2015: A Year In Review

All that I can say is WOW, what a year!  Throughout our 19-year history, WMHS has had so many successes from our very tumultuous beginning and then evolving to our current state of success to the acquisition of Frostburg Hospital 20 years ago and creating what is now Frostburg Nursing and Rehabilitation Center to building a new hospital and opening it in 2009 to our value-based care delivery model, which is now in its sixth year while the rest of the hospitals outside of Maryland begin to introduce a similar delivery model.  

For 2015, we have continued as the region's largest employer, we still have an economic impact on the region of over $350 million annually, we provide tens of millions in community benefit each year and we have demonstrated solid financial performance over the last three fiscal years.  

What has been significantly different about 2015 has been the amount of recognition that we have received for our quality and patient safety at WMHS.  We were recognized as best in Maryland in the Quality Reimbursement Program and as a top performer in hand hygiene.  We received awards from the Maryland Patient Safety Center for Distinguished Achievement in Patient Safety, the National Cardiovascular Data Registry for performance measure scores in acute myocardial patients, recognized by Healthgrades in five categories including Excellence Awards in Patient Safety and Cardiac Surgery, ranked by US News and World Report as 11th out of Maryland's 46 hospitals and first in Western Maryland and honored by the March of Dimes, the Department of Health and Mental Hygiene and the Maryland Patient Safety Center for improving the quality of care provided to mothers and babies.  

In late 2014, we also received recognition through the Total Patient Revenue Collaborative by the American Hospital Association through the awarding of their Living the Vision Award.  For the first time in our almost two decade history, we were also recognized by AHA as one of the country's Most Wired Hospitals.

For 2016, we are finalists for two nationally recognized quality awards, but since we are still in a communication blackout period, I am not permitted to disclose the awards.  These achievements and recognition haven't come easily as we have spent years preparing the organization for success.  We are so fortunate to have so many dedicated individuals who are committed to being the best at what they do.  

As I have blogged previously, we are not perfect and we do make mistakes.  Our goal is to learn from these mistakes and bring improvement to our programs and services.  If 2015 is any indication, we have made significant inroads in bringing improvement to the care that we deliver system wide.  Have a Blessed New Year!

Thinking Out of the Box

On December 24th, Fierce Healthcare published a blog that they asked me to write related to the impact WMHS is having on our community.  The blog was limited in the number of words so my examples were limited in demonstrating how we are impacting the community through our out-of-the-box thinking related to meeting the community's needs through our unique care delivery model.  

In my blog, I used examples related to Bridges to Opportunity, the Imagination Library and our community garden.  However, there are so many more examples of how we have applied that out-of-the-box thinking in addressing the social as well as health needs of our community. These include 

• providing 30 days of free medications to patients as they are discharged
• embedding care coordinators and navigators in clinics and practices,
• providing free care through our Center for Clinical Resources to the sickest of the sick who are suffering from diabetes, CHF, COPD and/or hypertension
• placing doctors and nurse practitioners to care for patients in skilled nursing homes
• expanding primary care throughout the region
• using Community Health Workers to visit patients in their homes to ensure that they are living in a safe environment and that their needs are being met
• performing tele-monitoring for select patients in their homes to check their blood glucose levels, their BP, their weight, etc.
• partnering with agencies such as Allegany Health Right on dental services
• providing a Transition Clinic to newly discharged patients who may not be able to get a follow-up appointment to see their physician within the first week after being discharged
• working with a host of agencies on ensuring that the transportation needs of patients getting to and from their appointments are being met
• and the list goes on.  

This year we also fed the hungry, clothed those who have a need and partnered with others in ensuring that the homeless have a place to sleep.  As I have indicated in the blog, we have gone far beyond what the traditional hospital is expected to do for its community, but truly recognize that it is now both our responsibility and our mission.

Caring for What Matters Most

We have been running a series of commercials on what matters most to our employees and the theme has been helping others.  This year, like every previous year since my arrival in Cumberland 26 years ago, we have had a Christmas Families program.  For 2015, we provided Christmas for 63 families of which some were our own employees, some were patients at WMHS and the rest were families identified by community agencies.  Our Foundation Office estimates that we spent over $50,000 this year on toys, food, clothing and gift cards for these families and individuals in need.  

The generosity of our employees and their families, along with our medical staff and groups like the Ladies of Charity, is truly amazing.  No child should be without presents to open on Christmas morning; and through such efforts of the WMHS staff, we strive to make that goal a reality.  This year we provided, along with the area's Catholic churches and Pharmacare, over 1000 Thanksgiving meals to those in our community who may have gone without a such a meal.  

As we care for what matters most at WMHS, I am so very proud of our staff for their compassion, their dedication and their generosity in making Thanksgiving and Christmas truly a celebration for so many who may not have had that opportunity otherwise.  Merry Christmas!

Citizens Against Virtually Everything / The CAVE People

The CAVE people have once again reared their ugly heads; this time it's concerning economic development………specifically, the Rolling Mill project in Cumberland.  On Tuesday, the Mayor and City Council voted to approve a $2.5 million funding package for the project which will result in the acquisition of 68 properties within the area of I-68, Maryland Avenue, Park Street and Williams Road.  

The Cumberland Economic Development Corporation has been spearheading the project and I am one of the members of this newly formed public / private entity.  At the Mayor and City Council meeting, it bought back the bad memories of the creation of the Western Maryland Health System.  Some of the same people who were involved with the “Kill the Merger” initiative are back with their protest signs and spewing insults.  

The property owners have been offered the appraised value of their property and relocation assistance.  The great majority have taken advantage of the opportunity.  There are still a handful of property owners who are not interested in selling or are holding out for the best deal; only time will tell as to how they fare in the process. 

What one can find interesting is that the majority of the protesters aren’t even residents of the Rolling Mill area.  This area has the highest incidence of crime and drug abuse in the city and the Rolling Mill project should be embraced by all.  I listened to a woman on the radio this AM with no understanding of what is happening in this community from an economic development perspective.  The radio host, who was well informed, spoke of the economic boom that is taking place in LaVale; her response was “but that’s the county, not the city.”  Well, madam, it is because of what’s happening throughout our region that there is now interest in the city.  There is one newly opened hotel in LaVale and planning is underway for three additional hotels, one in Frostburg near FSU and two in the city (one downtown and one just off of I-68 and Baltimore Avenue).  There are restaurants and retail centers that have either just opened or the planning is underway.  Buffalo Wild Wings is planning to open for March Madness and both Cracker Barrel and Sheetz will open in the spring of 2016.  New companies are finding their way to Cumberland and Frostburg, as well.  New housing starts are being pursued as well as senior residential living.  A 40,000 square foot spec building is being constructed in the Barton Business Park for future development and it too will be ready in the spring of 2016.  

