Honoring a Staunch Supporter of GBMC

On Monday, we held a dedication ceremony to officially rename the Physicians Pavilion North (PPN) to the William E. Kahlert Physicians Pavilion North. The naming was made possible by The Kahlert Foundation’s $5 million pledge during GBMC’s 50th anniversary celebration.

The Kahlert family has become part of the GBMC family and has been supporting us for the past 18 years. Bill and Yvonne were both GBMC patients and began giving to our healthcare system in gratitude for the care they received.During Bill’s battle with cancer, he developed a strong relationship with Dr. Ronald Tutrone and later with Dr. Paul Celano. Bill and Yvonne first supported GBMC HealthCare in the year 2000, four years before Bill developed a relationship with Dr. Tutrone, with a $250,000 to name the William E. Kahlert Cystoscopy Suite. This gift was soon followed by a $500,000 gift to secure the daVinci Surgical System that allowed GBMC to provide robotic urologic surgery. Three years after that, Bill personally made the bold step to endow a Urologic Research Fund to support research efforts under the direction of Dr. Tutrone. The Kahlerts also endowed the William E. Kahlert GBMC Chair in Urological Research which was the first of its kind at GBMC and has inspired a host of others to honor physicians and the great care they provide.

In 2009, to demonstrate his gratitude to Dr. Celano and the oncology team who cared for him as his cancer battle continued, Bill established a fund to promote multi-disciplinary medical research, which has helped GBMC to increase enrollment in oncology clinical trials by 25%.

Bill and Yvonne’s son Greg and his wife, Roberta, as well as their children, Heather and Scott, have continued the family’s support of GBMC. In 2014, The Kahlert Foundation gave $1 million to name our chapel in honor of Yvonne and to fund a second chaplain position. With the latest $5 million gift, their family and the family foundation have donated more than $13 million to our system!

Please go see the beautiful plaque and inscription in the Kahlert Pavilion lobby and the wonderful new signage on the exterior of the building.

I was honored to help commemorate Bill’s life through this dedication and we at GBMC are extremely grateful for the ongoing gifts from The Kahlert Foundation. We applaud Greg, Roberta, Scott, and Heather for continuing their family’s support of our work in the community.

Vanta Brewster

Celebrating Dr. King!
Yesterday, we hosted our annual Black History Month celebration. This year’s program, titled Black History Month and Spirit of King Awards Celebration, started off with a keynote presentation by Patrice Sanders, co-anchor of WBFF-TV’s weekday morning newscast, along with live music from the Dunbar High School Jazz Band. The winner of the inaugural Spirit of King award was Vanta Brewster. Congratulations Vanta and to all the nominees!

I am grateful to Jennifer Maraña, our Director of Diversity and Inclusion, and all of my colleagues on the Diversity and Inclusion Council for hosting this event and helping to bring us closer together. Thanks also go out to members of the Dunbar High School Jazz Band and our Black History Month committee that put together the outstanding celebration.

Random Acts of Kindness…
Last week, we celebrated “Random Acts of Kindness (RAK) Week” and this year, more members of our GBMC family helped to spread kindness throughout our healthcare system.

Dee Brown               Samantha Gendler

Kindness Kits were distributed to each hospital department, GBMC Health Partners practices, and Gilchrist units, so the GBMC family could display kindness to each other. This year had a new twist, as representatives from KIND also came to the hospital last Wednesday to hand out KIND bars and Valentines to passersby.

We also awarded our annual Random Acts of Kindness Ambassadors. The RAK Week planning committee received many worthy submissions and choosing the winners was extremely difficult. Congratulations to Dee Brown (Gilchrist Subacute) and Samantha Gendler (Marketing) for being selected as the co-recipients of our second Random Acts of Kindness Ambassador Award.

Thanks to everyone who helped with this event for making it such a success.

Book Drive…
Sticking with acts of kindness, just a reminder that we’ve been accepting donations of new and/or gently used books for the Reading Partners “Take Reading Home” program that will help provide support to children from kindergarten through fourth grade. Donations will be accepted until Wednesday, Feb. 28. Please consider leaving your books at our drop-off locations which include the main lobby of the hospital, the Human Resources department, the Marketing office (South Chapman building (Suite 102), Family Care Associates in the William E. Kahlert Physicians Pavilion North, or at any GBMC Health Partners primary care office.

National Tissue and Organ Donor Day

Did you know that this year today is not only Valentine’s Day but it is also National Donor Day? National Donor Day is a time to reflect on the gift of life that comes to many when they receive an organ, eye, tissue, or blood from another human being.

