Our Team Comes Together When Hurricane Irene Strikes

In times of trouble it’s amazing how people are able to put aside their problems and “step up to the plate.”  And in times of trouble, people look to GBMC HealthCare and other healthcare providers even more than they would in other times.

As you can imagine, preparations for hurricanes are fairly complex for healthcare organizations.  Although we drill, practice, train and plan for various types of crisis situations, there are still a lot of "moving parts" that need to be considered. 

Such was the situation last weekend, continuing into this week, as Baltimore was hit with Hurricane Irene’s damaging wind and rain.  Roads were flooded, trees came crashing down and power lines were snapped, but our healthcare system  forged on, never stopping to provide quality healthcare for our community.

We’re very fortunate to have people like Dan Tesch, Michelle Tauson and Donny Dietez – our Emergency Management Department and leaders of the hospital’s Critical Incident Committee – who have created and organized the organization’s response to significant incidents like hurricanes. Critical Incident Team C was on-call for this storm, and led our staff in overcoming challenges and adversity to manage patient care in a safe and caring environment.

Carolyn Candiello, normally our Vice President of Quality and Patient Safety, served as the Incident Commander since it was her turn as senior executive on call. Carolyn did a marvelous job of getting us focused on what our needs would be in advance of the storm and in leading the team in dealing with issues as they came up. My team, Team D, was “on deck” and set to come in on Sunday evening. We stood down from Code Yellow on Sunday afternoon.

Kudos also to staff in our Facilities, Engineering and Nutrition departments  (Mitch Scholtes, Scott Sporre, Sam Tracey, Chas Pearce, Joe Warnecker, Charles Pochepko, George Dillon & Bob Marshall) who dealt with electrical issues, overnight flood remediation, cutting down and removing six trees near entrances and parking garages, false alarms with fire systems, and maintained food services for patients and staff on Saturday night into Sunday with no disruptions.

Dr. Chessare and Carolyn Candiello thank several members of the  Facilities, Engineering & Emergency Management staff for their work during Hurricane Irene.

Staff scheduled to work during the weekend were reminded to pack overnight supplies as we didn’t know what travel would be like.  Kudos to quite a number of employees who spent the night on Saturday to ensure our patients were cared for.

Sarah Roehl-Jacobs in Medical Records, Casey Porter Freeman, RN, from the Post Anesthesia Care Unit and Ryan Toth from the Emergency Department all performed "above and beyond" the normal protocol for weekend department coverage, staying overnight Saturday in order to guarantee continuity of patient care and ensure other staff would not have to travel to the hospital in the storm.  When our Central Sterile Processing Department lost power for a brief time on Saturday evening, employees Damon Briley and Violeta Gavin stayed overnight Saturday trying to get the sterilization equipment back online only to have their efforts go for naught when we were thrown a curveball just after 6 a.m. Sunday when the power went out hospitalwide.

Our brand-new emergency generators kicked in but while life-sustaining and other critical patient care equipment was connected to the generators, the chillers were not and for the nine hours that the main power was out, the temperature became somewhat uncomfortable for patients and staff.  On Sunday at 2:30 pm, I was in contact with Maryland Secretary of Health Joshua Sharfstein. Secretary Sharfstein was assessing the state of Maryland’s hospitals and he assured me that getting the Towson hospitals’ power restored was among the state’s top priorities. I was very glad when Carolyn informed me at 3 p.m. that the power had been restored. 

However, because the humidity levels increased when the air conditioning wasn’t working, the team had another hurdle to overcome as sterile equipment in the operating rooms was compromised.  More than 70 elective surgeries for Monday had to be postponed due to environmental cleaning and the reprocessing of all surgical instrument sets in house, and staff were able to get the cases all rescheduled by Tuesday, quite a yeoman’s effort. ORs had to be terminally cleaned and the complete inventory of sterile equipment was compromised and needed to be reprocessed. When I rounded on Monday afternoon in our central sterilizing department, our team, under the direction of Steve Adams, with assistance from the OR team led by Treva Kosco and Laura Perdue, had the situation well under control. Many operative kits had been sent out to be re-sterilized and staff displayed incredible teamwork working around the clock to ensure we would be ready for surgeries on Tuesday.  We even picked up a few surgical cases from a local surgicenter that had also lost power. 

