Continuing Our Work Towards a Better Healthcare System

The GBMC HealthCare system has been transforming itself for more than 6 years to deliver better health and better care at lower cost with more joy for those providing the care. We have been very successful so far. The health outcomes of our care have improved. Our patient engagement scores are up, especially in our advanced primary care sites. We have reduced the total cost of care for the Medicare beneficiaries served in those sites by more than 7 percent, and our people are delighted to have the support they need to better manage those with chronic disease.

Over the last week, I’ve been asked many times, “What effect will the presidential election have on our work?” Truthfully, I don’t really know. What I do know is that every American wants a healthcare system that is less costly, delivers better health outcomes and is more focused on the patient. Republicans and Democrats realize that we cannot return to a system that only financially rewards the number of services provided without regard to whether or not those services actually helped the patient and were provided in the most efficient manner possible. The move toward value is well under way and payers are not reverting to the old ways that had healthcare costs rising by 7-10 percent annually. Also, Republicans and Democrats know that even though we have made progress, we are still spending 40 percent more per capita on healthcare than any other country in the world and our industries are less competitive because of this.

The Affordable Care Act (ACA, Obamacare), in my opinion, has been very successful. More than 10 million Americans now have health insurance who did not have it before. People who were born with a disease now can buy insurance when they couldn’t before. Children can stay on their parents’ plan until they are 26 years of age. Medicare has seen the lowest annual cost increases in decades, and employers have benefited from lower increases to their plans.

The one area where the Act needs improvement is in controlling premium increases for individuals buying insurance on the exchanges. Before the ACA, people who were already sick (like someone I know who was born with epilepsy) could not get health insurance. Therefore, the price of insurance for individuals was lower than it is now because the insurance companies were only insuring well people. The ACA “mandates” that everyone not covered by their employer, Medicare, the Veterans Affairs or Medicaid buy insurance. You need the healthy people in the plan to spread the cost of the people with a disease over more policies to keep the price low. Well, too many healthy people are not buying the insurance and, therefore, the price has gone up significantly. This is the classic “chicken and egg” situation. People are not buying the insurance because the price is too high, and the price is too high because people are not buying the insurance. Medicare works pretty well for America’s senior citizens because it is paid for by the Medicare tax, and the younger beneficiaries don’t consume much while the older ones do. Medicare doesn’t make the sicker patients pay more. By the way, Medicare only spends about 8 percent on administration, the other 92 percent goes to pay for care. Before the ACA, private insurance companies were spending 70-80 percent on care and the other 20-30 percent was going for administration and profit. The ACA limits the percentage for administration and profit to 18 percent. If the act is repealed, this limit will go away.

Homeowners insurance wouldn’t work if you could wait to buy it until your house caught on fire. The same is true of health insurance. The risk must be spread over the entire population, including the healthy, for it to work. So it’s the “individual mandate” part of the Affordable Care Act that isn’t working well, and everyone agrees on this.

How will the new administration deal with this? No one really knows. But it is clear that we must continue to work to create a better system. We in the GBMC HealthCare system must deliver even better health and even better care at even lower cost by driving out the waste. We must educate citizens on the facts. We must make prices more transparent so it is easier to see one source of the waste in healthcare. We must recommit to working both in our state and with the new federal leaders to deliver better value to the American people.

Celebrating Nurse Practitioner Week
Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NP) this week. Across our nation, there are more than 220,000 NPs who provide care to millions of Americans.

We have excellent Nurse Practitioners working in our hospital, in our physician practices, and in Gilchrist Services. They help us reach our vision of a patient-centered system of care every day. Please join me in thanking them this week!

What a Great Party!

I would like to thank everyone involved in our very successful Art of Nursing celebration last week. The event’s emcee, Ron Shapiro, did a great job overseeing the event that featured presentations by our Board Chair, Bonnie Stein, our Chief Nursing Officer, JoAnn Ioannou, and a panel of physicians, which included Chief of Staff Dr. Melissa Sparrow, Chair of Surgery Dr. Jack Flowers and Chair of Emergency Medicine Dr. Jeff Sternlicht.  Each of them spoke about what nursing had meant to them in their careers. Two of our patients also recognized a nurse who had helped their families cope through the loss of their loved ones. This year’s winners of our nursing awards, Roxann Cavey, BSN, CCRN, RN, Samantha Clayton, MA, Alejandro Maynard, RN, Marcus Nicholson, MSN, MBA, RN, Nicola Wagner, RN, Delores Williams, AA, RN, Linda Young, CNOR, RN were all recognized.

