Why a Blog?

Now that I have been blogging for the lengthy duration of three weeks, the most common question is WHY?

The intent is to connect with people, whether they are employees, physicians, patients, community members, donors, friends, colleagues or young healthcare professionals.  The list is lengthy.  I am surprised by the people who stop me to tell me that they are reading my Blog.  Because I am so new at this, my first reaction is WHY.  But, that is the intent:  to reach, to connect and to share. 

I want to engage people in what is important to WMHS, to healthcare and to a leader.  There is so much to tell people about:  the great things that we are doing at WMHS, the successes of individuals, health care in Maryland, the challenges of health care reform, our impact on people's lives, the role of community health and wellness, collaboration with other hospitals to enhance the delivery of care in our communities, and the list goes on.

The bottom line is that I really enjoy blogging and the ability to connect with people in a very different way.

New CARELink Inititiave

I would like to welcome Toni O'Donnell to WMHS as our first CARELink coordinator.  Toni will be responsible for patient populations at high risk for readmission.  She is certified in chronic care and will be able to support chronically ill patients through coordination of care by matching the appropriate resources to the individual needs of each patient. 

Toni’s job is to call patients after discharge to ensure that they are complying with their discharge instructions, following up with their care provider, taking their medications and keeping scheduled appointments.  As the Care Coordinator, Toni has a variety of care delivery options available to her. She can send nurses to the patient's home, arrange appointments, interact with physicians on individual symptom management, and provide educational resources and telephone triage. 

It is our goal to meet the needs of our patients after they are discharged to allow them to remain at home provided they are following their doctor's orders.  Although our goal is to keep patients healthy and out of the hospital,  it is also important for our patients to know that if they need to be hospitalized that we will continue to be there for them. 

Total Patient Revenue

Beginning this fiscal year (2011), WMHS is no longer paid on a volume-based model (charge per case).  We are now paid under a total patient revenue model.  WMHS is one of 10 Maryland hospitals in what you may call a 3-year demonstration project.  Under TPR, our annual amount of total revenue is fixed for all services, care, treatment and procedures provided in the hospital.  Our focus is now the appropriateness of the admission rather than the number of admissions.  We must also focus on the setting where the care or service is delivered.  TPR focuses on wellness and the cost effectiveness of the care delivered; it is preparing us for health care reform on a national level.  Introducing this change throughout WMHS has had its challenges, but it is so rewarding to see the leadership of the organization embrace this change.  Knowing that we have an opportunity to make a difference in lives of those we serve, gives one a great feeling and reminds us why we chose this field.

Changes in Health Care

Over the last several months, I have had the opportunity to attend several meetings and conferences which have proven to be very timely with the dramatic changes facing those of us in health care.  It is nice to know that the messages are very consistent. 

Here are the top 10 messages that I have gleaned from these meetings:

1) Going forward, we can't afford Medicare as it exists now.  

2) The passage of health care reform will significantly impact providers both positively and negatively but will establish a much needed transformation of health care. 

3) There will be far less dollars available for health care in the future.

4) We must be prepared for the shift from fee for service to a global payment. 

5) Hospitals will be managing their populations to keep them out of the hospital. 

6) Hospitals will become the focus for wellness in their communities. 

7) Physicians and hospitals will integrate as they have never done before. 

8) There will be a high degree of consolidation between hospitals and physicians as well as between hospitals. 

9) Volume of services will be replaced by the value of the care provided (safe, efficient, effective and delivered in the most appropriate setting).

10) EVERYONE associated with health care has to change going forward.

Over the next few weeks I will address how WMHS is incorporating these messages into our care delivery model.

Welcoming New Employees

Each month, I have the opportunity to spend time with our new employees at Orientation.  I open each session by introducing myself, welcoming them to WMHS and congratulating them on being selected through our new selection and on-boarding process since not everyone is chosen to work at WMHS.  The new employees then have the opportunity to tell me about themselves.  It is really enjoyable and can be great fun. 

In my introduction, I talk about my background in health care, which started 35 years ago in Central Processing, where most notably I worked cleaning and sterilizing bedpans.  Being able to inform them that throughout my career I have worked at every level of the organization from orderly to CEO, lets them know that I have walked in their shoes.  I routinely get follow up emails and notes describing their surprise when they learn of my humble beginnings.  I love having the opportunity to describe how I got my start in health care, as it gives many of the entry-level employees the idea that they too can make health care a career. 

