Friday, December 30, 2011

Better Care

Something exciting is happening at GBMC.

Our vision is to become the healthcare system where everyone, every time, is treated the way we would want our own loved ones treated. We say that this includes: the best health outcomes (better health), with the best satisfaction with the way the care is delivered (better care), with the least waste (lower cost), and the most joy for those providing the care.

So what is the exciting thing that is happening? The November monthly patient satisfaction survey shows an overall 87.6 inpatient satisfaction score, the highest score ever for our hospital!

More than 40 percent of U.S. hospitals utilize the company Press Ganey to measure patient satisfaction. Each month, a random sampling of inpatients from units across the hospital are surveyed by Press Ganey and asked to score their patient experience in a variety of areas, on a scale from 1, equaling “very poor” (score of “0”), to 5, equaling “very good” (score of “100”). Press Ganey than converts respondents' ratings to a mean score for hospitals in various areas such as nursing care or meals.

Since about the beginning of 2011, GBMC’s overall monthly inpatient satisfaction scores have been improving; marking real change as opposed to random peaks and valleys. If you look at the scores of most other hospitals or health systems you are not going to see this. (You actually can compare hospitals by going to and compare HCAHPS scores but the data are only published yearly and what you find today is from December of 2010.)

This most recent survey score of 87.6, places us in the 82nd percentile for hospitals with 300 beds, which is our peer group in the Press Ganey database.  The percentile ranking means we scored higher than 82 percent of comparably-sized hospitals. We’ve certainly made significant improvement, considering that in 2007 we were at the 35th percentile for hospitals in our peer group.  We were at a plateau from about early calendar year 2010 until essentially this year and have started moving our scores higher and higher.  We are making true measurable progress.

I have been in healthcare a long time and I have seen many organizations measure patient satisfaction. Every month the score would come out and people would try to explain the result. Rather than get in action on implementing change, we were wishing that the score would improve.

Today, at GBMC we are now using continual improvement as our way to manage our organization. In more and more areas of our system, leaders are asking the question: “How can we do it better?” and then getting their team in action on change!

So what changes have brought our score up? There are too many changes to talk about them all but let me give you a few.

In February and April of this year, we had fallen to a score just under 77 in patient satisfaction for meals, which ranked GBMC at the 10th or 15th national percentile, which is well below average. We are not a well below average system….but that’s where we were scoring.

Nurses were telling us that a mistake was made when the structure of meal delivery was changed and we needed to return to the system where foodservice workers were assigned to a specific unit.  So we made that change, and have seen a statistically significant improvement in our meals score since doing so. The arrow shows when we implemented this change. There is still room for improvement in our overall meals score, but patients are voting that we have improved.

Meals Section Score

We have also improved our score in room cleanliness. We know that people don’t like a dirty hospital, insensitive staff, cold meals, or waiting. And we are working on initiatives around these issues. Press Ganey scores show that the hospital is getting cleaner through the eyes of the patient, which is who matters the most. You can see from the scores that we are still working to standardize our new processes and make them happen reliably and everywhere.

Room Cleanliness Score

Our nurses are working hard to improve communication with patients. They have begun to standardize when and how they communicate to reduce the chance that the patient feels left out. One of the tools that nurses are using is called AIDET. The AIDET model is a helpful framework comprised of:

§  Acknowledge - Greet people with a smile and use their names if you know them.
§  Introduce  Introduce yourself to others politely. Tell them who you are and how you are going to help them. Escort people where they need to go rather than pointing or giving directions.
§  Duration — Keep in touch to ease waiting times. Let others know if there is a delay and how long it will be. Make it better and apply service recovery methods when necessary.
§  Explanation — Advise others what you are doing, how procedures work and whom to contact if they need assistance.
§  Thank You — Thank somebody. Foster an attitude of gratitude. Thank people for their patronage, help or assistance. Use reward and recognition tools.

