A Wild Year Comes to a Close

What can I say about 2020 that hasn’t already been said? The GBMC family will look back on it as a year of extremes. At the end of November, I thought that I would remember the pandemic as the most stunning challenge of my career….and then the cyberattack happened!

But how could I say that I will be happy to see 2020 fade into the past when it was also the year that we achieved the Malcolm Baldrige National Quality Award?

 All my GBMC colleagues have been phenomenal in this year! Our clinicians stood up to the pandemic day after day and our support staff did everything they could to make it easier to get the job done despite the coronavirus. And, as if that were not enough, when criminals brought down all our computer systems, we pivoted hundreds of processes in order to treat every patient the way we would want our own loved ones to be treated. Our IT professionals then began the monumental task of rebuilding all those systems. 

I will always remember the tenacity, dedication, and tireless work of our staff members who helped us get through two huge challenges simultaneously.

As the year is coming to an end, the number of people hospitalized in Maryland with COVID-19 has again plateaued, and we have begun vaccinating healthcare workers – there is light at the end of the tunnel in the battle against the pandemic. We have also begun to bring our systems back online. We are hopeful that the end of the computer downtime is also in sight. 

I would like to remind everyone that, in addition to the achievement of the Baldrige award, there were many other good things that happened within our system in 2020. Some of these were:

• Our Marketing and Communications team positioned GBMC as the “trusted healthcare communicator.” In addition to being prominently featured on television, radio, and social media to educate the community about the pandemic. As an example of this, I had the honor of serving as the host for a virtual question and answer session with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), and member of the White House Coronavirus Task Force. This was a unique opportunity to discuss COVID-19, our healthcare system, and our response to the global pandemic with a world leader in infectious diseases.

• We received approval of our Certificate of Need (CON) for a three-story hospital addition known as The Promise Project. We are on schedule to break ground late next summer.

• We opened our new advanced primary care site – GBMC Health Partners at Padonia. The practice serves the entire family, from newborns to elders, and is staffed with a team of physicians, advanced practitioners, nurse care managers, care coordinators, and support staff. 

• The Gilchrist Center Baltimore broke ground on a new inpatient hospice center at Stadium Place in November. The new center will continue to be the only residential hospice in Baltimore and will house the only pediatric inpatient hospice unit in the state. The addition of Gilchrist’s inpatient hospice will give Stadium Place the full continuum of care for elders.

• We earned a five-star rating from the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare Program. We are one of only a few hospitals in the state to achieve the highest score! CMS created the star-rating system to give patients the tools they need to find the organizations that will provide the highest value to them.

• GBMC was the first hospital in the state to earn the Joint Commission Advanced Certification in Perinatal Care! This certification means that patients can expect integrated, coordinated, patient-centered care through pregnancy and childbirth.

• Our Primary Stroke Center was selected for the 2020 American Heart Association’s (AHA) Get With The Guidelines® (GWTG)-Stroke: Gold Plus with Target: Stroke Elite Honor Roll and Target: Type 2 Diabetes Honor Roll. The award recognizes hospitals that meet specific quality measures for the diagnosis and treatment of stroke patients.

• Our Sexual Assault Forensic Examination and Domestic Violence Program (SAFE/DV) officially opened its new 2,500-square-foot location to help care for the growing number of victims of sexual assault and domestic violence.

• GBMC received the highest award of Summa Cum Laude in Epic’s Honor Roll Good Maintenance Grant Program. This is the highest level of achievement for Epic users! We were also a recipient of the Most Wired Hospital award from the College of Healthcare Information Management Executives (CHIME) for both our acute and ambulatory services. We were one of a few hospitals in the state to receive two Level 9 Most Wired recognitions. Many institutions have only been successful on the acute discipline.

• Our Lymphedema Center was awarded the LE&RN (Lymphedema Education & Research Network) classification of Network of Excellence in Lymphatic Disease. The goal of the LE&RN Centers of Excellence program is to increase access to the best possible multi-disciplinary care for individuals with lymphatic diseases (LD) and their families through a geographically diverse network of clinical centers. 

• Our Sandra and Malcolm Berman Cancer Institute achieved QOPI® Re-Certification, Quality Oncology Practice Initiative (QOPI®) status. This reflects our ongoing commitment to quality of care that leads to fundamental changes in the clinical practice of oncology. QOPI®, a program of the American Society of Clinical Oncology, is a three-year certification for outpatient hematology-oncology practices. 

• Our Cancer Institute was also recognized as a “high-performing site” by the National Cancer Institute (NCI) for the second year in a row. The NCI’s High-Performing Site Initiative recognizes institutions that enroll many patients in the National Clinical Trials Network and demonstrate scientific leadership in the design and conduct of clinical trials. I also want to congratulate our Cancer Institute for opening a satellite location in Owings Mills.

I am excited about returning to “normal” some-time in 2021. We will continue to focus on our vision of being the community-based system of care that the patient experiences as a system, and can deliver the care we want for our own loved ones to every patient, every time. We have done very, very well during the pandemic and the cyberattack, but these have been unwanted distractions. In 2021, we will build on our achievement of the Baldrige award to move even faster towards our vision. I am also excited about working with others to invest in the Baltimore community and deliver on our vision to neighborhoods that are presently being left behind. 

I want to thank all of Team GBMC, whether they are in Gilchrist, GBMC Health Partners, or Greater Baltimore Medical Center for everything they have done in 2020! I love to work with every one of you and I am in awe of what you have accomplished against all odds. So, although we can’t have a big celebration (yet), let’s raise a glass and say goodbye to 2020 as we welcome 2021!

Happy Holidays

Let me wish all my GBMC HealthCare colleagues and members of the community a wonderful holiday season filled with peace and joy. And boy do we need it!

As if the pandemic wasn’t enough, being the victim of a cyber attack has not been fun for anyone, but it has been marvelous to see everyone pulling together to continue to serve our patients the way we want our loved ones served.

We have been able to begin to bring Epic (our electronic medical record system) back up for GBMC Health Partners and Gilchrist. Things are much more complicated in the hospital and our teams are working hard to restore our electronic capabilities while keeping our patients safe.  

Thank you to Dave Hynson and our IT teams for their tireless efforts since the downtime began. Let me also thank the rest of the workforce, starting with our physicians, advanced practitioners, nurses and all other clinicians for their incredible work under very difficult conditions. And of course, let me thank all the rest of us as support staff. Many of you stepped up to do new jobs that were required in the absence of automation. I am so very grateful for your efforts. 

We are not done yet. There is still a lot of fixing and learning to do. But I am sure that we will be a stronger system because of this challenge.

Best wishes for a healthy and safe holiday to all of you and your families. 

“If we thought it was always going to be easy, we wouldn’t have become nurses!”

We are now finishing our second week of redesigned processes that remind us of the past, as we continue to recover from the cyberattack. Our IT professionals are working with experts from around the world to recreate our computer systems and clean the hardware of the malware that caused the damage. Meanwhile, our clinicians, with the help of our support staff, who are going above and beyond their normal duties, keep stepping up to deliver the care that we want for our own loved ones to every patient, every time.  

