Friday, September 30, 2011

Recognizing the Hard Work and Commitment of GBMC HealthCare Employees

Much has changed in healthcare in the last several decades – new treatments are being discovered for treating diseases, new equipment has allowed for surgeries unimaginable a few years ago, and patients are often experiencing shorter and safer hospital stays.

One thing that hasn’t faded over the years at GBMC HealthCare is the loyalty of our employees.  A generation or two ago - across many industries - it was not uncommon for employees to work for only one employer during their entire career. My father for example spent more than 25 years working for a defense contractor.  But today, the world is different and people change employers frequently.  Thankfully, many of our employees have given many years of hard work and commitment to GBMC.

Last week, we enjoyed a wonderful celebration – the annual Employee Recognition Dinner, where we recognized nearly 500 employees for milestones in their employment with the organization.  This was a very important night, because we need to recognize our people for their dedication. It’s also a reminder to me of my duty to look to create opportunities for our staff to grow within our organization.

Thirty-six employees were recognized for working at GBMC for 30 years or longer – including four for 45 years and seven more who’ve worked for the organization for 40 years!  These people have been with us for almost the entire existence of the organization - GBMC HealthCare was incorporated in 1960, consolidating the operations of two specialty Baltimore hospitals: The Hospital for the Women of Maryland, of Baltimore City and Presbyterian Eye, Ear and Throat Charity Hospital, and GBMC opened its doors in 1965 as a regional medical center. That’s amazing and quite a commitment that these individuals have made to us, and in turn to our patients and the community.

It was truly humbling to think of all of the years of commitment to serving the patients of GBMC represented at the dinner by each of our 493 employees who were recognized for at least five years of service. Each service milestone is quite an accomplishment and all of us sincerely thank our staff for their commitment to GBMC and its patients over the years. 

All of our employees give meaning to our mission of providing medical care and service of the highest quality to each patient leading to health, healing and hope.  In addition, we hope each models our vision that to every patient, every time, we will provide the care that we would want for our own loved ones.

In addition to the 40 and 45 year milestones, we also recognized 10 individuals who have dedicated 35 years to this hospital; 16 people who reached their 30-year service milestone; 29 individuals who have been with us for a quarter of a century; 46 employees who have spent 20 years of their career at GBMC;  55 employees celebrating 15 years; 91 employees celebrating 10 and a whopping 235 celebrating five years of service.

The dinner also gave us an opportunity to think about the present and the bright future of the GBMC HealthCare system and reflect on a few of the accomplishments we have made during the last year:
  • Created the Greater Baltimore Health Alliance (GBHA), a collaboration of physicians both employed by GBMC HealthCare as well as those in private practice, to integrate care delivery across the full spectrum of clinical services. 
  • Implemented electronic medical records (EMR) that facilitate the exchange of health information, and help coordinate care among the practices, the hospital, our hospice and other future community partners.
  • Implemented computerized physician order entry (CPOE) in the hospital.
  • We redesigned our quality and safety system.
  • Gilchrist Hospice Care opened its new 10-bed acute care inpatient hospice center in Harmony Hall Assisted Living in the Howard County Health Park. 
  • Gilchrist Hospice Care and Gilchrist Greater Living was one of only 3 organizations in the country to win the prestigious Circle of Life award from the American Hospital Association.

Were you one of the employees honored at the dinner?  Please share your thoughts about why you enjoy working for GBMC HealthCare.

On a final celebratory note, the GBMC family enjoyed a wonderful 11th running of the Shawan Downs at Legacy Chase last weekend.   We were happy that thousands of community members, staff, and supporters, including Baltimore County Executive Kevin Kamenetz, enjoyed the thrill of steeplechase racing along with a day in the beautiful countryside.  I was pleased to have the opportunity to thank many GBMC donors, who have been very generous over the past years.

The Stick Pony Race for children under 8 years benefited our Pediatric Emergency Department and with more than 70 little jockeys competing in four age groups, the event generated $22,000.  The annual car raffle (a heartfelt thank you to former board chairman Charlie Fenwick and Valley Motors for their continuing support) was also a success with a local resident and grateful GBMC patient William Franswick winning the 2012 Volkswagen Passat lease. A truly gracious winner, Mr. Franswick will make a gift to GBMC while opting for the cash prize of $10,000, for which we are very grateful.