Another area of standardized work that nurses are testing is called hourly rounding. This technique schedules a member of the nursing team to do a formalized check-in with each patient once per hour during the day (and less frequently during the night when patients are sleeping.) Below you can see the effect of nursing standardization of these tools on the patient’s response to the question of whether or not nurses kept them informed.

Nurses Kept You Informed

Standardizing the work gives us a better shot of getting to the desired outcome than if we are just relying on the hard work and good intentions of our staff alone.

We’ve made a lot of real changes and I am very grateful to all of our hard-working staff who have made them.  We must stay in action by reviewing what our patients are saying, asking ourselves what changes we can try, and then testing those changes. Once we find a change that works, we need to implement it throughout our system. This is how we will get to Better Health, Better Care, Lower Cost, and More Joy.

We are using Continuous Improvement as our business model.  One of the tenets is design, and right behind that is measurement.  The examples above show that we are redesigning systems, and we are measuring the performance of these redesigned systems, and I’m very proud of all of our people for doing this.

So, right now we stand at a patient satisfaction score of 87.1, with room to improve.  What idea do you think your team could test in your area to get better and to foster continual improvement?  Please share your thoughts below.

Friday, December 23, 2011

2011 – A Year Of Great Accomplishments for GBMC HealthCare

2011 was a year of tremendous accomplishment for the GBMC HealthCare system.  In this week’s blog I wanted to look back at what we’ve been able to achieve throughout the year.

At the top of the achievement list for 2011 is rolling out the organization’s new strategic plan "GBMC HealthCare System – Our New Vision, Our New Plan to Get There" and new vision phrase, "To every patient, every time, we will provide the care that we would want for our own loved ones."

These aren’t just words, but rather are the guiding principle behind all of our actions – whether they occur at the bedside giving patient care, in the hallway providing directions, or on the phone offering guidance.

We have committed as an organization to Better Health, Better Care, Lower Cost and More Joy and our system is working to dramatically transform healthcare delivery.  We recognize that the healthcare system as we know does marvelous things everyday but it is too fragmented. We are working to be a part of the national solution by building continuous, reliable, and integrated care.

This year, we have moved toward a system that is more patient-centered, and evidence-based using the medical home model where physicians and their care teams focus on a patient's overall wellness rather than just focusing on episodes of illness. To accomplish this, we have made significant investments in healthcare information technology and are building a network of hospital and community-based healthcare providers (Greater Baltimore Health Alliance) to oversee the integration and coordination of that care.

In 2011, we finished the implementation of a Computerized Provider Order Entry (CPOE) system, that has already significantly improved patient safety by significantly improving the turnaround time of orders, and launched our electronic medical records system using eClinicalWorks, which will help to better integrate care, reduce unnecessary testing, improve the underuse of necessary testing, increase efficiency, reduce costs and improve communication and sharing of information among providers.  At our Greater Baltimore Medical Associates at Hunt Valley practice, we launched our patient portal pilot, a personalized and secure communication link between the patient and physician’s office that provides convenient 24-hour electronic access to an individual’s health information.

Another important highlight during 2011 was the re-launch of the Board of Directors Quality Committee, which is a recognition by the organization’s governing body of our true mission.  We have always talked about Health, Healing and Hope but frequently we’ve acted as if it were enough to be a financially successful organization. While that is important, if the board is not directly and deeply scrutinizing the quality of the product which is generating Health, Healing and Hope then they are missing an important part of their job.  The board embraced this notion and quickly got together an action plan, led by Bonnie Stein who was appointed as the quality committee’s first chairperson.  We had a board retreat dedicated to quality issues, and members all read the book “Why Hospitals Should Fly”, an essential look at patient safety and service quality.  Board members now have a much deeper understanding of the product and what they need to do to better oversee the fulfillment of our mission.