When the formal program was over, Dionne Figgins, accompanied by our own Lisa Griffee, Director of Performance Improvement, Carolyn Keller, Nurse Manger of Unit 36 and Rachel Ridgely, Clinical Unit Coordinator of the MICU, got the place jumping with their rendition of “Stand By You.” This was followed by dancing to the tunes of DJ Mikey V.

It was a great opportunity to thank all of our nurses for all that they do for GBMC and our patients every day and to have some fun!

Recognizing Colleagues: Radiologic Technology Week & Forensic Nurses Week
This week is both “Radiologic Technology Week” and “Forensic Nursing Week” and I would like to thank all of our registered technologists (R.T.s) and our forensic nurses for their important roles in providing care and serving our patients as if they were their loved ones.

R.T.’s perform diagnostic imaging examinations and administer radiation therapy treatments and may specialize in a specific imaging technique such as bone densitometry, cardiovascular-interventional radiography, mammography, MRI, nuclear medicine, sonography or general radiography.  They work closely with our radiologists and radiation oncologists.

Forensic nurses are specially trained and certified examiners who care for adolescent and adult victims (ages 13 and older) of sexual assault.  Forensic nurses complete a full assessment of the patient, obtain potential forensic evidence and provide antibiotic therapy, emergency contraception, and resources for crisis counseling and support services.  Our forensic nurses, as part of our Sexual Assault Forensic Examination (SAFE) Program, are also an instrumental part of the Baltimore County Sexual Assault Response Team (SART) and work closely with local law enforcement agencies in cases of sexual assault in our community.

Please join me in thanking Phil Komenda, our Director of Imaging and Cardiac Services, and Laura Clary, RN, FNE-A/P, SANE-A, CPEN, our Clinical Program Manager for the SAFE Program, and their teams for all their hard work and for their important role in caring for our patients.

Thanking Our Veterans on Veterans Day and Every Day
Today, we honor the millions of American military veterans who have given of themselves to protect us. Let’s pause and salute all who have served and honor the tremendous sacrifices made by members of the U.S. armed forces and their families to preserve our freedom. I know that I speak for all of us at GBMC in offering our sincere gratitude for their personal sacrifices, past and present.

In Grand Celebration of Our Nurses

It has often been said that nurses are the backbone of a hospital, and that is clearly true at GBMC. The more than 1,000 nurses, across the GBMC HealthCare system, work very hard to deliver to all the care that we would want for our own loved ones. Without them, we would have no system.

I often write in this blog of all of the things that we are working to fix in our national healthcare system but nursing is not one of them.  I am a firm believer that the United States has the best prepared and hardest working nurses in the world.

GBMC’s nurses have been known for outstanding care at the bedside, but now they’ve also become leaders in quality improvement. Just look at our patient falls rate, our CAUTI rate, or our patient satisfaction scores.

Our nurses have done an outstanding job collaborating marvelously well with their physician colleagues and others to help us achieve our four aims.  And we cannot forget all of their contributions towards making our Epic implementation so successful.

Caring for sick patients with many needs requires physical and mental stamina. Our nurses are smart, well-trained and resilient. Their work is not predictable. I am so grateful for their ability to adapt to the variability in demand for their services from day to day and sometimes from minute to minute.

I am so grateful for the commitment, compassion, and expertise that our nurses bring to their work.  We will be celebrating The Art of Nursing this Friday night and I look forward to seeing many of our nurses at the event.  I am very proud of all of them and honored to call them my colleagues.

ARE WE IN AN ECHO CHAMBER?