We are using our downtime procedures and staying vigilant to keep patients safe without our typical computer oversight. Our pharmacy team has done an outstanding job of serving patients without their usual computer systems functioning. I have been rounding frequently and I have been humbled again and again by the hard work, commitment, and resiliency of our staff. I was rounding on Wednesday evening and I asked a couple of our nurses on an inpatient unit how things were going. 

When I told them how grateful I was for their work, one of them replied: “If we thought it was always going to be easy, we wouldn’t have become nurses!” I couldn’t see her smile because of her mask, but I could see the twinkle in her eye and the joy that comes from service in the face of adversity. The teamwork has been so evident throughout our healthcare system - I am in awe of my colleagues.

We recognize our responsibility to keep the information entrusted to us secure. There is no evidence at this time that any information has been misused by the criminals who attacked us. We will continue to partner with outside experts in the field of IT and cybersecurity, as well as law enforcement, as we assess the situation and safely return functionality.  

Please let me express my sincere gratitude for the tireless efforts that our IT team, clinicians, and other staff have shown. We are getting through this together and we will learn from this event. We will become an even stronger system because of it!

Getting Through This Together

It has now been just short of a week since GBMC became the victims of a ransomware attack.  

Dave Hynson, GBMC’s Chief Information Officer, and his team have been working with experts from around the world – literally – to rebuild our systems. It is an incredibly arduous task that will take time.

Our people have once again shown their amazing resilience. As if the pandemic were not enough, caring for patients without computer systems is extremely difficult. Our team has returned to paper documentation and ordering. Many folks have stepped up to be runners and safety nurses. People have manned the command center 24 hours a day and we have been redesigning care on the fly. Despite all of these challenges, we have been united under our vision phrase and our four aims. 

We value the privacy and security of the information entrusted to us. There is no evidence at this time that any patient information has been misused and we will continue to partner with outside experts in the field of IT and cybersecurity, as well as law enforcement, to continuously assess this situation as we carefully return functionality.  

As I walk around the hospital and visit physician offices, I am humbled by the resilience and dedication of our team. I want to express my sincere gratitude for the tireless efforts of our IT team, clinicians, and all other staff in the hospital, Gilchrist, and GBMC Health Partners. Their level of dedication and commitment to our patients is truly inspirational. I am also appreciative and moved by the ongoing support from our patients, their families and our community.

The GBMC Family is getting through this together. 

Virtual but Beautiful

Earlier this week, we held our annual Physician Recognition Event to celebrate our medical staff. Traditionally, this has been an in-person event with excellent food, music, and entertainment, however due to the continuing COVID-19 pandemic and restrictions placed on public gatherings, it was done virtually this year.

Our Vice President for Philanthropy and Marketing and Communications, Jenny Coldiron, and her team, led by Kim Davenport and assisted by Laurie Wagerman and Garrett Morris, did not let the pandemic prevent this year’s event. Beginning at 1 p.m., our physicians and advanced practitioners came to a drive through at the Baltimore Country Club where they picked up a beautiful GBMC bag that contained a meal for them. They were greeted by members of the Senior Team as we distributed the meals. Holiday carolers sang in the background. 

At 7 p.m., our event began online. To watch the event, click here. The night started off with some fantastic entertainment courtesy of GQ, a female barbershop and contemporary a cappella quartet based in Baltimore. I truly enjoyed their performance. If you are interested in finding out more about them and their unique journey, please visit girlsquartet.com 

I gave a brief presentation thanking our physicians and advanced practitioners as well as Dr. Harold Tucker, our retiring Chief MedicaI Officer, for his years of service. Dr. Tucker then recognized those physicians celebrating a milestone of 25 years with GBMC and those who have reached Emeritus Status. If you see the physicians listed below, please congratulate them on their years of service and for the service they have given to GBMC and our patients through the years!

25-plus years of service:
David S. Goldstein, MD         Surgery/Urology
Randolph B. Gorman, MD Anesthesiology
Marc A. Honig, MD      Ophthalmology
David J. Hoyt, MD         Otolaryngology - H&NS
Michael S. Murphy, MD         Surgery/Orthopedic Surgery
David L. Strauss, MD. Emergency Medicine
Francis J. Townsend, III, MD Emergency Medicine
Robin M. Ulanow, MD Surgery/General Surgery
Karen R. Vail, MD         Anesthesiology

Emeritus Status:
Katherine M. Bass, MD         Gynecology
Paul Z. Bodnar, MD        Pediatrics
David D. Collins, MD Medicine/Internal Medicine
Stephen R. Feldman, MD Pediatrics
Deborah L. Hebb, MD Gynecology
Marshall A. Levine, MD         Medicine/Medical Oncology
Nader Gary, MD         Ophthalmology
Santiago L. Padilla, MD         Gynecology
Vivian Rismondo, MD Ophthalmology
Leon Strauss, M.D.         Ophthalmology
Anthony J. Vazzano, M.D. Pediatrics
Claire M. Weitz, M.D. Obstetrics

After our brief ceremony celebrating these clinicians, I was delighted to welcome some jazz greats to entertain us. Warren Wolf and the Christmas Vibes played holiday numbers and they were fantastic! Accompanied by vocalist Micah Smith, the quartet included Sean Jones, Professor and Richard and Elizabeth Case Chair of Jazz at the Peabody Conservatory, on the trumpet; the sought-after sideman, Jeff Reed, who is a faculty member at Towson University on the bass; Quincy Phillips, a world-renowned drummer, who is also a faculty member at the Peabody Conservatory; and of course, Warren Wolf, also a faculty member at the Peabody Conservatory and a fabulous multi-instrumentalist, who is best known for his work on the vibraphone. Warren also played the piano for us at the event. I was in seventh heaven listening to this group! I am so grateful to them for coming to entertain us and to help recognize the excellence of our medical staff and Dr. Tucker. 

After they finished playing, Dr. Robin Motter-Mast, our Chief of Staff, again thanked our clinicians and closed out the evening (I then went home and ate the incredible meal). Especially during this time of the pandemic, it was important to take a moment to recognize our medical staff for everything that they do to serve the community.

Research at GBMC
Community hospitals are generally not thought of as centers for clinical research – it is the large academic medical centers that we think of in this arena.

GBMC is different. Among the centers of research excellence on our campus is the clinical trials program at the Sandra and Malcolm Berman Cancer Institute. They are currently working in partnership with The National Cancer Institute (NCI) to study those who have tested positive for COVID-19 while receiving cancer treatment. The COVID-19 in Cancer Patients Study allows researchers to learn more about how COVID-19 is affecting disease progression and outcomes in cancer patients. This study is vital to increasing our knowledge to improve the care of infected patients during their treatment and is just one example of the research being done at GBMC.

It is remarkable is that our Cancer Institute was recognized as a “high-performing site” by the National Cancer Institute (NCI) for the second year in a row. The NCI’s High-Performing Site Initiative recognizes institutions that enroll many patients in the National Clinical Trials Network and demonstrate scientific leadership in the design and conduct of clinical trials. 

