Who Are You Serving? Who Is Your Customer?

In order for a large complex system to work, everyone has to be thinking about their interrelationships with the other parts of the larger system. Everybody needs to get into the mindset of continual performance improvement, which begins with a focus on the customer and evaluating what patients or other customers need.

In early November, GBMC staff will be receiving an email about the organization’s 2011 Internal Customer Service Survey.  Staff will be asked to take a brief but important survey, which should take 10 minutes or less to complete. This is an important tactic in our effort to continually improve our service to each other.  The survey tool will be made available for a two-week period between November 7 and November 20 and is web-based and easy to access.  

Staff will be asked to evaluate departments with whom they have had regular interactions. The goal is to capture information that is needed for departments to improve their service and provide an opportunity for recognition.   The survey objectives include:

• To provide a “service” metric for non-clinical departments that are not surveyed by Press Ganey
• To emphasize the importance of “service” to our internal customers that ultimately impacts our patients’ experience.
• To provide a snapshot of how departments are doing with promoting and living our Greater Behaviors.
• For some departments, provide valuable data to compare to last year’s survey results.

As each department works to improve their level of service, we move closer to our vision of "Every Patient, Every Time...as if it was your loved one!” Thank you in advance for taking a few minutes out of your busy day to provide this invaluable information via the survey.

Do you have thoughts on areas of the organization that you work with?  Please share your comments below.

One employee who has been providing excellent service to our customers is Pat Blanding, a Nurse Support Technician on Unit 35.  On behalf of the entire organization I want to congratulate Pat, who was recently recognized by the National Gerontological  Nurses Association (NGNA) with the Excellence in Gerontological Nursing Award.  The award has been established to recognize excellence in individuals who provide care to older adults and is intended to honor a certified nursing assistant who has consistently provided outstanding care to older adults and has been an inspirational role model and mentor to other healthcare workers.  Pat was also the 2010 recipient of the Cynthia Steele Caring Hands Award presented by the Maryland/DC Chapter of NGNA which is designed to honor nursing assistants who strive to provide excellent, compassionate service and highlights the importance of the role of the nursing assistant in the care of older adults.

Unit 35 NST Pat Blanding (left) receiving the Excellence in Gerontological Nursing Award from NGNA President, Sue Carlson at the national convention in Louisville, Kentucky.

This theme of customer service extends to a topic that is likely on the minds of many of our staff – what is the future of our healthcare neighbor, St. Joseph Medical Center. As you might have read on this blog two weeks ago http://ahealthydialogue.blogspot.com/2011/10/results-are-in-learning-from-our.html, Catholic Health Initiatives, owners of SJMC, has issued a request for proposals seeking a strategic partner.  We are exploring a possible response to that RFP, and board chairman Harry Johnson has appointed an ad-hoc subcommittee of the board to work with hospital management to oversee this process.

Unit 46 is ready for its HBO debut.

MICU nurse Michele Cox, RN, CCRN served as a medical consultant for the HBO filming.

Two extras on the set.

Ready to film.

I’ll end this week’s blog with some exciting news – we’re going to be on national television! A crew from the HBO network was at the hospital this week filming a scene for their new comedy show VEEP, which will premiere in early 2012.  The show stars Julia Louis-Dreyfus of Seinfeld fame (“Elaine”), who portrays a fictional United States vice president. Seinfeld is one of my all-time favorite shows, and Elaine in the show was from the Towson area, so it was a natural fit to film here.  It was amazing to see how “Hollywood” transformed one of our units into the set for “Our Lady of Hope Medical Center.” I’ll be sure to let everyone know when the episode is scheduled to air.

Healthcare Technology Talk with Maryland’s Health Secretary

As some readers of my blog may know, I spent a great deal of my healthcare career in the Boston, Massachusetts area, both as a practicing pediatrician and as a hospital administrator.  In January of this year, I was pleased to learn that a former colleague, Joshua M. Sharfstein, M.D. had been appointed as Secretary of the Maryland Department of Health and Mental Hygiene.  I served as Dr. Sharfstein’s preceptor while he was in residency training in pediatrics at Boston Children’s Hospital and Boston Medical Center, and I was eager to renew our connection.

