Every 90 days since I have been at GHS we have done Town Hall Meetings. Time has gone quickly and we are about to begin the 23rd series of quarterly Town Hall Meetings.

This is one of our routine methods for connecting with front-line staff. The meetings allow me, along with our Campus Presidents, the opportunity to communicate progress on organizational goals and to provide updates on other topics of general interest to employees. My sense is the broader community may like to see and hear what is going on.

This quarter, we are highlighting:
(1) Progress on reviewing our values statement;
(2) Results of our 2012 Employee survey; and
(3) Other system-level goal updates

Below is a copy of the PowerPoint slides that will be presented at the Town Hall. If you cannot see the presentation, CLICK HERE to download a PDF of the presentation.

One thing and one thing only happens in OR #10 at Greenville Memorial Hospital…robotic surgery. This room is dedicated to surgeries performed using the daVinci® robotic surgical system.

GHS entered into the daVinci arena over two years ago. In case you aren’t familiar with the daVinci, according to davinicsurgery.com “it is an effective, minimally invasive alternative to both open surgery and laparoscopy (a form of minimally invasive or minimal access surgery). Through the use of the da Vinci® Surgical System, surgeons are able to offer a minimally invasive option for complex surgical procedures.”

Today, complex conditions ranging from prostate cancer to uterine prolapse, fibroids and even thoracic disease can be treated minimally invasively with da Vinci Surgery. This approach uses a robotic surgical system that provides Greenville Hospital System surgeons better vision, more precision and control. It requires only a few small incisions, so you can get back to your life faster — without the usual recovery following major surgery.

Hear directly from an upstate patient about his experience with prostate cancer surgery. (Hey, if you’re a Clemson football fan, his name may sound a little familiar.)

Remember, there still is a very skilled surgeon (sometimes two) performing the surgery. Every GHS robotic surgeon, whether it is an urologist, gynecologist, or thoracic surgeon, completes a very aggressive training protocol before he or she performs a solo surgery. In addition, there is a dedicated robotics team in OR #10, assisting the patient and surgeon.

At GHS, there are currently eight surgeons trained. To learn more about them, click on the first link under Learn more at the end of this post.

One more thing, our CEO, Mike Riordan, always mentions our mission in meetings or when talking in the community. So, I’m going to follow his lead because I can’t write about the daVinci without thinking about how it is a great example of how we live our mission:

Heal compassionately. The healing process is shorter and incision is smaller. Just as important is that patients no longer have a reason to travel out of the county or state to have daVinci surgery.

Teach innovatively. GHS purchased what is called a dual console robot. It has two consoles. One for the surgeon, and one for another physician who is being trained.
Improve constantly. Now we are able to offer the right care the patient needs – open surgery, laproscopic or daVinic robotic surgery.

So, if you’re a candidate for the daVinci robotic surgical system, we’ll see you in one place and one place only … OR#10. (Until later this year when we are hoping to get another robot.)

Learn more:
http://www.ghssurgery.org/roboticsurgery.php
http://www.ghswomens.org/davinci-surgery-for-women.php

Snort, sniffle, a-hack. Me, neither.

Respiratory viruses are making life a misery for the Upstate. One, in particular, is leaving behind a trail of tissues and veritable cacophony of coughing thanks to its prodigious output of drainage and yucky stuff best left undescribed.

But, fear not – quick action can help turn off that faucet in your head.

Start treatment the second you feel the first sniff, says Dr. Jeremy Byrd, fellow sufferer and a founding partner with Heritage Pediatrics and Internal Medicine in Simpsonville. He warns that this particular virus is difficult to treat and routinely lasts 2-4 weeks – but can last for more than a month. (His lasted for eight weeks.)

Here’s his general advice for adults. Remember, it’s always a good idea to your doctor or pharmacist about your own specific care.