I have been in Cumberland 26 years and this by far is the most activity from an economic development perspective in a very long time.  I am proud of the Mayor and City Council for their unanimous approval of this much needed project for the City of Cumberland.  These are exciting times for an area that has been economically depressed for quite sometime.

Community Benefits Report for FY 2015

Last week, the WMHS Board of Directors approved our Community Benefits Report that was then submitted to the Maryland Health Services Cost Review Commission (HSCRC).  Our total for FY’15 was $36,954,026.  That amount is slightly more than FY’14 and consistent with previous years, with the exception of FY’13 when our charity care was at its highest at over $17 million.  Subsequently, the eligibility for Medicaid has expanded over the last few years, reducing the amount of charity care that is now provided.  Although charity care has been almost cut in half from FY’13, it is still the second highest community benefit activity at WMHS.  Our highest activity is mission-driven health care services at over $22 million for the year.  

As we continue our role as the safety net for the region, our community benefit activities provide a thorough breakdown of our individual contributions to the region.  We have a great deal to be proud of as we strive to fulfil our mission of providing patient-centered care and improving the health and well-being of people in the communities we serve.  The Community Benefits Report serves as a great indicator of that success. 

Celebrating 20 Years

Last week, I had the privilege of participating in the 20-year anniversary celebration at our Frostburg Nursing and Rehabilitation Center (FNRC).  I was honored to provide remarks to the residents and their families as well as our employees and volunteers.  

Just prior to finalizing the affiliation between Memorial and Sacred Heart Hospitals to form the Western Maryland Health System, Sacred Heart acquired Frostburg Hospital with the intent of transitioning the hospital to a nursing home.  When the health system was formed, FRNC, then St. Vincent DePaul Nursing Center, became part of WMHS.  There are still a handful of staff who have been a part of nursing home since its inception, and some who were even employees of Frostburg Hospital.  We have been so blessed with the staff and leadership of the facility.  

I heard so many positive comments from our residents and their families while I was at the event.  I am both pleased and proud to be associated with such individuals.  Congratulations!

The Father’s Daughter

Pamela and I were in Charleston, SC. for Thanksgiving to spend it with both daughters and our son-in-law.  It was a wonderful time; every day was sunny and 75 degrees. We had Thanksgiving on their screened-in porch with a roaring fire in the fireplace and football on their big screen TV.  The meal was delicious and the drinks were aplenty, including the traditional Williamsburg Champagne Cocktail, a tradition in which we are in our 40^th year.  

As we were leaving to return home, Pamela asked if I had seen the magazine next to our bed in the guest room.  I said that I hadn’t.  Pamela suggested that I read the article on page 22.  I wasn’t familiar with the magazine “Charlie” and learned that this particular issue, the Unity Issue,  grew out of the horrific shooting at Mother Emanuel Church this past year in downtown Charleston.  The magazine is very well done and extremely positive; it celebrates the culture of Charleston.  Charlie was published to inspire change not to entertain; it is to encourage reflection, discussion and action according to its publisher.  

When I opened the magazine to page 22, there was my daughter Jessica in their People section.  She never said a word that the article was there.  They were featuring a half dozen or so individuals who are making a difference in lives of Charlestonians.  The article on Jessica, who leads Boeing South Carolina’s Global Corporate Citizenship Program, is attached to my blog.  I continue to be amazed by Jessica’s commitment to her community.  She has been in Charleston for five years and she has truly become immersed in her community.  Jessica is involved in just about everything related to making Charleston a better place to live and work.  Last year, she received the Charleston Chamber of Commerce’s One to Watch award.  

When asked what I do in my spare time, it’s giving back to the community.  It appears that my “hobby” has transcended to my eldest and I couldn’t be more proud.  Congratulations, Jessica, not only for the recognition, but for what you have accomplished in five short years.

Celebrating the True Meaning of Thanksgiving

On Thursday, we will celebrate Thanksgiving; a time to give thanks for all that we have.  There are many who are far less fortunate than most of us.  In an effort to ensure that residents in our area had a Thanksgiving meal, Our Lady of the Mountains Roman Catholic Parishes asked for sponsors to assist with feeding those in need.  WMHS and Pharmacare joined these area churches as sponsors in feeding over 1000 people last Saturday.  There were 128 volunteers from the churches, WMHS and Pharmacare preparing, serving and delivering meals.  Meals were delivered to senior living apartments, Archway Station and the Union Rescue Mission. The meal was also open to police, fire and rescue personnel.  The group then fed hundreds at St. Mary's Church.  Jo Wilson, VP of Operations at WMHS, had the lead from the health system and shared some stories from the event.  

Notes From Jo
The folks from Friends Aware came from the individual group houses. It was so wonderful to see these people with special needs so happy and joyful. What really made one's eyes tear up was the fact that a couple of these people work at WMHS. They were so proud to be singled out when they arrived by their WMHS coworkers and could show their house mates that they were part of such a loving group of health system volunteers. 

We also dropped off food to the senior apartments in the area. Hana and Melody (two of our very young dieticians) came back to tell us how incredible it was to bring food to the individuals living there. These two young girls were floating in their happiness.

From Gabriela, our Social Worker at FRNC, and her husband Ray I got this story.......
Just wanted to let you know that Ray and I had a great time delivering meals at Cumberland Meadows on Saturday and that all the residents that received meals were very appreciative. We met a sweet lady named Rita who insisted on taking us for a tour of her apartment. She told me that more people would have signed up for a meal had they known about it earlier. She's on the activity committee there and offered to put up fliers by the front and back door if someone gives them to her next year. Thank you for organizing a wonderful experience for all. We look forward to helping again next year.

Another thing that really was spectacular was the double line of volunteers who came in early to get things ready for delivery to the senior centers. We did 280 meals in 30 minutes!! All totaled, just under 500 meals were delivered. It was incredible team work and really speaks to Mary Jo and Tara’s organizational skills.  

