What is Quality in Health Care?

Every day, the GBMC HealthCare System uses its core competency, redesigning care, to improve our services. Patients come to us because they want to stay well or get well. So, is quality healthcare defined as care that uses the best evidence to maximize the health of the patient? Well, it is clear that care without this is not high-quality care, but maximizing health outcomes alone is not enough. Quality encompasses the care experience as well as the physical health outcome. Providers often find that patients place higher value on the care experience than on the actual care decisions and its provision. We shouldn’t be surprised by this because the lay person may not understand the science, but they can clearly see differences in efficiency, cleanliness, and compassion.

We also need to consider waste, especially waste of the patient’s money, as an indicator of low quality. And finally, although some may consider it a stretch, the provider of the care must have a say on whether the care he or she provided was of high quality, independent of these other factors. I believe that when the provider has an opportunity to reflect, he or she must experience the joy of serving others.

My GBMC colleagues will realize that I have just described our four aims as the definition of quality in healthcare – the best health outcome and the best care experience with the least waste and the most joy for those providing the care. If any of the four aims has been missed in the care, we still have work to do on quality!

Virtual Town Halls
On Tuesday, July 28, we began our annual summer Town Hall Meetings. These discussions are a way for leadership to share information about our healthcare system, to hear concerns and ideas from our people, and to discuss how we can continue to improve. I truly want to hear from our colleagues in all three of our work systems: the hospital, GBMC Health Partners, and Gilchrist. My hope is that our people will bring their questions and ideas, and I encourage all GBMC staff to join one of the 15 scheduled meetings that run through September 25.

Due to COVID-19, the Town Halls are being conducted via Webex. The schedule is available on the InfoWeb. Please mark your calendars!

I want to thank Anna-Maria Palmer, our Vice President of Human Resources/Organizational Development and Chief Human Resources Officer, for her assistance in coordinating these virtual get-togethers.

Congratulations!!

I want to congratulate Dr. Robin Motter-Mast for being elected by our medical staff as Chief of Staff of GBMC. Over the years, Dr. Motter-Mast has held several key positions within the GBMC HealthCare System and I look forward to working with her in her new role.

I also want to offer my kudos to Dr. J. Christopher Greenawalt, Director of our Hospitalist Program, and Dr. Kelly Ellis, from our Emergency Department, for being elected as Vice Chief of Staff and Secretary/Treasurer respectively.

The Passing of a Dedicated Physician
I was truly saddened to hear about the passing of Joseph Costa, MD, an ICU physician and chief of the critical care division at Mercy Medical Center. Dr. Costa worked tirelessly on the front lines of the COVID-19 pandemic. What can you say other than that Dr. Costa literally gave his life in working to save others? Our thoughts and prayers are with his family, friends, and colleagues.

Walking The Talk As Leaders

We begin every leadership meeting at GBMC with a review of our system to remind us of the answer to the question: “How do leaders lead at GBMC?” Without a designed leadership system, we can’t expect to move quickly towards our vision of providing the care we would want for our own loved ones. This system lets every leader know what is expected of him or her.

In this blog, I would like to highlight box 2a in the figure below, Role Model Vision and Values. This box is shaded blue because it contains work that no leader can delegate to others. All leaders must role model our vision and our values. By modeling our vision and values, they are walking the talk and setting the tone for their entire team. I am very grateful to my GBMC colleagues who take this to heart and live our values every day. 

The Leadership System

Recently, I was involved in a conversation with a few of our people who were concerned that some of our leaders stray from these values. They were describing episodes of behavior that did not follow our value of respect.

Everyone has a bad day now and then and all humans are at risk of becoming angry and disrespectful from time to time. But as leaders, we need to continually reflect on our behavior and consciously work to be respectful at all times. We must make it safe for those around us to give us feedback when we are being disrespectful and thank those who are helping us improve. We have to be comfortable with apologizing when we have offended someone. Our system benefits from formal assessments of our leadership from supervisors, peers, and subordinates. When all members of the team review our behavior, we get a clear picture of how we are performing and have the best chance of improving.

Thanks to everyone for making our leadership system come alive and thanks for walking the talk and living our values. 

