Communicating in a “Large” Company

I think of our healthcare system as being small, which is good because we can change faster than bigger companies in our industry. On the other hand, with more than 3,000 employees, we are a pretty big organization and trying to make sure that all of our people know what we are trying to do and what is changing is really difficult. There is no one good way to communicate. So, we use many methods. One of those methods is the Town Hall Meeting.

This week, we started our summer Town Hall Meetings. These meetings attempt to narrow the gap between what the frontline staff knows and what the front office staff knows. The meetings are meant to be two-way communications, a sharing up and down of information. The bigger the group, the harder it is to make this happen.

One of the goals of holding these Town Hall Meetings is for our employees to come away feeling informed about our healthcare system and what is going on around it. These meetings are a place to learn more about your role in moving us closer to our vision and are one of your opportunities to have your opinion heard.

We welcome everyone to come with questions and ideas, and I encourage all GBMC staff members to attend at least one of the 12 scheduled meetings that run through August 14 on the GBMC campus, in Owings Mills, and at the Gilchrist headquarters. I am willing to come at other times and to other locations. If you wish to schedule a session, please call Tina Hughes at ext. 2495.

Some of the important topics we will be covering include:
• An update on our system performance
• The results of our recent employee engagement survey
• Facilities improvements
• The new fitness center on campus

The detailed schedule is available on the GBMC HR’s InfoWeb page.

Again, these meetings provide an opportunity to ask questions, raise issues, share information, and clarify key objectives. If you would like to submit a question prior to the meeting, please submit it via email to Tina Hughes at cdhughes@gbmc.org

All are encouraged to attend!  The value of these meetings is directly related to your participation, so we look forward to seeing you there!  Please mark your calendars!

New NICU Opens Its Doors
On Wednesday, we officially started treating patients in our new NICU. Here are a couple of photos from Day One. Again, I want to thank Howard Birenbaum, MD, the NICU medical director, Drs. Maria Pane and Sabah M. Helou, and our incredible nursing staff, led by manager Kristin Trawinski, as well as our pediatricians, nurse practitioners, and talented and dedicated therapists who provide the best care to our tiniest patients.

Tragedy In Annapolis
We are all sad to hear about the tragic event that took place at The Capital Gazette newspaper in Annapolis. We extend our deepest sympathies to the family, friends, and colleagues of those killed and injured in yesterday's event.

HAPPY BIRTHDAY TO US!!!

Finally, I want to wish everyone in our GBMC family a safe and happy Independence Day. July 4th marks the birthday of our great country, the land of the free and the home of the brave. Let's take some time to reflect on what we can each do to make our country even better than it is today. 

Helping the Tiniest of Our Patients

For years, GBMC has been called “the baby hospital.” We are known as a premier birthing center, but we are also an outstanding center for the care of premature and sick babies. Our Neonatal Intensive Care Unit (NICU) treats roughly one in ten of the 4,000 babies born at GBMC annually.

On Tuesday, June 26, GBMC will officially open the doors to a new NICU that will allow us to continue to achieve excellent clinical outcomes in a state-of-the-art setting.

The new NICU will provide individual private spaces for babies and their families. Each of our new 13 rooms (10 single and 3 multiple-birth rooms) will allow for an individualized environment in terms of lighting, temperature, and sound.

Now, with this new NICU, we will provide an enriched environment for the infant and family to complement the leading-edge care provided to these highly vulnerable patients. We anticipate that the new NICU will further promote the short- and long-term clinical outcomes we are proud of at GBMC. As a member of the Vermont Oxford Neonatal Network (VON), we can compare our own outcomes annually as well as with a universe of tens of thousands of low birth weight infants each year.  Here are some key examples:

• Utilizing VON definitions, we have reduced our incidence of chronic lung disease in very low birth weight babies by 75 percent since 2002.  These improvements were the result of our group adopting a standardized approach to the initial support and management of these infants, avoiding intubation and mechanical ventilation, improving nutrition, and adhering to tighter parameters for the provision of oxygen. For several of the past years, none of our babies were discharged home on supplemental oxygen therapy.  These quality improvements have been published in Pediatrics and other journals, and continue to be referenced in other peer-reviewed publications.

• Similarly, with our improvements, our length of stay has also fallen significantly during the same period, and on average about 10 fewer hospital days than that of VON.

We know we have outstanding neonatologists, including Howard Birenbaum, MD, the NICU medical director, and Drs. Maria Pane and Sabah M. Helou.  We are also fortunate to have an incredible nursing staff is led by manager Kristin Trawinski, pediatricians, nurse practitioners, and talented and dedicated therapists. None of this though would be possible without the phenomenal support of our community, which over the past 30 years, has provided us with the financial assistance to provide expert around-the-clock, comprehensive care to our tiniest patients.

