2016: Another Year of Accomplishments for the GBMC HealthCare System

It’s hard to believe that another year is ending. As we get ready to make our resolutions for 2017, it’s good to take a moment and reflect on how well we moved closer to our vision in 2016.

Here are some of our accomplishments during 2016:

--2016 The Year of The Nurse…In 2016, we formally celebrated our incredible nurses and all that they give to GBMC and our patients. The culminating event was the spectacular Art of Nursing affair.  This was a festive occasion and a great opportunity to thank all of our nurses and to have some fun! A month later, thanks to the 30-minute TV special, “The Art of Nursing, which aired on ABC2 Baltimore, we got a glimpse into the lives of our nurses who make caring, comforting and providing kindness to their patients their life’s work. The special reconfirmed for me that our health system is truly blessed to have phenomenal nurses in our inpatient units, in our operating suites, in our outpatient areas, our physician practices, and in our hospice. Again, I am very proud of all of them and honored to call them my colleagues!

--The GBMC HealthCare System was honored with the inaugural American Society for Healthcare Risk Management (ASHRM) Patient Safety Award. We were selected from many applicants nationwide for our use of Lean Daily Management to improve health outcomes for patients and reduce preventable harm such as infections, falls with injury and hospital-acquired pressure ulcers. Receiving this recognition from an external authority, like ASHRM, is a substantial confirmation of the work we're doing to move us towards our quadruple aim.

--GBMC Goes Epic…On Oct. 1, we flipped the switch and Epic went live. While things are not perfect, Epic is running smoothly and patients now have only one record at GBMC. No longer do patients have multiple allergy lists with the inherent danger of this. So many people worked so hard to make this happen. It is now easier to have all of the patient’s information present when we are serving them.

We implemented simultaneously more modules than all of the other local hospitals, and there is clearly more work to be done. Stay tuned as we optimize the system over the months and years to come!

--Breaking A World Record… GBMC Healthcare set the Guinness World Record for the longest cancer awareness ribbon measuring 7,593 feet and 1 inch – more than 1.5 miles – during the 16th annual running of the Legacy Chase steeplechase event. The lavender ribbon is a symbol of GBMC’s commitment to continually reduce the scourge of cancer. Beyond breaking the record, this year’s event was a huge success. The annual event benefited GBMC’s oncology support services at the Sandra and Malcolm Berman Cancer Institute. The event would not have been successful without the support of our loyal volunteers. I thank all those who attended and all those who donated time or treasure.

Some of our other achievements in 2016 included:

--TOP DOCS 2016!..Dr. Melissa Sparrow, our first female chief of staff, was the physician on the cover of this year’s Baltimore Magazine Top Docs issue. I would also like to commend Dr. Neal Friedlander, chairman of the Department of Medicine, who was selected to be one of only seven doctors profiled in the issue, chosen from more than 680 doctors who were nominated for the honor. More than 120 Greater Baltimore Medical Center (GBMC) physicians, in 74 unique specialties, were also named in the issue. Once again, we had more physicians recognized than any other community health system in the region! We are so fortunate to have outstanding surgeons, internists, pediatricians, family physicians, and other wonderful specialists.  Congratulations to both Dr. Sparrow and Dr. Friedlander for their achievements as well as all others who were named 2016 Top Docs.

--Baltimore Magazine released a second list of exceptional medical providers, recognizing 50 of the region’s top nurses for their extraordinary contributions to healthcare. The 2016 “Excellence in Nursing” issue featured SIX GBMC HealthCare nurses among the 50 awardees! Having our nurses represented on this list is evidence of what we already knew – our HealthCare system has the best nurses!

--GBMC HealthCare added three new Physician Titans of Care: Rudiger Breitenecker, MD; John E. Savage, MD; Claire Weitz, MD.  Their outstanding skills, service, commitment, and instrumental roles have helped expand GBMC HealthCare’s reputation in our community and beyond.

--Our maternity care staff received the Blue Distinction Center+ for Maternity Care designation, a new designation under the Blue Distinction Specialty Care program.  Blue Distinction Centers+ for Maternity Care, an expansion of the national Blue Distinction Specialty Care program, is awarded to hospitals recognized for delivering quality, cost-effective specialty care safely and effectively, based on objective measures developed with input from the medical community.

--Our SAFE program received its share of accolades in 2016.  Colleen Moore, our Domestic Violence Coordinator, recently won a Governor’s Award for Excellent Victim Services, Laura Clary, RN, FNE-A/P, SANE-A, CFN, CPEN, clinical manager of our SAFE program, was recently awarded the Henry Gleim Memorial Award by the Governor’s Maryland State Board of Victim Services. The award recognizes her outstanding contribution to the field of victim services and for her work in the area of victim advocacy, and our program was also awarded a Citation from the Maryland General Assembly for excellent services provided to the citizens of Baltimore County.

--I was so pleased that in 2016 GBMC hosted our first Walk a Mile in Her Shoes®:  The International Men’s March to Stop Rape, Sexual Assault & Gender Violence. The one-mile event, in which men (wearing heels) and women (wearing tennis shoes) walked together, was a way to educate the community and support our SAFE and domestic violence programs. I was so grateful for the more than 300 participants who helped us raise over $30,000 and allowed GBMC to continue providing necessary services to women across the community.

--Our Comprehensive Obesity Management Program (COMP) achieved certification for weight loss surgery under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) which sets standards for safe, high-quality bariatric patient care.  To earn the MBSAQIP designation, GBMC’s COMP program met essential criteria for staffing, training and facility infrastructure and protocols for care, ensuring its ability to support patients with severe obesity. Currently, there are more than 700 centers in the country that hold this accreditation. Congrats again to COMP for this great accomplishment!

--In 2016, GBMC was again recognized as a leader in Lesbian, Gay, Bisexual, Transgender (LGBT) healthcare equality by the Healthcare Equality Index (HEI). This acknowledgment reinforces GBMC’s strides in HEI’s stringent core four leader criteria: Patient Non-Discrimination; Equal Visitation; Employment Non-Discrimination; Training in LGBT Patient-Centered Care. We are proud to have met the criteria and sub-criteria in all four categories!

--Our care management team in the hospital, at Gilchrist Hospice, and in our patient-centered medical homes won a few awards at Decision Health’s 8th Annual Care Coordination Summit.  The summit showcases new models of care and innovative processes that are transforming the healthcare system leading to improved patient outcomes and appropriate use of healthcare resources.

--In June, the hospital started using the Patient¬-Centered Care Team (PaCT) model of care. This is a collaborative model between physicians, nurses and other clinicians that makes it easier for us to stay focused on the patient. We have made telemetry available on most units to eliminate unnecessary patient transfers; physicians and case managers are now located on a single unit; multidisciplinary rounds include all members of the care team, and medical directors and their partner nurse managers are now accountable for the care on each unit and for achieving our four aims.

--Gilchrist Hospice received their CHAP (Community Healthcare Accreditation Partner) accreditation. Gilchrist is the best hospice anywhere, period. Cathy Hamel and her team are exemplars in healthcare management.

--Dr. Albert Blumberg and his wife, Beth, in a magnanimous gesture of gratitude, established the Beth and Albert Blumberg Radiation Oncology Staff Development Fund. For over 30 years, Dr. Blumberg has cared for patients at GBMC.  This wonderful gift is one way that the Blumbergs have decided to say, “Thank you!” to the Radiation Oncology staff who have made possible the department’s and Dr. Blumberg’s success in delivering life-saving treatment.

--This year, unfortunately, we said goodbye to Darin Lerner, MD, our former Chair of Psychiatry. Darin’s hard work and marvelous devotion to his patients made him such a trusted healer, friend, colleague, and teacher.  We also felt the loss of our good friend Joseph Keelty. Joe gave so much to the GBMC community and was a force in giving of his time, talent and treasure to both Gilchrist Services and our hospital. There is no doubt that we lost someone who was very special and a great friend to GBMC. We will always be thankful for what Joe did for GBMC and we are truly going to miss him.

