Friday, January 27, 2012

Educating the American Public On Our Health Care Dilemma

As the saying goes, “A picture is worth a thousand words.”  Perhaps many pictures, in this case illustrations, are worth many thousands of lives improved and dollars saved.

Jonathan Gruber, an economist at Massachusetts Institute of Technology who served as an advisor for both the Massachusetts and national healthcare reform bills, recently posted a video that through the use of simple narration and illustration aims to explain the Affordable Care Act (ACA) and healthcare reform in a way that everyone can understand.

The Affordable Care Act legislation has been called “A Thing of Majesty” by Dr. Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services, and I agree. The problem is a majority of the American people don’t know anything about this law, and don’t know anything about the problems this law is trying to fix.

I encourage you to take a few minutes to watch Mr. Gruber’s "Illustrating the Success of Health Care Reform" video Gruber cites a “crisis in American health care now” and I agree.   The video does an excellent job of explaining what the ACA will do:

  • Make insurance affordable and provide insurance coverage for an additional 32 million Americans
  • Eliminate discrimination against the sick and denial of coverage for pre-existing conditions
  • Control health costs by establishing healthcare exchanges
  • Reduce the deficit

Gruber makes a point of explaining that the ACA is not a government takeover of insurance, but rather is an expansion of private insurance.  He notes the ACS does not force Americans to buy insurance they can’t afford and in fact includes an “affordability exemption” so no individual has to pay more than eight percent of their income for insurance.

We need more tools like this video to better educate our people on what the problems are with the present system because really smart people are fighting against the act without knowing what’s in it or even worse without knowing about the problems that it is trying to fix!

Everyone is entitled to their opinion.  It really isn’t about politics.  It’s about the huge burden that our present health care system places on our citizens, on our employers and small business owners and on our economy. Let’s at least understand what the issues are and then have an agreement that we’ll try to work together to find solutions.

What ideas do you have for how we can educate Americans on the burdens created by our current healthcare system? Please share your thoughts below.

Independent of what is going on in our healthcare market I want to remind people that GBMC has been a fixture in this community for more than 45 years. We will continue our work to be the health care system that treats everyone, every time, the way that we would want our own loved ones treated.  United with our private practicing and employed physicians, we will continue to serve the people of Towson and the region and drive ever-increasing value for those seeking their healthcare from us.

Great healthcare systems are not measured by the number of hospitals or buildings they own or the age or beauty of their physical plants. They are measured on what they achieve for the patients they serve. Therefore, our work for better health outcomes, better care experience, at lower cost and with more joy for those providing the care will continue with an increased fervor.

While we have not yet reached perfection, I want to share highlights of an email I received from a GBMC employee and some exciting news we received about how the hospital compares nationally with our peers.

Last Friday I was looking for a Raven's t-shirt in a local store.  I was wearing my GBMC Emergency Department fleece jacket, with my name.  I was talking with another girl that was also shopping for Ravens gear, although she was looking at the jerseys.  I had mentioned how nice they were and that I had never owned one.  She said she had many and found them to be good luck.  As I was talking with the girl, there was a merchandise supplier standing close by who kept looking at me and looking at my jacket.  He approached me and said, "So, you like those jerseys? You work for GBMC's ER?"  I replied, "Yes, they're great and I have worked in the ER for almost 9 years."  The man became a little emotional and said to me, "You guys saved my mother's life.  Just before Christmas my mother was in heart block and your ER caught it, cared for her and got her off to be stented. Because of your wonderful staff, my family and I were fortunate to spend another Christmas with my mother.  I cannot thank GBMC's ER enough for everything they've done for my mother and my family."  It took everything to hold the tears back, and maybe one or two slipped out.

This man told our colleague of an episode where we had treated his mother the way we would want our own loved one treated. Way to go ED staff! 

Finally, I’m proud to report that GBMC is one of 263 hospitals that ranked among the top five percent of the nation's hospitals, according to a survey by HealthGrades, a consumer group which tracks information on hospitals and doctors. The survey, which reports Baltimore-area hospitals provide the best patient care in the country, looked at clinical outcomes across 26 of the most common diagnoses and procedures.  Go and look at the hospitals that HealthGrades says are making Baltimore the best city in the country to get care… may be surprised. You can read more in the Baltimore Sun.

Friday, January 20, 2012

Working with legislators to buy better healthcare value

It is that time of year when we in Maryland get a bit more “tuned in” to the workings of our government.  Maryland lawmakers have convened in Annapolis for the annual legislative session, and we see and hear of the Republican presidential campaigning and debating with regularity.

Healthcare issues are certainly front and center on both state and national stages. We are now upwards of 17.4% of our gross domestic product being spent on healthcare. This is not sustainable and our elected officials, present and future, are looking for solutions.

Healthcare reform has been called out by some as something to undo. But the huge problem of the cost of our existing system, and the fact that not all Americans have health insurance, are going to be issues that will not go away even if we have a new president.

