual screening for all women over 40.  They do not offer an opinion as to at what age mammography screening should stop.

The National Cancer Institute advises screening every one to two years beginning at age 40.  The American College of Physicians, every one to two years age 50-74 with individualized recommendations ages 40-49.  The American College of Ob/Gyn recommends every one to two years from 40-49 and annually thereafter, with no stopping recommendation.

Interestingly, the United Kingdom National Health Service recommends screening every three years from age 47-73.

NO organization recommends a baseline mammogram at age 35.

In order for a screening test to be adopted or changed it must improve on all of the parameters already discussed.  Touted as the new era in breast imaging is Tomosynthesis or 3D Mammography.  It is a digital mammogram, that instead of taking a flat top-to-bottom and side-to-side picture, the machine swings around the breast, taking as many as 60 thin “slices” through the tissue.  This may benefit women with dense breasts on imaging as it does away with overlapping tissue shadows so that white lesions can be separated from the white tissue background.  Another advantage is that there will be fewer call-backs for additional films to evaluate vague areas of density.

Although some say there is less pain during a 3D mammogram, this is not true.  Compression is the same. Other disadvantages:  Although 3D mammography has FDA approval, there may be additional out-of-pocket expense to the patient because there is no insurance reimbursement at this time.  There is increased radiation exposure, approximately that of the old analog films, because both 2D and 3D mammograms are performed at the screening visit.  The 2D films will probably not be needed after the technology for creating a 2D picture out of the 3D slices is improved.  Radiologists have to be trained in new reading techniques and interpreting the films takes about twice as long as for the 2D films alone.  In terms of increasing ability to detect cancer or decreasing mortality from breast cancer, studies are underway.

**********

I thank Dr. Schnaper for her insights and continued work on behalf of all the patients who turn to GBMC for superior breast care.

For anyone who isn’t familiar with GBMC’s program, the Comprehensive Breast Care Program and its affiliated Advanced Radiology Breast Imaging Center have received national accreditation as Centers of Excellence, which speaks to the integrated and superior care our patients receive. From the Breast Cancer Risk Assessment Program to GBMC’s Rapid Diagnostics Program, our patients truly benefit from the expertise of our physicians and care providers and the advanced technology available for diagnosis and treatment of breast cancer. But, most importantly, our team of specialists takes to heart GBMC’s vision of treating every patient, every time, the way they would want their own loved ones to be treated.

Finally, GBMC is currently offering 3D Tomosynthesis Mammography at the Breast Care Center. You can call 443-279-9639  for more information or to make an appointment or visit the Comprehensive Breast Care Center page on GBMC’s website to learn more.

The GBMC System is Prepared for Maryland’s New Medicare waiver

We in Maryland are fortunate to live in a state that is willing to experiment with novel healthcare payment systems. Maryland is the only state where the standard federal Medicare hospital payment program doesn't apply, and this is because, since the mid-1970s, Maryland has had a waiver from Medicare rules that brings more than $1 billion extra Medicare dollars to the state annually. This waiver is for a demonstration project with the Federal government to test the idea that an all-payer rate setting commission in Maryland, working with hospitals, could keep the rate of increase of Medicare inpatient payments below the average rate of increase in Medicare inpatient payments in the other 49 states.

Maryland is, in fact, the only state where hospitals don’t negotiate rates with individual insurance companies. The Maryland Health Services Cost Review Commission (HSCRC) sets hospital rates. So, whether a patient is on Medicare or Medicaid, or has Blue Cross or some other private insurance, or is uninsured and comes to GBMC for care, our hospital is paid the same amount.  The HSCRC pays different rates to different hospitals.  Since the 1970’s, the federal government has been calculating the increase in Medicare inpatient costs in Maryland and comparing that to the average increase in inpatient Medicare costs in the other states and Maryland has kept its rate of increase lower. But recently, we have gotten dangerously close to exceeding the national rate of increase and have put ourselves at risk of “failing the waiver test.”

