Time Flies

It’s hard to believe that another year is ending. As we get ready to make our resolutions for 2013, it’s good to take a moment and reflect on how well we met our commitments in 2012.

In 2011 we committed to a new vision – a new direction for GBMC. We committed to becoming a true system of care through the eyes of the patient. Since we and our family members are all (at one time or another) patients as well, we created the vision phrase To every patient, every time, we will provide the care that we would want for our own loved ones. For our own loved ones we want the best health outcome, with the best care experience, at the lowest cost…so we said that this is what we want for everyone. We created a strategic plan to get to our vision. 2012 was essentially the second year into that strategic plan, so did we continue doing what we said we would do?

A fundamental building block of our system of care is the new primary care team: the Patient-Centered Medical Home (PCMH). In 2012, our Hunt Valley office was the first primary care team to reach Level 3 PCMH status and now most of our employed primary care offices have achieved this. The primary care teams now reflect on how they are doing for groups of patients and actively work to improve the health of individual patients with chronic disease with the help of care managers who work side by side with their doctor and nurse teammates. They have all extended their office hours and now some are open on Saturdays. In 2012, we implemented our patient portal, myGBMC, to make it easier for patients to participate actively in their care, see their own records, and to communicate with their physicians.

Now that we designed the foundation of a better system to help keep people well and to help people with chronic illness to better manage their health, we created a new company, Greater Baltimore Health Alliance (GBHA), that includes not only our employed physicians, but also many of our wonderful private practicing doctors working together on our vision. In 2012, we learned that GBHA had been accepted into the Medicare Shared Savings Program as an accountable care organization. In 2012, GBMC HealthCare became the first company in Maryland to sponsor an accountable care organization that included a hospital.

In 2012, we made our outstanding hospital even more outstanding. We made our care even safer than it had been. We rolled out a mandatory course called Getting in action for patient safety and all of our employees took the course. Teams made outstanding quality improvements in areas such as hand hygiene, central line associated blood stream infections, surgical site infections and catheter associated urinary tract infections. Our outstanding surgeons made patient care even better by participating in the National Surgical Quality Improvement Program. We are one of a few community hospitals to participate fully in this program. We opened our simulation lab as a place for people to learn and practice as individuals and in teams in a safe environment. We opened our Geckle Diabetes Center building on the strengths of the education center and now focusing also on the actual care of diabetic patients wherever they are in our system.  We empowered our physician leaders in Medicine, Surgery, Oncology, and Women’s Health to run these service lines and continually move us in those areas towards our vision. We added medical directors to all of our inpatient units and now have them working in partnership with our wonderful nurse managers to continually improve the quality of our care. We improved our ability to create standard work and use continuous improvement tools, specifically LEAN and the Model for Improvement and ran a number of value stream mapping and redesign events. An example of this was our weeklong 3P event to design our new inpatient pharmacy. Through the hard work of all, but especially our nurses and housekeepers, we achieved the highest overall inpatient satisfaction score in years and perhaps in our history (see the chart below). We added new flooring in many places in our hospital. We are the first hospital that I know of to scientifically calculate bed need for Medicine patients using queuing theory. This work resulted in our opening 12 more beds. In 2012 we opened our new Domestic Violence Program, becoming one of only seven such programs in Maryland. All of this work and much more combined with the wonderful dedication of our staff led to a very successful Joint Commission survey.

Gilchrist Hospice Care and Gilchrist Greater Living continued their spectacular work and truly lead the region in compassionate, evidence-based care to seniors and those at the end of life. Their year culminated in an outstanding outpouring of support from the community in the 2012 Holly Ball.

Our Human Resources Team redesigned our employee health benefit that reduced out of pocket costs for most of our employees and kept more of our dollars within our own system.

120 of our outstanding physicians were named to the Baltimore Magazine Top Docs list. Once again, GBMC had the most physicians of any community health system or hospital on this list. We are so fortunate to have outstanding surgeons, internists, pediatricians, family physicians, and other wonderful specialists.

In 2012, GBMC was recognized for the wonderful work of our Green Team. We won the Trailblazer award from the Maryland Hospitals for a Healthy Environment organization for our work in waste reduction and healthier food options. Our fantastic volunteer auxiliary again broke records in fundraising through our Nearly New sales and our Foundation ran a spectacular Legacy Chase steeplechase event that showcased our HealthCare system to the community.

I realize that these things only represent a small fraction of what the GBMC family did to move us closer to our vision. All I can say is thank you! I look forward to all of our accomplishments to come in 2013.

Compassion

For this week’s blog post, with her permission I am sharing a letter I received from Tara Holicky, a practice manager in Geriatrics, about her experience as a patient at GBMC when delivering her second baby.  Tara’s story is a wonderful example of GBMC delivering the kind of care that we would want for our own loved one.

After sometime, I’ve finally found the words to write to say thank you to hard working employees at GBMC.  I, myself, am actually a GBMC employee.  I started here after my first child was born in 2005.  It’s taken me some time to write this letter, because despite multiple attempts I’ve been unable to find the right way to express how grateful I am to the nurses, techs, doctors, and downright everyone for the miracle I have today.

In 2011, I was pregnant with my second child.  It was a very uneventful, normal pregnancy.  I had a c-section with my first and planned to have a scheduled c-section on 8/29/12 at 8 am.  (I wasn’t due until Labor Day, ironic I know).

To my surprise on the evening of July 11, 2011, my water broke.  I honestly thought I had an accident at first, and ignored it.  But when it seemed to be continuing, I called my OB’s office who advised I go in just in case.  Imagine my horror when I was told that indeed my water had broken.  I wasn’t even 32 weeks yet.  I panicked at the thought.   But the nurses were there for me.  They explained what would happen – I would be admitted.  They wouldn’t actively try to induce labor since it was a slow leak and the baby seemed okay, but they also wouldn’t try to stop labor if it happened either.  I would be staying in the hospital one way or another until my baby was born.  Fear cannot explain what I went through that first night in Labor and Delivery.  Wondering if I would get transferred to high risk, would everything be ok?  What would the NICU consult mean?  I didn’t sleep the entire night.  My nurses comforted and talked to me even though they were busy with other families having babies.  Each person who came into my room took time to really talk to me, knowing how scared I must be.

After a few days, despite not going into labor my fluid levels were too low for the baby to be safe, and I was whisked to the OR for an emergency c-section.  I was again terrified.  I had been through a c-section before, but this was different she was too early, I had to prepare myself that she might not cry, she may not make it, all the “what-ifs” that go along with a preemie.  But again, GBMC employees were there for me.  They explained exactly what was happening; the team in the OR all explained what would happen when she was born.