At WMHS, we then try to make that dream a reality through the many scholarships offered.  It is so rewarding rounding throughout the hospital and seeing one-time unit secretaries, housekeepers or  phlebotomists who are now nurses,  lab techs, managers and the list goes on.  Mentoring and developing future leaders and health care professionals is one of the great benefits of my job.

Good Friday Remembrance

Today is Good Friday.  I am reminded of the early beginnings of our health system and when we came together just after Holy Week in 1996.  When the Western Maryland Health System was formed, we brought Memorial Hospital and Medical Center together with Sacred Heart Hospital. Through the affiliation and over the first 12 years, I was blessed with having over twenty Daughters of Charity as part of my professional life as well as my family.  These very special women of religion would pray for me, give me both professional and spiritual guidance, as well as, provide direction and love.  They embraced this former Irish Catholic from the time that I met them to our separation from Ascension Health in 2008 and beyond.   (Note: I became a Lutheran shortly after I married my wife nearly 35 years ago.  I so admired, then and today, the strength of her faith, so I figured why not, I can use all of the help that I can get.)  As we celebrate the resurrection of Christ on Easter Sunday, it gives me great comfort knowing that many of these Sisters have found eternal life in Heaven, while others continue to serve other health ministries throughout the county.  Missed, but never forgotten.

Kudos to the Cardiac Team

Western Maryland Health System recently was designated as one of the Cardiac Interventional Centers in Maryland by the Maryland Institute for Emergency Medical Services Systems (MIEMSS).  Through this designation, emergency medical providers with heart attack patients can bypass those hospitals that aren't designated and take the patient to a hospital that can perform primary percutaneous coronary intervention, commonly known as balloon angioplasty.  A lot of work went into securing this designation by many dedicated, hardworking WMHS employees.  Our selection is a tribute to them.  We also now have in place field activation for our Cath Lab by the EMS providers.  After extensive training by the EMS community, they can now call from the field to notify the heart team so they are in place and ready when the patient arrives.  Our field activation model is being studied around the State.  Congratulations to the physicians, nurses and Cath Lab team--you continue to make us proud.

Better Than Disney?

Recently, a friend and co-worker asked at what point did the expectation of a hospital patient become that of a guest at a five-star resort?  It is interesting that some of our patients have an expectation equivalent to that of a resort guest.  Some of the demands are mind boggling, especially for a rural community, but we still strive to provide a level of service that is exceptional.  "Our best always" continues to be our service excellence moniker, and people who have visited the new Western Maryland Regional Medical Center have compared it to a resort.

That same friend attended a conference at Disney World last week and discovered that we may now have the edge on Disney.  We don't restrict your television viewing—there’s no Fox News Network at any Disney property.  In fact, shortly after we opened the new hospital, we were accused by an out-of-town visitor in a letter to the editor of the local newspaper of having every television tuned to Fox News.  It just so happens that our local visitors know that if you go over to the TV and press the channel selector, you can watch a variety of stations.  At WMHS, we give you all the shampoo and conditioner that you need.  At Disney, your initial shampoo and conditioner are free; after that, a $5 charge is assessed. 

Maybe there is a marketing opportunity here for WMHS.  In healthcare, we have studied Disney for years related to their service excellence.  Looks like we are now in a position to teach Disney something.  Just kidding! They continue to be a fine organization that has taken political correctness, their green policies and cost-saving initiatives to a new level.

Patient Satisfaction

In yesterday's blog, I noted the strength of our recent patient satisfaction scores.  Our overall March score was 76.2, meaning that 76.2% of our patients answered "always" to the 18 HCAHPS patient satisfaction questions.  For the last four months, we have met or exceeded our target of 70.0.  Our high score for the year to date was a 76.5 in January.  These results are attributable to a staff that truly gets it.  They understand why we are here each day and focus on the needs of our patients.  We care for patients during their most vulnerable time and obviously are doing it better than ever before.

Maryland’s Finest

In the April issue of Maryland Life magazine, there are the results of the first ever "The State's Finest for 2011" survey.  The Western Maryland Health System was the winner for finest healthcare in western Maryland.  We are in great company since the rest of the winners include Johns Hopkins in the Baltimore region, Anne Arundel Medical Center in the capital region and Peninsula Regional Medical Center in the eastern region.  Our new regional medical center has certainly helped to draw much favorable attention; however, we have an incredible staff that generates far more compliments than complaints each day.  Our staff truly gets the importance of being a mission and values focused organization.  They are committed to the Board's priority for this year of strengthening our dedication to service excellence, and they have the patient satisfaction scores to prove it.