This past Sunday, I ran in our 30th annual Father’s Day 5K. As always, it was great to see so many parents of former NICU babies, as well as so many other people from the community and the GBMC staff, come out and participate in this terrific cause.

This year’s event, once again presented by the GBMC Volunteer Auxiliary, was incredible because it raised $184,000 towards the $4 million cost of the newly renovated NICU!  I want to thank the more than 700 participants, who ran or walked, and who spent part of their Father’s Day with GBMC to help support the NICU babies and their families.

Lastly, I want to thank everyone involved in our community Wellness Village, which featured health-related vendors. Additionally, MIX 106.5 Radio was on-site with its Friends and Neighbors van playing music and sharing prizes. Great work, everyone!!!

Do you see the clutter?

On Wednesday, we were walking through the Pediatric Department and we saw the 6S that was going on in the supply room. You will recall that 5 (or 6) S stands for sort, separate, shine, standardize, sustain, and (#6) safety. Everything was in its proper place, beautifully labeled, and easy to find. Having items arranged and organized is fundamental for a high-performing unit or department. When things are not in their place, people waste time and effort looking for them. In addition, when spaces are cluttered, various items may be in the way, which can potentially lead to harm. 

Last week, one of our employees was injured after crashing into a chair that was obstructing her path. This injury could have been avoided if the chair had been placed where it belonged.

When things are routinely left in random places, we get “immunized” against seeing the disarray…we begin to accept it. On the same day, I was walking on another unit of the hospital and found two stretchers in the hallway. This hallway would be an exit route from the unit if there was a fire! I informed the local manager who told me that he would have them moved immediately, but this was not the point. I wondered who had left the stretchers there and how many people had passed them by without removing the safety hazard? Did people not “see” them? Or were some people leaving them there as hoarders because they did not trust the hub to send them back expeditiously when they were needed?

What do you think? Please let me know by commenting below. Thanks.

Congratulations Laurie Beyer!

Becker's Hospital Review has named its 150 Hospital and Health System Chief Financial Officers (CFOs) to Know, and our very own Executive Vice President and Chief Financial Officer, Laurie R. Beyer, BS, MBA, CPA, made the list. She has served as CFO for the GBMC HealthCare system since late 2017. According to Becker’s, the executives that were recognized across the country lead financial departments for large health systems as well as small community hospitals and play an integral role in their organization's strategic planning, growth and transactions. They have also been recognized by their peers and serve on the board of directors for community organizations.

Celebrating Survivorship

Last week, I was delighted to be with over 400 cancer survivors, their caregivers, friends, and family members as they celebrated life at our annual Cancer Survivorship Celebration.

This annual event provides an opportunity to commemorate our patients’ courage and our caregivers' commitment to their treatment. Every year, more than 2,000 individuals turn to the experts at The Sandra and Malcolm Berman Cancer Institute at GBMC when faced with potentially life-changing medical diagnoses. Our Berman Cancer Institute is recognized both locally and nationally and is fully accredited by the American College of Surgeons Commission on Cancer.

The number of people who attend this event continues to grow. Congratulations to our survivors, their families, and our caregivers!

Closing Time…

Voting for this year’s BALTIMORE Magazine: TOP DOCTORS issue is wrapping up soon. Docs, if you haven’t done so already, please vote for the colleagues that you most respect by NO LATER than Monday, June 18th! The survey can be found at: http://www.baltimoremagazine.net/about/top-doctors-survey. 

I’m sure your colleagues will greatly appreciate your vote! Thank you.

From Usually to Always

Imagine you are on a commercial flight from Baltimore to Chicago. The co-pilot comes out of the cockpit and you engage him or her in a conversation. You ask the co-pilot to tell you about the process for determining which runway to land on and the co-pilot says: “We usually get our instructions for the landing from the air traffic controller, but sometimes the captain likes to bypass the system and we pick the runway ourselves…it’s usually faster.” What would you think? Ok, I know that this is a ridiculous example of an unreliable system (reliability= what should happen happens and what should not happen, doesn’t). But you get the point.

Healthcare can be as high-risk as commercial aviation. It wasn’t too long ago that everything in healthcare was done the way that the most powerful person in the decision wanted it done that day. We are in a much better place today. As an example, we have nearly eliminated catheter-associated urinary tract infections by standardizing the process, according to the evidence of what works best, how a catheter is put in, how it is maintained, and when it comes out. There are some things in healthcare that shouldn’t be standardized because there is no one best way or there is no evidence as to what works best. Patients are not all the same and not everyone will benefit from the same therapy. But to leave time to make these more difficult decisions, we should standardize what we can.