To find out more about the research at the Berman Cancer Institute, and to put their recent important designation from the National Clinical Trials Network in perspective, I spoke with our Clinical Research Nurse Manager, Judy Bosley, RN, BSN, CCRP. Please see her responses to some of my questions below:

Judy, can you give us a little background on the NCI’s National Clinical Trials Network?
“The cornerstone of NCI’s clinical trials program, the National Clinical Trials Network (NCTN), is comprised of organizations and clinicians that conduct large Phase II and Phase III clinical trials across the United States and Canada. These trials help establish new standards of care, set the stage for FDA approval of new therapies, test new approaches to radiation therapy and surgery, and validate new biomarkers. NCTN provides an infrastructure for NCI-funded treatment, screening, and diagnosis trials at over 3,000 clinical trials sites.”

What does the “High Performing Sites” designation mean?
“This Initiative is targeted to those sites that have been identified by the National Clinical Trials Network (NCTN) Leadership as “High Performing Sites” based on accrual, site participation, and high-level of data quality across the entire NCTN. The “High Performing Site Initiative” provides additional funds and other support to cancer research organizations to conduct national clinical trials. It compensates high-performing sites recognizing that the ‘per-case management funding’ provided by the NCI is significantly lower than the actual costs incurred by the member institutions/sites to participate in a trial.” 

How does this speak to the level of research being done at the Sandra and Malcolm Berman Cancer Institute here at GBMC?
“This recognition is a testament to our efforts and commitment in growing the Sandra and Malcolm Berman Cancer Institute’s clinical trials program. It reflects the hard work of our physicians, research nurses, research coordinators, and regulatory staff in accruals, quality data management, and study conduct.”

Why is this important for our patients and the community to know?
“This grant recognizes GBMC’s commitment to bringing leading-edge treatments to our patients through our participation in clinical trials at a national level, as well as our high-quality standards for clinical trial conduct. It is also important for the community to know that our physicians at GBMC have their finger on the pulse of cutting-edge research. Clinical trials play a vital role in advancing cancer care and treatment. Today, people are living longer lives from successful cancer treatments that are results of past clinical trials and clinical trial participants play a major part in helping to create a cancer-free world.” 

Please don’t forget to VOTE!

Just a reminder, it's that time again - Baltimore magazine is collecting votes for its Excellence in Nursing issue. Please vote for the nursing colleagues you most respect! The survey ends soon, and you can vote here . The results will be published in the May 2021 issue of Baltimore magazine and the winners will be invited to a special reception.

Celebrating Gilchrist

Recently, I had the pleasure of attending the ground-breaking ceremony that will be the future home of our Gilchrist Baltimore Inpatient Hospice facility at Stadium Place. The current site on Eutaw Street – the former Joseph Richey House – has provided end-of-life care for city residents for more than 30 years. The new center will continue to be the only residential hospice center in Baltimore and will house the only pediatric inpatient hospice unit in the state. The addition of Gilchrist’s inpatient hospice center at Stadium Place will create a full continuum of care for elders. To find out more, please visit here. 

November is National Hospice and Palliative Care Month and I’d like to recognize the excellent staff and volunteers at Gilchrist, who are devoted to ensuring a respectful end-of-life journey. Our team has done so much over the years to serve elders through medical consultations, palliative care, in-home primary care, end-of-life care, and bereavement services.  

Our community is so fortunate to be served by Gilchrist. In this time of Thanksgiving, I want to express my deepest gratitude to Cathy Hamel, President of Gilchrist and Vice President of Continuing Care at GBMC HealthCare, and Dr. Tony Riley, Chief Medical Officer of Gilchrist, and their entire team for their devotion to their patients and families.  

Thank You!!

Over the last several months, there has been an outpouring of support for healthcare workers at GBMC, in our state, and across the nation. Many members of our community have shared encouraging messages for our nurses, doctors, and other members of our workforce on social media and in other ways. I’m very appreciative of the community’s efforts to encourage our team.

Recently, I received handmade posters from two young members of our community. What great work and how nice it is that these young individuals took the time to find a way to brighten our clinicians’ days during this coronavirus pandemic. I am truly humbled by their kindness and their artistic abilities. 

There is a belief that extraordinary times bring out extraordinary people. As the COVID-19 pandemic has evolved, I have been amazed with the outpouring of acts of kindness from the community to our people. I want to thank these young artists and everyone who has honored us.   

Happy Thanksgiving!!

Tomorrow is Thanksgiving Day. I would like to wish a Happy Thanksgiving to my GBMC colleagues and their families! 

Thanksgiving is a time to reflect on all that we have. I want to thank you all for your expertise, hard work, and compassion that helps us move closer to our vision of being a community-based health system where every patient, every time, is treated the way we would treat our own loved ones.  

I also want to extend a special “Thank You” to all who will be working tomorrow, or who are working during the extended holiday weekend to care for our patients and support their loved ones.

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

We did it!

I received a phone call recently from the United States of America Secretary of Commerce, Wilbur Ross, informing me that the GBMC HealthCare System has achieved the Malcolm Baldrige Award for Performance Excellence! We could not share this information with you until today because we had to wait until the Secretary sent out his public news release.

All I can say is “wow.” I am so happy and grateful to all my GBMC brothers and sisters for your hard work, your wonderful expertise, your embrace of our vision, and your willingness to design systems to help us get there. 

Our Board of Directors, led by our Chair, Mr. Fred Hudson, is so proud of all of you and they are also grateful for your efforts. They know that this award is a testament to your commitment to serve every patient the way you want your own loved ones served. Fred and the Board also realize how challenging this has been during the pandemic, which makes achieving the award even more remarkable!

I need to thank all of you, but there are a few people that deserve to be called out. Keith Poisson, our now retired Chief Operating Officer, did a marvelous job as the “Chief Implementer.” Carolyn Candiello, our Vice President for Quality and Patient Safety, and Lisa Groff Reuschling, DNP, RN, our Clinical Director of Women and Children’s Services, did a masterful job of writing the application and guiding us through all phases of its review. The Quality Department all worked overtime during the site visit. So many people stepped up to the plate when it was critical to do so, but sadly I cannot highlight all of them in this blog. 

We are just the third organization in our State to achieve the award and the first in healthcare! (The other two Maryland all-time winners were Montgomery County Schools and Howard Community College.) 

Since 1987, the Baldrige Award has been the highest recognition for performance excellence in the nation. It is the nation’s only presidential award for performance excellence, recognizing U.S. organizations and businesses that have shown an “unceasing drive for innovative solutions to complex challenges, visionary leadership and operational excellence.”

Words cannot express the pride that I feel for this organization and for our physicians, nurses, other clinicians, support staff, and volunteers who contribute every day to our serving the community with health, healing, and hope, and in educating the next generation of clinicians. You have now received the highest recognition in the country for your efforts. Thank you! 