Keeping Our Spirits Up

This week is GBMC Spirit Week! On Tuesday, I enjoyed our annual Ice Cream Social that we adapted this year to include masks and social distancing. Another Spirit Week event that I have really come to love is our annual Employee BBQ. Enjoying the summer weather, the food, the games, and seeing people having a good time under the tent has reaffirmed my belief that GBMC is one big family. We cannot reach our vision without a fully engaged workforce, and we can’t have a fully engaged workforce unless people feel appreciated. So, celebrating is important. Our fourth Aim, More Joy, requires that we take time to have some fun during our hectic work lives.

Unfortunately, the Employee BBQ was another victim of COVID-19.

Because the pandemic has halted large in-person gatherings, our event planners had to create new ways of having fun. The barbecue turned into catered meals delivered to our units and departments and a "Where am I at GBMC?" virtual photo scavenger hunt. Congratulations to the winners who correctly identified all ten locations.

We are also holding Virtual Bingo, which follows traditional bingo rules and allows you to draw random numbers like they do in bingo halls.

I am really looking forward to next year’s Spirit Week! I am hoping that the pandemic will be in the rearview mirror and we will be able to gather as we have in the past. I must thank our Human Resources Team, led by Anna-Maria Palmer, our Vice President of Human Resources/Organizational Development and Chief Human Resources Officer, and her executive assistant, Richelle Tighe, as well as Cristie Nickel, our Community Relations and Events Specialist, and Kim Davenport, our Director of Communications and Event Management Strategy, for their hard work on this year’s events.

Thank you to all my GBMC colleagues and happy Spirit Week!

GBMC Health Partners at Padonia

An essential principle of the ongoing transformation of the GBMC HealthCare System is advanced primary care using the Patient Centered Medical Home (PCMH) model.

PCMH is our design for being accountable along with the patient for his or her health. The PCMH model is the core building block of our system of care and is about providing evidence- and relationship-based, coordinated care. The goal of the medical home is our Four Aims - to achieve the best health outcome and the best care experience with the least waste of resources and the most joy for those providing the care. It’s not about visits. If the medical home can accomplish better health and a better care experience without a visit, all the better.

We began building PCMH practices when we created our transformational vision approximately 10 years ago. I have featured the concept of the PCMH in my blog previously, highlighting the great work of our existing practices.

Now, I would like to announce our soon-to-be PCMH at GBMC Health Partners at Padonia, located in the Padonia Village Center. This new advanced primary care practice will serve the entire family, from newborns to elders. It will be staffed with a team of physicians, advanced practitioners, nurse care managers, care coordinators, and support staff. We are looking forward to adding urgent care early next year.

The more than 14,000 square foot space will offer more than just primary and urgent care, but will also include: gynecology, urogynecology, and orthopedics services. There will be on-site X-ray facilities and lab testing capabilities along with 23 exam rooms. The new site will showcase interactive 47-inch touch screen monitors with the capability of voice activation.

The Padonia location will utilize the same model as our GBMC Health Partners Primary Care – Family Care Associates office. There will be no patient waiting room. Instead we will be using the lobby concept and on- and off-stage rooming. Patients have the option of using geo-referencing check-in technology (Hello Patient) and self-cleaning kiosks.

For more information about GBMC Health Partners at Padonia, check out this brief video with Dr. Sarah Whiteford, who will take the lead at the Padonia office, as she offers more details about the practice. Dr. Whiteford’s leadership partner will be Ericka Easley, our Senior Practice Manager.

Top Docs Survey Ending
Baltimore Magazine is collecting votes for its annual TOP DOCTORS issue, until the end of next week. The survey is online-only this year, so I want to make sure that all our physicians know that they will not receive a paper ballot.

Physicians, please share this link with your colleagues so we can maximize the number of GBMC physicians who make the list! The 100-plus specialties have been revamped for this year’s issue with new specialties and specialty groupings added. The survey may be found here. Thank you!

Achieving the Care Experience We Want for Our Own Loved Ones

GBMC has been driving towards our vision of providing the care we would want for our own loved ones as we defined it 10 years ago. We have made great improvement in each of the four aims (Better Health, Better Care, Least Waste, and More Joy). In FY 20, we made outstanding progress in the inpatient care experience. How do we know that our changes resulted in improvement? Well, in the early 2000’s, the federal government began requiring hospitals to ask their patients a standard set of questions after discharge so that patient satisfaction could be compared across hospitals. This system is called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS.