Also, one of the things were the people who came to eat. One elderly man came in and picked up a dinner for him and his wife. He said it was the first time that they had shared a true Thanksgiving dinner in more years than he could remember.

Another was a young father and mother with a toddler, a baby and one on the way. It was heartbreaking to see how carefully they scraped every drop of the leftover food on their plates into carry out containers for what I am sure is another meal. I wanted to give them everything.

Finally, a gentleman at the very end of the night came in through the back. He was so embarrassed to get food for himself and several children. Barry, he looked so hungry, it was pitiful. So I put all the turkey, stuffing and potatoes we had left in the line together and the other staff packed up the corn, beans, bread, pumpkin pies and cookies. Hopefully, this gave them food for a few days.

Barry, I just know this was a very good thing to do. Every one of us who volunteered, cooked, delivered or whatever we did felt a sense of giving back and warmth…it was like we paid back all the good we are blessed with because we have so much.

Thank you for allowing this to happen and me to be part of this. Jo

Is the Juice Worth the Squeeze?

Last week, a group of us from WMHS had the opportunity to visit a health system out of state that is doing what they describe as some amazing things with process improvement.  They have been involved with applying the Toyota Production System (TPS) since 2002 at their facility.  To this day, they take teams of their people to Japan annually for two weeks to study the Kaizen method of continuous improvement to eliminate waste and inefficiency.

In 2012, WMHS ceased our Lean Six Sigma efforts, a similar approach to process improvement, since the philosophy never really got any traction system wide.  We had so many competing priorities with transitioning to the new hospital and changing our care delivery model from fee for service based on volume to a care delivery model based on value (TPR).  Some areas at WMHS continue to use the Lean Six Sigma process improvement approach, but it is not applied throughout the system.  

The reason for the visit is that we want to re-engage our approach to process improvement, but as it applies to improved quality and care delivery.  This particular health system has dedicated their existence to TPS and it has worked in ensuring greater efficiency and eliminating waste.  What it hasn't done is dramatically improved quality, patient safety or even the overall patient experience as one would expect.  For the commitment of time and resources, one would have anticipated a much greater direct impact on the patient.  

They claim to be much more efficient, but it wasn't obvious when you toured their hospital and saw their outcomes.  It was apparent to me that "the juice hasn't been worth the squeeze," if you will.  They have committed millions of dollars and considerable resources each year for the last 13 years, including human resources, to this effort and yet they appear to be just like any other hospital with above-average performance in those areas that truly count: quality, patient safety and patient satisfaction.  

Sure they stand out in some areas as do most of us, but we have not spent millions of dollars year after year in being above average.  Quite honestly, I was expecting stellar performance in HCAHPS, clinical performance, US News and World Report rankings, core measures, hand hygiene and the list goes on.  But it wasn't there.  In fairness, there were a number of approaches that our team found useful for application at WMHS, but the effort and the commitment just didn't seem worth it.  Our journey will continue and I will keep you posted through future blogs.

Mea Culpa on My Care Zones Blog of November 10

Yesterday's blog opened with recognizing Care Coordination for their creative work on the newly created Care Zones.  I knew when I wrote it that a whole lot of other people were involved with their creation and application.  I used Care Coordination as a place saver, but failed to go back and add the many others who were involved until my drive in this AM.  I confessed to my error at Triple Aim Coordinating Council this morning.  

However, I still needed to sincerely apologize to Pam Ackerman and her Home Care team, who started using the Care Zone concept in the care of their patients years ago, Helen Morris and Suzie Layton who converted the concept to patient education and so many others who were involved in bringing the Care Zones to fruition.  Again, great job everyone.  The Care Zones are going to have a profound impact on our patients and community.

Recognizing My Veteran

I have blogged in the past about my daughter Lauren, who was an active duty Naval Officer up until June 1, 2015.  After four years at the Naval Academy, Lauren graduated and was commissioned as a Surface Warfare Officer.  

She was first stationed in San Diego, California, where she was then deployed to the Middle East for seven months.  It was on her return trip to the US that her ship stopped in Hawaii and I was one of around 60 family members who got the privilege to spend eight days on her ship as it returned to its home port in San Diego.  What an experience; it was like take your dad to work for eight days.  

Lauren was then transferred to Little Creek, Virginia, and was again deployed to the Middle East.  She had to meet her ship off the coast of east Africa.  At 25, she had to fly alone from Norfolk to Detroit to Amsterdam to Kenya to Djibouti, Africa. After her 32-hour adventure half way around the world, she was picked up by hovercraft and brought to her new ship.  That deployment was for "only" four months, but for her shipmates, it was 11 months of being away from their families.  When her ship docked in Norfolk, there were close to 100 new fathers who were allowed to leave the ship first to greet the latest addition to their families.  The attached photo was from that deployment.  

Subsequent to her return, Lauren was part of a group of ships and Navy personnel that were dispatched to the NY / NJ area to provide relief after the devastation of hurricane Sandy.  They were thrilled to be lending critical assistance until they were told to "get the f*** out" by a union boss.  They were apparently taking jobs away from the unions so the NJ politicians caved and the Navy was sent packing.  Recovery continues in both NY and NJ from Hurricane Sandy; can you imagine the impact that our military could have had on the recovery effort if it wasn't for powerful unions and spineless politicians?  

Lauren then found herself at Fort Meade involved with cybersecurity.  She said that it sounded much more glamorous than it really was.  Working with civilian government employees and contractors was quite an experience to the point that when Lauren was leaving the Navy after attaining her MBA from Maryland's Smith School of Business, she chose to pursue a career in marketing rather than cybersecurity or defense contracting.


The bottom line is that this is Lauren's first Veteran's Day since leaving the Navy and I couldn't be more proud of what this young woman has accomplished over the last ten years.  She served her country with honor and distinction and has created in me an lasting appreciation for our service personnel and our veterans.  Having never served, I feel a personal void after experiencing military life with Lauren and living through the sacrifices that Lauren and those with whom she has served have made for me, her family and her country.

A joyous homecoming!

Care Zones

Our Care Coordination team came up with a very cool way to educate patients as to their disease state.  For COPD, CHF, renal failure, diabetes and pneumonia, patients now have a much easier way to gauge the status of their illness.  

