Level 2 Mistake Proofing

On Lean Daily Management rounds this week we learned of a test of change to improve the rate of washing in and washing out of every Emergency Department room. We have been working on hand hygiene in the inpatient units for some time. We have greater than 90% compliance and we have now begun auditing our performance in the ED.

All the physicians, nurses, and other clinicians know that they should clean their hands upon entry and exit, but sometimes they forget. This has come up as a common cause of the lack of hand cleansing, so Mark Fisher, RN, the Nurse Manager, Shannon Barry, RN, and Amanda Icenroad, RN, Clinical Nurse 4’s, started thinking about how they might improve their team’s performance.

A common action for health care leaders when they see that someone is not doing what they need to do is to re-educate the individual on the process. Re-education is called level 1 mistake proofing. Re-education is a good tool if the person doesn’t know that they are supposed to do something. But if the problem is forgetfulness, then re-education is not of much value.

Mark and Shannon thought long and hard about level 3 mistake proofing. Level 3 mistake proofing occurs when the system makes it impossible not to do the required action. An example of level 3 mistake proofing is when you order something online and the seller needs your 3-digit security code from your credit card. You hit “enter” after putting in your credit card number but not your security code and what happens? You get a screen telling you that you must put in your security code. It is impossible to get to the next step without it. This is also called a constraint or a forcing function. In high-risk endeavors where errors my cause serious harm, engineers always look for level 3 mistake proofing. For example, after some fatalities that occurred when people inadvertently put their car in drive when they meant to put it in reverse, vehicles are now engineered so that you cannot start your car without your foot on the brake.

Mark, Shannon, and Amanda could not come up with a doable level 3 idea that would prevent you from entering or leaving a room without cleaning your hands, so they went to the next best thing — level 2 mistake proofing. Level 2 is not as powerful as level 3, but it is more powerful than level 1. Level 2 mistake proofing provides a reminder in the moment. These reminders are also called affordances. Mark, Shannon, and Amanda decided to create a very colorful sign of dirty hands to put on each ED bay door.

This way when busy, hard-working people are about to enter a room, they have a visual reminder to clean their hands. We applauded them for their thoughtful test of change and we look forward to their results!

Do you have examples of level 2 or level 3 mistake proofing from your unit or department? Please share them below.


Breast Center Earns Three-Year Full Re-Accreditation

Congratulations to the staff of The Sandra and Malcolm Berman Comprehensive Breast Care Center and the Advanced Radiology Breast Imaging Center, which recently were awarded a full three-year re-accreditation by the National Accreditation Program for Breast Centers (NAPBC). This is the center’s fourth consecutive NAPBC designation since it was first accredited in 2009.

The full accreditation program, administered by the American College of Surgeons, is only awarded to centers that voluntarily undergo a rigorous process that includes site visits by experts from the NAPBC, as well as an intensive review of the center’s records. Earning this accreditation means that our Breast Center is held to the highest standards for the quality of care we provide for patients with the full spectrum of breast disease and that we offer patients a multidisciplinary team approach to diagnosis and treatment and state-of-the-art treatment options.

Any hospital or program can say it provides excellent care, but with this accreditation, we have earned this designation for excellence under the scrutiny of experts, which speaks volumes about the high quality of care all members of the Breast Center and Breast Imaging Center teams provide for our patients with breast disease. And that’s great news for GBMC and for the community we serve.

Dr. JoAnn Z. Ioannou Delivers Hopkins School of Nursing Graduation Keynote Speech

It’s not every day that a world renowned top academic nursing program invites someone from a community hospital to speak at graduation, but the Johns Hopkins School of Nursing clearly shares our admiration and respect for JoAnn Z. Ioannou, DNP, MBA, RN, NEA-BC, our Senior Vice President of Patient Care and Chief Nursing Officer. Dr. Ioannou was the keynote speaker at the August 6 degree completion ceremony for students who had earned advanced degrees in nursing.

A graduate of Hopkins’ Doctor of Nursing Practice program, as well as the university’s MBA and MSN programs, Dr. Ioannou worked in a wide range of nursing roles at Hopkins for 23 years before she joined us at GBMC three years ago. In her speech, she shared the story of her journey from the bedside to nursing leadership, how her mother inspired her ongoing commitment to education, and the many challenging and rewarding paths that the graduates could choose to follow—direct care provider, nurse educator, nurse researcher, and nurse leader. In her closing remarks, she encouraged the graduates to “…continue to collaborate to improve the field of nursing any way you can” and reminded them “…doors will open when you persevere…You will be solving problems that don’t even exist yet.”

You can watch the whole speech here.