On July 13, 2011, around 10 am, my beautiful little 3 lb miracle was born at 32 weeks and 1 day.  And she screamed!  It was the most beautiful thing I’d ever head.  As it turned out she actually had a true knot in her cord, so it was quite lucky my water broke when it did.  The NICU team gave me a quick look and hug before they whisked her off to be fully evaluated.  My husband quickly followed them out, and the remaining OR team was there to comfort me while they sewed me up.  In recovery, I was fraught.   All the other women got to see their baby and I was there alone.  But the nurses understood my pain, and helped me deal. 

In postpartum, again, my family could all go to the NICU but I wasn’t able to yet.  Nurses, techs, housekeepers, even the people who delivered meals, were all sensitive to this.  They took the time to ask how she was, asked to see pictures, etc.  They were truly caring.  That evening when they told me I could up to the NICU, I was thrilled.  The NICU nurse who said I could hold her was my hero in that moment.  I had never seen a baby so small, much less held one.  To have my baby there in my arms doing okay, was such a miracle to me in that moment. 

It is tough to be in Post Partum when you can’t just have your baby in the room.  It is difficult to see families going home with their new little bundle of joy, knowing you will not get to do the same thing.  The nurses in Post Partum and the NICU were amazing people.  On my discharge from GBMC I cried so hard.  And Taylor my nurse sat down and cried with me.  She made me understand that it was okay to be sad, but I would be back tomorrow morning to see her.  The nurses in the NICU encouraged me to call in the middle of the night if I wanted to check in.

Since I worked at GBMC, my plan was to just go to the NICU for the full day while my husband was at work.  I could sit my office when I needed to.  Monica, a NICU nurse, knew that I wasn’t thinking clearly as woman who was recovering from her own surgery and arranged for me to use a room to rest during the day when I needed to.  I was so thankful to be able to take a nap during the day.  I was in the NICU essentially every day for at least 8 hours thereafter during the day.  I would cry when my husband came at 5 pm knowing we’d have to go home for the night. 

However, we were extremely lucky, despite her small size, my little girl was a fighter, and even though I was told she would need to stay until she was at least 35 weeks, she was discharged after only 13 days.

She is now a happy, healthy almost 17 month old, that you just saw the other day at the T. Rowe Price Scholarship award ceremony.  Despite her small size she is bundle of energy.  I thank the superb employees of GBMC for making this happen.  I am certain I cannot remember everyone by name and for that I am sorry, but I want to specifically thank Post Partum nurses Taylor, Suzie, Susan and all the others I know I’m forgetting.  The NICU nurses, Monica, Tamara, Janice, Pat, Ellen.  The doctors, my OB. Dr. Allen, the NICU team, Dr. Pane, Dr. Birenbaum and Dr. Helou, and the countless others at GBMC, housekeepers, techs, and meal servicers.  You are all special to me in that you each contributed to making my family whole.

What a great example of Team GBMC rallying around a patient and her family!  We need to continue our work to make this happen for every patient, every time.

This story is a good reminder that during this time of year we have many things to be thankful for and appreciative of, both in our personal lives as well as at work. Happy Holidays to all and best wishes for a safe and enjoyable holiday season.

On Becoming A Learning Organization

I ended last week’s blog by inviting people to comment and they did. I stopped replying to every comment as it appeared because I didn’t think that it would be helpful once I saw the emotions that were being released. So, let me try to respond to the comments now.

The blog is a mechanism for communicating. A regular reader of the blog knows that I am usually trying to accelerate change toward our vision of being the healthcare system that treats everyone the way that we would want our own loved ones treated, every time. Sometimes I highlight a “technical” concept, like the relationship between the number of hospital beds in an area and the cost of healthcare in that area, or the ability of the patient-centered medical home to make care less fragmented for people with chronic disease. Sometimes I highlight great work by our people in making change happen, like the blog on standard work and improving our hand hygiene scores, or the one on the great work of the team that created the design for our new inpatient pharmacy (see "What's a 3P?".) Other times I have interviewed patients to let them tell their stories about their care as a way to recognize our wonderful nurses, doctors, therapists, technicians, and other staff (see the February 24, 2012 blog with Chris Brandau’s Mom).

But until last week, I had only used “negative” incidents from other industries to highlight room for improvement, like the blog I wrote in which I talked about the poor (giving the appearance that the Southwest employee didn’t care) service that I saw at BWI airport; or my poor service due to a poorly designed system in getting a hot dog on the New Jersey Turnpike (see the August 24th blog, "Good Leadership, Poor Leadership, Well Designed Systems and Random Behavior"

Last week I took a chance. I decided that we had developed enough as a learning organization to begin to openly discuss negative feedback from one of our patients. I picked the letter in part because the author said many nice things about our people. I removed two names from the letter so that the individuals whose reported negative behavior was focused on by the writer could not be identified. I also removed the name of a nurse who had been complimented so that the floor of the hospital could not be identified by people who did not know of the episode.

The purpose of the blog was to get us all to reflect on how our behavior is perceived by those who we serve so that through this reflection we may all become better. The blog was not meant to hurt any individual. After the blog was published, more than one person told me that they knew of many incidents where we had left the appearance of callousness, the appearance that we did not care. All of these people also told me that they thought that GBMC had great people who really do care and who work very hard and usually delight their patients with their caring. But these folks agreed that it is good to reflect when we do appear to not care so that we can improve ourselves.

I know how hard people are working in our GBMC HealthCare System and I know that it is my job to make sure that they have what they need to get the job done; whether it be staffing or equipment. I realize that it is my job to see that they are empowered to improve the systems that they work in to make it less hard for them to get the job done. But I also am aware that it is my job to assure that we reflect on how we are doing because ultimately we are here for the people we serve.  

The Appearance Of Callousness

Have you ever seen the short film It’s a Dog’s World? (The “new” edition can be seen here).  This is a short film that makes the comparison of how a dog is treated with empathy, dignity and respect after an injury, while his master, also injured, does not get the same. The owner of the dog has to deal with among other things, people who don’t really seem to care about him.

I am very fortunate to be the CEO of the GBMC HealthCare system. I get so many wonderful letters about members of the GBMC family who do marvelous things for our patients. But I also get letters where we did not treat people the way we want our loved ones to be treated. When I read these letters, I most often believe that our people did care but they gave the impression that they didn’t.  I have come to call this the appearance of callousness. We often give the impression that we don’t care when we are overwhelmed or when we are busy trying to protect our teammates from being overwhelmed.

Here is an excerpt from a letter that I received this week:

“I am writing you about my recent inpatient stays at GBMC. I was admitted to GBMC for 4 days, went home for 2 days, but needed a readmission for another 3 days. My two stays couldn't have been more dissimilar. So I am writing about my observations, those who did a great job, and the few problems I found.

