Helping Patients with a Rare Disease

On Friday, December 7, we announced the naming of a new center that will help patients with Alstrom Syndrome (AS). A rare disorder caused by a genetic mutation, AS has devastating effects including blindness, deafness, and ultimately multi-organ system failure, and premature death.

The Jan D. Marshall Center of Excellence at GBMC is the first center in the nation to focus on AS. It was created thanks to a gift from Alstrom Syndrome International, whose mission is to help those afflicted and to search for a cure for the disease. Clair Francomano, M.D., Geneticist and Director of Adult Genetics at the Harvey Institute for Human Genetics, was close friends with the late Jan D. Marshall, co-founder, long-time board member, and the first Chair of the Scientific Advisory Board of ASI, who imagined a better life for children battling AS.

Since 2015, GBMC has been the home of a semi-annual multidisciplinary clinic for AS. Children come from around the world with their families to seek treatment, learn about the disease, and meet others who are living through it. Our partnership with ASI has not only provided comprehensive clinical care for patients, but also professional education for physicians and research regarding the causes of this debilitating disorder. The Jan D. Marshall Center of Excellence will continue to focus on helping those affected and search for a cure for Alstrom Syndrome.

Please join me in celebrating the founding of the center and in congratulating Dr. Francomano for being named the new Chair of ASI’s Scientific Advisory Board.

Nurse Residency Program Recognized by the American Nurses Credentialing Center

GBMC HealthCare is proud to announce that our nurse residency transition to practice program is now accredited with distinction by the American Nurses Credentialing Center (ANCC). This is the highest level of recognition awarded worldwide for programs that demonstrate excellence in continuing nursing education. GBMC is the only hospital in Baltimore to receive this accreditation, the first in our Maryland state nurse residency collaborative, and only the 61st to earn it globally.

I would like to recognize JoAnn Ioannou, DNP, MBA, RN, NEA-BC, Senior Vice President of Patient Care Services, Chief Nursing Officer and the following members of her team for their continued dedication and for earning this recognition: Lynn-Marie Bullock, DNP, RN, NEA-BC, Director of Professional Practice; Jennifer Spahn, MSN, RN, NEA-BC, Clinical Program Manager-Nurse Residency, Theresa Di Seta, MSN, RN, Education Specialist-Nurse Residency, Roxann Hurkamp, BSN, RN, CCRN, Education Specialist-Nurse Residency; and Lauren Raynor, MS, RN, Education Specialist- Nurse Residency.

An Outstanding Colleague Leaves Private Practice and Joins GBMC HealthPartners

Earlier this week, I spoke with our new GBMC colleagues at employee orientation. I gave the opening welcome and talked about the parts of our organization and how they fit together as a community-based system of care. I explained our mission and our values, and how we are owned by the community. I explained to our new people that the Board of Directors are the members of the community who oversee me and the rest of our team in the fulfillment of our mission of health, healing, and hope. I told our new colleagues how the Board held a visioning retreat in late 2010 that created our plan and that we have been implementing this strategic plan ever since. We are now a system that is designed to provide the care that we want for our own loved ones as defined by: the best health outcome and the best care experience, with the least waste of resources and the most joy for those providing the care. I did this because it is important for our new people to be enrolled in this vision as they are beginning their careers with us.

Among the people that I welcomed at orientation was someone who is not a new colleague. He has been with our system for quite some time, but he is moving from the private practice of medicine to employment with GBMC Health Partners. He is Jon E. Simon, MD, a double board-certified physician in Pediatrics and Internal Medicine. He attended medical school at the University of Maryland and completed his residency training at the University of North Carolina Hospitals in Chapel Hill, NC. He has been practicing primary care in Baltimore since 1998 and will now be joining our advanced primary care practice at Hunt Manor.

Given Dr. Simon’s transition from private practice to an employed Health Partners physician, I thought it would be a good idea to get his thoughts on the transition, the joys, and challenges of private or employed practice and to learn why he chose employment with GBMC.

