Friday, July 20, 2012

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.


  1. I also see many young employees parking in Lily Park, even though we've been told that you have to work here 25 years for that privilege. Perhaps that reminder needs to go out again. About smoking: Nothing about our campus is smoke-free. Visitors stand outside, blocking the sidewalks, and security guards just watch them. I have received some nasty comments when I've asked smokers to put out their cigarettes, and I'm not doing it anymore. One person pointed to the butts littering the ground as proof that he wasn't the only one smoking. A few weeks ago I met a woman coming down the steps from the hill. She hid her cigarette, embarrassed, and said, "they need to realize that we smoke when we're worried and stressed, and not treat us like criminals." Her 90-year-old mother fell ill suddenly, was not doing well and the family had some serious decisions to make. So we're either smoke-free in theory and our grounds look terrible, or we have some compassion and give smokers a contained area to use. Thank you.

  2. I am excited to be able to comment on two of my favorite pet peeves! Regarding parking: I too, see many employees who do not even look 25 years old much less look like they have been working here for 25 years parking in Lili garage! It is a very nice perk to be able to park there and I patiently waited my 25 years to do so. I called someone out on it one time and was told that "my manager told me I could park here on the top level." On one occasion recently, I came in to the garage in the afternoon and I noticed that all of the spots were filled up to level 7. It is a shame that anxious visitors are forced to drive around and around all of those levels, increasing their anxiety, before they can finally find a spot! Regarding smoking: I have never smoked but I understand that it is a burden for a visitor to have to go to their car in order to do so. I think that, based on the number of cigarette butts all over the ground, that we can consider the no smoking policy of the past 5 years a failure. I suggest that we have a designated area for visitors only with plenty of ash cans for disposing of butts. We could still support our healing environment by posting signs or brochures with tips for smoking cessation. I'm sorry, but employees should not also be extended this privilege since they can choose to work elsewhere if the policy does not suit them! Perhaps a penalty for employees caught smoking would be to spend an hour after work cleaning up the cigarette butts????

  3. They do have some place to smoke - their vehicles. I have tried to sit in shaded areas along the path and in the gardens to eat lunch and have been run out by smokers. I say something, but some don't care, they think they have a right to smoke. Only when they are disciplined will they get the picture. As far as parking, the ones that are taking patient & visitor parking spaces also feel they have a right to park where they are parking & the only thing that will affect them is discipline and towing their vehicle.

  4. Smoking STINKS! I've had the misfortune of getting on the Lily Park elevators with a few employees dressed in scrubs that are coming back from their "smoke break." They reek of smoke! My first thought is how sorry I feel for the patients they are caring for. Especially the ones that suffer from respiratory problems, because there is no way that the smoke that is embedded into the smokers' clothes will not effect their patients. It is very sad.

  5. What about the employees and visitors that smoke in the bus stop covered area? Is that permissible, because there is a constant stream of smoke from that spot.

  6. There should be zero tolerance policy for these employees whoever they are, for these kinds of activities. If they are not punished now, they will keep on doing the same things again and this habit will spread to others easily. It's a shame they are still working in GBMC!

  7. I am aware of several employees who do not put stickers on their cars so they can park in visitor spaces. Towing cars would teach a lesson, but the people who are using this loophole are not the ones who would be affected. Back to smoking - not all employees drive to work, and not all visitors drive here either. I would love to see a study of the productive time of smokers vs. non-smokers during an 8-hour shift. My guess would be that smokers put in less time doing their work because of the frequency in which they leave their unit or office to go smoke. That costs the company money in nonproductive time!

  8. Every day about 25 to 30 employees go out to the bus shelter and smoke. Visitors waiting for rides and buses see this and emulate their behavior. Have security/human resources cite these people with an official warning letter that enforces our smoke-free policy and warns about the cost to everyone to insure these people. After the warning letter is signed, the next infringement will be termination. There is absolutely no reason why employees can violate our rules with zero negative feedback. What happens when a non-smoker feels that the lateness policy should also be a wink and a nod enforcement?

  9. You're absolutely spot on with this observation. Our process to rid ourselves of people who dishonor the Greater Behaviors is way too lengthy, and we are way too lenient with employees who basically thumb their noses at the rules. We give too many chances for redemption, and they take advantage of it - not to improve, but to continue on with their current behaviors.

  10. It is quite apparent the the problem here is not so much the behavior of the smokers and parkers, but that security here at GBMC is a joke. They do not enforce any of the hospitals policies, therefore it appears that it is ok to park and smoke where you want.
    Lets not mention the amount of theft that occurs because security will just watch someone as the walk out of the hospital with large items in plain sight without even stopping the culprits to question what they are doing.

  11. Smoking on campus is flat out wrong. The policy needs to be enforced. I personally don't feel comfortable walking up to a co-worker and telling them they should not be smoking. Security needs to take the upper hand when it comes to that. Increase routine patrols during the times when people are more likely to be out there smoking (before and after shift change, during prime lunch hours). Also, security needs tell patients, who constantly leave their inpatient rooms to smoke, to extinguish their cigarettes and return to their rooms. Physcians need to make it clear to the patients, if they are well enough to go outside to smoke, they don't need to be a patient in the hospital.

    As for the parking situation, I think the policy needs to be revisted and updated accordingly. I have worked here for 4 years. I work at night, so I was told I could park anywhere in the Lily garage, level 3 and above, regardless of pt/visitor signs. When I did work dayshift, I was told, to park in Lily garage during the day, you needed 5 years of service, not 25. Obviously, there is some miscommunication

  12. I have seen employees smoke at the bus stop and then return to work in the newborn nursery of all places. You know their clothing reeks of smoke.

  13. I'm all for having a non-smoking campus. It sends the right message. On the other hand, I like the idea of having a place to deposit cigarette butts safely. Patients/ visitors may be new to GBMC and may not be aware of our non-smoking rule. I think removing these receptacles presents a serious saftey hazzard.

  14. I agree with the last post. I like the idea of having a place to safely extinguish lit cigarettes. The receptacles could be accompanied by a sign that says "GBMC is a smoke-free campus. Please extinguish all smoking materials." Thanks for your blog.

  15. I work in a hospital that is no smoking on the entire campus. This means no smoking even in your car. If you are caught smoking on campus you are fired on the spot. Maybe if GBMC had this stricter law then the smoking would stop.

  16. I think the people who smoke where they shouldn't and park where they shouldn't should have been asked to leave before many of the folks whose jobs were recently eliminated. Rules need to be enforced for decisions to seem fair.


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