Kudos to Central Sterile staff members who were assigned to work Sunday (Damon Briley, Violeta Gavin, Felicia Bostick , Mike Neally,  Lattia Lawson and Shiela Horne), all of whom who had lost power at their homes but still made it into work. Other Central Sterile staff members who braved the elements to offer assistance included Dan Schaefer, Doreen Schaefer, Maurice Dill and Jayd Aposaga).

Unfortunately, several patients didn’t receive the messages about canceled surgeries and still showed up for their scheduled Monday appointments.  No worries - a crew of OR staff - Kathy Lynch, RN, Brigid O'Keefe, Kim Thornton and Michelle Smith - all came in on Monday to greet the patients, explain the situation, handle service recovery and make them feel better, as well as to prep charts and schedules for Tuesday’s busy day in the ORs.

The storm also impacted GBMC at Hunt Manor, which has been without power and electricity all week.   We moved clinicians, patients and support staff to our GBMA practices in Hunt Valley and Texas Station each day this week in order to continue providing care for our community. 

Gilchrist Hospice Care had to make plans for the special needs of a patient population not just at their on-campus inpatient unit but at private homes, long-term care centers and assisted living facilities across Baltimore, Carroll, Harford and Howard counties and Baltimore City where they provide daily care for hundreds of patients.

For homecare patients, Gilchrist staff contacted each family to do a "tuck- in” call to review the patient's current comfort and care concerns and needed medications, supplies, equipment and oxygen.   Weekend staff left their usual home in Hunt Valley and relocated to the Gilchrist Center (on the GBMC campus) where facilities staff (led by Jack Hammel and Bill Kennedy) secured the units and stayed on site during our power outage until the rain subsided.

Gilchrist staff safely admitted eight new patients on Saturday and four on Sunday (thanks to Venus Corpus and her team!) and made close to another 100 home visits by hospice aides, social workers, and nurses.  These included death visits, visits to monitor patients in pain, patients who were actively dying, and visits for support families with bathing, and other supportive activities. 

Like many of our employees, I was also without power at home until Thursday evening, and I commend our staff for putting patients’ needs first.

Our thoughts and prayers are with those who lost loved ones or suffered property damage due to the flooding or wind damage of Irene.

Staff looking for more information about GBMC’s emergency preparedness efforts can visit the Critical Incident / Emergency Management section of our InfoWeb: http://infoweb/body.cfm?id=114

How did you weather the storm while working at GBMC or while at home?  Please share your comments below.

Adding Great Players To Our team

Baseball season is heading toward the playoffs, and the football regular season is almost upon us. What do these sports have in common with healthcare?  All require a group of individuals working together as a team to ensure success.

This week, GBMC HealthCare formally added new members to our team - a multi-provider practice in Perry Hall (Chapel View Family Care) and a solo physician practice in Lutherville (Dr. Joseph Pallan) have signed on as the charter partners for Greater Baltimore Health Alliance (GBHA), a network of employed and community-based clinician partners working collaboratively to provide better health and better care at a lower cost. 

GBHA was created as part of the organization’s recently-launched strategic plan which includes a vision (To every patient, every time, we will provide the care that we would want for our own loved ones”) for a system where a patient’s needs will be better met. GBHA aims to have 30 primary care and specialist physician practices as partners with our employed doctors in GBMA by 2012.

The backbone that is required to better oversee a patient’s health is a common electronic medical record system (eClinicalWorks) that will facilitate the exchange of health information, and help coordinate care among the practices, the hospital, Gilchrist Hospice Care and other future community partners.  GBHA will be providing practice management assistance to its partner providers, such as helping subsidize some of the costs of implementing the electronic record.

Leaders of Chapel View Family Care, a four-clinician family medicine practice on Bel Air Road that has served Baltimore and Harford counties since 1994 and handles approximately 17,000 patient visits annually, believe aligning with GBHA will enable them to successfully navigate healthcare reform and continue their history of taking care of multiple generations of families in their community. We are all honored that these outstanding clinicians chose to align with us rather than with one of the many other health systems that they could have chosen.

