Wednesday, December 26, 2018

Validation From A Patient

Readers of this blog know that from time to time, I interview a patient to check in on how we are moving towards our vision of being the community-based true system of care that can deliver on our promise “to every patient, every time we will provide the care that we would want for our own loved ones.”

Recently, I interviewed an inpatient, Deborah Copeland, who is acutely ill and has chronic disease. I had the opportunity to get her perspective on how we are doing to care for her on Unit 34. As you watch the video, you will hear Ms. Copeland validating that her nurses and doctors are going above and beyond in providing the care she needs.

What she did mention to me, though not in the video, is that her patient room is too small. This is a major reason why we are planning the construction of a new 3-story tower that will contain a medicine inpatient unit with state-of-the-art rooms, which will allow us to re-do our older medicine units that have very small rooms. This is all part of our master facility plan.

I want to express my gratitude to Ms. Copeland for allowing me to interview her and share the interview with our readers. I also want to thank all the GBMC team, especially the physicians, nurses, technicians, therapists, and the rest of the staff on Unit 34 who were involved in her care. Great job!

Friday, December 21, 2018


This past Tuesday, we hosted an emotional and heartwarming ceremony to announce a generous donation from the Presbyterian Eye, Ear and Throat Charity Hospital Board of Governors that will allow us to expand our Cochlear Implant Center’s services to a larger population of people who need assistance with their hearing loss. 

Our Center is one of the largest community-based programs in the United States and the only community-based program within a one-hundred-mile radius. Led by Dr. Brian A. Kaplan, Chairman of our Department of Otolaryngology, and Dr. Regina Presley, Senior Cochlear Implant Audiologist, our Center does excellent work. This was quite evident when listening to patient stories and watching videos of patients being able to hear sounds that they couldn’t hear before their procedure. Since 2002, the Cochlear Implant Center has helped 900 patients with their hearing loss and has brought the world of sound to more than 500 individuals through cochlear implantation.

The financial support from the Presbyterian Eye, Ear and Throat Charity Hospital will allow us to significantly improve the care to patients and to provide a unique setting for their evaluation, diagnosis, and treatment. The Center, under the new name, The Presbyterian Board of Governors Cochlear Implant Center of Excellence at GBMC, will also provide enhanced treatment options for all patients, from infants to seniors, diagnosed with moderate to profound sensorineural hearing loss, with the highest quality of clinical care, cutting-edge technology and research, and increased staff resources.

We are so grateful for this generous gift and for partners like the Presbyterian Eye, Ear and Throat Charity Hospital Board. Their financial support will help us to make our fabulous program even better.

For those of you who attended this year’s annual Employee Holiday Meal, I hope you enjoyed the good food and festivities. This is a GBMC HealthCare system tradition that brings us together. Music filled the air as the members of the GBMC Holiday Choir put on a wonderful lunch-time concert. Thanks to all who did their part to make this year’s event a success!

On behalf of the organization, I want to extend best wishes for a safe, healthy, and happy holiday season for those celebrating Christmas or Kwanzaa. 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 can’t be at home during the holiday season. I am so lucky to be associated with so many wonderful caregivers. In this season of giving, my colleagues give a lot and we are grateful. Merry Christmas and Happy Holidays to all!

Monday, December 17, 2018

Helping Patients with a Rare Disease

On Friday, December 7, we announced the naming of a new center that will help patients with Alstrom Syndrome (AS). A rare disorder caused by a genetic mutation, AS has devastating effects including blindness, deafness, and ultimately multi-organ system failure, and premature death.

The Jan D. Marshall Center of Excellence at GBMC is the first center in the nation to focus on AS. It was created thanks to a gift from Alstrom Syndrome International, whose mission is to help those afflicted and to search for a cure for the disease. Clair Francomano, M.D., Geneticist and Director of Adult Genetics at the Harvey Institute for Human Genetics, was close friends with the late Jan D. Marshall, co-founder, long-time board member, and the first Chair of the Scientific Advisory Board of ASI, who imagined a better life for children battling AS.

Since 2015, GBMC has been the home of a semi-annual multidisciplinary clinic for AS. Children come from around the world with their families to seek treatment, learn about the disease, and meet others who are living through it. Our partnership with ASI has not only provided comprehensive clinical care for patients, but also professional education for physicians and research regarding the causes of this debilitating disorder. The Jan D. Marshall Center of Excellence will continue to focus on helping those affected and search for a cure for Alstrom Syndrome.

Please join me in celebrating the founding of the center and in congratulating Dr. Francomano for being named the new Chair of ASI’s Scientific Advisory Board.

Nurse Residency Program Recognized by the American Nurses Credentialing Center

GBMC HealthCare is proud to announce that our nurse residency transition to practice program is now accredited with distinction by the American Nurses Credentialing Center (ANCC). This is the highest level of recognition awarded worldwide for programs that demonstrate excellence in continuing nursing education. GBMC is the only hospital in Baltimore to receive this accreditation, the first in our Maryland state nurse residency collaborative, and only the 61st to earn it globally.

I would like to recognize JoAnn Ioannou, DNP, MBA, RN, NEA-BC, Senior Vice President of Patient Care Services, Chief Nursing Officer and the following members of her team for their continued dedication and for earning this recognition: Lynn-Marie Bullock, DNP, RN, NEA-BC, Director of Professional Practice; Jennifer Spahn, MSN, RN, NEA-BC, Clinical Program Manager-Nurse Residency, Theresa Di Seta, MSN, RN, Education Specialist-Nurse Residency, Roxann Hurkamp, BSN, RN, CCRN, Education Specialist-Nurse Residency; and Lauren Raynor, MS, RN, Education Specialist- Nurse Residency.

Friday, December 7, 2018

An Outstanding Colleague Leaves Private Practice and Joins GBMC HealthPartners

Earlier this week, I spoke with our new GBMC colleagues at employee orientation. I gave the opening welcome and talked about the parts of our organization and how they fit together as a community-based system of care. I explained our mission and our values, and how we are owned by the community. I explained to our new people that the Board of Directors are the members of the community who oversee me and the rest of our team in the fulfillment of our mission of health, healing, and hope. I told our new colleagues how the Board held a visioning retreat in late 2010 that created our plan and that we have been implementing this strategic plan ever since. We are now a system that is designed to provide the care that we want for our own loved ones as defined by: the best health outcome and the best care experience, with the least waste of resources and the most joy for those providing the care. I did this because it is important for our new people to be enrolled in this vision as they are beginning their careers with us.

Among the people that I welcomed at orientation was someone who is not a new colleague. He has been with our system for quite some time, but he is moving from the private practice of medicine to employment with GBMC Health Partners. He is Jon E. Simon, MD, a double board-certified physician in Pediatrics and Internal Medicine. He attended medical school at the University of Maryland and completed his residency training at the University of North Carolina Hospitals in Chapel Hill, NC. He has been practicing primary care in Baltimore since 1998 and will now be joining our advanced primary care practice at Hunt Manor.

Given Dr. Simon’s transition from private practice to an employed Health Partners physician, I thought it would be a good idea to get his thoughts on the transition, the joys, and challenges of private or employed practice and to learn why he chose employment with GBMC.

