Reflecting Back and Looking Ahead to a New Year

As 2010 winds down and we gear up for 2011, it’s important to look back at some of the events that have impacted us as a team before we look forward to a new year. Internally, as we continue our focus on the Greater Values, one event in particular stands out as a prime example of teamwork.



The GBMC sign at the entrance to the gatehouse is almost covered in snow
 during one of the February 2010 blizzards




Staff members in the hospital's command center



 Hailing from Massachusetts, I’m no stranger to snow, and I’ve heard so many stories about how the staff rallied together during the blizzards of 2010 to ensure the hospital remained operational to serve those in need of our very best care. Employees and volunteers from GBMC, and even in our community, who had four wheel drive vehicles picked employees up to get them to work and drove them home after their shifts were over. Staff members manned the hospital’s command center, answering phones, coordinating accommodations for employees who stayed overnight and ensuring that all units had the proper coverage to care for our patients. Crews were out day and night clearing snow from GBMC roads and walkways. GBMC ran like a well-oiled machine in the midst of one of the worst winter weather events Maryland has seen in a long time. I can’t think of anything that exemplifies teamwork more than this. Here’s hoping that 2011 brings much less in the way of snow and more of this kind of team effort!

"Snow drivers" with 4x4 vehicles helped get employees to and from the hospital
 during the snow events of 2010

What 2011 will bring us is a renewed focus on doing what is best for our patients. We must continue to dedicate ourselves to treating all patients the way we would want our own loved ones to be treated, every time.


A number of new executives joined the leadership team in 2010, myself included. GBMC’s Dr. John Saunders was named the new Chief Medical Officer and we welcomed Carolyn Candiello to the role of Vice President for Quality and Patient Safety. They have some exciting plans for redesigning a new quality and patient safety system at GBMC in 2011.


And, the strategic planning process for 2011, which is already underway, will be rolled out in February. Planning for healthcare reform is also an ongoing process and I have been meeting with many physician leaders throughout the organization for their insights on how to make GBMC even stronger than it is today. In 2011, we will take another step toward being more accountable for the care we provide as we continue to move ahead with the Greater Baltimore Health Alliance partnership and the roll-out of electronic medical records in our employed and community-based practices.


There’s much to look forward to in 2011 and I wish to thank everyone – from our Board of Directors and leadership team to all employees, volunteers and physicians – for your commitment to GBMC in 2010. As we look ahead, let’s continue to achieve the best possible health outcomes, have our patients experience a higher level of satisfaction with the care provided, create less waste and take joy in our jobs and in caring for our patients.

Merry Christmas and best wishes to you and your loved ones

for a Happy and Healthy 2011!

Making A Connection

Being in healthcare is about making personal connections, whether it is through direct patient care or a single encounter with a patient or visitor. We often talk about the GBMC values and what they mean to us as an organization and as individuals. I’d like to share a story with you about two staff members who exemplify these core values and how sometimes, it’s the simplest, kindest actions that have the most impact.


JoAnn Parr, RN, a care manager on Unit 38, wrote in an email:

“…Last evening, a patient’s daughter who was here on Unit 38 and who had been up all night with her mother in the ED, was trying to leave the unit once her mother had been admitted, but her car battery was dead. The daughter called Security but their car charger was also dead…I called security and explained that I had jumper cables in my car and asked them to send an officer down to the garage to help this patient’s daughter. Kenny Burchett immediately responded and assisted in pushing this woman’s car out of its spot, hooked the cables from my car to hers and jump started it. The woman was so appreciative to GBMC Security and said, 'This is why I always bring my mother to this hospital.'"

Kenny was so kind and patient and stated, “If it were my wife or daughter, I would want someone to do the same thing.”


For those of you who have listened to me speak, you have probably heard me ask, “What if it were your daughter?” You’d want the same exceptional care for your daughter or loved one as Kenny provided to this woman. We should be proud to have Kenny as part of the GBMC family!

JoAnn goes on to tell a similar story about Security officer Arlene Hightower who helped JoAnn and a fellow coworker rescue a puppy that was left in a car in the garage on a hot summer’s day. “Officer Hightower helped us try and reach the owner of the car, kept in contact with us, let us know what to do and who to call, and was more than pleasant, kind and patient.”

Officers Burchett and Hightower serve as role models for GBMC’s values. I am certainly proud to have these individuals on our team.


