"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Tuesday, July 26, 2016

Clinical Quality in Western Maryland

Last month, the three health system CEOs in the Trivergent Health Alliance asked Nancy Adams, SVP & COO / CNE at WMHS, to serve as chair of the newly created Clinical Quality Initiative for the Trivergent Health Alliance (THA).  Nancy will lead a team of her clinical counterparts from Meritus Health, Frederick Memorial and WMHS with a focus on clinical quality at the three health systems.
The Trivergent Health Alliance has experienced a great deal of success with our population health initiatives and the management services organization, and we would like to build upon those successes in the area of clinical quality.  This team consisting of a Chief Operating Officer, Chief Nursing Officers, Chief Medical Officers and a Chief Quality Officer will be examining areas like understanding the clinical capabilities and program offerings at each health system, identifying which programs could benefit the Alliance as a whole, focusing on best practices in areas such as patient experience, strengthening physician engagement across the Alliance, exploring which clinical resources that could be shared, linking clinical quality to the THA’s Supply Chain and Value Analysis approach and working to reduce variation in clinical care specialty areas.
The Clinical Quality Team began its work earlier this month.  In addition to reporting to the three CEOs, they will be accountable to the Trivergent Health Alliance Board of Directors.
We are hopeful that we can experience the same level of success with this initiative that we have with population health and the MSO.
On a side note, the Trivergent Health Alliance was featured in Hospitals magazine article last week on ways hospitals can collaborate without merging.  The link is below. 

http://www.hhnmag.com/articles/7315-ways-hospitals-can-collaborate-without-merging

Monday, July 25, 2016

Unfortunately, There Is No End In Sight

The other day, I asked for an update about the number of opiate-related overdoses that our ED has treated from January 1, 2016 through June 30, 2016.  There have been a total of 198 overdoses, with 142 being opiate or heroin related.  Those 142 overdoses have resulted in 26 deaths.  For emphasis, that’s 26 sons, daughters, moms and dads who have died due to an overdose of heroin.  If the police, and now the public, didn’t have Narcan to be administered when an overdose occurs, the death rate would be much higher.  
Our ED is treating practically an overdose per day.  But, if it was only that easy.  On July 12, our ED staff treated five heroin overdoses in one evening.  As you can see, our July numbers aren’t even reflected in the total for the first half of calendar year 2016.  
Our ED staff and our EMS providers throughout the region are now dealing with an absolute crisis in our community.  On the evening of July 12, our staff not only dealt with the five overdoses, but also with nine behavioral health patients, a series of critical care patients and a host of other patients with a variety of emergent needs in our ED.  We were forced to go on diversion sending patients to another ED for a period of time with our staff being overwhelmed with a full ED and waiting room.  That diversion put a significant burden on the EMS community, which then had to travel much farther to an ED outside of Cumberland.  
To demonstrate just how significant our ED has changed, last weekend a Cumberland police officer was attacked outside our hospital when he went to question an individual who was wanted in another county.  Both the police officer and the suspect were treated in our ED.  The suspect came into the ED in a rage, knocking over a computer on wheels and threatening staff.  Such behavior is fast becoming an almost everyday occurrence as our ED staff and providers are being spit upon, threatened and assaulted.  
We now have an armed police officer in our ED from 7 PM to 3 AM every day.  We are reaching out to our ED staff and providers to get their input as we reassess security in the ED.  Knowing that an armed police officer is in our ED during peak times previously gave some comfort; however, that now isn’t even enough.  Our staff are dealing with challenging patients morning, noon and night.  We will be having an upcoming ED Summit to determine what changes need to occur to enhance the safety and security of our patients and staff.  
So, the next time you hear how long someone had to wait in our ED or the staff could have been nicer, please understand what these ED professionals are dealing with each day.  In no way am I condoning having anything less than a professional, courteous staff in the ED for our patients, but I am trying to enhance the community’s awareness of what has become a typical day in our Emergency Department.

Tuesday, June 28, 2016

How Our Garden Grows

As you know, I contribute to a blog called Hospital Impact published by Fierce Healthcare.  I recently had the opportunity to talk about our community garden project that began last year and how it has "grown" this year.  The link to the blog is below.  

However, the photo on the Fierce Healthcare website is not our garden--it's a stock photo of a generic garden.  Below are a few photos of the new orchard area that was added this year.  Planting took place during County United Way's Day of Caring and Sharing in May
.

