Our Region's Opioid / Heroin Crisis

Yesterday, I read about the Chamber of Commerce breakfast with the Western Maryland Legislative Delegation. I was unable to attend since I was on vacation.  During the breakfast meeting, one of the delegates commented on the opioid crisis when asked what the state was doing about it.  During his response, he said, "too many people are becoming addicted because physicians are prescribing too many opioid-based medications" and that this is a relatively new issue.  

After reading the comment, I realized that not everyone really knows about what all we are doing to address this problem and that has to change. In response, over prescribing isn't a new issue; in fact, much has been done to reduce the amount of opioids being prescribed, especially here at WMHS.  

The over prescribing evolved when health care regulators imposed what is known as the fifth vital sign in 2001, which was to control pain. As opioid addiction began to increase, hospitals and physicians began to move away from such requirements and worked to address pain in other ways.  Controls both self-imposed and those imposed by medical staff leadership at WMHS have been put in place in the Emergency Department, Surgery, our Pain Clinic, and in all of the WMHS clinics and practices.  Are there over prescribers out there; of course there are, but the more egregious offenders, who are very few in number, are known to law enforcement and are being closely monitored.  Dr. Jerry Goldstein, WMHS Chief Medical Officer, is having a list compiled through the Maryland state registry that monitors opioid prescribing, as well as through other sources, of those independent physicians and dentists who are considered to be prescribing beyond newly established standards.  Once that list is completed, Dr. Goldstein will meet with each practitioner individually.

Recognizing that this crisis was only going to get worse, the Western Maryland Health System convened its first community-wide meeting to address the opioid / heroin epidemic in our area in August.  Representatives from law enforcement, the State's Attorney's office, the Health Department, the Finan Center, the EMS community and WMHS met for nearly two hours to learn from each other as to the challenges that we each face and to plan the next steps needed to address the many issues.  

It is interesting to note that during that meeting, one representative commented that because there are so many controls on the prescribing of opioids by doctors and the hospital, those who were addicted to painkillers have become our newest heroin addicts.  

The meeting was an open and frank discussion.  It was so well received that a second meeting was held in December and with representatives from the dental community, the Allegany County Board of Education, the Greater Cumberland Committee (TGCC) and local pharmacists being invited to join the group.  A third meeting has been scheduled for February.  

During the December meeting, we talked about many topics, including:

• the amount of crime being committed in our community that is drug related 
• the inadequacies of the State Crime lab for drug testing and how that ties the hands of law enforcement when arrests need to be made 
• the idea of having crisis counselors ride along with EMS and the police
• the number of active Health Department and community programs that are available to wean those addicted off of opioids
• the drug court concept for drug offenders
• the availability of Narcan to law enforcement and EMS and how lives have been saved through its availability
• the new drugs that we are seeing in the ED that may be a danger to anyone who comes in contact with them from police to EMS to ED providers
• the amount of education that is going on throughout the community by Sheriff Robertson and others on the use and abuse of opioids
• the business community's involvement in the issue through an upcoming Greater Cumberland Committee meeting to address the issue throughout the tri-state region.

There has been a great deal of interest as well as action that continues to occur throughout our region on this subject.  After reading yesterday's Chamber breakfast comment, an invitation to the Western Maryland Legislative Delegation to attend our February meeting is in order.  As our progress evolves, there will be more to follow.

Experiencing Amazing Generosity

Once again, it's been a while since my last blog, but I have been exceedingly busy in both my personal and professional lives.  I have taken some time off earlier than usual to spent it with family for Christmas so I have found a few minutes to blog.

As for the generosity, last Friday, my daughter Lauren, who does market intelligence for the Pulte Group (home builders), turned over a newly built and furnished home in Summerville, SC, to a Gold Star family.  Lauren coordinated the entire project so we promised to be there for the release ceremony.  What an amazing gift to this family of a Navy Seal who was killed in action.  In addition to fully furnishing the home, they raised enough money for the taxes, insurance and utilities for at least three years.  A Charleston bar owner even donated a new tricked out golf cart for the surviving mother and daughter to travel around the neighborhood.  The Coastal Carolina Pulte Group pretty much does a home a year for a veteran wounded in combat, but this was a first for a Gold Star family.  There were dozens of subcontractors who donated their time and materials.  Big screen TVs and audio equipment were donated for virtually every room; Lauren had landscapers who were fighting over who was going to landscape around the home.  People are truly amazing and it was a very special day for me.