Q:  Prior to joining GBMC Health Partners, you owned your practice. What factors led you to switch to employed practice? Are other physicians faced with the same issues and how would you counsel them to proceed?
A:  "For years, I have enjoyed my solo private practice, which included seeing patients of all ages, as well as going to the hospital to see newborns and hospitalized adults. I read about so many of my primary care colleagues around the country experiencing burnout, and while I have never felt that in my career, I expect that many changes in healthcare in the next 5-10 years would add excessively to my administrative burden; I was looking for a way to help manage the administrative aspects of practice."
Q:  There are positives and negatives associated with being an employed physician and with being in private practice. Can you briefly describe the advantages, disadvantages, and similarities that you see in these roles?
A:  "The advantage of a private solo practice was in allowing me to have total control over my schedule, my employee wages, my office setting, etc. If I know that a certain patient needs an hour of my time, I can make that happen. If an unexpected number of patients need same day appointments, I can make that happen. I place a high value on making sure the patients have a good experience (are seen on time, don't feel rushed, get their phone calls returned, get same-day appointments, etc.). As an employed physician, I will need to rely on other people to make all those things happen. At the end of the day, being a primary care pediatrician/internist is about the experience of taking care of patients, regardless of the practice setting. The professional satisfaction comes from that experience in the exam room with the patient."

Q:  You’ve just described some of the advantages and disadvantages to employment versus private practice. I’m guessing that ultimately, it's up to the individual physician to decide what they want most. What did you want most and why did you decide to move to employed practice? Moreover, why did you choose GBMC Health Partners?
A:  "As a solo pediatrician/internist, I was the only doctor in the office. However, I was also responsible for administering all the immunizations, doing EKG's and spirometry, as well as managing the payroll, accounts payable, laundry, maintenance and repair, and IT support. Those secondary roles have been very gratifying, but that gratification can't last forever! In choosing to return to an employed group practice, I was looking for a way to keep the joyful parts of patient care and to lessen the burden of those secondary roles. I also am looking forward to having my patients benefit from the team-based approach of GBMC Health Partners. I have been on staff at GBMC for 18 years, and I trust the organization and respect the leadership. GBMC was not always skilled at running outpatient practices, but they have improved a great deal, and have committed to and invested resources in primary care practices especially."

Q:  The switch from private practice to a salaried position can be a complex decision. There were various factors that you had to consider. Are your colleagues in private practice dealing with the same issues? How might you advise them if they are considering making a similar transition to employed practice?
A:  "I can't really address what colleagues are going through, though I suspect that there are very few out there still in private (especially solo practice). For many years, I have noticed that there are few if any physicians younger than myself going into private practice. I am 51 and was still the youngest one I know of."

Q:  Whether a physician chooses to be employed or in private practice, what are a few tips you’d share on how to thrive in either work environment?
A:  "It is very easy to let the administrative hassles of your job get to you. There is a high degree of physician burnout in primary care, but it doesn't have to be that way. We should all recall that every day we come to work, we will make a difference in somebody's life. For me, whether it is seeing a newborn in the hospital, or helping patients in the office with complex or even simple problems, the patients are grateful to have a physician on whom they can rely. Keeping this basic fact in mind will help us all thrive as physicians, regardless of the practice setting.

Q:  What are you looking forward to the most in working for GBMC Health Partners and what will you miss the most in not working in private practice?
A:  "I will miss the intimate setting of my small office, the very personal, welcoming venue that allows me to be very close to my patients and close to the business as well. Though it sounds a bit crazy to hear myself say it, at times I enjoy answering the phones, making appointments, and running patient payments through the credit card machine. Having been in solo practice for the last 16 years, I wouldn't exactly say that it was lonely, but I can say that I am really looking forward to working with other physicians at Hunt Manor! There are a few physicians whom I already know and have great respect for, and there are others whom I do not know but am looking forward to getting to know."

I am so grateful to Dr. Simon for his willingness to give us his insights. Please join me in welcoming him in his new role! We are delighted that he is a teammate in our system of care.

Friday, November 30, 2018

Physician Offices and the No-Show Rate

This week, I had the pleasure of going on the GBMC Health Partners Lean Daily Management walk. I, along with members of my team, visited our Neurology Center, Ophthalmology, and Bariatric Surgery practices. I was so excited to see the incredible level of engagement of the staff in each practice. They are doing phenomenal improvement work to move us faster towards our vision!

In the Neurology Center, Kristen Stamathis, the Senior Practice Manager, presented a least waste metric. The team was working to better understand the causes of patients not coming for their appointment and how to reduce this “no-show” rate. Dr. Michael Sellman, the Medical Director, and Kristen know that the time neurologists spend with their patients is an incredibly valuable resource. With the aging of the population, there is an ever-increasing need for neurology consultations and there are very few neurologists in our community.

Literature suggests that the patient no-show rate goes up exponentially for appointments made more than 18 days before the date of their visit. People are more likely to forget about the appointment or have their needs met in some other way the more distant the scheduling date is from the appointment date. I pointed out that many restaurants will not allow you to make a reservation more than 30 days in advance because of this fact.

So, what should the team do to make sure appointments are not wasted? I told the group that my dentist texts me the day before the appointment and asks me to respond “Y” for yes if I can keep my appointment or “N” for no if I can’t. If I reply “no” or don’t reply at all, they give my appointment to another patient. For many restaurants that use OpenTable, I now get a prompt the day before asking me to confirm my reservation. We also discussed the commercial airline system where they calculate the average no-show rate and overbook the seats. They know that sometimes everyone will show up and then they must pay some passengers to fly later (Kristen and Dr. Sellman didn’t like the idea of paying some patients to come back another day…okay, I was only kidding) but by doing this, the airlines ensure that they won’t take off with empty seats from no-shows.

Of course, no reminder system is foolproof, but I was very proud of the team for the rigor of their study of the problem and their willingness to test new ideas.   

A huge “Thank You” to our Elder Medical Care team!!!
Last week, our Elder Medical Care (EMC) Home Services Team provided Thanksgiving dinner to families in need. Last year, we helped 10 families enjoy their Thanksgiving Day holiday, but this year, the need was greater than ever, and our program rose to the occasion.

Thanks to the efforts of our EMC Home Services Team and the Notre Dame University of Maryland pharmacy students, 15 turkeys and more than $400 in cash and gift cards helped to provide a very nice Thanksgiving Day meal to two small assisted living facilities (ALF) -- the donation to Agape ALF was made in honor of Kathy Ruane -- and 15 families. The Thanksgiving dinners consisted of turkeys or rotisserie chickens, side dishes, bread, and dessert. Some of our families, who are not able to cook due to safety concerns, received ready to eat or microwavable meals. Providing families with a Thanksgiving meal who would otherwise not have had one is an all-hands-on-deck effort lead by the providers of the EMC Home Services Team.