And, in the spirit of the holidays, I had the fortunate opportunity to hear the GBMC holiday choir performing many wonderful holiday songs for patients, visitors and staff this past week. In fact, we had a delegation from Russia visiting our Berman Cancer Institute to see what a top-notch community cancer program looks like in the U.S. as they take on the profound challenge of establishing a cancer program in Siberia. During their tour of GBMC, they encountered the choir, happily listened to a song and asked to have their photo taken with the group of talented singers! Thanks to all the GBMC employees who spread so much cheer during this holiday season, including our Russian friends!



Members of GBMC's Berman Cancer Institute and the Russian delegation enjoy the festive songs of GBMC's holiday choir


It’s all about connecting with people. I look forward to continuing to connect with our front line staff in the coming weeks as we kick off the winter Town Hall meetings in January and February 2011 (Click here for the listing of dates and times: http://infoweb/body.cfm?id=23&action=detail&ref=200). I want to hear from you, so whether it’s by leaving a comment on this blog or discussing issues that matter to you at the upcoming Town Hall meetings, let’s keep the dialogue rolling.

Individual Actions Help Our Patients

With the cold weather here to stay for a while and flu season about to kick into high gear, I want to thank everyone who was immunized against influenza (and thank all our healthcare professionals who worked to administer the vaccines) during the mass vaccination drill in October and throughout the past month. The Centers for Disease Control (CDC) believes that all individuals who work in healthcare facilities need to be immunized against influenza to protect the patients (and themselves). Hospitals nationwide are calling on their staff to make it a priority to get vaccinated against influenza. You can read more about the importance of getting vaccinated on the CDC’s website: http://www.cdc.gov/vaccines/spec-grps/hcw.htm or learn more about influenza in general on http://www.flu.gov/.

And, here’s another great example of individuals doing something to help our patients - hand washing. It’s a proven fact that washing our hands saves lives by preventing the spread of infection. But it must be a conscious decision, a task we are dedicated to doing. When a pilot and copilot of a plane take off without running a checklist, the most likely result is that they will land safely. But, it is their job to ensure the safety of their passengers, and so they run through their checklist before every take off and landing. Doing something as simple as a checklist – or as easy as washing your hands – is the right thing to do to protect those in your care, whether it is a plane full of passengers or a hospital full of patients.


In recognition of National Hand Hygiene Awareness Week you may have seen this message throughout the hospital – Wash in. Wash out. Repeat. The fundamental concept urges everyone to wash their hands, either with soap and water or with alcohol-based hand sanitizer, before and after entering a patient room.


The NICU staff does this quite well. And so does the staff on Unit 27. In fact, they serve as examples to follow as they achieved 100 percent compliance for hand hygiene in November. The employees on Unit 34 were right behind with compliance rates at 91 percent for November, well above the hospital goal of 70 percent compliance. I commend the staff and the managers of these units for their commitment to our patients’ safety and good health.


If you haven’t yet had the chance to see the hand hygiene video on the Infoweb, I encourage you to check it out:

And, on Thursday, December 9, members of GBMC’s Infection Control department demonstrated just how many germs live on our hands even after we think we have washed them thoroughly.

Employees, physicians, visitors and patients alike tried out Infection Control's Glow Germ and blue light demonstration to see just how clean their hands really were. Many people were surprised at the results! 

Working in healthcare is a calling of service. And when we put our patients first, it’s evidence of our dedication to their safety and to helping others.

As always, I welcome your comments and feedback on how you practice patient safety in your everyday duties.

We Are All In This Era of Change Together

As we continue to deal with the redesign of healthcare on a national level as well as a local level, we must keep an open dialogue about how the changes we are facing are impacting us, not only as a hospital, but as physicians, employees and members of the community-at-large. A leading facet of healthcare reform centers on the financial health and security of our country, our state, and our own medical center. It’s very important that we look out for the financial health of the hospital, as well as the hard working physicians who care for the many individuals and families who turn to GBMC for their care.

GBMC is a mission driven organization. We are here to serve our community. And, while we are not primarily about finances, we have to be financially strong in order to meet the mission. That is why I am very pleased to report that GBMC recently had its A+ bond rating affirmed by Standard and Poors. We are one of only two hospitals (along with Johns Hopkins) to achieve this high rating in Maryland, demonstrating that we are staying the course when it comes to fiscal responsibility and financial stability.  I want to thank all of our hard working staff members, physicians and nurses for helping us minimize waste so that we can keep this rating.