First, I think in general I got very good care. In the ED, I actually thought that the waiting was reasonable, they gave me a reasonable expectation of time delays etc. I found the ED nurses and techs very good- both in doing their job and giving the personal attention. One is struck by how busy they are and how they have to juggle many duties. Despite that, I didn't find it detracting from my care. Transport was fine, CT and sonogram people were pleasant, capable, and helpful.

I was admitted to an inpatient unit. My hospitalist was Dr. Renu Thomas, whom I found to be excellent. She was very thorough, had good insight into my care, was prompt about writing orders, and showed compassion and concern. Medically I thought she was excellent.  I was in a typical GBMC room- very small, but it was quiet.  I didn't really require a lot- mainly IV antibiotics etc. The nurses were all excellent, caring. One is struck by how busy they are, how they have to juggle many things. I liked that they wrote their names down each shift and left the direct number to the nurse. Once I used the call button, didn't get a response, but just waited since it wasn't that urgent. Later, I just called the nurse. Once a tech forgot something I asked for, and she was so apologetic. It really was fine. I had one aide who could have been a little quicker to help, but in general I found the staff great. The phlebotomists at 5:30 am were incredibly quick, quiet, and excellent at getting the blood work done. A night nurse, who clearly has many years of experience, was particularly helpful with her suggestions.

I was discharged home but the symptoms returned, so I came back for more intravenous medication. On my second visit my ED stay was again appropriate, not too long a wait, good staff. Then I was readmitted back to an inpatient unit. However I was put by the nurses’ station, in between a demented woman, and a hard of hearing man. And I was down from the ice machine- which is very noisy. So the room was very noisy and not ideal. This time I had a different doctor, whom I was not very impressed with. I found her manner not very caring. She made a mistake ordering me a medicine. When I mentioned it the next day- next time I saw her- she didn't even apologize. She just said that the computer wouldn't accept her code etc. When it was time to be discharged, she said I would have to wait at least 3 hours because she had sick patients she had to care for. I am sure that this was true but not what I needed or wanted to hear.

However my worst experience was from the unit coordinator. During my second stay, I developed a headache (my headaches often progress to severe migraines), and at 7:10 am hit the call button to ask for Tylenol. I was answered right away and told that it was change of shift so that it would be awhile for the medicine. At 8am when I still hadn't received the Tylenol, I called again. No answer. So I tried 2 more times over 5 minutes. No one even answered the button. So I got out of bed, and with my IV pole in tow, went out to the desk. As I approached, the unit coordinator said she told me the nurse would be coming. I said that no one answered the call button. She then, in front of many people at the desk, said that she had talked to me several times and told me that the nurse would be coming. At that point, I told her that she had only told me once at 7:10 and I wasn't sure that the bell had even worked the next time since no one even answered me. The nurse then came and gave me the Tylenol.

Later that day I spoke with the charge nurse, who was extremely polite, apologetic and helpful. She arranged for my room to be changed to one away from the nurses’ station. I did mention that I thought it was a problem that someone couldn't even get a Tylenol for an hour due to change of shift.

I will probably be returning again to GBMC as an inpatient because of my chronic medical problems. I am hopeful that I will have a better experience than my second stay. But in general the nurses are all excellent, caring, and very busy. You really get a sense of all they are taking care of with their patients. So many things go well at GBMC, but there is always room for improvement.

I am very grateful for the work of our people at GBMC, especially all of the nurses and technicians that this patient thanked and Dr. Renu Thomas.  But, as the patient said:  “There is always room for improvement”.  I called the patient and apologized for the appearance of callousness by that unit coordinator.  I told the patient that our unit coordinators do an excellent job but sometimes people slip and make it appear that they don’t care when they do, and sometimes they say the wrong thing when they are trying to prevent their nurse teammates from being overwhelmed. The patient accepted this and she told me that GBMC is still her preferred hospital. I thanked her for her trust in us.

I know that there was a discussion between that unit coordinator and her supervisor, to get her to reflect on her behavior and change it. I should also mention that our nurses are working to redesign our approach to answering the call light and they have embraced bedside handoffs and hourly rounding to reduce the frequency of patients needing to call them.

But in addition we all need to work to eliminate the appearance of callousness.  I look forward to your thoughts on this.

A Wonderful Legacy Remembered: The End of Catholic Health Care In Our Region

This week marks the end of Catholic healthcare in our region. With the purchase of St. Joseph’s Medical Center by a non-denominational hospital company, a 148 year legacy of service is finished. I spent three years in Catholic healthcare in Boston and that company, Caritas Christi, is also a thing of the past, having been purchased by venture capitalists.

The reality is that we have too much hospital capacity in Baltimore. The owners of St. Joseph’s, Catholic Health Initiatives (CHI) of Denver, Colorado, had only one hospital in the area and it was losing a lot of money. CHI is a very large company with $9.65 billion in annual operating revenues but after a number of years of losing money in Towson, they decided to divest themselves of St. Joseph’s. CHI is a mission-driven organization and they are also realists. It appears that the company could only rationalize losing millions if they could prove that there was an unmet need. With all of the excess hospital beds in Baltimore, they could not justify the need so they got out. Now, a smaller hospital company is the new owner.

What a long way from the reality found by the Sisters of St. Francis of Philadelphia in 1864 when Mrs. Catherine Eberhard donated three row houses on North Caroline Street to be used for the sick and infirm. In that era, there was not much available to cure disease. Hospitals were started as a place to care for the sick who were also poor. Those with means were cared for in their homes by their families. The Sisters of St. Francis and others who joined with them in this noble mission dedicated themselves to helping others in their time of need.

In 1870, the State approved the Act of Incorporation to create the Saint Joseph German Hospital and in 1872 a new facility with that name opened at Caroline and Oliver Streets in Baltimore City. During the 20^th Century, with the advances of modern medicine, the hospital grew and changed and in 1965 (the year of the opening of GBMC), St. Joseph’s moved to Towson. In 1981, the hospital became a part of the Franciscan Health System and they began doing open heart surgery the next year. In 1996, St. Joseph’s became a part of CHI and continued their growth in heart and orthopedic procedures.

Everyone in Baltimore knows what happened next with the governmental investigation and the accusations of unnecessary procedures. What has not been discussed is how the hard-working nurses, doctors, and other clinicians kept serving patients. Unfortunately for them, the business model that St. Joseph’s had chosen is hard to make work with so many hospitals pursuing the same model, and the American people and American businesses are desperate for a new model. You see, building a lot of hospital beds and waiting for people to get sick to use them, or only providing a lot of elective procedures because that is where you make the money, has led us to our national predicament where we are bankrupting our federal government, our state government and making it difficult for businesses to provide health insurance to their people. The new model, a system of health care that works to keep people healthy and limits the need for patients with chronic disease to be admitted to the hospital, requires different capacities and capabilities.

