Tuesday, March 25, 2014

A Day to Reflect on the Great Commitment and Hard Work of Our Physicians

This year, National Doctor’s Day is March 30th. This is the one day of the year that we reflect on the many contributions made by our physicians and say thank you to them. The doctors of the GBMC medical staff work very hard to care for patients as they would want their own loved ones cared for. We have physicians throughout our healthcare system that are making a tremendous difference in the lives of patients every day.

This superior care is certainly evident in the 171 members of GBMC’s medical staff who were recognized in Baltimore magazine’s 2013 Top Doctor’s list, which also demonstrates just how good they are since the award comes from the votes of their peers.

And, last week we heard from patients who were very grateful for the coordination of care they received from their primary care physicians, Drs. Gregory Small and Nishi Das, and how the simple act of managing a person’s chronic health condition and providing them with a healthier, better quality of life, makes a world of difference. We are very fortunate to have a medical staff comprised of not only the best doctors in their fields, but doctors who dedicate their time, and their lives, to the care of people. So, in tribute to our physicians, I thought it fitting that we hear what our patients had to say, many of whom gave thanks throughout the year in our Foundation’s Gifts of Gratitude campaign for the care received from a GBMC physician:

“Dr. William McConnell is very kind, considerate and caring. He is always available when you need him.”
“Dr. Marshall Levine is so very special to me and my family.”
“I am fortunate to be in the care of Dr. Joseph Califano. He is a most caring and fine surgeon and a grand person.” 
“Drs. Lauren Schnaper and Sheri Slezak and their staff saved my life. They made me feel like I could make it and their skills made it true. I am forever grateful.”
“Dr. Geoffrey Neuner is a special doctor whose love of life and people shines through him in so many ways. I am here today because he cares.”
“Dr. Teresa Nguyen is fantastic! She takes the time to get to know the children and their families. We adore her!”
“I am 86 and walk pain free thanks to Dr. Victor Tritto.” 
“Dr. Thomas Guarnieri (cardiology)- For your care and wisdom, I thank you! Your referral last summer has resulted in a vast improvement in quality of life.” 
“I thank Dr. Kenneth Greene for his monthly medical updates and quick response to questions sent via email.”
“Thank you to Dr. Carter Freiburg, my vascular surgeon. He was so knowledgeable and caring and kind to me when I had my surgery. I rate him as a “10.”

From the surgeons and hospitalists to the ED physicians, primary care doctors and specialists all throughout GBMC, thank you for caring for patients and families from every walk of life, through all types of illnesses and injuries, and for helping GBMC move toward our vision: To every patient, every time, we will provide the care that we would want for our own loved ones.

In honor of Doctor’s Day and your physician, please share your thoughts and inspiring stories of patient care here…

Wednesday, March 19, 2014

What Do Our Patients Really Think About Our Care Management and the Patient-Centered Medical Home?

I've been discussing for a while the benefits of GBMC’s patient-centered medical home model and how we are working hard to ensure our patients receive coordinated care that focuses on the long-term management of chronic health conditions. We are building a system that delivers the care we would want for our own loved ones.

Over the past few months, I've talked about the new medical home office being designed and built for one of our primary care practices, Family Care Associates, and we've heard about coordination of care from one of our own RN care managers. But everyone knows how proud I am of GBMC and I am our chief salesperson. Readers of the blog expect me to say great things about our system and they should be curious about what our patients really think.  So, it was time I sat down and talked to some of them who are experiencing our care to hear what they really think about our system. Do they really believe that we are serving them better?

Last week, I met Alexis Watkins. Alexis has been a patient of Dr. Gregory Small, at our Texas Station primary care office, for several years and has worked closely with RN Care Manager Vergie O’Garro. Alexis, who is 65 years young, is being managed for type II diabetes, hypertension, and high cholesterol, among other conditions. She has seen significant improvement in her health because of the comprehensive coordination of her care. Vergie works with her to help her maintain proper diet and exercise as well as how to take her medications appropriately. She says, “When I first came in to the practice, Vergie took the time to really listen to me. She heard me and didn't overwhelm me. She took it one step at a time and that means everything. She and Dr. Small really know me and have helped me get my diabetes under control.”

As part of the coordination of care that has benefited Alexis, she tells me that the convenience has helped make staying on top of her health easier. “I use the GBMC patient portal to get my lab results, which really takes away some of my stress.”

Watch what else Alexis had to say about the care she receives from the team at GBMA’s Texas Station patient-centered medical home in this video:

I also had the privilege to meet with patient Eddie Bostic.  Eddie, age 40, was diagnosed with type II diabetes several years ago with an initial blood sugar level of more than 900. He soon landed in the ED with a blood sugar over 1,000. (He tells me he shouldn't be here, but he's a hard man to kill!). He sees Dr. Nishi Das and Vergie at our GBMA Texas Station primary care practice and says they have worked with him to get his diabetes under control through the use of appropriate medication as well as lifestyle changes such as diet. He has learned to use a Smartphone app to monitor his blood sugar and during his follow up visits, he provides the information from the app to Dr. Das to make sure everything stays in check.

