One of the Benefits of Clinical Innovation

Clinical innovation such as the one described in this report is just one of the many reasons why our evolving relationship with UPMC is so beneficial to our health system and to our community.  They are bringing cutting edge, evidence based medicine to our health system as we diligently work to serve patients throughout the tri-state region.

https://pittsburgh.cbslocal.com/2018/11/14/upmc-childrens-hospital-pittsburgh-diabetes-cure-research/

SWOT Analysis

I was extremely pleased to learn that 84 health system departments and patient units participated in our most recent ask of participating in a SWOT (that's the strengths, weaknesses, opportunities and threats facing our health system). As we strive to live up to our mission, being dedicated to providing patient-centered care and improving the health and well-being of the people in the communities we serve, information that can be provided through a SWOT analysis can be invaluable.

Such information also allows us to be better prepared to achieve our organizational vision of being the best place to deliver quality care, the best place to work, the best place to transform care, the best place to reduce the total cost of care and the best place to refer patients.

There was a great deal of consistency with the strengths that were identified, which were as follows (just to name a few):

• The many clinical services that we provide
• Our approach to population health
• Being a good place to work
• Our state-of-the-art facility
• The people with whom we work 

Our weaknesses were less in number, thank goodness, but included:

• The services that we currently don't have that we are pursuing through our clinical affiliation with UPMC
• A variety of issues surrounding the ED 
• Various communication issues

The opportunities included:

• The evolving relationship with UPMC
• Our work in population health
• Enhancing the community's perception of us

As for the threats, the leaders were:

• Growing competition
• Increasing violence in the community and its potential for carryover into the hospital
• Cyber attack concerns
• Over regulation

All in all, the list was very well thought out and will go a long way in assisting us in our strategic planning efforts for the next several years.

Thank you to the many staff who participated in this very important process.

One of the Greatest Transformations for Hospitals: Value-Based Care

BR:  Since 1980, the healthcare environment has been reshaping itself. Today, there are 1400 less hospitals and yet a 40 percent increase in population. In 2010, Western Maryland Health System (WMHS) could see this change and implemented a value-based care model within our system. We transitioned our workforce to shift the delivery of care away from volume-based care to value-based by moving care across the care continuum and to provide care in the most appropriate location. Value-based care is considered to be the future of healthcare with a focus on helping patients improve their health and well-being through a shift on health emphasis and resources. This care model engages healthcare providers to reduce admissions and readmissions; strengthen patient engagement; reduce variation in quality; work collaboratively with community partners; reduce utilization of the emergency department (ED) as well as observation and ancillary services while saving millions of dollars. This approach measures health outcomes against the cost of delivering those outcomes.

BR:  While implementing the value-based model at WMHS, we found that a critical component of keeping patients healthy and out of the hospital that still needed to be addressed were the social determinants of health. After a careful analysis, issues affecting the patient’s health outcome were the result of poverty, food insecurity, heart disease, chronic obstructive pulmonary disease, diabetes, access to care and substance abuse. We started to look at the whole person more carefully and the needs surrounding them.  From job opportunities to primary care “hot spot” clinics to community gardens, patients now have resources to address not only their physical health but the social triggers that may affect their health outcomes.

By building a culture of health and collaborating to address the social determinants of health, we have dramatically reduced the cost of care over the last eight years by tens of millions of dollars, improved the health status of our community in a number of areas, improved our regional health rankings in key focus areas, and truly made a difference in the lives of many of our patients and residents throughout the region.

BR: WMHS has established many safety net partnerships throughout the region with pharmacies, the local health department, social service agencies, the business community, the food bank, the Boards of Education, Chambers of Commerce, City and County governments, and our colleges and universities. By collaborating with community partners, we are working to build a culture of health and provide comprehensive care to our community and the surrounding region. Through this culture of health, WMHS has seen a decline of 27 percent in admissions, 25 percent in readmissions and 15 percent in emergency room visits through these initiatives. One such initiative is Bridges to Opportunity, this is a program that provides community leadership to bring people out of poverty. We have also implemented a focus on food insecurity throughout the community that is delivered through education around healthy eating, school exercise programs and participating in several feeding programs for children and the community at large. Through our community partners, we have gone even further by establishing seven community gardens and an orchard to ensure fresh fruits and vegetables are available in the surrounding food desert locations. To deliver accessible comprehensive care to the community, WMHS is providing primary care clinics or “hot spot” clinics in homeless shelters, churches, senior centers and even, municipal buildings. There are many health concerns facing our community, but by creating many community partnerships, we are very well positioned to address those concerns now and into the future. When delivering the value-based care model and the initiatives surrounding population health, it is necessary to respond to the needs of the community.

