Friday, September 28, 2012

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

Friday, September 21, 2012

Recognition Events, A Remembrance, A Farewell

This was a great week at GBMC.  On Wednesday night we held our annual Employee Recognition Dinner at Valley Mansion where more than 500 of our GBMC family members were recognized for their service to the organization.

This year, we were privileged to recognize two employees who’ve been with GBMC for at least 45 years. Chestina Chambers, an OR Support Assistant in the  PACU, started with us in October 1966 and will be celebrating 46 years of dedicated service next month.  Pamela Reed, a cytotechnologist, earlier this month celebrated her 45th anniversary at GBMC.

Our vision is for a system that gets everyone better health with better care at lower cost with more joy for those providing the care.  The starting point of reaching our vision is engaged employees.  We will never get to our vision, no matter how smart the ideas are, if our people are not engaged and don’t believe in where our company is going.

This week’s dinner was a reminder that we have so many people who have invested so much of their lives with us, which is really a gift. At the very least, once a year we need to reach out and thank them and celebrate them.  It’s also an opportunity for them to reflect on all of the people who they’ve helped in their career, either directly or indirectly.  That’s a great legacy.

In addition to Chestina and Pamela, five employees were recognized for 40 years of service to GBMC: Norma Butts - a nurse support tech in Unit 48 – Surgery; Mary Hoover – a nurse in the Wound Care Center;  Betty Jackson – anesthesia technician; Cindy Kahl – a patient service assistant in the Pediatric Associates practice; and Annette Williams, a medical technologist in the lab.

We also celebrated 12 employees with 35 years of service; 10 with 30 years; 32 with 25 years; 24 with 20; 52 with 15; 97 with 10; and 275 colleagues who have been with GBMC for 5 years.

To all of our employees - our patients, their loved ones, and your colleagues owe a special appreciation for all you do.
On Thursday evening, Dr. Julie Freischlag, Chair of Surgery at the Johns Hopkins School of Medicine, gave the first annual Peter J. Golueke, M.D. Memorial Lecture. Friends of Dr. Golueke, our past Chief of Vascular Surgery who died last year, raised the funds for this lecture to remember his wonderful work at GBMC. Members of Dr. Golueke’s  family were present including his wife, his sons, and his daughter Erin who spoke at the event and reminded us that she had helped raise the money by baking and selling cupcakes at her school. It is important that a family reflect on the contributions of its members who have passed on. Peter was an excellent physician, colleague, and leader at GBMC.

On Friday morning, we said farewell at a retirement reception in the cafeteria to Ceola Tabron, who worked in environmental services at GBMC for 41 years. Ceola will be missed for her hard work and dedication but also for her infectious smile. She told me of her plans in retirement to do some travelling and visit friends and family. She told me that she was proud that only one snow storm had prevented her from getting to work in all her 41 years!

After the reception for Ceola, I travelled to the Sheraton Towson for our annual Volunteer Celebration Luncheon. We celebrated the work of volunteers both at our Medical Center and also at Gilchrist Hospice Care. I learned that in addition to the thousands of hours of service at GBMC there are approximately 400 active volunteers at Gilchrist who contributed over 28,000 patient care hours in fiscal 2012.  Of that number over 2,000 hours were devoted to the end of life doula program and about 9,000 hours were dedicated to serving patients in our two inpatient units in Towson and in Howard County. What a tremendous gift of service to GBMC, Gilchrist, and our patients.

It was a long week of celebrating, remembering and saying thank you. This is a necessary part of the life of the GBMC family.

Friday, September 14, 2012

The Baltimore Orioles, Margaret Mead, and GBMC HealthCare

We have all been watching with wonder and amazement as the Baltimore Orioles have been ignoring recent history, salary inequities between teams, and the pundits as they just keep on winning. As of Friday morning, the team shares first place in the American League East. Unlike in recent seasons when they had no hope in September of making the playoffs, the O’s are right in the thick of things. How are they doing it? What is making this season different?