A big thank you to Laurie Whelden, Yolanda Greene, Jessica Trizna, Asma Hussaini, and Dr. Freedman for helping with the deliveries, to Thelma Winn for picking up our donations from the Assistance Center of Towson Churches, Kathy Roberts for delivering frozen and fresh poultry around Baltimore County, and to the EMC/Advanced Care Management employees who donated their frozen turkeys and canned goods/money. We could not have done this without all of you and I am truly thankful for your kindness and generosity!

Tuesday, November 20, 2018

Thankful for You!

This Thursday is Thanksgiving Day. I would like to wish a Happy Thanksgiving to my GBMC colleagues. 

Thanksgiving is a time to reflect on all that we have. I am very fortunate to have a wonderful wife and children, and wonderful friends and family members.

The GBMC family has a lot to be thankful for as well. We have a beautiful campus, great doctors, nurses, allied health professionals, and support staff working in the hospital, at GBMC Health Partners, and at Gilchrist. We are so lucky to have our fabulous volunteer auxiliary and tremendous community support. Members of the community serve on our GBMC HealthCare Board, the Philanthropy Committee, and the Gilchrist Board. Our governance bodies are made up of individuals who are dedicated to the mission of GBMC – a mission of health, healing, and hope for our community.

I am grateful for everyone who helps us care for our patients and I am grateful for the patients themselves, who entrust their care to us.

I also want to extend a special “thank you!” to all who will work on Thanksgiving, or who are working during the extended holiday weekend.

Again, wishing you all a joyful Thanksgiving!

P.S. What are you thankful for during this time? I’d love to hear about it – please leave me a comment!

Friday, November 16, 2018

We Earned An "A"

Last week, we got a report card of sorts and I am happy to report that we received an “A” grade! We achieved this high mark in The Leapfrog Group’s Hospital Safety Grades for fall 2018, which rates how well hospitals protect patients from errors, injuries, and infections. The survey assessed more than 2,500 hospitals across the nation, including 40 in Maryland. GBMC was one of only five hospitals in the Baltimore region and one of eight in the state to get an “A”! To see the grades, click here.

The Leapfrog Group, which launched its first hospital survey in 2001, began when a group of business leaders wanted to accelerate the improvement of hospital safety and worked with the Business Roundtable to review the evidence. If you would like to learn more about the survey, click here. The hospitals were given a letter grade from “A” through “F” based on several factors, including medical errors, accidents, injuries, and infections. The goal of the rankings is to determine a patient's risk of further injury or infection if they visit a particular hospital.

We should all be proud of this accomplishment. It is a measure of how well we are doing on our first Aim: the best health outcomes. We cannot be delivering the care we want for our own loved ones if patients are not safe from harm under our care. This “A” grade is another piece of evidence showing that we are moving towards our vision. We still have work to do but we have made great strides towards zero harm! I want to thank our entire team for all that you have done to move us to this point. I also want to thank Laura Hines, RN, SCNR, Director of Clinical Quality Outcomes and Carolyn Candiello, our Vice President for Quality and Patient Safety for their tremendous work in culling the data for the survey. Great work!

We are so fortunate to have Gilchrist in our system of care!

November is National Hospice and Palliative Care Month and I think It’s an appropriate time to recognize the Gilchrist team, led by Cathy Hamel and Dr. Tony Riley, who have designed an exceptional system of elder care and pediatric end-of-life care. Gilchrist has outstanding programs to keep elders well and to serve them as they develop illness and progress through to end of life. Our geriatricians assess patients in consultation, serve as medical directors in over 30 extended care facilities, manage the Gilchrist Rehabilitation Unit at GBMC, work with advanced practitioners to deliver in-home primary care, handle symptom management and palliative care for patients with terminal disease, and of course, they work with the fabulous Gilchrist nurses to deliver end-of-life care through Gilchrist Hospice. The work continues with families after the death of their loved one with bereavement support and counseling.

Recently, Gilchrist launched a new Integrative Medicine program that’s available to patients receiving treatment at our Sandra & Malcolm Berman Cancer Institute. Leading the initiative is the program director, Delia Chiaramonte, MD. In the program, cancer patients receive evidence-based interventions to alleviate the symptoms and the stress of cancer to improve their quality of life. Integrative treatment planning covers symptoms such as sleep problems, anxiety, depression, pain, nausea, and fatigue. Thank you, Gilchrist and welcome, Dr. Chiaramonte!

Last month, I had the pleasure of attending Gilchrist’s Taste of Howard County. This year’s theme was Merriment in Masquerade and the event featured food from more than 20 of Howard County’s premier caterers and restaurateurs. It also included more than one hundred bid items as well as a cash raffle. Over $200,000 was raised and all proceeds from the event will support Gilchrist Center Howard County, the only inpatient hospice in the county.

Over the last 24 years, Gilchrist has done so much to help so many people. We are so grateful for all that the Gilchrist team does every day.

Don’t Forget to Get Your Flu Shot!!

Immunization against influenza is the best way to prevent this illness. GBMC employees and volunteers are required to be immunized (those few who are not required to be immunized are required to wear masks during the flu season) to protect ourselves and our patients.
Currently, approximately 82% of GBMC employees and staff have gotten their flu shot. Our next FLU VACCINE EVENT is this Friday, Nov. 16, in the ED concourse, from 7AM - 7PM; or, you can receive your vaccine in Employee Health any Mon-Fri, from 7AM - 4PM. Thank you for getting your immunization.

Celebrating Nurse Practitioner Week

Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NPs) 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. They help us reach our vision of a patient-centered system of care every day. Please join me in thanking them this week!

Baltimore Magazine Excellence in Nursing

It's that time again - Baltimore magazine is collecting nominations for its Excellence in Nursing issue. Please vote for the colleagues you most respect! The survey, which ends on November 30, may be found here.

Thanking Our Veterans on Veterans Day and Every Day

On Sunday, we commemorated Veterans Day and took the time to remember and pay tribute to the brave men and women of the U.S. armed forces who have served in the past and those who are serving today. My sincere gratitude to all members of the U.S. armed forces and their families who make sacrifices to preserve our freedom.

Friday, November 9, 2018

A GBMC Giant is Retiring

This week, we began celebrating the outstanding career of Bennett J. (Ben) Beres. Ben joined GBMC HealthCare in February 2012 as Chief Operating Officer for Greater Baltimore Medical Associates (GBMA). He has made a huge difference in the functioning of our physician company in the almost seven years that he has been with us.

Ben and I previously worked together at Boston Medical Center. So, when we were looking for a new operational leader for GBMA in late 2011, I called him. I remember being ecstatic when Ben agreed to interview for the position.

I called Ben because I knew that he was a phenomenal physician practice manager and leader. He always started from the perspective of the patient, but he also looked out for those providing the care. It was important to him that physician leaders worked in partnership with practice managers. Ben was just the right person to oversee the implementation of our patient-centered medical homes. He completely embraced our vision of becoming an accountable system of care that the patient would experience as a whole. He championed extended office hours to include evenings and weekends and he led our work for better office throughput. Ben sent Sarah Whiteford, MD, and Ben Hand, MD, to the Virginia Mason Institute in Seattle to learn office flow science. They returned to work with our architects to design our Family Care Associates office in the Kahlert Pavilion. A hallmark of this office is that there is no patient waiting room. Patients go from the greeter station directly to the exam room. 