The survey asks questions about aspects of the patients' hospital experiences such as communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of the hospital, and whether or not they would recommend the hospital. This data is then published on the Hospital Compare website at https://www.medicare.gov/hospitalcompare/search.html

GBMC met the HCAHPS Overall and Cleanliness goals for FY 20. Our multidisciplinary teams implemented two tactics that led to this achievement: Leader Rounding and Purposeful Rounding. In leader rounding, the manager visits patients and asks them about their care experience. This gives the manager real-time information that can be used to learn about and improve systems as well as to do service recovery. In purposeful rounding, nurses and nursing technicians visit each patient hourly and check to see that all of the patient’s needs are being met.

I am so grateful to the entire GBMC team, especially to our nurses, nursing support technicians, and environmental service workers for this great accomplishment!

It will take some time before the Hospital Compare website is updated to include this most recent timeframe, but I encourage all readers to visit the website and see how GBMC measures up on HCAHPS and other quality of care metrics.

Happy Birthday to Us!

Finally, I want to wish everyone in our GBMC family a safe and happy Independence Day. July 4th marks the birthday of our country and I hope everyone can take time during this holiday to reflect on what being an American means and what we can each do to make our country even better than it is today.

A Great Example of GBMC as a Learning Organization

I was on-call this weekend, so on Sunday, Father’s Day, I did Lean Daily Management. As I was driving in, I was lamenting the fact that I would not be running in the Father’s Day 5K with hundreds of others to raise money for our NICU, and I was feeling a little down.

On the walk, when I arrived at the Pharmacy board, I was greeted by Perry Shafner, the Lead Clinical Pharmacist. Perry presented the Board and he told me of the previous day’s performance with missing medications on Unit 46. Readers of the blog know the Pharmacy is among our highest performers in the use of 5-why problem solving. For many years, the Pharmacy has investigated missing medications in real time, Monday through Friday, during the day. After hours and on the weekend, however, they are not staffed to send someone to the unit to ask the questions and “see” the work in process. Perry told me that the previous day, FIVE medications were reported as missing on Unit 46 and they were all on the same patient.

He went on to tell me that upon hearing of the missing medications the previous day, our pharmacist and his colleague, Michele Sharkey, got the call and wondered “how could this have happened?” Michele checked the delivery report and it showed that the medications had been sent through the tube system to Unit 46. Even though it was the weekend, Michele knew that the best way to get to the cause of the problem was not to wait until Monday and have someone else try to figure it out, but instead, go to the Unit and investigate while the episode was still fresh in people’s minds.

Michele arrived on Unit 46 and found that the patient had been sent there from another unit earlier in the day. The Pharmacy realized this and sent the medication to the new unit, but the document that accompanied the medication still had the patient’s previous location. Another staff member dutifully sent the medication to the old unit, believing that they were doing the right thing. So, the immediate cause of the error was putting the document with the old location in the tube that was sent correctly to Unit 46. Having gotten to the bottom of the problem, Michele and the Pharmacy team are changing the standard work to assure that the accompanying document shows the correct location.

It is silly to believe that mistakes will never happen in a large, complex system. It is exciting to see how GBMC has become a learning organization that delights in finding the cause of a problem and in using its core competency, redesigning care, to make things better! Because of Michele’s curiosity and her learning in real time, the Pharmacy achieved our Four Aims Recognition Award. 

Thank you!!
So, I went home much happier and I ran a 5K on my own, and I want to thank everyone else who participated in our Virtual Father’s Day 5K & 1 Mile Fun Walk to benefit our Neonatal Intensive Care Unit (NICU).

In response to the COVID-19 pandemic, we created a VIRTUAL version of this annual event. Despite this change, we had approximately 450 participants, who helped us raise more than $55,000 to help our NICU continue providing high-quality care with the best technology.

Every day, moms and dads turn to GBMC’s highly trained healthcare professionals to care for their sick or premature babies because we provide the same care that we would want for our own loved ones. I want to thank our neonatologists, nurses, advanced practitioners, technicians, and others who dedicate their lives to the health of babies. I am grateful for your commitment to our NICU, even through the COVID-19 pandemic.

A Great Doctor who now has Teammates to Improve Patient Outcomes

Recently, I had the opportunity to chat with Dr. Kenneth Greene, a general internist in private practice on the GBMC campus. Dr. Greene participates in the Maryland Primary Care Program (MDPCP), working with our Care Transformation Organization (CTO), the Greater Baltimore Health Alliance (GBHA). He has an excellent reputation and has been a primary care physician for many years. I was curious to learn about his experience in advanced primary care now that the Maryland Primary Care Model was giving him the resources to improve his patients’ outcomes.