--Approximately 900 participants spent part of their Father’s Day with GBMC and helped raise approximately $140,000 at the Father’s Day 5K. In 28 years, the 5K has raised close to $2 million for critically ill and premature babies.  More than 100 weight loss patients from our Comprehensive Obesity Management Program completed their first Father's Day 5K.  We had twins and 2007 NICU grads, Cody and Selena Staab, raise money for the NICU by selling their bracelets during the Father’s Day 5K.

--During this year’s Baltimore Running Festival approximately 100 runners joined team #RunGBMC to raise funds in support of Gilchrist Center Baltimore – the Joseph Richey House. The 19-bed inpatient center has been serving patients in Baltimore City for more than 30 years by providing residential, acute and respite care. We raised more than our $50,000 goal. I’m very grateful to all of the employees, volunteers, patients and supporters of GBMC Healthcare who helped us raise money and awareness of the outstanding work at the Joseph Richey House.

--Our Night at “The Yard"..Many of our employees attended our first GBMC Employee Night at Camden Yards.  It was nice to see so many of our people come out and have fun with their colleagues. And yes, the Orioles victory that night added more joy to an already festive event.

--For the first time ever, GBMC celebrated "Random Acts of Kindness Week.” These actions were spearheaded by the BeKind Brigade, comprised of GBMC staff from various departments, who randomly chose a certain hour on a selected date, to walk around the medical center and conduct random acts of goodwill.  In addition, GBMC delivered over 1,200 lbs. of non-perishable food to the Bea Gaddy Family Center for families in need. Thanks again to everyone who helped with this endeavor.

--GBMC Teamed up again with WMAR-TV to collect hundreds of toys for the 18th annual “It’s Kindertime Toy Drive.” Thank-you to all the hundreds of employees and their families along with the many donors who helped contribute to the toy drive.

--Our fantastic volunteer auxiliary again contributed thousands of hours of service and tremendous success in fundraising through our Nearly New sales.

The evidence is clear. GBMC HealthCare made great progress towards our vision in 2016! We have many, many people to thank for this. Our doctors, our nurses, other clinicians, and all of our non-clinical employees have done a fabulous job. And lastly, we must thank our patients – you are the reason we do what we do. We are honored and grateful that you have chosen GBMC for your care.

I realize that these things only represent a small fraction of what the GBMC family did in 2016 to move us closer to our vision. What others do you want to mention? Please share your thoughts below.

Best wishes to you and your loved ones for a Happy & Healthy 2017!

THANK YOU…Today we experienced a critical power failure to our data center in the North Pavilion that then caused our computer systems to shut down for hours.  We will take steps to assure that this cannot happen again. I want to thank all of our people who worked so hard under downtime procedures to care for our patients. I also want to thank Dave Hynson, GBMC’s Chief Information Officer, and his team, for all their hard work in addressing the issues and getting us back to normal operations as quickly as possible. I also want to express my gratitude to all members of our Incident Command Team.

Peace on Earth – Good Will to Men

It is very impressive how at the holiday season there are a few more smiles in the corridors of GBMC. We still deal with pain and the sadness that comes with illness and loss, but people’s spirits are raised as they focus on celebrating and gift –giving. In the executive office, we had our annual visit from Santa Dr. Gary Cohen and his elves from the Cancer Center and they brought joy to our day. Well wishes abound from staff members to other staff members and to patients and families.

With all of the meanness and evil that is evident in our world, we must make this time of year, especially this year, an opportunity to exhibit good will to all men and women and to have the spirit of giving lessen each other’s burden.

On behalf of the organization, I want to extend best wishes for a safe, healthy and happy holiday season for those celebrating Christmas, Kwanzaa or Hanukkah.  Enjoy your time with family members and think about the things that are important in your lives.  For those staff members working during the holidays, a special “thank you” for taking care of those who aren’t able to be at home during the holiday season. I am blessed to work with all in the GBMC family and I am very grateful for this.

THANK YOU!
This year GBMC had the privilege of teaming up with WMAR Baltimore to collect toys and donations for the 18th annual “It’s Kindertime Toy Drive.” 

Over the last three weeks, many of you have donated gifts at various drop-off boxes in our main GBMC Hospital campus and at each of our 10 primary care offices. To help promote the toy drive, people who donated towards the cause were entered into a raffle to win either two (2) pre-screening tickets to Star Wars; Rogue One, a BB-8 Talking Figure or a Star Wars Legendary Jedi Master Yoda Figure.

I just want to thank the hundreds of employees and their families along with the many donors who helped contribute to the toy drive. The toys were distributed, by ABC2, to children and families living on the Eastern Shore, Baltimore City, Baltimore, Carroll, Cecil, Harford, Howard and Anne Arundel Counties, and at the Ronald McDonald House and Kennedy Krieger.

Again, I am very grateful to Nick Travelstead, committee chair for our Father’s Day 5K, who provided us with a group of his employees to load one of his vehicles to transport all the toys to WMAR-TV, and our Marketing Department who ran the drive for us. It is outstanding to see so many people give back during the holidays.

A Letter from a Patient

December 9, 2016

Dear Dr. Chessare:
From Dec. 1 to Dec. 4, I was a patient in Unit 38 – Telemetry. This was not my first experience with GBMC, but it was a most pleasant experience at a stressful time because of the caring and attentive service provided by the nursing and tech staff.

I apologize to anyone I omit but these are the names I remember: 
NURSES: John, Kathleen, Shu, Brittni, and Rebecca (student nurse from Stevenson U).
TECHS: David, Tamika, Sade, Andrea and Amy. 

Not once did I have to wait more than a minute for someone to come assist me to and from the bathroom. Believe me when I say I have waited longer in other hospitals and units for someone to even answer the “bell.”

Most of all, I am extremely impressed with Hospitalist Dr. Carolyn O’Connor. What an asset to GBMC! Besides being competent, Dr. O’Connor offered clear, understandable explanations as to the findings of tests given. She had a caring attitude, didn’t rush and always followed through with whatever she said or advised. 

Please commend these caregivers and thank them for me. 

--Signed by a grateful patient. 

Does this sound like the care that you would want for your loved one? Expert, timely, caring and considerate. Always there when the patient needed help. Explained things in a way that the patient could understand. This is clearly what I would want for my loved one!

I am in awe of Dr. O’Connor, John Livingston RN, Kathleen Meade RN, Shu Zhang RN, Brittni Riemer RN, Tamika Parker NST, Sade Hunter NST, Andrea Sylvester NST and Amy Meiser NST.

I know how hard their work is and I am very, very grateful to them for not forgetting why they do what they do. The Unit 38 team is moving us closer to our vision.

Speaking of teamwork, it’s important that we share the stories of our success.

In September, GBMC HealthCare was honored with the inaugural American Society for Healthcare Risk Management (ASHRM) Patient Safety Award for our organizational efforts to improve care by utilizing Lean Daily Management (LDM). We were selected from many applicants nationwide for making care safer by reducing preventable harm such as infections, falls with injury and hospital-acquired pressure ulcers.

Since we started LDM, we have seen a significant reduction in not only patient harm but employee injuries as well. We have also used this technique to reduce waste and improve patient satisfaction. We measure our progress towards achieving our vision by our results in each of our four aims of Better Health, Better Care, Least Waste and Most Joy for those providing care. Receiving this recognition from a national organization, like ASHRM, is a validation of the work of our dedicated staff members.

So, earlier this week during hospital LDM rounds, members of leadership presented each unit and department with an ASHRM certificate as a way to highlight our accomplishment and to thank everyone for making this possible. We should all be very proud of our achievements in improving care.

