The GBMC Family Rises to the Occasion….Again

Hurricane Sandy hit the East Coast with a vengeance on Monday and Tuesday but our patients got the care they needed because of the dedication of our people. I was the Administrator on Call, so with my colleagues from our Critical Incident Team D, and with the able support of Dan Tesch and Michele Tauson, who have overseen the creation of an emergency plan second to none, we ran the command center throughout the storm.

Inside the Hospital Command Center during Hurricane Sandy operations.

We went on our “Code Yellow” on Monday at 11:30 a.m.  Code Yellow requires people to stay at GBMC until they are released by their supervisor. We do not take this decision lightly. I know that our staff would prefer to be with their families during a weather emergency (I was worried about a poplar falling on our house with my family inside) but it is our duty to care for and protect our patients. So, many nurses, technicians, physicians, other clinicians, housekeepers, food service workers, patient access representatives and administrative and support staff of all kinds stayed with us at GBMC and at our two Gilchrist Hospice Inpatient Units in Towson and Howard County from Monday until we lifted Code Yellow at 8:30 am on Tuesday. Since the MTA buses were shut down early on Monday and didn’t restart until Tuesday afternoon, many of our staff who normally take the bus had to find other ways to get to work. I am particularly grateful to them for their perseverance and commitment to our patients and to GBMC.

We dealt with storm related issues as they came up. Our wonderful, almost 50-year-old hospital has a flat roof and we had some leaks. The wind wreaks havoc with some areas, allowing water into cracks that are not normally there. The entrance to Unit 45 had a leak that went back into a staff locker room. We will fix these leaks when the weather permits. We were very lucky that we did not lose power. We have significantly increased our ability to generate power over the last two years but we still have a few areas, like our central sterile supply department, that are not on backup power. Since the power did not go out, this was not an issue.

We distributed cots and gave people meal tickets. I was a Boy Scout and I used to enjoy camping but I am glad that I only had to sleep on a cot for one night. Since we had power, we watched the storm reports on television. I worried about my son in New York City, as his apartment is not far from the areas where the storm surge caused flooding and the devastating damage to the subway system and the tunnels. When I heard that the power was turned off to his neighborhood to avoid a catastrophic meltdown of the power generating capability from water in the plant, I got a little more nervous. (As of the writing of this blog he is fine but the power is still off. He is getting extra exercise with the transit system still shut down!)

It was truly eerie on Tuesday morning at 7 am in the main lobby and in our main corridors. You could hear a pin drop. Usually at that hour on a weekday, there is significant hustle and bustle. Things were so quiet because for the safety of patients and staff, we had closed our outpatient clinics and services. The Emergency Department, however, was going full speed ahead. Since most physician offices were closed, anyone who could get in and needed to be seen came to the Emergency Department.  As usual, our fantastic staff just did their jobs and met everyone’s needs.   

Our thoughts and prayers are with Maryland’s shoreline hospitals that did not fare as well as we did and of course with people up and down the East Coast who were harmed by the storm, lost loved ones or who had devastating property damage. I grew up in New Jersey and used to go to Seaside Heights in the summer. It is so sad to see the boardwalk and so many homes destroyed. We Americans, the descendants of people who built this country often under adversity, are a resilient lot. I have no doubt that we will rebuild what has been lost. 

As for the GBMC family, we showed once again that we know what our mission is and we accomplished it again. To my colleagues at GBMC, I am very grateful to you for a job well done!

Finally, a reminder that GBMC offers, free to all staff, text-based notification of emergencies / critical incidents via Code Messaging. More than 200 staff members were added to our list in the days before Hurricane Sandy.  If you are not yet on the list, email your first and last name, cell phone number and provider (i.e. Sprint, AT&T, Verizon) to ddietz@gbmc.org  in Emergency Management and you will be added to the system. 

What’s a 3P?