We all know that Valentine’s Day is a day to celebrate love and giving an organ or tissue is a remarkable way to demonstrate love. Currently, there are over 120,000 people nationally who are waiting for a life-saving organ and each day 110 people are added to the national waiting list. One tissue donor has the potential to improve more than 50 lives and one organ donor has the potential to save up to eight lives. If you need more proof of the power of organ donation, I welcome you to stop by and visit our ‘Tree of Life.’ This permanent art installation, close to the Emergency Department Concourse, memorializes the selfless act of organ and tissue donation at GBMC. What’s great is that if you stop by The Tree of Life, there is a kiosk where you can designate to become a donor. Please consider doing so!

Give Blood, please!!!
This year, the extreme winter weather and a deadly influenza season have adversely impacted both donors and blood drive coordinators, resulting in the cancellation of many important drives across the U.S. This has created a shortage of blood. To add, many of us also, unfortunately, take the blood supply for granted. If your loved one had just had a serious injury or needed blood because of a significant disease, you would expect that blood would be available for them. We are very fortunate that blood is available when our loved ones need it…but it doesn’t magically happen.

At GBMC, it happens because of the American Red Cross, our community partners, and the many, many members of our dedicated and caring staff. It is because of those who take the time out of their very busy schedules that we often meet or exceed our blood donation goal each time we have a drive. We also have community members who come to GBMC to donate because they want to support their community hospital and health care system!

So, I am asking the GBMC family to help in our next blood drive slated for Thurs., February 15 in the Civiletti Conference Center from 5:30 a.m. to 4:30 p.m. Please click here to schedule your life-saving donation! By the way, members of the community who come specifically to donate blood will receive a FREE meal ticket to the GBMC Dining Room, FREE parking and cookies. Employees will also receive the FREE meal ticket and cookies along with a special "Jeans Day" pass for Friday, February 16!

I am so proud of the teamwork displayed through these drives, helping GBMC to be a leader in blood donation. I hope you all consider coming out and helping us with this very important endeavor.

Protecting GBMC
About a month ago, two healthcare facilities in the U.S. experienced separate ransomware cyberattacks that compromised their patient files, patient portals, and their datacenter. This attack ultimately compromised the personal information of their patients and made it difficult to deliver care. To make sure that this doesn’t happen at GBMC, we need your help.

We all know that ready access to information on all aspects of care delivery is important, but is not without its risks. Through the Internet, health systems and other industries are under attack from criminals who look to profit from stealing information that should be private. The unfortunate situations, mentioned above, should serve as a reminder not to click links unless you are sure it’s safe, not to go to websites you aren’t familiar with and to ask IT for guidance if something doesn’t seem quite “right.”

You all recently received a notification from our Cybersecurity team with an important message regarding safeguards that were recently installed in our e-mail system.  All email is now subject to GBMC’s security filters and any mail that has characteristics of a phishing or other attack, will now be sent to the Junk folder. Unfortunately, this includes some internal emails. Please check both your outlook inbox and your junk folder daily.

We must all be vigilant and own the security of our information systems. Please bring the same questioning attitude that you use when delivering patient care to your use of e-mail, the electronic record, and other applications. Remember that it takes all of us to keep GBMC safe from cyber attack.

Amazon, Berkshire Hathaway, and JP Morgan Chase Unite to Purchase Better Healthcare Value

Last week, the news headlines included a story that got my attention! The CEOs of Amazon, Berkshire Hathaway, and JP Morgan Chase decided they would no longer tolerate the high cost of healthcare in the U.S. These corporate leaders know that we spend 40 percent more per capita on healthcare than any other country in the world and that despite higher spending, health outcomes are often the same or worse than in other countries. They also know that the U.S. has the best trained and most hardworking doctors, nurses, and clinicians in the world. The CEOs know people aren’t the problem.

The cost of healthcare varies dramatically from place to place — frequently from hospital to hospital. These CEOs are aware that sometimes there are differences in clinical outcomes between providers, but it doesn’t make sense to pay higher prices when the clinical outcomes and care experience are the same. They want to buy higher value.

Value= clinical outcome + care experience

Cost

It seems these corporate leaders believe they can use their clout as the purchasers of healthcare for more than one million employees to find the highest value. They want the best health outcomes with the best care experience at the lowest cost. They want to send their employees to the providers that can deliver the highest value. After all, if they know that hospitals X and Y will both do a great job at removing your gallbladder, but it will cost 50 percent more at hospital Y, shouldn’t they be sending everyone to hospital X? If, on the other hand, hospital Y’s outcomes and care experience are better, paying more makes sense.

I think they have a great shot at reducing their expenses while giving their people better healthcare. I have argued that the individual patient cannot drive value and actually has a hard time figuring out who has the best outcomes and who has the lowest prices. But moderate and large size employers know what they are paying and can demand data from hospitals and physician groups and use it to buy healthcare in much the same way they buy everything else. Of course, there is a fear that healthcare providers will just lower prices for those with clout and make the prices even higher for everyone else. (But in Maryland, since we are a rate-regulated state, this “cost-shifting” won’t be possible for hospital care.)