Q:  Prior to joining GBMC Health Partners, you owned your practice. What factors led you to switch to employed practice? Are other physicians faced with the same issues and how would you counsel them to proceed?
A:  "For years, I have enjoyed my solo private practice, which included seeing patients of all ages, as well as going to the hospital to see newborns and hospitalized adults. I read about so many of my primary care colleagues around the country experiencing burnout, and while I have never felt that in my career, I expect that many changes in healthcare in the next 5-10 years would add excessively to my administrative burden; I was looking for a way to help manage the administrative aspects of practice."
 
Q:  There are positives and negatives associated with being an employed physician and with being in private practice. Can you briefly describe the advantages, disadvantages, and similarities that you see in these roles?
A:  "The advantage of a private solo practice was in allowing me to have total control over my schedule, my employee wages, my office setting, etc. If I know that a certain patient needs an hour of my time, I can make that happen. If an unexpected number of patients need same day appointments, I can make that happen. I place a high value on making sure the patients have a good experience (are seen on time, don't feel rushed, get their phone calls returned, get same-day appointments, etc.). As an employed physician, I will need to rely on other people to make all those things happen. At the end of the day, being a primary care pediatrician/internist is about the experience of taking care of patients, regardless of the practice setting. The professional satisfaction comes from that experience in the exam room with the patient."

Q:  You’ve just described some of the advantages and disadvantages to employment versus private practice. I’m guessing that ultimately, it's up to the individual physician to decide what they want most. What did you want most and why did you decide to move to employed practice? Moreover, why did you choose GBMC Health Partners?
A:  "As a solo pediatrician/internist, I was the only doctor in the office. However, I was also responsible for administering all the immunizations, doing EKG's and spirometry, as well as managing the payroll, accounts payable, laundry, maintenance and repair, and IT support. Those secondary roles have been very gratifying, but that gratification can't last forever! In choosing to return to an employed group practice, I was looking for a way to keep the joyful parts of patient care and to lessen the burden of those secondary roles. I also am looking forward to having my patients benefit from the team-based approach of GBMC Health Partners. I have been on staff at GBMC for 18 years, and I trust the organization and respect the leadership. GBMC was not always skilled at running outpatient practices, but they have improved a great deal, and have committed to and invested resources in primary care practices especially."

Q:  The switch from private practice to a salaried position can be a complex decision. There were various factors that you had to consider. Are your colleagues in private practice dealing with the same issues? How might you advise them if they are considering making a similar transition to employed practice?
A:  "I can't really address what colleagues are going through, though I suspect that there are very few out there still in private (especially solo practice). For many years, I have noticed that there are few if any physicians younger than myself going into private practice. I am 51 and was still the youngest one I know of."

Q:  Whether a physician chooses to be employed or in private practice, what are a few tips you’d share on how to thrive in either work environment?
A:  "It is very easy to let the administrative hassles of your job get to you. There is a high degree of physician burnout in primary care, but it doesn't have to be that way. We should all recall that every day we come to work, we will make a difference in somebody's life. For me, whether it is seeing a newborn in the hospital, or helping patients in the office with complex or even simple problems, the patients are grateful to have a physician on whom they can rely. Keeping this basic fact in mind will help us all thrive as physicians, regardless of the practice setting.

Q:  What are you looking forward to the most in working for GBMC Health Partners and what will you miss the most in not working in private practice?
A:  "I will miss the intimate setting of my small office, the very personal, welcoming venue that allows me to be very close to my patients and close to the business as well. Though it sounds a bit crazy to hear myself say it, at times I enjoy answering the phones, making appointments, and running patient payments through the credit card machine. Having been in solo practice for the last 16 years, I wouldn't exactly say that it was lonely, but I can say that I am really looking forward to working with other physicians at Hunt Manor! There are a few physicians whom I already know and have great respect for, and there are others whom I do not know but am looking forward to getting to know."