This wonderful event would not have been successful without the support of our loyal volunteers, who help put on this huge event each year.  Their efforts were also important in raising $22,000 to benefit GBMC nursing programs and the volunteer office through the sale of the car raffle tickets.

Photos from Employee Recognition Dinner:

Friday, September 23, 2011

Maryland’s Rate Setting For Hospitals : A Successful Plan that Needs to be Updated

Last week I attended my first Maryland Hospital Association Executive Committee meeting and one of the topics of focus was Maryland’s unique all-payer rate-setting system, governed by the state’s Health Services Cost Review Commission (HSCRC).  We certainly had some experts in attendance  for our discussions as we were addressed by Dr. Josh Sharfstein, Maryland’s Secretary of Health; John Colmers, Dr. Sharfstein’s predecessor as state health secretary and former executive director of the Maryland Health Care Commission (MHCC) who is now serving as HSCRC’s chairman; and by Chet Burrell, President and Chief Executive Officer of CareFirst Blue Cross Blue Shield.

For the uninitiated, the HSCRC was established nearly 40 years ago as an independent agency of the government and is primarily charged with setting hospital rates with ultimate goals of keeping hospital stays affordable, providing access to care for patients who are uninsured or underinsured, and covering some of the costs of uncompensated care.

Based on a federal waiver which exempts Maryland from adhering to Medicare and Medicaid reimbursement rates, the HSCRC sets rates for all payers: private insurance companies, HMOs, Medicare, and Medicaid – a system referred to as the "all-payer" system because all payers pay for their fair share of hospital costs. Additionally, Maryland hospitals cannot “mark up” their charges for patients as can hospitals in other parts of the country.  Maryland is the only state in the country that has a Medicare waiver. Under this agreement, Medicare reimburses Maryland hospitals according to HSCRC rates.

Some experts say Maryland’s system has saved citizens more than a billion dollars in hospital costs because hospital rates in Maryland have grown at a rate slower than at hospitals across the country.

Maryland’s story is one of success – the stipulation from the federal government was that the increase in the cost of healthcare in Maryland as a result of the waiver be less than the increase in the rest of the country and that has happened.  Now, our conversation is turning to how Maryland can continue to do things differently when it comes to healthcare and further our successes for the benefits of our citizens.

There’s been some deliberation on linking the waiver request to do things differently that are more in tune with what we are actually trying to do today. With the current waiver if we actually do things that reduce payments to hospitals we actually put the waiver potentially at risk.

However, there was unanimous agreement that Maryland should be a trend setter and we should take advantage of being different and try things that get us closer to the “Triple Aim” of better health, better care, and lower cost.

One such approach being implemented at some of Maryland’s smaller, often rural hospitals is the Total Patient Revenue concept.  Under TRP, essentially hospitals are given a budget based on their base revenue, regardless of volume.  Although this essentially puts a cap on revenue, any dollars that the hospital is able to cut – for example for unnecessary admissions/re-admissions or shifting care to less expensive outpatient services - they get to keep.

Hospital leaders at the meeting agreed to explore this and other innovative concepts more in-depth.  The movement is setting us in a direction of payments for health rather than payments for how many services we can do, and that will be a win for– hospitals, insurers, and most importantly, patients.

On a final note, on behalf of GBMC HealthCare I'd like to extend congratulations and a warm welcome to Dr. Maravene S. Loeschke, who earlier this week was named as the next president of Towson University.

It's a homecoming for Dr. Maravene, a Baltimore native who received both a bachelor’s degree in theater and English and a master’s degree in education from TU. She spent more than 30 years at TU, moving up through the faculty ranks and serving as dean of the College of Fine Arts and Communication from 1997 to 2002. We look forward to continuing the excellent working relationship with our neighbor and Towson Four (GBMC, TU, St. Joseph’s, Sheppard Pratt) partner under Dr. Loeschke's leadership.