GBMC’s leadership continues to navigate the ever-changing landscape of healthcare, working hard to secure a successful future for our great organization. The creation of the Greater Baltimore Health Alliance is one vehicle that will help ensure we are able to remain financially secure together by looking into:

• ways to legally be able to defer costs of launching the Electronic Medical Record (EMR) in private physician offices
• ways to make both the hospital and our physicians thrive in bundled payment arrangements
• ways to be ready for capitation, if it comes.

It’s important that we work as a team to reach our vision – where every person gets the best healthcare, every time, at the least cost. Over the past several weeks, I’ve heard from many physicians who are happy with the direction GBMC is heading and who are pleased to hear that we are focusing on the patient without sacrificing our staff.  I have also heard concerns.

I feel strongly that keeping the lines of communication open is the best way to address these concerns. In fact, I was very pleased to attend the first of many dinners with a group of physicians on December 2 to discuss what the vision and future looks like for GBMC. So, give me a call. Let’s set up a meeting. Send me an email. Or, leave a comment on this blog.

We’re all in this era of change together. Let the dialogue begin…and continue.

Looking forward, National Hand Hygiene Awareness Week is December 5 - 11. This is a great opportunity to reflect on the importance of maintaining the highest hand washing compliance rates, as patient safety is a top priority at GBMC.

Wishing all those who celebrate the Festival of Lights a very Happy Hanukkah.

We Have Much to be Thankful For

With all the changes taking place in the healthcare world today, we have a tendency to focus on our problems instead of looking at all the wonderful things at GBMC. But, at this time of year, it’s certainly nice that we have a day to reflect on what is good in our lives and what we have to be grateful for.

Here are just a few things we can be thankful for at GBMC:

• Patients who need us and turn to us in their time of need
  
• A top-notch medical staff. We had 121 physicians on staff that were recently recognized in Baltimore magazine’s “Top Doctors” issue – more physicians than any other community hospital in Maryland. In fact, these Top Doctors were recognized by their peers as the physicians to whom they would send a family member.
  
• The phenomenal support of our community including the many individuals who dedicate their time and resources to the various and important hospital boards
  
• Our consistently high performing Gilchrist Hospice Care and the team of healthcare professionals who tirelessly deliver wonderful, compassionate care to individuals and families at the end of life
  
• The GBMC Foundation and its ability to generate substantial gifts and strong donor relationships, helping the hospital acquire the latest technology and services that allow us to provide the best care to our patients
  
• And last, but certainly not least, all of you - the wonderful employees, nurses, doctors and managers who work so hard and are so dedicated to making GBMC the great place it is. For all of you, I am truly grateful.

I am also grateful to the 30 employees who just completed their first semester at GBMC’s Center for Frontline Leadership, a comprehensive, two-year leadership development program designed to enhance the leadership skills of employees [non-managers] throughout the organization. Thirteen GBMC coaches have been guiding these employees through the program and on November 16, all 30 participants presented their projects based on the leadership skills they have been working on with their coaches. I had the opportunity to see these presentations and was truly inspired to see so many future leaders flourishing, learning and working together.

Thanksgiving spirit was in full swing last week during GBMC’s annual employee turkey distribution on November 10 and 11. About 3,800 turkeys were given out to staff as tokens of appreciation for the hard work you do each and every day.

Wishing you a joyful Thanksgiving!

P.S. Are you doing anything special or unique for the holiday? I’d love to hear about it – leave me a comment!

Working Together to Make Things Better for Our Patients and Ourselves

Every day I meet people who are concerned about change in the world of healthcare. Last week I attended several focus groups that brought together primary care physicians from around the region to talk about healthcare reform and what it really means for our doctors. What I heard from these individuals is that many physicians are skeptical of healthcare reform, that the government doesn’t really know what is best for patients and that many doctors have little trust in hospital administrators.

I had the opportunity to address some of these very issues with our own physicians at the medical staff meeting on November 9. I spoke about the changes – and the possibilities – that are coming to healthcare, and how, if we confront the future together, we can come out stronger and better.

[Click here to see the video of the medical staff meeting presentation: http://vimeo.com/16745378. *Note: this is a large file - if you have problems playing, press pause to allow the video time to load.]

Quarterly Medical Staff Meeting- President's Report from GBMC on Vimeo.

Not too long ago I was a practicing pediatrician, so I know where physicians are coming from. But, what do we do?

We have two choices.

We can sit back and hope that maybe this reform everyone keeps talking about will just go away.

