“Getting Better at Getting Better”

This week, with the help of our colleagues from Next Level Partners, we have begun the training of another group of Performance Improvement (PI) Masters.  There is a science of improvement and we need more people to learn this science. Our existing PI Masters and now our new ones in training will lead more improvement efforts to help us get to our vision.

People love our vision and they are upset when we don’t treat people the way we want our own loved ones treated. When a patient waits in our Emergency Department waiting room, no one is happy. The waits and delays are nothing more than a characteristic of the system we are operating. We have a tremendous will to change.  But on a typical day managers are putting out fires and working hard to get through their day, so we need people who can support initiatives both small and large and help the process owner improve the process.

I am grateful for the work of Tressa Springmann, VP and Chief Information Officer, and Carolyn Candiello, VP, Quality and Patient Safety, along with Keith Poisson, our Chief Operating Officer, and John Saunders MD, our Chief Medical Officer, who have taken some time to redesign our overall system for supporting change. This week’s training program for more PI Masters is part of that redesigned improvement system. We need to get better at fixing big problems (like flow out of the Emergency Department) and smaller problems.

Over time, we all need to know at least the basic tools of improvement and it is our goal that we would all get this knowledge over the next few years. A great way to learn is by doing, so as part of the PI Masters education this week, three teams ran “mini kaizens” (improvement events) on ED flow, outflow from the PACU and discharge of chest pain patients. They have scheduled tests of change in these processes for next week and I am very excited to see the results! We will get better at executing change and sustaining these changes through our new oversight model. I am grateful for all of their hard work and excited that we will be getting better at continuous improvement.

Employee Opinion Survey

Just a quick reminder to all GBMC staff to fill out your annual Employee Opinion Survey, which is now available online and will run through the end of August.  This is a vital tool for management and we have made several changes in the past few years based on your feedback.  To maximize its value, it is important that every employee complete the survey.  We are striving for an increase in employee participation to 85 percent.  Make sure you save your survey brochure after you complete the online form, because at the end of each week during the survey, randomly selected access codes will be chosen for one of many valuable prizes, such as a $25 Target or gas card or the grand prize of an iPad or $500.

Parking and Smokers

Thank you to a number of readers who posted comments on last week’s blog about both the parking and smoking situations on campus.  You are correct, the rules need to be enforced better and we will be exploring ways to do this.

What is our personal responsibility for living our values at GBMC?

Let me share a story that happened recently here on campus. 

It was an early weekday morning. As I walked through the Lily Park garage toward the Main Hospital thinking about the day ahead, I encountered three employees in scrubs who were standing in the ramp, clearly smoking cigarettes. As you know, for the health of our patients, visitors and employees, GBMC is a smoke-free campus. It has been so for more than five years. This rule comes from our value, respect. Out of respect for our patients, visitors, and our colleagues, we don’t smoke on our campus (and we don’t toss cigarette butts on the ground for others to clean-up).

Now, I realize it is hard for us as employees to approach individuals who are violating our smoke-free policy, but I decided to do so and ask them to put out their cigarettes. As I got closer, it became evident to me that one of them had also parked in a space that was clearly marked as “Patient and Visitor Parking Only.” We reserve some parking spots close to the door so that our patients, especially the sick and the elderly, don’t have to walk so far. I think this rule also comes from our value, respect.

As they saw me coming towards them, they quickly tried to hide and extinguish their cigarettes. But I still asked, “Are you aware that our policy states you cannot smoke cigarettes here?” I also asked the person who had parked her car in a “Patient and Visitor Only” spot, “Do you work here? Because you are not supposed to park there.” Her response was “Yes, but I am only part-time!”

I know that cigarette smoking is an addiction for many, but what if it was your child with asthma or your mother with chronic lung disease who was about to walk by?

I also know that there are times when you may be running late and are just in a hurry to find a parking space so you can get to your work station on time. But, what if you were a visitor to our campus, and you were looking for a parking space so you could visit your mother? You are anxious, nervous and scared – all of the emotions one may have when a loved one is in the hospital. Those emotions can be elevated when you have to drive around and around to find an open parking space. Then, on top of that, when you do find a space and get out of your car, there is a strong odor of cigarette smoke (or worse, a cloud of recently exhaled smoke), and you need to step over discarded cigarette butts! It’s not reassuring to know this is the kind of environment where your mother is being treated.

I am confident that most employees park where they are supposed to and follow our smoke-free campus policy. But, when those rules are broken, I ask the following:

1) Does the individual member of the GBMC family have a duty to not park in spaces reserved for patients and visitors?

2) Does the individual member of the GBMC family have a duty to not smoke on our campus except in his or her vehicle?

3) Who should say something to those few employees who violate these rules?

4) “I will foster a healing environment” is one of the behaviors associated with our value of respect. What does this value of respect mean to us in these situations?

I ask especially that employees who park in spaces reserved for patients and who smoke outside of their vehicle on campus reflect on these questions. I also encourage all employees to provide ideas on how we can better enforce the smoke-free policy and assure our employees do not park in spots designated for our patients and visitors.