On Lean Daily Management Rounds, we are often asking what is our standard work. When we get an answer that starts: “Well, usually…”, we know that we have not created standard work, people don’t know that we have created it, we have not properly enrolled them in the standard work, or we are not holding them accountable.

What examples do you have of what should be moved to standard work? Please let me know below. Let’s move more things from usually to always!

GBMC Wins Award for Diversity
I am proud to announce that the GBMC Healthcare System was a recipient of this year's Rouse Excellence in Diversity Award. The James W. Rouse Diversity Award is presented annually by the Chesapeake Human Resources Association (CHRA) to a local organization which best exemplifies an attitude and environment of acceptance and inclusion. James Rouse was dedicated to diversity and CHRA's Rouse Diversity Award was established to honor his memory and vision of building a better way to live and work through diversity, which was embodied in his many nationally known urban redevelopment programs.

At GBMC, we know the importance of being inclusive and welcoming everyone to join our family. We were selected for the award because of our Celebration and Education Initiative, which provides employees with experiences and resources that incorporate celebrating diverse cultures and learning about diversity and inclusion. Components of this initiative include: monthly cultural celebrations, a calendar of celebrations and events, an annual corporate competency, orientation presentations, and other learning and development initiatives promoting a diverse workplace.

I want to congratulate GBMC’s Diversity & Inclusion Council and our Director of Diversity and Inclusion, Jennifer Maraña, Ph.D., for their leadership and for receiving this award.

Decentralized Parking Project Update 
What’s Completed?
The utility rough-ins, concrete islands, and road work have been completed at the South Chapman lot(s), F-Lot/Valet lot, Tulip (PPN) Garage, Lily (ED) Garage, and Rose lot. Most of the new parking control equipment has been set at these locations but will remain inactive until all the parking areas are completed.

What’s in Progress?
Daffodil (PPW) Garage is currently closed for the parking infrastructure installation and is scheduled to be re-opened on Tuesday, June 12th. The installation of the equipment at the parking areas as well as the pay-on-foot stations inside of the buildings will continue throughout the month of June.

What’s Next?
Iris (PPE) Garage will be closing on Wednesday, June 13th for approximately 3 weeks to complete the utility rough-ins, concrete islands, widening of the entrance/exit, and installation of the equipment. As equipment gets placed throughout campus, work is also completed to connect the equipment to the hospital’s electrical, network, and security systems and test it for proper operation.

Global Budgets: A Way to Save Rural Hospitals?

This week, I participated in a conference at the Johns Hopkins Bloomberg School of Public Health (JHBSOPH) entitled: State Policy Academy on Global Budgeting for Rural Hospitals. I was invited along with three other healthcare leaders: Leslie Simmons from Carrol Hospital, Joe Ross from Meritas, and Barry Ronan from Western Maryland Health System. The conference included an address from the new Executive Director of the Centers for Medicare and Medicaid Innovation, Adam Boehler, and a panel discussion that included Donna Kinzer, the Executive Director of Maryland’s Health Services Cost Review Commission (HSCRC).

The goal of this meeting was to educate healthcare leaders from other states who are looking for ways to support their rural hospitals. My friend and colleague, Dr. Joshua Sharfstein, JHBSOPH’s Vice Dean for Public Health Practice and Community Engagement, gave a compelling argument in favor of guaranteed global budgeting for rural hospitals. He cited Maryland’s success with this strategy and the fact that there are over 800 rural hospitals in America at risk of closing. Small hospitals cannot withstand variability in demand for their services in a fee-for-service world, and yet our citizens need dependable access to healthcare.

We met with leaders from Delaware, Pennsylvania, New Mexico, Hawaii, Colorado, and several other states and told them about our ability to increase - funds to services and programs that are truly needed but are not reimbursed adequately in fee-for-service.

I learned a lot about the challenges of rural healthcare and I have great respect for people who are helping this underserved group of Americans. Pennsylvania will implement global budgets for rural hospitals beginning in January 2019. It will be interesting to see how this works and if other states also give it a try.

Stroke Center Award
I want to congratulate our Primary Stroke Center which recently received the Gold Plus Quality Achievement Award from the American Heart Association/American Stroke Association. This award recognizes us for our commitment to ensuring that stroke patients receive care based on the latest scientific evidence. We earned this recognition by meeting specific quality requirements for the diagnosis and treatment of stroke patients, which will increase their chances of maximal recovery and lower mortality.

We also received the Target: Stroke Honor Roll. To qualify for this recognition, we must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment.