Or, we can take action now to improve health, improve care and reduce costs. We can change our current healthcare system into one that is more patient centric. By doing this we will not only do well by our patients but we will also have the best chance of doing well ourselves. I believe this is the right choice.

Physicians, nurses, other clinicians, support staff, and administrators must band together. Toward this end, we will be creating a new entity known as Greater Baltimore Health Alliance that will address the changing face of healthcare by working with our physicians, both employed and private practice doctors, to better focus on the needs of our patients.

It all comes back to – What if it were your daughter? Our goal is to achieve the best possible health outcomes, have a higher level of satisfaction with the care provided, create less waste and have our care providers take joy in what they do best – care for our patients. It’s up to all of us to take the lead in this new challenge.

And, speaking of this new world in which we live, I recently attended the signing of the Baltimore County Memorandum of Understanding (MOU) – an agreement between GBMC and six other local healthcare and educational institutions that in the event of a community disaster we will be able to come together to provide life-saving medical care to all those affected. This means the creation of a “surge site” that will allow a large number of patients to be rapidly treated if all local hospitals have exceeded capacity for receiving patients. I was proud to be associated with the men and women at GBMC and in the community who stand ready to meet an extraordinary need and work together in crisis.

Pictured at the signing are: Mike Forthman, Dan Tesch, Baltimore County Executive Jim Smith, Dr. Jeff Sternlicht, Dr. Chessare and Michelle Tauson.

I am a believer in change for the better and in working collaboratively to meet the needs of our hospital, our patients, our physicians and our community – are you? I welcome your comments and feedback on this topic.

We are a family.

At GBMC we are a family. All families have good days and bad days; they receive good news and bad news. Since I arrived here in June, I think there has been much more good news than bad news. But last week we had 2 tragic deaths of members of our GBMC family. The first was Patricia Brock-Johnson, a surgical technician in the Women's Surgical Center. Pat's work at GBMC began in 1992 in Labor and Delivery. She later transferred to the Women's Surgical Center. I did not know Pat well, but her colleagues have told me that she was a great member of our clinical team who was very skilled, kind, and who took great pride in her work. The second was Joshua Burger, an OR support assistant in the General Operating Rooms. Josh came to GBMC in 2009 and quickly became a valued member of our surgical staff. I did not know Josh but I have learned that he had many talents and that he was a freelance painter and specialist in exterior restoration. Josh was a dedicated and dependable member of the OR team. I know it was hard for people who knew Pat and Josh to get through work last week. Thank you for supporting each other and for remembering Pat's family and Josh's family in your thoughts and prayers.

Over 2400 members of our family received the annual influenza vaccine last week as part of our annual push to protect ourselves and our patients from this annual scourge. I am grateful for the hard work of all those who pitched in to make the first week of the initiative so successful!

Organizations that want to move forward must set goals for themselves. Our goals are the answer to the question: "How will we know if we are getting closer to our vision of treating everyone, every time, the way we would want our own loved ones treated?" We have now finalized the GBMC Healthcare System Goals for fiscal 2011. The goal's are:

GBMC Healthcare
Annual Goals
FY11
(July 1, 2010 - June 30, 2011)

I will be talking more about our goals as we go forward. We must get better at executing change. One way to do that is to celebrate teams that reach their goals. On Friday, we celebrated both Halloween and those teams that achieved their patient satisfaction goals for the first quarter of this fiscal year.

One of the Teams that reached their patient satisfaction goal for the quarter was the Chemotherapy Infusion Center in our Cancer Center. Treating patients with cancer is not easy. These members of our family are very good at it.

Reflecting on Our History

I spent a lot of time this weekend emptying boxes brought into our new home in Roland Park by the movers last week. We love the house and the neighborhood.....but I could do without the work of finding a place for all of our "stuff" and wondering why we brought a lot of it with us from Massachusetts in the first place. How many flower vases could we ever use, anyway? I must have unwrapped at least 20 of them yesterday.

One of the reasons why unpacking is taking me so long is that I am reminiscing as I go. You see I am finding things that were buried in our last house probably since the last time we moved. (I still haven't found my set of 1960 Topps baseball cards that my Mom swears she did not throw away.) I re-read some notes that my wife had sent me while we were dating; I found the certificates that my children received when they passed toddler swimming lessons; I again scrutinized my certificate from the American Board of Pediatrics; and I marveled at all of my wife's cookie baking paraphernalia (She has always amazed me at how good a baker she is, especially around the holidays.) I found myself reflecting on our family's history, with all of the good things and the challenges and was reminded about what was most precious. Remembering one's history is important so that the precious can be protected.

