Further Engaging Our Hard-working Physicians

Earlier this week I had the opportunity to speak at the triennial medical staff meeting about the state of GBMC. I thanked our physicians for their hard work in taking care of patients and also for helping us to be the financially strong organization that we are. We finished the year with a 1.9% operating margin for our system….which is better than what we budgeted. I also shared the results of our annual Physician Satisfaction Survey. The survey showed increased satisfaction among physicians in GBMC’s nursing care, in the overall quality of our care at the hospital, and a small increase in the ease of practice at the hospital. In areas affected by our implementation of CPOE, the speed with which orders are carried out and in the access to information, our scores went up significantly.

Unfortunately, I also had to tell them that in the area of communication and collaboration, our scores went down. The results are not uniform across all members of the staff. In some departments, our scores went up, but in some, they went down. I had to ask myself the question was it really our inability to communicate well with everyone or was it the message?

Our new strategy is about better coordinated care and we cannot do this without building a strong network of primary care providers. So, I have spent a lot of time working with primary care doctors and talking about primary care. I have not spent enough time with our surgeons, and some other specialists and engaging them in dialogue about our future. So, at the meeting, I told the staff that I and the senior leadership team of the system were going to redouble our efforts to hear from them. We will meet with our clinical department chairs individually at regular intervals and we will go to Department meetings.  I welcome any physician that has an idea about how we can make it easier to provide exceptional care to our community, to come and speak with his or her department chair or me.

GBMC grew up as a place for private practicing physicians to practice good medicine. It is becoming more and more important that we act together to bring even better value to those we are serving. This is not possible if everyone is doing their own thing. We need a tighter alliance to make things better for our patients and to make the practice of medicine more fulfilling while maintaining its financial viability. Large complex organizations can’t move forward without a hierarchy and a chain of command that includes strong physician leaders – thankfully we have such individuals in John Saunders, Jr., M.D. (Vice President of Medical Affairs), Harold Tucker, M.D. (Chief of Staff), and our department chairs.

We need to have a tighter affiliation with physicians, and the physicians need to understand that they are part of the team.  Physicians have to be in the mindset that if they have an idea they should go to their department chair and it’s the department chair’s responsibility to feel empowered to change things or kick things upstairs, if they are beyond their control. Hierarchy is not a bad word, it’s a way of making a complex organization work, and we have to narrow the distance between those doing the work of patient care and the organization’s senior leaders.  

We’re looking to our physicians to bring forward ideas.  For example, Dr. Bill Crawley, our division chief of plastic surgery, recently suggested that we begin offering microvascular reconstructive surgery and we are making investments in getting that program started.  That’s one example of how we have to plan together and be able to hold each other accountable if we are going to get to better health, and better care at a lower cost.

We’ll be investing a lot of time and effort in this in the coming months, working through and with department chairs and division chiefs, to make this happen.

I look forward to hearing from physicians and others about how the organization can further engage doctors and strengthen the relationship with senior management. Please share your thoughts by commenting below.

This weekend, I will be flying to San Diego to the American Hospital Association meeting to be present for the Circle of Life Award presentation to Gilchrist Hospice Care and Gilchrist Greater Living. I will share that experience in the blog next week.

New Year, New Vision, A Need for More and Faster Improvement

The New Year is always a good time to reflect on what you have accomplished and what you strive to do better. With July 1 being the start of GBMC’s fiscal year, it’s important to look back on last year’s goals – We had a good year, we remain financially strong, we hit some goals right on, yet there are other goals that still need more of our focus. It’s a new year with a new strategy, new operating plan and goals designed to address this important question - Are we getting closer to our vision of treating everybody, every time with the care we would want for our own loved ones?

It’s clear to me that in order to achieve this vision, we have to get better at executing change – change through the eyes of our patients. We place a great deal of emphasis on patient satisfaction scores, and over the past year we’ve made some progress thanks to measures put into place to improve our patients’ experiences…but we need to make the breakthrough changes that will really matter most. So to start, our goals this year about improving the patient experience will be more focused on the most meaningful things to patients, questions like “Was I included in decisions around my care?” And we know that to best understand and appreciate the experience we cannot lose sight of what it is like to be a patient in a hospital.

