Tuesday, June 25, 2013

How Much Progress Did We Make Toward our Vision in Fiscal Year 2013?

Our fiscal year ends this week so it’s time to reflect on our accomplishments. We won’t have the final tally on our system goals until the fall after our financial audit is complete, but we can already see that it has been a great year for our system. We all know that we measure our progress toward our vision of becoming the healthcare system where every patient, every time, gets the care that we would want for our own loved ones by assessing our four aims: better health,  better care, with the least waste, and the most joy for those providing the care.

Better Health

Our work in standardizing care around the evidence has helped us achieve great things this year. Since fiscal year ‘11, we have reduced our serious safety events by 45%. We went from 20 events in FY’11 to 11 in FY’13. While we did not achieve our goal of 10 or less in FY’13, the knowledge that we have gained from studying our events and creating more reliable systems where care is delivered will serve us well for the future. We have made significant progress in healthcare acquired infections. In this year, two highlights are the dramatic reduction in catheter-associated urinary tract infections and the big improvement in hand hygiene, where we are now close to 10 points above the statewide average. See the charts below. These achievements were made by redesigning systems and monitoring the performance of the new designs.

We would have clearly reached our goal of reducing incidents of harm by 20% had we not uncovered the fact that we were not counting falls at home for Gilchrist patients in our overall falls reporting. Our reporting of near misses, great catches, and lower level safety events has also improved significantly and we achieved our annual goal.  Our Board Quality Committee continued to mature in its ability to drive meaningful change with the addition of our patient members. Our Board authorized the release of our quality indicators to the general public. We now update the data monthly for all to see at www.gbmc.org. The Greater Baltimore Health Alliance, our Accountable Care Organization, has successfully reported all of its required quality measures to the Centers for Medicare and Medicaid Services for our first year in the Medicare Shared Savings program. Our work with the outpatient medical record and standardized order sets with prompts has made our primary care much more reliable. The attainment of level 3 certification for our patient centered medical homes has increased our ability to manage chronic disease.

Better Care 

While we will not reach our goal in many of our patient satisfaction areas averaged over the entire year, last month, May 2013, we achieved the highest overall inpatient satisfaction score in the history of the organization. I attribute this to many things but most importantly to the increased study and testing of changes that are now happening on our inpatient units and other clinical departments fostered by Lean Daily Management. On many floors, our nursing teams are now asking patients on a daily basis about their care and then problem solving to fix defects in care like inadequate communication or responsiveness.  

Gilchrist Hospice Care has achieved a 96% success rate with making patients comfortable within 24 hours of admission. This is a phenomenal accomplishment. Our employed physician group, Greater Baltimore Medical Associates (GBMA), has now reached its goal for overall satisfaction rating by truly focusing on the patient’s needs. In this year, GBMA primary care offices have opened on Saturdays, greatly increasing their patients’ satisfaction with access to care.

Less Waste

It is too soon to tell if we will achieve our 1.2% operating margin for the year but we are at 1.6% through May. Many Maryland hospitals are currently operating in the red. Our system is in the black, even though we get lower prices than many of the other nearby hospitals. I am very proud of our ability to drive waste out of our system. Our redesign efforts in the arena of moving admitted patients out of the Emergency Department and to the inpatient units are starting to payoff. Our overall throughput time for admitted patients in the month of May was 6.23 hours, a 1.45 hour reduction over May of 2012!

More Joy

Our employee and physician satisfaction surveys will happen later this summer. We have been working to address issues raised since our last survey. We have worked hard to empower our people to make changes to make their work lives easier. We have gotten better at moving decision making to the people doing the work (although we still have room for improvement in this area). We have listened hard to concerns about our benefits and we have worked to improve them. We plan to give raises based on merit in the fall.
While we will not achieve our goal of reducing employee injuries by 20%, we will have had fewer in FY’13 than in FY’12. The number of employee injuries for the preceding day is now a Lean daily metric for the senior executive team. Every morning we hear of the injuries from the previous day and we are beginning a daily problem solving process to root these out.

Looking Forward

So, we are getting closer to our vision – the measurements bear this out. We are getting more and more recognition from outsiders about our work in creating a value-driven healthcare system. We must stay in action and generate continual improvement.

Fiscal year 2014, which starts next week, will be a pivotal year for our healthcare system. In October, the health insurance exchange created by the Affordable Care Act will create a new marketplace for health insurance. Insurance companies, like the Evergreen Cooperative and Cigna Health Care and others, are racing to create new offerings that will provide measurably better care at lower costs. These companies see what we are doing and are happy to collaborate with us as they construct their new products.  They want to work with GBHA and its 100 plus primary care providers driving value through our patient- centered medical homes. They know of our great surgeons and other specialists providing great care in our lower cost hospital. They also know of the phenomenal work of our geriatricians and their nurse colleagues in Gilchrist Greater Living and Gilchrist Hospice Care and how wonderful they are at patient-centered care in the later stages of life.