Ben first partnered with GBMA Medical Director Dr. Mark Lamos and then with Dr. Harold Tucker, with whom he constructed the rebranding and relaunching as GBMC Health Partners. Ben has also done excellent work with our specialty practices. 

In addition to being an incredible manager and leader, Ben is also an incredible human being. He is dedicated, hard-working, and always focused on making things better. Perhaps Ben will be best remembered for being the consummate friend. I have never seen anyone make as many friends and make them so easily as Ben. I believe that this occurs because he treats everyone with respect.

Ben has lived apart from his dear wife, Ellen, as she has continued her career as an internist at Dartmouth. They have each spent a lot of time traveling between Manchester, New Hampshire, and BWI and we, the GBMC family, have benefited from their sacrifices.

GBMC has been so fortunate to have Ben as a friend and colleague, as have I. We will miss him dearly, but we wish him the best in his well-earned retirement!

We will never forget Ben or his dedication to patients and his work at empowering physicians to lead. Therefore, we have decided to name the library at Family Care Associates, the Ben Beres Library. Please join me in thanking Ben for all that he has done for GBMC and our patients. 

Thanking our Medical Staff Services Team
Each year, during the first week of November, we recognize the important role that our medical services professionals play in our healthcare system. During National Medical Staff Services Awareness Week, we thank all our staff who work behind the scenes to ensure our providers are properly credentialed, licensed, and trained in their respective specialties. Often called the “gatekeepers of patient safety,” the work our exceptional medical staff professionals do contributes to our system’s high safety and quality standards. We thank you for your efforts and dedication this week, and every week of the year.

I’d also like to celebrate the NICU’s recent recognition from the Maryland Patient Safety Council (MPSC), which awarded the GBMC NICU with a banner of excellence in the care of infants with Neonatal Abstinence Syndrome. This accomplishment is the culmination of two years of implementing best practices and compassionate care to our most vulnerable patients. As you can imagine, caring for newborns experiencing drug withdrawal because of in-utero exposure requires ongoing diligence and expert care. It’s an emotional and often difficult job seeing these infants through withdrawal while also helping to educate and support the mothers and families. I am extremely proud of the work being accomplished by our neonatal team.

Finally, GBMC will be kicking off the season of giving by participating in #GivingTuesday. Giving Tuesday is celebrated each year on the Tuesday following Thanksgiving (this year it’s November 27th) and will benefit GBMC’s Child Life Program. Supporting our #GivingTuesday campaign means you’ll help provide toys, games, and other tools our Child Life specialists use to help ease the stress our pediatric patients often experience during their hospital stay. There are two ways to give this season – through the CrowdRise page and by gifting a donation through the Amazon Wish List. It’s amazing to watch our Child Life specialists help our young patients cope with the anxiety brought on by hospitalization, and I know they will appreciate the support.

Friday, November 2, 2018

Working Smarter, Not Harder

Our hospital is a very complex system. What happens in one area of the hospital can have a major effect in what happens in another unit or department. Because of this complexity, it is difficult to maximize our efficiency such that no one is waiting to move to the appropriate place.

I have written in this blog before that we are students of flow. We are designing our systems and matching the demand for services with the supply of caregivers throughout our organization. When we design our systems, hold ourselves accountable to the design, and match capacity to demand, our patients move one at a time in beautiful choreography. This is called single patient flow. On the other hand, when we have no design or don’t follow our designs and rely on hard work alone, we frequently have patients stuck in a bottleneck.

Humans can overcome bottlenecks by working around them or exerting more pressure or influence to get through them. This is known as expediting. An example of expediting is when we take someone away from their usual work to complete a task that the people who normally do it cannot accomplish. An example would be having a housekeeping manager race to clean a room because many dirty rooms have been called in for cleaning at once in the early evening. Rather than fixing the root cause of the problem, in this case the batching of discharges, we send someone to work around the problem in the moment to get the patients what they need. We have improved patient flow, but we will need to fix it again the next day because the batching of discharges has not been fixed. Smart leaders will learn the cause of the bottleneck, redesign the system, and not become complacent with the short-term success of expediting.

We know about the Hawthorne Effect as well, that when a problem gets focused on, it usually gets better without anyone redesigning anything. This is generally because the people involved, knowing that their work is being studied, work harder and faster to overcome the poorly designed process. This is the reason why we are so focused on getting the work redesigned first before we celebrate what looks like an improvement. If the gains are due only to shining the light on the problem, we lose the gains as soon as the light is turned off.

Our flow team and our Emergency Department leaders have been spending time studying and redesigning our processes to move admitted patients out of the Emergency Department to an inpatient bed as soon as possible after the decision to admit has been made. This system is very complex, and it has many sub-systems. The ED physician must enter the admitting order, a bed must be identified as empty on the appropriate unit, and then it must be cleaned. The ED nurse must communicate with the receiving nurse, as does the ED physician with the receiving physician. Transport must be notified and arrive to move the patient.

The number of patients waiting in the Emergency Department to be moved to an inpatient bed at 7 p.m. is a metric on the Executive Lean Daily Management Board. Every morning, we review this metric to learn the reasons that patients are waiting. Much progress has been made through system redesign and I am so proud of all involved. And while we still have processes in need of further improvement, we are working smarter rather than harder. Take a look below at the results of their hard work.

Patient Engagement Question — Wait Time in ED Before Admitted (Quarterly)

Friday, October 26, 2018

TOP DOCS 2018….

GBMC has always been known for having outstanding physicians. This was again confirmed when more than 130 of them, in 81 specialties, were named in Baltimore magazine's “Top Doctors” list for 2018.

For more than 30 years, the magazine has annually recognized the excellence of the region’s physicians. Being recognized as a “Top Doctor” is an extraordinary honor, because it is awarded by their peers. In preparing its annual list of “Top Doctors,” Baltimore magazine surveyed 13,000 area physicians in Baltimore City and seven surrounding counties and asked to whom they would send a member of their family for care in a wide variety of specialties. This question mirrors GBMC’s vision phrase of providing each patient with the care we would want for our own loved ones. The annual Top Doctors recognition isn't, therefore, another popularity contest – the list is chosen by people who really know about the quality of care being delivered.

This year, the magazine also highlighted, Dr. Jose E. Dominguez, our director of pediatric anesthesiology. He was one of six physicians, from a pool of over 700 in the Baltimore area, selected to be profiled.

We are so fortunate to have such a talented and dedicated medical staff. Congratulations to Dr. Dominguez as well as the others who were named 2018 Top Docs.

To learn more about our “Top Doctors,” please visit GBMC's Top Doctors 2018 webpage.

Another Well-Deserved Award
Congratulations to members of our Child Protection Program and our Sexual Assault Forensic Examination (SAFE) and Domestic Violence teams, who were recently awarded a Victims of Crime Assistance (VOCA) grant for more than $243,000 from The Governor's Office of Crime Control and Prevention (GOCCP). The award will help offset the cost of these programs as we grow our capabilities in child protection after the elimination of the pediatric emergency department and inpatient pediatrics at Franklin Square Medical Center earlier this year. Please join me in thanking these colleagues for their hard work and dedication to the protection of children and adult victims of sexual assault and domestic violence.