I have attached a sample related to managing pneumonia.  For example, if you have easy breathing, no fever and no cough, you are in the Green Zone.  If you have thickening phlegm, increased coughing, wheezing, shortness of breath or slight fever, you are in the Yellow Zone and should call your doctor.  If you are really short of breath, your skin color is blue or gray, you have unrelieved chest pain or an increased heartbeat, you are in the Red Zone and should call 911 immediately.  

These Care Zones are a great education and reference tool to be used in our nursing homes, physician offices, clinics, our Center for Clinical Resources and Home Care.  Great job by our staff in always exploring creative ways to better educate our patients as to their varying conditions and trying to enhance awareness related to their specific illness.

Driving While Intexticated / It's Still Against the Law

Yesterday, I was on my way home from the BWI Airport and was truly amazed at the number of drivers who were texting while driving.  I wouldn't be exaggerating to say that one in four drivers who passed me or whom I passed were texting while they were driving.

To test my theory, I looked it up today and, much to my surprise, the national average is 34% who say that they text and drive.  My favorite was a guy in a shiny black Chrysler 300 traveling at a very high rate of speed over 90 mph (I was going 75 to 80 miles an hour and he passed me like I was parked) and even he was texting.  They say that driving 55 mph is equivalent to driving the length of a football field without looking.  This guy was driving the equivalent of almost two football fields paying very little attention to the road and more attention to his phone.  

Those texting while driving came in all shapes and sizes, all different age groups, new cars and old cars; either it's a new phenomenon or I just never noticed.  I still can't believe it.  This is one law that is virtually being ignored in Maryland as it is pretty much elsewhere.  Texting is against the law in 39 states, but you would never know it.  During my last trip to South Carolina, I thought that texting while driving was not yet prohibited by law since EVERYONE was doing it.  

Talking on the their handheld phones while driving is permitted; but then again, only ten states like Maryland have banned talking on your cellphone while driving.  In SC, texting while driving is against the law and it is a primary offense.  But then again, it's a primary offense in Maryland as well, but you would never know it.  Be careful out there!

Medical Marijuana

In today's Baltimore Sun, there is an opinion piece on medical marijuana by Shawn Hershberger, Executive Director of the Cumberland Economic Development Commission, and me.  I have blogged about my support of medical marijuana in the past and was asked if I would do an op/ed for the Sun as the decisions to award licenses are fast approaching.  I agreed.  So far, I have received positive responses to the letter, but it's still early.


http://www.baltimoresun.com/news/opinion/oped/bs-ed-medical-marijuana-20151028-story.html

Recognition of WMHS by Healthgrades

Healthgrades is the nation's leading resource for helping patients make informed decisions regarding their health care provider.  They evaluated nearly 4,500 hospitals throughout the US for the most common inpatient procedures and conditions and selected the 50 best performing hospitals for each condition.

For 2016, WMHS has been recognized as one of the 50 best hospitals for Cardiac Surgery.

Wow, what an amazing result!  Little old Cumberland in the national spotlight for our cardiac surgery program.  Obviously, a great deal of the program's success is directly attributable to Dr. Mark Nelson and his team, along with the many staff who serve in support roles.  

In addition to our recognition for cardiac surgery, we received a five-star rating in clinical outcomes for coronary bypass surgery, pacemaker procedures and total knee replacement for the past three years.  The great majority of conditions and procedures received 3 stars with a handful of areas getting just 1 star (obviously a great deal of focus will begin if it hasn't already in these areas).  We also received an Excellence Award for patient safety.   

We are in very good company with the other hospitals in the Trivergent Health Alliance,  Meritus and Frederick, in both the 5-star ratings and excellence awards.

With all of the recent advertising in Cumberland for cardiac surgery, orthopedics and cancer coming out of Morgantown, WV, I wonder how they fared with the 5-star ratings and excellence awards in each of those areas?


We have a great deal to be proud of and will be showcasing these awards on campus and in the community.  Congratulations to all at WMHS on a job very well done!

Hiring Physicians

Last week there was an article in Becker's Hospital Review, "Whistle-blower Physicians: We have got to get hospitals out of the business of hiring doctors."  The article was based on a physician who brought allegations against a Florida health system for engaging in improper financial relationships with physicians.  The health system settled with the federal government for $69.5 million.  

It was the same physician who stated that hospitals shouldn't be hiring physicians.  I couldn't agree more if their intent is to engage in illegal practices; however, that isn't the case for the great majority of hospitals.  There are always going to be some who push the envelope too far, but for the most part they eventually get caught.  The Feds have made it very lucrative for whistle-blowers, such as the physician in this case, by sharing in a percentage of the settlement payment.   

As for hospitals not employing physicians, that's ridiculous.  The ability to engage in improper financial relationships pretty much goes away when one takes volume out of the equation.  All US hospitals are transitioning to a new care delivery model and away from fee-for-service or volume-based care.  Basing payment and incentives on quality and performance as one does in a value-based care delivery model pretty much takes away the incentive for hospitals to pay for referrals.  

In addition, the federal government continues to make it very difficult for physicians to conduct business from a regulatory perspective.  With tens of thousands of federal regulations that both hospitals and physicians must comply with, physicians have found it easier to be employed by hospitals so they can focus on practicing medicine rather than complying with onerous regulatory requirements.  

There will always be an opportunity for hospitals and physicians to act inappropriately, but such opportunities as described by the physician whistle-blower are significantly reduced through a change in how both hospitals and physicians are paid.

Front Line Patient Engagement

Last week while I was on rounds with Nancy Adams, COO/CNE, she asked me to stop in the staff conference room on 7 South.  There was our Patient Experience and Culture team meeting with a group of nurses who started their own unit-based Patient Satisfaction Committee.  

I was blown away with how wonderfully prepared they were for this meeting.  They were reviewing the satisfaction scores for their patient unit when we arrived.  They showed us with great pride their "patient pick me ups," which are nicely done sayings, words of encouragement or Bible verses for patients primarily but also for staff should the need for a pick me up arise.  Their agenda also included purposeful rounding, scripting when speaking to patients and their new Oncology Family Room.  

Several weeks ago, they opened their newly created family lounge, which had been converted from a patient room.  More and more younger adults are now being diagnosed with cancer so having a place for families whose loved one is receiving inpatient cancer treatments has been very well received.   While we were there, the committee was talking about how to better serve the children who are now using the lounge to a much greater extent.  


I was thrilled to see the interaction among this group of dedicated nurses as well as their commitment to our patients and their families.  Hopefully, this is a model that other patient units will adopt as we try to bring continued improvement to our overall patient satisfaction.  I am so blessed to have the opportunity to work with such wonderful people each day.

