Addressing Workplace Violence and Staff Safety

Healthcare facilities are high-stress environments. This is one of many factors putting healthcare workers at higher risk of experiencing incidents of workplace violence, which can come in numerous forms – including (but certainly not limited to) physical assault, abusive language, threats, sexual language, verbal harassment, and racial slurs.

A workplace violence survey conducted across the health system in 2022 shed light into experiences and concerns among staff. Many employees shared that they have encountered verbal, emotional, or physical assault and that the instances often involved a patient and/or visitor. Our own Nursing Practice Advisory Council (NPAC) voiced concerns that mirrored survey feedback.

At GBMC HealthCare, the safety of our workforce (and everyone that visits our facilities) is critical. You cannot experience the joy of helping others if you do not feel safe. Several initiatives to improve staff safety are already underway (with more to come!). Thank you to Cate O’Connor-Devlin, MSN, RN, Director of Emergency Preparedness, Safety, and Security; Carolyn Keller, MS, RN, NE-BC, FNE-A, Clinical Nurse Manager - Unit 47; and Nicholas Kokkinakos, Senior Manager of Safety and Security; for their leadership in these efforts. And thank you to the entire Workplace Violence Committee, comprised of representatives across all three work systems and our Nursing Practice Advisory Council, for guiding us in our improvement.

Some key changes that have been implemented or are on the horizon are highlighted below.

Easier Reporting

With the launch of the new STAR incident reporting tool, staff can easily submit a formal Workplace Violence Incident Report from their mobile device, computer, or the Infoweb. A dedicated workplace violence icon was added to the homepage of the tool for convenient reporting, and staff can check the status of their reports.

Training Opportunities

Although we’ve offered training opportunities for higher risk areas, like the Emergency Department and Unit 47 (formerly Unit 36) for some time now, we plan to enhance training for these teams. Additional workplace violence prevention courses have been scheduled and can be registered for in NetLearning. We participate in “Stop the Bleed” training, which will be incorporating workplace violence topics, and in the future, we plan to incorporate clinical self-defense training into classes.

We will provide more hands-on training opportunities to include simulation drills within the Simulation Innovation Learning Center to help staff to feel as confident as possible in difficult scenarios and educate them about how to stay safe and de-escalate situations.

Policies and Leadership Support

In November 2022, GBMC launched a zero-tolerance policy for verbal or physical workplace violence. Staff can view the full policy in PolicyStat for details.

In June 2023, GBMC implemented a new policy to help clinical staff navigate challenging situations. The policy introduced additional resources including a Behavioral Support Team, that can advise on appropriate next steps when a patient is exhibiting disruptive behaviors. Similar to an ethics consultation, staff can request advice from the Behavioral Support Team for non-urgent situations. Again, I encourage staff to visit the Infoweb and review the full policy in PolicyStat to become familiar with all available resources.

In addition to policy changes, we have added a workplace violence metric to our vision dashboard, so we routinely analyze data and continuously improve.

Thank you to all our staff, patients, and visitors for your support in making GBMC HealthCare a safe environment for both work and healing.

Unveiling Our Annually Updated Strategic Plan

Back in April, I gave you a sneak peek into our strategic planning process in my post “Looking Ahead to a Bright Future.” As promised in that post, I have more information to share and am excited about our new initiatives!  

The plan is broken down into a series of “strategic moves,” all developed in alignment with our vision and our four aims: 

• Our vision of becoming the community-based true system of care capable of providing every patient, every time with the care we would want for our own loved ones 
• And the definition of that care embodied in our four aims: the best health outcomes and the best care experience with the least waste of resources and the most joy for those providing the care 

I’ve summarized the strategic moves below, but we will share a more detailed plan, to include specific initiatives and objectives, with our leadership team and employees soon.  

STRATEGIC MOVE 1: Evaluate, plan, and execute innovative ideas to improve the experience for patients while also keeping our unique Maryland reimbursement model in mind. Everyone benefits when patients get the appropriate care, at the appropriate time, in the appropriate setting. We will seek to expand service offerings in the post-acute, diagnostic, and cancer care programs.  