This week I was able to get out of the office and travel to Perry Hall to meet with the Chapel View providers and see firsthand how their use of the eClinicalWorks tool has made it easier for them to do their jobs and provide excellent care for patients. 

Chapel View physician Bradford Ebright, M.D. (seated) demonstrates the electronic medical record to (L-R): Patricia Chambliss, M.D.; Bob Adamczyk, P.A.; John Chessare, M.D. (President / CEO, GBMC); Kristine Salvo, M.D.

Chapel View physicians demonstrated how using these healthcare IT tools will allow for ease and efficiency in tracking data for patients.  For example, via an easily understood chart doctors can see how a patient’s blood pressure has progressed since a certain medication was started; when laboratory tests are ordered the results are automatically routed back to the patient’s electronic medical record; and prescriptions are electronically sent to pharmacies to be filled and available for pick-up when the patient arrives.

Our health care system takes great care of patients every day but we must do even better at coordinating that care, whether via physicians who are employed by GBMC or in private practice, and make things better thru the eyes of the patient.  Our strategy allows for the continued flourishing of the private practice of medicine for physicians who choose to run their own business.

 “We are excited about our relationship with Greater Baltimore Health Alliance because it allows us to partner with a larger medical system and readily exchange data with GBMC doctors to whom we refer our patients,” said Bradford Ebright, M.D., one of the Chapel View physicians.  “In doing this, we can optimize patient care but continue to remain a community based, independent practice that the patients in our community see as a medical home.

Joseph Pallan, M.D., believes aligning with Greater Baltimore Health Alliance will position him well for continuing his York Road solo practice as the changes mandated by healthcare reform unfold.  “This allows me as a physician to balance maintaining my independence while at the same time providing clinical coordination and integration of services,” said Dr. Pallan, a board-certified internal medicine physician who has been practicing for 10 years.

Have a minute?  Here’s a quick video of my visit to Chapel View and a demonstration of eClinicalWorks by Dr. Ebright. http://vimeo.com/gbmc/gbha

On a final note, I’m proud to report that GBMC's Primary Stroke Center is the latest of our services to earn high marks for the excellent care that physicians, nurses and the rest of the team provide every day to our patients.  The center was recently recognized by the American Heart Association with a Gold Plus Quality Achievement Award for sustained clinical performance in stroke care for at least 24 months. Congratulations to our Stroke Team!

In Action to Improve Our Care

What if you went on vacation and when you got to your hotel room, you discovered there were no bath towels for you to use during your stay? That scenario is unacceptable. You need bath towels in the room where you’ll be bathing, and you didn’t bring your own. There’s a simple fix - call the front desk and ask them to deliver clean towels. Within a few minutes, a hotel employee will be at your room with the towels.

In a hospital setting, the scenario is much different. Caregivers enter patient rooms and often don’t find all the supplies they need. There is no “front desk” from which to order non-latex gloves, water for the patient’s bedside, or a remote control for the television. Instead, the caregiver has to leave the room to get the items and bring them back. In taking this action, the caregiver has unwittingly added extra steps to his or her process and an opportunity for hand hygiene failure is born.

I recently attended a meeting where the results of a hand hygiene value stream were reported. A multidisciplinary team spent three days studying why hand hygiene failures occur, looking at workflow processes on Unit 48 and trying to make hand hygiene compliance better by improving efficiency at the bedside.

Members of GBMC's TCAB Hand Hygiene Value Stream Team

The team looked at a typical surgical admission scenario and identified 14 opportunities for a single nurse to practice hand hygiene. The 51-minute admission process was affected by a lack of a standard room setup and the need to continually leave the room to get missing supplies, which resulted in more chances for someone to forget to wash their hands. The team learned that hand hygiene compliance is more complicated than just remembering to “wash in, wash out.” Hand hygiene failures are actually the result of poorly designed processes.