As many of you are aware, my son-in-law Terrell's cancer is back in both his leg and his lungs; second time this year and third time since February of 2014 in his leg, but the first time in the lungs.  He started chemotherapy in October and will be heading to MD Anderson in Houston the day after Christmas for a five-day visit.  Because of his chemotherapy, my son-in-law will be severely immunocompromised so routine air travel wasn't the best option.  Last month, I reached out to friends and colleagues seeking a private jet / airplane to take them to Houston with the full intention to cover all of the expenses.  Not only did I have an offer within five minutes of the Facebook ask, but the entire trip has been donated by this friend. I continue to be amazed at the kindness of people.

This takes me to the Western Maryland Health System, where generosity abounds.  On the Saturday before Thanksgiving, the Health System, along several partners provided a complete Thanksgiving meal to over 2500 people who most likely wouldn't have had much to eat let alone a traditional Thanksgiving dinner.  They were invited to the Regional Medical Center for dinner with transportation being provided if needed.  If you were a shut-in and unable to come to us, we came to you.  Meals were also delivered to homes throughout the communities we serve.  It was an amazing event coordinated by our own Jo Wilson, who is by far one of the kindest, most caring people that I have ever met, and she was joined by a wonderful group of volunteers who were mostly WMHS employees and their families.

  

Which brings me to Christmas.  As I was preparing to head out for Christmas, I watched dozens of departments and patient units throughout the hospital prepare their many gifts for the Christmas families that they sponsored this year.  I saw bikes, games, clothing, toys, coats, blankets and gift cards being wrapped in spare offices and conference rooms.  Carts of gifts were being transported to waiting cars for delivery to homes, churches, the YMCA, nursing homes and the rescue mission so those less fortunate could experience Christmas like the rest of us.  I am honored to work with such wonderful people each day.

As I noted above, the year 2016 was a busy one and, for the most part, one that I would like to forget.  In addition, to Terrell's cancer returning, my mother-in-law was diagnosed with Stage 4 ovarian cancer in February, my own mother passed away in June and both of our six-year-old cocker spaniels died with a few months of each other; but there were bright spots as well.  The love, kindness and generosity of the people mentioned above as well as those who have been there to support me and my family throughout this year with so many personal challenges.  Undoubtedly, the brightest spot of all has been the birth of my first grandchild, Matthew Ronan Jackson.  (Photos below.)  What Jessica and Terrell went through to have Matthew and then to bring into this world this sweet, little child who is always smiling and laughing (at least when I am around). God knew that we needed something good this year and he certainly delivered.  

Now for 2017, I am hopeful, as is Terrell, that God is ready to deliver again.  Have a Blessed Christmas and a very Happy New Year.

Improving the Community’s Perception of WMHS

On Monday, I blogged about feedback that we received from our leadership related to improving the community’s perception of WMHS.  Lots of ideas were offered and I thought that it would be beneficial for everyone to know what we will be focusing on over the next few months related to perception.

Executing on Fundamentals

• First and foremost, find out the drivers for the misperceptions
• Educate and engage our employees to a much greater extent on the many positives occurring at WMHS
• Hardwire the patient experience process organization wide
• Explain why there may be long waits in the ED and the steps that are being taken to address
• Ensure accountability of our staff that they are putting the patient at the center of everything that they do
• Better manage patient and family expectations
• Encourage patients to make complaints when problems occur – we can’t fix it if we don’t know about it
• Do a better job of scripting staff when they hear negative comments about WMHS
• Make sure that the staff know where complaints should be directed
• Use Voice of the Patient findings from our patient satisfaction results to identify patient issues and follow up when possible
• Patients need to understand how health care is changing and what to expect when you come to the hospital
• Explain our triage process in the ED as to why some patients may be seen more rapidly than others
• Need to engage physicians more so they have a better and more accurate perception of WMHS; especially those who no longer have a hospital practice
• Establish a Patient / Family Council at WMHS