We will continue to use the Baldrige criteria to help us move faster towards our vision, but let us savor the moment. 

It’s no fun when the computers go down
A couple of weeks ago, I got a call from our Chief Medical Officer, Dr. Harold Tucker, informing me that our computer systems were down. My first thought was the worst-case scenario – that we were under a cyberattack. I knew that the U.S. was on heightened alert for such attacks. 

Out of an abundance of caution regarding system reliability and integrity, GBMC’s leadership took measures to protect essential systems and data by proactively taking systems off-line. Happily, our findings discovered no evidence of malicious behavior, but our team had to go to downtime procedures to care for patients. Returning to the paper world is very difficult, and much of our standard work had to be changed on the fly. Approximately 9 hours after our systems were taken down, we started to restore them, and by mid-afternoon we were back to standard operations. We now believe that last week’s event was due to a computer storage issue and we have already added more storage. We will continue our forensic examination to assure that we reduce the probability of this happening again. 

I am so grateful to everyone for their work to get through the downtime. Let me thank our physicians, nurses, and other clinicians, who did not let the computer failure negatively affect patient care. 

I also want to thank Dave Hynson, GBMC’s Chief Information Officer, and his team for always working hard to educate us about the threat of attacks on our computer systems and for continually working to minimize the harm from a potential attack. Let me thank our ITS team for their rapid response to the problem and for the many hours they worked through last weekend to get things running again and assuring they had made the correct diagnosis. We are better off because of their on-going efforts. 

Finally, let me ask all of you to not let down your guard! Cyberthreats continue, and we must always be ready. Thank you.

GBMC Has Always Been a Great Place to Have a Baby

It is clear that the pandemic has had a negative effect on the utilization of many healthcare services. GBMC was formed through the merger of The Hospital for The Women of Maryland of Baltimore City and the Presbyterian Eye, Ear and Throat Charity Hospital, so it’s not a surprise that GBMC has always had a very strong Obstetrics service. On average, we deliver more than 4,000 babies per year! We are now almost 9 months into the pandemic and our Maternity service is booming. 

One of the major reasons we continue to have mothers delivering at our medical center is because of our dedicated team of expert nurses, physicians, and advanced practitioners who are committed to providing safe and effective care to every patient who walks through our doors. Our staff, under the leadership of Dr. Victor Khouzami, GBMC’s Chairman of Obstetrics, and Lisa Groff Reuschling, DNP, RN, GBMC Director of Women and Children’s Service, are experts who work tirelessly to treat every patient as if she were their own loved one. 

I am so grateful to our nurses, physicians, advanced practitioners, and technicians for everything that they are doing to serve women, their babies, and their family members.

Help Is Just a Phone Call Away
The COVID-19 pandemic has put added stress on frontline healthcare workers who were already feeling the pressure of the ageing population and the opioid epidemic, among other stressors. A recent United Nations report said that frontline healthcare workers and first responders have been exposed to significantly increased stressors and emphasized that the mental health of healthcare workers is a critical factor in sustaining COVID-19 preparedness, response, and recovery.

At GBMC, we are fortunate to have the CARES program, which is a peer support service for any staff member who needs “psychological first aid” or experiences a particularly stressful work event. The CARES team services are free, confidential, and available 24 hours a day, seven days a week. The CARES team is here to help: 

• Increase awareness of the second victim problem

• Equip staff with healthy coping strategies to promote well-being 

• Reassure and guide staff to continue thriving in their roles

• Identify other support services

I am grateful to have this important program in our hospital. We realize how critically important it is to have a mechanism in place to support our staff. Help is only a call away. To utilize the peer support services of the CARES team, call 443-849-CARE (2273). 

Radiologic Technology Week & Forensic Nurses Week
This week is “National Radiologic Technology Week” and “Forensic Nurses Week.” I would like to thank all our registered technologists (RTs) and our forensic nurses for their very important roles in serving our patients.

Please join me in saluting our RTs and forensic nurses for their commitment to quality, patient-centered care, for their hard work, and for their valuable role in helping us achieve our vision.

Celebrating Nurse Practitioner Week
November 12-18 marks National Nurse Practitioner Week. Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NPs). Across our nation, there are more than 200,000 NPs who provide care to millions of Americans. We have excellent NPs working in our hospital, in our physician practices, and at Gilchrist. They help us move closer to our vision of a patient-centered system of care every day. 

Thank You to our Veterans!
On Wednesday, we commemorated Veterans Day and took the time to remember the millions of American military veterans who have served to protect us. I know that I speak for all of us at GBMC HealthCare in offering our sincere gratitude for the personal sacrifices, past and present, of all of our service men and women.

‘Tis the Season

Last week, a joint Federal taskforce, led by the FBI, notified healthcare systems and hospitals across our nation about an imminent cybersecurity threat that has already resulted in attacks on more than two dozen hospitals. Those attacked have suffered the loss of IT systems and are running on paper documentation, causing major patient safety concerns. The criminals make ransom requests in the millions of dollars. 

These attacks are taking advantage of healthcare’s focus on the pandemic and individuals’ focus on the election. Unlike other attacks, this group is specifically targeting U.S. based healthcare with the intent to disrupt. Those leading the attack are from a Russian speaking foreign group. U.S. intelligence has intercepted communications that indicate more hospitals are being targeted this week.  

Our cybersecurity team, led by David Hynson, Vice President and Chief Information Officer, quickly and proactively implemented safeguards to help protect the systems that we rely on to deliver care.  

However, we know that the weak link in our defenses is us! Everyone must be vigilant and have a questioning attitude. Be especially careful when you receive an email from an unknown sender or if it contains an unfamiliar email address or subject matter. Here are some key safety behaviors:

--Do NOT click on or copy links in an email, instead type the site url into a new browser window.
--Do NOT open or download email attachments, instead utilize the phishing button in Outlook, or you can call the sender directly to verify that they sent the attachment and/or call the IT Service Desk (ext. 3725).
--Conduct personal business on personal devices (i.e. online shopping, personal emails, etc.).
--Know your area’s downtime procedures. Towards this end, we will begin doing downtime drills on weekdays.  

If you need assistance, our IT Service Desk is available 24/7 to support you. For more IT resources and information on safeguards that are currently in place during this threat period, please visit the main page of the Infoweb (What’s New section). 

Remember, if something does not look right, please contact our IT department. Thank you for your help and for doing your part to keep our systems safe!

National Medical Staff Services Professionals Awareness Week
This week is National Medical Staff Services Awareness Week, and I would like to recognize the important role that our medical services professionals play in our healthcare system. They 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,” medical staff professionals are critical to our system’s high safety and quality standards. Please join me in thanking them this week. 

Congratulations!!!
I want to congratulate our Chairman of Radiation Oncology, Dr. Robert K. Brookland, and his department for being awarded a three-year re-accreditation in radiation oncology as the result of a recent review by the American College of Radiology (ACR). Re-accreditation is given to health facilities that meet specific ACR-developed practice guidelines and technical standards, following a stringent peer-review evaluation by board-certified radiation oncologists and medical physicists who are experts in the field. This designation is an honor and reflects GBMC’s ongoing commitment to excellence in cancer care.