Last week, I was pleased to host Dr. Sharfstein for a quick visit with Mark Lamos, M.D. at the GBMC at Hunt Valley practice, where as part of the “Triple Aim” goal of better health, better care and lower cost we have begun implementing our medical home model and transitioning from a “fee for service” healthcare model to a “fee for health” model.   

Some key components of GBMC’s medical home model:

• While the primary care physician is “captain of the ship”, there’s a team approach to caring for the patient.
• Access is one of the biggest differences – we have expanded our primary care practice hours, opening earlier (7 a.m.) and staying open later (7 p.m.) so care can be given during the hours a patient needs it. 
• Patients with medical problems that traditionally have been referred to the Emergency Department can be handled at physician offices, enabling ED beds to be free for true medical emergencies.
• The Hunt Valley practice is set up as a LEAN-based practice, where “PODS” are set-up and stocked in the exact same way (exam room layout, staff cross-trained in multiple skills) and staffing is done to best match the patient needs of a given day.
• A dedicated team facilitates pre-visit planning via telephone with scheduled patients enabling lab work and other tests to be ordered in advance and expediting the patient’s visit.
• Registries have been started for patients with chronic diseases such as diabetes and asthma.
• Blood-drawing services are on-site.

In addition, we will soon be installing several computers in the waiting room, and implementing a patient portal to our electronic record, which will allow patients to check-in for appointments, access their medical records, share information with our clinicians about their current medical problem and review their past medical history.

The Hunt Valley practice handles about 1,600 patient visits per month and takes care of about 17,000 patients a year. The average patient visit lasts about 40 minutes.

The healthcare system in the United States remains one with much opportunity for improvement, but via transformational redesign like in our primary care sites GBMC HealthCare can help lead the way toward much-needed reforms and to providing healthcare the way we’d want our families to be cared for.

Dr. Sharfstein was appreciative of the time spent at Hunt Valley and emailed me afterwards: "Thanks for the terrific tour. It is great to see a healthcare system moving so quickly to redesign care and improve outcomes for Marylanders."

Do you have any ideas of how the healthcare system can be improved for patients? Please share your comments below.

Last week I also had the pleasure of being the guest speaker at the annual Volunteer Auxiliary Luncheon where I explained to dozens of our volunteers how we can’t achieve our vision without the wonderful and generous gifts of their time and effort.  

Shown enjoying the Volunteer Auxiliary Luncheon are (L-R): Ann Stiff - Executive Office and Medical Staff Office, Herb Stiff - Front Desk,  Git Merryman, Diagnostic Center and Martha Moyer, Spiritual Support. 

Our hospital and our hospice are blessed to have hundreds of volunteers in both clinical and non-clinical settings.  Each day these individuals are engaged in meaningful tasks – from providing directions to easing fears, from shuttling loved ones across campus to delivering flowers and smiles to patients – that allow our staff to spend time providing the care that we’d want our own loved ones to experience. 

Cynthia Fager, volunteer services director, said, “The volunteers walked away with a much better understanding of GBMC's vision and what has been accomplished to date to support the vision.”

Also on the volunteer front, this weekend is the opening of GBMC’s tremendously-popular Nearly New Sale, which is somewhat of a legend in Baltimore.  

Folks make travel plans around the sale dates, entire families get together, and many unbelievable deals and steals are found.  Twice each year, GBMC employees, volunteers, and the general public get an opportunity to buy treasures, trinkets, and necessities from furniture, clothing, jewelry and silver to appliances, sporting goods, toys and games, and much more -- all at nominal prices. GBMC volunteers devote hundreds of hours this event that raises more than $250,000 annually and contributes all of its proceeds to the Volunteer Auxiliary's Patient Care Fund.  Nearly New will be open this Saturday and Sunday from 9 a.m. – 5 p.m., and on four other days this next week.  Check Nearly New Sale for a full schedule of sale dates and times.

Finally this week we dedicated a special new healing environment on GBMC’s campus - the Breast Care Center’s Pink Garden.  Unveiled during Breast Cancer Awareness Month, the Pink Garden was funded through donations and is the result of a collaboration between the Roland Park Garden Club, Signature Landscape and the Sandra & Malcolm Berman Cancer Institute. Floeresn bushes and trees with pink flowers will bloom nine to 10 months a year and the garden includes a special water effect, a stone bed in the shape of the cancer ribbon with water constantly flowing over the stones. This welcoming garden will be special for all patients and visitors, especially breast cancer patients and the 16,000 women who come for mammograms at GBMC each year.  Surely this will prove to be a special place for patients, family members and friends who are on their cancer journey.