The Daily Record Recognizes GBMC

GBMC was recently recognized by The Daily Record in its 2018 Reader Rankings in the categories of Best Hospital and Best Health System. Readers of the publication cast more than 12,000 votes in 60 categories. We’re grateful that the community members we serve are pleased with the care and compassion that our staff shows to all our patients and their families.

“Well, Usually” Revisited

I have been reflecting recently on how far we have come in the quest to achieve our vision of providing the care we would want for our loved ones to every patient, every time. This goal is lofty, and I must keep reminding myself of this. With the aging of the population, people’s needs are growing, and we do not control the entire system of care – we struggle to meet the needs of those with serious behavioral health problems. We have designed so many improved processes like Gilchrist’s entire elder care system, our patient-centered medical homes, our ERAS (Early Recovery After Surgery) program, and so many more.

But we still have work to do. Recently, I was with a clinician and I asked her the “how do we do it” question when I wanted to learn more about one of our processes that did not seem to be highly reliable. My colleague started her response with “Well, usually we …” I knew immediately that we did not have standard work and that many hard-working people were doing it whichever way felt right to them. In a tightly coupled, complex system, a small deviation in one area can cause huge problems downstream. Many of us, including myself, were not trained in the importance of following system design so that we get predictable results. Instead, we learned to do whatever felt right to us in the moment. Standard procedures don’t always work for every patient, but when possible, processes must be standardized and followed. This is critical to creating consistent results for our patients.

Do you know the song This is how we do it, by Montell Jordan? (No, I’m not talking about partying). We need more of us able to state, “this is how we do it” when asked how we complete a task. Then we will move faster towards our vision!

New Parking Rules in Effect on Monday, August 13th
Starting this Monday, August 13th, the decentralized parking model will take effect and all new gates at the garages will be activated. All GBMC employees have been assigned a home lot or garage and will be able to “tap and go” their badges to enter and exit our medical campus. Your GBMC ID badge will be automatically programmed to function at your assigned parking lot or garage’s reader, and stickers will still be issued to monitor compliance at free parking areas such as the Bluebell and the Labor and Delivery parking lots, which will remain patient-only parking.

I want to remind all staff to tap their badge on the card reader at their assigned garage prior to Monday. If the card reader light does not turn green after you tap your badge, please contact Robert Cole at rcole@gbmc.org and Karalyn Stitcher at kstitcher@gbmc.org from the badging office. If your badge is not active prior to August 13, you will need to use a ticket and contact the badging and parking office. The following parking assignments will be in effect:
• All offsite staff, volunteers, physicians, and board members may park in any garage or parking area, EXCLUDING “patient only” spaces.
• All employees may park in Tulip (PPN) or Lily (ED Garage) at any time, any day of the week, EXCLUDING “patient only” spaces.
• All employees may park on Farmhouse Hill at any time, any day of the week.
• All employees working in PPE may park in PPE, EXCLUDING “patient only” spaces.
• All employees working in PPW may park in PPW, EXCLUDING “patient only” spaces.
• Only employees working in South Chapman may park in South Chapman (between the hours of 6 am to 5 pm).
• After 4 pm, all employees may park in all garages.
• On Saturdays, PPE and PPW will be open to all staff.
• On Sundays, all gates are up on all garages.
• Complimentary passes will continue to be accepted.

Again, employees should never park in Rose park or Bluebell park or park in "patient only” spaces. Any employees found parking in these lots will be towed.

These changes are needed to make the entrance to our campus safer for vehicular traffic and to reduce delays when entering and exiting from our grounds. They will also improve parking accessibility for our patients. I want to thank Stacey McGreevy, our Vice President of Support Services, and her team for working very hard to make the transition as easy as possible for our people.

Ch-ch-ch-ch-Changes…

Last week, I talked about our summer Town Hall meetings, what their purpose is, and why it’s important for our workforce to be informed about what’s happening in our healthcare system. This week, I want to outline some of facility improvements here at our hospital as well as some other changes happening outside of our medical campus.

Over the last several months, the top two floors of the William E. Kahlert Physicians Pavilion North have been under major construction as we prepare to make it the home for a large physician practice and an ambulatory surgery center for Chesapeake Urology. The surgery center on the sixth floor will be up and running in a few months, and the practice will have a brand-new office suite on the fifth floor. The practice currently has three doctors on our campus and this expansion will allow them to increase to 10 to 15! This is a great step forward for our medical campus.

The new NICU officially opened in June and if you haven’t stopped by to look, I highly recommend that you do so! I am extremely proud of the NICU team, who worked incredibly hard, was very patient with leadership, and collaborated with the architects to design the space. The new NICU provides individual, private spaces for babies and their families. Each of our new 13 rooms will allow for an individualized environment in terms of lighting, temperature, and sound. For more information, check out one of my recent blog posts. It took us a while to finish this project, but I believe the final result was worth the wait.