How is WMHS Meeting the Many Challenges in Healthcare?

The healthcare field is certainly changing and if Western Maryland Health System isn’t keeping up with the changes, we could end up like one of the 89 hospitals that closed in 2017 with the majority being in rural areas. It has become apparent that because of our remoteness and economic development challenges, it is more difficult to bring physicians, primarily specialists and sub-specialists to our area. As a result, we have signed a clinical affiliation agreement with University of Pittsburgh Medical Center. They will assist us with such clinical needs as Vascular Surgery, Thoracic Surgery and coverage for Dr. Mark Nelson and the Cardiac Services program, as well as Oncology and Behavioral Health. We will continue to explore other ways in which UPMC can assist with the many challenges we face every day. Fortunately, we do have a lot still going for us. We benefit greatly from the Maryland Waiver which brings an additional $2.6 billion to the state provided we continue to meet a series of benchmarks related to improved quality, reduced utilization and cost savings. We transitioned healthcare delivery in Maryland eight years ago from a system based on volume to one that is value based. That transition brought us a great deal of advantage as it allowed us to demonstrate our commitment of placing the patient first in the care delivery system. We’ve been able to achieve remarkable partnerships across the care continuum to ensure patients receive the care they need where they need it. These partnerships have helped reduce the gaps in care and have better addressed the needs of the most vulnerable. We are much further ahead of other hospitals, in other states, with our care delivery model and our efforts in reducing the cost of care. We now care for patients in the most appropriate location including throughout the community and within the home.

As we attempt to work through the many changes, challenges and disruptions facing our industry, our goal at WMHS is to not only sustain healthcare services in western Maryland, but to enhance those services. Building upon the newly created relationship with UPMC could take us to long term viability through cutting edge technology, innovative programs and services as well as access to the many other clinical programs offered by one of the largest health systems in the United States. Most importantly, UPMC wants to offer those services in our community to the extent possible and not have the patient travel to Pittsburgh or Altoona unless it is absolutely necessary. This relationship with UPMC is an excellent next step for WMHS as we not only attempt to improve our viability but, with all of the difficulties that we face, our long-term survivability.

THE PEDIATRIC UNIT AT WMHS IS NOT CLOSING

If there was ever a time to re-engage my blog, now is it.

Since early June, I have been reading and hearing so much misinformation regarding the WMHS Pediatric Unit.  We are NOT abandoning children by closing our Pediatrics Unit.  The term “closing” is a regulatory term that we have to use even if we are transitioning our unit from virtually a single Pediatric inpatient bed on an adult patient unit to a five bed Pediatric Observation Unit adjacent to the Emergency Department.  Unfortunately, last Saturday’s newspaper headline stated that the unit was closing.  If you just read the headline and not the article, I can see how one would think that the Pediatric unit was actually closing, but again, that is not the case.

Beginning in early August 2018, any child requiring an overnight stay will be cared for in a dedicated, secure unit that is being newly constructed next to the ED.  The child can remain in the unit up to 48 hours; after that, clinical decisions will be made as to transfer or discharge to home.  This unit will be staffed by Pediatric Advanced Life Support trained nurses along with Emergency Department physicians and physician assistants.  Pediatricians will continue to attend to children in the unit, as well.  Because we have so few pediatric patients (for the first nine months of the fiscal year, we have admitted 44 children who have stayed an average of 1.93 days), our Pediatric staff nurses cannot maintain their expertise, nor can we recruit dedicated Pediatric nurses because we admit so few children.  The ED staff are very well trained in caring for and treating both adults and children.  In fact, last year we treated close to 9,500 Pediatric patients in the Emergency Department with 86 being admitted to WMHS and about 300 being transferred to a Pediatric Specialty hospital due to their chronic or critical condition.  As a parent and a grandparent, I can’t imagine why a parent or guardian wouldn’t want their very ill child treated in a specialty facility where the specialists treat thousands of children each year. 