Maryland luckily is one of the more enlightened states that has embraced the notion of healthcare reform and has embraced the notion of trying to cover more of its citizens. But most legislators realize that we cannot afford to cover even the ones that presently are covered if we don’t redesign the system.  We who have elected them owe it to our state legislators to help find new ways to make our people healthier and happier with their healthcare at lower cost.

Our legislators need to find a way to buy better value. They know that they are now spending too much on things that are not bringing better health or better care. So what are we doing to create a system of higher value?

On many issues before the state legislature this year, GBMC is working alongside our colleagues at the Maryland Hospital Association.

We’re looking forward to the creation of a healthcare exchange in Maryland – that was a key component of helping residents in Massachusetts who didn’t have health insurance. People often make the mistake thinking that those without health insurance are the poorest of the poor.  That isn’t true.  The people without health insurance are often working individuals who don’t get employer-based insurance or those who are running their own small business.  The most successful part of the Massachusetts law was creating these exchanges where for example a self-employed business person who wanted to buy health insurance could compare and contrast different plans on what was being offered and what it would cost. Creating the exchange would definitely be a step in the right direction in Maryland.  Now that insurers can’t deny you for pre-existing conditions there will be a little more competition in the marketplace for individual and small group coverage.

Along with many other Maryland hospitals, this year we are advocating for funding and innovations that will help us reach the Triple Aim.

For example, we need to strengthen hospital finances and preserve Maryland’s unique “all-payer” status system made possible by a federal waiver for setting hospital rates.  GBMC is doing its part by improving operational performance, utilizing LEAN tools to reduce unnecessary variation and implementing a surgical smoothing initiative to optimize occupancy on surgical units and drive out waste.

Our efforts also include building an integrated quality and safety infrastructure, expanding data collection and reporting, and strengthening / fostering a culture of safety throughout the organization.  In addition, organization initiatives in healthcare information technology such as implementation of electronic medical records and computerized physician order entry will support the clinical, operational and financial reporting needs of the system.

Finally, moving to a patient-centered care model will bring significant change throughout the organization.  We will accomplish this goal in partnership with our family of physicians – doctors employed by the organization (Greater Baltimore Medical Associates), as well as aligned community physicians who are members of the Greater Baltimore Health Alliance and connected back to GBMC through electronic health records which facilitates information sharing to improve care.  Our medical home model will promote wellness and more effective utilization of health care services, thereby making it more cost-effective.

What ideas do you have for how we can help our legislators redesign our health care payment system to buy better value? Please share your thoughts below.

Above I mentioned improvements to our culture of safety, and I am very excited to announce that GBMC’s new incident reporting tool Quantros Safety Event Manager went live this week.  It can be found on the InfoWeb main page (top left hand box).

One of the organization’s goals for 2012 is to increase reporting of good catches and other incidents.  We’re continuing to build an awareness of “unreliable” care and look forward to this new system which will allow for increased submission of reports - either anonymously or by registering a name.  Staff will then be able to analyze these incidents and redesign systems to achieve improved outcomes.

Staff with questions or who want to learn more can read about Quantros Safety Event Manager in the Pulse newsletter or in the Quality and Patient Safety News To Use 

Friday, January 13, 2012

"Every Defect A Treasure"

When you say that your vision is to get it right every time for every patient (because that is what you would want for your own loved one), you realize that you are striving for perfection. Even though we realize that we will never be perfect, we must keep on improving.

We are not improving as fast as we need to at GBMC. I think I know one of the reasons why. I am a very proud man. I believe that I work hard and that I am always trying to do the right thing. When I reflect on my own behavior, I see many instances where I could not learn easily from a mistake because I was too proud and I got defensive. I think that I am not the only one at GBMC that is too proud and is a bit too defensive.

Organizations that strive for perfection, when they don’t get it right, are excited about learning why.  They realize that it is in studying what went wrong that they can redesign the process to get it right the next time.

One of the early leaders of the continuous improvement movement, W. Edwards Deming, worked in Japan in the 1950s and was instrumental in building that country’s industry into an economic world power.  As the Japanese were studying Dr. Deming’s work, they coined a term which translated into English as “every defect a treasure,” meaning that errors and failures are opportunities for learning to generate changes that can improve the system.

I get a lot of wonderful letters, emails, and phone calls from patients who want to make sure that I know about our wonderful staff. But I also get some letters from people who have not gotten the kind of care that I want for my own loved ones. I have been a bit concerned that when I have sent patient complaint letters to staff, our people are like me - way too proud and they immediately want to defend themselves and staff members against the patient complaint.  “Oh the patient didn’t really understand,” “Oh this was somebody you are never going to make happy,” and “Oh that’s not exactly the way it happened” are common responses. I begin by believing that our people are wonderful and are working very hard. When I send a complaint letter to them, I am not indicting them. I am sending it as a learning opportunity. I expect them to be curious about how we might delight the next patient in the same situation as the one who has a complaint. Every reported defect is a treasure, but only if we take the time to learn from the report and redesign our systems!