Speaking of new, we have a modern and beautiful Orthopaedics office, located on the seventh floor of our Physician Pavilion West. It’s modeled after our Family Care Associates Practice in Pavilion North and it allows us to take walk-in patients, during weekdays and evenings, for injuries. So, let’s say one evening you twisted your ankle and you don’t want to go to the emergency department (ED), now you can go straight to the Orthopaedics office (this practice does not offer the same services as an emergency department).

Recently, we also signed a contract to partially own a one-room ambulatory surgery center (ASC) in Cockeysville. We’ve been fighting the impetus to create a free-standing ACS because we want to do the right thing by the community — Baltimore has plenty of operating rooms, with one on almost every street corner.

We are becoming part-owners in the surgery center because we do not receive additional revenue when we do more surgery at the hospital and because the patients don’t want to pay higher hospital rates when they can get the surgery for less in an ASC.

Our OR Simulation Lab is a recent addition that is greatly beneficial to our surgeons and patients. The lab is a comprehensive training center, which consists of a lab focused on task-based training and replica hospital rooms created to imitate real-life settings. Participants can train for almost any medical situation from inserting an IV, to performing complex surgery, to practicing difficult conversations with patients. The Simulation Center is a critical part of GBMC Healthcare System’s continuing education program which helps the staff grow their skills and adapt to evolving medical techniques and technology.

I’ve been promising a gym on the campus for several years and this week we held an open house for our new Fitness & Wellness Center. Some of you remember that we had a gym on our campus many years ago, which was converted to a surge center. Now it’s been converted back into a gym. Starting August 6, this facility, located by the South Chapman building, will be open 24/7 and is for employees ONLY at a cost of $9.00 per pay period. In the past, many employees said that they would like a place to exercise before or after work. We heard you and I want to thank Anna-Maria Palmer, Vice-President of Human Resources, and Stacey McGreevey, Vice-President of Support Services at GBMC HealthCare, for making this happen.

We are officially opening our Kosher Hospitality Room this September. The pantry, located by the main entrance of the hospital, was built to meet the dietary needs of Observant Jews who follow a Kosher diet and who have come to the hospital to visit a loved one. It’s evident that GBMC serves many Orthodox and kosher-observant Jews and the main goal of the on-premises kosher food pantry is to help ease the hunger and lift the spirits of concerned family members whose relatives are suffering from illness or injury.

Lastly, we’re thrilled about the grand opening of the new Kroh Endoscopy Center, slated for next year. The Center will be located where Sherwood Surgical Center was previously situated. It’s still under construction. There will be more to come on this as we get closer to the grand opening in January 2019.

It’s safe to say that it’s been a busy year.  I hope you are as excited as I am about the changes taking place with our healthcare system.  Let me know what you think.


Play Ball!!!!

Despite the inclement weather, we held our third annual GBMC Night at The Yard Event. I hope all of those who attended the event had a lot of fun! Having the Orioles win that night, with Tim Beckham (our special guest for our Birdland Social Media Night) hitting a home-run added more joy to an already festive event.

Highlighting Our System of Care at Town Hall Meetings

Since late June, we’ve been doing Town Hall meetings. These meetings are an attempt, as I mentioned in this blog a few weeks ago, to narrow the gap between what the frontline staff knows and what the front office knows. The meetings are meant to be two-way communications, a sharing up and down of information.

As part of my presentation, I discuss that we have built a community-based system of care that the patient experiences as a system. It is not perfect, but we should be proud of what we have accomplished. A core building block of our system is the patient-centered medical home. The medical home delivers advanced primary care. Advanced primary care is different than typical primary care. In both models, there are excellent physicians and advanced practitioners and other office staff who care about you and work hard. But advanced primary care is designed to be accountable with you for your health. In advanced primary care, the team, led by a physician, commits to overseeing your health over time. It’s not about a visit, it’s about a relationship. The team includes a nurse care manager, who helps the team stay focused and manage those with chronic disease. The team reaches out to patients to make sure they have a plan and are following the plan. The team connects the patient to specialists when needed. In advanced primary care, there are extended hours of operation, disease-state registries, and many processes designed to check back with the patient (like a phone call after every visit to an emergency room or after an inpatient hospital stay). In advanced primary care, there are also addiction specialists, master’s-prepared behavioralists, and psychiatrists as part of the team. None of this is available in typical primary care. Once again, the physicians and the rest of the office staff in typical primary care are wonderful and work hard, but they don’t have the resources and they are not designed to operate like advanced primary care. In typical primary care, you are more likely to be on your own if you are sick and the office can’t accommodate you. This is when you are left with the choice of going to an Emergency Department for a non-emergency or to an urgent care center, where people will not know you and you will not know them and it is unlikely that they will have your medical record. In advanced primary care, there is a commitment to see you when you are sick. We should all be very proud of advanced primary care!