On another note, I read a comment to last week’s blog in which a reader asked if the Medicare Shared Savings Program would ultimately lead to providers withholding necessary care.

This is a valid concern that we need to stay vigilant about. But, please know that the writers of the Affordable Care Act built in measures to prevent that very thing from happening. The Act includes 33 different quality parameters designed to assure better care. If we do not meet the quality parameters, even if we save money, we will not share in the savings.  We will add care that helps as we eliminate services that don’t. 

Under the Affordable Care Act, providers will wind up investing a lot more time and money on outpatient care. Let me give an example that I frequently use:

In the fee-for-service world, since no one pays for coordination, when we discharge a diabetic patient we don’t have a well-designed system for making sure that the patient takes their insulin correctly and stays on their diet. If the patient gets sick again and gets re-admitted, we get paid (well) again. The hospital and the doctors benefit financially from this second admission. However, if the patient was your mother, you wouldn’t want her readmitted for diabetes again. It is the second hospitalization that the Medicare Shared Savings Program is going after.

With the Affordable Care Act, we will be spending money (in the Patient-Centered Medical Home and with care coordinators) to keep the patient healthy, building a much more sophisticated system of care to keep that patient from getting sick again due to diabetes mismanagement. This is what you would want if it were your mother with diabetes. Yes, there is an opportunity for the unscrupulous to withhold necessary care but we will not let that happen.

Lastly, we held a very successful “Medical Staff and Employee Meet and Greet” last week. Approximately 200 employees came to the event, held in the back of the Dining Room, where they interacted with many of our physicians and their office staff members both from our GBMA employed group and from private practice. I want to personally thank Deloris Tuggle, Dione Harrison, Debbie Chilaris, Dr. Harold Tucker, our colleagues in the medical staff office and everyone who was involved in organizing the event; the 52 physician practices and their staff who participated; and those employees who attended. The feedback has been very positive and we are planning to hold similar events in the future.

Moving Forward Down The Path To Lowering Healthcare Costs

It’s a great time for us at the GBMC HealthCare system!

This week, the Centers for Medicare & Medicaid Services (CMS) announced that Greater Baltimore Health Alliance Physicians, LLC (GBHA) was one of the Accountable Care Organizations selected to participate in the Medicare Shared Savings Program, a part of the Affordable Care Act designed to incentivize physicians to improve the quality of care and drive waste out of the system through better coordination. This is part of the Act that is an attempt to lower the cost of care to Medicare beneficiaries.

A subsidiary of GBMC HealthCare (the parent of Greater Baltimore Medical Center), GBHA is the company we started that welcomes both employed physicians as well as private practicing physicians to work towards better health and better care with measurably lower costs. It’s a network (so far) of more than 300 providers.

More than 100 organizations nationwide have been approved for the Shared Savings Program, but GBHA is the first ACO selected in the Central Maryland region and the first in the state with a hospital partner, GBMC. At the outset, more than 10,000 patients will benefit from this new level of collaboration in GBHA.

GBHA was created as part of GBMC HealthCare’s strategic plan that follows from our vision ("To every patient, every time, we will provide the care that we would want for our own loved ones”) of a more patient-centric system where a patient’s needs are better met. This new law aligns the payment system with our strategy. This is a way for us to earn money for not doing unnecessary care. Hospitals have been financially incentivized to deliver medical services and there has been little or no payment to truly manage a patient’s health. Now, if we successfully keep Medicare patients out of the hospital we will be reimbursed for our efforts.

It’s exciting because this is a validation that our strategy is correct to build a strong primary care base in our system. Some doubters have been concerned that the patient-centered medical home would not be successful because no one would pay for it. Now we have more evidence that this is not true. We now need to continue to make our primary care network strong and link it tightly with our wonderful specialists.

With our participation in the single-sided model of the Shared Savings Program, there is no downside financial risk for the entire three-year agreement period. If we don’t end up saving any money, there is no penalty, and hence no risk. If we do save money, GBMC and our doctors will share a percentage of the savings. This is our first formal contract where we are being incentivized for providing patients with Better Health, Better Care, and Lower Cost.

A Model of Improvement

We’ve been holding employee blood drives at GBMC in partnership with the American Red Cross for more than a dozen years – a lot of people have worked very hard on these drives and many people have been helped because of them. But our most recent drive in June is cause for celebration.

Back in April, our blood bank leaders alerted me to the fact that Maryland was a net importer of blood from other states because we do not collect enough donated blood from our region to meet our own needs. In addition, they told me that GBMC was not meeting its own goals for units of blood collected and that we were not doing as well as some other Maryland hospitals. If your loved one needs blood, you expect that the system has the blood ready for your loved one. And I was also made aware that our lack of meeting targeted goals for blood donations had a significant negative financial impact on GBMC.

GBMC is a member of the Colonial Regional Alliance, a healthcare purchasing collaborative, and is grouped with two other hospitals in regional blood collection efforts. If the group meets an annual goal in units of blood collected, a significant discount is earned on the total price of our blood products. Heading into GBMC’s June 21st blood drive – the last one of the quarter among these regional hospitals – the group was projected to be well short of the overall goal.