It is very difficult, in a large complex organization, to make sure that everyone knows what is actually happening. At GBMC, we have many ways to communicate, but none of them are perfect. We communicate by word of mouth from manager to employee down the chain of command; we send email newsletters; we invite people to lunch meetings; we put information on the Infoweb; we use social media and many other methods. But I am still amazed at how little our people know about some of the things that I know, and how little I know, about some of the important things that are confronting our people. Sometimes people know very well what is going on in their unit or department but have no idea or are misinformed about things going on in other parts of our system.

I recall discussing this communication difficulty with Dr. Don Berwick, one of my mentors and someone who I have learned so much from. Dr. Berwick began the “triple aim” movement some years ago. This movement has been very successful at creating better health outcomes and better care experience at lower cost but most Americans don’t know that the movement even exists.  I remember telling him how few healthcare workers know what the triple aim is.  I ask this question at every employee orientation, mostly comprised of people who have worked in healthcare in other organizations, and most of them have never heard of this movement.   So, when I told Dr. Berwick how bothered I was about this, he responded that it was because we are in an “echo chamber.” Meaning that everyone runs in circles with the same people and we begin to believe that what we know and discuss is what the average person knows. Instead, we think this because we are speaking directly with a small group of people and we are reinforcing each other’s knowledge.  Unfortunately, the conversation is not getting out to the people who are not “in the room” with us.

The Epic implementation has been raising this issue of how to communicate well. If you are in a department where things are going smoothly, you believe that they are going well everywhere. If you are in an area that is still challenged, you assume that this is the case throughout the system. The true message about Epic is that on the whole, the implementation has gone very, very well. Very few companies have gone live with such a broad scope of applications all at once and accomplished what we have. But in some areas, like our physician practices, because the data conversion from our old system to Epic could not progress without major human intervention, we are still challenged to get the job of patient care done without a lot of data entry, verification, and rework. We are fixing this and I believe that in a few weeks all areas will be operating smoothly and will be ready to begin optimizing the system to help us get to our vision faster.

TOP DOCS 2016!
I am pleased to announce the selection of Dr. Melissa Sparrow, our first female chief of staff and medical director of Emergency and Inpatient Pediatrics, as the physician cover of this year’s Baltimore Magazine Top Docs issue. This recognition is truly an indication of Dr. Sparrow’s clinical expertise and leadership.

For 30 years, the magazine has annually recognized the excellence of the region’s physicians. Each year, we eagerly await the edition’s release to see how many of our accomplished doctors are chosen for their talent and compassion by their peers. I am certain that the entire GBMC family will agree that Dr. Sparrow serves as an excellent representative of the many other GBMC physicians who are recognized within the pages of the issue.

I would also like to commend Dr. Neal Friedlander, chairman of the Department of Medicine, who was selected to be one of only seven doctors profiled in the issue, chosen from more than 680 doctors who were nominated for the honor.

Please join me in congratulating both Dr. Sparrow and Dr. Friedlander for their achievements as well as all others who are named 2016 Top Docs.

GBMC is a Learning Organization

I have spent my career in healthcare and for most of it I was on the frontline, taking care of patients. During our Epic implementation, I was reminded how little I actually know, or how little anyone actually knows, about how our healthcare system functions. I don’t mean that glibly –– our company has thousands of workflows in order to get the job of patient care done. Some of them are designed beautifully and work very well. Others are very complex, have fallen together over time, and are more like a Rube Goldberg contraption (a device that performs a simple task in a complicated fashion).

All of my GBMC colleagues will have their favorite examples of well-designed processes they are involved in daily and others that are in need of redesign. I can think of many processes that work well, but one of our most elegant is the check-in and rooming process at Family Care Associates. Patients are greeted, checked in and then immediately escorted to an exam room to be seen by a doctor. It’s a very smooth, generally reproducible process.

One of my least favorite processes in our company is the process for telling new patients how to get to the location of their visit (and where to park!). Prior to a patient’s first visit, some offices/clinics call and/or mail instructions while others give the name (e.g. North Pavilion) and/or address of the building. I wish I had a nickel for every patient I have found lost on our campus or parked needlessly far from where they need to be.