STRATEGIC MOVE 2: Using data, develop and sustain a culture of continuous improvement and performance excellence that rewards our performance. We will continue to foster a culture in which our employees and leaders feel empowered, trained, and inspired to be part of a continual process for quality-of-care improvements. We will measure our progress through patient experience scores, value-based performance incentive dollars, and by minimizing incidents of patient harm.  

STRATEGIC MOVE 3: Redesign key work processes for care access, care delivery, and care transitions to prioritize an excellent patient experience to everyone, including historically marginalized populations. We will continue to emphasize preventive care services with the goals of reducing the prevalence of chronic disease, providing medical care and support for those diagnosed with chronic illness to keep them as healthy as possible, and encouraging the utilization of advanced geriatric and hospice care for those with serious and/or terminal illnesses when appropriate. We must ensure our services are easy to access with readily available appointments, responsive provider follow-up, and standardized work across the care continuum for chronic and serious disease management. 

STRATEGIC MOVE 4: Become the employer of choice in our market. Attracting, retaining, and engaging leaders, providers, nurses, and support professionals is essential to ongoing success, while we continue to diversify our workforce at all levels. 

STRATEGIC MOVE 5: Work with our suppliers, collaborators, partners, and other health systems to improve operational efficiency and effectiveness. In addition to other efforts, we will identify areas where we can streamline processes and collaborate with vendors on best pricing. 

STRATEGIC MOVE 6: Increase the philanthropic support for our programs and services and more closely align with the Marketing Department to grow market share. As a nonprofit organization, we appreciate the generosity of our donors, who ensure we are able to provide the critical services our communities truly need while removing barriers to care. 

To our GBMC HealthCare system leaders: Each of our strategic moves can connect to every employee, regardless of role, in some way. Be on the lookout for additional details in the near future to help you individualize action plans for your areas. And most importantly, as you review all the information we’ll be giving, please consider the “why" behind everything we do, remember your key stakeholders, develop goals that align with the plan, and enroll your teams using the Leadership System. 

Celebrating with the LGBTQ+ Community

Access to equitable and inclusive healthcare is vital. At GBMC HealthCare, we strive to provide an equal and exceptional level of care to ALL those we serve, per our vision. The same is true for our workforce – we aim to foster a work environment that is inclusive and values EVERYONE on our team. One way we nurture an environment of inclusion is through our employee resource groups (ERGs), which build community and allow individuals within our workforce to come together based on common interests and backgrounds. Today, I’d like to focus on work that’s being led by our Greater Pride team, which happens to be our longest-standing ERG.  

In addition to meeting monthly to discuss ways to improve the GBMC experience for LGBTQ+ individuals within our workforce and patient populations, the Greater Pride ERG takes the lead in forming a team for the Baltimore Pride Parade each year. This year, the group organized a wonderful team for the parade, which was held on June 24, and also participated in Pride in the Park held at Druid Hill Park the following day. 

Not only did the group come together to celebrate with the LGBTQ+ community, but they also took the time to share resources, explain how safe and inclusive care is embedded in all our services, and, most importantly, listen to people’s stories to learn how we might serve them better in the future. As an organization dedicated to continuous improvement, we value this type of feedback and even participate in the Healthcare Equality Index (HEI), the national LGBTQ+ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ+ patients, visitors, and employees.

I’m proud of the work that our Greater Pride ERG is leading throughout the year. Their guidance and engagement truly makes an impact on the experience of patients, their loved ones, and our own GBMC HealthCare work family. The Greater Pride ERG works in tandem with our overarching Diversity, Equity, and Inclusion team, council, and committees, led by Chief Diversity and Learning Officer Lisa Walker. I’d like to thank all of these individuals for ensuring we continuously learn and make improvements to provide EVERYONE with the care we’d want for our own loved ones.

Resisting the Status Quo to Reduce Hospital-Acquired Conditions

As a health system that is dedicated to continuous improvement, GBMC is consistently exploring ways to minimize the risk of hospital-acquired conditions, which are conditions that can occur during a hospital stay but were not initially present upon admission. In fact, within our aim of Better Health, we have embedded goals to decrease the number of these conditions to keep our patients safe and provide the best outcomes.