Please Donate A Toy For The Holidays
Again this year, we are a proud sponsor of the Kindertime Toy Drive! Annually, toys collected for the Kindertime Toy Drive are given to children at the Ronald McDonald House and Kennedy Krieger as well as children in need in the Baltimore area. Please don’t forget to donate a new, unwrapped toy at any GBMC drop-off location.You have until 5 PM on MONDAY, DEC. 19! Remember, that if you donate a toy you can enter for a chance to win either two (2) tickets to Star Wars; Rogue One, a BB-8 Talking Figure or a Star Wars Legendary Jedi Master Yoda Figure. To be entered into the raffle after donating a toy, visit:
https://gbmc.formstack.com/forms/toydrive_2016. If you’ve already donated a toy, you're also eligible to enter into the raffle via the same link!

The prize drawing will be held on TUESDAY, DEC. 20. For more information, please visit www.gbmc.org/toydrive

Holiday Spirit

I hope that many of you enjoyed the food and company at yesterday’s annual Employee Holiday Meal. This is a hospital tradition that draws a big crowd every year and I was happy to see many of you enjoy the event. Music also filled the air at the holiday meals as members of the GBMC Holiday Choir put on a wonderful lunch-time concert as usual.Thanks to all who did their part to make sure this year’s event was a success and I wish you all Happy Holidays!

Let’s Stop Doing Some Things

On a bad day, it appears that some people think that improvement always requires more steps. If we didn’t ask the nurse to add this click or that phone call then we couldn’t have possibly made it better. GBMC has phenomenal people who work very hard and are very well intentioned, but leaders need to be sure that the standard work is all necessary to help us get to our vision. If not, we will just overwhelm and frustrate our people.

So this week, when I learned of some tasks that we have not eliminated, like faxing reports to people who are already getting them through our new electronic medical record, I realized that we still have work to do in driving waste out of our system.

I watched the Art of Nursing television show this week. What a marvelous tribute to our nurses and their commitment to our patients! As I heard of all the things that our nurses were doing that really do help our patients, I realized that it is my job to make sure that we unburden them of tasks that don’t really help.



The Institute of Healthcare Improvement (IHI) National Forum

Some members of the GBMC Team attended the IHI National Forum this week. Lisa Griffee and Caroline Candiello presented some of our work in Lean Daily Management and in “breaking rules” that don’t really add value to our patients and their families. It made me very proud of all that we have done to improve care and move towards our vision. All of our attendees, including myself, learned a lot from other organizations as well.

The Front Office and the Front Line

There is often a huge gap between what the people doing the work of an organization know and what the senior executives know. We implemented Lean Daily Management in part to narrow this gap and I really believe that we have been successful. However, we still have work to do. This morning, I was reminded how hard it is to keep everyone “on the same page.” I was in a clinical area and the team there was very down. They were struggling with new workflows created by our Epic implementation, many “glitches” in the new system, and the inability to fill some positions on their team as the economy heats up. The net effect of this was making it much harder to perform their jobs at the high level to which they had become accustomed to while treating everyone the way that they would want their own loved ones treated.

The team in this clinical area got up the courage to tell me that they thought that no one was really listening to them. They had been reporting the problems, outside of their control, correctly and respectfully, but did not see much improvement and they thought they were getting lip service from people like me.

After the interaction this morning, I began to think of when I first started my career as a pediatrician in a large, complex organization. I remember experiencing the same feeling as my colleagues this morning. But when I was in their position, no senior leaders had ever come to my clinic. It was very easy for me to conjure up the notion of a bunch of executives who really didn’t care and were not looking out for my best interests and the best interests of my colleagues and my patients. At GBMC, we are a lot more “visible” than the executives had been when I was on the front line of care. But this morning I realized that this is not enough. I was truly grateful for how hard they were working and we clearly were in action to fix problems beyond their control but we had to do better.

Identifying the fixes, beginning to implement them and communicating to everyone where we are in the process is… very, very hard in a large complex organization. Some things are easier to fix than others and some take a very long time. I know for a fact that many excellent people were working on the myriad of problems that the clinical team this morning were concerned about…but how could I help the clinical team understand this?

One thing that I have learned the hard way is that it is a fool who believes that complex problems have simple answers. So, the best thing that I can do for my colleagues that are down is to commit to getting the right people in a room, listing the issues, creating reasonable timelines for them to be fixed, making the timelines visible, and holding ourselves accountable to meeting those timelines. I want them to know that we really do care about them and that I know that we must and we will fix these issues.

The Art of Nursing on WMAR-TV

As we bring our formal celebration of the year of nursing at GBMC to a close, I am really looking forward to seeing our nurses spotlighted on television for the great work they do every day.

The community at-large will get a first-hand look at the life of nurses in the GBMC system and understand how exceptional they truly are by watching The Art of Nursing, a 30-minute TV special, on Wednesday, December 7th on ABC 2 Baltimore (WMAR-TV) at 7 PM.  If you want a sneak peek at the special, please watch by clicking here.

I promise you that after watching it you will not want to miss this program!

Congratulations…
Kudos to our very own, Barbara P. Messing, M.A., CCC-SLP, BCS-S, who was one of 19 fellows across the United States recently honored by the American Speech and Hearing Association (ASHA). She received this prestigious recognition for her research, teaching, and clinical service.  Barbara is the Administrative-Clinical Director of the Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery and Johns Hopkins Voice Center at GBMC. She is also recognized as a Clinical Specialist in Head and Neck Rehabilitation and is a Board Certified Specialist in Swallowing and Swallowing Disorders. Her clinical and research interests are in the area of head and neck cancer rehabilitation, dysphagia and voice disorders.  Again, please join me in congratulating Barbara on her recent achievement!

So Much to Be Thankful for...Especially Some Unsung Heroes

We all know that Thanksgiving is a day for reflection of all that we have and cherish. I am a very fortunate man and I have so much to be thankful for starting with my loving family. I am so lucky to be the President of GBMC and I am very grateful to have thousands of phenomenal colleagues who give of themselves every day to help others and especially those who work on Thanksgiving and all the other holidays. I am truly blessed.

This year, I have a special group of dedicated people to be thankful for. Let me tell you a story….

I was the Senior Team member on call for the weekend of November 5th and 6th. Being “on” entails coming in for Lean Daily Management Rounds each day and being available to the administrative coordinator if any issue comes up that they cannot handle on their own. The administrative coordinators are a blessing in themselves; they are so good at what they do that we hardly ever get called. So I was surprised when Michelle Patchett, RN, called me on Sunday evening with a problem.

A man had come to the Emergency Department very sick and he needed to be admitted to the Intensive Care Unit. But the man had a “service dog” who I will call “Fluffy”. The man said that he had no friend or family member who could care for Fluffy. The intensive care unit is not a place for animals so our problem was what to do with Fluffy? This was clearly a “special cause” in quality improvement parlance, because most people with a dog will have a friend or neighbor who will be willing to care for their dog for a day or two but this man did not. GBMC did not have a procedure in place for this situation. Michelle called the Baltimore County Animal Control people but they had no answer for us.

I knew of the Maryland Society for the Prevention of Cruelty to Animals (MDSPCA), but I had no idea if they would be able to help. We got in touch with the Board President of the MDSPCA, Elizabeth Drigotas who asked us to call their Director of Community Affairs, Katie Flory. While it was clear that they too did not have a process in place specifically for this issue, Katie did not hesitate to offer her help. She essentially dropped what she was doing (at the dinner table with her family on a Sunday evening) and drove to GBMC and picked up Fluffy. Nichole Miller, the MDSPCA Director of Operations, met Katie and Fluffy at the shelter. The MDSPCA treated Fluffy with tender loving care at their shelter for one night until the patient was released from the ICU. Fluffy was then reunited with him the next day on an inpatient unit. But the work of the MDSPCA did not end there! Katie brought food, bowls, treats, blankets, and toys for Fluffy. For the next 9 days, Katie travelled to GBMC and walked Fluffy in the morning and Nichole came and walked him in the afternoon. They were aided by Amy Gonzalez, a GBMC employee, and an MD SPCA volunteer who walked him on the last couple of days. My wife, Tracey, and my daughter, Caroline, walked Fluffy every evening (They love animals and they really loved Fluffy! I see a dog in our future to go with our cats, Bonnie and Clyde).