However, the 40-year-old “waiver” test is out of date.

In order for Maryland to not fail the test, in recent years the HSCRC has been increasing hospital rates in the outpatient area and holding inpatient rates fairly constant. The net effect of this, however, is to increase overall costs to Medicare. The Centers for Medicare and Medicaid (CMS) are not happy that overall Medicare costs are getting significantly higher in Maryland. This, coupled with the fact that everyone knows that our national healthcare costs are unsustainable, has made CMS believe that the current waiver test is no longer a good idea. CMS welcomed an application from Maryland for a new demonstration. So, Maryland began negotiating with the Federal government for a new waiver where Maryland would continue to have an all payer system hospital rate setting, but now, the test would be more designed to reduce all-payer hospital spending, both inpatient and outpatient and reduce Medicare costs. The Affordable Care Act created the Centers for Medicare and Medicaid Innovation (CMMI) and this agency within CMS has been negotiating with Maryland to get a new waiver that would drive towards the triple aim of better health, better care and lower cost.

The overall objectives for the new waiver are:

• To CHANGE the way we pay for and provide health care
• To BUILD on the system we have that allows hospitals in Maryland to be paid for the care of the uninsured and make it even better (e.g. more affordable, safer and to create a healthier Maryland)
• To provide the opportunity for Maryland to be a NATIONAL LEADER in health care

So, with the support of the Maryland Hospital Association (MHA), a new application is being submitted to the Federal government through the partnership of Maryland hospitals, the State and insurance companies for a new, five-year demonstration project.  The MHA has more information on this “waiver” on its website, for anyone who wants to read more about this. 

This new test will look at how we can:

1. Work together to slow growth in spending for hospital care
2. Continue Maryland’s unique way of setting hospital prices
3. Change how hospitals are paid to reward the right things (such as reducing waste and services that don’t get hospitals to a goal of better health for patients)

With this new waiver test, growth in all-payer Maryland spending per capita cannot exceed Maryland’s rate of increase in Gross Domestic Product which is projected to be 3.58% over the next 10 years. In addition, Maryland must generate Medicare savings of $330 million over five years.

Is GBMC ready for this new waiver?

For GBMC, we've been working for three years to get ready for this new payment system. We've already started transforming our company away from hospital-centric fee-for-service to patient-centric fee-for-health.

The way I see it, the only people who can truly lead the charge in this change are physicians. This is why, over the past few years, we have been working toward building a legitimate physician leadership hierarchy within our hospital, as well as establishing the Greater Baltimore Health Alliance (GBHA), our accountable care organization that is already participating in the Medicare Shared Savings program and which is made up of both employed and private practicing doctors. Following the idea that physicians must lead the change, GBHA’s Board of Directors is comprised of 75% doctors - the physicians have to, and are, redesigning the way care is delivered.

This new waiver will ultimately change how hospitals are paid to reward value over volumes. A simple way to look at this is rather than wait for the patient to get really sick and then pay the hospital to fix the problem, the new system will pay to keep the well healthy and to better manage chronic disease.

Opportunities and Benefits

The new waiver will incentivize all to do what we have begun to do over the last three years.  It will give our state, our hospitals and our communities a number of opportunities, from the ability to continue our unique hospital rate-setting system and provide more equitable care for low income and uninsured people to putting a statewide focus on quality and safety and hopefully slow the growth in insurance premiums. The drive toward less waste and lower cost will lessen the burden on employers who want to continue to provide insurance for their workers and lessen the Medicaid strain on the State budget.

This will be a challenging but very exciting next chapter in healthcare in Maryland! And, GBMC is proud to be out in front as we continue to achieve our four aims, and move closer to our vision.

The Health Insurance Exchanges of the Affordable Care Act Open Today

The lead up to the government shutdown and today’s opening of the health insurance exchanges have once again brought about a lot of talk about the Affordable Care Act (e.g. Obamacare).  Many Americans are confused about what the Act has brought and what it will bring.