Last week, I met with members of the Otolaryngology (Ear, Nose, and Throat) Department. We are in the midst of a search for a new Chairman for ENT. Dr. James Kelly has decided to retire, after a long and illustrious tenure leading the physicians and growing the services to better serve the community. The physicians wanted to meet with me, to assure that the health system would hold on to what was precious in their department. They reminded me of the history of the founding of GBMC by the coming together of the The Hospital for the Women of Maryland, of Baltimore City and Presbyterian Eye, Ear and Throat Charity Hospital.

Julian Chisholm MD, a noted Civil War surgeon, had begun the Presbyterian Hospital to serve patients with eye and ENT diseases. Through its existence until 1965, this wonderful specialty hospital had welcomed well-trained physicians from the community and gave excellent care in a spirit of collegiality. Since the creation of GBMC in 1965, the Otolaryngology Department has continued to thrive by building on this wonderful history. In fact, GBMC may have the largest ENT service of any community hospital in the country! From general ENT care, to head and neck surgery, and now to our cochlear implant program, there is much that is precious and we must reflect on our history to not lose sight of this. I am grateful for all of our Otolaryngologists, our nurses, our audiologists, our speech and language pathologists, and all the rest of the team giving care to our patients. We will not lose what is precious.

I love to eat (I am fighting to not gain back the weight I lost by staying on an exercise regimen; my schedule has a lot of early morning and late evening meetings) so when I was asked by Stacey McGreevy to be a judge in our Chili Cook-off to kick-off our United Way campaign, I couldn't say no. So last week, I and the other judges tasted 10 different contestants' chili recipes. They were all so good it was hard to pick a winner. Please give as you can to the campaign, the United Way helps so many worthy organizations that cannot serve those in need without our help. Also, please thank Stacey and her Committee!

A shout out to Allison Habas MD, Lisa Griffee and all of our wonderful CPOE Team! The implementation is going very well so far. Our patients are safer and our staff will be doing so much less rework when our implementation is finished next spring.

Saving, Celebrating, and Planning

This past week saw a number of notable events involving our family at GBMC. The first was one that we did not plan. However, it showed our determination and strength in a moment of crisis.

A patient with mental illness started a fire in her room on Unit 36. The staff immediately went into action. They Saved the patient by removing her from harm; they called 3473 to sound the Alarm; they contained the fire and controlled Ventilation by closing the door to the room; and then Nicole Young RN and Helene Hyde NST used the fire extinguisher correctly to Extinguish the fire. The staff quickly and safely removed the patients on the floor to other units since smoke was present and the fire department arrived to make sure that everything was OK.

When I came in and saw the aftermath that evening, I was very grateful that no one was seriously injured. The team on Unit 36 was prepared, brave, and determined to keep the patients and themselves safe. They did a great job and I am proud of them. We will redouble our efforts to assure that episodes like this one do not happen again. Patient safety must be a given.

On Thursday evening we had our annual employee recognition dinner. I was truly amazed with the turnout and by the planning, spirit, entertainment, overall enthusiasm, and the joy of everyone involved. Patricia Larkin from Human Resources and her team oversaw the planning and organization of the event. Melissa Sparrow MD was the Master of Ceremonies extraordinaire and also displayed her wonderful comedic talent! I was rolling in laughter during the skits performed by a cast of characters too long to list here. All the time and effort was put in to recognize the many years of service of our people and to celebrate all 458 of them who had reached a milestone. We had 202 of our team with 5 years of service; 114 celebrating 10 years of dedication; 37 celebrating 15 years; 57 celebrating 20 years; 19 with 25 years of service; 14 with 30 years; 4 with 35 years; and an astounding 11 with 40 years of service many of whom are in the photo below!

Yesterday, we dedicated the sculpture, "Health, Healing, and Hope" that had been commissioned for the healing garden at our Sandra and Malcolm Berman Cancer Institute. The healing garden is a fantastic asset that helps cancer patients get through the ordeal of cancer and its treatment. Members of the Woodbrook-Murray Hill Garden Club invited Francesca Schuler Guerin, owner and director of Baltimore’s Schuler School of Fine Arts to partner with them in finding a sculpture to add to the garden. Francesca Guerin invited students at the Schuler School to participate in a design competition for the project, which resulted in the selection of the bronze wall sculpture that is now installed. The artist is Dana Maranto and the piece was cast and bronzed at New Arts Foundry in Baltimore. We are very fortunate to have such community support for our cancer care. Please visit the garden and view this wonderful piece of artwork when you get a chance.