We also created the positions of medical directors for the hospital’s inpatient units – effectively creating a leadership team on each unit.  It goes back to the concept in service that you don’t achieve outstanding performance in a large complex company by having brilliant people in the front office. You get to outstanding performance through the leadership at the smallest replicable unit, which in healthcare is the inpatient unit or the physician’s office or other clinical area or department.  We have always had nurse managers of our inpatient units who do a marvelous job every day but frequently we have lacked physician leadership on our units so that it was difficult for us to present to the patient as a team. We have had units where doctors come and go – working hard but not connected to the goals of the unit.  Now the appointed medical directors will work hand in hand with the nurse managers to help achieve the quadruple aim of better health outcomes, better care experience, at a lower cost with more joy for those providing the care. 

Accomplishments during 2011 also included:
  • Unveiling of the Pink Ribbon Cancer Garden at the Sandra & Malcolm Berman Cancer Institute.
  • 104 members of GBMC’s medical staff in 69 different specialty areas were recognized in the annual Baltimore Magazine Top Docs issue.
  • Two new members joined the organization’s senior management team – Jenny Coldiron, who joined in May as Vice President of Development and President of the GBMC Foundation, and Deloris Simpson Tuggle, who joined in December as vice president of human resources and organizational development / chief human resources officer.
  • Janet Sunness, M.D., medical director of Greater Baltimore Medical Center’s Richard E. Hoover Low Vision Rehabilitation Services, was recognized with the prestigious academic medical recognition, the 2011 Macula Society’s J. Donald M. Gass Medal.
There were also several significant accomplishments in 2011 for Gilchrist Hospice Care, including being recognized with the Circle of Life Award by the American Hospital Association; opening Gilchrist Center Howard County, the first-ever acute care inpatient hospice facility in Howard County and being recognized by FHSSA (formerly the Foundation for Hospices in Sub-Saharan Africa) in honor of their work with its partner in Tanzania, Nkoaranga Lutheran Hospital, to sustain quality palliative and end of life care in Africa.

I know there are lots of accomplishments that we’ve had throughout the year.  What others do you want to mention? Please share your thoughts below.

Happy Holidays

On behalf of the organization, I want to extend best wishes for a safe, healthy and happy holiday season for those celebrating Christmas, Kwanzaa or Hanukkah.  Enjoy your time with family members and think about the things that are important in your lives.  For those staff members working during the holidays, a special “thank you” for taking care of those who aren’t able to be at home during the holiday season. I am blessed to work with all in the GBMC family and I am very grateful for this. 

Friday, December 16, 2011

Improving Patient Flow: The Concepts of Natural and Artificial Variability in Demand

Those of us old enough to remember “I Love Lucy” remember the Candy Factory episode where Lucy and Ethel take a job at a candy factory and attempt to wrap candies as they progress down the belt. When the speed is slow enough they manage to keep up with the work, their boss orders that the belt be increased in speed and the demand is too much for Lucy and Ethel to keep up with. This episode is a humorous way to demonstrate how varying the demand affects a system. In healthcare, the mismatch between the supply of caregivers and the demand for their services is the major cause of waiting and delays in care.

It’s not a secret that services like the Emergency Department get overwhelmed at times of peak demand. In the ED, we never know precisely how many patients will arrive in a given day. Our operating rooms are very busy on some days and not so busy on others. As a practicing physician, I used to think that peaks and valleys in demand were just a fact of nature. You just had to “suck it up” if you were busy and then you were owed the break you got when business was slower. I now know that things are not quite so simple. 

Deeper study of the peaks and valleys in patient volumes shows that there are actually two kinds of variability affecting patient demand. 

The variability due to the amount of illness in the community at any moment in time is called natural variability. For example, we know we get more patients coming to the Emergency Department in the winter with fevers and colds and coughs than we do in the summer, and we know we get more patients coming in with trauma and outdoor related injuries in the summer than we do in the winter. Based on historical data, trends, etc. we know approximately how many patients we are going to get every day of the week in the ED. Although we don’t know the exact number, the variability from day to day is due to natural causes beyond our control. Natural variability cannot be controlled; we just have to manage it. We generally need to have a bit more capacity then we will use on average to be able to deal with the peaks in demand. The mathematical science called Queuing Theory helps us staff efficiently when demand is varying naturally.