GBMC Health Partners at Padonia Update
Since its official opening approximately three weeks ago, our GBMC Health Partners practice at Padonia, has been growing rapidly. This early success could not have been possible without the hard work of many, including Senior Ambulatory Practice Manager, Ericka Easley. Ericka has done an excellent job in leading the team, along with Sarah Whiteford, MD, and making sure that each patient receives the care that we would want for our loved ones. Thank you, Ericka!

Our Democracy is Strong
The United States of America was built on the principle of majority rule. It is very exciting to see so many people exercising their right to vote. We have the right to debate who are the best candidates to lead our government, but once the results are in, the citizens have spoken and we all must accept the results. I ask all my GBMC colleagues to work to bring people together to strengthen our democracy and improve our nation, no matter the results of the election. Thank you.

Being Ready for Your Loved One to be the Patient

GBMC will receive a site visit from the Joint Commission for our triennial accreditation survey in the next few weeks. In the old days, when a hospital thought that the Joint Commission was on the way, it was time to get ready and be on our best behavior. Thankfully, this is no longer the case.

We now realize that accreditation standards are the minimum that an organization needs to meet to deliver good care to those it serves. We all know that GBMC is moving towards its vision of being a community-based system of care that can deliver the best health outcome and the best care experience with the least waste of resources and the most joy for those providing the care. We do this for every patient, every time. This is the care that we want for our own loved ones. So, it is clearly necessary for us to be ready all the time for an accreditation group to give us a check-up. If all our leaders are following our Leadership System, we should always be ready for a Joint Commission Survey. I am very interested to see what we learn when the Joint Commission comes. I am sure that the surveyors will find some areas where we might improve but I am sure that we are ready as an organization. 

This Monday, on the Lean Daily Management walk, I visited the Women’s and Outpatient Surgery Center, the Sherwood General Operating Room, the Post-Anesthesia Care Unit, and the Kroh Endoscopy suite. At every site, these perioperative leaders told me what they were doing to take their units further along the journey towards high reliability. My colleagues were so far away from the old days of having to get ready to meet a minimum standard. On the contrary, it was so exciting for me to hear how highly they were performing and how they were setting the bar higher every day to move us towards our vision. I am humbled by the work of Jack Flowers, MD, Sharon Rossi, RN, John Kuchar, MD, and all their colleagues. They don’t need to be told to “get ready.” They, like their other GBMC colleagues, are ready.

Stroke Center Award
I want to congratulate our Primary Stroke Center which, under the leadership of Michael Sellman, MD, and Aaliyah Franks, RN, was recently selected for the 2020 AHA Gold Plus and Target: Stroke Honor Roll Elite and Type 2 Diabetes Honor Roll. 

These awards recognize our Stroke Center’s commitment to assuring evidence-based stroke care. Great work and congratulations!

Experts Should Be Trusted & Listened To

GBMC uses principles of high reliability to move closer to our vision every day. What does high reliability mean? A simplified version is that what should happen…happens and what shouldn’t happen…doesn’t happen. 

Academicians have studied highly reliable organizations and have found that these entities follow five principles. They are: sensitivity to operations, commitment to resilience, reluctance to simplify explanations of successes and failures, preoccupation with failure, and deference to expertise.

Leaders are in the position to make decisions. Being human, a leader can’t know everything. Smart leaders reflect on their knowledge and capabilities and seek the help of experts when they must make a decision. Governor Hogan should be commended for his work at the beginning of the pandemic. He sought the advice of epidemiologists from Maryland’s universities because he recognized that they had expertise that he did not have. He listened to them and took their advice in crafting Maryland’s plan for confronting the pandemic. Because of this, Maryland has done fairly well in confronting the coronavirus compared to other states where governors made decisions that were not informed by expertise.

Recently, I had an experience in my personal life that underlined for me the importance of seeking the input of experts. I was sitting at the dinner table when I heard a noise coming from the basement. I went downstairs to see what was happening and there was a loud “clicking” sound coming from our heating unit. 

I had no idea what I was hearing, or for that matter, what I was looking at in the component parts of the system. So I reached out to an expert – our Director of Facilities Jim Keyzer. Over the past few years, I have had many conversations with Jim about physical plant issues. I have been in awe of the depth of Jim’s knowledge about heating, plumbing, electrical works, and everything to do with building maintenance. So, I took out my phone and took a video of the heating unit. I then texted the video to Jim. Within minutes, I had a reply from Jim telling me that the noise was coming from the water pump and the most likely broken part that was causing the noise. The next day, I called a heating technician who came, validated Jim’s suspicions, and fixed the problem. 

This incident again reminded me how little I know about so many different topics and how important it is to reach out to experts and follow their advice. Giving deference to expertise is what helps us improve our situation as individuals, as organizations, and as countries. 

When leaders make decisions based on their own beliefs that may not be informed by truth and logic, things don’t go well. 

We are giving deference to expertise in our daily work at GBMC and our progression in achieving our Four Aims is evidence of this!

One family’s work in helping GBMC
Since the start of the COVID-19 pandemic, volunteers have sewn and donated more than 3,900 cloth face masks to GBMC for use by our staff. More than a quarter of these masks have been made by one volunteer – Rita Siwinski! A few weeks ago, Rita reached the 1,000 masks donated mark, which represents about 500 hours of work, not to mention the cost of materials which Rita so generously purchased. I wanted to make you aware of her efforts because she has truly demonstrated what it means to “give back.” During one of the most challenging periods in recent history, Rita’s example has been a bright star for all of us. What is also amazing is that Rita, a former employee, volunteers in the Pharmacy and her husband, Stephen, also volunteers in Spiritual Support. When you see them, please thank them for their ongoing commitment to GBMC!

GBMC Team…Please get your flu shot!
This year, getting a flu shot becomes even more important as the challenges of the COVID-19 pandemic continue. All members of the GBMC workforce are required to be immunized (those few who are excluded for health reasons are required to wear masks during the flu season) to protect our patients. Our next FLU VACCINE EVENT is Monday, October 26, at Employee Health Services. Next week’s schedule is as follows:

• Monday, October 26: 7:30 a.m. – 3:30 p.m.

• Thursday, October 29: 7 a.m. – 3:30 p.m.

• Friday, October 30: 7 a.m. – 3:30 p.m.

• Fridays: 7 a.m. to 3:30 p.m.

Your GBMC ID badge must be presented at flu events. Vaccines are only available at the dates and times listed above, no walk-ins will be accepted at Employee Health Services unless specified above. The deadline to receive the influenza vaccine is October 30. 

Top Docs Again!
GBMC has always been recognized for the quality of our medical staff, which was again confirmed when 143 of our physicians, in 76 specialties, were named in the Baltimore magazine “Top Docs 2020” survey in the November issue. Several of those medical staff members were recognized in more than one category, and some have been recognized many years in a row! 