Friday, September 16, 2011

Remembering 9-11 And Its Impact On Healthcare

During this past week, many of our community members have, in their own way, recognized and remembered the tenth anniversary of the tragic events of September 11, 2001.  What happened that day forever changed American history and had dramatic implications for our healthcare system as well.

Most everyone remembers where they were on that day.  I was chief medical officer at Boston Medical Center and got a call from our chief of trauma surgery, a former military surgeon, who said, “What are we going to do?”  Not knowing what had happened, I responded, “What are you talking about?” and he informed me that a plane had just crashed into the World Trade Center.  We immediately shut down our operating schedule and got ready for the potential of treating casualties.  My associate chief medical officer was a Colonel in the United States Army Medical Reserve and was deployed within minutes after the attack.  Within 18 hours he was in a medical tent blocks from where the World Trade Center once stood.  Both of those great surgeons with extensive training stood ready but, as we know now, sadly there were very few patients in need of medical treatment.

Although it was before my time at GBMC, I understand that our hospital, as well as dozens of others along the East Coast, also began preparing to treat the injured. Staff scrambled to get ready “just in case,” but we were never called upon to care for any patients.

However, as a result of what happened that fateful day, the federal government implemented several major changes to healthcare, specifically in the area of emergency management and crisis preparedness.  It is because of this that GBMC has a state-of-the-art Hospital Command Center, is home to a regional Alternative Care Site, and has a cache of supplies ready for use in an emergency.  Most recently, our emergency preparedness efforts were tested by Hurricane Irene, and while we did quite well, we encountered some  challenges and we have some changes to make.
"Our Team Comes Together When Hurricane Irene Strikes"

Like most Americans I was saddened by all of the people who lost loved ones and all of the phenomenal stories of those who gave of themselves for others in the days and months after 9/11 and who continue to do so.

One story I’ll never forget is that of Dr. Peter Moyer, who was medical director for Boston’s public safety agencies (police, fire, and EMS) and was chief of emergency medicine at Boston University School of Medicine.  Trained in casualty bereavement, Peter self-deployed to Logan Airport, where many family members of people on board American Airlines Flight 11 and United Airlines Flight 175 went for information.  Within two hours of working to console others, Peter learned that his stepson, a New York City Fire Department (FDNY) firefighter on Engine 5, died when the second tower collapsed.

This was then, and remains today, a cause for reflection.  How do you make spiritual sense of when someone doing something so selfless and valiant suffers such a significant tragedy in their own world?  Remember we are healthcare providers and things don’t always go well in healthcare.

The Wall of Hope and Remembrance at Saint Vincent's Hospital in Manhattan.
Another sad impact of 9-11 was an event that went down almost unnoticed outside of New York City. Saint Vincent’s Hospital was the hospital nearest to Ground Zero, where hundreds of medical personnel stood by ready to receive the injured.  Sadly, the hospital treated only 360 victims, as many more lay dead just two miles away.   The hospital was noted for its “Wall of Hope and Remembrance”, on which hundreds of fliers hung highlighting “missing” victims of the WTC attacks.

Aside from the forever-changed footprint of the World Trade Center complex, a significantly visible change for the community is that St. Vincent’s, which served the Greenwich Village neighborhood for 160 years and treated cholera victims and survivors of the Titanic disaster, is no more, having closed in April 2010.  St. Vincent’s staff stood tall during the 9/11 response and now they don’t even exist anymore. Why? Because they were unable to adapt to meet the needs of the community in an ever-changing healthcare world.

So what does this have to do with us at GBMC? Change and redesign are underway in lower Manhattan – both at the site of the former St. Vincent’s complex, where a new medical facility is planned, and at the former World Trade Center complex, where last weekend Americans saw the progress being made on Freedom Tower and the memorials at Ground Zero. Readers of this blog know that I’m a staunch advocate for redesigning systems as the only way to change what ails the American healthcare system.

Would you like to share your experience from September 11th, or how changes in the world, particularly in healthcare, have impacted you? If so, please comment below. 

