GBMC HealthCare System (GBMC) provides inpatient and outpatient care through the Greater Baltimore Medical Center, an acute care community hospital, and GBMC Health Partners, which includes 43 primary and specialty care medical practices; and Gilchrist which provides advanced care, elder care, post-acute care, and in-home and facility hospice, as well as inpatient hospice in three locations. With a net patient revenue of $581 million and a workforce of 4,388 employees and 1,140 volunteers, GBMC has a main hospital campus in Towson, MD; 32 of its GBMC Health Partners practices on the main campus and 11 in Baltimore City and county; and one inpatient hospice on the main campus, one in Baltimore City, and one in Columbia, MD.
GBMC has achieved a 5-star rating (the highest) from the Centers for Medicare and Medicaid Services.
GBMC demonstrates industry-leading and benchmark performance, with 100% of stroke patients receiving antithrombotic therapy at discharge, 100% of high-risk mothers receiving antenatal steroids, and 100% of patients receiving combination chemotherapy for breast cancer.
GBMC’s rating for communication with doctors has consistently been in the top 10% of national hospitals, and its emergency department rating for physician took time to listen is approaching top-10% performance.
The Nurse Residency Program is one of only 61 worldwide to achieve accreditation with distinction. Since 2017, first-year turnover for nurses decreased from about 27% to less than 15%, achieving performance in the top 10% of national hospitals.
In 2017, GBMC transformed its data and information systems by converting to an enterprise-wide medical record system. It has been awarded a 10 Gold Star Status, which measures capabilities that drive clinical and financial improvement and places GBMC in the top 1% of all users in the country.
Health Care Results
GBMC has achieved a 5-star rating (the highest) from the Centers for Medicare and Medicaid Services; 5 stars were achieved by only 8 of Maryland’s 45 hospitals in 2020. The rating is based on a composite of measures in mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging.
GBMC demonstrates industry-leading and benchmark performance for medical service line results, with 100% of stroke patients receiving antithrombotic therapy at discharge, 100% of high-risk mothers receiving antenatal steroids, and 100% of patients receiving combination chemotherapy for breast cancer.
Since July 2018, GBMC’s Screening, Brief Intervention, and Referral to Treatment program, which places a Peer Recovery Coach in the emergency department, has resulted in over 32,000 drug addiction screenings, with more than 3,600 patients referred for treatment.
Demonstrating commitment to its patient-centered medical home model and increased access to care, GBMC has maintained industry and benchmark leadership with 100% of its Health Partners (its physician group practices) offering extended hours for weekdays, weekends, and holidays since 2014.
All members of GBMC’s senior leadership team are active participants in Lean Daily Management, through which senior leaders visit all hospital units, hospices, and medical practices to have frank, two-way discussions with front-line leaders and staff regarding their performance against GBMC’s Four Aims of better health, better care, least waste, and more joy. The discussions, which are aided by the use of visual display boards showing the unit’s progress against the aims, move improvement to the top of the local leader’s agenda.
GBMC’s senior leaders introduce the mission, vision, and values to the workforce beginning with the employee application process. This continues through hiring and onboarding, which includes the personal participation of the CEO in all new employee orientations, and through the senior leaders’ active participation in the daily lean management walks. GBMC reinforces its mission, vision, and values to its suppliers and partners through negotiations, contract language, quarterly meetings, and performance reviews.
Financial and Market Results
GBMC has increased its net cash from operations from approximately $35 million in fiscal year (FY) 2016 to $50 million in FY19 and, even with a decline in elective volume due to COVID, maintained its financial sustainability with $35 million in 2020. During this same period, it has maintained more than 250 days of cash on hand and even increased it to $290 million in 2020, beating the Moody’s A2 rating benchmark. Moreover, GBMC has increased its cash-to-total debt from 200% to 340%.
GBMC has grown its inpatient market share in its primary service area from approximately 11% to 12.9% from FY16 to FY19, while its three competitors have experienced slight declines. Moreover, GBMC has grown its emergency department volume by 6% from 2018 to 2019, while its competitors have all experienced declines or remained flat. GBMC Health Partners has increased covered lives from approximately 75,000 in FY17 to about 78,000 in FY20.
Customer Process and Results
GBMC listens to its customers in many ways including through national surveys (e.g., Consumer Assessment of Healthcare Providers and Systems [CAHPS] and Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]), feedback from the Patient and Family Advisory Council, and comments posted on social media. It then determines its health care services and identifies or adapts its service offerings for its patients. Patients can express expectations, preferences, and questions through the patient portal, MyChart, and providers can share the patient data needed to ensure continuity of care. GBMC ranks in the top 10% of U.S. hospitals in percentage of primary care patients activating MyChart.
GBMC’s rating for communication with doctors has consistently been in the top 10% of national hospitals, and its emergency department rating for physician took time to listen is approaching top-10% performance. Its hospice CAHPS rating for recommend this hospice is currently approaching the national 90% best, outperforming the closest competitor at under 80%.
GBMC’s HCAHPS rating for communication of care after discharge is approaching benchmark performance established by the Health Services Cost Review Commission, an independent state agency.