So I have so much to be thankful for, but this Thanksgiving I am asking you to join me in thanking some “unsung heroes,” Katie, Nichole, Amy, Tracey, Caroline and all of the Team at the MDSPCA, who truly helped us and Fluffy’s owner and who help thousands of animals and people every year. The mission of the MD SPCA is to improve the lives of pets and people in the community by fostering healthy animal-human relationships.  The Maryland SPCA is a private, non-profit, independent organization which operates primarily in the Greater Baltimore Metropolitan area.

My family will be making a donation to the MDSPCA in honor of Katie, Nichole, and Amy. Please consider making a gift as you are able to this wonderful organization. You can do it at http://www.mdspca.org/give Thank you and Happy Thanksgiving to all!

Continuing Our Work Towards a Better Healthcare System

The GBMC HealthCare system has been transforming itself for more than 6 years to deliver better health and better care at lower cost with more joy for those providing the care. We have been very successful so far. The health outcomes of our care have improved. Our patient engagement scores are up, especially in our advanced primary care sites. We have reduced the total cost of care for the Medicare beneficiaries served in those sites by more than 7 percent, and our people are delighted to have the support they need to better manage those with chronic disease.

Over the last week, I’ve been asked many times, “What effect will the presidential election have on our work?” Truthfully, I don’t really know. What I do know is that every American wants a healthcare system that is less costly, delivers better health outcomes and is more focused on the patient. Republicans and Democrats realize that we cannot return to a system that only financially rewards the number of services provided without regard to whether or not those services actually helped the patient and were provided in the most efficient manner possible. The move toward value is well under way and payers are not reverting to the old ways that had healthcare costs rising by 7-10 percent annually. Also, Republicans and Democrats know that even though we have made progress, we are still spending 40 percent more per capita on healthcare than any other country in the world and our industries are less competitive because of this.

The Affordable Care Act (ACA, Obamacare), in my opinion, has been very successful. More than 10 million Americans now have health insurance who did not have it before. People who were born with a disease now can buy insurance when they couldn’t before. Children can stay on their parents’ plan until they are 26 years of age. Medicare has seen the lowest annual cost increases in decades, and employers have benefited from lower increases to their plans.

The one area where the Act needs improvement is in controlling premium increases for individuals buying insurance on the exchanges. Before the ACA, people who were already sick (like someone I know who was born with epilepsy) could not get health insurance. Therefore, the price of insurance for individuals was lower than it is now because the insurance companies were only insuring well people. The ACA “mandates” that everyone not covered by their employer, Medicare, the Veterans Affairs or Medicaid buy insurance. You need the healthy people in the plan to spread the cost of the people with a disease over more policies to keep the price low. Well, too many healthy people are not buying the insurance and, therefore, the price has gone up significantly. This is the classic “chicken and egg” situation. People are not buying the insurance because the price is too high, and the price is too high because people are not buying the insurance. Medicare works pretty well for America’s senior citizens because it is paid for by the Medicare tax, and the younger beneficiaries don’t consume much while the older ones do. Medicare doesn’t make the sicker patients pay more. By the way, Medicare only spends about 8 percent on administration, the other 92 percent goes to pay for care. Before the ACA, private insurance companies were spending 70-80 percent on care and the other 20-30 percent was going for administration and profit. The ACA limits the percentage for administration and profit to 18 percent. If the act is repealed, this limit will go away.

Homeowners insurance wouldn’t work if you could wait to buy it until your house caught on fire. The same is true of health insurance. The risk must be spread over the entire population, including the healthy, for it to work. So it’s the “individual mandate” part of the Affordable Care Act that isn’t working well, and everyone agrees on this.

How will the new administration deal with this? No one really knows. But it is clear that we must continue to work to create a better system. We in the GBMC HealthCare system must deliver even better health and even better care at even lower cost by driving out the waste. We must educate citizens on the facts. We must make prices more transparent so it is easier to see one source of the waste in healthcare. We must recommit to working both in our state and with the new federal leaders to deliver better value to the American people.

Celebrating Nurse Practitioner Week
Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NP) this week. Across our nation, there are more than 220,000 NPs who provide care to millions of Americans.

We have excellent Nurse Practitioners working in our hospital, in our physician practices, and in Gilchrist Services. They help us reach our vision of a patient-centered system of care every day. Please join me in thanking them this week!

What a Great Party!

I would like to thank everyone involved in our very successful Art of Nursing celebration last week. The event’s emcee, Ron Shapiro, did a great job overseeing the event that featured presentations by our Board Chair, Bonnie Stein, our Chief Nursing Officer, JoAnn Ioannou, and a panel of physicians, which included Chief of Staff Dr. Melissa Sparrow, Chair of Surgery Dr. Jack Flowers and Chair of Emergency Medicine Dr. Jeff Sternlicht.  Each of them spoke about what nursing had meant to them in their careers. Two of our patients also recognized a nurse who had helped their families cope through the loss of their loved ones. This year’s winners of our nursing awards, Roxann Cavey, BSN, CCRN, RN, Samantha Clayton, MA, Alejandro Maynard, RN, Marcus Nicholson, MSN, MBA, RN, Nicola Wagner, RN, Delores Williams, AA, RN, Linda Young, CNOR, RN were all recognized.

When the formal program was over, Dionne Figgins, accompanied by our own Lisa Griffee, Director of Performance Improvement, Carolyn Keller, Nurse Manger of Unit 36 and Rachel Ridgely, Clinical Unit Coordinator of the MICU, got the place jumping with their rendition of “Stand By You.” This was followed by dancing to the tunes of DJ Mikey V.

It was a great opportunity to thank all of our nurses for all that they do for GBMC and our patients every day and to have some fun!

Recognizing Colleagues: Radiologic Technology Week & Forensic Nurses Week
This week is both “Radiologic Technology Week” and “Forensic Nursing Week” and I would like to thank all of our registered technologists (R.T.s) and our forensic nurses for their important roles in providing care and serving our patients as if they were their loved ones.

R.T.’s perform diagnostic imaging examinations and administer radiation therapy treatments and may specialize in a specific imaging technique such as bone densitometry, cardiovascular-interventional radiography, mammography, MRI, nuclear medicine, sonography or general radiography.  They work closely with our radiologists and radiation oncologists.

Forensic nurses are specially trained and certified examiners who care for adolescent and adult victims (ages 13 and older) of sexual assault.  Forensic nurses complete a full assessment of the patient, obtain potential forensic evidence and provide antibiotic therapy, emergency contraception, and resources for crisis counseling and support services.  Our forensic nurses, as part of our Sexual Assault Forensic Examination (SAFE) Program, are also an instrumental part of the Baltimore County Sexual Assault Response Team (SART) and work closely with local law enforcement agencies in cases of sexual assault in our community.

Please join me in thanking Phil Komenda, our Director of Imaging and Cardiac Services, and Laura Clary, RN, FNE-A/P, SANE-A, CPEN, our Clinical Program Manager for the SAFE Program, and their teams for all their hard work and for their important role in caring for our patients.

Thanking Our Veterans on Veterans Day and Every Day
Today, we honor the millions of American military veterans who have given of themselves to protect us. Let’s pause and salute all who have served and honor the tremendous sacrifices made by members of the U.S. armed forces and their families to preserve our freedom. I know that I speak for all of us at GBMC in offering our sincere gratitude for their personal sacrifices, past and present.