The biggest capacity that is required of the new model is primary care. In the Greater Baltimore Health Alliance, (our system’s Accountable Care Organization) we now have close to 100 primary care providers, many of whom are working in Level 3 patient centered medical homes with care managers, extended office hours, and a fully functioning patient portal, among other things, to keep people healthy. None of these things are focused on by hospital companies using the old model, like St. Joseph’s.

It is sad to see the end of the legacy of the dedicated Sisters of St. Francis and all of the hard working physicians, nurses, and others who worked with them on a mission of service to others. We know however, that their spirit lives on in those who embrace the new model of service and who are willing to let go of the old model where filling hospital beds and focusing on services that make money were acceptable endpoints in and of themselves.    

Health, Healing and Hope for Victims of Domestic Violence

Last week I had the privilege of welcoming Maryland Lieutenant Governor Anthony Brown to the GBMC campus as he announced Maryland’s seventh hospital-based Domestic Violence Program (DVP).  Joining Lt. Gov. Brown was Maria Harris Tildon, vice president of corporate communications for CareFirst BlueCross BlueShield, who presented GBMC with a check for $15,470 toward the DVP. 

As a pediatrician, I have seen firsthand the impact of domestic violence in the home and the critical role medical providers can play in addressing this issue. We are fortunate to have two outstanding professionals leading these programs,  Linda Kelly and Sally Hess, who are educating and training our medical staff to better identify and respond to patients in need.  In this way, GBMC is adding a new program that will help us better meet our mission of health, healing, and hope for those in our community. 

This is another example of GBMC HealthCare focusing on what patients need. While others are amalgamating hospitals and propping up unnecessary bed capacity to get market share and drive up the cost of care in our region, we are adding this new service which will never cover its direct costs on patient revenue, let alone be profitable.  

GBMC has been serving victims of violence for many years through our Sexual Assault Forensic Examination program (SAFE), which has always had the goal of expanding its services to include victims of Intimate Partner Violence (IPV). Now that this is a reality, the goals of the GBMC DV program include providing direct services (24/7 crisis response such as support, education, safety planning, referral to community resources and follow-up) to any patient, staff or community member experiencing IPV, educating staff on the effects of DV on health, and how to best identify and support patients experiencing IPV.

To date, GBMC’s DVP has provided services to more than 50 individuals.  We anticipate serving an average of 30 patients per month by 2014 based on similar-sized hospital programs.  In addition to corporate and state grants, the program is being financially supported by generous donations from our community.  We are grateful for all the support that is allowing GBMC to continue its legacy of providing healthcare services for women across the community.

To learn more, watch a video of the press conference announcing the program.

Our Green Team Gets Recognized for its Accomplishments

L-R: Keith Magel, Regional Manager, ARAMark; Jim Duerr, Corporate Materials Manager Director, GBMC; Matt Tresansky, Nutrition Director at GBMC, ARAMark; Ryan O'Hara, Retail Manager at GBMC, ARAMark ; Keith Sappington, Food Production at GBMC, ARAMark; Michael Forthman. Vice President of Facilities & Support Services, GBMC; John Chessare, M.D., President & CEO, GBMC HealthCare system

Congratulations to everyone involved with our Green Team, led by Michael Forthman, vice president of facilities and support services, on the occasion of the GBMC HealthCare system being recognized with one of five Trailblazer Awards at the Maryland Hospitals for a Healthy Environment (MD H2E) Environmental Excellence in Health Care Conference. Trailblazer Awards are given annually to hospitals that have shown leadership in advancing sustainability in their operations.

GBMC was recognized for its dedication to providing improved diet options for patients, employees, and visitors. During the first month after launching a campaign to promote healthier beverages, hospital sales of non-sugary drinks exceeded sugary ones for the first time on record. GBMC reduced food waste by 1,100 pounds per month from March to August of 2012, and installed hydration stations which encourage refilling reusable bottles with filtered water.

Treating everyone the way you want your own loved ones treated…with clean hands.

I also wanted to recognize our employees, who are working hard to reach our hand hygiene goal. As you know, if we achieve a score of 79 percent or greater in November, we will pay out a bonus in December to eligible employees.  We are just past the halfway point for November, and our hand hygiene compliance score is at 81%.  We still have a ways to go, though!  I encourage you to keep up the good work!  Practicing hand hygiene is the number one way to prevent healthcare acquired infections.

If it were your loved one, you would want to be sure that any staff entering the room had clean hands.   This will be an excellent achievement, so let’s all work together to make sure we clean our hands on the way in and on the way out every time!  

Finally, I hope everyone in our GBMC family had a happy and enjoyable Thanksgiving holiday.  Each day I am thankful for every member of our team who does the very best they can do in whatever role they play in helping provide the best possible care for our patients. 

Welcome To Our Family

I’ve been in healthcare for quite awhile and I know that every healthcare organization of any significant size does formal orientation. I firmly believe that orientation is a great opportunity to have a conversation with people when they are first forming their impressions of the new workplace.  New people don’t yet know the ways of their new organization so they are kind of a constant opportunity for change.  I believe if you can get to the new people they can make change happen faster, whereas someone who has been in your organization, although they may be a wonderful person, they kind of accept the way the organization operates and it’s harder to see opportunities for change.

Every two weeks I give the opening welcome for the GBMC HealthCare system orientation. I start by talking about our mission, vision and values and our plan for the future. I talk about the fact that we are not just a hospital, we are a wonderful healthcare system with a great hospital and a great hospice (Gilchrist) and a great physician company (GBMA), and now a great new physician company (GBHA) to embrace private practicing doctors in the pursuit of the Quadruple Aim of Better Health, Better Care, Less Waste and More Joy. I underline for the new staff that we are a system of care, and explain that if we could get the kind of coordination that Dr. Tony Riley and his colleagues in Geriatrics get for frail elderly patients for example, for every patient, we’d be a marvelous healthcare system.

I often have a great dialogue with the new staff at orientation about what doing it the way you would want for your own loved one every time actually means. The experience every two weeks has been invaluable. It's probably the best interaction I have with employees about where we are headed as a company.

As we approach the Thanksgiving holiday, I want to take a moment to thank all of the GBMC HealthCare system private practice physicians, employees, volunteers, and board members who help us in one way or another provide outstanding care around the clock for our patients.  Healthcare is a 24/7/365 enterprise, and we recognize that many individuals make personal sacrifices during the holiday season in order to help care for our community.