It is a fact that the United States is the only developed country in the world where all citizens do not have health insurance. And, it is clear that some Americans are afraid of the Affordable Care Act in part because of the positions taken by many elected officials.

What people should understand is that several parts of the Affordable Care Act have already gone into effect:

1. The children of workers who have employer sponsored health insurance can now stay on their parent’s plan until age 26. 
2. As of January 1, 2014, insurance companies will no longer be able to deny an individual coverage because of preexisting health conditions. Until now, if you were born with or acquired a disease that would cause you to use your insurance to pay for care, the insurance company could refuse to insure you as an individual. If you were part of an employer sponsored plan or had Medicare or Medicaid, this did not apply to you and you were covered. What many people don’t understand about this part of the Act is, for insurance companies to be able to cover the cost of sick people with preexisting health conditions, there must also be healthy people in the mix. This is called community rating. As a result, the Affordable Care Act requires that everyone have health insurance – either through the government, a private employer or through purchasing individual coverage through the new healthcare exchange. This is called the individual mandate. 

Which brings us to today, October 1, the date the health care exchanges open for everyone who does not have health insurance to purchase individual coverage that will take effect on January 1, 2014. 

Mitt Romney created the idea of these healthcare exchanges when he was Governor of Massachusetts. Governor Romney thought that it was wrong that so many working people did not have health insurance and he also knew that Massachusetts hospitals had huge amounts of bad debt from individuals who got sick and couldn't pay their bills. The State of Massachusetts wound up covering this debt. Governor Romney was also concerned with the cost of health insurance for business owners who were already covering their employees and he wanted to create a true market where insurers would compete for customers and drive costs down. He also recognized that once you start requiring individuals or small employers to buy insurance, you must help them by creating a true market. President Obama’s people later recognized that the notion of health insurance exchanges was a good idea, which is why it is part of the Affordable Care Act. And again, individuals with preexisting conditions will not be excluded (which is great).

One of the big misconceptions of this law is that it contains “government run” healthcare. There is NO provision in the law for the government to provide care. 

Our government already purchases care for everyone over age 65, which is called Medicare. It purchases healthcare for many of the poor and disabled along with the States through Medicaid. Our government purchases care for federal employees. It is true that our federal government already provides care directly to our veterans through the Veteran’s Administration (VA). In fact, the VA, the military medical systems, and the National Institutes of Health are the only organizations where government employees provide care. There is NO new government run healthcare within the Affordable Care Act.

Additionally, one of the major portions of this act that has already taken effect is the Medicare Shared Savings Program. The GBMC Healthcare System is participating in this program through the Greater Baltimore Health Alliance (GBHA) which we created in 2011. The Board of GBHA is over 75% physicians with Dr. Anthony Riley, head of geriatric medicine at GBMC, as the Chairman of this board.

The incentive here is for doctors to work towards the triple aim for those with Medicare:

1. Better health and health outcomes for the Medicare beneficiaries
2. A better care experience for Medicare beneficiaries
3. Lower costs for beneficiaries and the Federal government

Early first year results for GBHA’s participation in the Medicare Shared Savings Program shows that we have saved about 7% per beneficiary. If we improve our quality parameters and save money, some of the savings are then shared back with the doctors participating in GBHA and GBMC.

This is another part of the law that I think is good for Americans. It’s driving value in healthcare. Notice that there is no money given back to the providers unless the quality and patient satisfaction goals are achieved and money is saved. Most people believe this is good because if we don’t drive Medicare costs down, we could bankrupt the country.

Every American has the right to dissent – it’s one of the wonderful things about our country. But every American also has the duty to review the facts before they make up their minds.