The second source of variation is called artificial variability. In artificial variability, the cause is man-made. Like in the candy store episode, the manager was controlling the speed of the conveyor belt. The concept of batching is the opposite of continuous flow. Generally individuals or subsystems batch things to reduce their own personal inefficiency. What they generally do not realize is that batching generally makes the larger system inefficient. 

When I was a pediatric resident we knew that if we ordered a lead test on a child, we wouldn’t get it back until later in the week because the lab waited to get a number of blood specimens before running the test in an effort to save money and run them all on one day. The lab director was trying to do the right thing but was not really thinking about the waits and delays for pediatricians or the rework required to get the results later and deal with the patient on another day. Physicians and nurses generally batch discharge work until later in the day because they sense that they need to deal with new admissions and the work of seeing sicker patients first. After all, the patient who is ready to go home is safe, so it feels like batching discharge work is a good thing. However when discharges all happen late in the day, admissions backup at other places, like the ED and the PACU waiting for the beds of the patients who are to be discharged. The largest single source of batching between days at GBMC is the elective surgery schedule. On some weekdays we do many more elective surgeries than on other weekdays. You can imagine how difficult it is to staff Unit 48 or Unit 58 efficiently if they are going to get 10 new patients on Tuesday and 3 or 4 on Wednesday. 

What we know now is that artificial variability is actually a BIGGER source of day to day variability in census and the stress caused by peaks in demand than natural variability is.  We also know now that healthcare workers who are overwhelmed are much more likely to make errors and potentially put patients at risk or much more likely to not be able to get to provide all of the care to each individual if they’ve got too many patients. 

So the goal is to reduce artificial variability caused by batching in order to reduce stress on our providers and make it safer for our patients. We also know that we can actually serve more patients in a more cost-effective way if we smooth the demand and try to get to continuous flow.   Once we have eliminated as much of the artificial variability as we can, we can then predict the natural variability and staff our hospital effectively. 

We’ve engaged some consultants from the Institute for Healthcare Optimization to help us do this work.  We are now in the midst of an initiative to smooth the elective surgery schedule, to keep the patients safer, to reduce waits and delays, to make the surgeons work more predictable and to make it easier to do even more surgeries. Under the leadership of Dr. Jack Flowers, our Chairman of Surgery and Dr. Lewis Hogge, our most recent block time changes have helped to begin the smoothing of patients by destination unit, Unit 48 or 58. 

Another part of our initiative to use science to manage flow and eliminate artificial variability is with our medicine service, under the guidance of Drs. Neal Friedlander, Paul Foster and Fred Chan, who have begun an initiative to smooth the discharge time of their patients to eliminate late afternoon batching. Their new mantra will be to discharge the patient as soon as he or she is clinically ready.  Most of us believe it’s unethical to send patients home in the middle of the night; we should have a relatively continuous flow of discharges from about 8 a.m. to 8 p.m.  Right now, we don’t.  We have a peak of discharges from 4 p.m. – 8 p.m. and we have very few patients going home before that, mostly because the system now has staff batching their work rather than trying to get to continuous flow. As they redesign the sequence of people’s work, or do discharges as a team, they will be helping to maximize the efficiency of the entire system. 

Interestingly, Israeli economist Eliyahu M. Goldratt examined this issue in his 1984 management-oriented novel titled The Goal, which focused on constraints and bottlenecks and how to alleviate them, and applications of these concepts in industry.  For example, Goldratt looked at the issue of why Japanese automakers were doing better than western automakers in producing vehicles, and noted that American manufacturers were focused on issues such as how often a machine was used rather than focusing on what the end goal was, how much product was coming off the assembly line. Required reading at Harvard Business School that was originally published nearly three decades ago and republished twice since, this book was a seminal work in American industrial thought that we can benefit from in healthcare today. Dr. Goldratt followed this novel with his book, The Theory of Constraints, another must-read for students of patient flow.

If it was your daughter, you wouldn’t want her waiting for long hours in the ED for a bed on the unit. We used to take care of this by always having a lot of excess capacity. Now no one can afford this so we have to use science to make the system work better. 