We should not be surprised that we have many processes that are too complicated and wasteful, nor should we be ashamed when we identify them. We should, however, be ashamed if we don’t learn from what we find and test changes to improve. This is the whole reason for doing Lean Daily Management (LDM). Maybe we should change the name of this practice to Learn Daily Management.

I was speaking with Radiology Quality and Patient Safety Coordinator, Brenda Schuette, on LDM this week. Brenda explained that she discovered a change in the process for ordering electrocardiograms, a result from the Epic implementation which created difficulty in getting ECGs read quickly by a cardiologist. The bad news was that the process had been slowed down, but the great news was that Brenda was part of a team that was studying the process and using their learning to test a fix! Having people learning about our processes every day is a requirement for getting to our vision of treating everyone, every time, the way we want our own loved ones treated. Let’s keep learning!

Thank You!
We couldn’t have asked for better weather during last week’s Baltimore Running Festival. Thousands of people participated in this year’s event including approximately 100 runners who joined team #RunGBMC to raise funds in support of Gilchrist Center Baltimore – Joseph Richey House. The 19-bed inpatient center has been serving patients in Baltimore City for more than 30 years by providing residential, acute and respite care. We’re still counting, but so far we have raised more than our $50,000 goal. The money raised by team #RunGBMC will help cover Joseph Richey House’s operating expenses not covered by insurance or patient payments.

I participated as part of a four-person marathon relay team with Lisa Baylin, a patient from our Comprehensive Obesity Management Program and teammate who so graciously hugged me when handing off the timer, along with Greg Shaffer and John Lazarou from our marketing department. We all had a great time in support of an important cause.

I’m very grateful to all of the employees, volunteers, patients and supporters of GBMC Healthcare who helped us raise money and awareness of the outstanding work at Joseph Richey House.

Running for The House

Gilchrist Hospice has helped so many individuals and families through the end of life.  The Gilchrist team not only delivers world class medical care to patients in their final days, but they also provide the emotional and spiritual support needed through the bereavement process.  One of the things that continues to impress me 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. The GBMC system and our community are very lucky to have Gilchrist to help individuals complete their lives with dignity and on their terms.

Gilchrist is the largest hospice in Maryland and is repeatedly recognized nationally for its work. Almost two years ago, the Joseph Richey House, a 19-bed inpatient center that since 1987 has been serving patients in Baltimore City by providing residential, acute and respite care, was acquired by Gilchrist. Joseph Richey was failing financially, in large part because it was serving the poor. We acquired it because it was the right thing to do, but now we must raise the funds to cover its operating expenses not covered by insurance or patient payments.

So, this Saturday, I am participating as part of a four-person marathon relay team in the Baltimore Running Festival with approximately 100 other runners.  The funds we will raise are in support of the Joseph Richey House and the outstanding care that is provided there.

I want to thank all of our employees, volunteers, patients and supporters of GBMC Healthcare who are participating in the Festival and helping to raise awareness of the great work at Joseph Richey.

So please support RunGBMC, and join us in raising money for The Joseph Richey House and giving back to our community. If you want to lend financial support please click on this link: https://www.crowdrise.com/run-gbmc

Thank you for your generosity!

2016 Healthcare Security and Safety WeekPlease join me in recognizing all members of our GBMC security staff as this week is Healthcare Safety and Security Week (Oct. 9-15).  This is a good time to celebrate the work of our security and safety professionals in serving our healthcare facilities, personnel, visitors and patients.

The GBMC security team can be seen walking or stationed throughout our medical center from the emergency department to labor and delivery.  Our security and safety officers meet the challenge every day to keep all of us safe at GBMC. They are vital members of the healthcare team and we cannot be successful without them.

Please join me in thanking our security staff for their hard work and for their strong commitment and the diligence they display in the practice of their profession.

Epic is Now Live Thanks to Everyone’s Hard Work

Early last Saturday morning we flipped the switch and Epic went live. While things are not perfect, Epic is running smoothly and patients now only have one record at GBMC. This has really been a big team effort.