So, in developing the patient experience and satisfaction goals for this year, we did something a little different. Unlike last year where the senior management team drove the goals, this year we asked the Quality Committee of our Board of Directors to take the lead on creating our goals. A sub-committee was formed that included a number of our physicians and nurses who brought an important perspective to the table as they developed the clinical outcomes and patient experience goals. These providers at the bedside know and understand what the patients need and how to make their experience better.

Our goals this year are again in four areas:
  - Better health outcomes
  - Better [patient] satisfaction with the care experience
  - Less waste and lower costs
  - More joy for those providing the care [employee and physician satisfaction]

This year, we need to get more ownership of our goals by every member of the GBMC family. We must have everyone in action. To this end, the Senior Management Team is working with their people to develop departmental and unit level goals that will drive attainment of the system goals.  

Everyone at GBMC has the ability to create positive change through the eyes of our patients.  But we have to take action, because if it’s just talk and nothing changes, then we will never get closer to our vision.

So I need you – our staff on the front lines of patient care – to tell me:
How can we improve our care even faster than we have in the past?

What do you need and what can I do to help you create better health, and better care, with more staff joy at lower cost?

Please share your thoughts by commenting below…I look forward to the dialogue!

Changing of the Guard

We are fortunate at GBMC to have truly great leaders who believe strongly in the mission of GBMC and in its vision for the future. We have leaders who are undoubtedly passionate about GBMC and believe fervently in ensuring the success of our community’s hospital and health system for generations to come. And as one great leader’s term comes to an end, another takes the reins as Chairman of the HealthCare Board of Directors for GBMC. I am so grateful for the service our outgoing Chairman, Charlie Fenwick, has given and look forward to working with our new Chairman, Harry Johnson, another example of a great leader and community advocate. 

I met both Charlie and Harry when I interviewed for the CEO position a little more than a year ago and both made an indelible impression on me even then. As I have had the opportunity to get to know both of these men quite well over the past year, I realize that both Charlie and Harry share something very special in common – a love for GBMC and a commitment to giving of themselves to benefit others in the community.

Charlie Fenwick…Now here’s a man who has accomplished a lot in his life. Like any great equestrian, Charlie approaches life with passion.  He is one of only two Americans to have won the prestigious English Grand National steeplechase race as well as many other horse racing honors including the Maryland Hunt Cup (which he won five times) and the Grand National Steeplechase (which he won 10 times!). Charlie and his family have strong roots in the community and he has spent a good part of his life training and racing horses in Maryland. And when he’s not racing, he’s busy running a very successful business - Valley Motors. Charlie has served as President of the Board of Trustees of The Gilman School as well as the director of the Land Preservation Trust, which works to preserve open spaces in Baltimore County. One of the Trust’s first projects was to create the Shawan Downs steeplechase course in Hunt Valley as a legacy for future equestrians. In fact, thanks to Charlie’s work, GBMC has been the recipient of proceeds from the annual Shawan Downs Legacy Chase event for the past 10 years.

Charlie has served on the GBMC Board since 1999 and has been an inspiring and strong leader since becoming Chairman in 2007. In addition to knowing Charlie as a true professional, I am also thankful for his friendship. He is as giving as a friend as he is as a community leader. Charlie has helped me and my family get oriented to Baltimore and since I’ve known him, he’s been a guiding light for GBMC.

GBMC’s new Chairman of the Board, Harry Johnson, is a very passionate man who has also accomplished a great deal in his life.  Harry, a partner at the law firm of Whiteford, Taylor & Preston, has become one of the most distinguished attorneys in Maryland. He is a past President of the Maryland State Bar Association and serves on a number of prestigious committees of the American Bar Association. Harry has served a myriad of community organizations through the years. He has been involved with GBMC since the mid 1980s as a lawyer handling medical negligence cases on behalf of GBMC and its physicians. In March of 2000, he joined the GBMC Foundation Board of Directors and was then asked to join the GBMC HealthCare Board because of his excellent leadership and commitment. Harry is clearly a man who gets things done and is keenly focused on fulfilling GBMC’s new strategic plan and moving the organization forward, helping us continue to be committed to providing the best medical care to our community.  