The Results Are In: Learning from our Employee Satisfaction Data and Making Improvements

Two weeks ago, I wrote about the loyalty of our employees and how nearly 500 colleagues were celebrated at GBMC HealthCare’s annual Employee Recognition Dinner. Today, I want to share highlights – some positive results and some areas where we have room for improvement – of another annual organization event, the Employee Opinion Survey.

Providing healthcare is a joyful profession. People allow us to enter into their lives at vulnerable moments in the hopes that we will make their loved ones better, or at least comfortable, and GBMC leaders need to be able to make sure that our people can feel that. One way we can do this is by making sure that we do whatever we can to make their work lives better. This is the reason why we do the Employee Satisfaction Survey each year. 

Nearly eight of every 10 GBMC employees participated in the 2011 survey, and in an organization with more than 3,000 employees, that’s good. Hopefully next year we’ll have closer to 100 percent participation, as the results we receive are very important and can effect changes for all staff.

Our overall average score was a 70 – a mixed blessing of sorts. The good news is that it didn’t go down from the previous year, but the bad news is that we had the same overall score last year.

I’m happy to report that our greatest area of improvement – an increase of eight percent – was for the question asking if employees trust executives (Senior Management). Our leaders have been working hard to say what we mean and then do what we say we are going to do.  Communication between the front office and the front line is critical. You build trust by delivering on what you say you are going to do.

As part of the senior management rounding process, leaders have been assigned units to visit and ask questions, such as if staff has the equipment and resources they need to do their job. We’re also inviting employees to share ideas with us; if someone brings forward an idea we owe it to them to have one of three responses: “Yes that’s a great idea we’re going to do that right away”; “Yes that’s a great idea but it may take us a while to accomplish that”; or “No, we can’t do that” and explain to them why it can’t be done.  Those are words, statements and commitments that we need to follow-through on which is how we’ll continue to build trust.

The management team exists to help make it easier for the people who are actually caring for patients to get the job done. Our people need to know that senior leaders do listen to them.  We expect that anything that can be fixed by a local manager and his or her team will be fixed by them. Anything that is beyond the scope of the local leader needs to be owned and addressed by senior leadership.

One area that did not receive a positive response was the question asking if employees are satisfied with pay increases, with a 14 percent drop from the 2010 result.

We get it. In a stressful economic period, people who maintain their jobs would like to get a substantive raise.  But with an operating margin of two percent, we have 2 cents of every dollar leftover after we pay all of our bills and it’s very difficult to give large raises.  We’ve been happy to give raises in the past that hopefully aligned with increases in the cost-of-living, and we know that in families where the GBMC employee may be the only breadwinner that it could be a difficult situation.  We are looking forward to giving a two percent raise again this year before the end of the calendar year, but this is a “call-to-arms” for all GBMC employees to pay attention to the organization’s waste reduction initiatives because that is where we would get the money from to give even bigger raises in the future. 

Do you have any examples of unit-specific improvements that have been made as a result of senior management rounding? Please share your comments below.

Some readers of this blog may have seen the recent news that Catholic Health Initiatives, owner of St. Joseph Medical Center, has issued a request for proposals seeking a strategic partner for our neighboring Towson hospital.

Unfortunately SJMC has experienced some difficult developments in the past few years.  Although we are “competitors” in the healthcare arena, GBMC and SJMC have traditionally been united in our quest to meet the healthcare needs of Towson and neighboring communities. Whatever the outcome of the SJMC situation, many believe that the result that would make the most sense is for there to be one strong system of care in Towson that is focused on better health, better care, and more joy for those providing the care at lower cost. One strong regional system increases the ability to maintain access to existing services with the possibility of adding additional services as they are needed. Healthcare leaders must realize that one united system has a better shot of creating efficiencies to ensure that people can continue to get the care they need close to home.