Do you have any thoughts on how we can improve patient flow and eliminate batching at GBMC? Please share your thoughts below.

Friday, December 9, 2011

The Triple Aim … in Baltimore County

As frequent readers of this blog know, I’m a staunch advocate of the Triple Aim of Better Health, Better Care and Lower Cost.  And there’s a growing recognition on the part of many that if we are going to achieve the Triple Aim we need to move “upstream” from healthcare delivery.  We need a coordinated approach involving community agencies, the patient and the patient’s family.

That’s why I was glad to be asked by the Baltimore County Health Officer, William Branch, M.D., to participate in the Baltimore County Health Coalition whose charge is to write an action plan to focus on several significant health issues including cigarette smoking, childhood obesity and low birth weight. I volunteered to participate in the subgroup that is focusing on childhood obesity.  As a pediatrician by training, this issue holds special significance to me.

Our first childhood obesity subgroup meeting was Thursday and I look forward to working with professional colleagues and lay people in the community to help us achieve a healthier community.  Soon, the greater GBMC family will need to be in action on this initiative beyond our walls, since the healthcare system can only do so much, we need to rely on “buy in” and commitments from faith-based groups, educators, county agencies, etc.

One individual who is an incredibly strong advocate for such changes is Donald Berwick, M.D., a mentor to me early in my medical career who recently was forced out as administrator of the Centers for Medicare and Medicaid Services after about 17 months on the job. “A Healthcare Icon is Forced Out of Service to Our Country”

I had the wonderful opportunity to be among a team of GBMC leaders who earlier this week attended the Institute for Healthcare Improvement’s 23rd annual National Forum on Quality Improvement in Healthcare, and who got to hear an incredible speech from Dr. Berwick just a week or so after his departure from CMS.

Carolyn Candiello, GBMC's Vice President of Quality and Patient Safety,
poses with Dr. Berwick at the IHI meeting.
Dr. Berwick noted that the Affordable Care Act was a majestic piece of legislation and reminded the 6,000 healthcare leaders from around the globe that in spite of his departure, CMS staff are still desperate and eager to be a part of the healthcare solution in this country. It was invigorating to again hear Dr. Berwick encourage us to reach for the Triple Aim and to see how he is rededicating himself to the goal of improving health, improving care and driving out waste and reducing costs to employers, governments and patients.

Of particular interest to me at the IHI meeting was seeing Cindy Ellis, BSN, RN, and Lynn Marie Bullock, DNP, RN, both members of GBMC’s Nursing Education team, who presented on a vital patient safety issue.

Cindy and Lynn Marie led a collaborative GBMC task force of frontline staff, pharmacists, nursing leaders, clinical engineering and information technologists who examined medication safety errors – which nationally cause 7,000 deaths per year – and found that by using smart infusion pump technology with safety software, IV medication errors are significantly decreased.  It was heartening to see their “Embracing the ‘Good Catch’” presentation on a national stage.
Dr Chessare (L) and John R. Saunders, Jr., M.D., GBMC's Chief Medical Officer,
with Cindy Ellis and Lynn Marie Bullock.
Holiday Decoration Safety and Celebrations

As you may have observed in walking around the hospital, there are no holiday decorations on the doors this year.  For many years, it was a holiday tradition for units to decorate the doors to their work areas, and volunteers would decide whose decorative inspirations had the most holiday spirit.  I had a great time last year going around the campus and helping judge the door decorations.

Contrary to some rumors around the campus, there is no “Scrooge” at GBMC this holiday season.  Rather, in order to ensure the safety of our staff, patients and visitors and follow Joint Commission protocols, we’ve had to eliminate the annual door decorating contest.

Environmental and safety rounds revealed physical damage to fire walls and doors and fire door closure mechanisms were de-activated due to decorations and tape. Fire alarm pull stations, fire extinguishers, sprinkler heads and medical air emergency shut off valves were also found to be obstructed by holiday decorations. So, to keep our patients and ourselves safe, we won’t be decorating doors this year.  Nontheless, I see many beautiful holiday decorations on our campus!