Today, I want to highlight the work being done in our medical and surgical intensive care units (MICU and SICU) to reduce the number of catheter-associated urinary tract infections (CAUTI). While indwelling catheters can be helpful in certain situations, they also come with risks because they can introduce bacteria into the urinary tract and lead to infection. Preventing unnecessary catheter placements reduces infection risk. 

Too often in the emergency and ICU settings, there is a tendency to catheterize because that’s the way it’s always been done rather than pausing and considering alternatives. David Vitberg, MD, Director of our Medical and Surgical ICU, and his team reflected on this trend, analyzed data, and recognized the following opportunities for improvement in our own ICUs. 

• Shift of culture and critical thinking: The team noted that indwelling catheterization was part of the standardized order set for many conditions within our electronic health record system, when it actually wasn’t always necessary. They got out of the habit of following the status quo and implemented a “questioning attitude” to assess the need for catheterization on a case-by-case basis. As part of each assessment, they consider questions like, “Does this patient truly need an indwelling catheter?” and “Is there a lower-risk alternative to measure urine output for this patient?”
• Education: Nurse leaders have educated staff about alternative strategies to placing indwelling catheters to measure urine output, such as using external catheters instead.
• Continuous communication: Questions about catheterization have been built into discussions and checklists around the care of each patient to prompt critical thinking. Dr. Vitberg and Temitope Oseromi, MSN, RN, CCRN-K, Nurse Manager of the Medical and Surgical ICU, round the units and ask questions when they see patients have been catheterized to encourage staff discussion and identify educational opportunities.

With these enhancements, our ICU teams have significantly reduced their placement of indwelling catheters, with an expected result of fewer CAUTIs.

Thank you to Dr. Vitberg and Temi for leading this important patient safety work, as well as the entire MICU and SICU teams for working to improve outcomes for patients!

Celebrating Juneteenth

On Monday, June 19, our Black Alliance Employee Resource Group (ERG) hosted an excellent Juneteenth event to commemorate the emancipation of enslaved people in the US. This year’s theme was “Educating, Empowering, Entertaining” and was a wonderful celebration of history, culture and art and food. Thank you to our Black Alliance ERG for planning this thoughtful event!

Join us at the GBMC HealthCare Father's Day 5K and 1-Mile Fun Walk to Support Our Tiniest Fighters!

Father's Day holds a special place in our hearts as we gather to honor and appreciate the remarkable fathers in our lives. At GBMC HealthCare, we have a cherished Father's Day tradition that supports our Neonatal Intensive Care Unit (NICU) – the annual Father's Day 5K and 1-Mile Fun Walk.

Leading up to this year's event, I want to share a heartwarming story about our NICU, which has been caring for patients since 1968. Ruth Kotschenreuther, RN, was one of the first NICU nurses at GBMC. Although she retired nearly 40 years ago, she recently returned to a transformed NICU to meet her two-and-a-half-week-old great-grandsons. At the time Ruth retired in 1985, the NICU had just received its Level II designation, and is now proudly a 22-bed Level III NICU, providing complex and compassionate medical and general pediatric surgical care for about 400 babies annually that are born too small, too sick or too soon.

The Father's Day 5K provides families with an opportunity to revisit the NICU, a place that may have been their home for several weeks or longer. It also pays tribute to trailblazers like Ruth, who paved the way in NICU nursing, and celebrates the generations of families that GBMC has been privileged to care for. Additionally, the event raises funds to support a brighter future for all the vulnerable infants we treat.

Participants of all ages and abilities are welcome to join us. Whether you prefer running, jogging, or leisurely walking, the Father's Day 5K and 1-Mile Fun Walk allows you to stand in solidarity with families who have experienced the NICU journey firsthand.

Each contribution counts. We understand that not everyone may be able to attend the event in person. However, you can still make a meaningful impact by making a donation to support the NICU. Your generosity will help provide state-of-the-art medical equipment, specialized training for healthcare professionals, and ongoing support for families during their NICU experience. Every contribution, no matter the size, makes a significant difference in the lives of these vulnerable infants and their families.

Click here to register or make a donation! We hope to see you on Sunday!