I am so grateful to Dr. Simon for his willingness to give us his insights. Please join me in welcoming him in his new role! We are delighted that he is a teammate in our system of care.

Physician Offices and the No-Show Rate

This week, I had the pleasure of going on the GBMC Health Partners Lean Daily Management walk. I, along with members of my team, visited our Neurology Center, Ophthalmology, and Bariatric Surgery practices. I was so excited to see the incredible level of engagement of the staff in each practice. They are doing phenomenal improvement work to move us faster towards our vision!

In the Neurology Center, Kristen Stamathis, the Senior Practice Manager, presented a least waste metric. The team was working to better understand the causes of patients not coming for their appointment and how to reduce this “no-show” rate. Dr. Michael Sellman, the Medical Director, and Kristen know that the time neurologists spend with their patients is an incredibly valuable resource. With the aging of the population, there is an ever-increasing need for neurology consultations and there are very few neurologists in our community.

Literature suggests that the patient no-show rate goes up exponentially for appointments made more than 18 days before the date of their visit. People are more likely to forget about the appointment or have their needs met in some other way the more distant the scheduling date is from the appointment date. I pointed out that many restaurants will not allow you to make a reservation more than 30 days in advance because of this fact.

So, what should the team do to make sure appointments are not wasted? I told the group that my dentist texts me the day before the appointment and asks me to respond “Y” for yes if I can keep my appointment or “N” for no if I can’t. If I reply “no” or don’t reply at all, they give my appointment to another patient. For many restaurants that use OpenTable, I now get a prompt the day before asking me to confirm my reservation. We also discussed the commercial airline system where they calculate the average no-show rate and overbook the seats. They know that sometimes everyone will show up and then they must pay some passengers to fly later (Kristen and Dr. Sellman didn’t like the idea of paying some patients to come back another day…okay, I was only kidding) but by doing this, the airlines ensure that they won’t take off with empty seats from no-shows.

Of course, no reminder system is foolproof, but I was very proud of the team for the rigor of their study of the problem and their willingness to test new ideas.   

A huge “Thank You” to our Elder Medical Care team!!!
Last week, our Elder Medical Care (EMC) Home Services Team provided Thanksgiving dinner to families in need. Last year, we helped 10 families enjoy their Thanksgiving Day holiday, but this year, the need was greater than ever, and our program rose to the occasion.

Thanks to the efforts of our EMC Home Services Team and the Notre Dame University of Maryland pharmacy students, 15 turkeys and more than $400 in cash and gift cards helped to provide a very nice Thanksgiving Day meal to two small assisted living facilities (ALF) -- the donation to Agape ALF was made in honor of Kathy Ruane -- and 15 families. The Thanksgiving dinners consisted of turkeys or rotisserie chickens, side dishes, bread, and dessert. Some of our families, who are not able to cook due to safety concerns, received ready to eat or microwavable meals. Providing families with a Thanksgiving meal who would otherwise not have had one is an all-hands-on-deck effort lead by the providers of the EMC Home Services Team.

A big thank you to Laurie Whelden, Yolanda Greene, Jessica Trizna, Asma Hussaini, and Dr. Freedman for helping with the deliveries, to Thelma Winn for picking up our donations from the Assistance Center of Towson Churches, Kathy Roberts for delivering frozen and fresh poultry around Baltimore County, and to the EMC/Advanced Care Management employees who donated their frozen turkeys and canned goods/money. We could not have done this without all of you and I am truly thankful for your kindness and generosity!

Thankful for You!

This Thursday is Thanksgiving Day. I would like to wish a Happy Thanksgiving to my GBMC colleagues. 

Thanksgiving is a time to reflect on all that we have. I am very fortunate to have a wonderful wife and children, and wonderful friends and family members.

