What Do I Learn at Town Hall Meetings?

Over the past couple of weeks, I've met with large groups of employees as well as small groups in departmental town hall meetings. One of the goals of holding these town hall meetings is for our people to come away feeling informed about our health care system and what is going on around it. It is also an opportunity for me to get more people in action to help us reach our vision and to hear our people’s concerns and ideas on how we can continue to get better and meet our four aims.

Here are a few of the conversations that I had with our folks during the meetings thus far:

• A staff member was upset that she didn't get a raise this year. I reminded the employee that indeed she did receive a raise, but she let me know that it was ‘so small that she didn't notice it in her paycheck.’ I had to remind my colleague that GBMC’s profit margin this year is budgeted at less than one half of one percent. This means that for every dollar that we take in, we are spending 99.5 cents already. This does not leave much room for raises. I asked her to help us continue to reduce waste and to attract more patients to create an opportunity for bigger raises. I was concerned that she did not see the relationship between her efforts to improve things and her salary.

• At a town hall session for the GOR (general operating room) staff, a nurse asked me, “Why do I have to ask the patient for all of this information pre-operatively when the information is already in the physician’s outpatient electronic medical record?” To this nurse, it seemed this was a waste of her time as well as the patient’s time. I have to admit that I got upset when this question was raised because I agreed wholeheartedly, but I wondered why this hard working nurse had waited to bring this matter to my attention instead of turning to her boss the very first time she felt this frustration so that they could fix it together? Did she not feel empowered to fix it? When I asked the manager why the staff did not have access to the EMR, the manager did not know this was an issue or concern. We must have the whole team engaged in improvement. If it is within your control to fix…fix it. If it is not, bring it to your manager and work with him or her to get it improved. The manager, for her part, must be asking her team to bring forth ideas for improvement and she must be engaging them in problem solving on a regular basis. Our people need to believe that it is not only their right to speak up but it is their duty. All of our people at every level must not accept dysfunction or assume “that’s just the way things are done.”  We must all be in action to make things better. Our work with lean daily management has demonstrated what can be accomplished when many begin focused problem solving. But if everyone is waiting for me to fix things…we are not going to get very far.

• A Gilchrist staff member who had her arm in a sling raised her hand to tell me about the care that she had received recently. She fell and injured her arm and went to the ED. At registration she was asked if she had a primary care physician. She said yes but she was a bit reluctant to say that she went to one of our patient-centered medical homes because she had not been seen recently. Her injury was addressed and she went home. She was surprised when the next morning, about 10:30 AM, she received a call from her practice’s care manager inquiring about how she was doing, if her pain was controlled and if she had a follow-up appointment with an Orthopedist. She told me that she was delighted to see that someone was looking out for her and trying to help coordinate her care. I told her that every morning at 10:00 AM our primary care sites in GBHA get a download from CRISP, the Chesapeake Regional Information Sharing Network for our Patients, that tells them if any of their patients were seen in the previous twenty four hours in any hospital in Maryland. Her practice had been notified of her visit to the ED and they wanted to make sure that she was doing OK and that she understood the plan for her care. Her story made me feel very good because it was evidence that we are making real progress on becoming a true community based health system through the eyes of the patient.

The lessons I learned from these encounters in this series of town hall meetings are these – we must all:

• Be engaged, empowered and in action to improve the care we deliver
• Never accept dysfunction and cynicism
• Celebrate our improvements

I found myself wondering, ‘Why is it that most of our people are feeling empowered but some are not? What is happening at our department meetings? Why are some not engaged and don’t see that they can say, “I have an idea”?’

I urge our team not to accept the status quo but to continue to be in action to create positive change. Waiting to air grievances twice a year at a town hall meeting is not going to get us to our vision any time soon!

Department leaders have to take responsibility to keep lines of communication open between them and their staff. We need a free flow of ideas both ways. The boss must be all ears for questions and ideas from their team and employees must be ready to fix things within their span of control. This is not an issue unique to GBMC. Rather, it is an issue for all organizations that grows with the size of the organization. I hold our local leaders accountable for overseeing effective problem solving to generate positive change and for getting everyone engaged. Our tremendous progress in so many areas shows how well the majority of our local leaders are doing this. I am grateful for their hard work and for that of their teams.

So, my reflecting after the first few weeks of Town Hall meetings shows me that our culture is certainly changing for the better, but it has also made me ask myself what we could do to make it change even faster.

How can we get more people engaged, empowered and in action on meaningful change? As usual, I look forward to hearing your ideas.