The State of Maryland is embarking on a new plan to help more primary care physicians get closer to advanced primary care. The program, called the Maryland Primary Care Program https://health.maryland.gov/mdpcp/Pages/home.aspx, will allow primary care practices to enroll and get help from care managers and others, to do what we have been doing in our system. The support for physicians who don’t have the resources to do it themselves will come from new entities called Care Transformation Organizations (CTO). GBMC, through our Greater Baltimore Health Alliance, is applying to become a CTO. Stay tuned!

Congratulations to our Diabetes and Nutrition Center!
Hats off to our Geckle Diabetes & Nutrition Center for being recognized by the American Diabetes Association (ADA) for meeting the national standards for diabetes self-management education. This program has been in existence for over 25 years and has provided patients with education about the disease and how to properly manage symptoms to improve their physical and emotional health.

The ADA Recognition is a four-year certificate awarded to programs that offer high-quality diabetes education services. All approved diabetes education programs cover information relating to the disease, including: nutritional management, physical activity, medication management, and the monitoring, preventing, detecting, and treating acute and chronic complications.

According to the ADA, patient self-care is an essential component of diabetes treatment. Through the support of the healthcare team and increased knowledge and awareness of diabetes, the patient can assume a major part of the responsibility for his or her diabetes management. Unnecessary hospital admissions and some of the acute and chronic complications of diabetes may be prevented through self-management education.

The Geckle Diabetes Self-Management Education Program is available for anyone with diabetes who wants to learn how to manage their new diabetes diagnosis or better manage their current diabetes status.

Congratulations again for this achievement!

Getting the Word Out about the GBMC HealthCare System: It’s Not Your Father’s Marketing Plan

Over the last few years, our marketing department has done an excellent job promoting the GBMC HealthCare System on social media channels like Twitter, Instagram, LinkedIn, and Facebook (more on this below). You may not think about a hospital having a significant social media presence, but GBMC HealthCare is trying to change that for our patients, employees, volunteers, and other members of the community.

Facebook Live is the largest live streaming social media platform with over 1.7 billion Facebook users worldwide. In the last 18 months, GBMC has produced more than 100 Facebook Live shows, which serve as valuable content on our redesigned website, GBMC.org. The shows originate on Facebook and feature a variety of GBMC experts, services, and volunteers. GBMC’s marketing team has established partnerships with local television and radio media to produce content that highlights the great work being done at GBMC. This platform has enabled our healthcare system to build a bigger audience by making professional broadcasts that are richer in style and content. The key here is to go where people’s attention is and include them in the conversation. We’ve used the many advantages of Facebook Live to engage hospital patients and our followers through active listening, real-time feedback, and viewer participation.

We have monthly programs called “To Your Health” and “Greater Living Live,” which provide Facebook viewers and live-studio audience members with information on clinical and surgical services as well as other health and medical initiatives within the GBMC HealthCare System. It’s been a great avenue to promote subjects and specialties that don’t often receive coverage on local and regional broadcast news or print. I encourage you all to watch our previous shows by visiting https://www.youtube.com/user/GBMCMedia and to look for future shows on the GBMC Facebook page. I am sure you will enjoy them and learn more about GBMC!

One unique aspect of our social media strategy is the monthly “Healthy Cooking Demonstration,” featuring Mike Salamon, a chef who is also a bariatric surgical patient, and Jana Wolff, RD, LDN, the Director of Nutrition from GBMC’s Comprehensive Obesity Management Program. Mike and Jana prepare a healthy meal on their show and encourage viewers to post questions and feedback throughout the thirty-minute demonstration. The recipes are then posted on https://www.gbmc.org/greater-living for anyone who would like to refer to them.

In addition to a significant Facebook presence, GBMC’s second most popular social media platform is LinkedIn. LinkedIn provides a great opportunity to share departmental and staff accomplishments with potential job seekers and employees alike. GBMC is also very active on Twitter and Instagram, delivering messages to help guide patients to our services, provide helpful health information, and recognize our talented staff and volunteers.

Our social media strategy encourages two-way communication between our workforce and customers, who are encouraged to “join the conversation” virtually through Facebook Live events or in-person by attending live studio audience opportunities.