In preparing its annual list of “Top Doctors,” Baltimore magazine surveyed 13,000 area physicians and asked where they would send members of their own family for specialized care. This important question is at the very center of GBMC’s vision of providing each of our patients with care worthy of our own loved ones.

This year, the magazine also highlighted, Lauren A. Schnaper, MD, FACS, breast surgeon and our former Director of the Sandra & Malcolm Berman Comprehensive Breast Care Center. She was one of six physicians, from a pool of hundreds in the Baltimore area, selected to be profiled.

To all the “Top Doctors” at GBMC, congratulations from all of us! The rest of us in the family are very proud of you. To view a listing of our “Top Doctors” and to learn more about who they are, please visit here. 

Congratulations!!
I am delighted to announce that GBMC, was again a recipient of the Most Wired Hospital award from the College of Healthcare Information Management Executives (CHIME) for both our acute and ambulatory services. We were one of two hospitals in the state to receive two Level 9 Most Wired recognitions, which is no easy task. Many institutions have only been successful on the acute side.

Some of our IT advances include expansive telehealth services to accommodate the COVID-19 pandemic, a fully-integrated patient portal, and real-time data visualization tools. The electronic health record (EHR) can consume discrete data from multiple external entities to ensure continuity of care.

I am very proud of our IT Team in their recent achievement of the Most Wired Hospital award. Let me once again congratulate our information technology professionals and our clinicians on this fabulous accomplishment!

A GBMC Icon Retires

This Friday, October 16, is Keith Poisson’s last day as our Executive Vice President and Chief Operating Officer. He will begin his well-earned retirement on that day. 

Keith came to GBMC in 2007, after serving as Chief Operating Officer at St. Mary's Health Care in Grand Rapids, Michigan, to oversee patient care and support services as Chief Operating Officer of our hospital.  

In 2010, Keith took on much more responsibility as he became Chief Operating Officer for the entire system. In this role, Keith has been the key designer of our system of care, accountable for the day-to-day operations of not only our hospital, but also GBMC Health Partners and Gilchrist. Among Keith’s many accomplishments is his development of the service line model that has put physician leaders, nurse leaders, and administrators in charge of large components of our system. Keith has overseen the strengthening of our strategic planning process and the creation of our strategy deployment process. This work has caused GBMC’s resurgence in surgery, the tremendous growth in the medical sub-specialties, especially in cancer, and the solidification of our position in the market in maternal and child health. With Keith’s calm demeanor and great depth of knowledge about care delivery, GBMC has moved steadily towards our vision. Achieving a second site visit (and potentially achieving the award!) for the Malcolm Baldrige National Quality Award is a fitting testament to Keith’s legacy at GBMC. We would not have gotten this far without Keith’s oversight of the creation of standard work and an accountability model to sustain it. 

Keith has mentored so many young leaders at GBMC and we can thank him for leaving us with the capabilities to keep moving forward as he departs. Keith has been a partner and friend to me and has often given me sage advice just when it was needed most. 

GBMC has been very lucky to have Keith as a leader. He will be missed dearly, and we wish him all the best. Keith is relocating to Hilton Head Island, South Carolina with his wife, Liz. We will welcome Keith back to GBMC for the groundbreaking of our three-story hospital addition, and in recognition of his outstanding contributions to our system, we are naming him as a member of the Promise Project Campaign Committee.

We will never forget Keith and his dedication to GBMC. Please join me in thanking Keith for all that he has done for GBMC, our staff, and our patients. 

Congratulations to Our Lactation Support Team
GBMC was acknowledged recently by the International Board of Lactation Consultant Examiners (IBLCE) and the International Lactation Consultant Association (ILCA) for excellence and dedication in supporting and promoting breastfeeding.

The IBCLC Care Award is reserved for hospitals and community-based facilities that are found to protect, promote, and support the clinical management of breastfeeding, provide regular training for staff members who care for breastfeeding families, and support evidence-based projects. This recognition validates the efforts being made by our multidisciplinary team of nurses, nursing support technicians, lactation consultants, obstetricians, advanced practitioners, neonatologists, pediatricians, and anesthesiologists to help mothers get off to a good start with breastfeeding during their hospital stay, and beyond discharge.

GBMC is one of a few hospitals in the Baltimore region to receive this designation and this is the fourth concurrent two-year cycle since 2014 that GBMC has received the global recognition. Congrats to Jodie Bell, MSN, RNC-LRN, IBCLC, Assistant Director of Women’s & Children’s Services at GBMC, and her colleagues for this achievement.

Thank you!!
Emergency Department nurses never know what patient with what ailment is about to walk through our doors, and they can see many patients in a shift. When a patient comes to our ED, our nurses deal with them quickly and professionally regardless of the patient’s age, illness, or injury.

This week is Emergency Nurses Week (Oct. 11 – 17) and this year’s theme Heart of Gold, signifies the incredible heart that every emergency nurse has and how vitally important they are to hospitals. This is more than evident during these challenging times of COVID-19. Please thank our emergency nurses for their often heroic and compassionate service and for having a “heart of gold."

2020 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. 11-17).

Each day, GBMC security officers help maintain a safe and secure workplace. They can be seen walking or stationed throughout our medical center from the emergency department to labor and delivery. 

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 the strong commitment and diligence they display in the practice of their profession. 

The Affordable Care Act is Again Under Attack

A family member of mine, who would have been uninsurable before the passage of the Affordable Care Act because of a pre-existing condition, recently received a check from his insurance company for $350. It is a small percentage of what he paid for his coverage in 2019, but still, how often does someone get a check from their health insurer?

Well, he got the check because his insurer spent less than 80% of what they collected in premiums paying providers for the care they delivered. And why did they have to pay the money back? Because of the Affordable Care Act (ACA)! 

People know so little about the ACA, called Obamacare by many who want to deride it. The legislation is imperfect, but it has been successful in many ways – requiring health insurance companies not to keep too much premium as profit is one of those ways. 

The future of the ACA is again coming into question with the Supreme Court in its new term, which started this past Monday, and with the Senate looking to act on President Donald Trump's nomination of federal appeals court Judge Amy Coney Barrett to succeed the late Ruth Bader Ginsburg.

For this reason, I wanted to take some time this week to point out the part of the Act that has to do with the medical loss ratio (MLR), or the percentage of premiums that the insurer spends on care. This is a protection for the buyers of health insurance. If an insurer spends less than 80% on care, it owes the insured a refund. 

The purchaser of the policy receives a rebate directly from the insurer through either a check or a reimbursement to the account (credit card, for example) with which the premium was paid. Unfortunately, very few people realize they may be due a refund, so they don't know to look for a check from their insurer. 

There is much more waste in our healthcare system than in most other developed countries, but at least the Affordable Care Act is providing some protection for citizens by keeping insurers from making too much profit at the purchasers’ expense. 

Most Americans support the part of the Act that protects them from being uninsurable for a pre-existing condition and they also like the fact that their children can stay on their insurance until 26, but what do you think about the 80% rule? Would you be upset if it went away? Let me know what you think.