Speaking of our community, Joe Hart, GBMC’s chaplain and Spiritual Support Director, recently suggested that we ought to get to know our religious neighbors, so we have launched a "visiting our neighbors" series.  Joe and I recently visited the School Sisters of Notre Dame at Villa Assumpta on North Charles Street.  There are nearly 60 sisters who live in retirement at various stages of life.  We met with members of the provincial council and discussed the healthcare needs of their community. I explained our philosophy of care and asked how we might assist them in meeting their healthcare needs/goals.  Knowing the community well I was able to speak to the spiritual support offerings we have when their members come to GBMC for care.  It was nice to hear the many complimentary things they had to say about GBMC and how well the sisters have been cared for recently and in the past. 

Working Toward A Safer Culture For All Patients

This week I invited Carolyn Candiello, Vice President, Quality and Patient Safety, to write a guest blog post highlighting the organization's upcoming Safety Attitude Survey.

We all heard over and over in this most recent election about the importance of getting out to vote!   Next week we will begin our second annual Safety Attitude Survey.  I am very excited about this year’s survey and am looking forward to learning how we can continue to improve our safety culture.  I am also interested to see if our scores reflect the good work our staff has done over the past 18 months to reduce serious safety events and infections.     I hope everyone in our patient care units will take the time to “vote”!

When we conducted our survey last year, we learned that in those units with the lowest perception of teamwork there was a higher incidence of patient harm. We also learned that nurses and doctors working on the same unit can have a different perspective of patient safety and teamwork.  We learned that some of our staff felt that it was not easy to talk about errors and that we didn’t always address behaviors fairly.

Christina Welch, Clinical Unit Coordinator of Unit 58,
demonstrates the Quantos reporting tool.

In response to the survey, each unit reviewed their findings and implemented action plans aimed at specific improvement.    In addition, we initiated several organization-wide changes.   For example, our survey revealed that we did not have a good mechanism to report safety events. Since the survey, we have implemented our on-line incident reporting tool, Quantros, which allows for ease of reporting.  The increase in reporting and the quality of the reporting has allowed us to identify trends that block holes in our system.  The Quantros tool is located on the InfoWeb - look for the Patient Safety button on the homepage.  As a reminder, staff should report any incidence of patient harm, near misses or unreliable care. 

Quantos reporting on the InfoWeb

We also heard that it was difficult to discuss errors and there was inconsistency in our responses. We have since adopted a philosophy of a Just Culture were we console human error, coach at risk behavior and appropriately discipline reckless behavior.  We also continue to learn from our errors and share our learning throughout the organization.  Staff are involved in root cause analysis and participate in identifying permanent solutions to prevent an error from re-occurring.

A great example of learning from our experiences has been in our efforts to reduce falls.  Earlier this year, we noticed an increase in patient falls.   In response, a a multi-disciplinary improvement team  was appointed whose aim is to reduce falls and prevent injury.    So far, we have seen significant improvement (see the FY2013 system goals).    But also, we are seeing a culture change.  Units are measuring the time between falls.  Now, when a fall occurs, everyone takes notice.   The team does a post-fall huddle and looks for ways to prevent a similar occurrence.    Having everyone engaged and in action to prevent falls is powerful.

The Safety Attitude Survey will be conducted across all patient care units within the organization.  This is a confidential survey that focuses specifically on staff perception of clinical safety in their unique work setting.  The 33 questions focus on teamwork, safety, leadership, stress, working conditions, and learning.   While some of the questions are similar to the employee opinion survey, this questionnaire is designed to provide direct feedback around the clinical safety climate.  Responses to the survey are completely confidential and will be processed electronically by Pascal Metrics.

Staff who will participate in the survey will receive a  “token” and a link for the survey from their manager—this will be a similar process to the employee opinion survey.  Gilchrist Hospice employees will receive a paper survey.  Results of the survey will be shared throughout the organization in early 2013.  I look forward to sharing them with you and seeing where we have made improvements since last year.

When you receive the token or paper survey, please take the time to “vote”—our patient’s safety depends on it.

No, not that election!

This week, many of us voted in the Presidential election, statewide elections and on referendum questions. But recently there was another “election”.

Nearly 10,000 physicians in the region “voted” for which physician, in a variety of specialties, they would send a member of their own family to if they needed healthcare.  The highly regarded Baltimore Magazine annual “Top Doctors” November issue was recently released and the votes are in.

I’m proud to say that many doctors agree on who is best!  Once again, GBMC had more members of our medical staff cited as a “Top Doctor” than any other community  health system or hospital. It is with a great deal of pride and pleasure to share with you that 120 GBMC physicians, covering 60 specialities, were recognized a total of 132 times as a “Top Doctor”!  That’s right, there were several GBMC physicians who were cited as a “Top Doctor” in more than one specialty or sub-specialty!

Being recognized as a “Top Doctor” is an extraordinary honor, because it is a selection by peers for which physician they would select for a member of their own family.  To all of the “Top Doctors” at GBMC, congratulations from all of us! The rest of us in the family are very proud of you.

To view a listing of our “Top Doctors” and to learn more about who they are, please visit GBMC's Top Doctors 2012 webpage.

I would be remiss if I didn't thank our Chief of the Division of Gastroenterology, Dr. Niraj Jani, who was one of the five survey advisers (and thus was ineligible to be selected as a "Top Doc" by his peers), and recognize family medicine physician Dr. Sarah Whiteford, whose "Why I Became A Doctor" story was one of several profiled.

The GBMC Family Rises to the Occasion….Again

Hurricane Sandy hit the East Coast with a vengeance on Monday and Tuesday but our patients got the care they needed because of the dedication of our people. I was the Administrator on Call, so with my colleagues from our Critical Incident Team D, and with the able support of Dan Tesch and Michele Tauson, who have overseen the creation of an emergency plan second to none, we ran the command center throughout the storm.

Inside the Hospital Command Center during Hurricane Sandy operations.

We went on our “Code Yellow” on Monday at 11:30 a.m.  Code Yellow requires people to stay at GBMC until they are released by their supervisor. We do not take this decision lightly. I know that our staff would prefer to be with their families during a weather emergency (I was worried about a poplar falling on our house with my family inside) but it is our duty to care for and protect our patients. So, many nurses, technicians, physicians, other clinicians, housekeepers, food service workers, patient access representatives and administrative and support staff of all kinds stayed with us at GBMC and at our two Gilchrist Hospice Inpatient Units in Towson and Howard County from Monday until we lifted Code Yellow at 8:30 am on Tuesday. Since the MTA buses were shut down early on Monday and didn’t restart until Tuesday afternoon, many of our staff who normally take the bus had to find other ways to get to work. I am particularly grateful to them for their perseverance and commitment to our patients and to GBMC.