I applaud this initiative and I hope to see more business leaders demanding this in our market. We will all be better off. What do you think? Will it work?

Always Having the Supplies That the Team Needs…and not too many!

Managing the supply chain for a health system is no easy job. Last summer, I commented on the outstanding work of our materials management team led by Kendrick Wiggins and Kevin Edwards. Click here to see where we were last summer.

I recently met our new Director of Materials Management, Brian Reimer. In his role, Brian will oversee the entire supply chain from purchasing to procurement and distribution. Our goal is that our clinicians (and the rest of us!) always have what they need, when they need it, so that we can serve our patients well and move closer to our vision.

Brian has many years of experience as an engineer and supply chain manager in several high volume, fast-paced, technical environments.  He comes to GBMC after a nine-year career at Cardinal Health, a healthcare services company, where he was responsible for the operations of a major medical-surgical distribution center serving customers in the U.S. and overseas. He also possesses years of experience in establishing and executing supply chain solutions that helped to reduce waste and improve efficiency for the Cardinal Health distribution centers.

Brian’s job is far from easy. In the ever-changing healthcare world where new products constantly come on the market, Brian needs to make sure that we get what we need and do not waste resources through unnecessary purchasing. Brian’s most important customers are our clinicians. A couple of weeks ago a number of our units did not have enough face masks to care for patients. Brian needs to own the system for supplying the face masks but he also needs to own the system for learning why we didn’t have enough of them on certain units so we can make sure it doesn’t happen again. 

We have locked, computerized, supply storage cabinets on our inpatient units. They were purchased believing that the technology could help us with assuring that we knew precisely when supplies were getting low to prevent “stocking out." The system requires the user to enter the exact number of things removed every time they use the device. This is difficult to achieve in the hustle and bustle of a busy clinical unit so what the computer thinks is often wrong. A less sophisticated system, called a Kanban two bin system, is used in our physician practices. A necessary supply, let’s say 2- inch gauze pads, are stocked in the cabinet in an exam room in two bins. When the first bin is emptied, the clinician pushes it to the back (or to the front depending on how the cabinet is designed). The person doing the re-stocking then has the visual cue to refill the empty bin. The computer and the counting are then not necessary.

I am delighted to welcome Brian as a new colleague and expert in supply management. He knows that the most sophisticated (and expensive) system is not always the best system. Brian will help us get to a better-designed system by collaborating with the people actually using the system. I really look forward to working with him. Please join me in welcoming Brian to our family!

What if it was your mother?

I have been reflecting this week about an incident that made it to the national news; a woman wearing a hospital gown was left by hospital personnel at a bus stop in our city. We don’t know all of the facts, but this has been reported not to be an isolated occurrence. Could this happen at GBMC?

Emergency departments are frequently under siege. I have been in healthcare for more than 30 years and through those years, I have seen how we frequently use the emergency department as the pathway of least resistance. Primary care office closed? Send the patient to the ED. Specialist unable or unwilling to deal with a problem in the moment? Send the patient to the ED. Hospital leaders not able to create a smooth system for admitting a stable patient to the hospital? Send the patient to the ED. No way to get an infusion done on the weekend? Send the patient to the ED. Mental health system is broken? Send the patient in crisis and his or her family to the ED. I have worked in the emergency department when it seemed that we were overwhelmed with many problems beyond our control. And of course when the emergency department is overcrowded, people wait and they get upset.

What if we assume for the sake of discussion that there is a patient for whom the emergency department has done its job of treating an acute problem? The staff believes it has done all it needs to do and the patient is not happy. The patient begins to act in a belligerent manner after being told that she is being discharged. Let’s also assume that the first reaction of the staff is to try and reason with the patient and calm her down. But what if the patient escalates her behavior and starts yelling and screaming and even threatening the staff? And what if this is the third angry patient of the evening who has gotten confrontational? Can you understand the urge of a physician, nurse, or security guard to have this patient leave the ED? Of course, you can.

And what if the patient in this not atypical situation was your mother? What should happen next? There is no perfect answer in this hypothetical situation, but of course, you want your mother treated with respect and kindness, even if she is out of control.

As the leader of the GBMC HealthCare System, it is my job to make sure that the ED staff members believe that we will not leave them on their own when they are confronted with problems beyond their ability to fix. They must also believe that people like me mean it when we say that everyone must be treated the way we want our own loved ones treated. But we can only hold people to this standard if we are ready to give them the help and support that they need to carry it out.