Our Sympathies...
I want to express our collective condolences to Dr. Gary Cohen, former medical director of the Sandra & Malcolm Berman Cancer Institute, and his family on the passing of his beloved wife, Charlene. Charlene was always an advocate for our healthcare system. Many of you will remember that Charlene was the chair of GBMC’s 30th Anniversary celebration, which raised over $140,000 for the Gilchrist Center for Hospice Care in 1995. She also is the artist behind the many paintings hanging on the walls of the Women’s and Outpatient Surgery Center, Oncology Support Services, and other areas within our hospital.

Let’s thank…
I want to acknowledge the hard work and dedication of both our chaplains and medical assistants as we celebrate Pastoral/Spiritual Care Week (Oct. 21—27) and Medical Assistants Recognition Week (Oct. 22-28).

Medical assistants are incredibly versatile and are trained to perform clinical, laboratory, and administrative duties. They are truly vital members of our healthcare delivery team who help move us closer to our vision every day.

I want to thank Chaplain J. Joseph Hart and all members of our Spiritual Support team for their hard work and dedication to meet the spiritual needs of our patients. No matter the faith, our Spiritual Support team is always there to provide compassion and comfort to families as their loved ones face a serious illness or life-threatening injury. To learn more about our Spiritual Support Services, please go to their web page. Also, check out a recent “Day in The Life” segment, produced by our media partner ABC2 News, which focuses on Reverend Hart and his team by clicking here.

Thursday, October 18, 2018

Partnering with our Community to Meet Needs Beyond Healthcare

We have built a community-based system of healthcare that we can be proud of, but we know that healthcare can only do so much to generate health. The GBMC HealthCare System must also become more involved with the social determinants of health: safe housing, food and clothing, education, and jobs. I would like to review some of our involvement with community partners to improve health beyond healthcare.

Since 2016, our Community Benefits Committee has been led by Cathy Hamel, Vice President of Continuing Care at GBMC HealthCare and President of Gilchrist, and Carolyn Candiello, our Vice President for Quality and Patient Safety. The committee recently updated our Community Health Needs Assessment (CHNA) and as a result, they’ve chosen three priority areas: Behavioral Health/Substance Use, Access to Care, and Obesity. The group studied the existing resources in the community for these priority areas, identified gaps, and created ideas for improvement. Their next meeting is before the end of this month and I look forward to hearing about our next steps. Stay tuned!

This year, GBMC teamed up again with ABC2 News to collect hundreds of needed items for the Fill the House initiative supporting the House of Ruth. Thank you to all who donated items for this year’s drive and to all who helped with the campaign.

We have partnered and will continue to partner with other community agencies as well. You may recall that a couple of years ago we collected thousands of pounds of non-perishable food items and delivered them to the Bea Gaddy Family Center and to the Assistance Center of Towson Churches (ACTC), a consortium of 50 churches that provides support to disadvantaged families in our community.  We also conducted a book drive for new and/or gently used books for the Reading Partners “Take Reading Home” program, whose main goal is to help provide support to children from kindergarten through fourth grade.

I am very proud of our involvement in the community and I know we can continue to do more!

Healthcare Security and Safety Week

I want to thank all the members of our GBMC security staff as this week is Healthcare Safety and Security Week (Oct. 14 — 20).

The GBMC security team can be seen walking or stationed throughout our medical center and at Gilchrist. The officers work 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 to keeping us safe.

International Infection Prevention Week

This week is also International Infection Prevention Week and it’s a time to highlight the importance of infection prevention and raise awareness of everyone’s role in protecting the public from healthcare-acquired infections.

Our Infection Prevention team members are all registered nurses with additional qualifications in Infection Prevention and Control, immunization, and HIV and Hepatitis Testing. They oversee our cleanliness, our use of antibiotics, and our use of protective equipment.

Under the guidance of our infection preventionists, here are a few of our accomplishments in FY18: reduced catheter-associated urinary tract infections to 4; reduced central line-associated bloodstream infections to 3; and improved hand hygiene compliance to 91%.

Please join me in thanking our Infection Prevention Department on a job well done!

Tuesday, October 16, 2018

52 Clicks

During this past Friday’s Lean Daily Management rounds, I learned that a nurse doing a complete neurological check on a patient after spine surgery had to click 52 times in the electronic health record to document his or her assessment. I was stunned by this assertion. I have been very concerned about creating unnecessary work for our nurses who already work so hard. This example made me concerned that in our zeal to get to high reliability (what should happen happens and what should never happen doesn’t) by creating standard work, perhaps we had created a system that is not sustainable.

Checking on the neurological status of a patient who has just had spine surgery is very important to make sure that we do not miss a serious problem in the making. Documenting our check is important to our colleagues, in this instance especially the operating surgeon, can see the result of our neurological exam. But does it have to be so hard?

Before the reader races to blame the electronic record let me point out that the paper world left room for error as well. With a blank piece of paper, it was easy for the clinician to write Neuro: WNL, meaning the entire neurological exam was normal. This would always raise the question of whether an entire exam was done. We also had the problem of illegibility with some handwriting.

This is an instance where we healthcare leaders need to avoid the “either, or” trap. Either the documentation will be complete, or it will be efficient. We need “both, and” solutions that will allow for documentation that is both complete and efficient. Wouldn’t it be nice if as the nurse was doing the exam the documentation just happened? How about voice recognition software that would allow the nurse to speak the results of the exam as it was being done?

I am sure that we can come up with a system that would be better than the 52 clicks. Do you have an idea? Please share it.

Tuesday, October 9, 2018

A New Dynamic Dyad

The GBMC HealthCare System gets better every day at delivering on our four aims and the areas where we make the most improvement are where we have our best leaders. I have been teaching our leadership model in GBMC University classes a lot recently.

During our last GBMC HealthPartners meeting, Shannon Littleton, the Joppa Road Patient-Centered Medical Home Practice Manager, and Dr. James Baronas, the Physician Lead, presented some of their most recent results in patient engagement scores. This dynamic duo took over the leadership of the practice in the summer of 2017. Since then, they have reviewed the GBMC mission, vision, and values with their team and shared performance data. They redesigned their work to improve scheduling, the use of MyChart, phone answering, and office flow. At every step, they thanked their people and encouraged them to make further improvements.  Their results are remarkable!

We are so fortunate to have smart, caring, young leaders in our organization. Thank you, Shannon and James!

This year, during Domestic Violence Awareness Month, we are teaming up with WMAR 2 News (ABC – Baltimore) as a proud sponsor of the Fill the House for House of Ruth initiative to collect everyday necessities for this partner in care.

House of Ruth provides services to nearly 9,000 women annually who are victims of intimate partner violence (IPV). The work that the House of Ruth performs is closely aligned with our work in the community. Our Domestic Violence (DV) Program has provided services to more than 800 individuals such as support, education, safety planning, referral to community resources and follow-up.