GBMC quickly responded to patient needs during the COVID-19 crisis. It capitalized on technology to offer telemedicine visits (over 10,000 so far), which continue being offered based on patient feedback. The hospital also opened a COVID-19 testing center with a centralized drive-through. It put policies in place to keep patients and families safe, including temperature checks and health screenings for visitors, requirements of masks and social distancing, and extensive cleaning of facilities. Employees use technology to enable patients to communicate with their loved ones.
People Process and Results
GBMC offers 38 benefit options from medical coverage to tuition reimbursement, with each workforce member empowered to individually customize a package of services and benefits. GBMC redesigned its core employee health plan to include 100% coverage based on its workforce feedback. In response to COVID-19, the organization immediately addressed childcare needs, emotional and financial support, and preservation of time-off benefits. The organization minimized furloughs for its employees during the COVID-19 crisis and instead implemented an alternative workforce solution center to retrain and redeploy staff.
GBMC supports its nursing workforce through multiple recognition and educational programs such as the Art of Nursing awards, the Nurse Residency Program, and the Center for Nursing Excellence. The Nurse Residency Program is one of only 61 worldwide to achieve accreditation with distinction, the highest level of recognition from the American Nurses Credentialing Center. GBMC requires every nurse resident to fully implement an evidence-based practice project for graduation. Since 2017, first-year turnover for nurses decreased from about 27% to less than 15%, achieving performance in the top 10% of national hospitals.
A four-phase, nine-step Strategic Planning Process (SPP) ensures that strategic objectives are aligned with GBMC’s Four Aims: Better Health, Better Care, Least Waste, More Joy. The process results in short- and long-term action plans with goals, performance measures, targets, and benchmarks. Through the Environmental Analysis process, GBMC collects and analyzes relevant data about the external business environment.
Through its SPP, GBMC has identified key changes such as expansion of behavioral health services within its primary care offices and emergency department, provision of at-home outpatient rehabilitative services and for its skilled nursing facility, and the addition of a patient-centered medical home through a new office in its core market.
GBMC monitors action plans through key performance indicators, which are developed during the SPP. Alignment is reinforced through the Strategic Deployment Process, and measures are tracked at all levels of the organization. Front-line managers and senior leaders track cascaded metrics aligned with the Four Aims, strategic objectives, and action plans in real-time at daily lean management sessions. Resource needs are identified during the SPP and are allocated during the annual budget, capital planning, and workforce planning processes.
Citizenship Process and Results
Commitment to its local community is a primary focus for GBMC and its leaders. A focused and effective philanthropy program, which raises more than $15 million per year, has enabled GBMC to supplement its normal operations with programs not often found in community hospitals. These include the Sexual Assault and Forensic Examination (SAFE) and Domestic Violence services, which are not available elsewhere in the community. The SAFE program is supported by 19 forensic nurses and five victim advocates who provide sexual assault forensic exams and support individuals of all ages.
GBMC’s Community Benefit Program includes support to local organizations and initiatives. Funds can be provided in large or small increments to support activities such as funding a local elementary school for children to “Run a Mile” every day before class; supporting Baltimore’s Moveable Feast program, which provides healthy meals to chronically ill patients; and supporting an annual Weight Loss Reveal Celebration, an “Oscar-like” event, which has seen an increase in attendance from 750 in 2017 to 2,000 in 2019. The GBMC Community Benefit has increased 260% in four years.
Performance Management and Information and Knowledge Management
GBMC uses its Performance Review Process to track and assess organizational success, competitive performance, financial health, and progress on its Strategy Deployment Process goals. The Performance Measurement Selection System and Hardwiring Alignment and Integration processes enable GBMC to select and align measures to support organizational priorities. The organization tracks progress at the leadership level, and each action plan owner tracks achievement of plans at the local level to ensure alignment.
In 2017, GBMC transformed its data and information systems by converting to an enterprise-wide medical record system (using a third-party product). GBMC has been awarded a 10 Gold Star Status, which places it in the top 1% of all the product’s users in the country. GBMC was also recently honored with the Davies Award by the Health Care Information and Management Systems Society for being among national health care organizations with the highest access to information. It is the only health system in Maryland that has achieved this award and one of only 11 worldwide in 2019.
Process Efficiency/Effectiveness and Results
In order to provide a safe operating environment and to ensure that the organization is prepared for disasters and emergencies, GBMC utilizes a six-step Healthcare Emergency Operations Plan (EOP). During COVID-19, the EOP was activated, resulting in staff feeling educated, safe, and supported, and having the tools they needed to do their jobs. Senior leaders appointed a command team in mid-February before the situation became a national crisis. The Federal Emergency Management Agency Hospital Incident Command System is used to manage all internal activities, action plans, resources, and education, as well as to coordinate efforts with county, state, and federal agencies.
Leveraging its core competency of “redesigning care,” GBMC’s process design and management considers a wide range of factors, such as cycle time, productivity, and other efficiency and effectiveness factors, to achieve its aim of “least waste.” Each work unit aligns, integrates, and measures key performance indicators to achieve strategic objectives.
GBMC’s efforts to redesign care have resulted in decreasing emergency department “admit to departure times” from 170 minutes in 2017 to 120 minutes in 2019, outperforming the Maryland regulatory benchmark. GBMC is the market leader in laboratory turnaround time within 60 minutes, consistently performing well over the national standard of 90% for glucose, prothrombin time, troponin, and white blood cell count. GBMC performs 44% better than the national average for transport turnaround time, a measure of how efficiently it transports patients throughout the hospital.