Friday, November 30, 2012

A Wonderful Legacy Remembered: The End of Catholic Health Care In Our Region

This week marks the end of Catholic healthcare in our region. With the purchase of St. Joseph’s Medical Center by a non-denominational hospital company, a 148 year legacy of service is finished. I spent three years in Catholic healthcare in Boston and that company, Caritas Christi, is also a thing of the past, having been purchased by venture capitalists.

The reality is that we have too much hospital capacity in Baltimore. The owners of St. Joseph’s, Catholic Health Initiatives (CHI) of Denver, Colorado, had only one hospital in the area and it was losing a lot of money. CHI is a very large company with $9.65 billion in annual operating revenues but after a number of years of losing money in Towson, they decided to divest themselves of St. Joseph’s. CHI is a mission-driven organization and they are also realists. It appears that the company could only rationalize losing millions if they could prove that there was an unmet need. With all of the excess hospital beds in Baltimore, they could not justify the need so they got out. Now, a smaller hospital company is the new owner.

What a long way from the reality found by the Sisters of St. Francis of Philadelphia in 1864 when Mrs. Catherine Eberhard donated three row houses on North Caroline Street to be used for the sick and infirm. In that era, there was not much available to cure disease. Hospitals were started as a place to care for the sick who were also poor. Those with means were cared for in their homes by their families. The Sisters of St. Francis and others who joined with them in this noble mission dedicated themselves to helping others in their time of need.

In 1870, the State approved the Act of Incorporation to create the Saint Joseph German Hospital and in 1872 a new facility with that name opened at Caroline and Oliver Streets in Baltimore City. During the 20th Century, with the advances of modern medicine, the hospital grew and changed and in 1965 (the year of the opening of GBMC), St. Joseph’s moved to Towson. In 1981, the hospital became a part of the Franciscan Health System and they began doing open heart surgery the next year. In 1996, St. Joseph’s became a part of CHI and continued their growth in heart and orthopedic procedures.

Everyone in Baltimore knows what happened next with the governmental investigation and the accusations of unnecessary procedures. What has not been discussed is how the hard-working nurses, doctors, and other clinicians kept serving patients. Unfortunately for them, the business model that St. Joseph’s had chosen is hard to make work with so many hospitals pursuing the same model, and the American people and American businesses are desperate for a new model. You see, building a lot of hospital beds and waiting for people to get sick to use them, or only providing a lot of elective procedures because that is where you make the money, has led us to our national predicament where we are bankrupting our federal government, our state government and making it difficult for businesses to provide health insurance to their people. The new model, a system of health care that works to keep people healthy and limits the need for patients with chronic disease to be admitted to the hospital, requires different capacities and capabilities.

The biggest capacity that is required of the new model is primary care. In the Greater Baltimore Health Alliance, (our system’s Accountable Care Organization) we now have close to 100 primary care providers, many of whom are working in Level 3 patient centered medical homes with care managers, extended office hours, and a fully functioning patient portal, among other things, to keep people healthy. None of these things are focused on by hospital companies using the old model, like St. Joseph’s.

It is sad to see the end of the legacy of the dedicated Sisters of St. Francis and all of the hard working physicians, nurses, and others who worked with them on a mission of service to others. We know however, that their spirit lives on in those who embrace the new model of service and who are willing to let go of the old model where filling hospital beds and focusing on services that make money were acceptable endpoints in and of themselves.    

Friday, November 23, 2012

Health, Healing and Hope for Victims of Domestic Violence

Last week I had the privilege of welcoming Maryland Lieutenant Governor Anthony Brown to the GBMC campus as he announced Maryland’s seventh hospital-based Domestic Violence Program (DVP).  Joining Lt. Gov. Brown was Maria Harris Tildon, vice president of corporate communications for CareFirst BlueCross BlueShield, who presented GBMC with a check for $15,470 toward the DVP. 

As a pediatrician, I have seen firsthand the impact of domestic violence in the home and the critical role medical providers can play in addressing this issue. We are fortunate to have two outstanding professionals leading these programs,  Linda Kelly and Sally Hess, who are educating and training our medical staff to better identify and respond to patients in need.  In this way, GBMC is adding a new program that will help us better meet our mission of health, healing, and hope for those in our community. 

This is another example of GBMC HealthCare focusing on what patients need. While others are amalgamating hospitals and propping up unnecessary bed capacity to get market share and drive up the cost of care in our region, we are adding this new service which will never cover its direct costs on patient revenue, let alone be profitable.  

GBMC has been serving victims of violence for many years through our Sexual Assault Forensic Examination program (SAFE), which has always had the goal of expanding its services to include victims of Intimate Partner Violence (IPV). Now that this is a reality, the goals of the GBMC DV program include providing direct services (24/7 crisis response such as support, education, safety planning, referral to community resources and follow-up) to any patient, staff or community member experiencing IPV, educating staff on the effects of DV on health, and how to best identify and support patients experiencing IPV.