In Grand Celebration of Our Nurses

It has often been said that nurses are the backbone of a hospital, and that is clearly true at GBMC. The more than 1,000 nurses, across the GBMC HealthCare system, work very hard to deliver to all the care that we would want for our own loved ones. Without them, we would have no system.

I often write in this blog of all of the things that we are working to fix in our national healthcare system but nursing is not one of them.  I am a firm believer that the United States has the best prepared and hardest working nurses in the world.

GBMC’s nurses have been known for outstanding care at the bedside, but now they’ve also become leaders in quality improvement. Just look at our patient falls rate, our CAUTI rate, or our patient satisfaction scores.

Our nurses have done an outstanding job collaborating marvelously well with their physician colleagues and others to help us achieve our four aims.  And we cannot forget all of their contributions towards making our Epic implementation so successful.

Caring for sick patients with many needs requires physical and mental stamina. Our nurses are smart, well-trained and resilient. Their work is not predictable. I am so grateful for their ability to adapt to the variability in demand for their services from day to day and sometimes from minute to minute.

I am so grateful for the commitment, compassion, and expertise that our nurses bring to their work.  We will be celebrating The Art of Nursing this Friday night and I look forward to seeing many of our nurses at the event.  I am very proud of all of them and honored to call them my colleagues.

ARE WE IN AN ECHO CHAMBER?

It is very difficult, in a large complex organization, to make sure that everyone knows what is actually happening. At GBMC, we have many ways to communicate, but none of them are perfect. We communicate by word of mouth from manager to employee down the chain of command; we send email newsletters; we invite people to lunch meetings; we put information on the Infoweb; we use social media and many other methods. But I am still amazed at how little our people know about some of the things that I know, and how little I know, about some of the important things that are confronting our people. Sometimes people know very well what is going on in their unit or department but have no idea or are misinformed about things going on in other parts of our system.

I recall discussing this communication difficulty with Dr. Don Berwick, one of my mentors and someone who I have learned so much from. Dr. Berwick began the “triple aim” movement some years ago. This movement has been very successful at creating better health outcomes and better care experience at lower cost but most Americans don’t know that the movement even exists.  I remember telling him how few healthcare workers know what the triple aim is.  I ask this question at every employee orientation, mostly comprised of people who have worked in healthcare in other organizations, and most of them have never heard of this movement.   So, when I told Dr. Berwick how bothered I was about this, he responded that it was because we are in an “echo chamber.” Meaning that everyone runs in circles with the same people and we begin to believe that what we know and discuss is what the average person knows. Instead, we think this because we are speaking directly with a small group of people and we are reinforcing each other’s knowledge.  Unfortunately, the conversation is not getting out to the people who are not “in the room” with us.

The Epic implementation has been raising this issue of how to communicate well. If you are in a department where things are going smoothly, you believe that they are going well everywhere. If you are in an area that is still challenged, you assume that this is the case throughout the system. The true message about Epic is that on the whole, the implementation has gone very, very well. Very few companies have gone live with such a broad scope of applications all at once and accomplished what we have. But in some areas, like our physician practices, because the data conversion from our old system to Epic could not progress without major human intervention, we are still challenged to get the job of patient care done without a lot of data entry, verification, and rework. We are fixing this and I believe that in a few weeks all areas will be operating smoothly and will be ready to begin optimizing the system to help us get to our vision faster.

TOP DOCS 2016!
I am pleased to announce the selection of Dr. Melissa Sparrow, our first female chief of staff and medical director of Emergency and Inpatient Pediatrics, as the physician cover of this year’s Baltimore Magazine Top Docs issue. This recognition is truly an indication of Dr. Sparrow’s clinical expertise and leadership.

For 30 years, the magazine has annually recognized the excellence of the region’s physicians. Each year, we eagerly await the edition’s release to see how many of our accomplished doctors are chosen for their talent and compassion by their peers. I am certain that the entire GBMC family will agree that Dr. Sparrow serves as an excellent representative of the many other GBMC physicians who are recognized within the pages of the issue.

I would also like to commend Dr. Neal Friedlander, chairman of the Department of Medicine, who was selected to be one of only seven doctors profiled in the issue, chosen from more than 680 doctors who were nominated for the honor.

Please join me in congratulating both Dr. Sparrow and Dr. Friedlander for their achievements as well as all others who are named 2016 Top Docs.

GBMC is a Learning Organization

I have spent my career in healthcare and for most of it I was on the frontline, taking care of patients. During our Epic implementation, I was reminded how little I actually know, or how little anyone actually knows, about how our healthcare system functions. I don’t mean that glibly –– our company has thousands of workflows in order to get the job of patient care done. Some of them are designed beautifully and work very well. Others are very complex, have fallen together over time, and are more like a Rube Goldberg contraption (a device that performs a simple task in a complicated fashion).

All of my GBMC colleagues will have their favorite examples of well-designed processes they are involved in daily and others that are in need of redesign. I can think of many processes that work well, but one of our most elegant is the check-in and rooming process at Family Care Associates. Patients are greeted, checked in and then immediately escorted to an exam room to be seen by a doctor. It’s a very smooth, generally reproducible process.

One of my least favorite processes in our company is the process for telling new patients how to get to the location of their visit (and where to park!). Prior to a patient’s first visit, some offices/clinics call and/or mail instructions while others give the name (e.g. North Pavilion) and/or address of the building. I wish I had a nickel for every patient I have found lost on our campus or parked needlessly far from where they need to be.

We should not be surprised that we have many processes that are too complicated and wasteful, nor should we be ashamed when we identify them. We should, however, be ashamed if we don’t learn from what we find and test changes to improve. This is the whole reason for doing Lean Daily Management (LDM). Maybe we should change the name of this practice to Learn Daily Management.

I was speaking with Radiology Quality and Patient Safety Coordinator, Brenda Schuette, on LDM this week. Brenda explained that she discovered a change in the process for ordering electrocardiograms, a result from the Epic implementation which created difficulty in getting ECGs read quickly by a cardiologist. The bad news was that the process had been slowed down, but the great news was that Brenda was part of a team that was studying the process and using their learning to test a fix! Having people learning about our processes every day is a requirement for getting to our vision of treating everyone, every time, the way we want our own loved ones treated. Let’s keep learning!

Thank You!
We couldn’t have asked for better weather during last week’s Baltimore Running Festival. Thousands of people participated in this year’s event including approximately 100 runners who joined team #RunGBMC to raise funds in support of Gilchrist Center Baltimore – Joseph Richey House. The 19-bed inpatient center has been serving patients in Baltimore City for more than 30 years by providing residential, acute and respite care. We’re still counting, but so far we have raised more than our $50,000 goal. The money raised by team #RunGBMC will help cover Joseph Richey House’s operating expenses not covered by insurance or patient payments.

I participated as part of a four-person marathon relay team with Lisa Baylin, a patient from our Comprehensive Obesity Management Program and teammate who so graciously hugged me when handing off the timer, along with Greg Shaffer and John Lazarou from our marketing department. We all had a great time in support of an important cause.

I’m very grateful to all of the employees, volunteers, patients and supporters of GBMC Healthcare who helped us raise money and awareness of the outstanding work at Joseph Richey House.

Running for The House

Gilchrist Hospice has helped so many individuals and families through the end of life.  The Gilchrist team not only delivers world class medical care to patients in their final days, but they also provide the emotional and spiritual support needed through the bereavement process.  One of the things that continues to impress me is how every staff member and volunteer at Gilchrist Hospice has an unwavering dedication to gracefully guiding patients and families in their final journey together. The GBMC system and our community are very lucky to have Gilchrist to help individuals complete their lives with dignity and on their terms.