National Nursing Assistants Week

June 15-21 is National Nursing Assistants Week. I am grateful to our incredible team of nursing support staff across the health system. From assisting with activities of daily living to monitoring vital signs and offering emotional support, our nursing support staff members go above and beyond to ensure the comfort and well-being of our patients. Please join me in thanking our nursing assistants!

Simulation: A Key to Safety in Commercial Aviation and now in Healthcare

If you have kept up with my blog over the years, you’ll know I’ve referenced the commercial aviation industry in the past. I have done so because commercial aviation is a high-risk industry that healthcare is often compared to. It is an example of an industry that has learned from things that went wrong, made changes, and created standard work to ensure safety and prevent future harm. It’s a fabulous success story. The reduction in airline crashes has been dramatic. I remember Robert Hager, NBC’s last national aviation correspondent. When he retired in the early 2000’s, NBC eliminated his job because there were so few commercial aviation crashes. 

Recently, the story of one of our fabulous nurses quite literally intertwined healthcare with aviation. While on her way back from vacation on a flight from Ft. Lauderdale to Baltimore, GBMC nurse Emily Raines, RN, and her boyfriend Daniel Shifflett took quick action to perform CPR and save the life of a fellow passenger. You can read the full story of their heroic great save on several news outlets, including The Washington Post, WJZ, Yahoo, and WMAR.

I am proud of Emily, and I’m especially proud of our Nursing program. As cited in some of the articles, Emily attributed a portion of her ability to respond effectively to training through GBMC's Resuscitation Quality Improvement (RQI) program. The program delivers quarterly hands-on training to support mastery of high-quality CPR skills. Much like simulations practiced by pilots and co-pilots in the aviation industry, RQI training sessions allow clinicians to engage in hands-on simulated CPR practice with a manikin, while receiving real-time feedback from the system. Commercial pilots are required to practice at regular intervals in a simulator to assure that they know what to do during relatively uncommon flight conditions. Research has shown that CPR skills can begin to diminish three to six months following the previous standard training, which was only required every two years. So, our approach of utilizing technology with a more regular cadence of practice is critical.

I am so grateful that at GBMC we have nursing leaders who have designed a system that utilizes technology and standard work to ensure our clinicians are competent in their skills no matter where they are.  At GBMC, we are also fortunate to have our state-of-the-art Simulation Center that allows us to maintain this high standard of training. We do not rely on hard work and good intentions alone; we believe in designing systems to prevent harm and prepare for the unexpected. This helps to ensure that when a patient needs CPR, it is done correctly. This is the definition of high reliability.

Father’s Day 5K and 1-Mile Fun Walk

Our 35th Annual Father’s Day 5K and 1-Mile Fun Walk is being held on Sunday, June 18. This fundraising event benefits our Neonatal Intensive Care Unit (NICU), which cares for about 400 infants every year. We would love for you to join us for the event. You can register or donate by clicking here.

New this year is the Father’s Day 5K Fitness Frenzy Sweepstakes! This sweepstakes encourages the community and employees to improve their own health while also supporting the NICU. The winner will receive four tickets and a hotel stay to see their favorite baseball, football, hockey, or basketball team play anywhere in the country. 

There are two ways to win:

• Click here to log an activity every day through June 18 for one chance to win per day. Logging a daily activity is based on the honor system.
• Click here to register for the GBMC Father’s Day 5K and 1-Mile Fun Walk on June 18. By registering, you will earn 100 chances to win. Every additional donation of just $5 will earn you an extra 10 chances.

Thank you for your support of our NICU!

Do Hospital Mergers Really Save Money or Improve Outcomes?

At times over the years, people have misinterpreted why GBMC HealthCare has chosen to remain an independent health system rather than merge with a larger hospital company. To be clear, we are not independent for the sake of independence or due to any stubbornness or desire to have it our way. We strive to remain independent because it is truly best for our community, and it is in full alignment with our vision.

To help explain our reasoning, I would like to review key issues within our country’s healthcare industry and the need for transformation. Studies, such as this one performed by The Commonwealth Fund and reported on by CNN, have shown that the U.S. healthcare system is the most expensive in the world (without evidence of better care or outcomes). After researching this dilemma in depth, in 2007, the Institute for Healthcare Improvement (IHI) introduced its triple aim framework to address root causes.