Various drop-off boxes (see picture) have been set up throughout the GBMC campus including the GBMC Pediatric Group, Human Resources, Oncology Support Services, Spiritual Support Services, Volunteer Services, and Family Care Associates. They are also at each of our 10 off-site primary care locations along with Active Life & Sports in Nottingham and Karma Consignment Group in Timonium. Another way to donate is through our Amazon Wishlist. All items purchased through this link will be shipped directly to the GBMC Marketing department, so you don’t have to worry about dropping anything off.

Some of the House of Ruth's greatest needs include diapers, women's and children's undergarments, pillows, twin-sized sheets, comforters, and blankets along with personal care products — deodorant, shampoo, conditioner, bar soap, etc...The drive will run through Monday, October 15 and all items must be new and unopened.

Again, your donations meet the basic needs of victims — things we often take for granted — so please help the House of Ruth and victims of IPV.

Fun in The Sun for A Great Cause
The 18th annual Legacy Chase at Shawan Downs was a huge success! Approximately 8,000 attendees came together for great weather, beautiful horses, and time spent with family and friends. The more than $200,000 raised will go toward oncology services at the Sandra & Malcolm Berman Cancer Institute.

Hats, Horses, and Hope was the theme again this year to celebrate cancer survivors. Many of the annual crowd-pleasing traditions continued— such as the G. Leslie Grimes Memorial Stick Pony Race for kids — and GBMC added some exciting new components to help make the event a success. Brand new this year, was the Archway of Hope, which allowed volunteers and friends of our Cancer Institute to decorate and personalize wide-brimmed hats, which they placed on the arch. Each of the hats create a sense of comfort and strength for cancer patients and their families. Children also came dressed as their favorite superhero to show their support for the fight, while some guests boasted their best hat to show support for oncology patients.

Legacy Chase gives us an opportunity to engage with the community, employees, donors, and local businesses in the work of our healthcare system. We are proud to receive tremendous support from the community-at-large and our family here at home. 

I also want to thank the more than 150 volunteers who helped make this such a great event.

Tuesday, October 2, 2018

A Visit to a Team That is Doing Great Things

The opioid epidemic is getting a lot of press lately. We healthcare providers realize the role that we have played in causing the epidemic with our liberal use of narcotics for pain management. We are now acting to reduce this use and we are making great strides. Unfortunately, it will take a long time to reduce the number of those who have become addicted.

A few months ago, Dr. Andrey Ostrovsky, a pediatrician and the Chief Executive Officer of Concerted Care, LLC, an organization that treats addiction, came to visit GBMC with several of the members of his leadership team. They went on our Lean Daily Management walk with us and we spent some time learning from each other about care improvement. 

Last week, several of us from GBMC went to see the Concerted Care operation in Baltimore City on 25th Street. We were extremely impressed with the system of care that they have created for hundreds of addicted Baltimoreans. They prescribe and distribute methadone and they provide individual and group counseling for their patients. Dr. Ostrovsky also showed us some houses that they rented to provide living quarters for some who were also homeless.

We spent time with them in a team-building exercise called “The Marshmallow Game,” which is designed to create innovative thinking. As much as Concerted Care is doing, they believe that they could do even better, but it will require new ways of doing their work.

I left Concerted Care reflecting on how fortunate we are in Baltimore to have such dedicated people to care for those with tremendous medical and social needs. Rather than lament the difficulty of their work, they had found the energy to continually improve. We salute Dr. Ostrovsky and his team for all that they are doing to help our community!

Friday, September 21, 2018

Going LIVE…

Back in July, I discussed how our healthcare system has been growing its presence on social media channels like Twitter, Instagram, LinkedIn, and Facebook (more on this below). Social media has been a great way to promote subjects and specialties that don’t often receive coverage on local and regional broadcast news or print. For more on our social media strategy and how it encourages two-way communication between our workforce and customers, click here.

Last week, I was part of our monthly Facebook LIVE program, “To Your Health,” which allowed me to connect with a studio audience and Facebook viewers to talk about patient safety. If our patients are not safe when receiving our care, we will not achieve the care we want for our own loved ones because they will not have a good health outcome. To watch the interview, please click on the icon below.

I am very proud of the GBMC HealthCare System because we stay focused on our vision, but I am frequently asked: “How can we do a better job of getting the word out about our vision and how we are different?” The use of social media like Facebook LIVE is one way. Can you suggest others?

Be A Part of Our Celebration...

On Saturday, September 29, we will have our 18th annual Legacy Chase steeplechase event at Shawan Downs in Hunt Valley. This year’s race will again benefit GBMC’s Oncology Services at the Sandra & Malcolm Berman Cancer Institute.

Legacy Chase has become a signature event for GBMC HealthCare, combining the excitement of steeplechase racing 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. 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.

The Sandra & Malcolm Berman Cancer 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 care for oncology patients. We coordinate care across the continuum for more than 2,000 new cancer patients annually!

Make this year’s event a family affair and come and enjoy a day in the country. For more information visit I hope to see you there!

Cancer Program Gets National Recognition…Again!

Congratulations to our team at the Sandra & Malcolm Berman Cancer Institute, who recently earned the Accreditation Award with Commendation from the American College of Surgeons Commission on Cancer (CoC). In each of the last four surveys, the CoC recognized The Berman Cancer Institute for treating every cancer patient as if they were a loved one.

Accreditation indicates that a cancer program has met or exceeded 34 standards of quality measurement, while Commendation is awarded only to programs that exceed all required standards, plus 7 out of 7 commendation standards at the time of its triennial survey. Of the 1,500 CoC-accredited cancer programs nationwide, fewer than 40% earn Commendation.

Please thank our cancer team and congratulate them on this recognition of their excellence!

Wednesday, September 19, 2018

Saving Lives and Leaving Great Impressions

Last week, we had the formal grand opening of our new Neonatal Intensive Care Unit (NICU), Dr. Timothy Doran, our Chair of Pediatrics, also shared with me an email from grateful parents of babies who were recent patients in our NICU. The email reminded me that I am very fortunate to be the CEO of the GBMC HealthCare system. I get so many wonderful letters, emails, or thank you cards about members of the GBMC family who do marvelous things for our patients. The family had twins, but unfortunately each baby required special care. Happily, after almost eight weeks in the NICU, mom and dad have both babies at home.

Here is an excerpt from a letter I received this week: 
I never in my wildest dreams would have guessed just how big of a role the NICU would play in our lives. When you become pregnant, you imagine a chubby little bouncing baby, healthy as can be. You don’t ever expect that your baby (or babies) will need any extra help after they’re born. When I was told that my babies were going to the NICU, I was sad of course, but I felt content knowing that my little ones were in the best hands possible. We had met with Dr. Pane before they were born, and we trusted her and knew that the team upstairs were more than capable and knowledgeable. I didn’t realize just how much help we would be getting from the GBMC NICU staff. I didn’t realize just how much they had to offer and just how much they could do to help not only these tiny babies, but us parents, too…

I want to thank every single doctor, nurse, nurse practitioner, physician assistant, student, tech, secretary, respiratory therapist, lactation consultant, milk donor, social worker, speech pathologist, volunteer, and even housekeeper that we have had the joy of crossing paths with.