The GBMC family has a lot to be thankful for as well. We have a beautiful campus, great doctors, nurses, allied health professionals, and support staff working in the hospital, at GBMC Health Partners, and at Gilchrist. We are so lucky to have our fabulous volunteer auxiliary and tremendous community support. Members of the community serve on our GBMC HealthCare Board, the Philanthropy Committee, and the Gilchrist Board. Our governance bodies are made up of individuals who are dedicated to the mission of GBMC – a mission of health, healing, and hope for our community.

I am grateful for everyone who helps us care for our patients and I am grateful for the patients themselves, who entrust their care to us.

I also want to extend a special “thank you!” to all who will work on Thanksgiving, or who are working during the extended holiday weekend.

Again, wishing you all a joyful Thanksgiving!

P.S. What are you thankful for during this time? I’d love to hear about it – please leave me a comment!

We Earned An "A"

Last week, we got a report card of sorts and I am happy to report that we received an “A” grade! We achieved this high mark in The Leapfrog Group’s Hospital Safety Grades for fall 2018, which rates how well hospitals protect patients from errors, injuries, and infections. The survey assessed more than 2,500 hospitals across the nation, including 40 in Maryland. GBMC was one of only five hospitals in the Baltimore region and one of eight in the state to get an “A”! To see the grades, click here.

The Leapfrog Group, which launched its first hospital survey in 2001, began when a group of business leaders wanted to accelerate the improvement of hospital safety and worked with the Business Roundtable to review the evidence. If you would like to learn more about the survey, click here. The hospitals were given a letter grade from “A” through “F” based on several factors, including medical errors, accidents, injuries, and infections. The goal of the rankings is to determine a patient's risk of further injury or infection if they visit a particular hospital.

We should all be proud of this accomplishment. It is a measure of how well we are doing on our first Aim: the best health outcomes. We cannot be delivering the care we want for our own loved ones if patients are not safe from harm under our care. This “A” grade is another piece of evidence showing that we are moving towards our vision. We still have work to do but we have made great strides towards zero harm! I want to thank our entire team for all that you have done to move us to this point. I also want to thank Laura Hines, RN, SCNR, Director of Clinical Quality Outcomes and Carolyn Candiello, our Vice President for Quality and Patient Safety for their tremendous work in culling the data for the survey. Great work!

We are so fortunate to have Gilchrist in our system of care!

November is National Hospice and Palliative Care Month and I think It’s an appropriate time to recognize the Gilchrist team, led by Cathy Hamel and Dr. Tony Riley, who have designed an exceptional system of elder care and pediatric end-of-life care. Gilchrist has outstanding programs to keep elders well and to serve them as they develop illness and progress through to end of life. Our geriatricians assess patients in consultation, serve as medical directors in over 30 extended care facilities, manage the Gilchrist Rehabilitation Unit at GBMC, work with advanced practitioners to deliver in-home primary care, handle symptom management and palliative care for patients with terminal disease, and of course, they work with the fabulous Gilchrist nurses to deliver end-of-life care through Gilchrist Hospice. The work continues with families after the death of their loved one with bereavement support and counseling.

Recently, Gilchrist launched a new Integrative Medicine program that’s available to patients receiving treatment at our Sandra & Malcolm Berman Cancer Institute. Leading the initiative is the program director, Delia Chiaramonte, MD. In the program, cancer patients receive evidence-based interventions to alleviate the symptoms and the stress of cancer to improve their quality of life. Integrative treatment planning covers symptoms such as sleep problems, anxiety, depression, pain, nausea, and fatigue. Thank you, Gilchrist and welcome, Dr. Chiaramonte!

Last month, I had the pleasure of attending Gilchrist’s Taste of Howard County. This year’s theme was Merriment in Masquerade and the event featured food from more than 20 of Howard County’s premier caterers and restaurateurs. It also included more than one hundred bid items as well as a cash raffle. Over $200,000 was raised and all proceeds from the event will support Gilchrist Center Howard County, the only inpatient hospice in the county.

Over the last 24 years, Gilchrist has done so much to help so many people. We are so grateful for all that the Gilchrist team does every day.

Don’t Forget to Get Your Flu Shot!!