Thank you!!
My sincere thanks to all of you for your role during our Baldrige survey last week. I think it went well, and all we can do now is wait as the examiners complete their work and submit their report to the program judges. The judges will then evaluate our application and determine whether we meet the criteria to be recognized as Baldrige Award recipients. It is possible that if we don’t receive the award we might be Category Best Practice recipients again. In mid-November we will be notified and in December, we’ll receive a comprehensive feedback report from which we can continue to learn and improve.

GBMC has been using the Baldrige criteria to build systems. Regardless of the outcome, I’m so proud of all of you! GBMC HealthCare is improving in all areas, which means we are getting closer to achieving what is embodied in our vision phrase: “To every patient, every time, we will provide the care that we would want for our own loved ones.”

Again, my sincere thanks again for all your hard work and dedication for the sake of our patients and the community.

Let’s celebrate our colleagues!!

This week is Healthcare Supply Chain Week (Oct. 4-10), which celebrates resource and materials management professionals for their important contributions to healthcare. We all benefit from the work of our entire supply chain team. 

I am proud to recognize the great work of our pediatric nurses as this week is also Pediatric Nurses Week (Oct. 5-9). Our pediatric nurses, to me, are a special group of medical professionals who provide care and compassion to young patients and do critical work to improve healthcare delivery. Pediatric nurses face many challenges; they have to speak with children, pinpoint their pains, and manage fears. If you’ve had young loved one in the hospital, then you can understand the challenges that can come with this career choice. So, thank you to our pediatric nurses that constantly deliver the care that we would want for our own loved ones no matter how challenging their work can become. 

It is also Healthcare Foodservice Week (Oct. 5-11). I would like to express my gratitude to the men and women who work hard to keep our patients and colleagues fed. 

Thanks to all GBMC physician assistants (PAs) this week during National PA Week (Oct. 6-12). This is the week when PAs celebrate their profession and showcase the value they bring to today’s healthcare team. I am so grateful for their hard work!

A Discussion with a National Hero

This morning, I had the honor of serving as the host for a virtual question and answer session, with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) and member of the White House Coronavirus Task Force.

This was a unique opportunity to discuss COVID-19, our healthcare system, and our response to the global pandemic with Dr. Fauci, a world leader in infectious diseases. He addressed several issues ranging from updates about a vaccine and the possibility of other treatments for the coronavirus to the challenges schools have encountered due to COVID-19 and lessons learned in preventing future infectious disease surges. You can watch the video here.

I want to express my appreciation to Dr. Fauci for his participation in today’s event. Today also happens to be the 55th Birthday of the Greater Baltimore Medical Center (How cool is that?!). But most of all I want to thank him for his years of service to our country, most notably during the AIDS epidemic and for his guidance now during the COVID-19 pandemic. His calm reliance on the scientific evidence has been invaluable.

I would like to thank the GBMC community for providing the questions before-hand and for watching today’s event. I also want to offer my gratitude to Rebecca Barnes, one of our campaign project managers in our Philanthropy Department for securing Dr. Fauci’s involvement and to our marketing department for coordinating this incredible event. Thank you! 

One step closer?
This week we hosted a virtual site visit with examiners from the Malcolm Baldrige National Quality Award! This year, due to COVID-19, the process could not be done in person, yet despite this change, the examiners were able to speak with us to validate the information we submitted in our application. 

Like last year, they reviewed all three of our work systems: Greater Baltimore Medical Center, Gilchrist, and GBMC Health Partners. Everyone did a WONDERFUL job in telling them our story and for that I am so grateful and proud of all of you! I cannot name all of those who worked so hard to make the examiners’ visit a huge success, but I need to thank, Carolyn Candiello, Vice President for Quality and Patient Safety, Keith Poisson, Chief Operating Officer, Lisa Groff Reuschling, RN, Clinical Director Women and Child Health, Shelby Davis, Quality Outcomes Analyst, and Zebe Jacobson, Quality Improvement Resolution Specialist, who spent countless hours assuring that the survey went off without a hitch!

Now that the visit is over, the examiners will file a report that will be reviewed by the Baldrige judges, who will determine if we have achieved the award. This has been a tough year for all of us, and it would be great to have a celebration after we hear in mid-November. Until then, all we can do is wait and be proud of what we have accomplished together.

Epic Turns Four at GBMC

I can’t believe that this past Thursday (Oct. 1) was the four-year anniversary of our “flipping the switch” and going live with Epic – our electronic medical record (EMR) across the GBMC HealthCare System. It is clear that “one patient, one record” has been a huge change accelerator for us. 

Since 2016, our Epic program has received some of the highest honors possible. Earlier this year, I was proud to announce that we received the prestigious Summa Cum Laude designation, the highest level of achievement for Epic users in Epic’s Honor Roll Good Maintenance Grant Program, and we achieved a score of 9 out of 10 on the Epic Gold Star program. The Gold Star program exists to incentivize Epic users to get the most out of the software’s capabilities. In late 2019, we also achieved the Davies Award of Excellence, the highest achievement for the use of electronic records from the Healthcare Information and Management Systems Society (HIMSS), and for the first time the Surescripts White Coat Award. This award acknowledged our organization’s ability to positively impact patient safety, increase speed to therapy, and improve first-fill adherence and patient satisfaction by improving e-prescription accuracy.  

These are only a few of the recognitions we have received over the years that clearly illustrate our success with Epic. Without question, these achievements are due to the commitment and effort of the GBMC staff, which includes our highly skilled team of physicians, nurses, other clinicians, and IT professionals. I want to thank all my GBMC colleagues for so many achievements in such a short period of time. 

Using Artificial Intelligence to Help the Clinician Make the Right Decision

Physicians and Advanced Practitioners work hard to make the correct diagnosis and help each patient. They use their knowledge and experience to decide what information to gather, but we are all human and imperfect. No one can know everything, and everyone has biases in their reasoning. 

There are many studies showing that clinicians often don’t order the best imaging studies given the patient’s signs and symptoms. Sophisticated imaging studies like CT scans and MRI’s are priced fairly high because of the many associated expenses, and therefore the total cost to payers is enormous. When an inappropriate test is ordered, it is a prime example of waste. 

The Protecting Access to Medicare Act (PAMA) of 2014 established a program to increase the rate of appropriate advanced diagnostic imaging studies provided to Medicare beneficiaries. Examples of advanced imaging studies include:

• Computed tomography (CT)
• Positron emission tomography (PET)
• Nuclear medicine, and
• Magnetic resonance imaging (MRI).

The legislation requires that whenever a practitioner orders an advanced imaging study, he or she must use “a qualified Clinical Decision Support Mechanism (CDSM) with appropriate use criteria (AUC).” The CDSM is an interactive electronic tool that provides a determination of whether the order adheres to the AUC. It takes the input from the clinician and provides analysis and feedback to the ordering provider about whether the test is appropriate. This requirement is currently in the testing and education phase and will be fully implemented in January 2022.