If you have questions regarding the GBMC Decorations Policy contact the Safety Department at

Holiday Spirit

We have many ways to get in the holiday spirit at GBMC, including our annual Employee Holiday Meal on Wednesday, December 14, which will be served from 11 a.m. - 2 p.m. (Dining Room &  Civiletti Conference Center) and from 5 p.m. - 7 p.m. and 11 p.m. – 1 a.m. (Dining Room only).

The GBMC Holiday Choir will be performing at the holiday meals at 12 p.m. & 1:00 p.m. in the Civiletti Conference Center and at 5:30 p.m. in the back of the cafeteria, as well as on December 19 in the OB Atrium Lobby at 12:30 p.m. and December 21 in the Main Lobby at 12:30 p.m.

Other festive holiday events include:

  • “In the Holiday Spirit” with Jim Albrecht on the keyboard, scheduled for December 14 at 12 noon in the OB Atrium, presented by The Elma Donovan Memorial Concert Series and GBMC Spiritual Support Services.
  • A traveling instrumental performance on December 21 by Robert Yin, M.D., GBMC gastroenterologist and friends, which will begin in GBMC's Physicians Pavilion East at 12 p.m. and make its way throughout the hospital spreading holiday cheer to employees, patients and visitors.
  • GBMC’s Asthma Sinus Allergy Program (ASAP) on the second floor of Physicians Pavilion North is a designated drop-off site for the United States Marines Corps Toys for Tots program.
  • Spiritual Support Services is coordinating adoption of more than 30 families through the auspices of the Assistance Center of Towson Churches.  Interested departments and individuals should contact Chaplain Joe Hart at x2056 if you would like to help.  Wrapped packages are due to be delivered to ACTC in Towson by December 20.
  • Volunteer Auxiliary Board members will be delivering poinsettias to patient rooms on Friday morning, December 23.

Do you have any special ways you celebrate the December holidays, or any ideas for how you would like to see GBMC HealthCare celebrate in the future? Please share your traditions and ideas below.  Also, please let me know how you are working on the Triple Aim in your community.

Friday, December 2, 2011

“A Healthcare Icon is Forced Out of Service to Our Country”

It’s rare that you find an individual who is really about a goal and not so much about themselves.  Donald Berwick, M.D. is someone who for decades has embodied a zeal for improving healthcare through the eyes of the patient.

In the summer of 2010, ironically just a few weeks after I joined GBMC HealthCare, my old mentor Dr. Berwick was named as a recess appointment by President Obama as administrator of the Centers for Medicare and Medicaid Services (CMS).  During his brief time at the agency, you could palpate the difference in the tenor of the CMS operation at headquarters because he bolstered the spirits of people working there and gave them new hope.

Dr. Berwick is the person best-equipped to have pulled off the redesign of our national healthcare system to meet the “Triple Aim” of Better Health, Better Care and Lower Cost but as of today he’s going to be gone from service to our federal government.

My professional relationship with Dr. Berwick goes back several decades to when I was finishing my chief residency at the University of Massachusetts in pediatrics. I had gone into the residency with the intent of becoming a community-based general pediatrician but then got turned on to academic medicine.  During my fellowship at Boston Children’s Hospital / Harvard Medical School in general academic pediatrics, I had the good fortune of being assigned Dr. Berwick as my research mentor.

Don is known today as a healthcare policy expert and the universe’s  leading authority in the area of healthcare quality improvement but when I was assigned to him in 1982, Dr. Berwick was a practicing pediatrician and vice president for quality-of-care measurement at Harvard Community Health Plan. He was exploring the work of people like Harvey Fineberg and Jack Wennberg who were writing about variation in medical care. Even back then, it was known that much of what we do in health care does not actually benefit the patient and that there is a broad gap between what the evidence says should be done and what is actually done.

