Have we made the U.S. healthcare system safer?

There is a lot of evidence that patients are safer in American hospitals and health systems since the publication of the report from the Institute of Medicine (now the National Academy of Medicine) in 2000, To Err is Human. We have significantly reduced harm in the form of iatrogenic infections, falls, retained foreign objects and many others. To see how GBMC has done, you can go to our public website: www.gbmc.org/quality.

But it is clear that we still have work to do. Other high-risk industries, like nuclear power, commercial aviation, or the French high-speed rail system have error rates in the less than 1 per million range. The U.S. healthcare system still has rates in the 1 per hundred to 1 per 10,000 range. We can and must get even safer.

Dr. Donald Berwick, the President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI) gave the keynote address at the 19th annual National Patient Safety Foundation Patient Safety Congress. He applauded those who have generated these real improvements but he pointed out that we still have a lot to do. He listed seven areas of concern that health care leaders should pay attention to in the effort to continue the progress of the patient safety movement. They are in Dr. Berwick’s words:

1. Displacement by other concerns: "As we go to boardrooms around the U.S. and hear what is being discussed, there are two topics: a changing reimbursement system and workforce morale. I personally believe there’s a strong connection between safety and cost reduction, but that conviction hasn’t been firmly established in 20 years."
2. Illusion of completeness: "There’s an illusion that we’ve worked on safety — 'here are our scores on central line infections, pressure ulcers and here’s what’s happening on medication reconciliation' — on to the next problem. The concept of safety as a box-checking enterprise, where we start and finish, is lethal to patients of the future."
3. Incentive theory: "Most of the workforce is already trying as hard as it can. Until we become scientists and give up the incentive-oriented approach to safety, we won’t make the systemic progress we have been calling on for years."
4. Metrics glut: "In pursuit of incentives, we’ve glutted ourselves with metrics. I think we are way beyond a level of toxicity. It's not just safety.  We have to go on a diet."
5. Separation of safety from quality: "When people say 'quality and safety,' what I hear is 'fruit and bananas.' Quality improvement is the big tent. It’s the enterprise of constant improvement to everything we care about. The quality of my car is dimensional. It has safety, durability and fuel economy and so does health care. I think reuniting our endeavors is crucial to our future. We don’t have the resources to waste on tribalism. We have to think systemically."
6. System literacy: "We need to become literate about the systemic properties that produce improvement."
7. Academic attacks: "I’m not sure why, but I deeply regret that academic students who position themselves outside the safety movement have all too often become critics. Until our academic brethren join in the progression of safety instead of positioning themselves as critics of the good-hearted work going on, they’ll be riding the breaks."
We at GBMC will stay focused on our vision phrase and every day we will work to measurably improve the patient’s health outcome and her care experience while driving out the waste and increasing the joy for those providing the care.

THANK YOU to our Information Technology colleagues!
Ten days ago, a major cyber-attack brought disruption to the health system in England forcing many hospitals and doctors’ offices to turn away patients and cancel appointments. People in affected areas were being advised to seek medical care only in emergencies. As a result, the United States and countries around the world sought to manage the spread of the "WannaCry" ransomware attack immediately.  That was also the case here at GBMC.

Dave Hynson, GBMC’s Chief Information Officer, and his team went to work immediately to diminish risk as much as possible by implementing the most current Microsoft security updates, and best practices as defined by our vendor partners. They also did an excellent job of informing the GBMC HealthCare user community by asking them to be vigilant with unknown or suspicious attachments.

All of the patching was accomplished by Monday (May 15) afternoon, including our Citrix servers and systems for which Microsoft made a patch available. As of today, we still ask GBMC staff to continue to be vigilant regarding all email and help to ensure that GBMC remains safe from a cyber-attack.

I want to thank Dave and his team for all their hard work in addressing the issues and keeping us on normal operations.

Time To Reflect On Our Outstanding Nurses

This week is National Nurses Week (May 6 – May 12) – the time of the year where we thank our nurses for all that they do. Being a nurse is very taxing work. It is physically demanding and the expectations on them get greater all the time. We expect our nurses to maintain their competency with ever increasing diagnostic and treatment options that get more and more complex by the year. We also expect them to treat everyone with kindness and compassion even in the most challenging situations- like an Emergency Department full of behavioral health patients who can’t get out because there is no place for them to safely go.

GBMC HealthCare nurses meet this challenge daily and I’m always amazed at how they keep coming back. Why?  Because of their dedication to helping others in their time of need.

In honor of Nurses Week, a former patient posted words of gratitude, on her Facebook page (pic right), on how the nurses cared for her during a near death experience. This is just one, of the many patient stories, that reminds me how fortunate we are to have a remarkable and dedicated nursing staff, in the hospital, in our physician practices, in patients’ homes, and in our inpatient hospice units. Please join me in thanking them.

