Planning for the Future of Maryland Healthcare

On Monday, I had the opportunity to sit down and have a great discussion with leaders from the Maryland Department of Health (MDH), Maryland Hospital Association (MHA), and several local health systems. I was grateful that I was included with Dr. Laura Herrera Scott, MDH Health Secretary, and Erin McMullen, MDH Chief of Staff, in this conversation with my peers from Luminis Health, Frederick Health, TidalHealth, Johns Hopkins Health System, MedStar Health, and University of Maryland Medical System.

Each of our medical institutions is different, ranging from academic medical centers to rural community hospitals. Though we all face similar hurdles in this healthcare landscape, we also each have unique barriers and concerns. The purpose of our gathering was to identify strategies to address care delivery challenges and to build a vision for the next phase of Maryland's Total Cost of Care All-Payer Model, also known as the “Maryland Model.” 

The Maryland Model is a unique payment system in which hospitals are paid a fixed amount of money for the services they provide, rather than being paid for each individual service or procedure with no limit. This model is intended to control costs and improve the quality of care by incentivizing hospitals to provide efficient, effective care rather than simply selling individual services.

This model aims to truly incentivize what is best for patients – like effectively managing chronic illnesses to keep patients out of the hospital and providing the best care possible in the most appropriate setting. Some organizations, like GBMC, have used the revenue to build a system that can keep people out of the hospital. Others have not. So, there are clearly things we may do differently to make this model more successful.

Regardless of the differences in our healthcare organizations, we must be united in improving the health of those we serve, improving the care experience, and reducing cost. During the meeting, we talked through ways to address issues within our health systems, like behavioral health capacity; post-acute utilization, including opportunities to address discharge delays; care management concerns; and hospital utilization needs. These types of broad and inclusive conversations are critical in helping the state map out how to truly transform the healthcare system and provide better care to our communities.

Women of Impact Awards

On Tuesday, I had the privilege of helping to present our inaugural Women of Impact Awards. Congratulations to the following winners whose contributions are making an impact on the greater GBMC community.

Inclusion Champion Award

• Krystina Wales, Associate Director of Direct Response Marketing, GBMC
• Erlene Washington, Vice President and Chief Operating Officer of GBMC Health Partners

Leadership Award

• Leticia Armstrong, Senior Manager of Imaging Services, GBMC
• Theresa Nguyen, MD, Chair of Pediatrics, GBMC
• Lisa Walker, Chief Diversity & Learning Officer, GBMC

Lifelong Learner Award

• Evelyn “Eve” Bowmaster, Director of Quality and Patient Safety, Ambulatory Services, GBMC Health Partners

Mentor Award

• Leana Hoover, Chief Integration Officer, Gilchrist
• Rachel Weitzner, Associate Director of Jewish Care and Support, Gilchrist

Unsung Hero Award

• LaKesha Horsey, Anesthesia Supervisor, GBMC
• Jamie Sokolis, SAFE/DV Interventionist, GBMC

I’d also like to congratulate all of our Women of Impact Award nominees and thank everyone who took time to nominate a colleague. We are proud of all the remarkable women who are part of our workforce and who help us accomplish our vision of providing the care we would want for our loved ones. Thank you to Lisa Walker, Chief Diversity and Learning Officer; Angela Wu, Diversity Equity and Inclusion Manager; and JaRee Walker, Senior Organization Development and Change Consultant, as well as the Diversity, Equity, and Inclusion Planning Committee for organizing the event, awards, and all the robust activities for Women’s History Month.

Congratulations to the Supply Chain Team

For the second year in a row, GBMC HealthCare has been recognized by healthcare supply chain leader Global Healthcare Exchange (GHX) as a “Best 50” healthcare provider. This list recognizes the top performing hospitals and health systems in North America based on their ability to improve operational performance and drive down costs through supply chain automation, with honorees selected from more than 4,100 provider organizations connected to the GHX digital trading platform.