Gilchrist is the largest hospice in Maryland and is repeatedly recognized nationally for its work. Almost two years ago, the Joseph Richey House, a 19-bed inpatient center that since 1987 has been serving patients in Baltimore City by providing residential, acute and respite care, was acquired by Gilchrist. Joseph Richey was failing financially, in large part because it was serving the poor. We acquired it because it was the right thing to do, but now we must raise the funds to cover its operating expenses not covered by insurance or patient payments.

So, this Saturday, I am participating as part of a four-person marathon relay team in the Baltimore Running Festival with approximately 100 other runners.  The funds we will raise are in support of the Joseph Richey House and the outstanding care that is provided there.

I want to thank all of our employees, volunteers, patients and supporters of GBMC Healthcare who are participating in the Festival and helping to raise awareness of the great work at Joseph Richey.

So please support RunGBMC, and join us in raising money for The Joseph Richey House and giving back to our community. If you want to lend financial support please click on this link: https://www.crowdrise.com/run-gbmc

Thank you for your generosity!

2016 Healthcare Security and Safety WeekPlease join me in recognizing all members of our GBMC security staff as this week is Healthcare Safety and Security Week (Oct. 9-15).  This is a good time to celebrate the work of our security and safety professionals in serving our healthcare facilities, personnel, visitors and patients.

The GBMC security team can be seen walking or stationed throughout our medical center from the emergency department to labor and delivery.  Our security and safety officers meet the challenge every day to keep all of us safe at GBMC. They are vital members of the healthcare team and we cannot be successful without them.

Please join me in thanking our security staff for their hard work and for their strong commitment and the diligence they display in the practice of their profession.

Epic is Now Live Thanks to Everyone’s Hard Work

Early last Saturday morning we flipped the switch and Epic went live. While things are not perfect, Epic is running smoothly and patients now only have one record at GBMC. This has really been a big team effort.

Cindy Ellis, RN, the Epic Project Director shared a few facts with me:

--We had 200 Epic team members offering ‘at-the-elbow’ support during go-live;

- Care Everywhere patient data is flowing in over 1,000 patient transactions. Organizations across Maryland and as far away as Texas and Colorado are pulling records as we share information and better coordinate care;

- Our Epic Command Center is open 24/7 and has resolved 48.72% of support tickets.

- A few inpatients are now trialing MyChart Bedside to view health information, message with their medical team and better plan for the day during their hospital stay.

Dave Hynson, GBMC’s Chief Information Officer, told me that he thinks that overall the implementation has gone better than even he anticipated. None of the issues that have come up have surprised him. There have been some issues with system access and printing, but these are things encountered by all hospitals that have implemented Epic. Dave believes that when you look at the grand scheme of things, we are implementing simultaneously more modules than most other hospitals, and we have had tremendous success to date. Dave is pleased with the work of the users, their support, optimism and enthusiasm and how they’ve been patient in working to resolve issues that come along. He points out that the team members from Epic headquarters have been impressed with our problem solving skills and the low amount of frustration among all parties involved.

One of the areas where the rollout has gone very well is in the Emergency Department. Mike Santiago, MD, one of our ED physicians who has been very involved in building, testing and implementing Epic for the ED said that our Emergency Medicine team took this transition very seriously and as a result this monumental change has gone relatively smoothly. Mike points out that behind the smooth transition of the physicians and nurses however, was a lot of not so visible hard work and preparation. There was direct clinical input every step of the way as the GBMC analysts and Epic team customized our ED workflows and orders in the system. Without this direct collaboration we would not be experiencing this initial success. Every one of the providers came to a training class and were encouraged after this class to practice in the “Epic playground” environment to familiarize themselves with the program. They were also encouraged to come in during designated times to work with the Epic masters customizing their order sets, their smart phrases and their other documentation tools. Without the engagement of the providers in this process our transition would have been much more painful. On top of this preparation, providers in the group have eased the transition by coming in on their own time for 2 to 3 hours to decrease the overall department workload and practice their initial documentation on a handful of patients. This provider directed effort has decreased the burden and the stress during go-live. It has been a major factor in the ED’s ability as a department to get up to speed as quickly as they have.

Kimberly Vohrer, RN, the Nurse Manager of Unit 38 said that one of her biggest concerns, prior to go-live, was that the system would be turned on but then crash. Kim is happy that the system has stayed live so that her team could focus on all of the changes that were taking place. Kim points out that over the last few days, what’s been a major help has been the interdepartmental collaboration, with the physicians and pharmacy for example, and basically everyone coming together to tackle any issues that come up. Kim adds that the nurses have been “rolling with the punches” and learning. They’ve also had support ‘at-the-elbows’ which has been very helpful and the fact that various members of leadership, directors and managers, round constantly and are being visible has also been a huge help. All this has really allowed the nurses to focus on taking care of their patient and with their responsibility in completing their documentation.

All of our team at Gilchrist Services should be commended as well for their great work in implementing Epic. Since so many of our Gilchrist patients are in their homes or extended care facilities, this made the task of one patient - one record even more difficult. They have done a marvelous job at getting the system up including in our 3 inpatient units.

Our employed physician offices have done very well, too. They had the added challenge of not having all of the data from their previous electronic record move seamlessly into Epic. I am very grateful for their efforts in making the transition work.

There is clearly more work to be done in the “stabilization” phase and no one denies that the learning curve is steep. We have gotten over the early stress of the implementation and our patients and staff are already beginning to reap the benefits of this wonderful new tool. Stay tuned as we optimize the system over the months and years to come!

National Physician Assistant Week

Please join me in celebrating all GBMC physician assistants (PAs). This week is National PA week (Oct. 6-12) and is a time when we celebrate PAs and their profession and showcase the value they bring to today’s healthcare team.

A physician assistant (PA) is a nationally certified and state-licensed medical professional who first completes a bachelor’s degree and then an intensive three-year PA program with at least 2,000 hours of supervised clinical practice.  They then must pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).

The GBMC PA staff practice in many areas from the outpatient offices to the inpatient units in a wide variety of specialties. Please join me in thanking our PAs for their hard work and for their important role in moving GBMC towards our vision.

GO-LIVE IS FINALLY HERE!!!

One patient, one record…this phrase has been on the tip of my tongue now for more than 20 months. We are less than 24 hours away from implementing Epic, our new clinical and administrative information system, going from an idea to a reality. I am very excited about this implementation because each patient will have only one record in our system, and it will make it easier to treat everyone the way we want our own loved ones treated.

The road to this day started a couple of years ago, when we realized that it was not possible to coordinate care for our patients when their information was in multiple places, electronically and on paper. We met with several vendors, and after a thoughtful process we chose Epic. 

In early 2015, I traveled with members of our team to Epic headquarters in Wisconsin and had the privilege of meeting Judy Faulkner, principal owner and founder of Epic. We met with many people who explained to us the capabilities of the software and the importance of building it for GBMC in a way that would allow us to get the most out of it. We got a “test drive” of the software and we were all really impressed.

Technology cannot create a vision or change a culture, but it certainly can accelerate the rate of change toward a vision. I can’t stress enough how the Epic implementation is a strategic move for the GBMC HealthCare System. “One patient, one record” is critical for us to deliver the kind of care we want for our own loved ones to everyone and Epic provides the tools that will make it much easier for our patients to communicate with us and be involved in their care.

  

Getting to go-live with our new electronic medical record system has required a phenomenal effort and many hours of hard work by thousands of our people. Getting us to one patient, one record for all served by our employed and GBHA aligned physicians, our hospital and our hospice, clearly has not always been easy. Yes, there is no doubt that there will be much to do and issues to be addressed even after launch, but, we have so many smart, hard-working people who are ready to help us during and after Epic implementation.

I want to take a moment to thank Cindy Ellis, Epic Project Director, and Dave Hynson, GBMC’s Chief Information Officer, who oversaw the entire design, testing and education process, and their Epic team for all their hard work in getting us ready to go live.  