Compassionate Caregivers, Town Hall Meetings and the Father’s Day 5K

Each year at the annual Compassionate Caregiver award ceremony, GBMC honors staff members throughout the organization who exemplify what it means to be a true advocate for patients, a role model for their peers and someone who shows true empathy and caring through their interactions. True compassion is the ability to relate, empathize, listen and care for a person in need.

Amanda Hindle is presented with the
 2014 Compassionate Caregiver award

We have so many caring individuals at GBMC, as demonstrated at last week’s Compassionate Caregiver award ceremony. I congratulate this year’s winner of the 2014 Nancy J. Petrarca Compassionate Caregiver Award, Amanda Hindle, a nurse in the NICU.

Amanda was described in a nomination as the cheerleader for the NICU, a leader for all functions and events that raise awareness of the NICU and support patients and families. Working with some very sick patients who are in the NICU for weeks and sometimes months, Amanda comes in on her days off to help when needed. And, demonstrating the true spirit of compassion, Amanda has rallied the staff around one of the unit’s nurses who is bravely battling a deadly illness herself to help boost her morale in this difficult time. Amanda even gathered the NICU staff to sing the popular song, Happy, which they recorded and posted to YouTube to help bring a smile to their ailing colleague’s face. Thank you, Amanda for all that you do for our tiniest patients, their families, and your peers in the NICU.

Congratulations to all of the Compassionate Caregiver nominees

And, congratulations to all of our 2014 Compassionate Caregiver nominees:

• Susan Crouch, Gilchrist Hospice Care (honorable mention)
• Lynn Ellen Anderson, Gilchrist Hospice Care (honorable mention)
• Lauren Saval, Care Management (honorable mention)
• Amanda Hindle, NICU
• Francine Johnson, Physical Therapy
• Roberta (Jean) Hurtt, GYN/Oncology
• Shera Montero, TIPU
 

Don’t Miss the Town Hall Meetings

One of the single biggest problems for large organizations in any field is the ability to communicate to everyone. The bigger you get, the more layers of management you have- making it harder to get communication from top to bottom. This is why a couple of times a year we run a series of town hall meetings. These meetings help narrow the gap between the front office and the front line. Think of the town hall meetings as a sort of “State of the Union” address where I have the opportunity to update our team on how we’re doing and also hear directly from our people through open discussion and dialogue.
We welcome everyone to come to a meeting with questions and ideas. Town hall meetings will be held in both large forums and through individual unit and department sessions. Here is the schedule for the upcoming and remaining Town Hall sessions – please mark your calendars!

Running for a Cause and GBMC’s Tiniest Patients

And finally, June 15, is the GBMC Foundation’s annual Father’s Day 5K Race and 1 Mile Fun Walk to benefit GBMC’s Neonatal Intensive Care Unit (NICU). This is a wonderful event where former NICU babies, families, staff members, community supporters and friends come out to have some fun and support the vital services provided to premature and sick newborns by our NICU. There’s still time to register and support this wonderful event.

A 5S in the Transport Hub

Hospitals have a lot of equipment that is not always used but must always be ready for use when patients need it. Most hospitals struggle with knowing precisely where their equipment is so that it can be moved efficiently to where it is needed. When the organization cannot quickly find equipment and move it on demand, the staff get frustrated and begin to “hoard” equipment, which generally makes the problem worse. 

Last week, a team gathered to conduct a Kaizen event, 5S in the Transport “Hub.” Unlike many other hospitals, GBMC has a unique area that houses more than 200 pieces of patient use medical equipment such as beds, stretchers, lifts, bariatric supplies and pumps. GBMC’s “Hub” operates 24 hours a day and 7 days a week. The “Hub” was selected for a 5S event due to problems with overcrowding and lack of standardization, making it very difficult for staff to efficiently retrieve patient care equipment. This resulted in delay for patients and staff, and certainly less joy for transporters, nursing staff and patients.

A 5S event’s main goal is to organize and standardize an area. 5S stands for Sort, Set in order, Shine, Standardize and Sustain. 5S is at the foundation of LEAN performance improvement. Evidence shows that when a 5S is done well, the workplace will: “talk” to you, control itself, be refreshing, be safe, predictable and reliable. Results will shorten training for new employees and be welcoming to everyone: workers and visitors alike.

5S Patient Transport Hub Team

Michael Forthman, our Vice President of Facilities was the executive sponsor for the event. The team also included Neil Crockett (Facilitator), Courtney Hendon (Team Leader), April Herring (Director of Transport), Erin Wedemeyer, RN(IMC), Rayna Bush (Transporter), Asher Shorter (Transporter), Romaine Howard (Patient Flow Coordinator), Alex Ebright (Intern), Rachel Tonge (Crothall Manager) and William Shaffer (Bio-Med). It was important to have the transport staff on the team as the experts of “hub” operations. Nursing representation was also important to help the team understand the clinical needs of the transportation hub.