Some have said just bring the specialists to Cumberland and we do, but caring for children on an outpatient basis usually for chronic or follow up care in Pediatric Cardiology and Neurology.  With a two hour travel distance and so few patients, it is unrealistic to think that specialists would come to Cumberland to perform surgery on one child.  There are physician shortages in virtually every specialty for both adults and children and areas such as ours have the greatest challenges in recruiting.  WMHS like so many other community hospitals have had to resort to alternatives in the care and treatment of children.  We are using more digital technology, telemedicine, and partnerships to address the needs of children and through our affiliation with UPMC, these advancements will continue to grow.  In Maryland, 33 out of the 47 hospitals, have Pediatric Units.  Eighteen of those hospitals have a length of stay for Pediatrics of less than a day and there are nine Maryland hospitals similar to WMHS with a length of stay of less than two days.  Over the last 30 years, Pediatric beds in Maryland have decreased by more than half from 882 to 385.  More and more children are being cared for in the most appropriate location, a specialty hospital, when they have a critical or chronic condition.

I certainly recognize the hardship for families who have to travel out of the area if their child is very ill.  Our staff at WMHS will work with the specialty hospital as well as throughout our community to assist with this hardship to the extent possible.  Although such transfers have been occurring for the last several years, we will become more engaged in the process and assist these families in navigating the challenges that they face when such circumstances arise.

I hope that the information contained within this blog helps to clarify the circumstances surrounding Pediatrics at WMHS.

Insurers and ED Visits

I can’t tell you how many people sent me the article last week regarding Blue Cross and Blue Shield of Georgia stopping coverage for ED visits that they deem unnecessary.  I am not sure as to all of the fuss since insurers serving their members in western Maryland have been denying payment for what they deem unnecessary care for the last several years.  If BC /BS of Georgia is like our local insurers, they will do little to nothing to educate their members on when and when not to use the ED, but hold the hospital accountable for the care that it rendered to their member.  

When a patient presents in the ED, we are required by law to provide care.  We have been working to educate patients on when to use their physician versus urgent care versus the ED.  We have had some success over the last few years, but we still have to fight denials on a continual basis.  We have increased visits to urgent care while reducing the number of ED visits; but again, that responsibility has fallen to the hospital.  We can’t be providing expensive emergency level care knowing that we won’t be paid.  

I certainly do not begrudge insurers seeking to reduce their costs, but their solutions need to be well thought out and applied as such.  Simply removing the proverbial monkey from their back and placing on the back of the hospital isn’t a viable solution.

Reducing Healthcare Spending While Preserving Jobs

As you may know, I am a contributor to FierceHealthcare's Hospital Impact, an online publication that is a peer-to-peer forum for hospital executives, physicians, and other hospital leaders that addresses clinical and operational issues.  

Below is my latest post about the challenges involved with addressing healthcare spending while preserving jobs in the community.


FierceHealthcare

Status of Clinical Affiliation with UPMC

In an effort to keep everyone informed as to the progress that we are making in our discussions and negotiations with UPMC on our clinical affiliation, let me offer the following:

The discussions for a clinical affiliation with UPMC are progressing well.  The next step is finalizing the letter of intent, which summarizes the contractual agreement between WMHS and UPMC.  We anticipate that this letter should be signed in the next few weeks. Once the letter of intent is signed, we will negotiate the definitive agreement, which specifies the details for the clinical affiliation between WMHS and UPMC.

The following areas have been identified as part of the first phase of the clinical affiliation:  vascular surgery, thoracic surgery, cardiac surgery, neurosurgery, medical oncology, and behavioral health. We have established clinical services work groups for these areas, and we are in the process of identifying dates for a series of site visits by UPMC’s clinical leadership in theses areas.

Kim Repac, WMHS CFO, is in Pittsburgh today giving a presentation to UPMC leadership and staff on the Maryland Rate Regulation System.  Since our affiliation is their first in Maryland, they would like to have a better understanding of our rate system and our current payment model.

UPMC leadership will be presenting at the WMHS board meeting in April as to their plans for our affiliation and also will provide an update on other affiliation activity currently underway within their system.

Last Friday, I had the opportunity to meet and spend some time with six hospital CEOs from throughout Pennsylvania whose hospitals all have a clinical affiliation with UPMC in some form.  To a person, they were exceedingly complimentary of UPMC and how they are delivering what they say that they will provide in each of their relationships.

All in all, the process continues to proceed very well.  I am very much encouraged by our continued interaction and their commitment to WMHS.  

DEA Presentation on Heroin and Opioids

All that I can say is WOW!  This afternoon at WMHS, we had a continuing medical education session with well over two hundred attendees, most of whom were clinicians.  The presentation was made by Charles “Buck” Hedrick, who works in Intelligence for the U. S. Drug Enforcement Administration and is based in Baltimore.  Buck provided a wealth of information and answered many great questions that followed from the audience.  