Dr. Greene is an expert who has always been there for his patients, but his ability to do this has increased now that he has access to GBHA nurse care managers, care coordinators, and dietitians. He told me a wonderful story of a patient who was struggling to get her diabetes under control until the nurse care manager and dietitian helped her carry out the plan that Dr. Greene had developed. He also pointed out that the financial resources provided by the MDPCP were allowing him to take care of one of the social determinants of health – access to transportation. His practice now uses Uber to help patients with limited resources get to his office.

To watch the video of our conversation, click here.



I want to thank Dr. Greene for his many years of service to those in our community and for his trust in GBHA to help him deliver the care that we would want for our own loved ones to all his patients!

Get some exercise on Father’s Day for a great cause!
Another fundraiser for the GBMC HealthCare system is coming up in a few days – our 32nd Annual GBMC Father’s Day 5K & 1 Mile Fun Walk to benefit our Neonatal Intensive Care Unit (NICU). This is a wonderful event, where under normal circumstances, former NICU babies, families, staff members, community supporters, and friends come out to our beautiful campus and have some fun while supporting our NICU. This year, to keep participants safe, we are going virtual!

As you know, GBMC is a community-based system of care and we are lucky to have a fabulous NICU with excellent neonatologists, advanced practitioners, nurses, and other clinicians, working in a new unit with the most advanced equipment available. GBMC delivers more than 4,000 babies a year and approximately 400 of those babies are treated in the NICU. The equipment and staffing required to provide this care is expensive — our annual Father’s Day 5K raises funds to allow the NICU to continue providing high quality care with the best equipment. It also creates greater awareness of the strengths of our program and the wonderful expertise and commitment of our team.

GBMC gets tremendous support from the community because we are considered the best place to have a baby in our region. The care is expensive, and we need the community’s support to continue. We are incredibly grateful for the sponsors of this event and for all who participate.

So, please consider walking a mile or running a 5K and encouraging your family to do the same, anytime between Thursday, June 18, and Sunday, June 21. All you need to do is take a photo or video of your participation and share it with GBMC on social media and track your run through this form.

Please visit www.gbmc.org/5k for further details. Remember that your support will directly benefit the more than 400 critically ill and premature babies cared for annually in GBMC’s NICU. Thank you!

…also, Happy Father’s Day to all the fathers in our GBMC family!

Celebrating LGBTQ Pride Month
June is Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Pride Month throughout the world. It’s established to recognize and honor the history, diversity, and resilience of the LGBTQ community.

This month offers an opportunity for all of us to pause and consider that, while progress has been made to afford equal rights to all, there is still much more work to do. LGBTQ people deserve equal treatment in the workplace and throughout society.

At GBMC, we recognize that we must attract the best talent from around the region and maintain a culture where employees can bring their authentic selves to work every day. Inclusion has always been part of the GBMC culture. As a system, we feel that discrimination of any kind is unacceptable. Our policy of inclusion celebrates the diversity of our workforce.

Please join me in celebrating LGBTQ Pride Month!

Celebrating Survivorship, virtually!
For 28 years, our annual Cancer Survivorship Celebration has brought together more than 200 cancer survivors with their caregivers, friends, and family members who supported them through every step of recovery. In the face of COVID-19, an alternative option was offered to maintain the spirit of this important event while ensuring the health and safety of our community.

As a substitute to the annual in-person cancer survivorship celebration, Oncology Support Services at our Sandra & Malcolm Berman Cancer Institute invited survivors to share their picture and become part of The Virtual Wall of Overcomers.

Of course, we were disappointed that we were not able to have the opportunity to be together, renew acquaintances, and celebrate both the survivors and their caregivers; however, this virtual option still provided everyone with a special way to celebrate.

I want to thank Felicity Kirby, RN, BSN, OCN, our Survivorship Coordinator, and all those involved in putting together this year’s virtual celebration and to congratulate all survivors, their families, and our caregivers!

Nice job!
The Baltimore Jewish Times recently unveiled its list of “Best of Jewish Baltimore.” GBMC was named “Best ER/Hospital,” “Best Pre-Birth Program,” and “Best Vein Clinic” by the readers of the Jewish Times. I am truly proud of the wonderful support we have in the Jewish community and for their trust in GBMC to meet their healthcare needs.