Prove Our Credibility

• Tell our story to a greater extent; a little shameless self-promotion could be a good thing
• More thoroughly explain the Hospital Medicine program and the credentials of these very well trained hospitalists
• Make sure that the public knows that their primary care physician has chosen not to come to the hospital and that he or she has been replaced by a hospitalist
• Encourage staff to intervene as quickly as possible to address problems and issues so they can be resolved as quickly as possible.
• Send the latest annual report (Transforming Healthcare) to homes throughout the region
• Provide that same annual report to every patient upon admission
• Contact every patient post discharge to thank them for choosing WMHS
• Provide blameless apologies while patients and families are still at the hospital

Demonstrate Value

• Promote the positives, i.e. the WMHS Heart Institute, the Da Vinci Robot, the Wound Center, the Schwab Family Cancer Center, etc.
• Increase engagement of patients and families
• Ensure the community that it’s not only academic medical centers that have the latest technology.  We have state of the art technology for all programs and services offered at WMHS.
• Provide ongoing education to staff on the latest happenings at WMHS that would benefit both them and their patients
• Promote our quality measures that are already on our website to the community
• Ensure that our Marketing Dept is well aware of the latest technology, equipment and techniques being used and applied at WMHS

Again, it was a day very well spent with many wonderful ideas being offered.  I have attached an electronic copy of our annual report, Transforming Healthcare, to this blog so you can see for yourself what we have been up to at WMHS over the last year.  Lots of great things are happening every day at WMHS; we just need to tell someone.

WMHS FY2016 Accomplishments

A Day Very Well Spent

On Friday, we had an all day meeting of our department directors and nurse managers.  We used the day to get feedback and validation on the results of our recently completed department director survey and on our strategic plan.  

The WMHS Board approved the strategic plan in September, and we have been presenting components of our plan to the leadership group since then. On Friday, there were two primary objectives to be achieved during the meeting:  generate ideas to improve the community's perception of WMHS and build tactics to support the strategic plan. The ideas coming from the group on improving perception were amazing and will be put into action immediately.

In the afternoon, the group broke into five teams to build tactics around each strategic goal.  Attached is the strategy map outlining each strategic goal and their supporting objectives.  There are a series of strategies for each objective, and tactics will be developed at the department and patient unit levels around each strategy.  There was a great deal of information provided during the afternoon session, as well.  Numerous tactics were built around each strategy and over the next few months, the teams will continue to meet to finalize the plan with department and unit level tactics.  It was also determined that the plan will be a very dynamic document complete with performance measurement and accountability at every level of the organization.  In the past, the strategic plan pretty much remained at the management level.  

In the morning session, one of the suggestions for improving community perception was to have greater engagement of all WMHS staff.  We have over 2000 potential ambassadors who with the necessary knowledge, background and education could tell the story of what actually happens at WMHS, including the wonderful things happening every day through the work of some amazing people.  

Again, Friday was a day that was very well spent for all of us.  There will be more to follow in subsequent blogs on the specifics of a very successful day.

Prescription Opioid and Heroin Epidemic Awareness Week

This week has been designated by the White House as an awareness week for the heroin and opioid epidemic facing our nation.  The focus is on those who have lost their lives to the epidemic as well as to support those recovering from the addiction.  The Obama administration is looking for $1.1 billion from Congress to address the epidemic.  

In Cumberland, those of us in health care, law enforcement, EMS, the legal community and public health are well aware of the epidemic.  In early August, WMHS sponsored a summit on the topic with the above-listed groups.  We took the opportunity to understand the issues facing each other in this crisis and to learn what we can do to better support each other.  Due to the success of the summit, we agreed that we would continue to have the summit on an every-other-month basis.  We also decided to add members to the group from the local Board of Education and the Dental Society as well as a local pharmacist.

The impact of this epidemic is widespread in our community.  We have had over 30 deaths since January; we average just about an overdose a day in our ED. The great majority of crime in our region is directly attributable to this drug addiction, and the epidemic continues to put an undue burden on our community in so many ways.