Congratulations and thank you to Brian Riemer, Director of Supply Chain, and to our entire supply chain team, for ensuring our clinicians are well equipped with the supplies needed to provide safe patient care.

Happy Doctors’ Day!

This Doctors’ Day, we extend our deepest gratitude for the dedication and skill that our physicians bring to GBMC every day. Their devotion to patients reverberates throughout the community. Thank you to all our physicians for going above and beyond with gestures large and small to provide truly personalized care to our patients.

Honoring a Member of the GBMC HealthCare Family

Mary Mangione, a beloved member of the GBMC HealthCare family, passed away on March 15. We will always remember her for her warmth, generosity, and devotion to her loved ones. Her transformational impact will be felt by GBMC HealthCare and this community for generations to come. We are eternally grateful for the advocacy, friendship, and support of Mary and the entire Mangione family through the years.

Celebrating the Women of GBMC HealthCare

Throughout March, we have been celebrating Women’s History Month across our healthcare system. It is notable that according to our most recent Equal Employment Opportunity Commission (EEOC) data, women comprise about 81% of our total workforce at GBMC HealthCare, and 63% of our leadership group are women.

Our Diversity and Inclusion Planning Committee did not disappoint in finding ways to celebrate our very own inspirational women! During the course of the month, we have shared “Women of GBMC HealthCare” profiles as a way for our staff to get to know our team – we even followed up with trivia so employees could see what they remembered about their colleagues after reading. You can view the profiles by clicking these links:

• Women of GBMC HealthCare Profiles, Batch 1
• Women of GBMC HealthCare Profiles, Batch 2

The committee also hosted two webinars and will hold an in-person Women’s History Month networking lunch next week. During the lunch, we will announce the winners of our inaugural Women of Impact Awards to recognize women who are influencing the greater GBMC community through mentorship, learning, leadership, inclusion, and more. Check back next week when I will share the winners of each award.

Thanking Our Social Workers

March is National Social Work Month! Our social workers are the link between patients’ care in our system and beyond. I am grateful to all our social workers, who work tirelessly to break barriers by advocating for our patients' needs and connecting them to resources. If you are interested in becoming a social worker at GBMC, visit www.gbmc.org/careers.

Observing LGBTQ+ Health Awareness Week

March 20-24 is LGBTQ+ Health Awareness Week, which aims to address health disparities and barriers to accessing services for the LGBTQ+ community. At GBMC HealthCare, we are committed to understanding the needs of our LGBTQ+ patients and utilizing best-practice strategies to create affirming care experiences for them.

We Are Patient Safety!

 March 12-18 is National Patient Safety Awareness Week. Though the healthcare industry is currently facing many challenges, we cannot lose sight of maximizing patient safety and health outcomes. Our aim of the Best Health Outcomes is our preeminent aim. In recognition of this important awareness week, I’ve invited Carolyn Candiello, our Vice President of Quality and Patient Safety, to be a guest blogger. Thank you, Carolyn, for sharing your thoughts on this important topic!

This is National Patient Safety Awareness Week, and the theme this year is “We are Patient Safety!” I like to think this epitomizes GBMC – together, we all work to provide the care we would want for our loved ones – safe, reliable, and compassionate, with the least amount of waste and the most joy for those providing the care.  

The past few years have been especially difficult, and even though COVID-19 is (somewhat) in our rearview mirror, there are still challenges – staffing shortages, increased chronic health issues, behavioral health needs, the economy, and growing concerns of violence. Our public health infrastructure is stressed seemingly to its limits. But I am an optimist because of the organization I work for and the people I have the honor to serve with.  

This past weekend as administrator on call, I rounded on hospital units.  I was inspired by the positivity and enthusiasm I encountered as I talked with staff and students.  I am incredibly grateful for the dedication and perseverance demonstrated by our team over the past three years and encouraged by the unwavering commitment I continue to see towards our patients.  We will meet these challenges in the coming months as we work together toward our vision.  