Everyone who has been in healthcare for awhile can remember a building project where after it was completed, the staff said: “Why did they build it like this?” because the end result did not meet their needs. I am happy to report at GBMC we are using a powerful design tool to reduce the chance that we build something that doesn’t work. The tool is called a 3P, for production, preparation, and process. The 3P helps you design a new production process with the smallest amount of waste possible. This week, I asked Min Min Than, our Director of Pharmacy and the process owner for this PI engagement, to write a guest blog highlighting our team’s recent 3P experience.

Min says:

We recently used the 3P to begin planning for our new Inpatient Pharmacy. This 3P project was initiated and sponsored by Jody Porter, Senior Vice President of Patient Care Services. The project objectives included designing an efficient work flow process and positioning the pharmacy to meet future patient and internal customer needs.

Our team included our consulting PI Master from Next Level Partners; GBMC PI Masters Lisa Griffee, Julie Silver, Nicole Garrison and Julie Gabriele; and key pharmacy staff members including Pharmacists Paul Ku and Julia West, Technician Supervisor, Gigi Lei, and Buyer, Karen Delacruz. Joining the team was our Construction Project Manager from ProSys, Bryan Niles, and two of our architects from HMC, Usama Hassenein and Jim Albert.

In order to design an efficient work flow process, the team was challenged to evaluate not only overall square footage but also technology utilization and future needs.

Our team began the event the week of September 24 and used 3P. This process emphasizes meeting customer needs by first focusing on changes to improve flow and eliminate waste. By including cross-functional team members, we were able to bridge the gap between designing a layout to include needed storage, fixtures, machines and equipment to factoring in material flow, standard work and information flow. By encouraging a large number of ideas and thinking outside the box, the team was challenged to quickly come up with at least seven different layouts.

These were spread out on paper and documented the flow through each pharmacy process (spaghetti diagrams). They were discussed, rated, and narrowed down to the top three. These were reviewed again, and this time they were drawn to scale. Finally, we prioritized one design and we built it out in the Tulip Park garage using 1 inch thick cardboard! (We had to protect the mocked-up cardboard pharmacy from the rain and wind and our colleagues at Sheppard Pratt wondered why we had draped tarpaulins over the side of the garage!)

We filled the space with actual equipment when possible (chairs, trash cans, carts, trays, supplies) and modeled the rest (machines, desks, shelving, computers, etc.) By having 3-D, to scale representations that we could walk through, we started making modifications and testing out our design through simulations. We opened up the space for many other Pharmacists and Technicians to walk through and provide feedback for other modifications based on front line staff input.

On October 15 & 16, we conducted multiple simulations of each of the key processes to validate our final design. By implementing the right technology and efficient workflow processes, our final design accomplishes the following:

1. Freeing-up more time for Pharmacists and Technicians to spend in bedside pharmaceutical services;

2. Safer care by utilizing more bar code technology

3. Better inventory tracking and better managing of medication storage

4. Improved control and safety of narcotics, by shifting them to a secure room.

The project provided another great learning opportunity for performance improvement using LEAN tools and gave us a lot of “A-ha” moments. Also the 3-dimensional build gave a real feel for the new work flow and space to frontline staff and more ownership of the new design. Lastly, as with all LEAN projects, the 3 P process is much more cost-effective as it eliminates the need for most changes in the real build which are very costly.

Congratulations to one of our own!

Finally, on behalf of the entire GBMC HealthCare family, a warm “congratulations” to Erin Ament, BS, RN-BC, Clinical Unit Coordinator of the Acute Care for the Elderly (ACE) unit, who recently received the National Excellence in Gerontological Nursing Award for 2012! “Working in the ACE program, I consider myself lucky as I get the best of both worlds,” Erin said. “In my role I get to work with the patients I love and educate the nurses around me about the importance of their care with the elderly patient.” The Excellence in Gerontological Nursing Award is presented by the National Gerontological Nursing Association. The award was established to recognize excellence in individuals who provide care to older adults. Congratulations are also in order for a second ACE Unit nurse, Maria Baxter, who was also nominated for the award.

How do you communicate within a large organization?

It has been a very interesting (and at times humbling) week for me. I have spent a lot of time reviewing what our people think from sources like the Employee Satisfaction Survey, the Physician Satisfaction Survey, the Senior Team Survey, the thoughts of our wonderful Employee Relations Council and people at this week’s employee lunch forum, questions from our first Town Hall meetings, and comments on this blog.