The scope of the event included both sides of the “Hub,” - employee areas and wheelchair storage within numerous lobbies throughout the hospital. The objectives were to: train the team in 5S principles and implement those principles; target equipment areas to organize, standardize space for patient volume, staff workflow and restocking process; determine physical items and information needed in the “Hub” area; and design standard process for check in/check out of equipment and accepting new equipment/supplies.

Through this event the team “sorted,” “set in order,” and “shined” both sides of the Hub, the hallway, the employee areas and six lobby areas which house most of the hospital’s wheelchairs. Results included 10 dumpsters of disposal, 60 visual parking spots for equipment, 120 visuals, and labeling of 60 wheelchairs for their specific lobby areas. After the 5s event, the transport team targeted the time needed to take equipment to patient care areas to less than five minutes – a 66% improvement! In addition, the team discovered equipment stored which had never been used and learned that we had been renting similar equipment for the past year. This was a tremendous waste!

Before- Side 2

After- Side 2

The next steps include creating a standard process to introduce new supplies and equipment into the hub. The 5S principles will be shared with the whole transport team to ensure that the new design is sustained. I am very grateful to this wonderful team for making our transport hub so neat and orderly and for creating a more reliable system for storing and mobilizing equipment!

Town Hall Meetings

Don’t forget to attend one of the upcoming Town Hall meetings. Following is the schedule:

June 9 – 12:00 p.m. – 1: 00 p.m. – Civiletti Conference Center, A, B & C
June 10 – 7:00 a.m. – Unit 37
June 13 – 7:00 a.m. – SICU
June 13 – 8:30 a.m. – Hunt Valley
June 18 – 7:00 p.m. – Unit 34
June 20 – 7:00 a.m. – Unit 38
June 23 – 11:30 a.m. – Owings Mills
June 30 – 12:00 p.m. – 1:00 p.m. – Civiletti Conference Center, rooms A, B & C

Through the End of Life – Celebrating 20 Years of Gilchrist Hospice Care

Last week I had the privilege to attend the 20th anniversary celebration events for Gilchrist Hospice Care. We recognized all that Gilchrist Hospice has done over the years to help see so many individuals and families through the end of life. The care providers at Gilchrist not only provide world class medical care to patients in their final days, but also provide the emotional and spiritual support needed. One of the things that continues to resonate with me as we celebrate the many milestones reached over the past 20 years is how every staff member and volunteer at Gilchrist Hospice has an unwavering dedication to gracefully guiding patients and families in their final journey together.

I was equally impressed and touched by what the keynote speaker had to say about hospice care and a person’s end of life journey. Dr. Ira Byock is one of the nation’s foremost icons in hospice care and he highlighted the fact that death is a personal issue first and a medical issue second. His statement, “We need to take back dying as fundamentally personal and demand much better care for people THROUGH the end of life," was a poignant one. He stressed the notion of THROUGH the end of life rather than AT the end of life and that we should view a person’s final days as the completion of life.

 Dr. Byock, who authored a book about the end of life entitled, The Best Care Possible, stresses the term “dying well” as opposed to “ a good death.” It was fascinating to hear him speak about what it actually means to “die well,” and how important it is to have courageous conversations with individuals and family members about what they truly want when it comes to their own deaths.  For him personally, he talked about a Father’s Day gift that would mean a great deal to him from his two daughters who are in their late 20’s and early 30’s – he told them that the best gift they could give him was to complete their own Advanced Directives.  Each individual certainly views death differently, and many people take personal actions in their last days. For 20 years, Gilchrist Hospice Care has been helping individuals to reflect and take their final actions so that they can “die well.”