“Thank you” doesn’t even cut it when it comes to how completely grateful I am, but here it goes anyway: Thank you for your knowledge, compassion, understanding, and empathy.

Thank you for always asking how we’re doing, for explaining things in ways we can understand, for answering our questions, for taking our concerns and suggestions seriously and even implementing them in treatment, for always making sure we had everything we needed, and for being a shoulder to cry on/someone we could vent to.

I thank God, every day for the individuals that saved my baby and I thank modern technology and medicine that gives you all the ability to do what you do. I don’t know how you all do it, but I can tell that every single one of you is passionate about these tiny fragile babies and their families.

There will always be a place in our hearts for every single person that we’ve grown to know and love. God bless all of you, and thank you a million times over. ❤️”

Over the last eight years, we’ve been working hard to drive towards our vision. In 2010, we made a clear decision that we would become the healthcare 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, and with the most joy for those providing the care. Our vision is about a relationship between a physician, his or 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 patients’ health between visits, to make sure that they are getting what the evidence says will keep them well.

The letter above is a great example of teamwork and rallying around a patient and her family! We need to continue our work to make this happen for every patient, every time. I am very grateful for all the nurses and technicians that this patient thanked and Dr. Maria Pane for exemplifying the kind of expert, compassionate care that we would all want for our own loved ones. I know how hard their work is and I am very, very grateful to them for not forgetting why they do what they do. Our NICU team is moving us closer to our vision. Let me add my thanks to all our GBMC colleagues who are moving us closer every day to our vision.

Neonatal Nurses Day… 
Last Friday (9/15) was Neonatal Nurses Day. It’s a time where we honor our nursing colleagues and celebrate their hard work and dedication. With more than 4,500 babies born at GBMC annually, we are very fortunate to have such a high-level NICU to care for those babies who are born too small, too sick or too soon. Our NICU has an exemplary group of nurses and I want to thank them for all they do.

Environmental Services Week…
Last week was also Environmental Services (EVS) & Housekeeping Week (Sept 9--15) and I want to take time to recognize the contributions of our EVS staff. Cleanliness is everyone’s job at GBMC, but, our EVS staff members are the experts in cleaning who work tirelessly to get the job done. They spend countless hours in their vital role in keeping us clean and helping to prevent infections. There are more than 100 EVS associates working around the clock at GBMC in a variety of roles, servicing over 1.2 million square feet of facility. So, please join me in honoring all the men and women of EVS.

Monday, September 10, 2018

Kosher Pantry Grand Opening

Last Thursday, we held the dedication ceremony for our new Kosher pantry, located near the main entrance of the hospital. The pantry was built to meet the dietary needs of members of the observant Jewish Community.

The pantry was made possible through the hard work and commitment of our Chaplain, Rev. J. Joseph Hart, M.Div., BCC, and Rabbi Pinches Rabinowitz, with the help of Bikur Cholim of Baltimore, a non-profit organization dedicated to meeting the needs of the observant Jewish Community in healthcare settings. Bikur Cholim will stock the room with kosher meals and snacks. There is no charge for the food and observant family members will have special access to the locked pantry.

Kosher Pantry Ribbon Cutting
The pantry has a refrigerator and freezer, separate dairy and meat microwaves, and disposable utensils. It is stocked with non-perishable foods including fresh food options that will be double-wrapped in the refrigerator for Shabbot each Friday. Other amenities include two sinks, kitchen cabinets, a dining table with four chairs, sofas, and lighting fixtures, and prayer/faith and life books.

GBMC has always been welcoming to all members of our community, but we realized over the past few years that we had no options for nutrition of the family members of our observant Jewish patients. It is fitting that we had the grand opening last week as Rosh Hashanah started last night and Yom Kippur is next week.  I want to wish a Happy Rosh Hashanah to our family and friends who are celebrating!

WOW!! What a surprise…
A couple of weeks ago, I talked about our SAFE (Sexual Assault Forensic Examination) program receiving tremendous support from the band Breaking Benjamin. Each member of the group was seen during a recent concert wearing t-shirts that highlighted our program, giving it the visibility it deserves on a big “stage.”

Much to my surprise this week, I was given two electric guitars, signed by each member of the band, from Laura Clary, BSN, RN, FNE-A/P, SANE-A, CFN, CPEN, Clinical Manager of our SAFE program, and Ashley McAree, RN, FNE-A/P, CFN, forensic nurse examiner with our SAFE program. Now, I know what you’re thinking, “Why does he need two?” No worries, I plan on giving one to my son, Mike, who is a huge Breaking Benjamin fan. It’s the least I can do after he invited me to the band’s concert last month.

I want to thank Laura, Ashley, and the members of the band for these special gifts, but most importantly, I want to express my appreciation to all members of our SAFE and Domestic Violence (DV) programs who do so much for victims of sexual assault and domestic violence and in educating the community to reduce these attacks.

Speaking of our SAFE program…
I want to congratulate Valerie Weir, BSN, RN, FNE-A/P, CMSRN, who has been named the new Domestic Violence Coordinator for our DV Program. Valerie has been part of the GBMC family for 17 years and has held many positions across the organization. According to Laura Clary, Valerie brings a unique perspective to her new role as she is certified to care for patients of all ages, who have been victims of sexual assault, rape, child abuse/neglect, intimate partner violence, and human trafficking.  She has been a great asset in aiding the SAFE and DV Programs in expanding their pediatric resources. She is an active member of the Baltimore County Sexual Assault Response Team (SART), as well as the Maryland Child Abuse Medical Providers (CHAMP).

Please join me in welcoming Valerie into her new role!

I would also like to thank Colleen Moore for her many years of service at GBMC. Colleen did an outstanding job in victim advocacy and other support services. Thank you, Colleen, for all your hard work at GBMC and in the community.

Friday, August 31, 2018

The Next Generation of Nurse Leaders

This week, I was very excited to attend the graduation ceremonies for our nurses in the residency program. Twenty-five nurses finished the one-year long program, which was capped off by the presentation of their evidence-based nursing research projects. It was wonderful to see so many smart, well-trained, and dedicated young people who have committed to a career of service to others.

The GBMC HealthCare System is committed to being a learning organization. This requires that we have people, with profound curiosity, who are ready to deeply study our processes and to adjust them based on what they learn. This is the fundamental reason why we do Lean Daily Management every morning. I was so happy to see these young nurses already displaying their profound curiosity. Their projects ranged from ways to optimize scheduling and decrease errors during shift changes to developing best practices for patient bathing to minimize infection. They used evidence-based research to find ways to improve parental-infant bonding in the delivery room and to reduce alarm fatigue.

Sharon M. Rossi, MS, RN, CSSM, Director of Perioperative Services, gave a wonderful keynote address in which she encouraged the graduates to be life-long learners. Sharon also pointed out the need to find time to “recharge” and to never forget to be kind.

