Tuesday, December 31, 2013

Thank You to All Who are Helping GBMC Transform to be Even Better

On the last day of 2013, it is once again time to reflect and take account of our progress toward our vision. How much farther have we progressed in becoming truly patient-centered? What have we done to treat every patient, every time, the way that we want our own loved ones treated?

Aim #1: Better Health

Since the opening of Greater Baltimore Medical Center some 48 years ago, our system has been blessed with very talented physicians, nurses, and other clinicians who work very hard to maximize the health of those we serve. Over the last few years, we have gotten better at measuring and at getting in action to change things that we used to take for granted. In fiscal year 2011, we had 20 serious safety events. Through the first six months of fiscal 2014, thanks to the hard work of those very same talented clinicians and others in creating standard work and making us more reliable - we have seen three. Zero is the only ethical stopping point but we have come a long way. In 2010, we did not have a robust system for people to report minor events and near misses. Now, we have over 1500 incidents reported monthly so that we can learn from them and redesign our systems to plug “the holes in the Swiss cheese” so that they don’t align to create bad outcomes. In fiscal ‘11, we had 216 hospital acquired infections and we did not count all of them. Through the first six months of fiscal 2014, we have less than 50 total incidents of patient harm (central line associated blood stream infections, catheter associated urinary tract infections, surgical site infections of the hip and knee, falls with Injury and pressure ulcers)! We had 10 pressure ulcers alone in fiscal 2013. This year to date we have had zero! GBMC nurses and nursing technicians deserve a huge THANK YOU for this!

And we have begun moving upstream on measurably improving health. In 2013, Greater Baltimore Health Alliance made its first ever quality report to the Centers for Medicare and Medicaid Services under the Medicare Shared Savings program. We now know exactly how our diabetics are doing, for example, in getting evidence-based care and we know how many of our patients are hypertensive. Our Patient-Centered Medical Homes are in action improving these outcomes before patients require hospitalization.

Aim #2: Better Care

In 2013, we made significant progress at making continuous improvement in our culture. In April, we rolled out Lean Daily Management (LDM). LDM has helped us improve clinical outcomes, but perhaps the aim that it has had the biggest effect on is Better Care. A huge example of this is our success in moving admitted patients out of the Emergency Department to a floor bed faster. Units 35 and 38 have led the charge here by creating a pull system and measuring their success daily. The median time that an admitted patient spent in the ED in fiscal 2013 was 395 minutes. We have reduced this time to 305 minutes – a 23% reduction. The score on our patient survey question regarding waiting time to be admitted has reached an all-time high showing that the patients are truly feeling the effect of this work. In 2013, Greater Baltimore Medical Associates (GBMA) began seeing patients on Saturdays and their overall patient satisfaction scores reached all-time highs. And as I reported recently in this blog, GBMA has embarked in 2013 on the physical design of a new patient-centered medical home to minimize waits and delays and waste of all kinds. Gilchrist Hospice Care, already functioning at award winning levels in so many areas, redesigned communication with families and significantly improved the families understanding of the dying process and their feeling competent to deal with the impending death of their loved one.

Aim #3: Least Waste

Our nurses work very, very hard. A great example in 2013 of lessening their burden a bit has been achieved in the reduction of the number of “missing” medications. Nurses have enough to do in providing care for their patients without searching for things that should be there! Through the hard work of our pharmacy team collaborating with our nurses, we have reduced missing medications by 30% in 2013. Unit 45 has worked with materials management and has drastically reduced missing supplies. What used to be a major waste of nursing time has now become an uncommon event. There are many other examples of waste being driven out throughout the GBMC HealthCare system.

We finished fiscal 2013 a bit ahead of budget and we raised more money in Philanthropy than we had in many years. We are on track to break that record in this fiscal year.

Aim #4: More Joy

Our work in creating a hierarchy that engages and empowers our physician leaders through our service line model has had a positive effect in our physician engagement scores. Our overall physician satisfaction score increased significantly in 2013. We still have a lot of work to do in making all of our doctors believe that they have a voice and that it is heard. On a local level, our nursing staff has begun working on things like assuring that everyone gets an uninterrupted meal break and that they can get their work done and get home without having to do overtime. We have committed to reducing employee injuries at work and we are making great progress. In fiscal year 2013 we had 327 injuries on the job and half-way through this year we are at less than 100! In 2013, we changed vendors on our employee satisfaction survey so the results were difficult to interpret. We will continue to work at a senior team level on things like benefits and providing career growth opportunities and at a local level to bring more joy and to make the GBMC system an even better place to work in 2014.