Immunization against influenza is the best way to prevent this illness. GBMC employees and volunteers are required to be immunized (those few who are not required to be immunized are required to wear masks during the flu season) to protect ourselves and our patients.
Currently, approximately 82% of GBMC employees and staff have gotten their flu shot. Our next FLU VACCINE EVENT is this Friday, Nov. 16, in the ED concourse, from 7AM - 7PM; or, you can receive your vaccine in Employee Health any Mon-Fri, from 7AM - 4PM. Thank you for getting your immunization.

Celebrating Nurse Practitioner Week

Please join me in celebrating GBMC’s outstanding Nurse Practitioners (NPs) 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. They help us reach our vision of a patient-centered system of care every day. Please join me in thanking them this week!

Baltimore Magazine Excellence in Nursing

It's that time again - Baltimore magazine is collecting nominations for its Excellence in Nursing issue. Please vote for the colleagues you most respect! The survey, which ends on November 30, may be found here.

Thanking Our Veterans on Veterans Day and Every Day

On Sunday, we commemorated Veterans Day and took the time to remember and pay tribute to the brave men and women of the U.S. armed forces who have served in the past and those who are serving today. My sincere gratitude to all members of the U.S. armed forces and their families who make sacrifices to preserve our freedom.

A GBMC Giant is Retiring

This week, we began celebrating the outstanding career of Bennett J. (Ben) Beres. Ben joined GBMC HealthCare in February 2012 as Chief Operating Officer for Greater Baltimore Medical Associates (GBMA). He has made a huge difference in the functioning of our physician company in the almost seven years that he has been with us.

Ben and I previously worked together at Boston Medical Center. So, when we were looking for a new operational leader for GBMA in late 2011, I called him. I remember being ecstatic when Ben agreed to interview for the position.

I called Ben because I knew that he was a phenomenal physician practice manager and leader. He always started from the perspective of the patient, but he also looked out for those providing the care. It was important to him that physician leaders worked in partnership with practice managers. Ben was just the right person to oversee the implementation of our patient-centered medical homes. He completely embraced our vision of becoming an accountable system of care that the patient would experience as a whole. He championed extended office hours to include evenings and weekends and he led our work for better office throughput. Ben sent Sarah Whiteford, MD, and Ben Hand, MD, to the Virginia Mason Institute in Seattle to learn office flow science. They returned to work with our architects to design our Family Care Associates office in the Kahlert Pavilion. A hallmark of this office is that there is no patient waiting room. Patients go from the greeter station directly to the exam room. 

Ben first partnered with GBMA Medical Director Dr. Mark Lamos and then with Dr. Harold Tucker, with whom he constructed the rebranding and relaunching as GBMC Health Partners. Ben has also done excellent work with our specialty practices. 

In addition to being an incredible manager and leader, Ben is also an incredible human being. He is dedicated, hard-working, and always focused on making things better. Perhaps Ben will be best remembered for being the consummate friend. I have never seen anyone make as many friends and make them so easily as Ben. I believe that this occurs because he treats everyone with respect.

Ben has lived apart from his dear wife, Ellen, as she has continued her career as an internist at Dartmouth. They have each spent a lot of time traveling between Manchester, New Hampshire, and BWI and we, the GBMC family, have benefited from their sacrifices.

GBMC has been so fortunate to have Ben as a friend and colleague, as have I. We will miss him dearly, but we wish him the best in his well-earned retirement!

We will never forget Ben or his dedication to patients and his work at empowering physicians to lead. Therefore, we have decided to name the library at Family Care Associates, the Ben Beres Library. Please join me in thanking Ben for all that he has done for GBMC and our patients. 

Thanking our Medical Staff Services Team
Each year, during the first week of November, we recognize the important role that our medical services professionals play in our healthcare system. During National Medical Staff Services Awareness Week, we thank all our staff who work behind the scenes to ensure our providers are properly credentialed, licensed, and trained in their respective specialties. Often called the “gatekeepers of patient safety,” the work our exceptional medical staff professionals do contributes to our system’s high safety and quality standards. We thank you for your efforts and dedication this week, and every week of the year.