So, the group developed standard work for the processes they studied. They standardized forms, created a diagram of how a patient room should look before an admission and made a listing of necessary supplies for each room. These changes, along with several others, will be implemented and tested on Unit 48 over the next few months so that successes can be shared with other units.

Non-standardized room

Standardized Room Set-Up

I was excited to be present at the report out. It shows that we’re taking action to make changes. And I’m proud of the team that participated in this important work: Janet Achiro (U48), Rayna Bush (Transportation), Antonio Crossfield (EVS), Pat Forbes (U48), Ryan Gruver (Performance Improvement), Bridgette King (Hostess), Stephanie Mayoryk (Infection Prevention), Erin McCoy (Nursing Education), Eileen Skaarer (manager U48), Joyce Walters (Phlebotomy) and Jill Wheeler (Nurse Staffing). They were using continuous performance improvement to improve our care and reduce wasted steps for our nursing staff. See my blog posts from April 21, 2011 and February 18, 2011 to re-read the five tenets of continual improvement. Well-designed systems, like the ones being tested on Unit 48, will help us to achieve a high level of reliability to ensure safety and quality.

Do you see “broken” systems in your day-to-day job that need to be fixed in order to improve our reliability for providing safe, quality care? Share your thoughts in the comments section below, or make a suggestion to your manager for his or her monthly Zero Waste idea forms.

Finally, I want to take a moment to remember the lives of two men who helped to make GBMC the outstanding healthcare system it is today. Their generosity was truly inspirational.

William A. Kroh served on several GBMC boards and was also our patient. Mr. Kroh and his wife, Jarnetta, were instrumental in establishing the Kroh Center for Digestive Disorders at the hospital, which offers a multi-disciplinary approach for the diagnosis and treatment of disorders of the esophagus, stomach, small intestine, colon, pancreas, gallbladder and liver for both adults and children. Mr. Kroh passed away in July.

William E. Kahlert passed away last week. Also a patient of GBMC, he made one of the largest gifts by a living donor. This allowed GBMC to be at the cutting edge of clinical trials in urology through the organization’s first-ever endowed research chair. The William E. Kahlert Endowment for Urologic Research, led by Ronald Tutrone, MD, supports the research of prostate, bladder and kidney cancers, as well as other urological conditions.

Mr. Kroh and Mr. Kahlert will be deeply missed.

Working with Partners to Improve Health Care

Frequent readers of this blog know that I’m a fervent believer and advocate that significant change is the only way of escaping the quagmire we face in America’s healthcare system.  While we’re making some of these changes across the GBMC HealthCare system, we need more people in the boat with us to buy into the redesign of healthcare.

The state of Maryland has an overriding concern in making healthcare affordable and in insuring those who cannot insure themselves. The biggest part of the State budget dilemma this year was the cost of Medicaid.  Comptroller Peter Franchot recently visited GBMC at Hunt Valley – one of our 9 GBMA employed primary care sites (4 on campus and 5 off-site in the county) to see the innovations in action and learn how we are becoming more patient-centered and better able to coordinate the care of chronic disease.

There’s been an astronomical degree of change at the Hunt Valley practice to achieve better health and better care at lower cost. This is a trial site for our Greater Baltimore Medical Associates (GBMA) practices and it’s going very well.

GBMC is a great organization that has done great things but we want to be part of the local, regional and national healthcare solution.  Joining me from GBMC in meeting with Comptroller Franchot were our new Board Chairman Harry Johnson, and Dr. Mark Lamos, medical director of GBMA’s primary care physicians.

During the past six months, more than 8,000 paper medical records have been converted into electronic format; the practice has expanded its hours offering early mornings and later evening appointments to make healthcare more convenient for patients; and staff members have begun pre-appointment calls in the evenings and chart reviews to ensure all necessary labwork and other tests are completed in advance of a patient’s appointment. Hunt Valley has evening group visits for diabetic patients so they can learn from each other.  Thirty percent of appointments are available the day a patient calls, yet the slots are almost always 100 percent filled. CareFirst Blue Cross Blue Shield has also recognized the problems facing healthcare and is working closely with Hunt Valley as the practice has been redesigned into a level three Patient Centered Medical Home.

