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.

Friday, August 10, 2018

“Well, Usually” Revisited

I have been reflecting recently on how far we have come in the quest to achieve our vision of providing the care we would want for our loved ones to every patient, every time. This goal is lofty, and I must keep reminding myself of this. With the aging of the population, people’s needs are growing, and we do not control the entire system of care – we struggle to meet the needs of those with serious behavioral health problems. We have designed so many improved processes like Gilchrist’s entire elder care system, our patient-centered medical homes, our ERAS (Early Recovery After Surgery) program, and so many more.

But we still have work to do. Recently, I was with a clinician and I asked her the “how do we do it” question when I wanted to learn more about one of our processes that did not seem to be highly reliable. My colleague started her response with “Well, usually we …” I knew immediately that we did not have standard work and that many hard-working people were doing it whichever way felt right to them. In a tightly coupled, complex system, a small deviation in one area can cause huge problems downstream. Many of us, including myself, were not trained in the importance of following system design so that we get predictable results. Instead, we learned to do whatever felt right to us in the moment. Standard procedures don’t always work for every patient, but when possible, processes must be standardized and followed. This is critical to creating consistent results for our patients.

Do you know the song This is how we do it, by Montell Jordan? (No, I’m not talking about partying). We need more of us able to state, “this is how we do it” when asked how we complete a task. Then we will move faster towards our vision!

New Parking Rules in Effect on Monday, August 13th
Starting this Monday, August 13th, the decentralized parking model will take effect and all new gates at the garages will be activated. All GBMC employees have been assigned a home lot or garage and will be able to “tap and go” their badges to enter and exit our medical campus. Your GBMC ID badge will be automatically programmed to function at your assigned parking lot or garage’s reader, and stickers will still be issued to monitor compliance at free parking areas such as the Bluebell and the Labor and Delivery parking lots, which will remain patient-only parking.

I want to remind all staff to tap their badge on the card reader at their assigned garage prior to Monday. If the card reader light does not turn green after you tap your badge, please contact Robert Cole at and Karalyn Stitcher at from the badging office. If your badge is not active prior to August 13, you will need to use a ticket and contact the badging and parking office. The following parking assignments will be in effect:
All offsite staff, volunteers, physicians, and board members may park in any garage or parking area, EXCLUDING “patient only” spaces.
All employees may park in Tulip (PPN) or Lily (ED Garage) at any time, any day of the week, EXCLUDING “patient only” spaces.
All employees may park on Farmhouse Hill at any time, any day of the week.
All employees working in PPE may park in PPE, EXCLUDING “patient only” spaces.
All employees working in PPW may park in PPW, EXCLUDING “patient only” spaces.
Only employees working in South Chapman may park in South Chapman (between the hours of 6 am to 5 pm).
After 4 pm, all employees may park in all garages.
On Saturdays, PPE and PPW will be open to all staff.
On Sundays, all gates are up on all garages.
Complimentary passes will continue to be accepted.

Again, employees should never park in Rose park or Bluebell park or park in "patient only” spaces. Any employees found parking in these lots will be towed.

These changes are needed to make the entrance to our campus safer for vehicular traffic and to reduce delays when entering and exiting from our grounds. They will also improve parking accessibility for our patients. I want to thank Stacey McGreevy, our Vice President of Support Services, and her team for working very hard to make the transition as easy as possible for our people.

Thursday, August 2, 2018


Last week, I talked about our summer Town Hall meetings, what their purpose is, and why it’s important for our workforce to be informed about what’s happening in our healthcare system. This week, I want to outline some of facility improvements here at our hospital as well as some other changes happening outside of our medical campus.

Over the last several months, the top two floors of the William E. Kahlert Physicians Pavilion North have been under major construction as we prepare to make it the home for a large physician practice and an ambulatory surgery center for Chesapeake Urology. The surgery center on the sixth floor will be up and running in a few months, and the practice will have a brand-new office suite on the fifth floor. The practice currently has three doctors on our campus and this expansion will allow them to increase to 10 to 15! This is a great step forward for our medical campus.

The new NICU officially opened in June and if you haven’t stopped by to look, I highly recommend that you do so! I am extremely proud of the NICU team, who worked incredibly hard, was very patient with leadership, and collaborated with the architects to design the space. The new NICU provides individual, private spaces for babies and their families. Each of our new 13 rooms will allow for an individualized environment in terms of lighting, temperature, and sound. For more information, check out one of my recent blog posts. It took us a while to finish this project, but I believe the final result was worth the wait.

Speaking of new, we have a modern and beautiful Orthopaedics office, located on the seventh floor of our Physician Pavilion West. It’s modeled after our Family Care Associates Practice in Pavilion North and it allows us to take walk-in patients, during weekdays and evenings, for injuries. So, let’s say one evening you twisted your ankle and you don’t want to go to the emergency department (ED), now you can go straight to the Orthopaedics office (this practice does not offer the same services as an emergency department).

Recently, we also signed a contract to partially own a one-room ambulatory surgery center (ASC) in Cockeysville. We’ve been fighting the impetus to create a free-standing ACS because we want to do the right thing by the community — Baltimore has plenty of operating rooms, with one on almost every street corner.

We are becoming part-owners in the surgery center because we do not receive additional revenue when we do more surgery at the hospital and because the patients don’t want to pay higher hospital rates when they can get the surgery for less in an ASC.

Our OR Simulation Lab is a recent addition that is greatly beneficial to our surgeons and patients. The lab is a comprehensive training center, which consists of a lab focused on task-based training and replica hospital rooms created to imitate real-life settings. Participants can train for almost any medical situation from inserting an IV, to performing complex surgery, to practicing difficult conversations with patients. The Simulation Center is a critical part of GBMC Healthcare System’s continuing education program which helps the staff grow their skills and adapt to evolving medical techniques and technology.

I’ve been promising a gym on the campus for several years and this week we held an open house for our new Fitness & Wellness Center. Some of you remember that we had a gym on our campus many years ago, which was converted to a surge center. Now it’s been converted back into a gym. Starting August 6, this facility, located by the South Chapman building, will be open 24/7 and is for employees ONLY at a cost of $9.00 per pay period. In the past, many employees said that they would like a place to exercise before or after work. We heard you and I want to thank Anna-Maria Palmer, Vice-President of Human Resources, and Stacey McGreevey, Vice-President of Support Services at GBMC HealthCare, for making this happen.

We are officially opening our Kosher Hospitality Room this September. The pantry, located by the main entrance of the hospital, was built to meet the dietary needs of Observant Jews who follow a Kosher diet and who have come to the hospital to visit a loved one. It’s evident that GBMC serves many Orthodox and kosher-observant Jews and the main goal of the on-premises kosher food pantry is to help ease the hunger and lift the spirits of concerned family members whose relatives are suffering from illness or injury.

Lastly, we’re thrilled about the grand opening of the new Kroh Endoscopy Center, slated for next year. The Center will be located where Sherwood Surgical Center was previously situated. It’s still under construction. There will be more to come on this as we get closer to the grand opening in January 2019.

It’s safe to say that it’s been a busy year.  I hope you are as excited as I am about the changes taking place with our healthcare system.  Let me know what you think.

Play Ball!!!!

Despite the inclement weather, we held our third annual GBMC Night at The Yard Event. I hope all of those who attended the event had a lot of fun! Having the Orioles win that night, with Tim Beckham (our special guest for our Birdland Social Media Night) hitting a home-run added more joy to an already festive event.