So, regardless of what happens (although it does not appear there will be changes to the Affordable Care Act) GBMC will not deviate from its vision – to treat every patient, every time the way we would want our own loved ones to be treated. And we will continue to measure our progress towards our four (or quadruple) aims: better health, better care, with the least waste, and the most joy for those providing the care.

****

Babies small and grown who were born at GBMC and parents of GBMC babies 

Finally, this past Saturday, GBMC’s Foundation held its 13th annual Legacy Chase at Shawan Downs. It was a fine fall day in the sun celebrating our vision and commitment to families and the community. Through the 2013 Legacy Chase event we have raised more than $1 million in commitments toward the Endowed Chair in Pediatrics. Close to 8,000 people came out to support this great event which also included several special reunions. This year marked the second year of our annual NICU reunion to celebrate the milestones of our smallest patients and GBMC’s volunteer auxiliary also celebrated its 50th anniversary! And, we had a wonderful group photo taken of babies born at GBMC (above) where several generations made this reunion truly special.

I thank all those who attended and all those who donated time or treasure. Kudos to the GBMC Foundation for another successful, fun-filled event. There’s still time to support the cause by visiting http://foundationevents.gbmc.org/.

Perfecting the Hand-Off – to Better Coordinate Care

Our vision is to treat everyone as we want our own loved ones treated. Most of us have had loved ones with some chronic disease where our loved one was caught between providers of care and we had to try to bridge the gap. I often get calls from family members asking me to help resolve differences of opinion between providers. I have told the story of a woman who was admitted to the medical intensive care unit at GBMC with diabetic ketoacidosis because her insulin plan was wrong. Our physicians and nurses got her back on her feet and discharged her to the care of her doctor. Unfortunately, her doctor put her back on her previous plan and she ended up back in the Emergency Department. It seems that her doctor did not get the message about her new plan at the time of her discharge. A clear lack of coordination.

How do we fix this? 

Well, the improvement has to start with someone being willing to coordinate the care. This is why the GBMC HealthCare system has embraced the concept of the patient-centered medical home (PCMH) because the physician-led team knows that it is accountable to provide the coordination 24 hours a day, 365 days of the year, and actually has the capability to do that! Also, the other members of the healthcare system must work with the primary care teams at the time of handoff, like when a hospitalist is discharging a patient from GBMC back to the primary care physician.

The Head of the GBMC hospitalist group, Rekha Motagi, MD, and her team have been working tirelessly to improve the handoff back to the primary care doctor. You can imagine that communicating to literally hundreds of different doctors and offices can be quite a challenge. Rekha and her colleagues have been redesigning their communication process and measuring its performance as a measure on their Lean Daily Management board. Every day on our management rounds, Rekha or one of her hospitalist colleagues and members of our two internal medicine resident teams, report on the percentage of the previous day’s discharges where they have had a high quality communication with the primary care physician or his or her office staff. As a result of their work, they rarely miss a handoff with a GBMA PCMH practice and we are seeing improvement with our non-GBMA practice colleagues as well.

I’ve asked Dr. Motagi to explain the obstacles that have been identified and the improvements that have been made in the transition of care since the team started testing changes:

Rekha Motagi, MD

Dr. Motagi explains: 

The hospitalist group has always made it a priority to communicate with a patient's primary care physician to provide verbal hand-off when patients are discharged from the hospital. This is a very important aspect of the transition of care. Reviewing a patient’s hospital course, medication changes, test results and pending tests during this hand-off is also an important patient safety measure.

Previously, we were not sure how consistently this hand-off communication was occurring in our large group and the reasons we were not always successful. But since we started the lean daily management process, where one of our metrics is for each physician to note if they have been able to reach the PCP for discharge hand-off, we have identified several areas for improvement.  