Our healthcare system is strong in large part because of its diversity in so many dimensions, one of those being its diversity of opinion. In the various formats that I listed above, many people have stated their opinions. I believe that we generally get to a consensus belief about most things when there is a free flow of information between the “front line” and the “front office”. But some of the thoughts expressed by people in our family are quite startling and underline for me how important it is to try to communicate with everyone. Some of our hard working physicians, nurses, and others believe things about what we “administrators” (and me in particular) are trying to do that are literally the opposite of what we are trying to do.

My reflection on how to continually improve communication such that people believe that someone is listening to them and they get to hear what our senior leaders think has to begin with me. The effective question is: what can I do to improve direct, open, and honest communication? It is clear that I need to make myself more available and I need to reach out to members of the family who are less likely to be physically present at on-campus forums like many of the members of our medical staff, both private practicing and employed. I also need to continue to work with our senior team to continue to make decision-making easier. I need to get better at listening. When you are passionate about something, you cannot let your passion run away with you.

But I also realize that a big part of the dilemma of making sure that everyone feels that they have a voice and that someone cares about their opinion is just a characteristic of large complex organizations. It is hard to get the message down and around to everyone without the final received message getting distorted. I am sure that the readers of this blog have played the game where someone whispers a message in a person’s ear and then that person passes the message down the line until the last person repeats what he or she heard. 

Everyone laughs when they hear the difference between what the last person heard and what the first person said. For example, a message that starts “We need to build a big robust primary care enterprise within our company to better coordinate care for patients and to send more patients to our surgeons when they need surgery” becomes:  “We only care about primary care physicians and we don’t need excellent surgeons, excellent OR teams,  and  strong  surgery departments”.

I also know that the world continues to change rapidly and it may be that sometimes people have heard the message but they don’t like it. In this instance, the challenge is to make sure that people are appropriately reassured, their fears are addressed and that people like me try to look out for their interests when they are in line with the interests of our patients and the GBMC system. 

I am very interested in hearing people’s ideas on how we can communicate better and truly give people a voice. Please share your ideas either by commenting on the blog, or if you would like me (or another member of the senior team) to come and visit your practice, your department, or your unit please email me at Jchessare@gbmc.org.  

Thanks for going “above and beyond”

Last Friday I was the senior executive on call for our hospital. Dr. Dave Strauss, one of our outstanding Emergency Medicine physicians, called me about a case that got me annoyed very quickly. The larger healthcare “system” and the patient were making it very hard for our team to do what I and more than 99% of rational thinkers would want done for themselves or their loved ones. Dr. Barry Waldman, one of our medical staff orthopedists, stepped forward and treated the patient according to his wishes and took care of his immediate medical problem under very difficult circumstances. I would like to publicly acknowledge Dr. Waldman and thank him for helping this patient. 

Starting with the Facts, and Staying in action to make things better

The first presidential debate contained a lot of talk about our healthcare situation. Let me again say that the United States has the best-trained and hardest working doctors and nurses in the world. Unfortunately, they toil everyday in a broken system that makes their work of trying to prevent and treat illness very difficult. The US spends about 40% more per capita on healthcare than Germany, France, the Netherlands or any other industrialized country and our outcomes are generally no better and sometimes worse. In addition, the citizens of these other countries have significantly higher satisfaction with their systems. We are not buying value with our health care dollar. These are all statements of fact.

After stating the facts, leaders must engage people in creating solutions. In this blog, I have pointed out that these facts should not cause panic; there is great news here! Since we spend so much more on healthcare than these other countries, we could redesign our system and reach the so-called Triple Aim of better health, better care and lower cost. We could end the disgrace of hard working American citizens not having health insurance and being one illness away from bankruptcy and reduce health insurance costs for business, our government, and individuals. I am disappointed that neither debater made this case.