Enhancing community awareness was determined to be an area where our summit group could make an impact.  Everyone pledged to ensure such awareness related to this epidemic.  Hopefully, the President’s campaign will serve as an impetus to generate awareness nationally as so many communities like Cumberland are dealing with this horrific problem.

Where've Ya Been

I have heard from a number of people asking why no recent blogging.  There is an easy explanation and it’s called “there were too many distractions.”

Distraction number one was the birth of my first grandchild on August 1, 2016.  Matthew wasn’t expected for another 18 days, but he arrived early weighing in at 7 lbs 14 oz and 20.5 inches long.  As soon as being notified that our daughter was in labor we packed and left for Charleston, SC.

We arrived just after he was born and then stayed to help out.  This grandparenting thing is very cool and we are so looking forward to things to come.  Right now, we get a photo and/or video each day.  That helps with the 650 mile or so separation, but as he grows and starts crawling, talking, walking, that 650 miles will get further and further away.

Distraction number two has been the finalization of our strategic plan, especially a few key components in bringing them to fruition over the last two weeks.

Distraction number three has been catching up after being out of the office for two weeks, especially unexpectedly.  We thought that we had at least two weeks before the baby was due, but he threw us a curve.

My goal is to resume blogging with some frequency next week.  Have a great weekend!

Preparing for the Future

Attached is an Update that was distributed to our Department Directors and Medical Staff yesterday afternoon.  It brings the first phase of our strategic planning process that began in April, 2016 to a close.  The Update describes Board actions taken last Friday in an effort better prepare WMHS for the future.  

Everyone recognizes the need to remain viable and to keep health care delivery local.  In order to do so, we will need to explore gaining greater access to physician specialists and sub-specialists to complement and enhance our existing clinical programs at WMHS.  A key component to any potential affiliation will be to bring those specialists to Cumberland and not have patients traveling out of town needlessly. 

The next phase will be to send a request for proposal to three academic medical centers, WVU Medicine, UPMC and UMMS in order to gauge their interest and commitment to such a partnership.  As this process proceeds, I will be blogging on the subject in an effort to keep everyone informed.

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

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.

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

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.

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 6^th 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 6^th 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 2^nd 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 2^nd floor to the 6^th 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!

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/

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.

Nursing - It's Hard to Think of a More Wonderfully Deserving Profession

Last Friday began another Nurses Week, and I can't think of a more deserving group of people for such recognition.  For 14 consecutive years, nurses are our nation's most trusted profession with the highest ethical standards.  Wow!  Rounding out the top five according to Gallup were medical doctors behind nurses, pharmacists in third place followed by police officers and then members of the clergy.  That is quite a group of honorable professions.  

As soon as Gallup added nurses to the list in 1999, they have held the top spot except for 2001 when they were knocked off the top spot by firefighters, another very honorable profession.  According to clinical psychologists, people tend to trust those who are directly caring for them.  In the care of the patient, the nurse is the captain of the ship, if you will; they provide the continuity of care at the bedside.  Being in this business for over 40 years, I have had the pleasure of meeting, working with and being cared for by thousands of nurses.  They are truly amazing people in the care that they deliver, the compassion that they express and the advocacy that they demonstrate.   

At WMHS, we are now highlighting our nurses in a promotional campaign.  The spots are reflective of our amazing nurses.  The idea came from Texas Health Resources after their Ebola situation a few years ago.  There was a great deal of misinformation about their hospital and their care of our nation's first Ebola patient.  Their nurses said let us be interviewed by 60 Minutes and we'll set everyone straight--and they did.  These nurses were masterful and certainly made their profession proud.  Just as our nurses have done in their reflections on being a nurse.  

Nurses at WMHS and across the nation have truly earned their recognition as the most trusted, highly respected and ethical in their profession and in the care of their patients.  Happy Nurses Week! 

We Are Unique

Last week after the Dr. Perman lecture, I stopped to thank him.  He was engaged in a conversation with Hans Killius, the WMHS Director of Pastoral Care.  Hans had a cell phone and a pager on the table in front of him.  I commented that I didn't realize that we still use pagers at WMHS.  We all laughed.  