To date, GBMC’s DVP has provided services to more than 50 individuals.  We anticipate serving an average of 30 patients per month by 2014 based on similar-sized hospital programs.  In addition to corporate and state grants, the program is being financially supported by generous donations from our community.  We are grateful for all the support that is allowing GBMC to continue its legacy of providing healthcare services for women across the community.

To learn more, watch a video of the press conference announcing the program.

Our Green Team Gets Recognized for its Accomplishments
L-R: Keith Magel, Regional Manager, ARAMark; Jim Duerr, Corporate Materials Manager Director, GBMC; Matt Tresansky, Nutrition Director at GBMC, ARAMark; Ryan O'Hara, Retail Manager at GBMC, ARAMark ; Keith Sappington, Food Production at GBMC, ARAMark; Michael Forthman. Vice President of Facilities & Support Services, GBMC; John Chessare, M.D., President & CEO, GBMC HealthCare system
Congratulations to everyone involved with our Green Team, led by Michael Forthman, vice president of facilities and support services, on the occasion of the GBMC HealthCare system being recognized with one of five Trailblazer Awards at the Maryland Hospitals for a Healthy Environment (MD H2E) Environmental Excellence in Health Care Conference. Trailblazer Awards are given annually to hospitals that have shown leadership in advancing sustainability in their operations.

GBMC was recognized for its dedication to providing improved diet options for patients, employees, and visitors. During the first month after launching a campaign to promote healthier beverages, hospital sales of non-sugary drinks exceeded sugary ones for the first time on record. GBMC reduced food waste by 1,100 pounds per month from March to August of 2012, and installed hydration stations which encourage refilling reusable bottles with filtered water.

Treating everyone the way you want your own loved ones treated…with clean hands.
I also wanted to recognize our employees, who are working hard to reach our hand hygiene goal. As you know, if we achieve a score of 79 percent or greater in November, we will pay out a bonus in December to eligible employees.  We are just past the halfway point for November, and our hand hygiene compliance score is at 81%.  We still have a ways to go, though!  I encourage you to keep up the good work!  Practicing hand hygiene is the number one way to prevent healthcare acquired infections.

If it were your loved one, you would want to be sure that any staff entering the room had clean hands.   This will be an excellent achievement, so let’s all work together to make sure we clean our hands on the way in and on the way out every time!  

Finally, I hope everyone in our GBMC family had a happy and enjoyable Thanksgiving holiday.  Each day I am thankful for every member of our team who does the very best they can do in whatever role they play in helping provide the best possible care for our patients. 

Friday, November 16, 2012

Welcome To Our Family

I’ve been in healthcare for quite awhile and I know that every healthcare organization of any significant size does formal orientation. I firmly believe that orientation is a great opportunity to have a conversation with people when they are first forming their impressions of the new workplace.  New people don’t yet know the ways of their new organization so they are kind of a constant opportunity for change.  I believe if you can get to the new people they can make change happen faster, whereas someone who has been in your organization, although they may be a wonderful person, they kind of accept the way the organization operates and it’s harder to see opportunities for change.

Every two weeks I give the opening welcome for the GBMC HealthCare system orientation. I start by talking about our mission, vision and values and our plan for the future. I talk about the fact that we are not just a hospital, we are a wonderful healthcare system with a great hospital and a great hospice (Gilchrist) and a great physician company (GBMA), and now a great new physician company (GBHA) to embrace private practicing doctors in the pursuit of the Quadruple Aim of Better Health, Better Care, Less Waste and More Joy. I underline for the new staff that we are a system of care, and explain that if we could get the kind of coordination that Dr. Tony Riley and his colleagues in Geriatrics get for frail elderly patients for example, for every patient, we’d be a marvelous healthcare system.

I often have a great dialogue with the new staff at orientation about what doing it the way you would want for your own loved one every time actually means. The experience every two weeks has been invaluable. It's probably the best interaction I have with employees about where we are headed as company.

As we approach the Thanksgiving holiday, I want to take a moment to thank all of the GBMC HealthCare system private practice physicians, employees, volunteers, and board members who help us in one way or another provide outstanding care around the clock for our patients.  Healthcare is a 24/7/365 enterprise, and we recognize that many individuals make personal sacrifices during the holiday season in order to help care for our community.

Speaking of our community, Joe Hart, GBMC’s chaplain and Spiritual Support Director, recently suggested that we ought to get to know our religious neighbors, so we have launched a "visiting our neighbors" series.  Joe and I recently visited the School Sisters of Notre Dame at Villa Assumpta on North Charles Street.  There are nearly 60 sisters who live in retirement at various stages of life.  We met with members of the provincial council and discussed the healthcare needs of their community. I explained our philosophy of care and asked how we might assist them in meeting their healthcare needs/goals.  Knowing the community well I was able to speak to the spiritual support offerings we have when their members come to GBMC for care.  It was nice to hear the many complimentary things they had to say about GBMC and how well the sisters have been cared for recently and in the past. 