Sunday also marked the beginning of National Hospital Week, the celebration of which dates back to the early 1920s. According to the American Hospital Association, the week is “a celebration of the history, technology and dedicated professionals that make our facilities beacons of confidence and care.” At all hours of the day and night, all year long, our team of parking lot attendants, grounds crew, patient access reps, and billing staff, to transporters, environmental services workers, food service workers, security personnel, social workers, care managers, advanced practitioners, physicians, nurses, therapists, volunteers, and all other non-clinical and administrative employees to serve our community in our mission of health, healing and hope.

So, as we observe National Hospital Week, I want to sincerely thank all the members of our staff, Board of Directors and volunteers and everyone who has helped us improve our care and make our system more reliable to move us closer to our vision: to every patient, every time, we will provide the care that we would want for our own loved ones.

PARTY ON!!!!
Last night, I had the privilege of attending the second annual Art of Nursing celebration. This was a special evening for our nursing staff, as we formally celebrated all that our incredible nurses give to GBMC and our patients. We highlighted the seven winners of the 2017 Art of Nursing Awards. They are:
Diversity in Nursing Award – Anton Panuela, BSN, RN
Clinical Assistant Support Award (Inpatient Award) – Dorothy Alexander, NST
Clinical Assistant Support Award (Outpatient Award) -- Irene Irby, CNA and Shartiya Boykin, Lead MA
Patient-and Family-Centered Care Award – Alexis Schultz, BSN, RN
Nursing Evidence-Based Practice Award – Rosalyn Berkowitz, BSN, RN, FNE-A/P
Mrs. H. Norman Baetjer Jr. Nursing Graduate of the Year Award – Almina Hrbinic, RN
Nurse Clinician of the Year Award – Rachel Ridgely, BSN, RN, CCRN

Congratulations to the winners and all those who were nominated!

I also would like to thank everyone involved in our very successful Art of Nursing celebration, especially our Marketing and Communications team and our Philanthropy team.

America’s Most Amazing Nurse Is In Our Hospital!
Speaking of our great nurses, and one who truly incorporates our vision is Laura Clary, manager of our Sexual Assault Forensic Examination & Domestic Violence Programs. Earlier today, during a very festive occasion in our Yaggy Atrium, Laura was announced, on The Doctors TV Show, as the winner of Prevention magazines nationwide search to find America’s Most Amazing Nurse.

Since November, Prevention magazine and The Doctors have joined efforts in a search across the country to find America’s Most Amazing Nurse. Each entrant or nominee had to have an active RN license or advanced nursing credential and must have been currently working in the nursing field. Laura was nominated by her husband and selected over hundreds of applicants and four other finalists because of her compassion, commitment, and expert care.

Our SAFE program cares for patients across the lifespan, with our oldest patient being 98 and our youngest under one-year-old. We have expanded the program, thanks to Laura, to not only care for adult victims of sexual assault but also victims of child abuse, human trafficking, intimate partner violence and non-fatal strangulation.

Barbara O'Dair, editor-in-chief of Prevention Magzine, said this about Laura: "Her extraordinary work embodies the true spirit of nursing." Laura is truly an example of how powerful nurses really are and how they're strong advocates in addition to being devoted and comforting caregivers.

We hope Laura’s honor inspires people in our community to acknowledge and appreciate the incredible contributions nurses, like Laura and her team, make in our communities every single day.

Congratulations Laura!  This recognition is truly well deserved!

Golfing for a good cause…
On Monday, the sun made an appearance and the weather was just right for the 29th Annual GBMC Golf Classic at the Turf Valley Country Club.  Over 200 golfers teed up to help raise funds for the GBMC HealthCare system.

I had a great time playing with John Maroon, CEO and founder of Maroon PR; Harry S. Johnson, former chair of the GBMC HealthCare Board of Directors, and an attorney with Whiteford, Taylor and Preston and Ronald M. Cherry, Esq, a partner in the law firm of Bonner Kiernan Trebach & Crociata LLP.

It was clear that countless hours were spent preparing for this great day that grossed approximately $200,000 to benefit GBMC. Money from this year’s event will aid various initiatives including the John E. Savage Medical Library which provides the medical staff, patients, visitors, and members of our community the most up-to-date medical information; and the Continuing Medical Education Department which provides programs offering medical education for our attending physicians, nurses, resident physicians and allied health professionals.

A great time was had by all and it was evident that so many community members and supporters of GBMC are truly dedicated to our future success. I’m very grateful to everyone who helped us raise the money and everyone who came out to play. Kudos to the entire golf committee, led by Chairs Rob Stoltz MD and Lisa Goodlett, our Chief Financial Officer and to Jenny Coldiron and the GBMC Foundation staff, and many of our nurse leaders all of whom worked together for a great event!

Health Care Policy is Back in the Forefront

On Wednesday, I had the honor of participating in an internet broadcast, titled “The High Stakes of Health Care Policy,” which was hosted by the Institute for Healthcare Improvement (IHI). The IHI is a leader in health and health care improvement worldwide and over the last 25 years, they’ve partnered with visionaries, leaders, and frontline practitioners to look at ways to improve the health of individuals and populations.