We were all very pleased that the comptroller seemed genuinely interested in learning more about how we are working to drive the waste out of healthcare and change from a transactional “fee for service” system of medicine to one based on preventative care and better coordination of chronic care. While currently there are no mechanisms in Maryland to reward systems for keeping patients out of hospitals, we’re hoping the state might recognize that we are pioneers and work with us as we continue redesigning care.

On a related note about the challenges facing healthcare, it was sad to see my colleague Jeff Norman last week announce his departure from St. Joseph Medical Center. While our careers in Baltimore only intersected for a short while, I grew to know Jeff as a professional of the highest level of ethics and trust and wish him the best in his future endeavors.

Do you have questions or comments? Please share your thoughts by commenting below.

1,300 Cupcakes, a Daughter’s Love, and a Father’s Legacy

A few months ago, the GBMC family was saddened by the loss of Dr. Peter Golueke, our Chief of Vascular Surgery. This week, I had the pleasure of meeting Peter’s daughter, Erin. To honor Peter, and his wonderful legacy of caring for our patients, the GBMC Foundation is raising money for the Peter J. Golueke, M.D. Lectureship in Vascular Surgery. Erin, a senior at Roland Park Country School, wanted to get in action to help maintain her father’s legacy and also to help vascular surgery patients at GBMC. So, as part of her senior project, she (and her friend Allie pictured with me and Erin below) baked 1,300 cupcakes and raised $2,500 for the lectureship! It was wonderful to meet Erin and Allie. Out of a very sad and difficult event for Erin and her family, she found the strength to get in action and do something good. Erin’s work will further her Father’s legacy and do good for others. The lesson for us all in this is that lamenting our lot in life, talking about the need for change, or standing on the sidelines and waiting for someone to make things better gets us nowhere – we must act to make things better.

Erin (on the left in the photo) and her classmate Allie Mason present me with a check.


In another story that was more about yelling and arguing about a problem rather than getting in action on real change, this week saw Congress act to raise the debt ceiling in hopes of avoiding a historic negative financial event in American history. The passage of the legislation only occurred after weeks of political posturing and fighting between members of Congress. I was amazed at how much our elected officials were relying on their own beliefs and ignoring the recommendations of learned economists. I was reminded of a line in the song Reeling in the Years, by Steely Dan…..”the things that pass for knowledge I can’t understand”. We are now headed down a road of drastically cutting federal expenses and putting the economy at further risk. There is absolutely no one who believes that the U.S. can continue to have deficit spending - the national debt is too big and we must reduce it. However, trying to fix a problem that started in 2001 (the last budget surplus was with President Clinton in 2000) with drastic spending cuts with 9% of Americans already out of work, makes no sense. We need a more measured response that gradually reduces spending while letting the economy grow.

Be that as it may, the enacted legislation will force expense cuts in entitlement programs like Medicare and this will have a negative effect on healthcare systems like GBMC. Don’t get me wrong. We must reign in Medicare spending. We must reign in all of our national expenditures on health care. The chart below was recently released by The Commonwealth Fund using the data of the Organization for Economic Cooperation and Development. It shows that in 2009, the last year for which data are complete, the US spent more than 17% of gross domestic product on health care. The next biggest spenders, France and the Netherlands spent 12% each.

We also know that the French and the Dutch have health outcomes that in many areas are better than ours and that their citizens are much happier with their health care than Americans are. Their systems are imperfect, too, but we should try to learn from them.
Unfortunately, rather than embracing the notion that we need to redesign our system, Congress is now getting ready to “squeeze” money out of the big areas of spending, like hospital care, without redesigning the system itself. Healthcare costs in our country are nothing more than a characteristic of the system we have to deliver health care. Every system is perfectly designed to get exactly the results that it gets. If we want a more cost-effective health care system, we need to design a new one.

Erin Golueke had a goal and she got in action. GBMC has a strategic vision of a changed system and we are building it. We need to stay in action. The ride may get a bit tougher now, but I have no doubt that we will get to a better place.