Now here is the reason for the celebration - through the efforts of many GBMC was able to reach and surpass our goal!  How did GBMC accomplish this?  We redesigned the system.

Kim Davenport, our Community Relations and Events Manager, has been working extremely hard on our blood drives but it was apparent to me that she was not getting all of the help that she needed, so we formalized a new Team called the Blood Donations Improvement Team. The Team reviewed our most recent performance in units of blood collected per drive. It appeared that we had not done things very differently over the past few years in running the drives (and the outcome was too dependent on the work of a few) and our results were varying around 60 units of blood per drive (with the most recent drive in February of this year resulting in 58 units collected). The Team concluded that to reach our goal of 85 units we had to do things differently.

The Institute for Healthcare Improvement (IHI) uses the Model for Improvement as a framework for accelerating change.

Our Team decided to use this tool. It was clear that our Aim was to collect more blood. We were fortunate in having a metric of success that we had been collecting routinely (the number of units of blood donated). We then needed to study what had worked elsewhere (so we didn’t recreate the wheel). We made a list of what was known to work to increase donations and created a “change package” of things that our team could try.

Our “change package” included increasing the visibility of senior leadership, identifying department recruiters who would be charged with asking colleagues to donate blood, because we learned from the American Red Cross that many people would donate blood but are never asked.  We also increased signage and raffled off a lunch for two with me - congratulations to Dana Hack, clinical pharmacist in Oncology Services, who won the raffle!

After picking the things that we would try we planned our drive. On the date of the drive we tested our changes (the “do” in the model). We have now got our results (the “study” in the model). And we will “act” on what we learned to plan our next drive.

So how did we do? …..drum roll please…. at our June blood drive, we collected 124 units, more than double the previous average!  We had to turn people away because we were so crowded!

Because of the successful blood drive, GBMC will realize an additional $7,500 in savings on blood products this quarter.  If we continue with successful blood drives, we can earn more than $20,000 in additional savings. And more importantly, we have helped at least another 44 or so loved ones.

The next blood drives will be held on Wednesday, September 19 and Tuesday, November 20, 2012 in the Civiletti Conference Center.

I’d be remiss if I didn’t thank those who stepped up to the plate as Blood Donation Improvement Team members and/or Recruiters and helped play a big role in our success!  - Jeff Biedronski, Reggie Bodnar, Nora Brunner, Bud Butler, Carolyn Candiello, Pat Caudle, Fred Chan, M.D., Aaron Charles, M.D., Peggy Collier, Kim Davenport, Tim Doran, M.D., Sue Erickson, Sandy Fahrman, Lisa Frank, Ceil Gayhardt, Susan Gueiss, Mike Hartnett, Kathleen Hider, Dave Hynson, Lori Kantziper, Justine Kellar, Treva Kosco, Judie Kusiolek, Karleen Lombard, C.J. Marbley, Barbara Messing, Brittany Miles, Anita Petri, Ken Rutkowski, Jonathan Schoemann, Lin Simon, Janis Smith, Eva Stone and Dan Tesch.

Also, a special thanks goes out to all those who took the leap and became a first-time blood donor! We’d also like to thank those individuals who are long-time, repeat blood donors. Your efforts do not go unnoticed!

On another note, summer is definitely upon us!  Last week’s temperatures surpassed 100 degrees and that coupled with power outages in our community made it very uncomfortable.

When the hot weather hits, GBMC’s Red Day Alert goes into effect, during which staff and visitors may notice some non-essential lights turned off and a slight indoor temperature increase in non-critical areas.  This is a commitment by the organization to reduce our peak electrical load on critical summer days, which will reduce our environmental impact as well as our operative expenses.

I’d also ask that on such days staff take additional steps to “be green”, such as

• Turning off lights in unused/vacant rooms
• Turning off PC’s at the end of the workday
• Not obstructing air registers
• Pulling shades on windows to shield sunlight
• Not letting hot water taps run

I was grateful on Wednesday evening when power was returned to our home. I spent most of the weekend at GBMC because I was the Administrator on Call and the storm left us without power in our “out” buildings. The hospital was fine but we were on emergency power generation at the Gilchrist Center and in our Pavilions. Clinical care was not compromised (except that our MRI scanning was out). A sincere thank you to all who stepped up to the plate to help us get through this, but especially to Dan Tesch, Mike Forthman, and our facilities folks, Mike Hartnett from Marketing, and to Sue Bowen and CJ Marbley and their staffs for helping us plan for the week after PPW and the Women’s Surgical Center had been without power for about 8 hours on Saturday thus affecting the surgery schedule for Monday. Also, the Towson Gilchrist Center did a marvelous job of dealing with the lack of air conditioning for over 40 hours! They went above and beyond to keep their patients and family members as comfortable as possible. And a final word of thanks to all of our GBMC people who came to work to help others when they may have been without power in their homes!