It’s easier to get the job done when everything is in its place - 5 (or 6) S's revisited

Last week a team from GBMA did a weeklong kaizen. Staff from Joppa Road, with the help of GBMA COO Ben Beres and others, worked to systematize how their office was setup with a subsequent plan to extend this to other offices.

On August 30th of last year (http://ahealthydialogue.blogspot.com/2012_08_01_archive.html), I wrote about the 5 or 6 S process: When Safety is added the 6 S’s are:

1. Sort: eliminating everything not required for the work being performed
2. Separate: efficiently placing and arranging equipment and material
3. Shine: tidying and cleaning
4. Standardize: standardizing and continually improving the previous three
5. Sustain: establishing discipline in sustaining workplace organization
6. Safety: creating a safe work environment

The team: Elaine, Susan, Vivian, Maryanne, Jeanne, Joyce, Robin, Janice,
Jennifer, Courtney and Ben 

The team did a fantastic job of organizing all of the “stuff” required to get the job done in a primary care office and made it much easier to know what needs to be replenished. They started by throwing away all of the accumulated things that they didn't need and then planned to store things to minimize steps to get things when they were needed. They bought bins and created audit forms to make re-ordering easier. The process also creates the discipline of standard work. I am very proud of the team!

Annual Competencies
I was completing my annual competencies last week and stopped for a moment to reflect on the importance of knowing a core of information for all of our GBMC employees. While it does take time to complete these tests, it’s imperative that we know what to do in a fire, that we know how to keep ourselves safe on the job, and that we understand the importance of keeping information about our patients confidential. Unless all of us have this basic knowledge, we cannot get to higher reliability and to our vision. I want to thank everyone for completing their annual competencies by July 31st.  

Connecting with and educating a segment of the business community on healthcare reform

Last week I participated in a panel for Biz Now, a meeting with real estate brokers, developers and others from the local real estate community and some healthcare leaders. Also on the panel with me from healthcare was Bonnie Phipps, President and CEO of St. Agnes Hospital. The topic for discussion was healthcare real estate. The discussion was lively and centered on the changing healthcare real estate needs as they relate to healthcare reform, the affordable care act, accountable care organizations and value-based purchasing.

I raised the point that it’s a problem that the business community doesn't understand the dilemma of our national healthcare system.  I explained that our country’s need for healthcare reform really has nothing to do with politics. Whether you’re a fiscal conservative or a wide eyed liberal you should be concerned that we’re spending 40% more on healthcare  than any other country.  And, the business community should be demanding reform regardless of whether or not they are for or against the affordable care act. To fight against reform is absurd, especially when healthcare impacts businesses just as much as individuals.

We went on to talk about the playing field and the fact that some Maryland hospitals get higher prices than others, but that with insurance exchanges and the notion of restricted networks, this is starting to change. We also explored the concepts of the GBMC transformation and our focus on the patient centered medical home as the fundamental building block of the healthcare system.  

As I talked about GBMC’s transformation I was extremely proud when Bonnie Phipps told the audience that GBMC is way out in front in the evolution to accountable care organizations and with our work developing the patient centered medical home model. This was really nice to hear and is important for everyone at GBMC to know…

The business community is slowly waking up to the need to demand greater value for their healthcare dollar and this panel discussion was a great exchange of information.  I was glad to have had the opportunity to educate these real estate professionals about the changing tide of national healthcare and GBMC’s role in creating a value-driven system. I believe that there are a few more business leaders who now see a new roadmap for change and their role in designing a new and better system.

Welcoming New Physicians Who Will Help Move Us Closer To Our Vision

Delivering the kind of care we want for our own loved ones starts with adding the most passionate and dedicated healthcare providers to our system. Over the next several months, GBMC will be welcoming a great group of new physicians, both employed physicians and private practice doctors, who have such a drive for superior care. From stellar surgeons to family practitioners, we’re fortunate to have some of the best doctors joining the GBMC family.

Dr. Jillian Verby

Just this month, a new family physician, Jillian Verby, MD, hit the ground running in our Primary Care Associates practice. Dr. Verby completed her residency training at Montana Family Medicine where they already have the patient centered medical home model. She knows the importance of collaborating with case managers and nurses and understands how well this model of care works for the overall well-being of patients.

Before joining GBMC, Dr. Verby worked as a rural general practice physician in Oxford, New Zealand and she has some incredible insights on primary care medicine from different cultural and regional experiences that she brings to GBMC. She’s very motivated to further incorporate this patient centered medical home perspective into our practices and tells me:

“The patient centered medical home model is really about relationship-based, coordinated  care and paying attention to each individual’s needs instead of just treating a general diagnosis. It’s a really exciting  concept and that’s why I’m in family medicine – to develop these lifelong relationships and to get to know the patient as a whole person.”