Also, I want to thank all of our physicians, those employed by GBMC and in private practice, all of our nurses, all of our nurse practitioners and physician assistants, all of our other clinicians, patient access representatives, billing personnel and every GBMC family member who has helped build the system, test it and get us to this point of readiness. I know how hard you have all worked and I am very grateful for all of your efforts. I am also grateful for the hard work and expertise of our colleagues from Epic. 

Lastly, I want to express my gratitude to all those who worked in PP North and also at our Owings Mills site, entering several thousand appointments from the hospital and our physician practices into Epic. Recently, our team worked very hard on the schedule and registration conversion from Meditech and eCW. They posted more than 6,000 original Meditech appointments into Epic and an estimated 22,000 appointments from eCW. The team also completed an estimated 10,000 total registrations! Gilchrist Hospice manually converted the records of more than 750 patients.

Thank you all!

Some Records Are Made To Be Broken…

And boy did we break one! In case you didn’t know, GBMC Healthcare set the Guinness World Record for the longest ever awareness ribbon measuring 7,593 feet and 1 inch – more than 1.5 miles – during the 16th annual running of Legacy Chase steeplechase event at Shawan Downs last weekend. The lavender ribbon is a symbol of GBMC’s commitment to continually reduce the scourge of cancer.

Beyond breaking the record, this year’s event was a huge success. Cool weather, beautiful horses, a picturesque countryside setting and many family and friends – there were approximately 10,000 attendees this year – coming together equaled a spectacular time.  And it was all for a good cause, as the money raised benefits oncology support services at the Sandra & Malcolm Berman Cancer Institute. The Institute is the only comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer in the Baltimore region. GBMC has invested in talent and technology to provide the best for oncology patients. Whether they are in need of outpatient, inpatient, home care, hospice or survivorship services, the more than 2,000 new cancer patients annually at GBMC get the best care.

This wonderful event would not have been successful without the support of our loyal volunteers, who helped us break the record and really made this year’s event very special. I thank all those who attended and all those who donated time or treasure. Special thanks to the GBMC Philanthropy and Marketing Departments, who worked so hard in putting the event together and for helping us break the record!

We Will Break the Record!

This coming Saturday, Sept. 24, we will have our 16th annual Legacy Chase steeplechase event at Shawan Downs in Hunt Valley.  This year’s event will again benefit GBMC’s oncology support services at the Sandra and Malcolm Berman Cancer Institute.

Legacy Chase has become a signature event for GBMC HealthCare combining the excitement of steeplechasing with a celebration of our patients and the services we provide to the community. There’s more to the event than great horse racing and there is something for everyone.  Past events have attracted more than 7,000 equestrian fans, friends, and families from across the region who’ve enjoyed the rail-side tailgating, live music, great food, and family-friendly activities. Many of the crowd-pleasing traditions continue this year—such as the kids’ Stick Pony Race, — and we have added some exciting new components to help make the event another memorable success.

This year we will celebrate our commitment to fight all cancers with an attempt to break the Guinness World Record for the longest cancer awareness ribbon—right in the infield of Shawan Downs.  Stretching a mile and a half long, the lavender ribbon is a symbol of GBMC’s commitment to continually reduce the scourge of cancer.  I’m really excited about this and I am sure with everyone’s support we are going to make it happen!

GBMC HealthCare has worked to perfect cancer care over the last 51 years.  The only comprehensive community cancer program certified with distinction by the American College of Surgeons Commission on Cancer in the Baltimore region, GBMC has invested in talent and technology to provide the best for oncology patients. Whether they are in need of outpatient, inpatient, home care, hospice or survivorship services, the more than 2,000 people with newly diagnosed cancer that GBMC diagnoses and treats annually receive the best care possible. 

I want to thank all those who’ve donated time or treasure and to the GBMC Philanthropy and Marketing Departments who’ve worked so hard in putting together the event and for taking a run at the record!

So, make this year’s event a family affair and come and enjoy a day in the country.  I hope to see you there!

Working Very Hard to Get Ready for October 1

We are less than THREE weeks from our Epic go-live date of October 1. Last weekend, I was really impressed to see so many of my GBMC colleagues working in our command center in the North Pavilion and also at our Owings Mills site to enter appointments from both the hospital and our physician practices into Epic. Our team worked very hard on the schedule and registration conversion from Meditech and eCW. They posted 6,881 original Meditech Appointments into Epic and an estimated 21,052 appointments from eCW. The team also completed an estimated 10,000 total registrations! Gilchrist Hospice began manually converting the records of approximately 750 patients yesterday.

These phenomenal efforts are only the most recent example of the many hours of hard work that literally thousands of our people have done to move us to one patient, one record.  It clearly has not always been easy and we are not yet done, but, I am humbled by the efforts of our family. They have collectively worked through many barriers and completed countless hours of training to get us to this point. The transition will be hard, but once the hospital, our hospice, and all of our employed and GBHA affiliated physicians and other providers are using this system, it will be easier for us to move towards our vision faster. Please let me thank all of our physicians, both employed by GBMC and in private practice, all of our nurses, all of our nurse practitioners and physician assistants, all of our other clinicians, patient access representatives, billing personnel and every GBMC family member who has helped build the system, test it and get us to this point of readiness. I know how hard you have all worked and I am very grateful for all of your efforts. I am also grateful for the hard work and expertise of our colleagues from Epic. Thank you all!

Healthcare Environmental Services Week
This week is Healthcare Environmental Services (EVS) & Housekeeping Week (Sept. 11—17) and I am proud to acknowledge the dedication and professionalism of our EVS staff as we celebrate them.

Cleanliness is everyone’s job at GBMC, but, our EVS staff are the experts in cleaning who work tirelessly to get the job done. They spend countless hours in their vital role in preventing infections, patient safety, and patient satisfaction, maintaining sustainable buildings, lending a helping hand and working to ensure that our healthcare facilities are always presentable and ready for business.

There are over 100 EVS associates working “around the clock” at GBMC in a variety of roles servicing over 1.2 million square feet of facility. Their work is vitally important to the health and safety of our patients, so, please join me in honoring all the men and women of EVS.

A Collaborative Effort for Better Care

GBMC is a fabulous place to have a baby and everyone knows it. Our clinical outcomes for mothers and newborns are excellent!  While our patient satisfaction scores for maternal and newborn are always among the best in inpatient units in Maryland, there is always room for improvement especially if we compare ourselves to hospitals in the Midwest and West. In these comparisons, we are still very good as we find ourselves in the top 25 percent.

Recently, Jodie Bell, RNC, BSN, IBCLC, Clinical Director, Postpartum and Newborn Nursery, got together with leaders from food and environmental services, Kelly Bechtel, General Manager of Food & Nutrition Services and David Fatokun, Quality Assurance Manager with Sodexo, and through Lean Daily Management started studying the mothers’ beliefs about their care, how their room was being maintained and their thoughts about the food.  As a team, they have been working on courtesy and friendliness and auditing their performance. They have begun to study things like how a food tray does not always have what the patient ordered or why the food that is supposed to be hot is not always hot when it is delivered.

This new higher level of collaboration and inquiry has already begun to yield results! 

In August, patient surveys scored the courtesy of the person serving their food at 92.9 (99th percentile in MD and the 80th percentile nationally) and their room cleanliness score at 90 (97th percentile in MD and the 70th percentile nationally). On the so-called “overall” HCAHPS score, where patients are asked to rate their hospital stay on a scale from 0-10, where 0 is the worst hospital ever and 10 is the best, the Maternal and Newborn Health team, so far, are now scoring 86.7 (99th percentile in MD and 94th percentile nationally)! 

I am so grateful for all of their hard work and their learning and tests of change. When you see Jodie, Kelly, David or anyone on their team please congratulate them.