We are excited about the future of GBMC’s social media presence and we invite you to follow us on all of our social media platforms!

Facebook: @gbmcmedia
Instagram: gbmchealthcare
LinkedIn: gbmchealthcare
Twitter: @gbmchealthcare
Pinterest: gbmchealthcare

Good Food, Hula Hoops, and Karaoke

On Tuesday, we had the 2018 Employee and Volunteer Appreciation Luau. This event was a great opportunity for the GBMC family to come together and celebrate what we’ve accomplished as a healthcare system while also having some fun! We cannot reach our vision without a fully engaged workforce, and can’t have a fully engaged workforce unless people feel appreciated. Our fourth Aim  ̶  More Joy — requires that we take time to have some fun. There’s no doubt that the work of healthcare is hard and requires self-sacrifice and dedication.

The luau came in the middle of GBMC Spirit Week, a time for us all to show the pride we have in our organization and our caring for each other. This year, to accommodate all members of our workforce, we started the festivities earlier than usual and we made sure that we offered similar activities to our hospital night shift employees, Gilchrist, and our off-site locations.

The barbecue began at 11 a.m. and hamburgers, hot dogs, veggie burgers, BBQ chicken, watermelon salads, desserts, and beverages were served by Rouge Catering. The Kona Ice truck was also on site providing shaved ice for a cool treat.

Everyone enjoyed the music, good food, luau-themed games, a surprise visit from the Oriole Bird, and having a relaxing time with friends and colleagues. Many enjoyed participating in or watching the hula hoop contest, relay race, egg toss, and the flamingo ring toss. We assembled again from 10 p.m. until midnight to BBQ and play games with the night shift staff.

We also hosted a Legacy Chase Hat Contest in which teams decorated wide-brimmed floppy hats to show support for Legacy Chase and the Oncology department. A huge thank you to all the departments, units, and practices who participated! There were 27 hats submitted, and attendees voted on their favorites in three categories: Best Legacy Chase (Equestrian) Theme, Best Cancer Awareness Theme, and Best Department/Unit Theme. I hope many of you voted for your favorite!

Here are the winners in each category, pictured below from left to right:

From left to right: Best Legacy Chase (Equestrian) Theme submitted by Nursing Education; Best Cancer Awareness Theme submitted by The Milton J. Dance, Jr. Head & Neck Center; Best Department/Unit Theme submitted by The Emergency Department

We also had raffles and games sponsored by departments raising money to win a tent at Legacy Chase!

Our Philanthropy Team, led by Jenny Coldiron, our Human Resources Team, led by Anna-Maria Palmer, and our Marketing and Communications Team, led by Greg Shaffer, put on a fabulous event! Special thanks to Kim Davenport from Marketing, Shannon Baumler from Philanthropy, and Tina Hughes from Human Resources for their hard work on this event, beginning early in the morning and stretching all the way through the night shift.

It was a great opportunity to celebrate together and leave our work behind, even if only for an hour or so. I am honored to be a part of the GBMC HealthCare family and I am very grateful for all that our people do. I am delighted to show my spirit. 

All in all, we had a great day celebrating our employees! Check out the photos.



What did you think about the luau?

Congratulations to Dr. Celano!

As we celebrated at the GBMC employee and volunteer recognition luau, I am pleased to share some wonderful news from a donor who also recognizes the hard work that you do. In July, the Samuelson Foundation made a generous pledge to name in perpetuity the Herman and Walter Samuelson Medical Director of The Sandra and Malcolm Berman Cancer Institute held by Dr. Paul Celano. The trustees of the Samuelson Foundation made this gift to show their appreciation for the remarkable job that physicians, nurses, and the entire staff of GBMC does to provide cancer patients with evidence-based and compassionate care.

Summer Reflections

I was very fortunate to be on vacation this week, spending time with extended family members and friends who I hadn’t seen in a while. On the Fourth of July, I was thinking about the Declaration of Independence and that “all men are created equal with certain inalienable rights, among them Life, Liberty and the pursuit of Happiness...” I believe that healthcare is a right that allows us to live life to the fullest and to pursue happiness.

When we gather with friends and family, we discuss all the happenings since our last visit, - both good and bad. Inevitably we discuss illness, who was just diagnosed with what disease and how they are coping. These conversations always bring me back to GBMC HealthCare and our vision of being the community-based healthcare system that can deliver the quadruple aim to every patient, every time.  It is a very noble cause, which I am so fortunate to be part of along with my 3,000+ colleagues.

So, I am going to spend a few more days away enjoying family and friends, the beach, some good meals, good music (of course Steely Dan and the Doobie Brothers), and then return to GBMC recommitted to help move us closer to our vision.