Could this happen at GBMC? It is my duty to assure that our incredibly hardworking physicians, nurses, advanced practitioners, other clinicians, and support staff teams have the equivalent of a safety button that they can push which will bring other leaders to help when they feel overwhelmed. I have shared this commentary with Dr. Jeff Sternlicht, medical director of our ED, and Monica Goetz, assistant nursing director, who oversee the emergency department, to have them assure our staff members that we will not leave them to deal with episodes like these on their own. What do you think?

What if it was Your Loved One in the Bed? The Absence of Alarm Fatigue in our MICU!

Back in July, I wrote a blog about “alarm fatigue.” In that blog I discussed my experience as a pediatric resident in a Neonatal Intensive Care Unit with alarms that constantly went off. We had become oblivious to them, unconsciously assuming that they were false alarms. In that blog I also commented that in highly reliable high-risk systems, like in an airplane cockpit, the alarms are minimized to those that are critical and that in those systems everyone responds immediately to them.

This morning I was on our Lean Daily Management walk in the MICU. Stacey Klingler, RN, the charge nurse, was presenting the Board accompanied by her manager, Rachel Ridgely, RN. Stacey was in mid-sentence explaining something to us when a patient alarm went off. Stacey immediately stopped and started to move to the patient’s room as did Rachel. I turned and looked towards the source of the alarm to see that other staff members were on the move as well. A staff member gave a thumb’s up “all clear” and everyone went back to what they were doing. Without missing a beat, Stacey finished her explanation. I was so proud of Stacey, Rachel and the entire team. If it is your loved one who is a patient in our ICU, you don’t have to worry about an alarm being ignored.

We thanked Stacey and Rachel for exhibiting the “preoccupation with failure” that all high reliability teams exhibit and for not assuming that the alarm was false or would be dealt with by someone else. Afterwards, I reflected on how quiet the unit had seemed before the alarm went off even though the unit was very full. We are making excellent progress in eliminating alarms that are not helpful and in presuming that all alarms are real until proven otherwise.

Drift

Rachel also told us that she was meeting with the leaders of our equipment hub. A few years ago we created the hub to remove clutter (and eliminate blocked corridors in the event of a fire) from our patient care units and also to have a system where we always knew where our equipment was. This way it could be moved quickly to where it was needed. At that time, we realized that hard-working, well-intentioned physicians and nurses were hoarding equipment because they were afraid that they would not get it back when they needed it…in other words, they knew that the system for removing equipment from and returning it to the units was unreliable.  Well, our system has worked pretty well since we created it but Rachel was seeing some drift away from our standard work. The physicians and nurses were beginning to hoard things again after one or two episodes where they had called for things that could not be found.

It is not a surprise that workers in unreliable systems begin to work around the system. They are not doing it for malicious reasons. They do it because they believe it will help them get their work done. But, as students of systems, we need to point out that when a system starts to fail and people stop following the design, it actually makes the system worse! Rachel is taking the correct step to meet with the hub leaders and ensure that we continue to follow our standard work to make sure that everything is in its place and moves according to need.

What do you think? Do you see other examples of drift away from standard work? Please comment below.

On Becoming a Learning Organization: 8 Employee Injuries

Today, I met with Simon Freyou, our new Director of Occupational Health, and discussed the GBMC HealthCare System’s progress in making our environment safer. Back in 2011, as we started becoming aware of the magnitude of this problem, we had as many as 40 injuries per month, many of which were lifting injuries, injuries due to slips on wet floors and sprains.

Last month we had “only” eight injuries. I use the quotes because if you are one of our eight colleagues who was injured, you deserve to be annoyed if the CEO says “only eight injuries.” I was telling Simon that the good news is that there were no sprains, strains, slips, and falls or chemical exposures this year.

How did this improvement occur? Was it by wishing and hoping? Or by paying better attention? I am sure that paying attention to wet floors or to how we lift patients did help; but most of the improvement came from studying the causes of the injuries, learning from them and making real changes. We now have “spill stations” throughout corridors where we often have spills or wet feet. We no longer place full trash bags on the floor, instead, we place them directly into carts because many contain liquid and may leak. We have placed lifting devices in most rooms or near where the care is delivered to aid in lifting patients.

With “only” eight injuries we still have work to do. All eight were in the category of potential blood-borne pathogen exposure- needle stick or other sharps injuries and splashes of body fluids. This category is probably the worst for our people. It is very unlikely that someone will get a serious pathogenic exposure from a sharps injury or a splash, but can you imagine going home after your work as a physician, nurse or other clinician and telling your spouse that you just converted to Hepatitis C positive because you stuck yourself with a needle? We owe it to our people to learn from every injury to make changes to eliminate injuries from our workplace. While we will never achieve perfection, we must always be working to reduce harm to our patients and our workforce. I am proud to report that we are becoming a learning organization and we are making progress. Let’s keep learning and testing changes on the basis of what we learn.