GBMC is a leader in patient safety and population health. We have spent the last decade building an infrastructure to meet chronic health issues head on in patient-centered medical homes, exceeding national benchmarks. Our culture of safety continues to strengthen, and we are laser focused on improving health outcomes, addressing the nursing shortage, and stopping workplace violence.   

We have recently upgraded our incident reporting system, the STAR tool, and I am proud to say staff members are reporting in greater numbers than ever before. This reflects a strong safety culture where employees feel safe speaking up when care might be compromised. 

In April, we will celebrate ten years of conducting Lean Management rounds, measuring incidents of patient harm each day. This includes hospital-acquired infections, complications, and serious adverse events, such as falls and pressure injuries. I am proud to report we are improving – we are better than last year at this time and are on track to achieve our goal for fiscal year 2023. We have gone more than three months without a serious hospital-acquired pressure injury and had many zero-harm months related to surgical site and other hospital-acquired infections.  There has been marked improvement in our Maryland Hospital Acquired Infections. Our primary care practices are achieving excellent results in addressing chronic diseases such as diabetes and obesity and we are meeting all our Gilchrist safety goals this year for adverse events, falls, and medication errors. These improvements happen because our clinicians use the science of improvement to design, implement, and sustain the use of evidence-based standard work.  

I’m excited to report our quality and safety leaders have created some great ways to share learning this week. Be on the lookout for ways to participate in your email and in Pulse!  

If you have ideas for how we can continue to make care safer both in our healthcare system and on a national level, please reach out to me. I’d like to foster more dialogue. We will all be patients at some point in our lives. Let’s continue to work together to make things better, because after all, “We are Patient Safety.”

Thank you for all you do every day to make our system of care reliable and safe as we provide the care we would want for ourselves and for our loved ones!

I’d also like to take a moment to recognize a couple of additional departments and disciplines within our healthcare system. This week is National Pulmonary Rehab Week, so please be sure to thank our pulmonologists and respiratory therapists for the impact they make on our patients’ lives. They help patients who are suffering from lung disease acquire increased endurance, strength, and a better quality of life. Thanks to them, many of our patients are able to take on and complete daily tasks that can be strenuous to someone living with shortness of breath.

And, in honor of Healthcare Human Resources Week, I’d like to extend my gratitude to our Human Resources team for their ongoing contribution to GBMC each day as we work toward our vision of providing every patient, every time with the care we would want for our loved ones.

Working with Community Partners to Create a More Value-Driven and Equitable Healthcare System

In February 2022, GBMC HealthCare received the Maryland Community Health Resources Commission (CHRC) Pathways to Health Equity grant*. We are fortunate to partner with about a dozen community organizations who have been chosen to help address our patients' social determinants of health. The grant supports innovative programs designed to achieve equitable access to healthcare and reduce health disparities.

The grant allows us to focus on medically underserved communities in Baltimore City, and the ways we are making care more accessible are two-fold:

• Through our GBMC Health Partners Jonestown primary care practice, where we offer flexible hours, an on-site laboratory, 24/7 online portal access, and even rides to and from appointments if transportation is a barrier
• Through our Gilchrist Elder Medical Care program, which offers care to those who are 55+ with chronic disease in the comfort of home

With the help of our partners, we’re also able to connect city residents with resources like fresh groceries, fitness programs, legal and insurance help, mental health services, wellness programs, transportation, and more. By improving access to medical care and lifestyle resources, we reduce the barriers to achieving better health and address chronic diseases such as diabetes, hypertension, and obesity that contribute to avoidable hospital visits and shortened life expectancy.

Last week, I had the opportunity to sit down with our Baltimore City community partners to talk about our efforts and how we can continue to get the word out about this opportunity for residents of Baltimore City. I was grateful for this chance because it was the first time we’ve all been able to come together in person, in the same space for a valuable conversation about our organizations and how we can take action to build trust in the neighborhoods we serve. I look forward to continuing to build relationships with these wonderful organizations as we take the next steps for the community.