Both Charlie Fenwick and Harry Johnson share a love for GBMC and for giving back to the community. We’re fortunate to have them as part of our team. I’m truly grateful for Charlie’s guidance and service and I’m looking forward to the next chapter with Harry at the helm.

Wishing everyone a safe and happy Independence Day…

Thanks for Helping Save the Lives of Babies

We frequently talk about GBMC’s top-rate cancer care, women’s services and our Emergency Department, but we don’t laud our pediatrics department as often as we should. Pediatrics is an important part of GBMC, meeting the healthcare needs of the children of our community. A critical part of pediatrics and our organization is our Neonatal Intensive Care Unit (NICU), and with more than 4,500 babies born at GBMC annually, we are very fortunate to have such a high level NICU to care for those babies born too small, too sick or too soon.  While many people expect to find large NICUs in the big academic medical centers, isn’t it good to know that one of the area’s leading NICUs is right here in the community – at GBMC? The vast improvements that have been made in neonatal care through the years have certainly been extraordinary. We can care for babies born weighing a mere two pounds or less and help them thrive.

I had the opportunity to meet many of the “graduates” of our NICU at GBMC’s 23^rd annual Father’s Day 5K last weekend. The outpouring of community support was incredible. It was great to see so many parents of former NICU babies, as well as so many dedicated members of the community and the GBMC staff come out and run for this terrific cause – raising money for the NICU and the technological needs that help us care for so many babies. I’m proud to report that this year’s event raised more than $97,000 for the NICU, which is phenomenal! I thank everyone involved for your outpouring of support.

Last year was my first Father’s Day 5K race (within only five days of arriving at GBMC) so this year I knew the drill! Not only did I get to meet our long-time MC Denise Koch from WJZ-TV, who is also a former GBMC NICU parent, but I met so many wonderful people, handed out awards and truly felt so much pride for the wonderful volunteers as well as GBMC’s NICU doctors, nurses, technicians and others who dedicate their lives to the health of babies.

I ran again in the race this year too…I’m not divulging my time, but will say I’m grateful that running with me was with C.J. Marbley, our wonderful clinical nurse manager in the medical intensive care unit and Dr. Jeff Sternlicht, our Chairman of Emergency Medicine! I knew I was in good hands with the two of them by me if anything went awry during my race!

I also want to mention our mock Joint Commission survey that was held last week… not only do these mock survey exercises help us to be continually ready for a joint commission visit, but proves that GBMC is constantly working toward improving how we deliver healthcare to everyone’s loved ones. I’ve been in healthcare a long time and used to fear surveys by the Joint Commission.  I don’t anymore. I realize that these surveys are a mark of approval and that we must be ready all the time. GBMC is continually improving and we are at the ready for our next survey. 

Graduations Serve as a Reminder of the Importance of Education

‘Tis the season for graduations and end-of-the-school-year celebrations. Many of us have a personal connection to graduation this year. Perhaps you have a loved one graduating from high school, college or even preschool. Maybe you are the one celebrating this special milestone in your life. One of my sons just graduated from college and there is no way to express the pride a parent feels at such a momentous occasion. Every year, GBMC celebrates and applauds graduates for their accomplishments in the Greater Connections Honors Graduates edition – don’t forget to check it out when it hits publications stands and the InfoWeb in a few weeks.

Speaking of education and milestones, GBMC takes continuing education for staff very seriously. The tuition assistance program is just one of the ways in which our employees can get help with pursuing a degree. We also offer educational assistance through the T. Rowe Price Family Education Fund, the Physician Education Fund, 1199 Service Employees International Union (SEIU) Training and Upgrading Fund, as well as partnerships with Drexel University Online, Kaplan University and Stevenson University for nursing. This allows employees to either increase their expertise in their current field, or explore a whole new career in healthcare. What it comes down to is this – we are invested in our workforce and believe that knowledge is important, especially for healthcare professionals and especially for those of us who want to make our current system better.

Sarah Schwarzmann is a great example of an employee pursuing educational opportunities. Sarah, a User Support Specialist in the MIS Department, is working towards a nursing degree thanks to the T. Rowe Price Family Education Fund.  Chris Cooper, an Accounting Specialist in Corporate Finance, is also advancing his education through the fund. Currently studying Accounting at Carroll Community College, he plans to continue with graduate studies at University of Baltimore.