We dealt with storm related issues as they came up. Our wonderful, almost 50-year-old hospital has a flat roof and we had some leaks. The wind wreaks havoc with some areas, allowing water into cracks that are not normally there. The entrance to Unit 45 had a leak that went back into a staff locker room. We will fix these leaks when the weather permits. We were very lucky that we did not lose power. We have significantly increased our ability to generate power over the last two years but we still have a few areas, like our central sterile supply department, that are not on backup power. Since the power did not go out, this was not an issue.

We distributed cots and gave people meal tickets. I was a Boy Scout and I used to enjoy camping but I am glad that I only had to sleep on a cot for one night. Since we had power, we watched the storm reports on television. I worried about my son in New York City, as his apartment is not far from the areas where the storm surge caused flooding and the devastating damage to the subway system and the tunnels. When I heard that the power was turned off to his neighborhood to avoid a catastrophic meltdown of the power generating capability from water in the plant, I got a little more nervous. (As of the writing of this blog he is fine but the power is still off. He is getting extra exercise with the transit system still shut down!)

It was truly eerie on Tuesday morning at 7 am in the main lobby and in our main corridors. You could hear a pin drop. Usually at that hour on a weekday, there is significant hustle and bustle. Things were so quiet because for the safety of patients and staff, we had closed our outpatient clinics and services. The Emergency Department, however, was going full speed ahead. Since most physician offices were closed, anyone who could get in and needed to be seen came to the Emergency Department.  As usual, our fantastic staff just did their jobs and met everyone’s needs.   

Our thoughts and prayers are with Maryland’s shoreline hospitals that did not fare as well as we did and of course with people up and down the East Coast who were harmed by the storm, lost loved ones or who had devastating property damage. I grew up in New Jersey and used to go to Seaside Heights in the summer. It is so sad to see the boardwalk and so many homes destroyed. We Americans, the descendants of people who built this country often under adversity, are a resilient lot. I have no doubt that we will rebuild what has been lost. 

As for the GBMC family, we showed once again that we know what our mission is and we accomplished it again. To my colleagues at GBMC, I am very grateful to you for a job well done!

Finally, a reminder that GBMC offers, free to all staff, text-based notification of emergencies / critical incidents via Code Messaging. More than 200 staff members were added to our list in the days before Hurricane Sandy.  If you are not yet on the list, email your first and last name, cell phone number and provider (i.e. Sprint, AT&T, Verizon) to ddietz@gbmc.org  in Emergency Management and you will be added to the system. 

What’s a 3P?

Everyone who has been in healthcare for awhile can remember a building project where after it was completed, the staff said: “Why did they build it like this?” because the end result did not meet their needs. I am happy to report at GBMC we are using a powerful design tool to reduce the chance that we build something that doesn’t work. The tool is called a 3P, for production, preparation, and process. The 3P helps you design a new production process with the smallest amount of waste possible. This week, I asked Min Min Than, our Director of Pharmacy and the process owner for this PI engagement, to write a guest blog highlighting our team’s recent 3P experience.

Min says:

We recently used the 3P to begin planning for our new Inpatient Pharmacy. This 3P project was initiated and sponsored by Jody Porter, Senior Vice President of Patient Care Services. The project objectives included designing an efficient work flow process and positioning the pharmacy to meet future patient and internal customer needs.

Our team included our consulting PI Master from Next Level Partners; GBMC PI Masters Lisa Griffee, Julie Silver, Nicole Garrison and Julie Gabriele; and key pharmacy staff members including Pharmacists Paul Ku and Julia West, Technician Supervisor, Gigi Lei, and Buyer, Karen Delacruz. Joining the team was our Construction Project Manager from ProSys, Bryan Niles, and two of our architects from HMC, Usama Hassenein and Jim Albert.

In order to design an efficient work flow process, the team was challenged to evaluate not only overall square footage but also technology utilization and future needs.

Our team began the event the week of September 24 and used 3P. This process emphasizes meeting customer needs by first focusing on changes to improve flow and eliminate waste. By including cross-functional team members, we were able to bridge the gap between designing a layout to include needed storage, fixtures, machines and equipment to factoring in material flow, standard work and information flow. By encouraging a large number of ideas and thinking outside the box, the team was challenged to quickly come up with at least seven different layouts.

These were spread out on paper and documented the flow through each pharmacy process (spaghetti diagrams). They were discussed, rated, and narrowed down to the top three. These were reviewed again, and this time they were drawn to scale. Finally, we prioritized one design and we built it out in the Tulip Park garage using 1 inch thick cardboard! (We had to protect the mocked-up cardboard pharmacy from the rain and wind and our colleagues at Sheppard Pratt wondered why we had draped tarpaulins over the side of the garage!)

We filled the space with actual equipment when possible (chairs, trash cans, carts, trays, supplies) and modeled the rest (machines, desks, shelving, computers, etc.) By having 3-D, to scale representations that we could walk through, we started making modifications and testing out our design through simulations. We opened up the space for many other Pharmacists and Technicians to walk through and provide feedback for other modifications based on front line staff input.

On October 15 & 16, we conducted multiple simulations of each of the key processes to validate our final design. By implementing the right technology and efficient workflow processes, our final design accomplishes the following:

1. Freeing-up more time for Pharmacists and Technicians to spend in bedside pharmaceutical services;

2. Safer care by utilizing more bar code technology

3. Better inventory tracking and better managing of medication storage

4. Improved control and safety of narcotics, by shifting them to a secure room.

The project provided another great learning opportunity for performance improvement using LEAN tools and gave us a lot of “A-ha” moments. Also the 3-dimensional build gave a real feel for the new work flow and space to frontline staff and more ownership of the new design. Lastly, as with all LEAN projects, the 3 P process is much more cost-effective as it eliminates the need for most changes in the real build which are very costly.

Congratulations to one of our own!

Finally, on behalf of the entire GBMC HealthCare family, a warm “congratulations” to Erin Ament, BS, RN-BC, Clinical Unit Coordinator of the Acute Care for the Elderly (ACE) unit, who recently received the National Excellence in Gerontological Nursing Award for 2012! “Working in the ACE program, I consider myself lucky as I get the best of both worlds,” Erin said. “In my role I get to work with the patients I love and educate the nurses around me about the importance of their care with the elderly patient.” The Excellence in Gerontological Nursing Award is presented by the National Gerontological Nursing Association. The award was established to recognize excellence in individuals who provide care to older adults. Congratulations are also in order for a second ACE Unit nurse, Maria Baxter, who was also nominated for the award.