The next morning, I received an email from Hans commenting on the preceding evening's event and asked that if I ever wanted to take chaplaincy call that I could and it would be assuredly eyeopening.  I responded that my days of "on call" were over, excluding urgent or emergent situations involving the CEO.  I explained that my start in health care was processing bedpans in Central Sterile Service as an equipment orderly.  I continued that throughout my career from that entry-level health care position to CEO and every position in between (Equipment Technician; Equipment Supervisor; Manager CSS; Assistant Director, Materials Management; Director, Materials Management; Assistant VP; VP; Chief Operating Officer; and CEO), that I had not only spent decades on call but also worked years of weekends and holidays.  During such time, I had to deal with some very interesting and enlightening situations over my 41 years in health care.  I told Hans that I would leave the eyeopeners of today to both him and his associates.  

Hans responded that he was glad that I knew health care from the front lines.  He said that knowing my career path will empower his advocacy of health care leadership and our health system going forward in the presence of occasional negative and ill willed messages.  (Very well stated.)  

Hans' response got me to thinking as to how fortunate and unique we are to have an administrative team that pretty much began their careers in health care at levels well below administration.  Many in health care leadership upon completion of their graduate degrees (MBAs, MHA, MPH, etc.) go directly into administration and never experience the "front lines," using Hans' terminology.  Personally, I have found working at every level of health care has been exceedingly beneficial and rewarding, as have my colleagues at WMHS.  The following is a list of our Senior VPs and VPs at WMHS and where they started in the front lines of health care:

• Nancy Adams, Chief Operating Officer and Chief Nurse Executive - EEG Technician at Sacred Heart
• Dr. Jerry Goldstein, Chief Medical Officer - Dishwasher at Baltimore County General Hospital
• Kim Repac - Chief Financial Officer - Staff Accountant at Sacred Heart
• Bill Byers - Chief Technology Officer - Computer Systems Manager at Memorial
• Jamie Karstetter, Vice President Patient Care Services - EVS Assistant
• Michele Martz, Vice President, Clinics and Practices - Staff Accountant at Memorial
• Kevin Turley, Vice President, Operations - Manager, Sacred Heart Home Medical Equipment
• Jo Wilson, Vice President, Operations - Radiologic Technologist

Impressive to say the least!

Team-Based Care

Last evening, I had the pleasure of introducing Dr. Jay Perman, President of the University of Maryland at Baltimore, who spoke at the health system about interprofessionalism, which succinctly put is team-based care.  He talked about how team-based care is optimal  for our patients, its importance in our transition to value-based care delivery, and how it results in better quality and allows us to better address the socioeconomic factors that our patients experience.  

Team-based care involves a care team that may include physicians, nurse practitioners, RNs, respiratory therapists, pharmacists, dietitians,  dentists, attorneys, social workers, care managers, physical and occupational therapists, physician assistants and the list goes on.  In addition to teaching the concept, Dr. Perman uses the team-based approach in his clinic when he sees patients.  After his presentation, I offered an example here at WMHS  that supports his concept of interprofessionalism. 

Our Center for Clinical Resources was built around team-based care delivery.  I explained that when WMHS began our demonstration project on value-based care delivery, we learned that there were 1,972 patients who accounted for $140 million of our cost.  Obviously, these were patients with multiple co-morbidities such as diabetes, congestive heart failure (CHF), COPD and hypertension. To help these patients manage their conditions, we opened a Diabetes Clinic and a CHF Clinic and then added an Anti-Coagulation Clinic.  Unfortunately, all were in separate locations, both on and off campus and it was difficult for patients who had appointments in more than one clinic.  It was then that we decided to combine all of the clinics into one location, the Center for Clinical Resources.  We moved the separate clinics to one office suite in our medical office building and decided not to charge any co-pays or deductibles .  We consolidated the pharmacists in our Anti-Coagulation Clinic, the Diabetes Clinic and its team of a nurse practitioner, a dietician and others, along with the CHF team that was led by a nurse practitioner.  We then added a navigator, respiratory therapists, nurses and other key staff all with access to physicians who specialize in each area.  Through the team approach, we provide a more comprehensive level of care to these patients with multiple illnesses.  They can get their care in one location by a team that is focused on them specifically.  We have reduced admissions, readmissions, ED visits and ancillary utilization for these patients, resulting in a saving of over $8 million in less two years.  Through this approach and a host of other initiatives those 1,972 patients incurring $140 million in cost is now 1300 patients incurring $80 million.