Fierce Healthcare Blog






Wednesday, June 22, 2016

Addressing Gun Violence

Now this is an area in which I have little expertise, but like those in Hollywood or the music industry who weigh in from time to time on political and social issues without any knowledge or expertise, I am going to offer my unsolicited personal opinion. 
I don’t own an assault weapon, but my house contains a few less threatening weapons so I am a proponent of gun ownership.  However, when it comes to assault weapons, I can’t think of one good reason on God’s green earth that any individual outside of law enforcement or the military would need to possess an assault weapon.  But yet, 1.3 million such weapons are sold each year in the US.  The amount of carnage left by such weapons in the hands of radical extremists, those motivated by hatred or deranged murderers is unimaginable unless you have been directly impacted--and then I am sure that it’s surreal but in a bizarre way.  
The focus needs to be on gun control legislation, which disappointedly wasn’t passed by either party yesterday in the Senate.  How embarrassing. The American people deserve far better than what we are getting from our Senators and Congressional representatives as they allow special interest and partisanship to influence their voting.  We are going to continue to allow those on terror watch lists, those with mental illness and known or suspected terrorists to buy guns?  Seriously?  They couldn’t even support expanded background checks to weed out those who are a danger to virtually everyone.  
And don’t give me that we are trampling on the rights of gun owners.  If you don’t fall into one of the above categories, i.e. radical extremists or deranged murderer, then you have nothing to worry about.  You’ll get your gun, just not today.   I don’t think that our forefathers when writing the second amendment of the Constitution had weapons in mind that could mass murder its citizens in a matter of seconds.
What you don’t hear after a mass shooting like San Bernardino or Orlando is that more needs to be done to address behavioral health issues.  We already spend over $220 billion annually in the US exclusively on behavioral health, but it still isn’t enough or it isn’t being spent wisely.  Just look at the waste that occurs in the fee-for-service acute care setting with testing, retesting, unnecessary admissions, ED use for non-emergent situations and other potentially avoidable utilization.  Maybe, how those monies are being spent needs to be re-examined?  Congress needs to allow funding for gun violence research then work to appropriately apply funding that addresses behavioral health issues which can lead to gun violence.  
There is so much more that needs to be done and our leaders in Washington need to do their jobs in representing the American people and not special interests on this issue.  From 1994 to 2004, there was an assault weapons ban in the US.  During that time, there was only one outlier year and that was in 1999--the year of the Columbine High School shooting.  Since the ban was allowed to expire in 2005, there have been 44 mass shootings where three or more people were killed.  During the preceding ten years during the ban, there were 17 such shootings.  

In addition to the legislation and funding mentioned above, reinstituting the ban would certainly be worth a try because whatever we are doing currently, it isn’t working.

Wednesday, June 15, 2016

Today, I am delighted to present a blog that was written by Debbie Jenkins, our Nurse Manager for Perinatal Services.  Debbie shared this wonderful story with me about the remarkable spirit of the employees at WMHS.  I am sure you will enjoy reading it.
Barry

From Debbie Jenkins:
I wanted to share an observation of mine from a week ago—the day the storm and lightening caused a malfunction to ALL of the elevators within the main hospital.  The storm passed fairly quickly, with much wind and lightening but I guess just enough to cause problems with the elevators.  I heard comments made that the elevators were out of service and questions as to what we would do if patients were ready for discharge. (They would wait for restoration of power was my reply.)

Anyhow, just before 5 pm, I was ready to end for the day and go home.  I gathered my things and went to the stair tower that exits onto 6th floor between the north and south wings.  As I opened the door to enter the stair tower, I could see a person coming up the stairs and I just stood and held the door for him.  As that person walked out the door, I saw another person’s head emerge from the lower stair case to climb to the 6th floor.  I again waited and saw that person was carrying a cafeteria/dietary tray.  I held the door for him and was totally amazed at what I saw next.

 It was like a train----one by one, people climbed the stairs.  Dietary staff, patient transport staff--all carrying patient meal trays.  One strong fellow actually carried a small cart with him; I guess to place trays on it.  He was slightly winded and quite red in the face from carrying that cart from the 2nd floor!

I have never seen anything like that in my life!  All these people providing the BEST for our patients—providing EXCELLENT SERVICE!  Up they came, one by one, all carrying a hot meal tray for the patients. Not a complaint, not a comment made.  They were doing what needed to be done at the time—providing the patients with their evening meal.  I guess there were no less than 20 or so staff members carrying trays up that stair tower at that time.  I stood in amazement as these people walked past me, each with their own tray for their own patient in need.  I did say “I can’t believe this!” to which I heard—“what else can we do—they need their meals.”