On Friday and Saturday, members of our Board of Directors, our senior management team, and some of our physicians met off-site for a strategic visioning retreat to help set the course for GBMC Healthcare over the next few years. I will be telling you more as our Strategic Planning Subcommittee of the Board continues its work, but I wanted to share with you our "elevator speech" to let you know where we are going:

"We have decided to evolve our current health system to one that is patient centric. We will actively manage the patient’s health in the most effective and efficient way. Our integrated system of care will involve an alliance with our physicians, both employed and in community practice, to efficiently manage patients’ needs.

We will evolve into an accountable care organization (ACO) where we will coordinate patient care with other partners to build healthy communities."

There is much more planning to do and then the execution of our plan will be the harder part. I look forward to working with all of you on this. It will be the extension of the work we have already begun to be the healthcare system where everyone, every time gets the healthcare that we would want for our own loved ones. (see my blog: "What if it was your daughter?")

I would love to hear your thoughts on this.

A Dynamic Duo

Emergency Departments were created in hospitals in the early twentieth century as a place where accident victims or the seriously ill could be brought for rapid assessment and treatment. Over the course of the twentieth century they became much more than that, and are now a place where patients are often sent or come on their own because their needs cannot be met elsewhere. If a physician's office or clinic is closed, or if it is determined that another patient can't be accommodated in the office, the patient is sent to the ED. If a patient needs to be admitted, but there are no available beds on the floor, the patient is sent to the Emergency Department. If you have no doctor (or no insurance) but you need help, even if the issue is not an emergency, you go to the ED. The Emergency Department is the pathway of least resistance in our complex healthcare world.

So it is easy to understand why the ED is a very busy, frequently over-crowded place and why it can be a very difficult place to work. I am very proud of the people that staff our Emergency Department at GBMC. They do great work and they have made incredible progress at redesigning the processes that they control, all towards the goal of making it better for our patients. From the nurse in triage, to the registration staff, to the nurses, physicians, and other clinicians and staff providing the care and maintaining the rooms, the whole Team has been in action making improvements. I know this because I hear about their work at meetings, I read about it in letters from grateful patients, and I have seen it with my own eyes when I have visited the ED. I was thinking about why it is that the Emergency Department does so well, often against all odds. I have concluded...and I'm sure it will come as no surprise to the readers of this blog....that its about leadership.


Our Emergency Department has two great leaders: Paula Terzigni, RN, our Nurse Manager and Jeff Sternlicht, MD our Medical Director. Paula and Jeff meet with their Team at regular intervals; they celebrate and thank people for their hard work: they study the design for care in the ED and engage their staff in ways to make it better; they take on problems within their control and fix them; and they make direct requests of other leaders for help on things outside of their control. Paula and Jeff are "glass half-full" people. I am very grateful for their leadership and the hard-work and dedication of their staff.

The good news for me, our system, and the community we serve is that GBMC is full of great leaders like Paula and Jeff. I will be thanking them in this blog as we go forward.

The rest of us owe Paula, Jeff and their Team more than words of thanks, however. I would love to hear your thoughts on how to unburden the Emergency Department. What can we do to make non-Emergent care more available in other venues? How can we improve our ability to directly admit patients who need to be admitted from their doctors' offices? How can we move admitted patients from the ED to their inpatient beds faster? (see my blog of August 16, 2010). How can we "smooth" our inpatient bed demand over the five work days so it is more likely that we will have a bed for a sick patient in the ED? Please share your ideas!

Celebrating a Nursing Mentor

Jody Porter, MBA, RN our wonderful Chief Nursing Officer, and I visited our Surgical Intensive Care Unit last Monday in the morning at change of shift. As I walked into the staff room, I was really surprised to see so many younger nurses. I remember not too long ago when we were worried that we would not have enough nurses to serve the baby boomers because many of our nurses were themselves, baby-boomers, and would be retiring soon.

Our nurses work very hard, and this is certainly true in the SICU. The job in the SICU requires a high-degree of professional competency. Among the many advantages of youth are: energy, enthusiasm, and a lack of being set-in-your-ways. After a few words of introduction about myself, the staff gave me a brief education about what was going on in the unit. I then asked them the question: "Is there anyone who is really helping you in your work that I should be thanking?"