Our System and our community are very lucky to have Gilchrist to help individuals complete the circle of life with dignity and on their terms. I congratulate the staff, board members and volunteers of Gilchrist as we reflect on some of the major milestones over the past two decades:

• 1991 - Philanthropist Jeanne “Jinny” Gilchrist Vance makes a multi-million dollar pledge for the construction of a dedicated hospice facility, paving the way for Hospice of Baltimore
• 1994 – Hospice of Baltimore begins serving Baltimore City and Baltimore and Carroll Counties
• 1995 – Ground is broken on the site of the Gilchrist Center for Hospice Care
• 1996 – Gilchrist Center for Hospice Care opens in its Towson location
• 1997 – Hospice of Baltimore merges with Hospice Services of Howard County to serve even more people throughout the state
• 2004 – In 10 years, 10,600 individuals have received hospice care
• 2008 – Hospice of Baltimore is renamed Gilchrist Hospice Care to create a unified name and to honor Jinny’s legacy
• 2009 – Gilchrist Hospice Care partners with Nkoaranga Lutheran Hospice’s hospice and palliative care program in Tanzania
• 2010 - Gilchrist’s pediatric and perinatal hospice program is created and called Gilchrist Kids
• 2011 – Gilchrist Center Howard County opens
• 2011 – Gilchrist Hospice Care receives the prestigious Circle of Life award for innovation in end of life care
• 2012 – Three new programs launch – Music Therapy, End of Life Doula and We Honor Veterans
• 2014 – In the past 20 years, Gilchrist Hospice Care has cared for 40,000 patients and close to 100,000 loved ones

Gilchrist 20th Anniversary Dinner Presentation from Gilchrist Hospice Care on Vimeo.

What is “Meaningful Use?"

In February 2009,  the American Recovery and Reinvestment Act (ARRA) was signed into law.  ARRA was designed to stimulate the economy and to spend money in areas where the country needed investment. One of those areas was in electronic medical records. It is an indictment on our system in the United States that if a citizen arrives in an emergency department the doctors and nurses don’t have complete access to the patient’s medical information. The U.S. was lagging and still lags behind many industrialized countries in the use of electronic records.

$27 billion was set aside through the Health Information Technology for Economic and Clinical Health Act (HITECH Act.) The legislation was initiated in the belief that expanded meaningful use of healthcare information technology would improve quality, safety and reduce health care costs.

This initiative covers both hospital and provider practices and is widely known as Meaningful Use (MU). Our medical center and our employed physicians (GBMA) are both participating, and we have successfully completed two years of Stage I requirements. We are now working on Stage II, which has significantly raised the bar on the electronic clinical documentation and exchange requirements.

GBMC has been working toward a complete electronic health record for many years, long before Meaningful Use was initiated. One of the requirements, Computerized Physician Order Entry (CPOE) was already in wide use when we started working toward Meaningful Use.  Medication reconciliation (checking to see that the patient’s medication list is correct at every transition in care) is another component of MU that GBMC has successfully implemented.

Stage II focuses on Patient Engagement and clinical information exchange for transitions of care.  GBMC will soon be implementing a patient portal for the hospital to complement the existing practice (GBMA) patient portal, known as myGBMC. The new portal will allow patients to access, view and download information about their inpatient stay or ED visit. Another challenge is providing a Continuity of Care Document (CCD) to the provider to whom the patient is referred or the transfer facility at discharge. This has required mapping over 27,000  test codes, procedures and other medical terms to standards that can be universally accepted by other health information systems, as well as changes to the discharge process, and will require providers to use problem lists.

Creating an effective medical record system requires a lot of design and implementation work but it is necessary to drive us closer to our vision. We cannot deliver the care we want for our own loved ones to everyone without electronic records.

Thanks to all who are working to develop and use the electronic patient record. 

Celebrating What Makes GBMC Great During Hospital Week - Our People

As we celebrate Hospital Week, I think about what a great story we have to tell at GBMC HealthCare. Over the past few years, we’ve been moving toward creating standard work and a more reliable system of care. As GBMC approaches its 50th anniversary caring for the health of our community, this week is a great time to reflect on some of the things that make our hospital a great place to come to for care and a great place to work that continues to be a mainstay in the community.

It’s no doubt that our physicians, nurses, techs, therapists, housekeepers, food service workers, maintenance staff, security, volunteers, managers, and all staff members work very hard to continue moving GBMC toward its vision. This past year, our units and departments have made significant strides in creating and improving processes that meet our four aims: Better health, Better care, Least waste and More joy for those providing the care. Leaders and staff throughout the organization have been empowered to execute change.

At GBMC, we believe in being transparent with our quality data, which is updated monthly on gbmc.org/quality. We measure many factors from patient satisfaction to infection rates and I’m happy to say that because of the collective efforts of our teams as well as the commitment to lean daily management, we've seen great improvement in many areas. Take pressure ulcers, for instance – we have gone almost an entire year without a pressure ulcer, which is a tremendous accomplishment.

So, this week, I sincerely thank our employees and everyone who has helped us improve our designs and  make our system of care more reliable and set a course for the future and help meet our vision: to every patient, every time, we will provide the care that we would want for our own loved ones. I truly believe that what makes GBMC exceptional is its people and I’m proud to see the dedication and passion of our team every day.

