John B. Chessare, MD, started his position as CEO of Greater Baltimore Medical Center in mid-June. Here, he answers some questions about his plans for the future of GBMC and his insights into EMR implementation, physician-hospital relationships and profitability.
Q: How will you cut costs and increase profitability for GBMC?
Dr. John Chessare: It's sort of incredibly timely that [Donald Berwick, MD] has come to lead the Centers for Medicare and Medicaid at the same time that I've arrived in Baltimore. Dr. Berwick has been quoted as saying that 30 to 40 percent of healthcare costs might actually be pure waste. There are a lot of expenses that don't actually contribute to the patient's health or satisfaction.
All our internal efforts will be focused on improving our systems to get better critical outcomes, patient satisfaction and staff satisfaction. GBMC has already chosen lean tools and gotten teams together to work on things like turnover in the operating room. An operating room is a very expensive resource, and we don't want patients waiting for surgery, and surgeons wasting their time waiting for ORs to be ready.
We're also using engineering tools to improve the flow of patients out of our emergency department, so we can use the same resources to improve efficiency.
Q: During your previous post as CMO of Boston Medical Center, you oversaw the implementation of the hospital's EMR system. What changes did you see at the hospital after fully implementing your EMR?
JC: At Boston Medical Center, we were able to take 10 to 25 percent out of our pharmacy budget per year for three years in a row. You have an opportunity to drive evidence-based medicine at the bedside.
In addition, many specialists are in very short supply right now, and asking them to give up their lives to care for patients 24/7 isn't going to work real well. As we implement EMR, we give people the opportunity to consult at a distance. Right now, if a cardiologist could see an image of a heart and read the ECG at a distance, he could give his colleague hospitalist a great consultation without ever being at the bedside.
When I got to Boston Medical Center in 1998, nothing was electronic. When I left, everything was. It made life so much easier to just turn on the computer and just have the consultant's report right there in front of you — you didn't have to worry about dictating a letter, mailing it, getting the right address and so on. It made my life as a practicing doctor a lot easier. I got home in time because I didn’t' have this drag of time searching for information about patients.
Q: What are your EMR implementation goals for GBMC?
JC: Our goal with GBMC is that eventually we would give our patients access to their own records online. I think the country would be better served by a healthcare system that was incentivized to keep people healthy, and a patient with access to his own information is more likely to be able to keep himself healthy than one who is less informed. We are currently using our website to give people access to experts [with GBMC's "Ask an Expert" feature].
We're going to use the technology to become the organization where everyone is treated the way we would want our own loved one to be treated every single time. And I don't know of an organization that is anywhere near that vision, but we want to drive towards it.
In the book Good to Great, Jim Collins points out that technology is never the driver of change, but it's a fantastic accelerator of those changes. We have to change our own individual mindset about what it means to be a healthcare provider and challenge ourselves about whether the patient is coming first and redesign the systems in a way that the patient really is coming first.
Q: How do you plan to boost morale among staff members?
JC: The most important thing is to try to make decisions in as transparent a way as you can and to communicate well. I learned long ago that people will judge you on what you do and not necessarily on what you say. So trying to give a lofty speech — which I think I'm pretty good at — will only go so far. People will look for the proof in the pudding. We want to make sure that we do what we say we're going to do.
To do that, we survey our employees anonymously at regular intervals and then create action plans for our management team based on what we learned. We use the same survey methodology for physicians [with a separate survey], and most of the things that we cull from physician surveys are work-life problems. With all the financial constraints on providers, everyone's worried about making enough money to send their kids to college. We owe it to them to get as tightly aligned with them as we can so we can find win-win situations.
Q: How will you cut costs and increase profitability for GBMC?
Dr. John Chessare: It's sort of incredibly timely that [Donald Berwick, MD] has come to lead the Centers for Medicare and Medicaid at the same time that I've arrived in Baltimore. Dr. Berwick has been quoted as saying that 30 to 40 percent of healthcare costs might actually be pure waste. There are a lot of expenses that don't actually contribute to the patient's health or satisfaction.
All our internal efforts will be focused on improving our systems to get better critical outcomes, patient satisfaction and staff satisfaction. GBMC has already chosen lean tools and gotten teams together to work on things like turnover in the operating room. An operating room is a very expensive resource, and we don't want patients waiting for surgery, and surgeons wasting their time waiting for ORs to be ready.
We're also using engineering tools to improve the flow of patients out of our emergency department, so we can use the same resources to improve efficiency.
Q: During your previous post as CMO of Boston Medical Center, you oversaw the implementation of the hospital's EMR system. What changes did you see at the hospital after fully implementing your EMR?
JC: At Boston Medical Center, we were able to take 10 to 25 percent out of our pharmacy budget per year for three years in a row. You have an opportunity to drive evidence-based medicine at the bedside.
In addition, many specialists are in very short supply right now, and asking them to give up their lives to care for patients 24/7 isn't going to work real well. As we implement EMR, we give people the opportunity to consult at a distance. Right now, if a cardiologist could see an image of a heart and read the ECG at a distance, he could give his colleague hospitalist a great consultation without ever being at the bedside.
When I got to Boston Medical Center in 1998, nothing was electronic. When I left, everything was. It made life so much easier to just turn on the computer and just have the consultant's report right there in front of you — you didn't have to worry about dictating a letter, mailing it, getting the right address and so on. It made my life as a practicing doctor a lot easier. I got home in time because I didn’t' have this drag of time searching for information about patients.
Q: What are your EMR implementation goals for GBMC?
JC: Our goal with GBMC is that eventually we would give our patients access to their own records online. I think the country would be better served by a healthcare system that was incentivized to keep people healthy, and a patient with access to his own information is more likely to be able to keep himself healthy than one who is less informed. We are currently using our website to give people access to experts [with GBMC's "Ask an Expert" feature].
We're going to use the technology to become the organization where everyone is treated the way we would want our own loved one to be treated every single time. And I don't know of an organization that is anywhere near that vision, but we want to drive towards it.
In the book Good to Great, Jim Collins points out that technology is never the driver of change, but it's a fantastic accelerator of those changes. We have to change our own individual mindset about what it means to be a healthcare provider and challenge ourselves about whether the patient is coming first and redesign the systems in a way that the patient really is coming first.
Q: How do you plan to boost morale among staff members?
JC: The most important thing is to try to make decisions in as transparent a way as you can and to communicate well. I learned long ago that people will judge you on what you do and not necessarily on what you say. So trying to give a lofty speech — which I think I'm pretty good at — will only go so far. People will look for the proof in the pudding. We want to make sure that we do what we say we're going to do.
To do that, we survey our employees anonymously at regular intervals and then create action plans for our management team based on what we learned. We use the same survey methodology for physicians [with a separate survey], and most of the things that we cull from physician surveys are work-life problems. With all the financial constraints on providers, everyone's worried about making enough money to send their kids to college. We owe it to them to get as tightly aligned with them as we can so we can find win-win situations.