Without a moment of hesitancy, one of the nurses said: "Justine! She is always there for us." The nurse was referring to Justine Kellar, RN, BSN, the nurse manager of the SICU and Unit 38. In the photo above, Justine is seated fourth from the right. The other nurses chimed in with many reasons why Justine deserved to be recognized and it was clear that she was more than just a boss to them. Justine Kellar is a great example of a mentor. The dictionary defines a mentor as an adviser and supporter: somebody, usually older and more experienced, who advises and guides a younger, less experienced person. The downside of youth is that lack of experience. Our younger SICU nurses are smart, well-trained, and caring and they need a mentor.....and they've got one!

Nursing is a marvelous vocation. It is all about serving others. It is a difficult, physically taxing profession, but it is a joyful profession. It is people like Justine Kellar, who in guiding younger nurses in their work, help to keep the joy alive! I am so grateful to Justine and all of our other nurse leaders. When you see one of our nurses, please thank him or her for all that they do for our patients and our hospital.

Designing Our Systems

Last week, I had the great pleasure of attending the report out session for our team that was redesigning our discharge process. Many patients come to us needing inpatient care. Frequently, we don't have a bed ready for them when they need it so.........they wait. Sometimes, we actually do have a bed for them, but it hasn't been cleaned yet. We knew that our process for getting a discharged patient on her way and then cleaning the bed for the next patient was not well designed. We also knew that it had too many steps......but we didn't know how many.


The wonderful team in the photo above found that the process had 109 steps!

The Team realized that the system was never really designed in the first place so there were many steps that were not necessary or were being done more than once. Until the Team got all the steps written down, we did not know what the whole process looked like. The Team then set out to remove all of the waste.....the steps that didn't help get the patient on his or her way and then get the room ready for the next patient. The Team redesigned a process that had about 40 fewer steps! They are now testing their changed system to make sure that it works well and then we will roll it out to the whole hospital.

We are now using the science of continuous improvement as the way we move GBMC forward toward our goal of being the healthcare organization that treats everyone, every time the way we want our own loved ones treated. Since we don't want our own loved ones to wait for a bed......no one should wait for a bed.

This science, whose fathers included W. Edwards Deming http://en.wikipedia.org/wiki/W._Edwards_Deming, and Walter Shewhart http://en.wikipedia.org/wiki/Walter_Shewhart, has four main components.

The first is a focus on the person you are serving. In our case, we are serving patients. We must make sure that our work stems from what our patients need and want and to be careful not to focus on our own needs and wants.

The second component is the notion of design. High performing organizations don't get closer to perfection by relying on hard work and good intentions alone. Every system is perfectly designed to get exactly the results that it gets. If our patients are waiting, exhorting our people to move faster is not very smart. Our Team pictured above knows this, so they redesigned the existing system to reduce waiting.

The third component of continuous improvement is the use of measurement. Measurement provides the answer to the question: "How will we know if our change is an improvement?" The team is measuring the time from when a discharge order is written until the room is ready for the next patient. They plan to display the data on our inpatient units so that our people can see how we are doing.

The fourth component is teamwork. The hospital is a complex set of interconnected parts with many people doing specialized roles......just like the Ravens. Imagine what would happen if the Ravens tried to win as individuals, without the planning, practice, camaraderie, and collaboration that is required to win. We need the same in our healthcare organization.

The last component is empowerment. In winning organizations, people come to work saying "Its interesting how well we did yesterday....how might we do it better today". They don't wait for the boss to tell them what or how to change...they see generating meaningful change as part of their job.

Our teams are using Lean tools in their improvement work. The tools help us to get the waste out and to make things better for us and those we are serving....our patients!

I am very proud of our discharge process design team! We should all thank them for making things better.

Verbal Orders

I have been on airplanes a lot since I came to Baltimore for my first interview at GBMC this spring and a few times recently to see my family (my college-age children have summer jobs in Massachusetts). When I fly, I don't worry about my safety. This was not always the case.

I am old enough to remember when NBC had a correspondent, Robert Hagar, who only reported on airline crashes when they used to happen about 4 or 5 times a year in the US. Mr. Hagar retired and NBC eliminated the position (I think) because it is now a rare event that someone dies in a commercial airplane. What happened to make airline travel safer than it used to be?