“During my residency training at Montana Family Medicine, we initiated the patient centered medical home model. Every patient was greeted and evaluated by a team, from the front desk person, medical assistants, nurses and care managers to the physicians. We were all a team working on behalf of an individual patient. And, if we needed to involve other healthcare professionals in a patient’s care, we had case managers, behavioral health specialists, and clinical pharmacists available as needed, which allowed us to provide a coordinated, comprehensive care experience.” 

“We also initiated the concept of accessible care by offering extended evening hours and providing continuity of care in the hospital. We offered more same day visits for acute concerns through physicians or nurse practitioners so that we could make care accessible. These are all things we are doing here at GBMC, which is great.” 

“I’m very excited about the future of the patient centered medical home here at GBMC. Ultimately we’ll see better access to care for patients and a big focus on preventative screenings. One major study in 2007 found that people have higher quality care with less racial and ethnic disparities in the medical home model. I’m optimistic we’ll see better patient oriented outcomes in the future once we have fully initiated this model. It takes a lot of adaptation on the provider side, but in the end, all patients will have continuity of care, build a lifelong relationship with their provider and be in a system where everyone contributes to a person’s overall care and well-being.”

Dr. Elizabeth Dovec

Similarly, we welcome a new bariatric surgeon, Elizabeth Dovec, MD, who has such passion for her work and the development of a truly comprehensive bariatric program that accounts for the health of the whole person. Dr. Dovec completed a fellowship in minimally invasive and bariatric surgery and says that being a bariatric surgeon enables her to combine her love for surgery, nutrition and helping patients achieve overall health through weight loss surgery. She doesn't just stop at being a truly skilled surgeon;  she has a vision for bariatric care that, as she shares with me, “Will take complete control of the entire well-being of the bariatric patient.”

Dr. Dovec is out to beat morbid obesity. She understands that weight loss surgery has many important components and that preparing patients for life before and after surgery can make a tremendous difference in a patient’s long term health. Here’s what she had to say about her vision for the future of GBMC’s Comprehensive Obesity Management Program:

“Becoming a part of the GBMC team was a perfect opportunity for me. GBMC already has the outstanding Comprehensive Obesity Management Program and this is an opportunity to focus all my energy on bariatrics. My vision is to add an exercise therapist to help in our office, as well as add a psychologist, and a primary care physician with a special interest in treating bariatric patients. We will continue providing excellent nutritional services and really take complete control of the entire well-being of the bariatric patient. I have always loved all aspects of bariatric care – the surgery as well as incorporating the psychological, nutritional and exercise components of the surgery.”

“This type of comprehensive program is so important as obesity is a national crisis. At some point, just diet and exercise alone doesn't work for these patients. I’m very empathetic to this fact. I understand that it takes a lot of courage to make the decision to have this surgery. The road is not easy for bariatric patients and creating a supportive environment is just as important as the surgery itself.”

I am confident that physicians such as Dr. Verby and Dr. Dovec and all of those joining our system will continue to move us closer to our vision: To every patient, every time, we will provide the care that we would want for our own loved ones.  Please join me in welcoming all of our new providers to the GBMC Healthcare system family.

Town Hall Meetings and GBMC’s Bright Future in an Evolving Healthcare Marketplace

Yesterday, I did the first in a series of Town Hall Meetings. These meetings are one of our tactics for narrowing the distance between the “front office” and the “front line.” It is very important that all of the members of the GBMC family know what is happening in the national and local healthcare environment and how this affects the GBMC HealthCare System. 

We are well into our transformation as a health system and we are better prepared for the changes to come than most hospital companies, but there are challenges out there and we need wide open conversations to give us the best shot at effectively dealing with these challenges. 

Real changes described in the newspaper like layoffs at other organizations or rumored changes heard about in hallway conversations make our people nervous and generate questions about job security, salary and wages, and the future of our own healthcare system, among others.

The Town Hall Meetings are an opportunity for me to keep people focused on our vision and the work of transforming ourselves into a high performing system through the eyes of the patients we serve. If we do this work, our company will continue to thrive. I will share our recent accomplishments and the reasons why hospitals are at risk and why our strategy to move to a system of care is now paying off. 

Holding the town hall meetings also provides our staff with the opportunity to ask questions, raise concerns and let us know what they are thinking.  

Some of the important topics we will be covering over the next month include:
- The GBMC healthcare system’s progress toward our vision
- Financial challenges to hospitals in Maryland and nationwide
- Positive changes to GBMC’s benefits and wellness initiatives
- Employee wages and bonuses – an update on our FY’13 incentive plan and merit pay for FY’14

To ensure that every employee has an opportunity to attend a town hall meeting, they will be held in large and small group settings on the GBMC campus as well as at satellite locations including Hunt Valley, Owings Mills and the South Chapman building. The detailed schedule is available on the GBMC InfoWeb. 