While some others are focused on getting much higher hospital rates even though their existing rates are already much higher than ours, we are working to lower costs and drive value…because this is what the community is desperate for us to do.

I am very excited about the future of the GBMC HealthCare System and the next steps in the attainment of our vision. I look forward to discussing this with many of you at our Town Hall meetings which will begin on July 8th.

Let me know what you think of some of the positive changes that have taken place over this past year - I welcome your feedback…

Tuesday, June 18, 2013

A 5K and a Commitment to Better Health – a Great Way to Begin Summer

I spent part of Father’s Day running at the 25th annual GBMC Father’s Day 5K. It was a great day and I was fortunate to have my wife Tracey, and my daughter, Caroline, running, too. Caroline was being polite and running with me but I encouraged her to go on ahead at her own pace. Tracey finished third in her age bracket. I was happy to finish without an injury.
Dr. Chessare with his wife Tracey (left), daughter Caroline (second from right)
 and WJZ-TV's Denise Koch (right), Honorary Chair and emcee of the event.

Robert Hlavac has been participating in the
Father's Day 5K since the very beginning.
This important event has been helping to raise much needed funds for GBMC’s Neonatal Intensive Care Unit (NICU). Over the years, funds raised through this event have helped purchase lifesaving technology and services for our NICU babies and their families. I thank everyone who ran or walked and participated in this great day, including one 25-year supporter of the event, Robert Hlavac, who has been participating in the Father’s Day 5K since its inception.

I also had the opportunity to meet with the kids from the West Towson Elementary School PlayFit program. As I talked about in the May 21st blog, GBMC partnered with the school to develop an after school fitness program called PlayFit, designed to help kids at risk for childhood obesity. The “Westy’s,” along with our GBMC volunteers, have done a fabulous job staying active while having fun. The culmination of this six-week fitness program was having the kids run in our Father’s Day 5K event or do the one mile walk.  These kids were so proud of what they had accomplished, as were we, and GBMC looks forward to continuing this beneficial fitness program with the Westy’s going forward. Great work, kids!
The "Westy's" from the West Towson Elementary school
 PlayFit program get ready to walk!

As we realized with our work with the kids from West Towson Elementary School, prevention of disease is vital to the future health of our community.  As a system of care, GBMC continues to take important steps toward enacting healthy change. We recently took another step toward this mission of preventative care by introducing a new Employee Wellness program.

The U.S. health care system is struggling to care for the ever-increasing number of people with chronic disease like obesity and diabetes. While we at GBMC are building a better coordinated system to care for chronic disease, we also need to work to prevent these diseases in the first place and what better place to start than with our own GBMC family members. This is why GBMC is adopting a healthcare insurance model that promotes wellness and emphasizes maintaining good health. Through this new wellness program, we are helping our staff focus on staying healthy by providing opportunities for employees to engage in various wellness activities while earning incentives for their efforts. This moves us another step closer to changing the mindset of, “go to the doctor when you’re sick,” to “keep yourself healthy so you don’t get sick.”

GBMC employees and staff who participate in the Platinum health plan will be able to take advantage of this important wellness program as well as savings on healthcare premiums by participating in a biometric screening process and registering with our wellness partner, Allegeant. Employees interested in the screening process should visit the InfoWeb for all of the details and upcoming deadlines for participating or call Allegeant at 410-605-0007.

Those employees who participate are making the effort to maintain their good health and minimize days of illness. This program is all part of GBMC’s commitment to better health.

Schools are out for the summer now and the longer, hotter days are a perfect time for all of us to get outdoors and stay active and healthy.

Tuesday, June 11, 2013

Celebrating GBMC’s Most Compassionate Caregivers

The GBMC Healthcare System is working toward our vision of treating everyone, every time the way that we would want our own loved ones treated. We remind each other that there are four components of the care that we want for our family members:

1. Better health: the best possible health outcome;
2. Better care: the best possible satisfaction with the way the care is delivered;
3. Lower cost: with the least waste of money, effort, and time;
4. And with the most joy for those providing the care.

But as I reflect on our quadruple or four part aim, the one that the patient has the easiest time judging is the better care aim.

Patients cannot easily tell if we have made the right care decisions. They don’t know if we have ordered the correct tests, they can’t tell if they got better because of our therapies or in spite of them. Our patients don’t often know if we have wasted their money or time. And frequently we don’t show them our joy in being able to help them.