Designing Patient Flow

Patient flow in healthcare continues to be a daunting challenge. It is not the same as building a car. All patients are different and their clinical needs and rate of improvement vary. The hospital doesn’t get to choose how many patients it will serve in a day. It serves all who need care. Because of the variability in these inputs, it is very important that we approach patient flow the way an engineer would. We study the patient demand and try to have just the right number of clinicians and support staff to serve them. And we design the system of patient movement to minimize the waste of time and energy.

Previously in the blog, I have discussed the concept of synchronization.  It’s a change concept that brings the players or processes in a design into “harmony.”  When we synchronize processes in patient flow, we allow the operators to organize their work so they can be ready to act at a specified time. In order for success, all parties involved must align their work to be ready for the chosen time.

People do not like to feel overwhelmed in their job. When we don’t synchronize, we run the risk that the “downstream” function isn’t ready to accept the patient when we want to move them. An example of this is the emergency department calling an inpatient unit to move a patient to them but there is no nurse ready to accept the patient. The emergency department gets upset because they want to get the patient out so that they can see the next patient. The inpatient unit gets upset because they feel they are being ‘jammed’. Both groups feel that the other doesn’t respect them.

Synchronizing flow from one unit to the next begins with a conversation before the patient moves. Information is shared about the patient and a time is chosen with the input of the sender and the receiver with enough advance notice for both to be ready.

Monica Goetz, our clinical nurse manager for the Medical Intensive Care Unit (MICU -- Unit 57) and her team felt that the previous process for moving patients out of the MICU was leading to many challenges as well as dissatisfied and frustrated staff on both ends of the transfer.  This is why they redesigned the process and are now studying it during LDM rounds, helping them to focus on how best to complete the transfer they redesigned the process.

The MICU team redefined the term “ready to move” as when both the sending and receiving nurse could safely perform a patient inclusive bedside handoff. Now, when the patient’s room is ready, the ICU nurse calls the new unit to identify a time, within the hour, that they both will be prepared to meet.  This allows both nurses to plan their work to be ready. At the agreed upon time, they meet in the new room, perform bedside handoff, review the patient’s belongings & share the “getting to know you” form. The “getting to know you” form is a tool used by the MICU team to learn about who a patient is as a person; their hobbies, things they enjoy when they are not in the hospital, fun facts, and things they want us to know about them.  

Monica shared a recent story to illustrate how the new design is working;
We had a patient (87-year-old male), with many co-morbidities and more hospitalizations than he could count.  He has always hated hospitals, the feel of being in them, and how he is treated…until this hospitalization.  He went on to describe that the care he received was like a well-orchestrated symphony.  Everyone in tune and working in harmony.  From the conductor (manager) to the lead violinist (the charge nurse) ...all setting up to tune for the concert (the shift).  Everyone worked together to make the beautiful music that we call patient care.  

This story is a good example of the work that the MICU is doing with patient transfers…. moving our patients in “synchrony”.  Working together to find a time that is agreed upon (within the hour) and then performing the handoff at the bedside – making the transition not only safer but patient inclusive.  This design demonstrates improvement from the back and forth phone tag, impersonal phone report and leaving a patient in a room alone until someone on the new unit is able to greet them.   I am very proud of Monica and her team and all of the nurses and others who have designed this new system. Let’s hear it for synchrony!

A Story That Illustrates How GBMC is different

We have been building our system of care to drive towards our vision for six years now. In 2010, we put a stake in the ground that we would become the health care system where everyone, every time, got the care we would want for our own loved ones. Our vision statement talks about physicians leading teams to deliver this. We have had a dialogue among us in the GBMC family, that we want the best health outcome and the best care experience with the least waste of time and money with the most joy for those providing the care. We chose the patient centered medical home as a design to deliver this. We already had a great hospital with excellent physicians and nurses and a great hospice, but, the medical homes were required if we were truly going to maximize people’s health and not just wait until they got really sick and needed to be admitted. Our patient-centered-medical homes are different from typical primary care because they are no longer dependent on a visit to the doctor. This model is about a relationship between a physician, her team and a patient. It is about a promise to that patient to work with him or her to maximize his or her health. It is about having the time to reflect on a patient’s health between visits, to make sure that they are getting what the evidence says will keep them well.

On a bad day, I am concerned that many people in our community don’t know how we are different or don’t believe that we are different. So let me tell you a recent story in the words of Dr. Sarah Whiteford, of Family Care Associates:

“I wanted to share this wonderful letter from a very appreciative patient whose life was quite possibly saved by the efforts of PCMH and our population health outreach.  In brief, this lovely patient of mine received a call from our care coordinator, Shelly Deckelman (go Shelly!), who was going through the list of patients aged 50 and older in our practice who had not yet had a colonoscopy.   This day of Shelly’s call happened to be her 50th birthday and her name clearly “fell onto the list.”   She was quite surprised to receive the call but it prompted her to immediately schedule her colonoscopy (which she admitted would have likely been many months later if left to her own devices).  Much to everyone’s surprise, her colonoscopy revealed a large, ominous rectal mass.  She had no symptoms at all. Despite a negative initial pathology, she was sent for urgent surgery for removal of this mass as its malignant potential was quite high.  Fortunately, her surgery was successful and the mass was ultimately a very high grade polyp which most certainly would have become malignant if not removed in a timely manner.” 

Dr. Whiteford thanked all of her team and congratulated them for making the medical home concept a reality.

Physicians and other clinicians practicing in regular primary care are smart and care about their patients just like Dr. Whiteford and her teammates. It’s just that in regular primary care after the visit, it’s on the patient. If the patient never comes in for a visit, and they don’t know the evidence about care that can save a life, they are not likely to get that care unless someone is looking out for them. This story is one of many that shows how we are different. Without the patient centered medical home, this patient may not have had her mass found until it was too late!  Let me add my thanks to all of my GBMC colleagues who are moving us closer every day to our vision.

Taking it to the street…

In the last blog post, I spoke of the great work of our patient-centered medical homes and how we have truly transformed care to become more patient-centered. It has been very difficult for us to get the word out about this transformation. I believe that the average member of our community does not know how we are innovating and what it means for individual patients, families, and the local economy. We’ve made progress, but, we still have a lot of work to do to “get the word out” to the community.

So, last week, I was the featured speaker at a “house party” with the folks at Quarry Lake Condo Association. The purpose of the meeting was to share GBMC’s vision and our quadruple aim—better health and better care with the least waste and the most joy for those providing the care. I was truly excited at this opportunity to speak directly to patients and prospective patients.

At the event, I had the pleasure of meeting the host, Mrs. Rozzie Brilliant, who received oncology support care at GBMC and whose own daughter also received life-saving testing and care at GBMC. During her presentation, Rozzie, a four-year survivor of ovarian cancer, explained her personal story and connection to GBMC and her oncologist, Madhu Chaudhry, M.D. Rozzie hosted the event out of her desire to give back to GBMC and to assure that all of her friends knew of our work.

I spent a few minutes speaking of our vision and our vision phrase: To every patient, every time, we will provide the care that we would want for our own loved ones. I told those in attendance that in America, it was clear that we have the best doctors, nurses and other clinicians in the world, who are working very hard, but, that the system they work in needs to be redesigned to help them get the job done. I told them that the biggest challenge was how to coordinate care for those with chronic disease and how we were redesigning just about everything at GBMC to become more patient-centered and to meet this challenge. They listened attentively as we discussed advanced primary care and our hours of operation. They were intrigued by our disease state registries and how we were working to assure that everyone had evidence based colon cancer screening among other things. I reminded them how good our specialists are, how we have outstanding surgeons and that surgery at GBMC costs much less than surgery at most other local hospitals and with outcomes that are at least as good if not better. The participants had many questions and we had a great dialogue. Greg Shaffer, Director of Marketing, and his team were there to help me answer questions and to provide more information about how to access our care.

I felt very good about this session where I was speaking directly to those who benefit the most from our redesign work…members of the community. We will do many more of these sessions. Do you have a group that you would like us to address?