When I get one of these letters I start from the supposition that there are two sides to every story, but the game is not to defend yourself.  The game is to be self-assured enough to say “Wow, if we didn’t get it right through the eyes of the patient what might I learn from this instance and how can I get it right the next time?”

We need to drop our defenses a little bit and get a little more into the spirit of continuous improvement and look at every report of a failure as an opportunity for learning.  In some instances we will learn a lot, in some instances we won’t learn much.  But either way, we need to make sure our pride doesn’t get in the way of executing change to get closer to our vision.

What did you learn from a patient recently that led to a change in one of our processes? Please share your thoughts below.

On a similar note about striving for perfection but learning from where we don’t quite reach that goal, we are expecting an unannounced triennial visit from the Joint Commission, the accrediting body for hospitals, sometime soon.

While some in healthcare administration believe a Joint Commission survey necessitates a lot of urgent preparation, it really is all about a continual state of readiness.  Our hallways should always be clear of clutter. Our documentation should always be properly filled out.  And we should always strive to give the best care possible to our patients.

If we are really serious about learning, then we should welcome the Joint Commission to GBMC and be excited about the survey because it is a way for us to get feedback about how good our care is and our opportunities for improvement.  When I started in this business decades ago, the Joint Commission was checking things that were too far removed from patient care….like the documentation that staff had been to 50 percent of meetings - even if the staff never listened to anything that was said!  Hospitals would get involved in games, like one that took all the clutter off their units and packed it into a rented tractor trailer that was driven to and parked at a nearby shopping center. When the survey was over, the clutter was right back where it was before. They were obviously missing the point that clutter was about fire safety. Shame on the hospital administrator who authorized that.

Finally, congratulations are due to our Maternal Newborn Health staff.  GBMC was recently recognized with a Breastfeeding-Friendly Workplace Award from the DC / MD Breastfeeding Coalition.  Maternal Newborn Health staff led efforts to provide space, time and other accommodations for staff who choose to breastfeed. It’s always nice when an outside group recognizes your efforts.

Friday, January 6, 2012

Better Health for Diabetics

In the seven months since we launched GBMC’s new vision and strategic plan (“To every patient, every time, we will provide the care that we would want for our own loved ones”)(See: "GBMC HealthCare System – Our New Vision, Our New Plan to Get There") we’ve taken a number of steps in the right direction.

Last week, I talked about the evidence of us improving the patient experience of care (Better Care). This week, I want to highlight an initiative designed to improve the health outcomes of a group of patients with a serious chronic disease (Better Health).

I shared an update on the organization’s strategic plan earlier this week at a Department of Medicine meeting. On the agenda before me, was a presentation from Dr. James Mersey, Chief, Division of Endocrinology and Medical Director of GBMC’s Geckle Diabetes and Nutrition Center.

Dr. Mersey presented GBMC’s new Diabetes Initiative, designed to bring evidence-based and patient centered care to everyone with diabetes in our system. Dr. Mersey laid out a wonderful plan designed to bring experts to the bedside of everyone admitted to our hospital with diabetes. A certified diabetes educator from the Geckle Diabetes Center along with an endocrinologist will visit every admitted patient. At discharge, the patient’s diabetic care plan will be transmitted to the primary care physician, either through our electronic medical record, eClinicalWorks, or via fax for those who do not have the EMR. The diabetes educator will see the patient in follow-up if necessary and will be available to consult with the primary care team. For patients who are not in the hospital, standardized care protocols will be built into the EMR and consultations for difficult patients will become easier to schedule. The initiative will also include on-line and in-person educational updates for our primary care physicians. We will have the equivalent of a diabetes registry so that we can check back with patients and measure the effectiveness of our new system. This will then lead to clinical research to help further improve our care.

You see, Dr. Mersey understands that a major problem for diabetes patients is the fragmentation of their care and communication gaps between the experts, the patients, and those caring for the patients. He shared a story of a lady who had been in and out of our intensive care unit for the management of her diabetes because her plan kept being changed by her primary care physician once she left the hospital because he misunderstood the diagnosis. As Dr. Mersey was telling the story I had two thoughts; the first was that if that was someone I cared about, I would be pretty upset that my loved one had to go back to the ICU because of poor communication. The second thought that I had was that this was fixable by the type of designed system that Dr. Mersey was talking about. We can and we must do better! We can no longer rely on hard work and good intentions alone.

Anything that we do that better coordinates what has been a very fragmented system will make it easier to get to better health for those we are serving, and make for fewer trips to the ICU!

The work of Dr. Mersey and our wonderful diabetes educators is one example of how we’re focusing on the second tenet of continuous improvement and designing the system to get to the desired outcome - better health. We need to have our thinking caps on about how we bring evidence-based medicine to the patient no matter where he or she is in the system and to tightly connect what happens to a patient at every place in our system.

What ideas do you have to improve our fragmented healthcare system? Please share your thoughts below.