None of our successes in value-based care delivery or the Center for Clinical Resources could have been achieved without using the team-based care approach.  It was also nice to be able to provide Dr. Perman with a real live success story related to his passion for interprofessionalism.

Telling Our Story

As you may know, I contribute to a blog called Hospital Impact.  The editor asked if I would comment on an article that recently appeared in the Journal of the American Medical Association.  Below is my post from April 14, 2016.  I thought you would find it interesting.

When I was asked if I would blog about pushing the healthcare industry into a new era, I agreed based on my own personal experience. At the time, I wasn’t aware of Don Berwick’s recent commentary in the Journal of the American Medical Association on the subject. Fortunately, I can certainly relate to his commentary since I have been living his “Era 3” for the last several years.

Berwick states that healthcare needs to be pushed into a new era. He writes about Era 1 when medicine was good and depended on self-regulation. Then Era 2 evolved once the flaws and contradictions of Era 1 became apparent. Era 2 saw the need for accountability and measurement. Era 3, though, will require a combination of Eras 1 and 2, but emphasizing less measurement related to cost and volume and more measurement related to quality and value; moving away from maximizing revenue; focusing on care improvement as a core competency for healthcare leaders; and complete transparency with the communities that we serve.

At Western Maryland Health System, Era 3 has been evolving over the last several years. In 2011, we transitioned to a value-based care delivery model, and care improvement has been at the core of our care delivery model ever since. We have to maintain market share, but otherwise we are expected to bend the cost curve, which we have achieved each year since 2011.

We deliver care in the most appropriate location and partner with many who previously were our competitors. We have reduced use rates, emergency department visits, readmissions, unnecessary admissions and use of observation beds. We have added primary care practices throughout the region, embedded care coordinators in our physician practices and established a pay-for-performance initiative for our physicians to better align incentives. We provide medications for 30 days to any patient upon discharge, follow up immediately with discharged patients and have dramatically expanded our Home Care program. We also work in partnership with our area skilled nursing facilities, and we address chronic conditions such as diabetes, COPD and hypertension at no cost to the patient through our Center for Clinical Resources

Our quality measures focus on a host of hospital-acquired conditions and potentially preventable conditions, but our performance measures such as readmissions, length of stay and mortality rates are equally important.

Over the last six years, we have become a very different organization by moving away from volume and focusing on a value-based care delivery system that embraces the components of the triple aim of health care reform. It wasn’t easy, but we are now very well positioned in an Era 3 healthcare landscape as well as for an ever-challenging healthcare landscape in the future.

What a Great Start to our 20th Anniversary Celebration

In Sunday’s Cumberland Times News, there was a wonderful letter to the editor from Steve Friend, a local attorney.  The letter is attached below.  I have received many complimentary letters regarding the health system, but this has to be up there in the top three.  To have a prominent attorney tout our health system and our staff as excellent, superb, professional, courteous, attentive, pleasant, a culture of kindness and very importantly, great senses of humor, is quite an honor.  All of these attributes are true, but then again I am biased.  But as Steve writes, look at the external objective sources like US News and World Report (hospital rankings), Healthgrades (top 50 heart programs in the US), the Maryland Patient Safety Center (Distinguished Achievements in Patient Safety Innovation),  the American Hospital Association (Living the Vision Award), Premier (Cares Award finalist) and being recognized as one of the nation’s Most Wired Hospitals by AHA.

We have so much to be proud of at WMHS as we celebrate our 20^th anniversary.  In addition to our awards and what we do every day in the care of our patients, we successfully consolidated three hospitals in Allegany County, we built a new state of the art medical center and now provide care under a model that focuses on value not volume and is recognized nationally.  Our 20 years as a health system have been remarkably successful and our success is attributable to an amazing team of people doing some amazing things day after day.