On a much happier note, I was excited to be a guest at the recent Notre Dame of Maryland University celebration.  Founded by the School Sisters of Notre Dame as Notre Dame of Maryland Collegiate Institute in 1873, more than two decades later in 1895 they were re-established as the College of Notre Dame of Maryland, and have continued as a thriving undergraduate and graduate campus just a few miles away from GBMC on North Charles Street in Baltimore City. This year they changed their name to the Notre Dame of Maryland University to better represent the fullness and richness of what they do.  Congratulations to everyone affiliated with Notre Dame of Maryland University, including GBMC HealthCare board member P.J. Mitchell, a Notre Dame alumna who chairs their board of trustees, and Dr. Mary Patricia Seurkamp, Ph.D, who has served as president of the College of Notre Dame of Maryland since 1997 and is the first layperson to lead the school.

A hallmark of a Notre Dame of Maryland education is service, whether students are first-year undergraduate or Ph.D. candidates, which should be commended.  Two years ago, their School of Pharmacy welcomed its first class of students, and we look forward to these graduates joining us in the healthcare profession.  Hopefully there are opportunities in the future for our two campuses to collaborate on projects of benefit to the greater community.

Finally, we’ve had good turnout for the Town Hall meetings held so far, with many excellent questions being asked by staff.

I encourage all GBMC employees who haven’t yet joined us to attend one of our Town Hall meetings, which are an opportunity for direct communication between employees and senior management. If you would like to submit a question about the hospital/organization prior to the meeting, please submit it via GroupWise to Ann Brecht-Castle or drop your written question off to the reception area in Human Resources.  These meetings provide an opportunity to ask questions, raise issues, share information and clarify key objectives. Raffles will be conducted at each meeting, and lucky employees can win gift certificates! The value of these meetings is directly related to participation by staff members so we look forward to seeing everyone there.

Remaining Town Hall meetings:
DATE                             TIME                                          LOCATION

September 22       9:00 a.m.                                      Owings Mills
October 7               7:00 a.m.                                      Back of Dining Room
October 14       8:30 a.m.                                      Gilchrist - Hunt Valley

For more information about the Town Hall meetings, check here on the InfoWeb: Town Hall Meetings - Infoweb

Thursday, September 8, 2011

What If Mrs. Brown Was Your Mother?

Our vision is to be the hospital where everybody gets treated the way we want our own loved ones to get treated, and we often get it right.

Meet Jane Brown, a woman in her late 70s who recently received healthcare in GBMC’s Emergency Department (ED), Cardiac Care Unit (CCU), and the Acute Care for the Elderly (ACE) Unit.  Mrs. Brown is someone who knows our organization and was around as the hospital was being built.  She jokes that the kids used to say GBMC stood for “Great Big Medicine Chest” because it looked like a series of drawers going up the hill.

Mrs. Brown came to the ED with a complaint of severe pain (10 on a scale of 1 to 10) in her lower left quadrant. “This was the first time I was really, really sick,” Mrs. Brown says.  “I was sick enough that I begged to die.”  Thankfully, Mrs. Brown did not die; in fact she was released from GBMC and sent home last week in better condition than when we first met her.

In Mrs. Brown’s words, “From the very first time I entered the emergency room, I felt safe and felt surrounded by human beings who were going to try to help with my excruciating pain.  I knew I was in a safe place. I’ve never been this sick in my life. I’ve had breast cancer, and I don’t mean to diminish that but breast cancer has a beginning, a middle and an end.  This was a jolt to be so disabled.”

“I have been truly fortunate to find myself in a place where you understood what was happening and from a patient’s point of view that is extraordinary. The staff was present, not just physically there but there’s no question that they cared and I was not just a patient in a bed.  While on Unit 35, I’ve met some fascinating human beings.  We’ve had conversations about things besides just my medical condition, like whale watching and science for young kids.”

Asked where we can improve, Mrs. Brown made a comment about noise. Being quieter is something that we are already working on but the source of the noise that bothered Mrs. Brown was different. She said the high heels worn by women walking in the hallways of the ACE Unit were somewhat noisy.

We don’t always get it perfectly right but Mrs. Brown had to stretch to find anything that could be improved about her experience at GBMC. It’s interesting that noise, which is very hard to control because many of us are moving around in small spaces, was the one thing she brought up.  We need to reflect on how much noise is going on when a patient is convalescing nearby.

