Friday, February 24, 2012

Great Surgical Care. Great Emergency Care.

I’ve experienced traumatic emergencies with children both as a pediatrician and as a parent, so I understand from both perspectives how significant of an event it is when a child suffers a major injury.  As the President and Chief Executive Officer of GBMC HealthCare, it’s ultimately my job to make sure our people treat every patient with the same care, comfort and respect they would as if they were treating their own child or family member.

Sometimes, there’s room for improvement in our efforts. But more often than not, our staff gets it right.  In the case of 13-year-old Chris Brandau, the staff in our Department of Surgery and Pediatric Emergency Department got it right.

Last November 19, Chris was at a friend’s house when he slipped while climbing a bunkbed ladder.  He was rushed to GBMC, where his parents met him and he was seen in the Pediatric Emergency Department.

Megan Silberzahn (a Pediatric Emergency Department nurse) was kind and competent with Chris,” his mother Trish reported in a letter sent to me shortly after the incident, commending several of our staff members.  “She immediately recognized the potential severity of the break (it turned out Chris had a complete fracture of the radius and ulna bones) and treated him with the utmost care and compassion.”

Chris was admitted to the hospital under the care of orthopedic surgeon Mark Deitch, M.D., a hand and wrist specialist, and a plan was set in motion for Chris to have surgery in the General Operating Room to repair his fractured arm. “All the nurses that cared for Chris provided exceptional care,” Trish wrote, specifically citing Megan Silberzahn, Carlye Page and Debbie Jerez.   The Pediatric Emergency Department staff, in Trish’s words, “all made what could have been a horrible experience feel like recovering from a cold.  They were kind, responsive and gentle with Chris, and informative and understanding with us.”

After the initial surgery last November, Dr. Deitch removed the rods from Chris’ arm in a second procedure in January at the Sherwood Surgical Center, and his mother happily reports Chris is back to playing basketball and lacrosse with no complications.

Trish recently shared her thoughts on the family’s experience at GBMC.  I encourage you to take a few minutes to watch this brief video and hear from the perspective of a patient’s parent how our staff is working toward providing Better Health and Better Care.

We’ve got great people who are really good at what they do, and we almost always get it right.  We owe it to our patients to be striving for perfection in the care and the patient’s experience of the care because when we don’t get it right that family doesn’t take any comfort in that we usually get it right.

Kudos to the staff who in this case, got it right for the Brandau family.

"Leap Labor"

Do you know any Leap Year babies? You might get to meet some on February 29th if you watch WMAR-ABC2’s newscasts.  GBMC is hosting the station for 24 hours for “Leap Labor”, a series of stories visiting with parents, family members and friends of babies born on Leap Day at GBMC.  Be sure to tune in to the station’s morning or evening newscasts and meet some of the hospital’s newest arrivals and their families.

Friday, February 17, 2012

Who is in charge?

A few weeks ago I wrote about our improvement in patient satisfaction scores ("Better Care"). Our people have really been working hard to deliver wonderful care to those we serve and their families.

I am so grateful for how hard our physicians, nurses, other clinicians, and support staff are working. But recently I have gotten some feedback from staff that they are concerned that patients and their families are “getting their way” because of our desire to improve patient satisfaction. At least one person suggested that a test had been ordered when the clinicians knew that it would not help the patient but they ordered it anyway, for fear that the patient would be upset.

I know some people think that my response to this is trite but I am going to say it anyway: “What if it was your daughter?” If it were your daughter, you would not want her to get something where the evidence showed that it was not in her best interest. On the other hand, you would want your daughter to “get her way” if she were talking about comfort, respect, companionship, or anything that made her experience of the care better. It’s true; we want our patient satisfaction scores to be as high as we can get them. It is our duty to do this because that is what we would want for ourselves and our loved ones.