These awards are the result of the hard work and expertise of our entire stroke team and demonstrate GBMC’s high level of commitment to caring for stroke patients. Great work, everyone!

GBMC Recognized for Excellence

The GBMC HealthCare team has recently received several awards. The American Association of Critical-Care Nurses (AACN), the world's largest specialty nursing organization representing the interests of more than a half-million acute and critical care nurses, recently recognized our Medical Intensive Care Unit (MICU) with a silver-level Beacon Award for Excellence. Our hospital is just one of five in Maryland to achieve this prestigious recognition.

This award recognizes the incredible contributions that have been made by the MICU staff members who are driving us towards our vision daily. They don’t rest on their achievements; they ask how they can make the clinical outcomes and care experience of their patients even better. It takes teamwork and a strong culture of improvement to earn this recognition.

I am truly honored by and proud of our magnificent MICU staff. Congrats to Rachel Ridgely RN, the MICU Nurse Manager, Monica Goetz, MSN, RN, CCRN, our Assistant Director, and all the MICU team!

Kudos to Our Lactation Support Team

GBMC was also acknowledged by the International Board of Lactation Consultant Examiners (IBLCE) and the International Lactation Consultant Association (ILCA) for excellence and dedication in supporting and promoting breastfeeding.

The IBCLC Care Award is reserved for hospitals and community-based facilities that protect, promote, and support breastfeeding. Specific criteria include having dedicated lactation specialists available five to seven days per week for breastfeeding families and having staff that is currently IBCLC (International Board-Certified Lactation Consultant) certified. This recognition validates the efforts being made by our multi-disciplinary team of nurses, nursing support technicians, lactation consultants, obstetricians, midwives, pediatricians, and anesthesiologists to provide breastfeeding mothers support prenatally, during their hospital stay, and beyond discharge.

GBMC is one of three hospitals in the Baltimore region to receive this designation until the year 2020!  Congrats to Jodie Bell, BSN, RNC, IBCLC, Assistant Director of GBMC’s Women’s and Children’s Services, and her colleagues for their strong commitment to our patients.

Gilchrist Named a Great Place to Work
Gilchrist was recently certified by independent analysts as a Great Place to Work®. Gilchrist earned this distinction based on feedback from their recent Great Places to Work/Best Workplace in Aging employee survey. Cathy Hamel, President of Gilchrist and Vice President of Continuing Care at GBMC, feels that being named a “Great Place to Work” is a ringing endorsement of the employee culture at Gilchrist. This award will greatly enhance recruitment efforts to attract more of the outstanding, compassionate employees that make Gilchrist so special. I couldn’t agree more. Well done, everyone!

ACR Ultrasound Accreditation

The American College of Radiology (ACR) recently awarded GBMC with a three-year term of accreditation in ultrasound. I am pleased to let you know that we passed with flying colors, and not one deficiency was noted on any of the cases submitted for review. Accreditation by the ACR is approved for 1st Trimester OB, Gynecological, General, Pediatric, and Vascular (Peripheral, Cerebrovascular, Abdominal, Deep Abdominal). This accreditation wouldn’t be possible without the commitment of our sonographers, who are required to maintain ongoing continuing education to ensure they are current in their field. I’d like to congratulate Tracey Stroosnyder, Clinical Supervisor, and her whole team on this accomplishment.

Great job, GBMC Ultrasound!!!

GBMC Awarded for Including Minority-Owned Businesses
Over the last year, our Construction Management Department has worked to improve our inclusion of minority business enterprises within our construction process. Last fall, we held a minority business fair and conducted interviews with several companies that had an interest in partnering with GBMC HealthCare. Because of this intentional work, we now have several minority-owned companies on our pre-approved contractor list. In recognition of our efforts, GBMC was awarded Best Healthcare Provider for Minority Business Enterprises from the Maryland-Washington Minority Companies Association. I want to commend Stacey McGreevy, CPA, Vice President of GBMC HealthCare Support Services, and Russ Sadler, GBMC Capital Resources Manager, for this noteworthy recognition.

Honoring Our Heroes
Monday is Memorial Day, a special day when we honor those who have given their lives during military service to our country. Many of our GBMC HealthCare System employees have family members serving in the armed forces. Some are veterans themselves. So, on this Memorial Day holiday, let’s make time to honor all our veterans and their commitment to safeguard our security and be mindful of our heroes — living and deceased. Let this be a moment to recognize our nation’s champions with appreciation and respect.