The fact that Mrs. Brown is so laudatory of her experience at GBMC should mean a lot to us. The fact that we really helped Mrs. Brown in her time of need is something we all need to reflect on.

Do you have a patient experience you’d like to share? If so, please comment below.

Finally, I encourage all GBMC staff to attend one of our Town Hall meetings, which are an opportunity for direct communication between employees and senior management. If you would like to submit a question about the hospital/organization prior to the meeting, please submit it via GroupWise to Ann Brecht-Castle or drop your written question off to the reception area in Human Resources.  These meetings provide an opportunity to ask questions, raise issues, share information and clarify key objectives. Raffles will be conducted at each meeting, and lucky employees can win gift certificates! The value of these meetings is directly related to participation by staff members so we look forward to seeing everyone there.

The meeting schedule is as follows:   

DATE                             TIME                                          LOCATION

September 12, 2011        11:30 a.m. (Lunch Provided)      Civiletti Conf. Room A & B
September 13, 2011        06:30 a.m.                                  Back of Dining Room
September 22, 2011        09:00 a.m.                                  Owings Mills
October 7, 2011              07:00 a.m.                                  Back of Dining Room
October 14, 2011            08:30 a.m.                                  Gilchrist - Hunt Valley

For more information about the Town Hall meetings, check here on the InfoWeb:
Town Hall Information

Friday, September 2, 2011

Our Team Comes Together When Hurricane Irene Strikes

In times of trouble it’s amazing how people are able to put aside their problems and “step up to the plate.”  And in times of trouble, people look to GBMC HealthCare and other healthcare providers even more than they would in other times.

As you can imagine, preparations for hurricanes are fairly complex for healthcare organizations.  Although we drill, practice, train and plan for various types of crisis situations, there are still a lot of "moving parts" that need to be considered. 

Such was the situation last weekend, continuing into this week, as Baltimore was hit with Hurricane Irene’s damaging wind and rain.  Roads were flooded, trees came crashing down and power lines were snapped, but our healthcare system  forged on, never stopping to provide quality healthcare for our community.

We’re very fortunate to have people like Dan Tesch, Michelle Tauson and Donny Dietez – our Emergency Management Department and leaders of the hospital’s Critical Incident Committee – who have created and organized the organization’s response to significant incidents like hurricanes. Critical Incident Team C was on-call for this storm, and led our staff in overcoming challenges and adversity to manage patient care in a safe and caring environment.

Carolyn Candiello, normally our Vice President of Quality and Patient Safety, served as the Incident Commander since it was her turn as senior executive on call. Carolyn did a marvelous job of getting us focused on what our needs would be in advance of the storm and in leading the team in dealing with issues as they came up. My team, Team D, was “on deck” and set to come in on Sunday evening. We stood down from Code Yellow on Sunday afternoon.

Kudos also to staff in our Facilities, Engineering and Nutrition departments  (Mitch Scholtes, Scott Sporre, Sam Tracey, Chas Pearce, Joe Warnecker, Charles Pochepko, George Dillon & Bob Marshall) who dealt with electrical issues, overnight flood remediation, cutting down and removing six trees near entrances and parking garages, false alarms with fire systems, and maintained food services for patients and staff on Saturday night into Sunday with no disruptions.

Dr. Chessare and Carolyn Candiello thank several members of the  Facilities, Engineering & Emergency Management staff for their work during Hurricane Irene.
Staff scheduled to work during the weekend were reminded to pack overnight supplies as we didn’t know what travel would be like.  Kudos to quite a number of employees who spent the night on Saturday to ensure our patients were cared for.

Sarah Roehl-Jacobs in Medical Records, Casey Porter Freeman, RN, from the Post Anesthesia Care Unit and Ryan Toth from the Emergency Department all performed "above and beyond" the normal protocol for weekend department coverage, staying overnight Saturday in order to guarantee continuity of patient care and ensure other staff would not have to travel to the hospital in the storm.  When our Central Sterile Processing Department lost power for a brief time on Saturday evening, employees Damon Briley and Violeta Gavin stayed overnight Saturday trying to get the sterilization equipment back online only to have their efforts go for naught when we were thrown a curveball just after 6 a.m. Sunday when the power went out hospitalwide.