As humans, we often look for ways to continue to grow and better ourselves as we age, and I can think of no better way to do this than through education. Take advantage of all that GBMC’s tuition and educational programs have to offer. You’ll be glad you did. Have you earned a degree thanks to GBMC’s education programs? I’d love to hear about your experience.

Finally, on an unrelated note, I just returned from a business trip with Eric Melchior, Executive Vice President and Chief Financial Officer, and Susan Martielli, General Counsel, to speak with the companies that sell us catastrophic malpractice insurance. We have to convince our reinsurance companies that we are doing the right things to make our care as good and safe as we can make it. I want to thank you all for your continued diligence in standardizing the work we do and your focus on providing quality care in a safe environment. When we make our healthcare system more reliable, it helps us to minimize risk and contain insurance costs. Money saved can then be dedicated to other areas of importance.

P.S. – The InfoWeb and our Human Resources Department can provide more information about educational opportunities at GBMC.

• Tuition Assistance and T. Rowe Price Family Education Fund are featured on the Human Resources pages, under “Organizational Development and Training.” Or contact Sharon Croghan at ext. 3074.
• Physician Education Fund information can be found on the Nursing page, under “Educational Offerings/Scholarships.” Interested in Nursing school at Stevenson? Contact Jami Hohner, School Affiliate Liaison, at ext. 3704.
• To find out more about the 1199 Service Employees International Union (SEIU) Training and Upgrading Fund, stop by Human Resources to pick up a form.

Why Do Patients Wait in the Emergency Department?

I frequently receive letters from annoyed patients who had to wait to be seen in the Emergency Department. The writers often accuse me of not caring about their pain or their time and suppose that I have never gone to the ED myself to see what happens there. Nothing could be farther from the truth.

I often go to our Emergency Department to see how things are going and to thank our marvelous nurses, physicians, technicians, patient access reps, and others for their wonderful hard work, skill, caring, and perseverance. I have been a patient in an overcrowded emergency department, I have accompanied loved ones in overcrowded ED’s, and I have worked as a doctor in an overcrowded ED. When my loved one has an urgent or emergent medical need, I want them to be seen right away. I want this for everyone’s loved one.

The main cause of waiting in any Emergency Department is the bottleneck created by patients who need to be admitted to a floor of the hospital when there are no beds. Our largest fixable source of this problem is the artificial variability in scheduling elective surgeries. Hospital administrators own this problem and we are fixing it at GBMC. We must get better at scientific management to reduce delays in all of our care processes.

I get very frustrated with the letter writers who are complaining about the delays, not because I shouldn’t hear about the problem, but because the writers accept no responsibility for the problem. Patients are, in part, responsible for the second biggest reason for waiting in the Emergency Department - a healthcare system that is poorly designed to meet the needs of the patient. You see, our system is pretty good if you have an appointment with your usual provider of care. But if you have an acute need or a flare up of a chronic problem and your doctor’s office is closed or cannot accommodate you, there aren’t many good choices other than the ED.

ED waiting is nothing more than a characteristic of a system in desperate need of improvement. Emergency Departments were designed to take care of emergencies and we have now made them the path of least resistance, the catch-all for everything that is inconvenient for the rest of the system. This system would get redesigned much faster if people would demand better care! Ask your physician what he or she is doing to make care more accessible.

I laugh when I see billboards announcing shorter ED waits or a place you can check the wait online. If you have time to wait…you don’t have an emergency by definition! Our society is not well-served by driving patients who shouldn’t be there to the Emergency Department. We need better access to teams of healthcare providers who know us and our problems, who have our records and who have designed systems that can accommodate us when we need them!

At GBMC HealthCare we are racing to redesign our systems to give people in our community the care that we want for our own loved ones. We are working hard to eliminate waits and delays. We want to get to a new world where your primary care practice is the place you turn to, your medical home.  And while our physician offices won’t be open at 2 a.m., we will be open into the evening and earlier in the morning to better accommodate patient schedules so that you won’t need to go to the ED and wait. And, our primary care practices will have your electronic medical records so that if you do need to visit our ED, we’ll have access to your medical history to better care for you. It’s what we call integrated care. We’re working hard to advocate for true reform of our community’s healthcare system.