How do you communicate within a large organization?

It has been a very interesting (and at times humbling) week for me. I have spent a lot of time reviewing what our people think from sources like the Employee Satisfaction Survey, the Physician Satisfaction Survey, the Senior Team Survey, the thoughts of our wonderful Employee Relations Council and people at this week’s employee lunch forum, questions from our first Town Hall meetings, and comments on this blog.

Our healthcare system is strong in large part because of its diversity in so many dimensions, one of those being its diversity of opinion. In the various formats that I listed above, many people have stated their opinions. I believe that we generally get to a consensus belief about most things when there is a free flow of information between the “front line” and the “front office”. But some of the thoughts expressed by people in our family are quite startling and underline for me how important it is to try to communicate with everyone. Some of our hard working physicians, nurses, and others believe things about what we “administrators” (and me in particular) are trying to do that are literally the opposite of what we are trying to do.

My reflection on how to continually improve communication such that people believe that someone is listening to them and they get to hear what our senior leaders think has to begin with me. The effective question is: what can I do to improve direct, open, and honest communication? It is clear that I need to make myself more available and I need to reach out to members of the family who are less likely to be physically present at on-campus forums like many of the members of our medical staff, both private practicing and employed. I also need to continue to work with our senior team to continue to make decision-making easier. I need to get better at listening. When you are passionate about something, you cannot let your passion run away with you.

But I also realize that a big part of the dilemma of making sure that everyone feels that they have a voice and that someone cares about their opinion is just a characteristic of large complex organizations. It is hard to get the message down and around to everyone without the final received message getting distorted. I am sure that the readers of this blog have played the game where someone whispers a message in a person’s ear and then that person passes the message down the line until the last person repeats what he or she heard. 

Everyone laughs when they hear the difference between what the last person heard and what the first person said. For example, a message that starts “We need to build a big robust primary care enterprise within our company to better coordinate care for patients and to send more patients to our surgeons when they need surgery” becomes:  “We only care about primary care physicians and we don’t need excellent surgeons, excellent OR teams,  and  strong  surgery departments”.

I also know that the world continues to change rapidly and it may be that sometimes people have heard the message but they don’t like it. In this instance, the challenge is to make sure that people are appropriately reassured, their fears are addressed and that people like me try to look out for their interests when they are in line with the interests of our patients and the GBMC system. 

I am very interested in hearing people’s ideas on how we can communicate better and truly give people a voice. Please share your ideas either by commenting on the blog, or if you would like me (or another member of the senior team) to come and visit your practice, your department, or your unit please email me at Jchessare@gbmc.org.  

Thanks for going “above and beyond”

Last Friday I was the senior executive on call for our hospital. Dr. Dave Strauss, one of our outstanding Emergency Medicine physicians, called me about a case that got me annoyed very quickly. The larger healthcare “system” and the patient were making it very hard for our team to do what I and more than 99% of rational thinkers would want done for themselves or their loved ones. Dr. Barry Waldman, one of our medical staff orthopedists, stepped forward and treated the patient according to his wishes and took care of his immediate medical problem under very difficult circumstances. I would like to publicly acknowledge Dr. Waldman and thank him for helping this patient. 

Starting with the Facts, and Staying in action to make things better

The first presidential debate contained a lot of talk about our healthcare situation. Let me again say that the United States has the best-trained and hardest working doctors and nurses in the world. Unfortunately, they toil everyday in a broken system that makes their work of trying to prevent and treat illness very difficult. The US spends about 40% more per capita on healthcare than Germany, France, the Netherlands or any other industrialized country and our outcomes are generally no better and sometimes worse. In addition, the citizens of these other countries have significantly higher satisfaction with their systems. We are not buying value with our health care dollar. These are all statements of fact.

After stating the facts, leaders must engage people in creating solutions. In this blog, I have pointed out that these facts should not cause panic; there is great news here! Since we spend so much more on healthcare than these other countries, we could redesign our system and reach the so-called Triple Aim of better health, better care and lower cost. We could end the disgrace of hard working American citizens not having health insurance and being one illness away from bankruptcy and reduce health insurance costs for business, our government, and individuals. I am disappointed that neither debater made this case.

As Maryland Secretary of Health Joshua Sharfstein and his colleagues Laura Herrera and Charles Milligan pointed out in their recent commentary in the Baltimore Sun, the fundamental shift that must happen is moving from a payment system that rewards handsomely the provision of some healthcare services but does not incentivize care coordination, to one in which teams of clinicians help individual patients manage their health. We have many wonderful hospitals and our present system is very good at dealing with acute episodes of illness – there is no better country to be in if you have just been hit by a car or you have acute appendicitis – but not very good if you have a chronic illness like diabetes at assuring that you get only the best care to prevent you from getting sicker. Our system uses the Emergency Department and now Urgent Care Centers as the pathways of least resistance leading to more utilization and less coordination.  The notion of the patient-centered medical home is an outstanding design for coordination. Primary care teams, led by physicians, with office hours 7 days per week and with the use of information technology to have all of the patient’s information available when it is needed, can improve health and the patient’s experience with the care as they are reducing the cost of care by driving out wasteful practices, like extra tests, unnecessary hospital admissions, and Emergency Department and Urgent Care visits.

To get to a better system we have two large challenges. The first is the challenge of redesigning the system – to take resources from our current hospital-centric system and apply them to the new system. We need to let the public know that we have too much hospital capacity. Rather than propping up failing hospitals, we should be funding the new design. The second is to change the reimbursement system so that we are buying the health care we want – that which leads to measurably better health and better care – and not just a lot of services.

The GBMC HealthCare system, a not for profit company with a mission of serving the health care needs of our community is racing to transform itself to get to the Triple Aim. The stakes are high but the people we serve desperately need us to do this. The facts are the facts, there is no debate about this.

Spectacular Saturday in the Country Benefits GBMC HealthCare

The 12th running of The Legacy Chase at Shawan Downs last weekend was a huge success.  Great weather, beautiful horses, a picturesque countryside setting and many family and friends – there were approximately 4,500 attendees this year – coming together equaled a spectacular time.

And it was all for a good cause, as the money raised benefits patient care at the GBMC HealthCare system. In previous years The Legacy Chase at Shawan Downs has generated considerable financial support for GBMC’s Nursing, Emergency and Pediatric Emergency Departments.