Showcasing WMHS

The other evening, WMHS hosted the Maryland Chapter of Healthcare Financial Management Association for a reception. The attendees were mostly Chief Financial Officers from Maryland hospitals and their financial teams. They were at Rocky Gap for a three-day meeting.  We had around 200 attendees at the reception and, to a person, they were amazed at what we have accomplished both structurally and in our care delivery model.
  
In addition to hosting the reception for around 180 of the attendees, Kim Repac and I served on two different panels.  Kim's panel was related to the formation of the Trivergent Health Alliance and I discussed our shift from fee for service to value-based care delivery. 

Being able to show off our hospital to others from around the state was a lot of fun.  Those who attended the reception also wanted to know about our fabulous caterer in Cumberland who could put on such a wonderful event.  It brought great pleasure to our team to tell the group that the "so called" caterer was our own food service staff at WMHS.  John, Mary Jo, Tara and the team do an exceptional job with such events and they instill a great deal of pride in me with all that they accomplish.  

Thank you's go out to John Wilson and his team; Michele Martz for organizing so many aspects of the HFMA meeting and activities, the Finance folks at WMHS for their involvement in the meeting and planning some of the events, Kathy Rogers for conducting tours of WMHS for our out-of-town guests and John Sensabaugh for his AV expertise at the reception.  I continue to say how blessed I am to be surrounded by so many phenomenal people.

Amazing Accomplishments

I have had the opportunity over the last week to express my appreciation to the leadership of WMHS as to our accomplishments over the last year.  I also asked that they convey that same appreciation to our staff throughout the System.

Some of the more notable successes for fiscal year 2015 are as follows:

• Created the Bridges to Opportunity program to address poverty throughout our region.
• Established our first community garden, providing fresh fruit and vegetables to those who may not have the opportunity to get them.  We also  provided hundreds of pounds of fruits and vegetables directly to the Western Maryland Food Bank from the garden.
• Strong recruitment year for physicians and advanced practice professionals helped to meet a number of previously unmet needs at WMHS.
• Refinanced our hospital bonds and saved $43 million over the next 25 years.
• Ended the year fiscally very strong with a total margin of 14.45%.
• Grew days cash on hand to 208 days.
• Ended the year as Maryland's top performing hospital for hand hygiene.
• Received Premier's Platinum Performance Achievement Award for the treatment of myocardial infarction.
• Selected as one of the nation's Most Wired Hospitals by the American Hospital Association.
• Ranked as the 11th best hospital in Maryland by US News and World Report.
• Received the Maryland Patient Safety Center's Distinguished Achievement in Patient Safety Award.
• Saved over $8 million through the Center for Clinical Resources by caring for patients with heart disease, Diabetes, hypertension and COPD in a setting other than inpatient acute care.

FY 2015 was an exceptional year and only achievable through the hard work and dedication of some amazing people.

On Time and Under Budget

As November approaches, it will be six years since we moved into the "new" hospital. I was reminded of the success that we had when we were nearing completion of the building process during a meeting last week.  The audit partner from KPMG was rotating off of the WMHS account and, during the Audit and Compliance Committee, he took a walk down memory lane in his farewell remarks.  He commented on the "new" hospital project coming in on time and under budget.  He said that in all of his years in accounting and auditing, he never saw a project of this magnitude come in on time let alone under budget, especially a new hospital.  

My thought at the time was if you only knew how difficult that it was to accomplish.  Without strong, direct oversight neither would have happened.  Toward the end of the project in 2009, we were told that there was no way that the project would be completed on time.  We were told that instead of a November opening, it would be more in the February / March timeframe.  Our contractor was reminded that we were a hospital and that we planned our completion around our less than busy season.  Their revised completion date would put us the middle of our peak season with flu and pneumonia.  They were told that we would enforce our agreement and there would be penalties for every day that they missed our original completion date.  Fortunately, we prevailed but it wasn't easy.  

What also wasn't easy was keeping the project under budget.  The intense oversight that was involved by Kevin Turley, the VP in charge of the project, and Mike Smith, our Internal Auditor, were the reasons for our success.  The financial aspects of this project could have been equivalent to a runaway train if those building the hospital were given the opportunity.  They would submit receipts for the pay application without any detail, which we would not accept.  There was obviously a great deal of pushback and evasiveness, but we prevailed.  We would also have Mike Smith audit every pay application before any payment was awarded.  This process alone saved hundreds of thousands of dollars, if not more.  We applied a number of techniques to ensure that the project remained on budget and fortunately, we were successful.


There is a new book out called F.I.R.E. by Dan Ward, which focuses on Fast, Inexpensive, Restrained and Elegant methods for leaders when involved with projects. He copied the term F.I.R.E. from the military's approach to project work, Fast, Inexpensive, Simple and Tiny (F.I.S.T.).  Ward says Fast is for having a short schedule; speed is important, don't let the project be dragged out.  Amen!  The Inexpensive doesn't mean cheap; it means exactly what we did by effectively managing the construction and payment process.  Restrained means tight controls, a small group providing oversight and a well-defined schedule to which all are held. Very important as we found out first hand.  Ward's Elegant represents elegant simplicity.  Don't make the project more complicated than it has to be.  He says that you can have true sophistication as well as true design and process maturity through deep simplicity.  

I can certainly get on board with Fast, Inexpensive and Restrained; I am having a little difficulty with Elegant.  No matter how hard we tried, there was nothing simple about bringing this "new" hospital from the drafting table to reality.  Fortunately, we ended up with a wonderful outcome, but it took a great deal of time and oversight of the project for it to be known as such an exceptional outlier--being on time and under budget--in the eyes of our audit partner.

Sharing Forty Years of Learning (Continued)

Yesterday, I blogged about what I have learned after four decades in health care, with today being my 40th anniversary in health care.  Five of my top ten lessons were covered yesterday, with the remaining five to be covered today.  They are as follows:

Lesson 6: Treat People as You Would Like to be Treated
This lesson is easy to say but more challenging to put into practice for many.  I had the advantage of working in an entry-level position when I first started working in health care.  I saw how my co-workers were treated by supervisors, managers, nursing staff, physicians and other employees with more seniority; I even experienced much of it myself.  Some people were downright rude and disrespectful.  That was clearly not the way that I was going to treat people and I have pretty much tried to "walk the talk" if you will in this area.  I have found that it really isn't that difficult to be nice and respectful toward others.