• To help control the nasal congestion, Dr. Byrd recommends over-the-counter Afrin for 3-4 days if there’s no history of hypertension.
• Pseudoephedrine also helps in drying it up but shouldn’t be used if you’ve a history of hypertension.
• Mucinex can help break up the sputum, or mucus, coughed up from the lower airways. It’s important to thin it so that the body can cough it out; otherwise, you may be setting yourself up for a secondary infection such as sinusitis, bronchitis or even pneumonia.
• Humidifiers, neti pots and saline sprays likewise help thin the mucus and speed the healing process.
• As always, use ibuprofen or acetaminophen per directions and body weight for general body aches. Remember to drink extra fluids and get extra rest.
• While it’s OK to have a fever of 100.4 in the setting of a viral illness, call your doctor if it lasts more than 48 hours.

Even if the fever is gone, you can still spread the virus through coughing. Remember, don’t cough into your hands; instead, cough into tissues or, in a pinch, the crook of your elbow.

GHS turns 100 Tuesday and officially kicks off a year-long celebration, complete with a Centennial Habitat for Humanity House project; historical exhibits at GHS, local libraries and the Upstate History Museum; interactive living history events; a centennial marathon; extensive community outreach; and a community-wide scavenger hunt launching in May. A book chronicling the first 100 years will debut this spring at the Upstate History Museum.

Key events Tuesday include the following:

• 9 a.m. unveiling of a historical marker on the Memminger Street site of the original City Hospital, which later was renamed Greenville General Hospital. (Location: S. Memminger Street between Dunbar Street and Arlington Avenue – CLICK HERE for the map)
• 10:15 a.m. centennial history exhibit unveiling at Greenville Memorial.
• 10:30 am. centennial ceremony at Greenville Memorial, which will be live-streamed and broadcast to GHS’ 10,000 employees. CLICK HERE for the live stream on Ustream.tv.

The public is invited to all events, and hundreds are expected to crowd the lobby of Greenville Memorial for the main morning ceremony. Greenvillians will get to enjoy an additional piece of history: pictorial postmarks will be available that day with a representative from the U.S. Postal Service there to stamp envelopes.

Community and volunteer support was the catalyst behind the creation of the original City Hospital on Jan. 10, 1912. That 84-bed hospital has now grown into a 1,268-bed academic medical center that is the state’s largest not-for-profit health care organization.

Guests Tuesday will include elected officials and U.S. Sen. Jim DeMint as the keynote speaker. Also featured will be current and former GHS leaders, employees and volunteers, including Will McMasters, who boasts a record 24,000-plus volunteer hours. Drafted into the U.S. Army in 1941, he helped liberate the Mauthausen concentration camp during World War II and was awarded the Purple Heart and Bronze Star w clusters. Mr. McMasters is a retired Liberty Life vice president.

Can’t make it person? Watch it via web streaming at http://www.ustream.tv/channel/ghs-centennial-celebration. The celebration will also be streamed and broadcast to GHS’ 10,000-plus employees and 141 physician practices.

You can also watch the live streaming from your smart device. If you have an iPhone or iPad, you can download the Usteam application by CLICKING HERE. If you have an Android device, you can download the application by CLICKING HERE. Once you download the Ustream application, search for Greenville Hospital System.

Tuesday’s events will celebrate the historic significance of the day but also keep an eye toward the future, including the new USC School of Medicine-Greenville, which opens with its inaugural class of students in July.

For more information on the centennial, visit ghs.org/100years.

The centennial website features vignettes of GHS history, support opportunities and even a link to a Centennial Store, where a percentage of proceeds goes to the Centennial Habitat for Humanity House project.

New Year’s Resolutions are a vast mine field of guilt, wallet pain and, for many of us, an overwhelming need to eat our feelings.

But if your tummy is starting to cross the county line while the rest of you is still in downtown, it’s time to take action.

First, set realistic goals, say the experts. If you haven’t been active in a while, Jose Garcia at the GHS Life Center Health & Conditioning Club advises starting with only a 15-20 minute walk. Start small and build. Take joy and triumph in every step and don’t sweat the ‘recommendations’ yet – just sweat! (Most adults need at least 30 minutes of moderate physical activity at least five days per week. But to lose weight, the recommendation is 45 minutes five times a week.)