Tragedy Strikes Our County
Earlier this week, we were saddened to hear the news that a Baltimore County police officer was killed in the line of duty. Our condolences and prayers go out to the family of fallen patrol officer Amy Caprio and her fellow officers at the Baltimore County Police Department. As members of the community, we must remember and be thankful for all those who risk their lives to keep us safe.

Continuing To Build A More Rational Health Care System

On Monday, Governor Larry Hogan announced the federal approval of Maryland's Total Cost of Care All-Payer Model, also known as the “Maryland Model.” This long-awaited announcement sets in motion the next phase of Maryland’s move towards a more value-driven healthcare system. Since January of 2014, Maryland has used global hospital budgets as a way to reduce costs and incentivize hospital leaders to improve health outcomes and the patient care experience. This was done to help these leaders build better systems of care and move away from the fragmented model in which they were providing acute care services but bearing little responsibility for how those services fit together to improve the health of the population they serve.

Setting revenue budgets for hospitals can be done in Maryland because we are the only state in the nation where hospitals don’t negotiate rates with individual insurance companies. In our state, the Health Services Cost Review Commission (HSCRC) sets the rates that all payers, including Medicare and Medicaid, will pay a hospital. The rates that are paid can vary from hospital to hospital by up to 60%, so the buyer must beware. Since the HSCRC controls the rates, beginning in 2014, it began to guarantee the total annual revenue for services under its purview to each hospital. If the hospital then reduced hospital utilization by keeping patients healthier, it did not need to worry that its total revenue would go down. This system gave hospital leaders more flexibility to spend money on things that prevent disease or better manage patients who are already sick with a chronic disease, like diabetes.

Maryland’s current model has saved Medicare more than $586 million through 2016, compared to national spending, and the new model is expected to provide an additional $300 million in savings per year by 2023 — a total of $1 billion over five years.

The Maryland Model aims to control the growth in healthcare costs, both at hospitals and community providers such as physician practices and nursing homes. Hospitals will be responsible for reducing the total cost of care for Medicare beneficiaries. Readers of this blog will know that GBMC has been building a system of care capable of improving health outcomes and the care experience while reducing wasteful spending for seven years. To do this, we embraced the concept of the patient-centered medical home. We created teams led by physicians that included nurse care managers, care coordinators, behavioral specialists, addiction specialists, and psychiatrists. We extended our hours of operation, created disease-state registries, and implemented a single medical record (Epic) across our whole system to improve care coordination. We made our specialty care even better than it was and made it easier to communicate between primary and specialty care. Now, there will be even bigger incentives for others in the state to do what we have done.

A piece of the new deal is the Maryland Primary Care Model. This program will financially incentivize primary care physicians to improve patient outcomes and ultimately lower cost by using care managers and others, as GBMC has already done. Since small primary care practices will not be able to afford to hire these new team members, new entities, called Care Transformation Organizations will be set up to provide care management and other services to small practices. GBMC will apply to become a Care Transformation Organization through our existing subsidiary company, Greater Baltimore Health Alliance. 

We are excited about this next phase of redesign in our state. The financial incentives of the Maryland Primary Care Model will make it easier for us to move closer to our vision of being a community healthcare system where every patient, every time, gets the care we would want for our own loved ones! Stay tuned.

Celebrations Galore!
Last week was full of events to celebrate GBMC HealthCare and our people. It started on Monday with the 30th annual GBMC Golf Tournament. Hats off to the entire golf committee, the many employees who helped with the event, and to Jenny Coldiron and the GBMC Philanthropy staff, all of whom worked together for a great event. Approximately 200 golfers supported our efforts and raised more than $195,000 to benefit GBMC. Dr. Bernard McGibbon, posthumously, and Dr. Rob Stoltz were each recognized; the first for having created the event and the second for his many years of service as the Chair of the Golf Tournament committee. 

We also held our annual Donor Recognition Dinner, and again I was honored to spend time with donors, members of the GBMC HealthCare System family, philanthropy committee members, and volunteer auxiliary members. Heidi Kenny-Berman, Chair of the GBMC Philanthropy Committee, was the host of the event, along with her husband, Steve Berman. Heidi and Steve did a fabulous job. The event featured a wine and food pairing that was educational and fun. Thank you to all for everything you do to help us continue to move towards our vision and remain an independent, community-owned and controlled healthcare system.


Lastly, on Friday we had our annual Art of Nursing celebration. We formally celebrated all that our incredible nurses give to GBMC and to our patients and highlighted the winners of the 2018 Art of Nursing Awards. Congratulations to the winners and to all those who were nominated! I also would like to thank everyone who made the Art of Nursing so successful, especially the emcee for the night, Denise Koch, and our GBMC Nursing Ambassador, Matt Stover!