Lesson 7: Be a Visionary
Yesterday, I blogged about accepting and embracing change, which is related, but as a leader you have to have a vision for what needs to be accomplished in your department, unit or organization.  If you don't have a vision for the future, you will be lost.  I have always loved being able to focus on what's next for me and for WMHS.  Fortunately, my visions for WMHS have been successes as they have become reality.  From the consolidation of the two hospitals to the building of a new hospital to creating a new care delivery model to the Trivergent Alliance; all have been successes (Thank God).  On the personal side, after realizing that health care is where I wanted to be, I had to create a vision for my career and, fortunately, that paid off as well.

Lesson 8: Listen, Listen, Listen
All forms of communication are critically important, but for me listening is the most important form of communication.  Believe it or not, I don't talk as much as I listen.  Case in point is when our Triple Aim Coordinating Council meets at the health system.  I sit there in awe of our folks in the trenches who are trying to ensure that our value-based care delivery model is as effective as it can be and that our patients are always at the center of everything that we do.  I have learned so much over a very short period of time from these caregivers and clinicians all through active listening.

Lesson 9: Use Common Sense
I have been blessed with good common sense and I use it.  People have a tendency to make things a lot more challenging than they should.   Quite frankly, the application of common sense can be an exceedingly powerful problem-solving technique.  I couldn't imagine functioning effectively without it.

Lesson 10: Career Should Not be at the Expense of Family
It can be very difficult to balance work and family.  At one point in my life, the hospital leadership for whom I worked, expected virtually 24/7 dedication to my job.  After three years of that, enough was enough.  I made the decision to come to Cumberland, which afforded me a better balance between my work life and personal life.  Over the years, I may have been the guy in the business suit coming into the school gym to see my daughters play in a basketball game, but I made sure that I was there.  Although, I must say having an understanding and supportive spouse over these many years certainly has helped with the work \ family balance.

I could go on but I think ten lessons are plenty.  It has been an unbelievable journey over the last 40 years and what's really cool is that it's not over by a long shot.


Thanks to all of you who have made these years as much memorable as rewarding.

Sharing Forty Years of Learning

A few weeks ago, I wrote about my milestone anniversary of 40 years in health care.  That anniversary is September 22.  It is hard to imagine that I have spent 40 years in a profession that I had never intended on pursuing.  Being in this profession for so many years, one has a tendency to learn a few things.  The following are the ten lessons that I learned over four decades working in the many levels of health care, from the entry-level position of equipment orderly to CEO and everything in between.

Lesson 1: Get a Mentor / Be a Mentor
I was fortunate enough to have a number of mentors over my many years in health care, especially the formative years.  As a result, I have been and continue to be a mentor to a number of individuals.  I learned how to speak correctly, write effectively, organize everything, manage my time, interact with just about everyone, develop trusting relationships, learn to depend on people, overcome my shyness and better prepare for what has become an amazing journey.

Lesson 2: Accept and Embrace Change
It's amazing when seasoned executives are asked to change and they just can't.  I have seen it all too often, an executive, including CEOs, being asked to consider a change and simply can't, or better yet, won't.  I have witnessed executives being terminated over their unwillingness to accept change.  From the time when I entered the first hospital in which I worked, change has been required.  Sometimes I didn't even have time to assess whether the change was good or bad for either the organization or me.  But, I had to eventually embrace it.  I loved the status quo early in my career.  Let me do my job and stay out of my way.  That was short lived.  As soon as I got into management, change became a critical component of what I had to do and it continues to this day.  Embracing change over the last 20 years, whether it was consolidating the two hospitals, planning for a new hospital, changing how we do business under value-based care delivery or forming the alliance with Meritus and Frederick, was critically important.   Change became necessary and under each of these major changes, we have become a better organization and I a better executive.

Lesson 3: Dress for the Next Level in the Organization
Set yourself apart and dress for the next level in the organization in the traditional sense.  Look professional while at work.  I wear a suit and tie almost every day and "dress down" to a sports jacket and tie; rarely, will I be dressed casually at work.  When WMHS relaxed our dress code to business casual a number of years ago, a department director said to me, "I hope that you don't deviate from your suit and tie everyday; we expect to see our CEO dressed as a CEO."  Fortunately, I like wearing a suit and tie each day, but I also think that the CEO should always look like a CEO, again in the traditional sense--not the Silicon Valley sense of a tee shirt and jeans.  There is plenty of time to dress down, just not at work. Again, my opinion.

Lesson 4: Surround Yourself with the Best
This is a lesson that I learned from Ronald Reagan, who as President of the United States, said that he could not be effective without his team of wonderful advisors.  He said that he always would surround himself with the very best. I recently heard a CEO describe himself as a mile wide and an inch deep.  That's me, a generalist.  I have wonderful people with whom I work; they are highly talented.  I depend on their expertise each and every day.  They, I guess, are the ones who are an inch wide and a mile deep.  Actually, that's not fair to them; they are so well versed in so many areas that an inch wouldn't cover it.   I have always surrounded myself with the best and I have been truly blessed over the last 30 years in health care administration.

Lesson 5: Make Yourself Indispensable / Reinvent Yourself
I don't want this lesson to sound like a contradiction of the preceding lesson; but early in my career, I always tried to know everything that I could about my job but also the jobs of those around me.  I tried to make myself indispensable.  I did so with great results as I had seven promotions in eleven years.  However, as the years went on, I found it to be exceedingly challenging to know everything about every aspect of health care, especially since I am not clinically trained.  So, there can be a limit to indispensability as you take on more responsibility, but constantly be reinventing yourself through continuing education.

The next five lessons will appear in tomorrow's blog.

They Said What?

I can't for the life of me believe that two of the co-hosts on the View went on the attack earlier this week against Miss Colorado and her appearance during the talent part of the Miss America pageant.  Kelley Johnson, who is a nurse, gave a monologue about her patient Joe, who was suffering from Alzheimer's disease, and not being "just a nurse." The two co-hosts mocked her for having a "doctor's" stethoscope around her neck, being dressed in scrubs and lacking any talent.  I saw the clip of Kelley's monologue and I found it to be unique for the talent component of the pageant. I thought that she did a great job.  