About 90% of the time, our doctors have made an attempt to reach the patient’s PCP; but we've only connected with them from 50-70% of the time due to various reasons including:

• Offices were closed or the front office did not want to interrupt the PCP. In these instances, we left a message but were not sure if the PCP received it (This becomes much more challenging on weekends/holidays.)
• We have been put on hold for 10 minutes or more; in many instances, our doctors have had to hang up because they needed to respond to other calls
• The PCP was on vacation, so there was no way to ensure they received the message
• There is no attempt made to call when there is no PCP or if the patient is going to be transferred to a facility and no provider in the facility has been identified

Since we started Lean Daily Management, the physicians relations office (Mary Ely, Ann Veltre and Bonnie Longerbeam) has been working to reach out to several physician groups to obtain their feedback on the best ways to accomplish a successful transition of care. What we've found is that there are some PCPs who are very involved in their patient's hospital stay. Some are interested in receiving the call from the hospitalist, but only call back if they have questions. From this outreach, we've been able to make improvements and design a more effective system for coordinating the transition of care, including:

• Obtaining back-office telephone numbers for PCPs (and in some cases cell phone numbers) which provides us with faster access to some of the PCPs
• Updating incorrect physician office numbers in our database 
• Identifying physician offices that have care co-coordinators (RNs) who will take the patient’s information, relay it to the PCP and contact patients to arrange follow-up

We are now working with all primary care providers to further standardize this process. Our group is also committed to making sure the written communication (discharge summary) is completed within 48 hours of a patient being discharged. Currently, we are over 95% compliant with this effort and we are working to get this rate to 100% so that the information is there for the PCP to use in follow-up.

***

I want to thank Dr. Motagi, our hospitalists, our internal medicine residents, the physician relations group and our PCPs for their commitment to creating a more reliable system for patient hand off. Continuous improvement requires a focus on who it is that we are serving, system design, measurement, teamwork, and empowerment. Lean daily management appears to be helping us speed up the implementation of all of the above!

Honoring, Remembering One of GBMC’s Founders, Mrs. Jeanne H. Baetjer

Last week, GBMC lost an inspiring and visionary leader. Mrs. Jeanne H. Baetjer, one of GBMC’s founders, passed away at the age of 91 years. What a legacy she left behind. Mrs. Baetjer was a true leader in every sense of the word. Her strong sense of community was quite evident in her life’s work, which included her vision for the development of a community hospital in Towson.

In 1958, while serving as President of the Hospital of the Women of Maryland, of Baltimore City, Mrs. Baetjer and other community leaders saw the need for a hospital in this area and set out to work on making this vision a reality. This was no small feat as the creation of GBMC entailed combining The Hospital for the Women of Maryland, of Baltimore City (Women’s Hospital) with the Presbyterian Eye, Ear, and Throat Charity Hospital. But, her tenacity and dedication to filling a greater community need paved the way for the establishment of our hospital, and from 1962 to 1965, while building was underway, Mrs. Baetjer oversaw the massive project. Her commitment to GBMC spanned five decades and she served in various roles in our history including the very first President of the Board of Trustees.

Since GBMC first opened its doors to the community in 1965, we have cared for countless individuals and we are forever grateful for Mrs. Baetjer’s vision and dedication. Her impact on GBMC and the community is immeasurable and far reaching. To this day, GBMC embraces her guiding principle that the patient always comes first– through our current Vision of “to every patient, every time, we will provide the care that we would want for our own loved ones.”

Please join me in honoring her life and legacy by sharing your memories and thoughts about Mrs. Baetjer with our blog community.

What can we do to make GBMC safer for our people?

Our fourth or “quadruple” aim is more joy for those providing the care. All of us in our healthcare system should derive joy from serving those in need. But how can work be joyful if it is not safe? Safety on the job is surely relative. There are many jobs that have higher risk of injury than working in healthcare. Nonetheless, it is unethical to not be working toward zero injuries among our people.

The run chart below shows the monthly number of injuries reported to employee health. 