The program was hosted by Madge Kaplan, from the IHI, and I was joined by John E. McDonough, DrPH, MPA, professor of public health practice in the Department of Health Policy & Management at the Harvard T.H. Chan School of Public Health. The interview focused on the newest threat for cutbacks on the protections to people provided by the Affordable Care Act (ACA), whether through legislation or regulation. Yesterday, the House of Representatives passed the American Health Care Act by a vote of 217-212. The future of the health care law still remains unclear as it now moves on to the Senate. The Republican proposal that is being debated would diminish the protection to people with preexisting conditions.

Since the passage of the ACA, our nations’ hospitals, physicians, nurses and the rest of the healthcare team have generated significant improvements in care. Medicare has seen the smallest annual per capita cost increases in its history. Employers, like GBMC, have also seen annual health care cost increases that have been much lower than they were before the federal government started incentivizing the movement from “volume” to “value.” Much of this is a direct result of the ACA and the agency it created: The Centers for Medicare and Medicaid Innovation. Millions of Americans who did not have insurance before passage of the ACA now do and people who have preexisting conditions can now get insurance when before they could not.

No one disagrees that we must improve the part of the ACA that deals with the ability of individuals to purchase health insurance on the exchanges. Not enough healthy individuals are buying insurance, thereby making the premium cost go up for individuals to try to cover the cost of care for people who are already sick.

The President of the American Hospital Association, Rick Pollack released this message yesterday: “America’s hospitals and health systems are deeply disappointed in the House passage of the AHCA because it will jeopardize health coverage for millions of Americans.”

Despite last-minute changes, the proposal eliminates essential protections for older and sicker patients, including those with pre-existing conditions, such as cancer patients and the chronically ill. It does little to help the 24 million Americans who would be left without coverage following repeal and makes deep cuts to Medicaid, which provides essential services for the disabled, poor and elderly people in this country.

As the backbone of our nation’s health safety net, America’s hospitals and health systems — which include more than 270,000 affiliated physicians and 2 million nurses and other caregivers — believe it’s vital that Medicaid is protected.

We urge the Senate to restart and reset the discussion in a manner that provides coverage to those who need it and ensures that the most vulnerable are not left behind.”

So, what will the Senate do? Every major healthcare organization, including the American Medical Association and the American Public Health Association, have come out against the Republican bill.

I am one of those people who believe that health care is a right. In order to guarantee this right, however, those of us in health care positions of authority must drive the system toward the Triple Aim of better health and better care at lower cost, and the ACA has been helping us do this.

I participated in the interview to highlight the GBMC story and how federal incentives and initiatives brought about by the ACA have contributed to our recent success. I am glad to help in this endeavor by discussing our commitment to the transformation of the delivery system to better manage chronic disease and to prevent disease in those who are healthy.  I am hoping many more healthcare leaders join me and help in our fight to maintain health insurance access for all.  If you are interested in listening to the webcast, please click here.

Congrats to Dr. Sternlicht…
Jeffrey P. Sternlicht, MD, FACEP, chairman of our Department of Emergency Medicine, was recently appointed by Governor Larry Hogan’s office as a member of the Maryland Behavioral Health Advisory Council. This council consists of 28 members (or designees) representing state and local government, the Judiciary, and the Legislature along with 13 members, appointed by the DHMH Secretary, representing behavioral health provider and consumer advocacy groups; and 14 representatives that include a diverse range of individuals who are consumers, family members, professionals, and involved community members.

Improving Maryland’s behavioral health system is very important to Dr. Sternlicht and I am sure that he will bring new energy and ideas to the council.  Congrats again Dr. Sternlicht and thank you for your service!

Mark your calendars...
With the Monday, May 8th deadline right around the corner, I wanted to kindly remind you all to do your part and complete our annual Employee Engagement Survey. The survey can easily be accessed through the icon on any GBMC desktop computer (see pic on right).

So far, OVER 60 percent of our colleagues have responded. We need your opinion! The survey is anonymous to GBMC and confidential. We work with a third party vendor, Press Ganey, who compiles survey data for us. We at GBMC never see individual responses.

Please make your voices heard and complete the survey so that we can identify opportunities for further improvement, to judge the value of changes we made since the last survey and to make GBMC an even better place to work and a safer health system for our patients.  Thank You!

Also, don’t forget to be part of the festivities on Friday, May 12th, starting at 8:30 AM at the Yaggy OB Atrium, as we watch and find out if our very own Laura Clary, BSN, RN, FNE-A/P, SANE-A, CFN, CPEN, is named “America’s Most Amazing Nurse” by Prevention magazine on The Doctors TV show. Prevention and The Doctors received thousands of entries from across the country. We’re are really proud to have Laura as one of just five finalists. Click here to RSVP. We’re setting up a screen in the Yaggy OB Atrium so everyone can be part of the fun. Light refreshments will be provided. Regardless of the outcome, I agree with senior vice president of patient care and chief nursing officer (CNO), JoAnn Z. Ioannou,
DNP, MBA, RN, NEA-BC, that we have the most amazing nursing staff in the country!