Funds raised from the 2012 Legacy Chase will support Emergency Medicine at GBMC. GBMC HealthCare’s own Dr. Jeffrey Sternlicht, Chairman of Emergency Medicine, has served as the Medical Director of Legacy Chase and other high-profile horse races for more than 10 years. We’ve launched an endowment campaign to honor Dr. Sternlicht and the exceptional work of his medical team. Annual income from the endowment will be dedicated solely to GBMC Emergency Services. To date, we have raised more than $1 million towards the $1.5 million campaign and look forward to formally presenting it by the end of the year.

Stretched across 300 acres of green meadows at Shawan Downs in Northern Baltimore County, The Legacy Chase attracts visitors of all ages for the steeplechase races, railside tailgating, live music, great food, and family-friendly activities. Many of the crowd-pleasing traditions continued this year—such as the G. Leslie Grimes Memorial Stick Pony Race for kids— and GBMC added some exciting new components to help make this year’s event a success.

The “Chase on the Hill” wine tasting lecture and luncheon proved very popular; Baltimore-based band GAZZE kept everyone musically satisfied throughout the afternoon – even being accompanied at one point by our own Reggie Davis, M.D., Director of Neurosciences, and Gary Cohen, M.D,, medical director of the Sandra and Malcolm Berman Comprehensive Cancer Institute; the GBMC Kids' Korner with moon bounces and face painting was well attended and people enjoyed the three food trucks (Chowhound, Iced Gems, and Hula Honey's Shaved Ice).

This year’s Legacy Chase was, for the first time, managed by GBMC staff and volunteers. Kudos to the GBMC Foundation team and everyone from across the organization who helped make the 12th annual Legacy Chase the best yet!

Finally, thanks to our friends at the Land Preservation Trust and to Charlie Fenwick, one of the Legacy Chase event founders, himself a champion steeplechase rider and former chairman of the GBMC healthcare board, without whom the event couldn’t have been as successful as it was.

What do our people think about our system as a place to work?

In order to get to our vision, we must have our people fully engaged. We added “more employee joy in their work” to the triple aim of better health, better care and lower cost because we knew that the other three are not possible unless our physicians, nurses, other clinicians and support staff feel valued by our organization.

So how can we tell if our people feel that our system is a good place to work? Every year we do an Employee Opinion Survey. The results of this year’s survey are in and they show that in some areas we are improving and in others we are not.

Every year we hope for 100% participation so that we can hear from everyone. This year 75 percent of employees participated in the survey, which is down from 80 percent last year.

Our Employee Relations Index, which is a roll-up score of how satisfied employees are, was 69, down one point from where we stood between 2009 & 2011 and two points below our goal of 71.  While this is higher than the national average (65) for healthcare organizations surveyed by the same company, the fact that we are not improving is a problem for us. The actions that we must take to improve next year, however, lie in the responses to the individual questions.

Where did we improve?  The questions with the greatest score improvement included: Is senior management responsive to employee concerns?, which increased by seven percent;  trust in senior management, which increased by five percent; Does senior management treat you with dignity and respect, which saw a three percent favorable increase; and pay increase satisfaction, which also rose three percent.  I am grateful for the work of my colleagues on the Senior Team and our work in narrowing the distance between what the “front line” knows and what the “front office” knows. Things like senior leader rounding where we are partnered with a manager and his/her unit/department and luncheons with our staff and managers have clearly helped us build trust.

But while our scores improved in questions around trust in senior management (they were the highest since we started with the survey in 2007), these improvements were unfortunately offset with people’s unhappiness about compensation and benefits. Scores decreased on questions about satisfaction with benefits (10 percent drop), competitive benefits (nine percent), job security (eight percent), and future advancement opportunities (three percent).

We made some significant changes in benefits this year in an effort to save both the organization and employees money and keep as much of our “healthcare spend” within the GBMC family.  We will be asking our people for their insight into what specifically they may not like about the new plan. I realize that we have had some billing issues with the new system and I ask for patience as we correct these defects. We understand there is some confusion both among employees and physician practices and we’re working on improving that, but the fact that employees can now save significant family dollars is a benefit. Now, if you use a GBMC doctor in a GBMC facility, you have no out of pocket expense.

We’ve already begun taking steps to increase satisfaction with the new medical benefits program.  Letters have been sent to physician offices clarifying the co-pay process, additional communication is being sent to plan participants within the next two weeks and employee information sessions are being planned for early October.

We certainly faced some challenges in Fiscal Year 2012, and unfortunately had to make some personnel changes.  It’s understandable that some people get nervous about their longevity and security with the organization.

In the areas of job security and pay practices, some changes are already underway that will hopefully improve employee satisfaction.  Human Resources will be redoubling its efforts in ensuring managers understand how compensation decisions are made. We will work to provide clear expectations and processes for promotions, and we will continue educating managers on promoting our philosophy of a “Just Culture.”

Even though the formal survey process is over, I encourage all employees to share ideas, concerns and suggestions with their managers.  Every manager will review his or her department’s scores with their staff and come up with ideas for improvement. For things that cannot be fixed locally, like benefits and compensation, our Human Resources Department will take the lead on improving things.

The input shared by our employees is invaluable as we continue striving to reach our vision.   I encourage all of our employees to fill out the survey next year.  Without your thoughts we cannot improve. Also, you can share your ideas, concerns and questions at one of the upcoming Town Hall meetings. You will also want to attend a Town Hall meeting because we will be rolling out our Employee Incentive Plan for this fiscal year.

Town Hall Meeting Schedule

Thursday, October 11:  12 p.m. – 1 p.m., Civiletti Conference Center (Lunch will be served)
Friday, October 12: 2 p.m. – 3 p.m.., South Chapman
Tuesday, October 16, 9 a.m. – 10 a.m., GBMC at Owings Mills
Friday, October 19, 7 a.m. – 8 a.m., rear of the GBMC Dining Room (for OR staff)
Friday, October 19, 8:30 a.m. – 9:30 a.m., Gilchrist Hospice Care Corporate Office in Hunt Valley
Friday, October 19, 12 p.m. – 1 p.m., Civiletti Conference Center (Lunch will be served)

*Additional meetings will be scheduled during evening and weekend hours

Legacy Chase at Shawan Downs

If you don’t have any plans for this Saturday, September 29th, bring the family to Shawan Downs, which will once again be the home of The Legacy Chase, hosted by and benefiting the GBMC HealthCare system. The Legacy Chase has become an annual social event; marrying the excitement of steeple chasing with the beauty of the countryside.  As Jenny Coldiron, president of the GBMC Foundation says, "You don't need to be an avid steeplechase fan to have fun. Pack a picnic basket and come enjoy a day in the country."  In addition to the great horse races, there’s something for everyone – from wine tasting and live music to antique car displays and tons of kids’ activities including a stick pony race.   For more information, go to Legacy Chase at Shawan Downs