So I think the evidence is clear. GBMC HealthCare made great progress towards our vision in 2013! We have many, many people to thank for this. Our doctors, our nurses, other clinicians, our administrators and all of our non-clinical employees have done a fabulous job. We must thank our phenomenal Volunteer Auxiliary, who in 2013 celebrated 50 years of service to GBMC! We also need to thank all of our donors who gave of their treasure. And lastly, we must thank our patients – you are the reason we do what we do and you will make us do it even better in 2014!

Please click on the video link above to be thanked!


  1. As a nurse at GBMC and having been a patient on Unit 58, I can say that our staff including physicians, nurses, NSTs, lab techs, housekeeping and dietary hostesses are top notch. My husband was also a patient several times and we have always been very happy with his care. We would love to see GBMC expand their cardiac services for urgent heart caths. You have physicians like Dr Porterfield and partners who are the best at what they do for their patient's sake. We are thankful!

    1. Thanks very much, anonymous. We have wonderful people on Unit 58 and I am grateful for all that they do for our patients. The State of Maryland controls who can do urgent cardiac catheterizations for heart attack and we are not authorized to do these. I agree that we have outstanding cardiologists and that Dr. Porterfield and his colleagues are great doctors and we are so fortunate to have them at GBMC!

  2. I believe GBMC has quality care-givers and support staff, thank you for recognizing that in your dialogue.

    I am confused regarding your statement related to patient safety. The operative areas have just instituted a new "checklist" because we are told that there has been a surge in patient injury over the last year (thirteen listed on the related power point presentation). This contradicts your statement about reductions in this area.

    Also, as a nurse, it was difficult not to notice that under the heading of "More Joy" - only Physicians are demonstrating improved employee satisfaction survey scores, while Nursing satisfaction continues to deteriorate. Could the patient injury noted above be the outcome of an abused and devalued Nursing Staff? If so, is there a concrete action plan being developed?

    1. Thanks, Anonymous. I am sorry if I confused you. I think you are looking at our fiscal 14 goals Powerpoint that is available for all to see on the Infoweb and the data is also on www.gbmc.org. You are correct that the document lists 13 as the number of serious safety events in fiscal 13, the year that ended on June 30, 2013. As I stated in the blog, in fiscal year 2011, we had 20 serious safety events and thus far halfway through fiscal 2014, (July 1, 2013 until now), we have had 3. I did not include the fiscal 2012 number which was 12, one less than in 2013.

      In 2013, of the 13 serious events, 11 were in the hospital and 2 were with Gilchrist patients. You may recall a number of months ago we ran a meeting for all of our OR staff, led by Dr. Flowers, Chief of Surgery, where we discussed those events that occurred in surgical settings. We talked about our need to get to higher reliability to prevent them from happening again. The new checklist, and more importantly more engagement with our staff on the need for standard work in our operating rooms is indeed part of our response to those events and to take us closer to our vision. Our physicians, nurses, and other staff work very hard but they work in a very complex field and they make errors. We need things like checklists to catch these errors before they occur. Our more recent results suggest that our actions are working! Thanks for all that you do to treat every surgical patient as if they were your loved one.

      In the blog when I was discussing our fourth Aim of more joy, I pointed out that we had changed the vendor for our employee satisfaction tool in calendar 2013 so that it is difficult to see if we made progress or not. I am not sure what you mean when you say "Nursing satisfaction continues to deteriorate". In the blog I called out how hard our nurses work and what a great job they do. I do not believe that we abuse our nursing staff and I value them immensely. The survey showed that people were not happy with compensation and career advancement. Our Senior Team is working on the feedback from the 2013 employee survey. We were happy that we were able to give a small bonus in December and a modest raise when many were laying off staff. We know that we need to create more and better career advancement opportunities and we are putting a plan in place to do that. In addition, every manager has developed an action plan to respond to local issues identified in the survey.

      I am curious to hear what you are working on with your manager to improve the job satisfaction of you and your team?


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