GBMC’s Annual Goals – How We Know If We are Getting Closer to Our Vision

The GBMC HealthCare System has a vision of perfection. Our vision is to deliver the care that we want for our own loved ones to everyone, every time. Since we are human and our designs are created by humans, we know that we will never truly get to perfection, but we accept that we must keep getting better. So, how do we know if we are getting better? We see where we are at the end of every fiscal year, we set goals for ourselves, and we then measure our performance on a regular basis (at least monthly) - and we keep score!

At GBMC, we work throughout the year to improve in our four Aims (the areas that best describe the care that we want):
1. Best health outcomes
2. Best satisfaction
3. Least waste
4. Most joy for those providing the care

As we begin this new fiscal year this summer, it’s a good time to look back over the last couple of years to see how far we have come. I am happy to report that year over year, GBMC has seen improvement in most of our aims, but not for every measure, and we still have a lot of work to do:

GBMC annual goals-  Click image to enlarge

Under the Aim of “Best Health Outcomes,” we saw significant improvement in the number of “good catches” and reported events that allow us to ensure patient safety and implement important safety measures. We also reduced total incidents of harm from 190 incidents in FY’ 12 to 96 in FY’ 13, and our plan is to decrease the number of incidents even further in FY’ 14. Again, this reduction is due in large part to the safety processes and redesigned systems put in place by our team members.

If you look at the aim of “Most Joy,” we are focusing efforts not only on reducing employee injuries but also improving our employee and physician satisfaction. We know that when our employees and physicians are satisfied and happy with their work and work environment, our patients truly benefit. We’re still waiting for FY’13 actual scores, but I’m confident that we will meet our goals in this area.

Meeting our annual goals, and in some cases exceeding them, is a result of the hard work and dedication of our staff as well as new processes and redesigned systems that have enabled us to work more efficiently and effectively for our patients. The results show that new initiatives and redesigned systems help us ensure better health outcomes, while improving patient satisfaction, reducing waste throughout the system, and increasing the joy our staff experience delivering the high level of care.

I thank all GBMC employees for doing their part to help ensure we keep moving toward our vision, and ask that everyone continue to work toward even better results in FY’14.

Finally, I’d like to welcome to the GBMC team, Tanya Townsend, who recently joined us as Vice President and Chief Information Officer. She comes to us from Wisconsin where she was the Chief Information Officer at the Eastern Wisconsin Division of the Hospital Sisters Health System in Green Bay. Tanya’s background as a leader in healthcare IT and her experience with standardizing systems will surely benefit our organization. Please join me in welcoming Tanya to the GBMC family.

Reflections on the 2013 Ancestral Health Symposium

I just returned from the 2013 Ancestral Health Symposium in Atlanta.  Despite a few challenges with the audio/visual setup, I think it went well.

I arrived on Thursday evening, and so I missed a few talks that would have been interesting to attend, by Mel Konner, Nassim Taleb, Gad Saad, and Hamilton Stapell.  Dr. Konner is one of the progenitors of the modern Paleo movement.  Dr. Saad does interesting work on consummatory behavior, reward, and its possible evolutionary basis.  Dr. Stapell is a historian with an interest in the modern Paleo movement.  He got some heat for suggesting that the movement is unlikely to go truly mainstream, which I agree with.  I had the opportunity to spend quite a bit of time with him and found him to be an interesting person.

On Friday, Chris Kresser gave a nice talk about the potential hidden costs of eradicating our intestinal parasites and inadvertently altering our gut flora.  Unfortunately it was concurrent with Chris Masterjohn so I'll have to watch his talk on fat-soluble vitamins when it's posted.  I spent most of the rest of the day practicing my talk.

On Saturday morning, I gave my talk "Insulin and Obesity: Reconciling Conflicting Evidence".  I think it went well, and the feedback overall was very positive, both on the content and the delivery.  The conference is fairly low-carb-centric and I know some people disagree with my perspective on insulin, and that's OK.   The-question-and-answer session after the talk was also productive, with some comments/questions from Andreas Eenfeldt and others.  With the completion of this talk, I've addressed the topic to my satisfaction and I don't expect to spend much more time on it unless important new data emerge.  The talk will be freely available online at some point, and I expect it to become a valuable resource for people who want to learn more about the relationship between insulin and obesity.  It should be accessible to anyone with a little bit of background in the subject, but it will also be informative to most researchers.

After my talk, I attended several other good presentations.  Dan Pardi gave a nice talk on the importance of sleep and the circadian rhythm, how it works, how the modern world disrupts it, and how to fix it.  The relationship between sleep and health is a very hot area of research right now, it fits seamlessly with the evolutionary perspective, and Pardi showed off his high level of expertise in the subject.  He included the results of an interesting sleep study he conducted as part of his doctoral work at Stanford, showing that sleep restriction makes us more likely to choose foods we perceive as unhealthy.

Sleep and the circadian rhythm was a recurrent theme at AHS13.  A lot of interesting research is emerging on sleep, body weight, and health, and the ancestral community has been quick to embrace this research and integrate it into the ancestral health template.  I think it's a big piece of the puzzle.

Jeff Rothschild gave a nice summary of the research on time-restricted feeding, body weight and health in animal models and humans.  Research in this area is expanding and the results are pretty interesting, suggesting that when you restrict a rodent's feeding window to the time of day when it would naturally consume food (rather than giving constant access during both day and night), it becomes more resistant to obesity even when exposed to a fattening diet.  Rothschild tied this concept together with circadian regulation in a compelling way.  Since food is one of the stimuli that sets the circadian clock, Rothschild proposes to eat when the sun is up, and not when it's down, synchronizing eating behavior with the natural seasonal light rhythm.  I think it's a great idea, although it wouldn't be practical for me to implement it currently.  Maybe someday if I have a more flexible schedule.  Rothschild is about to publish a review paper on this topic as part of his master's degree training, so keep your eyes peeled.

Kevin Boyd gave a very compelling talk about malocclusion (underdeveloped jaws and crowded teeth) and breathing problems, particularly those occurring during sleep.  Malocclusion is a modern epidemic with major health implications, as Dr. Boyd showed by his analysis of ancient vs. modern skulls.  The differences in palate development between our recent ancestors (less than 200 years ago) and modern humans are consistent and striking, as Weston Price also noted a century ago.  Dr. Boyd believes that changing infant feeding practices (primarily the replacement of breast feeding with bottle feeding) is the main responsible factor, due to the different mechanical stimulation it provides, and he's proposing to test that hypothesis using the tools of modern research.  He's presented his research at prestigious organizations and in high-impact scientific journals, so I think this idea may really be gaining traction.  Very exciting.

I was honored when Dr. Boyd told me that my 9-part series on malocclusion is what got him interested in this problem (1, 2, 3, 4, 5, 6, 7, 8, 9).  His research has of course taken it further than I did, and as a dentist his understanding of malocclusion is deeper than mine.  He's a middle-aged man who is going back to school to do this research, and his enthusiasm is palpable.  Robert Corruccini, a quality anthropology researcher and notable proponent of the idea that malocclusion is a "disease of civilization" and not purely inherited, is one of his advisers.

There were a number of excellent talks, and others that didn't meet my standards for information quality.  Overall, an interesting conference with seemingly less drama than in previous years.