Another thing that I heard as an example of “patients getting their way” is that we are “letting a patient have 5 visitors at a time when our rule is 2”. What is the correct number of visitors at a patient’s bedside? I believe that the correct number is the number that the patient wants…..within reason. Sure, if the room is full so that the caregivers can’t do their work, or if they are disturbing others or if a visitor is clearly sick, we need to act to remove some visitors. We need to do this because of our commitment to improving the patient’s health.

I am concerned that talk about patients “getting their way” is really about some of us having a hard time letting go of a paternalistic view of care-giving.  I believe that the patient is in charge until the patient is asking me to do something that I know is not in his or her best interest because of the evidence; or if the patient is requesting something that prevents us from accommodating our other patients.

So, we should start from the premise that we want the patient to “get his way” until we know that we can’t or we shouldn’t. It is impossible to get to our vision of everyone, every time getting the care that we would want for our own loved ones if we don’t.

What do you think?

Friday, February 10, 2012

Using technology to get to Better Health, Better Care and Lower Cost

The time-honored way of meeting face-to-face with your physician is a marvelous thing for patients and it is required, but not for every case and every situation.  There should be a way to have a communication other than face to face about follow-ups, minor medical issues, lab results and other simple things.  There should also be a way other than by making a phone call to make an appointment.  If we expect patients to better take charge of their health, they have to have easier access to their medical records.

Patients have historically not had a way to interact with the healthcare system and their provider other than face-to-face or via the phone.  But now, across the Greater Baltimore Medical Associates physician practices on the GBMC campus and in locations across the region, there is such a way – introducing “myGBMC” ( – our brand-new patient portal that went live January 31. “myGBMC” gives patients the ability to take a more active role in managing their healthcare and offers instant, around-the-clock, password-protected access to their personal health information.

“myGBMC” is a free service available to current GBMC patients. It is a personalized, secure communication link between patients and their physician's office that provides convenient, 24-hour access as well as online tools to help manage care more effectively. A similar portal will soon be available to patients of private practice primary care physicians who are part of the Greater Baltimore Health Alliance (GBHA) (See “Adding Great Players To Our Team”, August 26, 2011)

Our goal is to keep patients informed and involved in their healthcare every step of the way!

Through “myGBMC”, patients can confidentially and safely:

· Access their personal medical record.
· Communicate with their physician's office.
· View recent laboratory results, medication lists and health summaries.
· Request prescription refills and referral renewal.
· Update their personal information, and more!

The patient portal is patient–centered and is another way that using healthcare technology gets us closer to our vision of the Triple Aim - Better Health, Better Care, and Lower Cost in the eyes of the patient.  This is part of our transformational work to get us closer to our vision of being the healthcare system where every patient, every time gets the care that we would want for our own loved ones. (Review our vision statement)

Since its launch last week, our practices have web-enabled more than 2,350 patients on the “myGBMC” portal (not including more than 1,000 patients of the Hunt Valley practice which went live as the pilot site in mid-November 2011), evidence that our new tool is proving very popular with patients.

In the words of Hunt Valley patient Ken Drews,

“The changes that have taken place at GBMC Hunt Valley have all been very positive. “myGBMC” has been a terrific addition to the medical service that they offer.  By accessing the patient portal I am able to obtain important information such as test results and examination information.  I am also able to see my history with regards to visits and diagnoses.  Because medical care is a group effort I am now able to be more actively involved in monitoring my medical conditions and needs.  The patient portal is definitely the start of a new and important era in health care.  I feel like medicine and technology are now more closely combined than ever before.”

Well said Ken!

We are very excited about this and need to thank our doctors, nurses, clinicians, people working in the practices and all the IT staff who worked hard to get “myGBMC” launched. A big “kudos” especially to Julie Gabriele and the GBMA Applications Team, the Marketing Department, the Hunt Valley practice (practice manager Robyn Schaffer), and Mary Phillips who coordinated the GBMA leadership and training.

If you are a “myGBMC” user and want a refresher of how to navigate through the portal, or are not yet a GBMA patient and want to take a video tour of “myGBMC”, click

Have you used the “myGBMC” portal yet? What do you think about it? What ideas do you have for other ways that healthcare technology can be implemented to help patients? Please share your thoughts below.