Friday, November 9, 2012

Working Toward A Safer Culture For All Patients

This week I invited Carolyn Candiello, Vice President, Quality and Patient Safety, to write a guest blog post highlighting the organization's upcoming Safety Attitude Survey.

We all heard over and over in this most recent election about the importance of getting out to vote!   Next week we will begin our second annual Safety Attitude Survey.  I am very excited about this year’s survey and am looking forward to learning how we can continue to improve our safety culture.  I am also interested to see if our scores reflect the good work our staff has done over the past 18 months to reduce serious safety events and infections.     I hope everyone in our patient care units will take the time to “vote”!

When we conducted our survey last year, we learned that in those units with the lowest perception of teamwork there was a higher incidence of patient harm. We also learned that nurses and doctors working on the same unit can have a different perspective of patient safety and teamwork.  We learned that some of our staff felt that it was not easy to talk about errors and that we didn’t always address behaviors fairly.

Christina Welch, Clinical Unit Coordinator of Unit 58,
demonstrates the Quantos reporting tool.
In response to the survey, each unit reviewed their findings and implemented action plans aimed at specific improvement.    In addition, we initiated several organization-wide changes.   For example, our survey revealed that we did not have a good mechanism to report safety events. Since the survey, we have implemented our on-line incident reporting tool, Quantros, which allows for ease of reporting.  The increase in reporting and the quality of the reporting has allowed us to identify trends that block holes in our system.  The Quantros tool is located on the InfoWeb - look for the Patient Safety button on the homepage.  As a reminder, staff should report any incidence of patient harm, near misses or unreliable care. 
Quantos reporting on the InfoWeb

We also heard that it was difficult to discuss errors and there was inconsistency in our responses. We have since adopted a philosophy of a Just Culture were we console human error, coach at risk behavior and appropriately discipline reckless behavior.  We also continue to learn from our errors and share our learning throughout the organization.  Staff are involved in root cause analysis and participate in identifying permanent solutions to prevent an error from re-occurring.

A great example of learning from our experiences has been in our efforts to reduce falls.  Earlier this year, we noticed an increase in patient falls.   In response, a a multi-disciplinary improvement team  was appointed whose aim is to reduce falls and prevent injury.    So far, we have seen significant improvement (see the FY2013 system goals).    But also, we are seeing a culture change.  Units are measuring the time between falls.  Now, when a fall occurs, everyone takes notice.   The team does a post-fall huddle and looks for ways to prevent a similar occurrence.    Having everyone engaged and in action to prevent falls is powerful.

The Safety Attitude Survey will be conducted across all patient care units within the organization.  This is a confidential survey that focuses specifically on staff perception of clinical safety in their unique work setting.  The 33 questions focus on teamwork, safety, leadership, stress, working conditions, and learning.   While some of the questions are similar to the employee opinion survey, this questionnaire is designed to provide direct feedback around the clinical safety climate.  Responses to the survey are completely confidential and will be processed electronically by Pascal Metrics.

Staff who will participate in the survey will receive a  “token” and a link for the survey from their manager—this will be a similar process to the employee opinion survey.  Gilchrist Hospice employees will receive a paper survey.  Results of the survey will be shared throughout the organization in early 2013.  I look forward to sharing them with you and seeing where we have made improvements since last year.

When you receive the token or paper survey, please take the time to “vote”—our patient’s safety depends on it.

Wednesday, November 7, 2012

No, not that election!

This week, many of us voted in the Presidential election, statewide elections and on referendum questions. But recently there was another “election”.

Nearly 10,000 physicians in the region “voted” for which physician, in a variety of specialties, they would send a member of their own family to if they needed healthcare.  The highly regarded Baltimore Magazine annual “Top Doctors” November issue was recently released and the votes are in.

I’m proud to say that many doctors agree on who is best!  Once again, GBMC had more members of our medical staff cited as a “Top Doctor” than any other community  health system or hospital. It is with a great deal of pride and pleasure to share with you that 120 GBMC physicians, covering 60 specialities, were recognized a total of 132 times as a “Top Doctor”!  That’s right, there were several GBMC physicians who were cited as a “Top Doctor” in more than one specialty or sub-specialty!

Being recognized as a “Top Doctor” is an extraordinary honor, because it is a selection by peers for which physician they would select for a member of their own family.  To all of the “Top Doctors” at GBMC, congratulations from all of us! The rest of us in the family are very proud of you.

To view a listing of our “Top Doctors” and to learn more about who they are, please visit GBMC's Top Doctors 2012 webpage.

I would be remiss if I didn't thank our Chief of the Division of Gastroenterology, Dr. Niraj Jani, who was one of the five survey advisers (and thus was ineligible to be selected as a "Top Doc" by his peers), and recognize family medicine physician Dr. Sarah Whiteford, whose "Why I Became A Doctor" story was one of several profiled.