Is finding an Emergency Department with short wait times an illusion? I believe so. It’s really up to the community as a whole to be a part of the solution to the overarching issue of long ED wait times. Are you ready to get in action with us to create a system of better care? Please do your part.

At the Ready to Serve Our Community…with Fortitude and Compassion (and Fresh Fruit!)

This week, I really got a taste for how important community partnerships are for GBMC. We have the opportunity to make quite an impact with the many things we do to help our neighbors as well as our own employees.

On Thursday I was fortunate enough to enjoy some time outdoors while touring the opening day of the GBMC Farmers’ Market. Thanks to Mike Forthman and Keith Sappington, who explained the genesis of the market, I had the opportunity to stop by and meet with some of the local vendors who brought their goods to our campus. I really got a sense for the importance of supporting our local community while also promoting healthy eating by bringing wholesome food right to our employees.

Keith explained that by providing our staff, as well as the local community, with the opportunity to buy local meat and produce, we are helping to reduce our carbon footprint. Events such as this really support GBMC’s vision for creating a healthy community by focusing on what people need to stay healthy, or become healthier. In this new era of healthcare, we’re focusing more on prevention and long term wellbeing, and eating nutritious foods certainly plays a major part in maintaining health.

Check out this short video to get a true taste for what the GBMC Farmers’ Market is all about: http://vimeo.com/24613209

Then, this morning, GBMC hosted the quarterly Towson 4 Facilities Managers Meeting which included facilities executives and managers from St. Joseph's Medical Center, Sheppard Pratt Hospital, Towson University and GBMC.  Dan Tesch and Mike Forthman provided an overview and gave tours of our Maryland Region III Alternative Care Site (ACS) and Training Center at GBMC, which is located in the former South Chapman Gym.

The intent was to share with them the capabilities of the ACS should an emergent situation like a natural disaster or other major catastrophic events develop in which any of the Towson 4 would need surge capacity. The ACS is equipped to hold upwards of 100 patients in an emergency situation and also has a back up command center for GBMC.   The site is also used as a training center for Emergency Management skill building by GBMC staff as well as members of Region III.

We’ve been thinking a lot about how to prepare for such major events and how to care for mass casualties, especially in the wake of the devastating tornadoes in the Midwest over recent months. The tornado that ripped through Joplin, Missouri, devastating that community’s hospital, certainly served as a wake-up call. When I heard about this tragic event, I couldn’t help but internalize it – what if this happened at GBMC or to one of our neighboring hospitals? Would we be ready to spring into action to help all those people in need? I believe the answer is yes. In fact, back in November 2010, I attended the signing of the Baltimore County Memorandum of Understanding (MOU) – an agreement between GBMC and six other local healthcare and educational institutions  that states, in the event of a community disaster we will be able to come together to provide life-saving medical care to all those affected. This is a prime example of community partnership forged for the benefit of the people who live here.

Finally, I would like to extend my congratulations and gratitude to internal medicine physician Dr. Hmu Minn, the recipient of this year’s Compassionate Caregiver Award, which I had the pleasure of presenting on June 1^st.

Dr. Minn was recognized for going above and beyond in the care of his patients and in the mentoring of GBMC’s medical residents. I believe this statement, which was part of the nomination letter submitted by 30 GBMC residents, really sums up the qualities that Dr. Minn brings to his profession:

“No one else but the people he has touched would really know his kindness and commitment he has towards all the residents and patients who come his way. Dr. Minn is an example of humility and compassion when it comes to patient care.”

   

I’d also like to congratulate and thank our staff members who were recognized for Honorable Mention for this year’s Compassionate Caregiver Award:

Elizabeth Bishai - Gilchrist Hospice Care volunteer, Abby Dentry, Neonatal Nurse Practitioner in GBMC’s NICU, Linda Henderson, RN,  Clinical Program Manager, Acute Care for the Elderly Unit and Debbie Johnston,  Clinical Social Worker, Women’s Services.

All of you exemplifying the kind of expert, compassionate care that we would all want for our own loved ones.