Cindy Ellis, RN, the Epic Project Director shared a few facts with me:

--We had 200 Epic team members offering ‘at-the-elbow’ support during go-live;

- Care Everywhere patient data is flowing in over 1,000 patient transactions. Organizations across Maryland and as far away as Texas and Colorado are pulling records as we share information and better coordinate care;

- Our Epic Command Center is open 24/7 and has resolved 48.72% of support tickets.

- A few inpatients are now trialing MyChart Bedside to view health information, message with their medical team and better plan for the day during their hospital stay.

Dave Hynson, GBMC’s Chief Information Officer, told me that he thinks that overall the implementation has gone better than even he anticipated. None of the issues that have come up have surprised him. There have been some issues with system access and printing, but these are things encountered by all hospitals that have implemented Epic. Dave believes that when you look at the grand scheme of things, we are implementing simultaneously more modules than most other hospitals, and we have had tremendous success to date. Dave is pleased with the work of the users, their support, optimism and enthusiasm and how they’ve been patient in working to resolve issues that come along. He points out that the team members from Epic headquarters have been impressed with our problem solving skills and the low amount of frustration among all parties involved.

One of the areas where the rollout has gone very well is in the Emergency Department. Mike Santiago, MD, one of our ED physicians who has been very involved in building, testing and implementing Epic for the ED said that our Emergency Medicine team took this transition very seriously and as a result this monumental change has gone relatively smoothly. Mike points out that behind the smooth transition of the physicians and nurses however, was a lot of not so visible hard work and preparation. There was direct clinical input every step of the way as the GBMC analysts and Epic team customized our ED workflows and orders in the system. Without this direct collaboration we would not be experiencing this initial success. Every one of the providers came to a training class and were encouraged after this class to practice in the “Epic playground” environment to familiarize themselves with the program. They were also encouraged to come in during designated times to work with the Epic masters customizing their order sets, their smart phrases and their other documentation tools. Without the engagement of the providers in this process our transition would have been much more painful. On top of this preparation, providers in the group have eased the transition by coming in on their own time for 2 to 3 hours to decrease the overall department workload and practice their initial documentation on a handful of patients. This provider directed effort has decreased the burden and the stress during go-live. It has been a major factor in the ED’s ability as a department to get up to speed as quickly as they have.

Kimberly Vohrer, RN, the Nurse Manager of Unit 38 said that one of her biggest concerns, prior to go-live, was that the system would be turned on but then crash. Kim is happy that the system has stayed live so that her team could focus on all of the changes that were taking place. Kim points out that over the last few days, what’s been a major help has been the interdepartmental collaboration, with the physicians and pharmacy for example, and basically everyone coming together to tackle any issues that come up. Kim adds that the nurses have been “rolling with the punches” and learning. They’ve also had support ‘at-the-elbows’ which has been very helpful and the fact that various members of leadership, directors and managers, round constantly and are being visible has also been a huge help. All this has really allowed the nurses to focus on taking care of their patient and with their responsibility in completing their documentation.

All of our team at Gilchrist Services should be commended as well for their great work in implementing Epic. Since so many of our Gilchrist patients are in their homes or extended care facilities, this made the task of one patient - one record even more difficult. They have done a marvelous job at getting the system up including in our 3 inpatient units.

Our employed physician offices have done very well, too. They had the added challenge of not having all of the data from their previous electronic record move seamlessly into Epic. I am very grateful for their efforts in making the transition work.

There is clearly more work to be done in the “stabilization” phase and no one denies that the learning curve is steep. We have gotten over the early stress of the implementation and our patients and staff are already beginning to reap the benefits of this wonderful new tool. Stay tuned as we optimize the system over the months and years to come!

National Physician Assistant Week

Please join me in celebrating all GBMC physician assistants (PAs). This week is National PA week (Oct. 6-12) and is a time when we celebrate PAs and their profession and showcase the value they bring to today’s healthcare team.

A physician assistant (PA) is a nationally certified and state-licensed medical professional who first completes a bachelor’s degree and then an intensive three-year PA program with at least 2,000 hours of supervised clinical practice.  They then must pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).

The GBMC PA staff practice in many areas from the outpatient offices to the inpatient units in a wide variety of specialties. Please join me in thanking our PAs for their hard work and for their important role in moving GBMC towards our vision.