An Evening with Condelezza Rice

Recently, I, along with WMHS Board leadership, had the opportunity to see and hear former Secretary of State, Condelezza Rice, at a conference.  She provided her audience with an awe-inspiring talk about her life and the most current issues facing the United States.  What stuck with all of us is her lifelong motto, "make the impossible, the inevitable," something that she has truly accomplished throughout her life.

Ms. Rice's motto is something that we are trying to achieve at WMHS by transforming health care delivery.  We are now focusing on providing the most appropriate care in the most appropriate setting.  For example, we are looking to expand primary and urgent care throughout the region in an effort to treat people in a less costly setting so they don't have to visit the Emergency Department for minor illnesses.  The care provided in the Emergency Department can be over four times more expensive than an urgent care setting.   Obviously, the ED is a much more costly alternative.

Health care reform on a national level and payment reform in Maryland are driving change in how we care for our patients—it will be in a different way that was once thought to be impossible to achieve, but now has fast become the inevitable.

WMHS Health Fair

Earlier this month, WMHS held a Health Fair at the Regional Medical Center that was an obvious success. Greater attendance than last year was a clear indicator of that success.  Medical testing on site with immediate results and then the opportunity to discuss the results with a caregiver was a new feature this year.  Another highlight of the event was the chance to listen to physicians speaking on a variety of health-related topics.  A lot of planning goes into these events, and we have great staff making them happen.  Thanks to all who made the Health Fair an event to remember.

Loss in WMHS Family

The Western Maryland Health System recently lost one of its own.  Samantha "Sam" Purbaugh was a dedicated charge nurse on 5 West who died suddenly while on the job caring for patients and supervising staff.  Sam was only 39 years old, but had two recent bouts with cancer.  She was in remission after her most recent cancer.  During her chemotherapy treatments, Sam would come to work and you wouldn't know that she undergoing cancer treatment except for her designer head covers.  She was always smiling and going about her work touching lives each day, including those with whom she worked.  We truly lost a very special nurse and member of the WMHS family.

Sam Purbaugh

Superior Cardiac Care

Recently, WMHS celebrated our 3000th open heart surgery case since our program began in November 2000.  We are so fortunate to have Dr. Mark Nelson, Dr. Subrato Deb and their team of exceptional caregivers who provide safe, quality care to each heart patient.  The team recently recognized Dr. Nelson, who had no deaths among his 203 surgery patients during calendar year 2010—a remarkable demonstration of superior care.

Expecting Perfection

Someone asked me the other day at what point did health care change to where absolute perfection became the expectation by patients, government regulators, politicians and the media? A very valid question in this day and age.  To answer that question, I think back to a quote from the Institute for Healthcare Improvement's Jim Conway, "Our systems are too complex to expect merely extraordinary people to perform perfectly 100% of the time.  We, as leaders, must put in place systems that support great practice by people who suffer from being human and will make mistakes.  We must have systems that catch our humanness before it gets to patients and causes harm." At WMHS, we have state-of-the- art technology and a staff dedicated to providing the most effective and efficient care.  Are we perfect all of the time?  No, but we strive to be.  When we are not, we inform our patients and work to right the situation.  You can't ask for much more from a values based organization that focuses exclusively on the care of the patient.

Welcome to The Ronan Report

Today starts the first of my almost daily blog called, "The Ronan Report." The blog will cover a host of topics--from health care reform to happenings at WMHS. There will be personal musings as well as stories of individuals living out the mission and values of the health system. There will be an opportunity to ask questions about each entry that is posted.

Fifteen years ago today, the Western Maryland Health System was created.  We lived through many challenges during the first two years of the affiliation between Memorial and Sacred Heart Hospitals back in 1996.  Some were self-inflicted by the leadership, especially since no one had experienced such an undertaking in their career.  We eventually worked through the challenges, the fear, the discrimination, the threats and the lack of trust and gave the region a mission and values focused organization.  The culmination of the affiliation was the planning, the design, the construction and the opening of the new Western Maryland Regional Medical Center thirteen years later in November 2009.  As of April 10, 2011, the health system continues to be successful through the efforts of a wonderfully dedicated staff of employees and physicians who are focused on providing superior care for all we serve.