As always, our town hall meetings are a place to learn more about your role in assuring the success of the GBMC HealthCare System and your opportunity to have your opinion heard. I encourage all employees to attend at least one of the 14 scheduled meetings that run from July 8 through July 26. 

Training the Next Generation of Physicians

GBMC is known as a system that has excellent doctors. Educating the next generation is a great way for any professional discipline to stay on top of its game. So, it’s wonderful that GBMC sponsors an Internal Medicine Residency training program, a Colo-Rectal Surgery fellowship program, and hosts residents in Gynecology and Otolaryngology from Johns Hopkins and residents in Ophthalmology from the University of Maryland. Led by Dr. Paul Foster, our new first year medical residents began their training last week. It’s been great to see the young, smart men and women joining our healthcare system as they embark on their post-graduate training.

The environment that these interns are coming into is quite different from the one that I found when I graduated (more than a few years ago). I was curious to see what a couple of our interns thought about the work world they were entering, so I posed a few questions to get their thoughts on how the practice of medicine is changing, some of the challenges they face and some of the positives they see as a result of healthcare reform.

Medical resident Abdimomun Iuldashev, MD, comes to GBMC from Marmara University School of Medicine in Istanbul, Turkey, where he completed a one-year internship and received his medical degree. Coming from another country and culture certainly has its challenges but also provides residents like Dr. Iuldashev with new opportunities and experiences.  Bryce Harbertson, MD, is a Maryland native who received his medical degree from the University of Maryland School of Medicine. As a student from the U.S. educational system, Dr. Harbertson tells me that there is still a great deal of unknowns regarding the future of healthcare. It is interesting to hear their perspectives on what lies ahead for the practice of medicine:


Q: How do you see the practice of medicine changing as we move into a new era of healthcare? 

Bryce Harbertson, MD

Dr. Iuldashev: “Practicing medicine is getting better because of advances of medical technologies. By using MRI, CT, echo or other medical devices, we can diagnosis with high sensitivity and specificity. As we move into a new era of healthcare, accurate diagnosis and treatment rates are increasing so we have more satisfied patients and an increasing number of doctors satisfied with their jobs.”

Dr. Harbertson: “We will continue to see technological advances that make patient care more safe and efficient.  I imagine individual hospitals will continue to figure out how to improve communication and care coordination among physicians, nurses, techs, therapists, social workers, and other patient care services.”

Q: What are some of the challenges you may face in this new healthcare arena? 

Dr. Harbertson:  “We are going through changes that hopefully will lead to better care and lower costs. In addition, we have an always growing body of clinical evidence to help us make patient-care decisions. The challenge will be staying abreast of all the evidence so we can use it to provide cost-effective care.”

Abdimomun Iuldashev, MD

Dr. Iuldashev: “The population is aging and this means an increasing number of patients per doctor. This is causing doctors to work more and spend less time with each patient. The other challenge is that we are becoming more dependent on technologies. This is good if you practice where you have the technology, but can we become handicapped as doctors if we go to underdeveloped countries that do not have this technology?”



Q: What are some of the positive aspects of the practice of medicine today?

Dr. Iuldashev:  “Being a doctor is exceptional because every day you have a chance to make a difference in somebody’s life. Today, we have technologies that are helping us in every way. We can teleconference with hospitals thousands of miles away and watch the live procedures they are performing. We have advanced drugs that act at cellular levels, and we can treat many diseases that were untreatable in the past. These things make us lucky to practice medicine today.”

Q: How do you see the changing landscape of healthcare and healthcare reform benefiting the future of medicine?

Dr. Harbertson:  “The anticipated benefits are improved patient care in terms of quality and safety while also making it more efficient to keep costs down. I think the hope is that as more people are able to have insurance they will regularly go to PCPs. However, we have to have a sufficient number of PCPs, NPs or PAs in order to handle the increase in the number of insured patients. Perhaps as patients regularly visit their providers, they can better manage their chronic illnesses, reducing complications and hospitalizations.”


I am delighted that our young colleagues see the next years as an opportunity to improve care. Their responses show that they are aware that there are challenges ahead and that the availability of technology brings new efficiencies, but also new risks. They recognize that it is their duty to use resources wisely and that the coming increase in need brought on by the aging population will require greater teamwork and cooperation with the other members of the healthcare team. I am excited for them as they begin the next phase of their careers and I am delighted that they have come as our colleagues. Please join me in welcoming all of our new residents! Say hello to them when you meet them in the corridors of GBMC.