Finally, I encourage all GBMC HealthCare employees to consider participating in our United Way campaign which runs through November 18. You can pledge online here: https://epledge.uwcm.org/epledge/crm/Start.jsp   There are many options to choose from if you’d like to keep your donation “in the GBMC family” –the Sandra & Malcolm Berman Comprehensive Breast Care Center, Geckle Diabetes & Nutrition Center, Harvey Institute for Human Genetics, Gilchrist Hospice Care, Neonatal Intensive Care Unit, or Hoover Rehabilitation Services for Low Vision.  Unrestricted gifts can also be made to the GBMC Foundation or to support the hospital in general.  As an extra incentive to donate early, all employees who contribute by 8:00 a.m. on October 17 either electronically or by dropping off paper forms at Human Resources on the 5^th Floor will be entered into a drawing for an iPad 2. 

Healthcare Promises

Promises made and promises kept are an important part of most any successful business today.  Healthcare is no different.

Last weekend, I traveled to New England to see my daughter play in two field hockey games and help my wife and one of our sons move more 'stuff' (and our two cats) to Maryland. On Saturday, with confirmation in hand, I stopped to pick up my 10-foot Budget rental truck, only to be told “we don’t have any 10-foot trucks”.  Surprised, I showed the clerk my paperwork, to which he responded, “Oh, THEY’VE been doing that to us a lot lately,” noting his shop was not actually a Budget office but merely a vendor offering Budget rentals.

So I called Budget’s 800 phone number, and was offered a much larger (24-foot) truck at their cost, or I could wait a few hours and they’d try to find a 10-foot truck at another vendor.  The problem was, it was Saturday afternoon and that was not likely as most other rental locations in a 50-mile radius were closed.  So, I took the 24-foot truck even though it was much larger than what we needed and wasn’t what I was promised.  When I pulled up to load the boxes, my wife came outside, aghast and surprised at what I was driving.  When I shared with her that Budget had failed to deliver on their promise and this is what we had to deal with, we realized I had to change my plans for Sunday, skip my daughter’s game and drive straight through to Baltimore.

Thankfully I made it back to Maryland safely, and was able to navigate the large truck through the small streets in my neighborhood, but was frustrated at Budget’s failure and how it impacted my family plans.

At GBMC, our promise is to do our best to take care of you like we would our own family members. We have to understand that we promise things to our patients every day, even if we don't always state the promise explicitly to the patient. The promise includes not harming the patient, doing our best to make them get better, and doing it in a way that is respectful of them as humans. It is very important that the whole GBMC family understands the nature of such promises and that we are continually working to make it easier to keep our promises.

That's why I was delighted to spend most of yesterday in a day-long retreat with our entire Board of Directors, chairmen of our clinical departments,  and members of our HealthCare Board Quality Committee. With the help of an outside consultant, we spent the day strategizing about how to make care at GBMC even safer and of higher quality than it is already. We discussed our recent changes to our quality structure, our culture of safety survey results, and other measures of quality. We got input on how other organizations approach quality and patient safety, and we shared our thoughts about the book: Why Hospitals Should Fly, by John Nance. All participants reaffirmed their commitment to our new vision phrase, and to our desire to never break our promises to our patients.

On a related note, there’s somewhat of a promise, or an expectation, that technology equipment will work and do the job that it is supposed to do. In the 21^st century of healthcare, we rely a great deal on technology to power the electronic systems that allow us to do our jobs and care for patients.  Unfortunately, on Saturday and again this Tuesday, a series of problems occurred with the power supply in our data center, and many of the systems that we rely on to collect data and do our jobs failed.

We opened our Hospital Command Center on both days and our teams of experts (information technology, facilities, engineering, and others) successfully managed both critical situations. Kudos to our clinical staff who were able to continue providing the excellent care we are known for and our patients deserve despite facing the challenges of multiple electronic systems not working correctly for a period of time. I promise you that we will work hard and find the money to create more redundant systems to reduce the chance that this should happen again. We are too dependent on information systems to do otherwise.

Do you have any stories about promises in business or healthcare that have made a significant impact in your life?  Please share your comments below.

Finally, I invite you to help support Team GBMC for the upcoming Baltimore Marathon. More than a dozen staff members, including Neal Friedlander, M.D., Chairman of Medicine, are working together to complete the marathon and raise funds for GBMC. They have set a goal of $2,620, that's $100 for every mile in the 26.2 mile race they will complete! To make a donation in support of the team or a runner, please complete the form at Support Team GBMC for the Baltimore Marathon!.