There are many careers that are “easier” than being a nurse…but there are few as rewarding. I left the graduation ceremony proud of all the graduates and assured that their futures are bright. The GBMC HealthCare System’s future is bright as well, in large part because they are with us!
Labor Day
As our country celebrates the hard work of the American people this Labor Day holiday, some of us will enjoy a three-day weekend. But, many of our colleagues will be working. Please let me thank all the phenomenal people of the GBMC HealthCare System for their labor towards our vision. What makes a healthcare system truly outstanding is not the technology or the facilities, but the people. I want to thank all of you who make our health system strong because you go to work every day to serve others!

Thursday, August 23, 2018

Support from an Unexpected Source

Many people at GBMC know that I am a huge Steely Dan fan. I love jazz and Steely Dan brought the harmonics of jazz to rock and roll music beginning in the 1970’s. What those same people don’t know (and may not believe) is that I have become a big supporter of the band Breaking Benjamin.

My son, Mike, is a huge Breaking Benjamin fan. Mike invited me to go with him to see them at an outdoor venue in Massachusetts, the Xfinity Center, last Saturday. Suffice it to say that Breaking Benjamin is a very high energy metal band and I stood up for all 90 minutes of the concert. I enjoyed the show, but it wasn’t until this week when I learned that Breaking Benjamin are big supporters of GBMC’s SAFE (Sexual Assault Forensic Examination) program that I became a real fan.

Laura Clary BSN, RN, FNE-A/P, SANE-A, CFN, CPEN, Clinical Manager of our SAFE program, told me that recently the members of Breaking Benjamin were seen during a concert wearing t-shirts that highlight our program. These shirts call out the wonderful work that Laura and her team do for the community.

Our SAFE and Domestic Violence programs do so much for the victims of sexual assault and domestic violence as well as educating the community to reduce these attacks. The assessment and treatment of victims of sexual assault is very complex. Expertise and caring are required not only to address the medical and psychological needs of the patient but also to complete the forensic work necessary to aid law enforcement in the identification of the perpetrator to see that justice is served.

I am glad to see our program get the visibility it deserves on such a big “stage.” Many of us are guilty of stereotyping celebrities as being self-centered and uncaring. This certainly is not the case for Breaking Benjamin!

Thursday, August 16, 2018

Level 2 Mistake Proofing

On Lean Daily Management rounds this week we learned of a test of change to improve the rate of washing in and washing out of every Emergency Department room. We have been working on hand hygiene in the inpatient units for some time. We have greater than 90% compliance and we have now begun auditing our performance in the ED.

All the physicians, nurses, and other clinicians know that they should clean their hands upon entry and exit, but sometimes they forget. This has come up as a common cause of the lack of hand cleansing, so Mark Fisher, RN, the Nurse Manager, Shannon Barry, RN, and Amanda Icenroad, RN, Clinical Nurse 4’s, started thinking about how they might improve their team’s performance.

A common action for health care leaders when they see that someone is not doing what they need to do is to re-educate the individual on the process. Re-education is called level 1 mistake proofing. Re-education is a good tool if the person doesn’t know that they are supposed to do something. But if the problem is forgetfulness, then re-education is not of much value.

Mark and Shannon thought long and hard about level 3 mistake proofing. Level 3 mistake proofing occurs when the system makes it impossible not to do the required action. An example of level 3 mistake proofing is when you order something online and the seller needs your 3-digit security code from your credit card. You hit “enter” after putting in your credit card number but not your security code and what happens? You get a screen telling you that you must put in your security code. It is impossible to get to the next step without it. This is also called a constraint or a forcing function. In high-risk endeavors where errors my cause serious harm, engineers always look for level 3 mistake proofing. For example, after some fatalities that occurred when people inadvertently put their car in drive when they meant to put it in reverse, vehicles are now engineered so that you cannot start your car without your foot on the brake.

Mark, Shannon, and Amanda could not come up with a doable level 3 idea that would prevent you from entering or leaving a room without cleaning your hands, so they went to the next best thing — level 2 mistake proofing. Level 2 is not as powerful as level 3, but it is more powerful than level 1. Level 2 mistake proofing provides a reminder in the moment. These reminders are also called affordances. Mark, Shannon, and Amanda decided to create a very colorful sign of dirty hands to put on each ED bay door.

This way when busy, hard-working people are about to enter a room, they have a visual reminder to clean their hands. We applauded them for their thoughtful test of change and we look forward to their results!

Do you have examples of level 2 or level 3 mistake proofing from your unit or department? Please share them below.

Breast Center Earns Three-Year Full Re-Accreditation

Congratulations to the staff of The Sandra and Malcolm Berman Comprehensive Breast Care Center and the Advanced Radiology Breast Imaging Center, which recently were awarded a full three-year re-accreditation by the National Accreditation Program for Breast Centers (NAPBC). This is the center’s fourth consecutive NAPBC designation since it was first accredited in 2009.

The full accreditation program, administered by the American College of Surgeons, is only awarded to centers that voluntarily undergo a rigorous process that includes site visits by experts from the NAPBC, as well as an intensive review of the center’s records. Earning this accreditation means that our Breast Center is held to the highest standards for the quality of care we provide for patients with the full spectrum of breast disease and that we offer patients a multidisciplinary team approach to diagnosis and treatment and state-of-the-art treatment options.

Any hospital or program can say it provides excellent care, but with this accreditation, we have earned this designation for excellence under the scrutiny of experts, which speaks volumes about the high quality of care all members of the Breast Center and Breast Imaging Center teams provide for our patients with breast disease. And that’s great news for GBMC and for the community we serve.

Dr. JoAnn Z. Ioannou Delivers Hopkins School of Nursing Graduation Keynote Speech

It’s not every day that a world renowned top academic nursing program invites someone from a community hospital to speak at graduation, but the Johns Hopkins School of Nursing clearly shares our admiration and respect for JoAnn Z. Ioannou, DNP, MBA, RN, NEA-BC, our Senior Vice President of Patient Care and Chief Nursing Officer. Dr. Ioannou was the keynote speaker at the August 6 degree completion ceremony for students who had earned advanced degrees in nursing.

A graduate of Hopkins’ Doctor of Nursing Practice program, as well as the university’s MBA and MSN programs, Dr. Ioannou worked in a wide range of nursing roles at Hopkins for 23 years before she joined us at GBMC three years ago. In her speech, she shared the story of her journey from the bedside to nursing leadership, how her mother inspired her ongoing commitment to education, and the many challenging and rewarding paths that the graduates could choose to follow—direct care provider, nurse educator, nurse researcher, and nurse leader. In her closing remarks, she encouraged the graduates to “…continue to collaborate to improve the field of nursing any way you can” and reminded them “…doors will open when you persevere…You will be solving problems that don’t even exist yet.”

You can watch the whole speech here.

The Daily Record Recognizes GBMC

GBMC was recently recognized by The Daily Record in its 2018 Reader Rankings in the categories of Best Hospital and Best Health System. Readers of the publication cast more than 12,000 votes in 60 categories. We’re grateful that the community members we serve are pleased with the care and compassion that our staff shows to all our patients and their families.