Our brand-new emergency generators kicked in but while life-sustaining and other critical patient care equipment was connected to the generators, the chillers were not and for the nine hours that the main power was out, the temperature became somewhat uncomfortable for patients and staff.  On Sunday at 2:30 pm, I was in contact with Maryland Secretary of Health Joshua Sharfstein. Secretary Sharfstein was assessing the state of Maryland’s hospitals and he assured me that getting the Towson hospitals’ power restored was among the state’s top priorities. I was very glad when Carolyn informed me at 3 p.m. that the power had been restored. 

However, because the humidity levels increased when the air conditioning wasn’t working, the team had another hurdle to overcome as sterile equipment in the operating rooms was compromised.  More than 70 elective surgeries for Monday had to be postponed due to environmental cleaning and the reprocessing of all surgical instrument sets in house, and staff were able to get the cases all rescheduled by Tuesday, quite a yeoman’s effort. ORs had to be terminally cleaned and the complete inventory of sterile equipment was compromised and needed to be reprocessed. When I rounded on Monday afternoon in our central sterilizing department, our team, under the direction of Steve Adams, with assistance from the OR team led by Treva Kosco and Laura Perdue, had the situation well under control. Many operative kits had been sent out to be re-sterilized and staff displayed incredible teamwork working around the clock to ensure we would be ready for surgeries on Tuesday.  We even picked up a few surgical cases from a local surgicenter that had also lost power. 

Kudos to Central Sterile staff members who were assigned to work Sunday (Damon Briley, Violeta Gavin, Felicia Bostick , Mike Neally,  Lattia Lawson and Shiela Horne), all of whom who had lost power at their homes but still made it into work. Other Central Sterile staff members who braved the elements to offer assistance included Dan Schaefer, Doreen Schaefer, Maurice Dill and Jayd Aposaga).

Unfortunately, several patients didn’t receive the messages about canceled surgeries and still showed up for their scheduled Monday appointments.  No worries - a crew of OR staff - Kathy Lynch, RN, Brigid O'Keefe, Kim Thornton and Michelle Smith - all came in on Monday to greet the patients, explain the situation, handle service recovery and make them feel better, as well as to prep charts and schedules for Tuesday’s busy day in the ORs.

The storm also impacted GBMC at Hunt Manor, which has been without power and electricity all week.   We moved clinicians, patients and support staff to our GBMA practices in Hunt Valley and Texas Station each day this week in order to continue providing care for our community. 

Gilchrist Hospice Care had to make plans for the special needs of a patient population not just at their on-campus inpatient unit but at private homes, long-term care centers and assisted living facilities across Baltimore, Carroll, Harford and Howard counties and Baltimore City where they provide daily care for hundreds of patients.

For homecare patients, Gilchrist staff contacted each family to do a "tuck- in” call to review the patient's current comfort and care concerns and needed medications, supplies, equipment and oxygen.   Weekend staff left their usual home in Hunt Valley and relocated to the Gilchrist Center (on the GBMC campus) where facilities staff (led by Jack
Hammel and Bill Kennedy) secured the units and stayed on site during our power outage until the rain subsided.

Gilchrist staff safely admitted eight new patients on Saturday and four on Sunday (thanks to
Venus Corpus and her team!) and made close to another 100 home visits by hospice aides, social workers, and nurses.  These included death visits, visits to monitor patients in pain, patients who were actively dying, and visits for support families with bathing, and other supportive activities. 
Like many of our employees, I was also without power at home until Thursday evening, and I commend our staff for putting patients’ needs first.

Our thoughts and prayers are with those who lost loved ones or suffered property damage due to the flooding or wind damage of Irene.

Staff looking for more information about GBMC’s emergency preparedness efforts can visit the Critical Incident / Emergency Management section of our InfoWeb: http://infoweb/body.cfm?id=114

How did you weather the storm while working at GBMC or while at home?  Please share your comments below.