I’d also like to celebrate the NICU’s recent recognition from the Maryland Patient Safety Council (MPSC), which awarded the GBMC NICU with a banner of excellence in the care of infants with Neonatal Abstinence Syndrome. This accomplishment is the culmination of two years of implementing best practices and compassionate care to our most vulnerable patients. As you can imagine, caring for newborns experiencing drug withdrawal because of in-utero exposure requires ongoing diligence and expert care. It’s an emotional and often difficult job seeing these infants through withdrawal while also helping to educate and support the mothers and families. I am extremely proud of the work being accomplished by our neonatal team.

Finally, GBMC will be kicking off the season of giving by participating in #GivingTuesday. Giving Tuesday is celebrated each year on the Tuesday following Thanksgiving (this year it’s November 27th) and will benefit GBMC’s Child Life Program. Supporting our #GivingTuesday campaign means you’ll help provide toys, games, and other tools our Child Life specialists use to help ease the stress our pediatric patients often experience during their hospital stay. There are two ways to give this season – through the CrowdRise page and by gifting a donation through the Amazon Wish List. It’s amazing to watch our Child Life specialists help our young patients cope with the anxiety brought on by hospitalization, and I know they will appreciate the support.

Working Smarter, Not Harder

Our hospital is a very complex system. What happens in one area of the hospital can have a major effect in what happens in another unit or department. Because of this complexity, it is difficult to maximize our efficiency such that no one is waiting to move to the appropriate place.

I have written in this blog before that we are students of flow. We are designing our systems and matching the demand for services with the supply of caregivers throughout our organization. When we design our systems, hold ourselves accountable to the design, and match capacity to demand, our patients move one at a time in beautiful choreography. This is called single patient flow. On the other hand, when we have no design or don’t follow our designs and rely on hard work alone, we frequently have patients stuck in a bottleneck.

Humans can overcome bottlenecks by working around them or exerting more pressure or influence to get through them. This is known as expediting. An example of expediting is when we take someone away from their usual work to complete a task that the people who normally do it cannot accomplish. An example would be having a housekeeping manager race to clean a room because many dirty rooms have been called in for cleaning at once in the early evening. Rather than fixing the root cause of the problem, in this case the batching of discharges, we send someone to work around the problem in the moment to get the patients what they need. We have improved patient flow, but we will need to fix it again the next day because the batching of discharges has not been fixed. Smart leaders will learn the cause of the bottleneck, redesign the system, and not become complacent with the short-term success of expediting.

We know about the Hawthorne Effect as well, that when a problem gets focused on, it usually gets better without anyone redesigning anything. This is generally because the people involved, knowing that their work is being studied, work harder and faster to overcome the poorly designed process. This is the reason why we are so focused on getting the work redesigned first before we celebrate what looks like an improvement. If the gains are due only to shining the light on the problem, we lose the gains as soon as the light is turned off.

Our flow team and our Emergency Department leaders have been spending time studying and redesigning our processes to move admitted patients out of the Emergency Department to an inpatient bed as soon as possible after the decision to admit has been made. This system is very complex, and it has many sub-systems. The ED physician must enter the admitting order, a bed must be identified as empty on the appropriate unit, and then it must be cleaned. The ED nurse must communicate with the receiving nurse, as does the ED physician with the receiving physician. Transport must be notified and arrive to move the patient.

The number of patients waiting in the Emergency Department to be moved to an inpatient bed at 7 p.m. is a metric on the Executive Lean Daily Management Board. Every morning, we review this metric to learn the reasons that patients are waiting. Much progress has been made through system redesign and I am so proud of all involved. And while we still have processes in need of further improvement, we are working smarter rather than harder. Take a look below at the results of their hard work.

Patient Engagement Question — Wait Time in ED Before Admitted (Quarterly)