We’re doing great work at GBMC but we have to get even better at continually adding value to our care. If there are things we are doing that are not truly helping the patient then we need to get rid of them. We need to keep innovating to create a more coordinated system that delivers what the patient wants and needs – better health and better care at lower cost.

Do you have ideas to improve our current healthcare system? I welcome your thoughts.

If you would like to make a tax deductible gift toward Erin’s efforts, visit https://foundation.gbmc.org/petergolueke or call the GBMC Foundation at 443-849-2773.

Lastly, the annual GBMC Employee Opinion Survey is underway. As you know, we need the information that we get from employees to make improvements to make GBMC HealthCare a more joyful place to work! In the year that I have been here, we have made many changes on the basis of what you have told us. I also know that there are still many things that we need to improve, but we must hear from you to identify them. The survey is scheduled to end August 21.

Please complete your survey and encourage others to do the same!!

Working Together For Safety

Dr. Chessare is on vacation this week.  Guest blogging is Carolyn Candiello, GBMC's Vice President, Quality and Patient Safety.

As I approach my one-year anniversary this fall of joining GBMC HealthCare as Vice President, Quality and Patient Safety, I find myself continually impressed with the strength and commitment of my colleagues. 

For example, soon after I started, the mother of one of our patients sent me a letter sharing some thoughts about how care might be improved in the Neonatal Intensive Care Unit (NICU). She and I met to discuss her ideas, and GBMC’s Chairman of Pediatrics, Dr. Timothy Doran, took time out of his busy administrative and clinical schedule to attend and hear the parent’s thoughts first-hand. At a lot of hospitals you wouldn’t find a clinical leader who takes the time out of their day to do that. We listened to the mom’s feedback from her experience and she offered some good suggestions about ways we could improve our care. Dr. Doran and I subsequently met with the rest of the clinical team and they implemented changes to improve and enhance the patient care experience in the NICU.

I also reflect back on the leadership off-site in March.  My colleagues and I spent time learning about how errors occur and how to design our processes and strengthen our behaviors to prevent them.  When looking at an error it is easy to focus on “the sharp end” or the person closest to the error.  This might be the nurse administering the medication or the tech assisting a patient out of bed who falls.  However, knowing that “every system is perfectly designed to get the results it gets” we recognize that failures in our system occur anywhere along the continuum of the process.  Strengthening our processes can make care safer for patients and provide more joy for those at the bedside. 

The best example for understanding errors is Reason’s Swiss Cheese Model.  Looking at this model, we can see that errors occur when failures in our process line up.  We also can see that errors can be prevented when we block the holes through safe system design and using safe behaviors. 

Safe system design can be anything from a simple checklist to redesigning our information system for safe medication ordering.  Safe behaviors such as “having a questioning attitude” can also help prevent errors.  Not long ago, I learned about a situation where a nurse saw that a physician had ordered a medication for a patient that didn’t make sense for that individual’s treatment.  Using a “questioning attitude” the nurse appropriately questioned the physician and it turned out that she had intended to order that medication for another patient.  In turn, the physician’s response and gratitude for the nurse’s “good catch” demonstrates another safe behavior of “working together with your team”.  While this error never reached the patient, we are grateful that she reported this to us as it helped to understand some holes in process which have been fixed.

Learning about incidents such as these is a gift to those of us who work in quality and patient safety here at GBMC. It may seem counter-intuitive that we’d want to hear reports about times when something goes wrong or “almost” happens, but every incident report we get is a treasure because it gives us a chance to see where there may be holes in our process and allows us the opportunity to make care safer.

Recently we became aware of some instances where our process for patient identification wasn’t followed as designed. While we have a great system for medication administration using bar code technology, there are other times when this technology is not available to assist us—for example identifying patients for treatment, transport, nutrition and outpatient medication.  At GBMC we ask the patient to state their name and date of birth.  We then compare that to the patient's name and date of birth on the order or requisition.  Finally, we look at the patient's identification bracelet to confirm the correct name and date of birth.  But add in other complexities and interruptions and it’s easy to get ourselves into “auto pilot” and miss one of these important steps—we’re human after all.  A good tool to help is “S-T-A-R”!