I walked down the stairs then with an elderly gentleman who had some difficulty in walking to make sure he got there safely.  I encountered visitors walking up the stairs---stopping on the landings to catch their breath and I stopped and spoke with them to make sure they were OK.  People were pleasant and not grumbling.  As the comment was made by one of the transporters carrying a tray—“we do what needs to be done" and DO  IT--DID THEY!!!!


Ultimately,  I am sure to the patients on the floors that evening, nothing was amiss.  They received their hot meal tray at the designated time.  Who would have guessed that a dedicated staff from several departments did what they did that evening.  I can’t imagine carrying trays up a flight or two—much less from 2nd floor to the 6th floor.   It was quite humbling to see this occur in front of me; and at the same time, I was very happy to be able to witness this happening.  I, like others, hear comments both positive and negative from people in the community.  I try not to dwell on the negative, but instead focus on the positive because each person has his own opinions that are not always based on facts.  

I am proud to work for WMHS and have always been so.  After 41 years of service, I have seen quite a bit and heard that much more, but there is one thing I know for sure.   WMHS has some wonderful people working here;  people who ALWAYS make a difference; people who care for others and do what needs to be done!  That was never more evident than what I witnessed that day in the stair tower.  When the going gets tough---WMHS employees make it work, regardless of the situation!  These ladies and gentlemen deserve a HUGE THANKS and a BIG PAT ON THE BACK---and I extend my thanks to them!

Monday, June 13, 2016

How States Are Redesigning Healthcare

I recently had the opportunity to talk with a writer who was working on an article for the Healthcare Financial Management Association (HFMA) about how states are redesigning healthcare.  The article appears in the Spring 2016 edition of HFMA's Leadership magazine and focuses on changes being made in Maryland, Arkansas, Minnesota and Oregon.

Change is definitely coming.  A link to the article is below.

http://www.hfma.org/Leadership/Archives/2016/Spring/How_States_Are_Redesigning_Healthcare_Delivery/












Friday, May 20, 2016

Does a Shift in Care Delivery Change One’s Mission, Vision & Values?

As you may know, I contribute to a blog called Hospital Impact.  My latest submission was about the effect of value-based care on our mission, vision and core values at WMHS.  Here is what I submitted and was published on May 19.   

It is interesting to see how our mission, vision and core values at Western Maryland Health System have been applied over the last few years as we transitioned to our value-based care delivery model.  As we transitioned from volume to value, we felt that it was essential to re-examine our mission statement, our vision statement and our values. 
As we embraced the triple aim of health care reform, our Board decided to bring our mission statement more in line with our new commitment to value-based care delivery.  It was changed from “superior care for all we serve” to “we are dedicated to providing patient-centered care and improving the health and well-being of people in the communities we serve.”  The board felt that our previous mission statement focused more on care delivery within the hospital while the new mission statement introduced a much needed community health perspective. 
Our vision statement was also adjusted to reflect the change in care delivery that depends on establishing partnerships in advancing the health and well-being of those we serve now and into the future.  Many of our previous competitors are now our partners in this care delivery shift and we are continually seeking new partners to best deliver care in the most appropriate setting.  
After considerable input from a variety of stakeholders, the board felt that it wasn’t necessary to change our core values.  It was determined that they could be applied quite easily to our new care delivery model.  Our core values at WMHS are Innovation, Integrity, Compassion, Accountability, Respect and Excellence.  Innovation has been the mainstay of our core values as it relates to value-based care.  We have introduced many new and innovative initiatives into our care delivery model that are designed to keep patients out of the hospital and cared for in the most appropriate location.  Most importantly, they work!  There has been change in how our core values of integrity, compassion and accountability have been applied at WMHS over the last few years.   We have become much more transparent with the sharing of our quality and performance data; we always show compassion to all whom we serve and our accountability has been extended to ensuring that we provide the most appropriate care in the most appropriate location.  We will always respect the dignity and worth of each person whom we serve by delivering care in such a way that they can live their lives to the fullest going forward.  Lastly, excellence through superior performance has resulted and is supported by our recognition in improved systemwide metrics specifically in quality and patient safety. 
Our values haven’t changed, but the manner in which they have been applied has been expanded to encompass the new dimensions of care delivery.
On a personal note, I have been significantly impacted by the transition to valued-based care delivery.  To see firsthand the very positive impact that we continue to have on those patients who are considered to be the sickest of the sick is just short of amazing.  We are seeing significant reductions in admissions, readmissions, ED visits and ancillary utilization because these patients are benefiting from the many initiatives that have been put in place and they are being case managed like never before.  In many instances, we are also reaching their adult children who could be pre-disposed to similar co-morbidities in the future.  We are truly making a difference in the lives of these patients and our staff is also seeing the impact firsthand.