Well, I think it starts with leadership. I am a big fan of Buck Showalter. Buck came to town and did not focus on the past or the team’s problems. He immediately got in action with a plan to make things better. He has methodically built the team. It is true that there have been some great additions, but I am more impressed with his support for and encouragement of the players that he found. He is a great teacher. Buck has taken his men and gotten them to believe in themselves. He has laid out the plan and has not gotten too upset with setbacks. Have you seen the look on his face at the end of recent tough games that the Orioles have won? It is the look of a proud father as he is watching his offspring celebrate.

Margaret Mead, the famous anthropologist, is quoted as having said: “Do not doubt that a small group of thoughtful people could change the world. Indeed, it's the only thing that ever has”.

Those of us toiling in our dysfunctional healthcare system should reflect regularly on these words. This may in fact be the mantra of Buck and the Birds, too. We in healthcare need to stop looking for the savior and get in action to redesign the system and get to the outcome we want, just like the Orioles have.

My hat is off to the Orioles and I am very proud of all that my GBMC colleagues are doing to get to the outcome we want … our vision of a system that gets everyone better health with better care at lower cost with more joy for those providing the care. People ask me if we will join a bigger company. I have begun to respond that they should not doubt that our small company could change the healthcare world. Margaret Mead knew that we could and Buck and his O’s are showing us the way.

A New Leader in Towson

Please join me in congratulating Dr. Maravene Loeschke as she is inaugurated as the 13th President of Towson University. I am proud to represent GBMC at the celebration. Dr. Loeschke is the university’s first alumna president since 1947. Originally from Baltimore, she graduated from then-Towson State College in 1969 and again in 1971. She became a theatre instructor in 1970 and spent three decades with Towson, rising through the ranks to become dean of the College of Fine Arts and Communication. Following academic leadership positions at several other campuses, Dr. Loeschke is coming home to Towson, and I look forward to working together on issues of joint importance.

Graduate Students

Finally, I had the opportunity recently to meet with several graduate nursing students from Morgan State University. In a very nice thank you note, the students thanked me and noted they appreciated meeting with a hospital CEO. “Your expertise and knowledge is a great asset our quest to further our education,” their note said. It was time well spent for me also, to connect with some of the region’s future healthcare leaders.

Friday, September 7, 2012

Learned People Know that We Can Do Better

This week, the Institute of Medicine (IOM) of the National Academies of Science, published a report entitled: Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. (

The report’s summary states: “America's health care system has become far too complex and costly to continue business as usual. Pervasive inefficiencies, an inability to manage a rapidly deepening clinical knowledge base, and a reward system poorly focused on key patient needs, all hinder improvements in the safety and quality of care and threaten the nation's economic stability and global competitiveness. Achieving higher quality care at lower cost will require fundamental commitments to the incentives, culture, and leadership that foster continuous "learning”, as the lessons from research and each care experience are systematically captured, assessed, and translated into reliable care.”

The report pointed out (again) the facts about the functioning of our current system. These experts concluded that 1/3 of the money we spend annually on healthcare, $750 billion, is pure waste.  (This runs in the face of politicians screaming into the microphone that we have the best healthcare system in the world. I believe that we have the best doctors, nurses, and other clinicians in the world and that they are working very hard but they are let down every day by a system that is not the best in the world and must be redesigned.)

True to form, the IOM report spends little time lamenting the status quo and moves quickly to discussing the solution. The IOM listed some goals for our country’s system and how they might be achieved by adopting practices already in use in other industries.

Let me highlight their solutions and talk about what the GBMC HealthCare system is doing in these areas.

1. Use Information Technology More Effectively – Clinicians and patients should have real-time access to medical records and use technology to streamline administrative tasks.

What the GBMC System is doing: We have rolled out the electronic record to all of our employed physicians and to our affiliated GBHA doctors and other practitioners. We are now beginning to connect our private practicing specialists. We have created our patient portal myGBMC. We have implemented computerized ordering in our hospital and we are now converting from hand-written doctor notes in the hospital to computerized ones. We have much more work to do here but we are well on our way. (Hospital companies, as opposed to health systems, have no hope of leading on this one.)

2. Create Systems to Manage Complexity – Prompts, technologies and delivery systems should help clinicians manage the growing complexity of medical knowledge and care required.