• Stop, pause for 1-2 seconds and focus on what you are about to do
• Think, think about what you are doing– is it the right thing?
• Act, concentrate and take action to perform the task
• Review, do a self check to review if the task was done correctly

“S-T-A-R” is not just designed for clinicians, it’s a good tool for all of us to use in situations where the potential consequences might involve high risk or will require a lot of re-work if not done correctly.  For example, it is a great tool to use before sending an important email; or at home, it might be helpful to use the tool before locking the door (with the keys on the other side!) or paying a bill electronically (did I get the decimal in the right place?).

I am looking forward to sharing and learning from each of you over the coming months as we work together to improve our system of care.   I am both pleased and proud to be a part of GBMC and thank you all for what you do every day to keep our patients safe. 

If you have any stories you would like to share about safe behaviors or redesigning systems please comment below.  Also for GBMC employees, please follow the Patient Safety group on Yammer (GBMC’s Social Network).  Go to www.Yammer.com--sign up using GBMC email and join the conversation!

Change Agents To Be Proud Of: Gilchrist Greater Living and Gilchrist Hospice Care

On Monday, I was proud to accompany several GBMC HealthCare colleagues to San Diego where GBMC’s geriatric and palliative medicine practice Gilchrist Greater Living and Gilchrist Hospice Care were recognized with the prestigious 2011 Circle of Life Award from the American Hospital Association (AHA). The Circle of Life Awards, given to only three organizations in the country, were created in 2000 to recognize programs that have found innovative ways to deliver the best and most timely palliative and end of life care possible. Circle of Life Award winners are considered role models for other communities.

In choosing Gilchrist for the national honor, the AHA selection committee noted the organization’s unique role in creating the Gilchrist Greater Living (GGL) geriatric and palliative medicine practice, which follows its mostly elderly patients throughout the healthcare continuum – from office visits, to the hospital, to nursing homes, assisted living and rehabilitation facilities and ultimately, to hospice. GGL is overseen by Cathy Hamel, Gilchrist’s executive director, and Tony Riley M.D., medical director, and is designed to ensure that the frailest of patients receive care that is compassionate, coordinated and comprehensive.

(L-R) Proudly representing Gilchrist and GBMC HealthCare at the AHA Circle of Life Awards were Regina Bodnar, R.N, Gilchrist Director of Clinical Services; Lori Mulligan, Director of Development and Marketing, Gilchrist Hospice; Catherine Hamel, Executive Director, Gilchrist Hospice; W. Anthony Riley, M.D, Medical Director, Gilchrist Hospice; and John Chessare, M.D., President and Chief Executive Officer, GBMC HealthCare.

When I read in the award brochure, “Because the geriatricians at Gilchrist Hospice Care monitor patients and oversee patient care in multiple settings, ranging from home to skilled nursing facilities to hospital to hospice, their patients benefit from the greatest possible coordination”, I realized what a wonderful gift it is to have Cathy, Tony, and all the Gilchrist staff as part of our GBMC family. Our strategic plan is about coordinating care for the patient and this part of our family is already doing it exceptionally well.

The day began at 7 a.m. with a “sunrise session” in which Dr. Riley and representatives from the other recognized organizations discussed how they met the needs of patients and families and continually worked for even better care for the elderly. I then went to a plenary session where Dr. Atul Gawande, the noted Harvard surgeon and writer for the New Yorker, spoke about his work to improve health care in America (and across the globe) by the use of the checklist.

Dr. Gawande noted that there are three new values that health care providers needed to embrace to improve care. The first was humility. We should celebrate the intelligence, training, hard work and dedication of our physicians and nurses. But these professionals (especially physicians) must understand that they too are human and the practice of medicine has gotten way too complex for any individual to be able to deliver the care as a “lone ranger” that we would want for our own loved ones. The second new value required was discipline, required in complex endeavors to do things the same way every time according to the evidence of what works best. Gone are the days of allowing professionals to do things in whatever way feels right to them if the evidence shows that one way is best. Dr. Gawande suggested that the third required value was teamwork. Because healthcare is now too complicated for any one provider to be able to meet the needs of the patient, providers must value the input of all of their teammates. I found it interesting that he said that studies now show that the most powerful element of the use of checklists is not the checklist itself, but the teamwork required to use the checklist correctly. While he was speaking, I was thinking that Gilchrist displays these values daily.