I invite all employees to take part in the Hospital Week celebrations planned this week including:

• Monday, May 12  - An email from HR Broadcast will be sent out with trivia questions for employees to participate in a drawing for $15 gift cards to Safeway Supermarket. 

• Tuesday, May 13 - An employee gift will be given out May 13 between 8 a.m. - 12 p.m. 

• Wednesday, May 14– Ice cream social! Come hungry:    
• 12 p.m. – 2:00 p.m. in ED entrance and Civiletti Conference Room
• 6 p.m. - 7:00 p.m. - ED entrance 
• 11 p.m. – 12:00 a.m. -  ED entrance 

• Thursday, May 15 - GBMC Employee Health Fair in the Civiletti Conference Center.  The winners of the trivia questions will also be announced on the InfoWeb.

Celebrating Our Extraordinary Nursing Staff During Nurse’s Week 2014

Each year, GBMC celebrates National Nurse’s Week to recognize the outstanding efforts nurses put forth on behalf of their patients. I’ve been at GBMC for almost four years and I have learned how talented and hard working our nurses are. With the introduction of Lean Daily Management, I’ve had the opportunity to meet many more of them and witness first hand their true dedication to our patients and our vision.

Our nursing staff is a phenomenal group – well-trained, caring and resilient. In fact, the resiliency of our nursing staff never ceases to amaze me. Through major snowstorms and torrential downpours, our nurses are there for our patients, whether they have to sleep on cots in the hospital so that they don’t miss a shift, or come in early to make sure shifts are covered.

Our nurses and nursing support technicians are the face of GBMC. They spend the most time with our patients and, in partnership with our physicians, generate the best health outcomes possible. Their untiring work this past year in improving patient safety and redesigning systems to better deliver care has been remarkable.

I’ve talked about some of our excellent nurses in this blog over the past year, highlighting examples of the hard work they have put forth to achieve our four aims including:

• The move toward standard work successfully implemented on Unit 38 by Kim Vohrer and director Justine Kellar, who led their team to dramatic improvements in the reliable use of falls prevention devices for patients at high risk
• Kathy Bull and her team on Unit 35 for implementing the standard work of calling the Emergency Department within 15 minutes of the patient being ready to move to “pull” the patient to their Unit. This new design has had excellent results in reducing the time that an admitted patient waits in the ED
• Charlene Mahoney, the Nurse Manager of the GOR PACU and her team who reached 100% compliance after just two weeks when they decided to measure and enforce the daily completion of the Post Anesthesia Evaluation Note before the patient could leave the PACU as one of their LDM metrics 
• How care managers like Vergie O’Garro in our patient-centered medical homes are effectively helping patients manage chronic health conditions 
• How Kate Devan and her team in the Sherwood Surgical Center are working hard to improve the aim of least waste by moving toward having all cases start on time at 7:30 a.m.
• How our nurses have been working diligently to reduce the rates of pressure ulcers to zero
• The work of Linda Kelly, clinical program manager for SAFE, who was our 2013 Compassionate Caregiver
• Cate O’Connor-Devlin and CJ Marbley, who volunteered their time to get the Playfit program up and running with the kids at West Towson Elementary School to combat childhood obesity

These are just a few examples of how our nursing staff has been getting in action to improve their units and departments as well as the community at large, for the benefit of our patients and all those who come to GBMC for the best care.

GBMC Introduces the Daisy Award for Nursing

Erica Wilkerson

Lindsey Turnbaugh

GBMC has become a proud DAISY Award partner, honoring one nurse every other month with a special recognition. The DAISY Award is an international program that celebrates the extraordinary clinical skill and compassionate care given by nurses every day. The DAISY Foundation was established in 1999 by the family of J. Patrick Barnes who died of complications of the auto-immune disease Idiopathic Thrombocytopenia Purpura (ITP) at the age of 33. (DAISY is an acronym for diseases attacking the immune system.) During Pat’s eight week hospitalization, his family was awestruck by the care and compassion his nurses provided not only to Pat but to everyone in his family.

Nok Ganotong Tongprom

We presented GBMC’s first DAISY award back in November to Erica Wilkerson, RN, the second award to Nok Ganotong Tongprom, RN, in February and most recently, we presented Lindsey Turnbaugh, RN, with the special award in May. All three of these extraordinary nurses showed deep compassion for their patients and embodied our vision – “To every patient, every time, we will provide the care that we would want for our own loved ones."

Thank you to GBMC’s entire nursing staff for everything you do, day in and day out, to help patients in need!