In fiscal year 2013, which ended on June 30th, we had 327 injuries. That number is an improvement of 12% from fiscal 2012’s 370 injuries. We have set a goal of no more than 294 injuries in fiscal 14, a further 10% reduction. Our Senior Executive Team receives a daily report of the number of employee injuries in the preceding 24 hours and measures this on our Lean Daily Management board. We are driving toward a goal of zero injuries.

The injuries can be grouped into a number of large categories. The most dangerous of the injury groups is the needle stick/body fluid splash category. Being injected with hepatitis C or HIV contaminated blood can lead to a lifetime of therapy and/or long term morbidity. These injuries can be prevented by using the appropriate safety devices like needle-less systems, needles with protective sheaths and protective eyewear. A respiratory therapist was recently exposed when the therapist did not use protective eyewear when inducing cough in a patient.

System design is also important. Standard work in the passing of sharps in the operating room is critical to reducing needle stick injuries. Recently, a resident physician stuck himself with a contaminated needle because he used his fingers rather than pickups to reposition a needle on a needle driver.

Another category of injury among workers at GBMC is sprains and strains, usually from lifting. With the national epidemic of obesity, it is very important that we use the appropriate lifting devices to avoid musculoskeletal injuries. Slips and falls is a category of injury that usually occurs from spills that go unnoticed or from workplace clutter. An employee recently fell after tripping on an exposed electrical wire. Our IT Team has recently been doing environmental rounds to make sure that computer and printer electrical cords are not creating tripping hazards on our units.

Our last major category of injuries is those due to workplace violence. We have made some progress in this area by implementing training for employees in high risk areas like the Emergency Department and also by stationing a security guard on Unit 36. There are other injuries that don’t fit into common categories like the employee who was recently harmed when a swinging door came off its hinge.

So what can we do to drive towards zero workplace injuries? First, we can make sure that we are following safe practices and using protective devices when appropriate. Secondly, we can report all injuries and participate in the learning from injuries to make our systems even safer. Thanks very much for sharing your ideas on how we can reduce employee injuries in the GBMC HealthCare system.

A Day of Remembrance

Finally, tomorrow is a somber day for our nation as we remember those we lost on September 11, 2001. It’s hard to believe it has been 12 years since that tragic day in our country’s history. We should all take some time out of our daily lives to reflect on the sacrifices made by our first responders and every day citizens. Instead of focusing on the inhumanity and the horror of the day, let us focus on the many stories of hope and humanity that we witnessed as people came together to help others in any way possible. It’s the examples of humanity that keep us strong and we hope that by remembering incidences of the past, we can grow and change to create a better future. My thoughts are with everyone touched by this tragedy as we remember and hope for a more peaceful tomorrow.

A Reflection on the Meaning of Labor Day

As our country celebrated the hard work of the American people during the Labor Day holiday on Monday, many of us enjoyed the three-day weekend which has also come to symbolize the unofficial end of summer. But, Labor Day is also an opportunity for us to reflect on what we have accomplished and will continue to achieve, and to thank the people that make our health system and our country strong because they go to work every day and put their best efforts toward serving a need. At GBMC, we are fortunate to be able to meet the important need of helping others by delivering to everyone the care that we want for our own loved ones.

And as I reflected on the true meaning of the Labor Day holiday, I realized how thankful I was for the efforts of the entire GBMC staff - from the doctors, nurses, and technicians to our food services workers, environmental service staff and parking attendants.  Every individual at GBMC is an important part of the collective team and I see the great efforts our team puts forth to provide the very best care to patients every day.

I also reflected on what it means to have a job, especially with the way our economy has been over the past six years or so. Now that I have four children who have graduated from college, I see how hard it is to find a good job that you love. I am grateful for my job, which I competed for and was delighted to get. GBMC is a great organization with a great vision and a great future. I know what it means to love what you do and I am honored to work with such dedicated individuals.

I have been talking a lot about standard work, processes and systems, but as we celebrate Labor Day and look ahead I need to remind myself that what makes a healthcare system truly outstanding is not the technology or the facilities, but the people.