As Maryland Secretary of Health Joshua Sharfstein and his colleagues Laura Herrera and Charles Milligan pointed out in their recent commentary in the Baltimore Sun, the fundamental shift that must happen is moving from a payment system that rewards handsomely the provision of some healthcare services but does not incentivize care coordination, to one in which teams of clinicians help individual patients manage their health. We have many wonderful hospitals and our present system is very good at dealing with acute episodes of illness – there is no better country to be in if you have just been hit by a car or you have acute appendicitis – but not very good if you have a chronic illness like diabetes at assuring that you get only the best care to prevent you from getting sicker. Our system uses the Emergency Department and now Urgent Care Centers as the pathways of least resistance leading to more utilization and less coordination.  The notion of the patient-centered medical home is an outstanding design for coordination. Primary care teams, led by physicians, with office hours 7 days per week and with the use of information technology to have all of the patient’s information available when it is needed, can improve health and the patient’s experience with the care as they are reducing the cost of care by driving out wasteful practices, like extra tests, unnecessary hospital admissions, and Emergency Department and Urgent Care visits.

To get to a better system we have two large challenges. The first is the challenge of redesigning the system – to take resources from our current hospital-centric system and apply them to the new system. We need to let the public know that we have too much hospital capacity. Rather than propping up failing hospitals, we should be funding the new design. The second is to change the reimbursement system so that we are buying the health care we want – that which leads to measurably better health and better care – and not just a lot of services.

The GBMC HealthCare system, a not for profit company with a mission of serving the health care needs of our community is racing to transform itself to get to the Triple Aim. The stakes are high but the people we serve desperately need us to do this. The facts are the facts, there is no debate about this.

Spectacular Saturday in the Country Benefits GBMC HealthCare

The 12th running of The Legacy Chase at Shawan Downs last weekend was a huge success.  Great weather, beautiful horses, a picturesque countryside setting and many family and friends – there were approximately 4,500 attendees this year – coming together equaled a spectacular time.

And it was all for a good cause, as the money raised benefits patient care at the GBMC HealthCare system. In previous years The Legacy Chase at Shawan Downs has generated considerable financial support for GBMC’s Nursing, Emergency and Pediatric Emergency Departments.

Funds raised from the 2012 Legacy Chase will support Emergency Medicine at GBMC. GBMC HealthCare’s own Dr. Jeffrey Sternlicht, Chairman of Emergency Medicine, has served as the Medical Director of Legacy Chase and other high-profile horse races for more than 10 years. We’ve launched an endowment campaign to honor Dr. Sternlicht and the exceptional work of his medical team. Annual income from the endowment will be dedicated solely to GBMC Emergency Services. To date, we have raised more than $1 million towards the $1.5 million campaign and look forward to formally presenting it by the end of the year.

Stretched across 300 acres of green meadows at Shawan Downs in Northern Baltimore County, The Legacy Chase attracts visitors of all ages for the steeplechase races, railside tailgating, live music, great food, and family-friendly activities. Many of the crowd-pleasing traditions continued this year—such as the G. Leslie Grimes Memorial Stick Pony Race for kids— and GBMC added some exciting new components to help make this year’s event a success.

The “Chase on the Hill” wine tasting lecture and luncheon proved very popular; Baltimore-based band GAZZE kept everyone musically satisfied throughout the afternoon – even being accompanied at one point by our own Reggie Davis, M.D., Director of Neurosciences, and Gary Cohen, M.D,, medical director of the Sandra and Malcolm Berman Comprehensive Cancer Institute; the GBMC Kids' Korner with moon bounces and face painting was well attended and people enjoyed the three food trucks (Chowhound, Iced Gems, and Hula Honey's Shaved Ice).

This year’s Legacy Chase was, for the first time, managed by GBMC staff and volunteers. Kudos to the GBMC Foundation team and everyone from across the organization who helped make the 12th annual Legacy Chase the best yet!

Finally, thanks to our friends at the Land Preservation Trust and to Charlie Fenwick, one of the Legacy Chase event founders, himself a champion steeplechase rider and former chairman of the GBMC healthcare board, without whom the event couldn’t have been as successful as it was.