At GBMC, we have used our core competency of redesigning care and made numerous enhancements to our CDSM/AUC workflow. By analyzing our data, we identified that the use of “free text” indications accounted for most of the non-compliant/indeterminate orders. We learned from discussion with providers that the “free text” field is used when a patient's condition did not match the available displayed diagnosis. We also learned that it is used to provide additional clinically-relevant information to the radiologist reading the study.

By working with the vendor of our CDSM software, we deployed their artificial intelligence tool to streamline the ordering workflow and to move us closer to our aim of increasing the rate of appropriate advanced imaging studies. The new artificial intelligence tool reads the “free text” field and presents discrete diagnoses to the provider so that he or she can pick one during the process of ordering advanced imaging tests. The pilot was done with providers in the Emergency Department because they had the highest utilization of the “free text” field. 

The chart below shows the “special cause” improvement in reducing the number of indeterminate studies in the pilot. This test of the use of level 2 mistake proofing  (a reminder in the moment or an affordance) shows that the use of artificial intelligence significantly improved ordering. 

My hat goes off to my colleagues in Radiology and in the Emergency Department for this great use of the Model for Improvement in moving us closer to our vision! 

Wash Your Hands

This week is International Clean Hands Week. It’s a good time to remind ourselves of the importance of good hand cleaning habits. We all know that proper hand hygiene is one of the most effective actions to reduce the spread of pathogens and prevent infections, including the COVID-19 virus. So please, wash your hands. Thank you!

Visual Prompts & Level 2 Mistake Proofing

Our daily lives seem to be getting more and more complex. We must remember so many things (taking our car keys, remembering all of our passwords, etc.) it is no wonder that we make mistakes. It is difficult to remember things that we don’t do regularly. With all the distractions that come at us daily, we frequently “slip” and forget to do something. 

When that the “slip” is minor (recently I had to return to my office to get my car keys before heading home) we shouldn’t worry about it too much. But, if the error could result in significant harm to someone, then that is a different story. 

Experts in safety list THREE levels of error prevention. The first level is education. So, when a young clinician or nurse forgets to do something, we might meet with them and remind them of the importance of the task that they did not do. If, in fact, they did not know the importance of the task, this may solve the problem. However, if they already knew of the importance, but got distracted in their work and just forgot to do it, then re-educating them about the task is not a very powerful way to prevent the “slip” from re-occurring. 

The second level of mistake proofing includes reminders in the moment. In the example of the clinician or nurse who forgot to do something important, this may be a BPA (best practice alert) that flashes on their computer screen to remind them to do something. It makes it harder to forget. Unfortunately, the clinician could ignore the alert (perhaps because he or she is getting too many alerts) or could see the alert, intend to do the work, but then get distracted and not complete the task. These reminders in the moment are sometimes called affordances. 

I am writing again about mistake proofing in this week’s blog because I saw three interesting uses of affordances on rounds this week. The first two were clever ways to get people to clean their hands before entering a patient’s room. The second was on the floor in the corridor outside of the Pediatric ED, in a place where people frequently leave beds, stretchers, and wheelchairs. This is a serious safety hazard. If there was a fire and we had to quickly move children out of the ED, we would have to move the misplaced equipment first. Recently, we put red tape on the floor in the places where the equipment is usually left. This is a great test of change. We believe that the red tape on the floor in front of the medical gas shutoff valves is the main reason why people don’t block the valves with equipment. Why not try the same method to keep equipment from being left in a narrow corridor? Please see the photos of the three new affordances that I saw this week below.

The third level of mistake proofing is the most powerful. It blocks the error by not letting you get to the next step without doing the important task. Think of a device on my office door where it would not let me open the door to leave unless I had my car keys in my pocket. A real-life example of this happens when you try to buy something online, but forget to enter the CVV number. The software won’t let you get to the next step. Level 3 mistake proofing methods are often called constraints. The more serious the potential harm from an error, the more important it is to get to level THREE. 

Let’s celebrate our outstanding Environmental Service Workers
This week is Environmental Services (EVS) and Housekeeping Week (Sept. 13—19) and I want to take time to recognize the contributions of our EVS staff. They work very hard to keep our facilities clean. In the face of COVID-19, our hospital colleagues have displayed an unwavering commitment to the health and safety of our patients and each other. They are playing a vital role in keeping everyone safe through proper cleaning and disinfecting.

Cleanliness is everyone’s job at GBMC, but our EVS staff members are the experts in cleaning and work tirelessly to get the job done. There are over 100 EVS associates working around-the-clock at GBMC in a variety of roles, servicing over 1.2 million square feet of facility. So, please join me in honoring all the men and women of EVS!

Neonatal Nurses Day...
This past Tuesday (9/15) was Neonatal Nurses Day. It’s a day to honor our nursing colleagues who care for our tiniest and most vulnerable patients. With more than 4,500 babies born at GBMC annually, we are very fortunate to have such a fabulous NICU team. Please join me in thanking them.

The Pandemic and the Complexities of Life

This week, many schools started the new academic year with virtual learning -- a situation that leaves many working parents trying to figure out how to work and take care of their children simultaneously. When the coronavirus outbreak led to school closures in the spring, parents had to figure out how to do their jobs while taking on the added roles of teacher, tutor, and at times, IT technician. We learned that managing the education of children without the help of schools is difficult for both parents and their children, especially for special education and elementary school students. 

My life has clearly been affected by the pandemic. At work, there are new issues to deal with that we haven’t encountered before, like the availability of test kits and personal protective equipment. But I have seen some upside in my time out of the hospital. During a typical late summer/early fall, I am at meetings and events at least three nights per week. This year, I am at home on those evenings since events and meetings are all virtual. This is clearly a benefit that allows me to better deal with what is happening at work. And, my children are adults, so I don’t have the added pressure of managing their education in addition to my “day job.” 

This is not the case for many of my GBMC colleagues, especially those who can’t work from home, which includes almost all of our clinicians. Somehow, they must keep “all the balls in the air” while juggling work and childcare responsibilities. And it’s no easy task for those who are able to work from home either. My colleague, Jenny Coldiron, our Vice President for Philanthropy and Marketing and Communications, told me that she was at a virtual meeting with a vendor this week, discussing a virtual event for this winter. During a one-hour meeting, the vendor was interrupted multiple times by her 6-year-old daughter who came into the room to say “Mommy, the computer isn’t working.” 

I understand how these pressures are pushing some to consider leaving the workforce until the pandemic is over. We are already having a difficult time staffing some areas. This has led me to wonder if there is something more that the GBMC HealthCare System can do as an employer that it isn’t already doing. I would love to hear your thoughts on this. Please comment below.

Let me end by thanking everyone for your efforts during the pandemic. I especially want to thank my colleagues who are parents of school-age children!

Remembering 9-11
As we remember the terrible tragedy that occurred 19 years ago on September 11 and the brave first responders who showed tremendous heroism in the hours, days and weeks thereafter, please remember to honor those whose lives were lost and to recognize the work of our first responders. When emergencies happen, they always answer the call. Thank you!