Friday, December 14, 2012

On Becoming A Learning Organization

I ended last week’s blog by inviting people to comment and they did. I stopped replying to every comment as it appeared because I didn’t think that it would be helpful once I saw the emotions that were being released. So, let me try to respond to the comments now.

The blog is a mechanism for communicating. A regular reader of the blog knows that I am usually trying to accelerate change toward our vision of being the healthcare system that treats everyone the way that we would want our own loved ones treated, every time. Sometimes I highlight a “technical” concept, like the relationship between the number of hospital beds in an area and the cost of healthcare in that area, or the ability of the patient-centered medical home to make care less fragmented for people with chronic disease. Sometimes I highlight great work by our people in making change happen, like the blog on standard work and improving our hand hygiene scores, or the one on the great work of the team that created the design for our new inpatient pharmacy (see "What's a 3P?".) Other times I have interviewed patients to let them tell their stories about their care as a way to recognize our wonderful nurses, doctors, therapists, technicians, and other staff (see the February 24, 2012 blog with Chris Brandau’s Mom).

But until last week, I had only used “negative” incidents from other industries to highlight room for improvement, like the blog I wrote in which I talked about the poor (giving the appearance that the Southwest employee didn’t care) service that I saw at BWI airport; or my poor service due to a poorly designed system in getting a hot dog on the New Jersey Turnpike (see the August 24th blog, "Good Leadership, Poor Leadership, Well Designed Systems and Random Behavior"

Last week I took a chance. I decided that we had developed enough as a learning organization to begin to openly discuss negative feedback from one of our patients. I picked the letter in part because the author said many nice things about our people. I removed two names from the letter so that the individuals whose reported negative behavior was focused on by the writer could not be identified. I also removed the name of a nurse who had been complimented so that the floor of the hospital could not be identified by people who did not know of the episode.

The purpose of the blog was to get us all to reflect on how our behavior is perceived by those who we serve so that through this reflection we may all become better. The blog was not meant to hurt any individual. After the blog was published, more than one person told me that they knew of many incidents where we had left the appearance of callousness, the appearance that we did not care. All of these people also told me that they thought that GBMC had great people who really do care and who work very hard and usually delight their patients with their caring. But these folks agreed that it is good to reflect when we do appear to not care so that we can improve ourselves.

I know how hard people are working in our GBMC HealthCare System and I know that it is my job to make sure that they have what they need to get the job done; whether it be staffing or equipment. I realize that it is my job to see that they are empowered to improve the systems that they work in to make it less hard for them to get the job done. But I also am aware that it is my job to assure that we reflect on how we are doing because ultimately we are here for the people we serve.  


  1. I think the blogs are interesting. They give the nurses an idea of how we are perceived by upper management and by someone who is so far removed from actual patient care.

  2. It is apparent that upper management are very far removed from what actually occurs at the bedside. This blog did not offer a response as much as a rebuttal to the real feelings and concerns of bedside employees. Dr Chessare did little more than defend his own position and agenda. He did not offer any better avenue for bedside staff to voice their concerns, nor did he suggest a solution (such as: more accessibility to executive leadership, suggestions of committees/groups staff could join to initiate practice change, direction toward open forum meetings, etc.) The issue has been identified. The reply is missing what the plan is moving forward.

  3. This blog usually highlights aspects of the facility that need to be improved or to be credited with being an asset to employees and patients. It also highlights everything that WE need to do as far as cutting costs and being financially solvent through OUR actions. When, pray tell, is the blog going to be written citing the efforts of our executive management regarding how THEY are increasing our patient base, marketing our fine and historic facility, and making our facility better financially because of THEIR leadership and decisions?

    1. Please read our vision statement and our strategy on the Infoweb. For the latest recounting of some of the things that we are doing to make the GBMC HealthCare system even better than it is today you may want to reread my June 1 blog post:

  4. To the previous post: "When, pray tell, is the blog going to be written citing the efforts of our executive management..." The executives are doing all the things you asked for, and it sounds like you should talk to manager to find out more about it. You should also understand that the internet is not the appropriate place for any company to share its strategy on how it plans to gain more market share.

  5. To the previous post: "You should also understand that the internet is not the appropriate place for any... So in other words annonymous, do not share strategey just air all of our grievances and dirty laundry here instead? If the executives were doing all of those things we would have a greater work satisfication score and greater joy in providing care to our patients, but that is not the case. Why annonymous, did this institution fall out of the top places to work in Maryland if the executives are doing such an extraordinary job as you infer?

  6. Just to clarify the facts, GBMC did not "fall out of the top places to work in Maryland." We did not seek the designation this year (nor did many other large employers), as the process required us to use the vendor's employee survey with participation minimums and other requirements, and we didn't want to take attention away from our own Employee Opinion Survey (which we administer annually), the Culture of Safety Survey, and other assessments we do internally.

  7. The elephant in the room is staff has lost confidence in Dr. Chessare.

  8. Was the cofidence ever there? I lived through the Uncle Larry and the one before him- Bob Cowel. During Bobs tenure we had men running around here dressed like women ( I have a transvesite cousin who I love so do not think this is prejudice but I would not want him taking care of a confused patient). During Uncle Larry's tenure we had a lot of talk and very little action. At the time I was part of administration and a large part of the time in meeting was spent on taking one person and tearing them apart. It came down to hair color and make up one time. Totally nonproductive. When it came my turn to be torn apart a senior staff member who is no longer here told me "to get off your fat ass and do your job". Her and I had words later. Is it any better with Dr Chessare? I doubt it but most of the staff had no idea what went on behind closed doors with either Bob Cowel or Larry Merlis. How do we know what goes on behind closed doors with Dr Chessare and his upper management? The truth is unless someone lets something leak like I just did we don't. Those who were there then know who I am and how well the "fat ass" remark went over. It was enough to make me leave that position. Dr Chessare is not my favorite person for many personal reasons having to do with an abusive former manager of mine and his refusal to respond to what was clearly hostile work environment and his useless human resources department respone. That being said I think he needs more time to work here. We longer termers have been so immersed in the GBMC Way we don't know any difference. I can tell you I have been to another hospital and if you think it is different try again. It it worse in most places. I am sick of hearing "what if it was your mother?" because when it was me as a patient the way my family member was treated by the adminstration of this hospital clearly shows they only believe in that for themselves and the VIP's not the staff. I have not known anyone to have confidence in the CEO of this hosptial so get used to it. I have never seen any staff have confidence in any CEO of any hospital I have worked at. It is not thier concern. Running an business is their concern and when it comes down to it the hospital is a buisness. The warm fuzzies went away when health care changed in the 80's. It is now run by insurance companies who give the hospital the when, howto's and whatfors. Making the comment that the elephant in the room is the loss of confidence in Dr Chessare can be said for the three CEO's I have been through here and the one in the other hospital. They do not sit in a room and say "How can we screw over the staff this week". Thier concern is the buisness and sometimes the outcome is not what we as employees want to hear to work with but it is what we have. With cost in health care reimbursement it is only going to get worse so buck up, put on your big girl panties and deal with it. Again I am not part of administration I am just someone who has spent over 20 years dealing with this. It gets worse then better and goes in cycles.


Thank you for taking time to read "A Healthy Dialogue" and for commenting on the blog. Comments are an important part of the public dialogue and help facilitate conversation. All comments are reviewed before posting to ensure posts are not off-topic, do not violate patient confidentiality, and are civil. Differing opinions are welcome as long as the tone is respectful.