Eddie explains, “They've helped me find a better way to manage my diabetes. I can share information through the GBMC patient portal and know I will always get a response from my doctor, which is very helpful. I feel like I’m talking to friends when I come in for an appointment.”

We had a nice conversation and Eddie ended it by telling me, “GBMC has always been amazing, for me and my family.”

Watch what Eddie had to say about the care he receives and how GBMC is making a difference in his life:

I sincerely thank Alexis and Eddie for sharing their experiences and stories of patient care with me. It’s heartening to hear how our system of care is working for our patients and helping us move toward our vision - To every patient, every time, we will provide the care that we would want for our own loved ones.

Wednesday, March 12, 2014

Mistake Proofing in the PACU

Everyone knows it – GBMC has outstanding anesthesia care. We have great anesthesiologists and nurse anesthetists. Our OR staff is second to none and we have excellent, dedicated nurses in our Post Anesthesia Care Unit. I have now been at GBMC for almost four years and I can’t remember a complaint about this team.

The system that they have been working in is not perfect, however.

High Reliability means “what should happen, happens and what should never happen, doesn't.” The Joint Commission has been concerned that there are infrequent events around the country where patients who have received anesthesia have suffered a bad outcome because they were not truly ready to leave the care of the anesthesia team after a procedure, but left anyway. So, to prevent against these rare events, the Joint Commission has a rule that a licensed independent practitioner must evaluate the patient before the patient can go to a lower level of care (the inpatient unit if an inpatient, home if an outpatient). Well, GBMC has not had untoward events that I am aware of, but we have had a significant problem with getting the documentation that the anesthesiologist has evaluated the patient.

Two weeks ago, the PACU joined the units participating in LDM (Lean Daily Management). Charlene Mahoney, the Nurse Manager of the GOR PACU decided with her team to measure daily completion of the Post Anesthesia Evaluation Note as one of their metrics. Earlier this week on LDM rounds, I was stupefied at how fast they had driven their performance to 100% completion of the form! On rounds, Charlene explained that the Team had implemented two process changes to meet their goal. First, she had met with Dr. Lewis Hogge from our Anesthesia group to discuss the charge anesthesiologist rounding on an hourly basis. This helped their compliance but did not get them to 100%. Charlene, CJ Marbley, our Director of Perioperative Services, and Dr. Hogge then decided to put a hard stop in the PACU. No patient would be allowed to leave the PACU without the form being completed. This is a huge culture change for our staff who are trained to keep the unit open for incoming patients from the OR. They have accepted this challenge with the support of Jennifer Trunk, the PACU’s clinical partner and our PACU charge RN's. And, the Team has gotten to perfection in this measure without slowing down the operating room.

Experts in mistake proofing identify three levels of this. The first level is when people remind others of the possibility of an error and ask them to be vigilant. This has a positive effect but since the operators are human, sooner or later someone will get distracted and forget. In healthcare we frequently turn to education of the staff as a level one mistake proofing action.

In level two mistake proofing, we make a process change that improves performance but does not fully stop the error from occurring. In the PACU example, Charlene, Dr. Hogge and their Team did this when they instituted hourly rounding of the anesthesiologists.

Level 3 mistake proofing is when a constraint or “hard stop” is created that totally prevents the bad outcome. An example of this from my daily life is that I cannot start my car without having my foot on the brake to assure that the car doesn't start moving before I intend it to. The PACU Team turned to this successful level 3 action when they stopped anyone from leaving without a signed form.

I am very proud of the PACU Team and grateful for their speedy problem solving to fix this hole in the Swiss cheese and make our patients safer!

Friday, March 7, 2014

Transparency…Does it Matter in Healthcare?

One of the reasons why people say that market forces don’t work in healthcare is because the consumer (patient) has poor access to data to judge the quality of the product. GBMC HealthCare has now had many of its quality data publicly available and updated monthly for over a year. Are people coming to our website www.gbmc.org/quality before they choose where to go for care? It is very hard to tell.

Our data show that we have made excellent progress in many areas. Hand hygiene is significantly improved over just a few years ago. Perhaps because of this and the hard work of our nurses, physicians, and other clinicians, our rates of hospital acquired infections- catheter associated urinary tract infections in particular, have decreased significantly as well. We have now gone seven months without a hospital acquired pressure ulcer. Do our patients care? Why have other local hospitals not followed us in making their data public? Do they know something that we don’t?

U.S. News and World Report continues to name “Best Hospitals” that the national data reporting system shows frequently as having average performances (see www.medicare.gov/hospitalcompare/search.html). The last round of awards did begin to generate some conversation among academics about the illogical nature of these awards but the public didn't seem to care. It appears that healthcare organizations keep their “brand” strong or otherwise independent of the evidence.

I believe however that the public is beginning to wake up and so called value-based healthcare will start to get some traction. We can no longer afford the 40% waste in the U.S. system. Please discuss this with your friends. Do you have ideas for helping patients make decisions about healthcare? Please share them.