What the GBMC System is doing: We have teams working in many areas to create better systems to get to better outcomes for the patient. In the hospital we are using more and more evidence-based standardized order sets. In our employed primary care offices we are designing the patient centered medical home to bring evidence-based medicine to every patient with chronic disease. Our readmissions team is designing a better handoff from inpatient care back to primary care. The Gilchrist Hospice Pain Team is reevaluating on a daily basis the performance of its design to make patients pain free within 24 hours of entrance into hospice.

3. Make Health Care Safer – Hospitals and providers should constantly assess performance and learn from experience to reduce errors and harm.

What the GBMC System is doing: We now have a Board Quality Committee that sets our annual goals, reviews our performance monthly, and demands improvement. 99 percent of existing GBMC employees and all new employees have taken our course in patient safety. We have implemented a new error reporting system that is now being used throughout the organization. We have taken a culture of safety survey and all departments and units have created action plans to improve their scores. The survey will be redone this fall to measure our improvement. Our Board, our Senior Executive Team, and our Physician leaders have all read Why Hospitals Should Fly and the Board all participated in a day-long facilitated retreat on their role in quality and patient safety. All leaders learned about the concept of Just Culture and their role in creating a safe environment. We opened our simulation lab to better train individuals to do procedures and teams to function well in emergencies. Our Women’s Service has begun Team Stepps Training to make care in the delivery room even safer.

4. Improve Transparency – Patients and clinicians should have easy access to the prices of tests and procedures and to reliable information about care outcomes and quality.

What the GBMC System is doing: We now have some data about our clinical quality on our internal website and by the end of this year, we will be showing our quality data on our public website.  Comparative information about GBMC is also available at . As for prices, we have some work to do here. Our prices are set in Maryland by the Health Services Cost Review Commission and they fluctuate regularly. Check out some hospital prices by clicking on the HSCRC URL below and then click on Maryland Hospital Pricing Guide and you will see that GBMC is a lower price hospital in our state.)

5. Promote Teamwork and Communication – Clinicians and hospital staff should communicate to provide seamless, coordinated care within and across different care settings.

What the GBMC System is doing: We are building the patient-centered medical home, making medical records electronic, using standard work tools like S-BAR in communications between clinicians, and standardizing hand-offs. See also what I wrote above in patient safety.

6. Partner with Patients – Clinicians should fully incorporate the needs and preferences of patients into care decisions.

What the GBMC System is doing: Again, the concept of the patient-centered medical home is fundamental to the provision of patient-centered medical care. A system that is not totally dependent on brief, face-to-face illness specific visits, but rather builds a relationship between the patient, the patient’s physician, and her Team, is better able to query the patient at regular intervals about the patient’s needs and preferences and then deliver on them. As a result of conversations with our patients, our employed primary care sites are now open weekdays from 7am to 7pm and on Saturdays in some sites. At a system level, we have added patients to some of our committees. An example of this is that we now have three patients on our Board Quality Committee. We also have a patient on the board of the Greater Baltimore Health Alliance.

7. Decrease Waste and Increase Efficiency – Money should not be spent on unnecessary administration, inefficiencies, and care that doesn’t improve health.

What the GBMC System is doing: We have significantly increased the number of our system level value-stream mapping events for this fiscal year. We have a system goal to reduce the time from arrival in the Emergency Department to placement in an inpatient bed for those patients that need to be admitted. We have trained a new crop of Performance Improvement Masters, and we will redouble our efforts to improve our systems. Our Medicine Service Line, under the direction of Neal Friedlander MD, our Chair of Medicine, has created standardized order sets and pathways in the care of congestive heart failure and diabetes among other clinical entities.

I am glad that the Institute of Medicine has taken the time to identify the problems with our national healthcare system and has also set some attainable goals to improve the system. I am also very proud of all that GBMC is doing to be a part of the solution.

Your loved ones deserve better than the status quo. None of the problems identified by the Institute of Medicine are fixed by the building of new hospital towers, the lumping of existing hospitals into one company, or the expensive propping-up of inpatient capacity that the community does not need.

GBMC is building a better system of care for our own family members and yours.