Virtually everyone who is involved with the Opioid / Heroin Crisis facing our community was in attendance.  There were law enforcement officers, psychiatrists, trauma surgeons, primary care physicians, hospitalists, nurse practitioners, dentists, ED staff, nurses, crisis counselors and Allegany Health Department staff in attendance.  

Some of the information that he shared included: 

• the USA has 5% of the world’s population, but we use 80% of the opioids and 99% of oxycodone
• there are 24 health departments and over 500 law enforcement agencies in Maryland so teamwork is key as has been the case in Allegany County
• Baltimore is almost exclusively western Maryland’s source for heroin
• the introduction of Fentanyl has set this epidemic apart from the others that began once soldiers started to return from Viet Nam
• Fentanyl is used to enhance poorly produced heroin and it is a killer
• there are over 100,000 clandestine labs in China producing drugs like bath salts and fentanyl
• the DEA has three offices in China
• one kilo of heroin can be bought for around $50K at the Mexican border but it can be cut 3 to 4 times with items like milk sugar and children’s laxative
• you can buy one kilo of fentanyl online for about $3500
• the world’s heroin comes from Southeast and Southwest Asia, South America and Mexico where the poppy crop grows the best
• the DEA has a drug monitoring program where they buy heroin in Baltimore for the sole purpose of testing it to determine where in the world it is coming from

The most interesting piece of information was that 95% of the heroin coming into the US comes from Mexico via three routes: Interstate 5 to San Diego, Route 85 to El Paso and Interstate 35 to Laredo, Texas. (This should be reason enough to better control our southern border.)

Throughout his presentation, Buck repeatedly emphasized teamwork, the sharing of best practices, the need for medical school training of new physicians on prescribing, the success with using peer recovery specialists who can relate very well to those who are addicted, the benefit of mandatory prescription drug monitoring in Maryland, and law enforcement involving the DEA once leads are obtained.  

When an overdose occurs, it is first a medical emergency and then a crime scene. Sharing information and leads among law enforcement with the DEA can be most helpful in addressing the criminal side of this issue.  I, along with the rest of the audience, could have listened to Buck all day.  Like Jimmy Pyles and Sheriff Robertson, who lead many of local efforts on this subject, Buck was a wealth of information and brought a very global perspective to this crisis.

Preserving Value-Based Care

As you may know, I am a contributor to FierceHealthcare's Hospital Impact online publication, which is a peer-to-peer forum for hospital executives, physicians, and other hospital leaders that addresses clinical and operational issues.  A current topic of discussion is the uncertainty about the fate of the Affordable Care Act.  

Below is my latest post that explains why preserving the value-based care components of the Affordable Care Act is so important to the patients we serve.  

FierceHealthcare

Selecting UPMC as an Affiliate Partner

As the WMHS Administration was finalizing our strategic plan, which will take the health system into 2020, it was determined that WMHS would need an academic medical partner to ensure that we could maintain and enhance the clinical programs and services we provide to our patients.  

After a careful review, the WMHS Board of Directors voted to send a Request for Proposal (RFP) to: UPMC (University of Pittsburgh Medical Center);  West Virginia University Health System (WVUHS); and University of Maryland Medical System (UMMS).  UMMS, although initially expressing an interest, chose not to submit a response to the RFP as they were already heavily engaged with the transition of Prince Georges Hospital into their system.  Both UPMC and WVUHS submitted responses to the RFP.  

The WMHS Board of Directors established criteria to determine which organization best fit with our health system.  The criteria included such items as: clinical breadth and depth, commitment to the community, organizational culture, physician alignment, population health initiatives, and clinical innovation.  After a thorough review of the responses to the RFP, responses to written questions posed by WMHS, visits to WMHS by both UPMC and WVUHS, site visits by WMHS representatives to both institutions, and meetings with the WMHS Medical Staff, the WMHS Board of Directors determined that UPMC had the breadth and depth of clinical services necessary to strengthen and broaden clinical programs here at WMHS.  

Throughout this process, we have maintained that our goal for a clinical affiliation is to maintain and expand the services that we provide to our patients locally.  Our intention is that our patients will continue to receive almost all of their care here, and would have to travel of out of town only for those highly specialized services that need to occur at a tertiary care center.  

We are very excited about this potential clinical affiliation and it is just that, a clinical affiliation.  I have already heard rumors that WMHS has been sold to UPMC, but that is not the case.  We will be working much more closely in a variety of areas, but WMHS will continue to be an independent health system that is part of the Trivergent Health Alliance.

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.