For the women on the View to respond as they did just shows as to how out of touch and self-absorbed they really are on this show, which again is FOR WOMEN.  It is certainly not a show that I have ever watched--only read about.  Of late, it is making the news for hirings, firings, fights among the co-hosts, attacks on political affiliations and most recently, Whoopi Goldberg, another co-host defending Bill Cosby ,who is being accused as a serial rapist for over the last four decades.  And, now this.  

Taking on a nurse and her profession, which is one of the most trusted and respected all in the US for the last umpteen years, is crazy.  What are you smoking, ladies?  You must have a screw loose to attack this woman, who actually was a runner up in this year's Miss America pageant.  For so many of us, nurses have touched our lives in so many wonderful ways and for them to be attacked and mocked is mind boggling.  

Finally, the View is paying the ultimate price for their actions.  Two major sponsors, Johnson & Johnson and Eggland, have pulled their sponsorships.  Hopefully, more will follow suit.  These are out-of-touch women who are supposed to be discussing issues facing women; and if this is the best that they have, the show deserves to be cancelled.  Boy, do they miss Barbara Walters, the show's creator and host since the late nineties.  Once she retired and turned it over to this lot, the show continues to be an embarrassment.

Milestone Anniversaries

This month marks two very significant anniversaries in my life--my wedding anniversary, Pamela and I will be married 39 years on September 10, and on September 22 I will mark forty years in health care.  Both of these milestones are inextricably linked.  You see, if it weren't for Pamela, I wouldn't be where I am today and most likely not in health care.  

I had some wonderful mentors in my early professional life, but no one has had more of an impact on my career decisions than Pamela.  (The amazing impact that she has had on my personal life is a given.)  These mentors would tell me that there was a promotion for me if I was interested.  I would come home and tell Pamela about the opportunity; she would say "and of course you are going to pursue this promotion."  

To this day, I am not sure if it was a lack of confidence at that time or if I hadn't really adjusted to a career in health care.  I had two degrees in Criminal Justice and my father was a police detective; I wanted to be in law enforcement.  I would tell her that I wasn't really interested and reminded her of my career goal at the time.  She would say, "that's ridiculous, a bird in hand is worth two in a bush."  

As I look back, it was clearly reverse psychology...she would say "continue in health care until that right law enforcement opportunity comes along."  In my early years in health care, I had seven promotions in eleven years.  Obviously, the more that I was exposed to the many aspects of health care through such promotional opportunities, the more I enjoyed what I was doing.  Fortunately, the mentors saw something in me, but it would have been for naught without Pamela.  

As they say, behind every great man is a great woman.  I am not sure as to how great I am so I will leave that for others to judge, but I can assure you that I have been married to a great woman for almost four decades.

Amy Gets It Right

I am not an avid reader of Dear Amy in the newspaper; however, I found today's column to be very appropriate for what we are trying to accomplish in health care today.  A woman wrote that her father, who is 91 and suffering from dementia, gave his son a living will a few years ago.  Under the circumstances, the son wants to fulfill his father's wishes by exercising the no heroic measures component of the Living Will.  The daughter wants to fulfill her mother's wishes, as she would like any measure necessary to resuscitate her father be exercised because the mother, who is of sound mind, will miss her husband terribly.  Amy's response was right on target; fulfill the wishes of the individual.  Why put someone through those heroic measures when they have no chance of any quality of life? 

Recently, my family experienced the same issue with a out-of-state distant relative who made his peace and said that he was ready to die. Unfortunately, the family hadn't conveyed his wishes to the staff.  Once he went into cardiac arrest and since he hadn't completed a do-not-resuscitate order, he was resuscitated.  Fortunately, his family finally got it and conveyed his wishes.  He died shortly thereafter.  

I just wish the family had that same "a ha" moment when their father was first hospitalized after a fall.  He was eventually transferred to a skilled nursing facility (SNF) from the hospital with two pretty significant pressure ulcers that only worsened at the SNF along with the addition of several other ulcers.  There was very little attention paid to the pressure ulcers with little care, treatment or wound therapy.   In addition, he was rarely ambulated by the staff.  The staff was pleased with themselves when they got him to sit in the chair.  When the family was asked about why they weren't more adamant about the care of their father, they said that the staff are working so hard as it is.  Yikes!  I can't imagine letting someone deteriorate right before your very eyes and not advocate for your loved one.  Between the pressure ulcers, the lack of ambulation and the meds that he was on, the entire scenario can be described in one word: iatrogenic.  His condition and subsequent deterioration were the direct result of an inadvertent lack of care brought on by medical professionals since his goal was to walk out of the hospital after that April fall.  It is so very sad in that there were so many who could have advocated for this man but didn't.

Backing Into a Solution for Improved Public Health

In the most recent issue of Health Affairs, there is an article, "Civil Unrest, Police Use of Force, And The Public's Health" by Jessica Bylander.  I read the article with great interest from several perspectives--a health system CEO working to champion value-based care delivery in my community and beyond, the son of a former police detective, and a holder of two degrees in Criminal Justice.  The article was well written and directed toward the considerable challenges facing the African American community.

Based on my upbringing and didactical training, I continue to take issue with the demonization of law enforcement.  It has become extremely popular to do so, but too many fail to take into account what police officers are subjected to as they try to enforce the laws and protect the citizenry.  I was taught to respect the police and comply with what they asked.  Have I been disrespected by the police?  Sure, but I have had to swallow my pride and do what I was told to do.   It appears that once a young man or young woman in the African American community feels disrespected by the police, they have to challenge that authority and there are times that such challenges end badly.  

Unfortunately, the breakdown of the traditional family has led to many of the problems in poorer communities, both black and white, with rarely anyone there to teach, guide, shape or mentor.  The article talks about an eight-year-old receiving health education in school who says that he didn't need to hear about heart disease or STDs.  Both of his brothers had died before their 16th birthdays and he didn't see himself most likely living much longer.  That to me is heartbreaking.  What a failure of family, community and government.  The political leadership in Baltimore and other cities in the US should be embarrassed as to what has become of their inner cities.  

So, what can health care do about it?  There is a very thought provoking statement in the article related to health care. Joseph Betancourt, associate professor of medicine at Harvard, said, "The mistrust that people have for the police force in these communities mirrors the mistrust that the same people feel for the health care system."  

