Another Wonderful Celebration in the Sun

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

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

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

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

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

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

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

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

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

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

How did you like it?

Did you use it?

Did you dislike it? If so, why? And…

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

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

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

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

Ashley Dickenson, RN, shows the MyChart Bedside app on an iPad on U25/26.

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

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

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

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

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

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

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

***

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

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

**

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lights! Camera!....

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

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

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



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

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

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

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

The Summer is Ending

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Baltimore City Fire Department Gives To GBMC

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

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

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

Are we following the standard work…the design?

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

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

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

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

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

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

Please share your thoughts with me.