Friday, February 3, 2012

Roemer's Law

We need to have a conversation with the American people (particularly with people in the Greater Baltimore area at this moment in time) about the main drivers of our costly healthcare system. There are many reasons why the American system is so expensive and wasteful. I remember learning about one of them when I was at the School of Public Health at the University of Michigan in the mid 1980s. One of my professors taught me about Roemer’s Law.

Milton Roemer, M.D.
 was a researcher and professor who spent a lifetime (he died in 2001) studying and advocating for health systems around the world. He was involved in creating the World Health Organization in 1951 and was a public health official in upstate New York in the 1960s.

After World War II, federal legislation was passed to make it easier to get government funding to open new hospitals.  With the baby boom, there was a need for hospitals to deliver babies, and with the burgeoning new technologies that gave medical professionals the ability to cure more people, many communities wanted a hospital.

The Hill-Burton Act, also known as the The Hospital Survey and Construction Act, was passed by Congress in 1946 providing grants and loans designed to make it easier to fund not-for-profit hospitals.  Money was designated to states to achieve a ratio of 4.5 beds per 1,000 people. There was a community in upstate New York that had a hospital that was operating at 70 percent of capacity.  But people in the region had a sense that they needed a new hospital. Hospitals were seen as good things, and there was a community groundswell of enthusiasm and a movement to build a second hospital.

Roemer believed a second hospital wasn’t necessary since 30 percent of the beds in the existing hospital were empty.  But the groundswell of support took off and the community received funding to build the second hospital.  Roemer expected the second hospital to be empty. He was astounded to find a few months after the second hospital opened that both hospitals were now operating at about 70 percent occupancy.  So there had been a significant number of beds added to the community and they were being used.

He wondered how this could be - was there a new influx of people?, had there been some new epidemic of disease?, had there been some major health catastrophe? -  but he couldn’t find any such new need for hospital beds. He wrote a paper suggesting that the demand for healthcare services in the United States was directly related to the availability or capacity to provide those services.  Rather than there being a supply and demand curve where the supply increased to meet the demand, he showed a new curve where increasing the supply actually was creating an increased demand for healthcare services.

It makes sense for consumer products like automobiles or swimming pools where the availability of something new and never seen before creates a new demand, but in healthcare services, before Roemer’s time, it was felt that it was illness burden in the population that was the only driver of the use of services. Since Roemer’s paper, we know differently.

Roemer’s Law holds true across the United States. Healthcare economists, in the United State and abroad have known that the availability of hospital beds and technology alone was driving up the cost of care. For many years, we accepted the added cost of more capacity because we believed that we Americans were better off because of it.

Now because we can no longer afford our system and because we are losing American jobs to other countries in large part because of our healthcare costs, we are taking a closer look. Studies are now being reported on in the national press almost on a daily basis highlighting the areas where consumption of healthcare services is not leading to better health. We citizens need to demand a greater focus on getting the care that will really help us and shedding the care that doesn’t.

Roemer’s Law of a direct correlation between hospital capacity and utilization of that hospital capacity still operates today, although in the 1980s the federal government through Medicare dampened that a bit by starting to bundle payments to hospitals for an entire hospital admission rather than paying by the day and for individual services. However, it still is true that the more services are available, the more they are used. Therefore communities with excess capacity have more costly and wasteful care and put burdens on small business and industry because they have to pick up the costs of extra capacity that the community doesn’t really need.

Smart people in the greater Baltimore area should think about how many hospital beds and high tech services we need in our community and in our region. We have the best trained physicians, nurses, and therapists in the world. We need to deploy them in strong, vibrant healthcare systems that use evidence-based medicine to help people and add value to our community. We need better health, better care, and lower cost but do we really need all of the hospital beds that we have now? Would we be better off if we closed some of them?

What are your thoughts on Roemer’s Law and the drain on our economy of hospital beds and healthcare services that are really not adding to health?  Please share your thoughts below.