There are many reasons why its safer to fly now than before but one big reason is that the Federal Aviation Administration has had pilots and air traffic controllers designing the communication system for safety. Pilots and air traffic controllers are humans....and humans make errors.

Even though both groups are very smart, have had many hours of training, and want all planes to land safely, in the past sometimes they would miscommunicate and cause catastrophes. Their communication system was reliable but not reliable enough. Very rarely, a pilot would hear "land on runway 1 Right" when the command was actually being given to a different airplane. The pilots and air traffic controllers realized that a system that was 99%+ reliable wasn't reliable enough if someone they loved was on the plane (see my first blog posting "What if it was your daughter?" http://ahealthydialogue.blogspot.com/2010/07/what-if-it-was-your-daughter.html).

All reliability means is "What should happen....happens and what should not happen.....doesn't. So, pilots and air traffic controllers now use a designed communication system called hear-back. The air traffic controller announces herself to the pilot and gives a command like "USAir 1006 ascend to 30,000 feet over" and the pilot announces himself and then repeats the command as he has heard it, like "Roger, USAir 1006 ascending to 30,000 feet, over". In this way, the air traffic controller "hears back" the precise instruction that she has given the pilot to assure that he has received the message correctly.

This week, I was with our wonderful planning team for the implementation of CPOE, Computerized Provider Order Entry. The team was discussing our on-going challenge of making sure that when a doctor gives a nurse or therapist a verbal order, that the order that the nurse "hears" is the order that the doctor intended to give. The computer system will give the physician the ability to directly put orders into the system from anywhere that he or she can get an internet connection. This will eliminate the handoff that exists in the paper world where a written order must be transcribed by a clerk. However, there will still be occasions like in an emergency, or when the physician is in the middle of a procedure, or when the physician is speaking with a nurse on the phone and is not near an internet connection, when verbal orders will be required. So the team was discussing our use of read-back where the nurse who has entered the order will read it back to the physician to assure that the correct care is delivered to the patient.

Medical care is a high risk endeavor just like commercial aviation. Its great to see us learning tools and techniques from another industry to make our care safer. If it was your daughter who was the patient, you would expect us to be doing this to protect her.

Collaborators in Care

This week, I had the great experience of having lunch with members of our Geriatrics/Palliative Care/Hospice team. Their work is inspiring to me as we figure out how to give outstanding care to very sick and often elderly patients in the last phase of their lives. You may know that our hospice company Gilchrist Hospice, recently had a Joint Commission survey and had no findings of deficiency! In my experience, surveyors always find some areas for improvement even if they are minor. Gilchrist got a perfect score. I am very proud of them.

Yesterday, I was given a tour of Sheppard Pratt Hospital http://www.sheppardpratt.org/ by the system's president, Dr. Steve Sharfstein. Dr. Sharfstein was very kind and he took me on a tour of the facility and educated me about the rich history of his hospital. I will spend more time on this blog in the future talking about care for our patients with mental illness, but it is a wonderful gift to have such a marvelous organization as our "sister hospital" and colleagues on the hill.

What if it was your daughter?

I would like to thank everyone for welcoming me to GBMC! Since taking on the CEO role in June, many people have asked “what is your vision for GBMC?”

Our vision statement talks about becoming the organization that is known for ….”personalized service” ….with the guiding principle that “the patient always comes first”. My take on this vision is that we want to become the organization that delivers the care that we would want for our own loved ones to everyone, every time.

I have asked myself many times “What if it was my daughter?” I would want my daughter to go where she would get:

· the best clinical outcome
· the highest level of satisfaction with the way the care is delivered
· with the least amount of waste in time and money
· and where those providing the care got the most joy from helping people.

The game for us then is to come to work every day trying to get closer to the goal of the care that we would want for our own loved one......... for everyone, all the time!

I have been in healthcare a long time. No one will argue with this vision. Why are we so far away from it on many days? I think its because we don't change as fast as we need to . We need to get better at executing change. Here's an example: yesterday I met with representatives of our "Hand Hygiene" team. GBMC is only average at getting everyone to clean their hands before they go into a patient's room and after. We know this is the thing to do and we have the will to do it.....proven ideas on how to do it are out there.....but we are not good enough at executing those changes. But we will get better at execution!

If it was your daughter.....you would want the caregivers to clean their hands before and after....so we have to get to it!

I would love to hear your thoughts and I look forward to working with everyone to make GBMC even better than it is already.