Until now, I have looked at health care as we are all here to help you no matter what your race or socioeconomic status and you should work with us and be grateful.  The mistrust concept is disconcerting but should serve as a starting point for those of us in health care who are trying to restore public health options to the inner cities as well as the poorer communities that we all serve.  

In Maryland, and certainly Baltimore, the recipients of our services should benefit from our industry's transition to value-based care delivery.  With the goals to care for people in the most appropriate setting and work with them to keep them out of the hospital, health systems are bringing care to the community in record numbers.  Primary care, chronic care, dental care, ancillary testing and health education are now being extended to housing complexes, barber shops, churches, schools, neighborhood centers, outreach clinics and the list goes on.  We are engaging community health workers with diverse backgrounds.  We are trying to best serve residents who are the sickest of the sick, the high utilizers of services, the non-compliant patients, and even the next generation of the sickest.  

There is a lot of work to be done related to these many challenges, but Maryland health care is off to a great start.  We are addressing some of the past inequalities through a conscious effort to improve the health status of the communities that we serve.

Conflict Resolution

I read an article in the most recent issue of Success magazine last evening.  The article was entitled "How to Resolve Conflicts Between Employees" by Emma Johnson.  The article offers 11 tips on how to resolve, better yet, stave off such conflicts.  

The tips are as follows:

1. Recognize that disputes can't be avoided.
2. Step in early.
3. Don't just tell people to get over it.
4. Make each person acknowledge the other.
5. Focus on expectations.
6. Tell them to come up with a solution.
7. Assist them is articulating a plan.
8. Skirt instincts to separate the warring parties. (Force them to work together on a project.)
9. Unite them in solving a crisis bigger than their argument.
10. Invest in personality assessments such as Myers Briggs.  (Actually, this can work.)
11. Create a process for dealing with the conflict.

Very useful information.  Actually, there is another option depending on what level in the organization the warring parties may work.  The alternate approach is one that was taken by the first hospital CEO with whom I worked. There were two warring Assistant Administrators, aka VPs, who had offices next to each other.  One was young, easy going and certainly an up-and-comer in the organization.  The other was older, retired military and much more autocratic in his approach with everyone.  The two were constantly arguing about pretty much everything......they were like oil and water.  

Finally, the CEO called them both into his office and told them that he had no time and little patience for their constant feuding.  He told them, "If the two of you can't solve this problem, I will. If you can't figure how to work together, I will summarily fire one of you and the other will not be far behind."  The feuding continued and a week after the CEO warned them, he fired the older one and told the up-and-comer to begin looking for another job.  The CEO told them both, "If I have to deal with this problem, it will end badly for the both of you."  Damn, if it didn't.  

In the article, there are three case examples of how three CEOs dealt with conflicts involving their employees. The information is useful and the strategies taken appear to be beneficial; however, I still like my first CEO's approach.  There is little time in one's day to have to deal with conflict resolution.  We are adults; figure out how to deal with each other to get the job done.  If your boss has to constantly play referee, I can assure you that the situation will eventually end badly for the warring parties.

Supporting Medical Marijuana

Below is a blog that I wrote back in February 2015.  At that time, I wasn't able to publish since Peak Harvest wasn't ready to announce their intentions to locate their medical marijuana manufacturing facility in Cumberland, Maryland.  Since I wrote that blog, much has happened leading up to yesterday's announcement.  I have continued to have meetings with the principals associated with Peak Harvest; and, if anything, my impressions of each of them have only strengthened.  

This is a first-rate group of business people with whom I would be honored to be associated.  In June, I, along with three other business leaders, visited their medical marijuana growing facility in Connecticut.  Their facility is state of the art with its growing, harvesting and production capabilities, along with exceptional security that far exceeds most banks.  Most recently, I have provided them with a memorandum of understanding on behalf of WMHS to work with them on the clinical aspects of medical marijuana.  Peak Harvest will continue to have my full support and I expressed that at the launch last evening.  

For those of you reading this blog, I will answer in advance the burning question of how much I personally have invested in Peak Harvest, and the answer is zero.  Although I was asked and feel very strongly that it would be a very good investment, I do not want my support for medical marijuana and the clinical role that WMHS may play to be in any way tainted by my personal gain.

February 5, 2015   Medical Marijuana

On Tuesday, I had my second meeting with md / phh, a company that is hoping to be awarded one of the 15 licenses to begin the manufacturing of medical marijuana in Maryland.  This company is looking to locate in western Maryland.  The City of Cumberland initially reached out to me for economic development purposes, but the meetings have now advanced to the potential for partnering on clinical trials in the future.  

Some may be surprised to learn of my support of medical marijuana since I am vehemently opposed to legalization of recreational use marijuana.  (Just look at Colorado and the mess that exists there.  Although their tax revenues are through the roof, they have significant challenges with increases in crime, public health issues as well as social issues.)   I have classified medical marijuana as another tool in the clinician's toolbox, if you will.  With the out-of-control use of opiates in Cumberland, Maryland and across the US, medical marijuana could be a wonderful option for patients whose pain is no longer effectively controlled by Oxycodone or other similar opiate derivative drugs.  It could also provide loved ones who are in their final days the ability to have quality time with their family rather than in a morphine-induced coma because of the severity of their pain.  It certainly has a place in many areas of health care and needs to be used.

I am most encouraged by the founding leadership of md / phh, who are clearly in this for all of the right reasons.  They have licenses in Connecticut and Minnesota and their description of their operations is just short of amazing.   These are very credible individuals who are extremely interesting and have a wealth of knowledge on the subject.   At yesterday's meeting, I invited Dr. Goldstein, WMHS's Chief Medical Officer; Nancy Adams, Chief Operating Officer and Chief Nurse Executive and Kevin Turley, our Vice President for Marketing, Planning and New Business Development.  That meeting was only an hour due to constraints with other meetings, but it could have lasted for three or four hours.  We are all intrigued by the science associated with medical marijuana and what this company is looking to accomplish.  

It would be of great benefit to the western Maryland region to have a company locate here and bring 50 to 150 new jobs with the economic impact of revenues from $50 to $75 million.  In addition, Western Maryland Health System and our patients would have another dimension for their care.  Medical marijuana also fits nicely into our value-based care delivery model by caring for patients in the most appropriate location and keeping them healthier and out of the hospital.  

I will be keeping everyone apprised of md / phh's progress over the next several months, but I thought that it was necessary to give you a prospective on such a new and different company and concept that will hopefully be coming to Cumberland.