I’d like to take a moment to recognize and thank my GBMC HealthCare colleagues who are leading this effort: Cathy Hamel, President of Gilchrist and Executive Vice President of Continuing Care;
Erlene Washington, Vice President and Chief Operating Officer of GBMC Health Partners; Karen Thompkins, Director of Community Partnerships; and Wayman Scott, Associate Director of DEI and Community Relations.

I would also like to extend my sincere gratitude to our Pathways grant community partners: 

• Live Chair Health
• Bmore Community Food
• The Mr. Mack Lewis Foundation
• Living Classrooms Foundation
• Maryland Volunteer Lawyers Service
• GEDCO
• City Springs Elementary/Middle School
• Helping Up Mission
• Morgan State University School of Social Work

*This program is funded in part by the Maryland General Assembly as part of the Maryland Health Equity Resource Act. Grant funding is administered by the Maryland Community Health Resources Commission. For more information, please visit: https://health.maryland.gov/mchrc/Pages/herc.aspx. The views presented here are those of the grantee organization and not necessarily those of the Commission, its Commissioners, or its staff.

What Is Really Causing Longer Emergency Room Wait Times?

 A couple of weeks ago, our Chair of Emergency Medicine, Jeff Sternlicht, MD, was asked to testify on a healthcare bill that would create a task force on reducing emergency department wait times. Dr. Sternlicht is an expert who’s been practicing emergency medicine in Maryland for more than 25 years.

Hospitals across the country struggle with emergency department overcrowding and long wait times. Unfortunately, data from the Centers for Medicare and Medicaid Services shows that Maryland’s wait times are the longest. It’s a topic I covered in detail in my post “Why Do People Wait in Emergency Departments” back in 2017 but warrants revisiting.

Often, people think long wait times exist because of barriers within the Emergency Department itself, but that isn’t the case. It’s actually a much broader issue.

The diagram below, which was created by the Robert Wood Johnson Foundation, helps explain reasons people wait in emergency departments:

Wait times increase when:

• The number of patients arriving to be seen increases (input)
• Anything slows down the assessment and treatment of patients (throughput)
• Anything prevents patient departure (output)

At GBMC, we have redesigned many of our systems to make the process more effective and efficient. Our primary care teams have addressed input by improving accessibility so patients with needs that aren’t true emergencies can be seen easily either by telemedicine or in primary care offices. And, our emergency medicine teams have done an incredible job of optimizing throughput to ensure patients are assessed and treated as quickly as possible. 

As Dr. Sternlicht (and many other experts) testified on February 21, the real culprit in ED waiting is the output of patients. While some of these output backlogs can be attributed to processes for discharging patients that are ready to leave the hospital, many challenges are often outside of the hospital’s control. 

Dr. Sternlicht and his peers across the industry shared the following challenges with our legislature:

• The lack of state-wide resources/facilities for behavioral health patients results in behavioral health patients occupying ED rooms for days, weeks, or months. 
• Admitted patients who must “board” in the emergency room due to lack of inpatient beds at GBMC or mental health facilities diverts the limited staff and space away from newly arriving patients.
• The current nursing shortage results in physical beds remaining open due to lack of nursing staff. 
• Our population is aging & illnesses are more complex than they were 20 years ago. We need to be having more conversations about advance care planning and discussions of end-of-life care so that patients consider the option of hospice versus spending their final days in the hospital. 
• We have had closures of critical pediatric beds.
• There is an evolving physician shortage. Fewer physicians are training to specialize in emergency medicine and the payment system is limiting the availability of primary care physicians.
• Moral injury & burnout have accelerated medical professionals' decisions to leave the field of emergency medicine. 

Thank you, Dr. Sternlicht, for sharing your expertise and advocating for emergency services so that we can provide the very best care for patients.

We appreciate the work of the lawmakers who are helping to bring these concerns to the forefront and look forward to working with our state healthcare agencies to be part of the solution. 

Thanking our Hospitalists

National Hospitalist Day was March 2! Hospitalists provide comprehensive, general medical care to hospital patients 24/7 during their stay. I am thankful to our hospitalists for helping to ensure our patients get the care that we would want for our own loved ones.