But our patients can readily appreciate kindness. They know a smile from a distracted look. They know if someone is rushing through an explanation or if the clinician really cares to see that the patient has understood. Our patients know when we are really listening and showing empathy as opposed to going through a checklist with no time for real understanding.

Our patients know when a care provider is compassionate.

Linda Kelly with her award.
And that’s why, once a year the GBMC family formally celebrates those who are the exemplars of compassion - those people who are closer to perfection in treating others like they love them even if they have just met them. I had the privilege of recognizing these wonderful individuals at this year’s Compassionate Caregiver’s Award ceremony and to honor Linda Kelly, RN, FNE-A, SANE-A, Clinical Program Manager of the Sexual Assault Forensic Examination (SAFE) Program, who was awarded with GBMC’s Nancy J. Petrarca Compassionate Caregiver Award on June 5.

Linda truly embodies the vision of our healthcare system with her dedication to caring for the victims of abuse as if they were her own loved ones. She received a number of nomination letters on her behalf that praised her not only for the compassionate care and extraordinary commitment to victims of sexual abuse and domestic violence, but also for her dedication to educating young people in the community about sexual and domestic violence. The nomination letters were extraordinarily touching and each one cited one particular patient – a victim of severe torture and abuse whose life was ultimately saved because Linda went above and beyond to provide her with loving care and to seek justice for the abuse she endured.

I also congratulate and thank all of those individuals nominated for this year’s Compassionate Caregiver Award including:

Honorable mention finalists:
Donna Thomas, Patient Access
Nancy Shackelford, RN, General Operating Room
Harold Goll, MD, Anesthesiology
Gabrielle Whalen, RN, Pediatric ED

LaChond Alston - Gilchrist Hospice Care
Daniel Blue, RT - Respiratory Care, NICU
Jaime Clark - Wound Care Center
Lynne DeLancey, LCSW-C - Greater Baltimore Cleft Lip and Palate Team
Lois Fitzgerald - Gilchrist Hospice Care
Melissa Frey, RN - Bariatric Surgery
Mike Lohnes - Physical Therapy, Joint & Spine Center
Modesty Lyles - Gilchrist Hospice Care
Diane Moniuszko - Core Clinical Laboratory, Gilchrist Volunteer
Cate O'Connor-Devlin, RN - Nursing Administration
Patricia Schoenleber – Gilchrist Hospice Care
Renu Thomas, MD - Hospitalist, Medical Residency
Claudia Williams, RN – NICU
Rita Yow - Gilchrist Hospice Care
Mary Zappala - Gilchrist Volunteer

It is hard to show compassion always. Everyone shows compassion at times. I count myself among those who intend to be compassionate but are too task-oriented. The people that I look up to are the ones that get the work done, but almost never fail to demonstrate that they get it - that they are dealing with another human being in need and not just completing another task.

We are fortunate that in the GBMC family we are surrounded by caregivers who inspire us and remind us of the innate goodness in people.

Tuesday, June 4, 2013

Learning From Each Other and Making Improvements

Last Wednesday I had the opportunity to spend a day with the teams that were part of our nine-month long improvement collaborative at their third and final learning session. The collaborative followed the format from the Institute for Healthcare Improvement, providing the teams with an opening learning session to teach the basic tools needed to define their goals, a mid-stream collaborative meeting to demonstrate early results, and a concluding meeting where final results were presented. Some of the results presented at this final meeting were just outstanding.

A team from Gilchrist Hospice Care worked to improve family members’ feelings of competency at the time of loved one’s death and generated marvelous results.

The Surgical Site Infection team, which was challenged to reduce the number of surgical site infections experienced by colorectal patients, has made significant changes and is well on its way.

The Falls team also had fantastic results in standardizing the work of protecting high falls risk inpatients. Prior to the collaborative and the implementation of the standardized process, the patient falls rate was 2.5 falls per 1,000 patient days. This rate was based on four units - U34, U35, U37, and U58. After implementing standardized processes on these units, the falls rate decreased to 1.78 per 1,000 patient days and we continue to drive the rate down.

Other collaborative teams included patient satisfaction and communication, a team to decrease the incidence of hospital-acquired pressure ulcers, one that focused on reducing employee injuries, as well as a team to improve the cleanliness of patient rooms.

Like everything we do, the ultimate goal of this collaborative work is to move us closer to our vision of providing the care we would want for our own loved ones to everyone, every time.

And, on June 5, we honor those individuals who have brought our vision to life by providing the highest level of care for our patients at the annual Compassionate Caregiver Awards ceremony. I thank and appreciate our staff members who embody our vision.