We had a great lunch with the Circle of Life Award Committee and the other honorees and then went to the award ceremony. When Cathy received the award on stage it was another proud moment for me and our organization.

We then heard a presentation by Chip Heath, a Stanford University professor, who with his brother Dan wrote the best-selling book: Switch: How to change things when change is hard. Chip is an outstanding speaker. He presented a “change methodology” that was quite compelling (and again got me thinking about all that we are asking our people at our health system to change at once.) Chip said that research from the field of psychology has shown that humans have an internal conflict between their analytical self that thinks about and plans change and their emotional self that does the change. He  offered as an example that the analytical self knew that he had to exercise to maintain his weight but the emotional self wanted to hit the snooze button rather than get up and go to the gym. The planner knew to count calories but the doer wanted to eat the Oreo cookie. He used the analogy of the rider as the analytical planner and the elephant as the emotional doer. The rider of an elephant can plan, think and analyze but sometimes the elephant has a mind of his own that overwhelms the rider’s plan.

Chip pointed out that the research literature had generated three surprises about change. The first is that what looks like resistance to change is often a lack of clarity about the change. You need to direct the rider. In this case, if you want to make change happen, rather than repeating the time honored dictum about “people just don’t want to change”, you should provide clear direction …and simple steps. The second surprise about change is that what looks like laziness is often exhaustion. People can’t do too many changes at once. “The rider can’t get his way by force for very long.” You need to motivate the elephant.  Mr. Heath added that telling moving stories is generally better than giving data to get people in action. The data are needed but the stories ignite the fire. The third surprise about change, Mr. Heath said, is that what looks like a people problem is often a situation (or process, or path) problem. When things go wrong, or not as we would like, we have a tendency to attribute the problem to a fundamental flaw in the people involved rather than to the situation they are in. By blaming the people for the difficulty with change, we make the solution impossible. How do you make a stubborn person not stubborn? Chip said to try making the change easier and forget trying to change fundamental characteristics of the people involved in the change. He called this shaping the path.

Again as I was listening to Mr. Heath, I thought of Gilchrist and their work to eliminate the pain typically experienced by a patient new to the hospice service. The national standard is 48 hours but Gilchrist has made a commitment to reduce it to 24 hours. Cathy, Tony and the Gilchrist Hospice team motivated the elephant by telling stories of new patients and their families and got team members charged up to make major improvements. They directed the rider with a clear message about the goal and they made it easier to achieve that goal by shaping the path with daily conference calls and small tests of change. Now greater than 75 percent of patients are pain-free within 24 hours!

For inpatient end of life care, Gilchrist offers a unit on the GBMC campus, which recently was expanded to offer 34 beds, and a 10-bed center located within Harmony Hall Assisted Living in Columbia, the first acute care inpatient hospice facility located in Howard County's borders, which opened in May.  This center ensures that terminally-ill individuals in Howard County and their families will have access to the full spectrum of the finest in end of life care, close to the homes they cherish. In addition, meeting a long unmet need, last summer Gilchrist Kids began providing comfort at home for terminally-ill infants, children and teens in Central Maryland, as well as care and support for their extended families.

I am so proud of Cathy, Tony and the entire Gilchrist Greater Living and Gilchrist Hospice team. Please join me in thanking them for making our care better! And please congratulate the Gilchrist staff when you see them. We can all learn from them.

UPDATE: Be sure to take a few minutes to watch this "Circle of Life" video. Dr. Riley and Cathy Hamel do a nice job of explaining Gilchrist palliative medicine and end of life services that help the patient and their family make the best decision for their situation.
http://www.youtube.com/watch?v=IdwmZm8lmKI

Can you relate to Dr. Gawande’s three values required for improving our health care system? Do you have examples of how you have used Chip and Dan Heath’s change model or some other model to improve care?  Please share your thoughts by commenting below.