Dr. Berwick studied the science of decision-making and became the  president of the Society for Medical Decision Making. He had a curiosity about the logic of using diagnostic information to help patients and how to help clinicians understand this logic. I had the good fortune of being present when Dr. Berwick dedicated the annual SMDM meeting to quality improvement and to Avedis Donabedian MD, the father of quality improvement in healthcare, who was given a lifetime achievement award.

Berwick began studying the history of quality improvement in industrial America and learning about the greats of the continuous improvement movement, such as W. Edwards Deming and Walter Shewhart, and realized that the tenets of industrial quality improvement were also applicable to health care.

Dr Berwick aligned with Dr. Paul Batalden, a pediatrician working for the Hospital Corporation of America, and they applied for a grant for a national demonstration project on quality improvement in healthcare.  They studied 16 different hospitals across the country and set out to redesign systems to get better outcomes for the American people.  The initiative was successful and spawned a book called “Curing Healthcare” and at the end of the project they used the momentum to start a new organization.  The Institute for Healthcare Improvement  (IHI) is now almost 25 years old and has been the international leader in improving healthcare, working domestically and internationally.

Dr Berwick got the idea a decade ago to borrow concepts from political campaigning to reduce harm in U.S. hospitals.  He started the 100,000 Lives Campaign and then moved on to the 5,000,000 Lives Campaign, both of which were very successful at improving care.  The federal government has learned from those initiatives and has grasped much of what he started even before he got to CMS. GBMC has participated in and learned from these initiatives. Our wonderful results in reducing central line associated bloodstream infections (CLABSI) are a direct offshoot of the work that Dr. Berwick began.

It was because of all of his wonderful accomplishments that President Obama invited Dr. Berwick to become the head of CMS and to implement the Affordable Care Act.  The fact that the most intelligent leader in healthcare who has accomplished the most internationally in improving health systems would be willing to join the federal government and take on a huge federal agency was a gift to the American people.

But now, sadly because of political payback, stupidity, and pettiness among elected officials who did not like the healthcare reform act, his term is ending prematurely and Dr. Berwick is going to have to leave before the  job is done. It is very disappointing that the American people don’t even know who he is or what he was trying to do. I believe the best person to fix our healthcare system is being thrown out by people who don’t understand healthcare or the American dilemma of spending almost twice what other developed nations spend on healthcare and having outcomes that are often not as good.

Donald Berwick has not spent one moment in his life in the “victim box”. He never focuses on the problem, instead he quickly gets in action on the solution. So, rather than lament Dr. Berwick’s departure from CMS, we must rededicate ourselves to the continual improvement of our healthcare system starting with what we control at GBMC. We must work hard and speed-up our transformation towards better health, better care, lower cost, and more joy for those providing the care!

Please share your thoughts on Dr. Berwick’s work or how we can make change happen faster in our system.

On a happier note, please join me in welcoming Deloris Simpson Tuggle to our family as the new vice president of human resources and organizational development/ chief human resources officer for the GBMC HealthCare system.  Deloris is an industry veteran with more than 20 years of experience in human resources and organizational development. Deloris will officially join GBMC on December 5.

Deloris Simpson Tuggle
As we continue our metamorphosis from an outstanding hospital into an outstanding system of health we need leaders who understand our vision and see their role as extended beyond the borders of our beautiful campus; Deloris is this type of person.

Deloris will have responsibility and oversight for planning, organizing and providing leadership and direction for the organization’s human resources functions including policy development, interpretation and administration; recruitment, orientation and retention of employees; compensation and benefits programs; performance management and competency assessment; employee relations and labor relations; and training and development programs.

Deloris comes to GBMC from the Dana-Farber Cancer Institute in Boston, Mass. where she spent three years in the roles of senior director of human resources and interim senior vice president of human resources for the Harvard Medical School-affiliated organization.  She also has worked for the May Institute in Randolph, Mass., Lifespan Healthcare Systems in Providence, R.I., The Housing Services Company in Boston, Mass. and Trans World Airlines.

Deloris has told me that living in the Baltimore area is “a wish come true.” She has an affinity for Maryland and has two brothers in the area. She is looking forward to moving to Baltimore. Please join me in welcoming Deloris.