This framework emphasizes improving the health of populations (better health), enhancing care quality and patient experience (better care), and reducing the per capita cost of healthcare (least waste). It reiterates a need to transform to see results. 

In late 2010, our Board of Directors went off on retreat. It was shortly after the passage of the Affordable Care Act, and they wanted to study the facts and decide what would be best for GBMC and the community it serves. They learned a few things. First, the U.S. has the best trained doctors, nurses, and other clinicians in the world, and they probably work harder than in other countries. They learned that the U.S. does extremely well with acute illness. As an example, look at our EMS system and our trauma care at places like Shock Trauma; we lead the world. If you have acute abdominal pain, as another example, you want to be in the U.S. But the Board also learned that for many chronic diseases, like diabetes or congestive heart failure, you are statistically better off in many other countries that have better designed systems for managing chronic disease. The Board also learned that we spend 40% more per capita on healthcare than all the other industrialized nations like France, Germany and the Netherlands and our outcomes are often not as good. The Board realized that we could not change the whole country, but they decided to improve what they did control. They wanted to build on our outstanding acute care hospital and create the ability to manage the health of a population, especially helping those who already suffered from chronic disease. They then wrote our four-paragraph vision statement that you can find here.  The vision statement contains my marching orders as CEO - to build a community based true “system” of care that covers people from birth to death.

At GBMC HealthCare, we have adopted IHI’s evidence-based triple aim approach with an added fourth aim of more joy for those providing the care. We are redesigning care and believe this quadruple aim is the definition of the care we want for our own loved ones. We are continuing to work towards providing it to every patient, every time.

There is no value in joining a larger hospital company unless what we are missing is hospital capacity. If we are trying to keep people out of the hospital, more hospital capacity just brings more cost. Also, becoming a part of a hospital company that is not committed to transforming towards the four aims, would create a clash of cultures, and slow down movement towards our vision. 

It is not universally true that when hospitals merge, economies of scale are created that lower costs for payers and patients. In fact, healthcare mergers are often designed to give hospitals more leverage with suppliers and insurance payors, which can result in the consumers (patients) seeing higher downstream costs. This concept of “hospital buyer power” is explored in many research papers including this one, published in 2021 in the RAND Journal of Economics. A 2020 study led by Harvard Medical School scientists that was published in the New England Journal of Medicine determined that mergers do not always result in improved patient care, experience, and outcomes, either. 

Many larger hospital companies do not share our vision and have continued to focus on building hospital-based services known to be reimbursed at higher rates and thus, drive more revenue. This will not improve the state of healthcare in our country.

At their core, hospitals are designed to serve three basic functions: to deliver babies, offer reparative surgery, and help patients when they are acutely ill. Hospitals are one vital component of the overall system of care, but they offer no mechanism for maintaining the health of the population. To influence change and generate better health outcomes with lower long-term cost, the industry overall must commit to advanced primary care, chronic disease management and prevention, and removal of barriers to accessing healthcare.

In Maryland, our unique payment and reimbursement model is intended to control costs and improve the quality of care by incentivizing more efficient, effective care rather than by simply selling individual services and hospitalizations. In theory, healthcare organizations that embrace system redesign and implement the triple aim framework should thrive under the Maryland Model. 

Therefore, if hospital leaders believe in the IHI triple aim and want the Maryland waiver to work, we must resist the status quo. We cannot simply identify areas of healthcare that reimburse well with a goal of filling up our hospitals. 

We must instead design true systems of care based on what our communities truly need, work to keep people OUT of the hospital by helping them manage chronic disease and be accessible when they are sick through advanced primary care and coordination. 

I am proud that GBMC HealthCare is devoted to this work and has built a system that is improved annually through our strategic plan. I am excited that we have taken additional steps such as aligning with community partners, especially those in Baltimore City, to assist with services like ride sharing, housing, and access to healthy food to work on the social determinants of health and support those we serve. By transforming the system, removing barriers, increasing access to care, and taking accountability for our patients, we are slowly but surely making a positive difference on the health of our community.