Second, be consistent – force yourself to do it on whatever schedule you’ve committed to until it becomes a habit. It needs to be as automatic as brushing your teeth.

Every time you do it, it will become just the faintest bit easier. This is what the experts tell us – and, frankly, tell me.

I’ve been varying degrees of, ahhh, chunkiness most of my life so I was accustomed to the XL side of the body-size aisle. But when my tummy started crossing time zones ahead of the rest of me, it was time to take action myself.

And so, God help me, the woman who used to say that there’s no point in running unless she’s being chased is now sweating like a pig on a regular basis – a frizzy-haired pig in high humidity at that. I’m even attempting to work out with weights – which is wildly entertaining and strangely Zenlike.

Research shows that being overweight or obese raises the risks for a universe of woe, including coronary heart disease, type 2 diabetes, certain cancers, high blood pressure, high total cholesterol or high triglyceride levels, stroke, liver and gallbladder disease, sleep apnea and osteoporosis.

Just re-reading that paragraph makes me want to immediately administer chocolate. But it’s just as true that losing as little as five to 10 percent of your body fat can significantly reduce your risk of developing these problems.

The other advice from Life Center staff: don’t beat yourself up – and don’t let others do it either. It is what it is – now make it better.

For more info about the Life Center, including free health classes, visit http://www.ghs.org/360healthed.

The following remarks were delivered by Marietta Lawson at the press conference announcing the South Carolina College of Pharmacy. I think she stole the show! If anyone is wondering why our mission includes teaching, here is the reason.

As you can plainly see, I am not your typical pharmacy student. I am an adult with adult issues. I have a house in Spartanburg, a husband, a mortgage, a child who just began high school Monday, and a another who is a student at USC Columbia, just a few years younger than most of my classmates. When I embarked upon this new career path five years ago I imagined a lot of challenges but one of them was not spending a large portion of my time on I-26 up and down the road from Columbia ,or spending many nights away from my family in Columbia. The original plan had been to pack up and move the whole family to Columbia, but the recession of 2008 dashed those plans and my option thereafter was either to go forth with commuting to SCCP on the USC campus or give it all up, the years of prereqs, the planning, the dream of becoming a pharmacist.

So I forged ahead.It has been a long two years for myself and my family but I just kept hoping that this greenville campus I had heard about was indeed going to make it for my 3rd year as I had heard it might. My favorite person to email on this matter was Dr. Dipiro because he was the most positive of anyone on the subject. Before I started school and every semester thereafter I would ask, how is the Greenville campus going? Is it really going to happen for my 3rd year. Every time he answered something like “everything is looking really good, it should be on schedule for your class.” I would immediately relay this important information to my husband and parents and we would hang on to every word.

Last spring I received an email that a Dr. Alissa Smith was coming to Columbia to meet with students who would consider transferring to the new Greenville campus for the fall. I immediately realized it was now a sure thing. This was the best meeting I had ever been to, in fact I could hardly keep myself from cutting cartwheels throughout her presentation. As if not commuting wasn’t’enough during the presentation I learned we were going to have state of the art facilities, a small class size of less than 20 and still all the resources of USC, MUSC and now GHS. After the meeting I introduced myself to Dr. Smith by giving her my name and stating this was one of the happiest days of my life. She looked a little surprised, but it really was the truth.

I don’t know if any of you who worked so hard to bring this program to Greenville really realize the impact you have had not just on my life, but many people who are limited geographically but will now be able to become a pharmacist, and stay in this area. I know GHS is a great place to be, because I just finished my first hospital rotation in May on this campus, and the facility and professionals you have on staff here are amazing and in my opinion first rate. Everyone I talked to seemed excited about this new campus and more than willing to help me learn during my rotation and thereafter.

I would also like to say, Thank you Dr. Dipiro, I trusted you could make this happen and you did. I know you were just one piece of the puzzle but your reassuring emails which always came promptly and encouraged future inquires made those 2 years go by a lot quicker. And thank you to all the previous speakers today who I am deeply honored to share the stage with. Without your support and making this a priority on your busy lists I know this would not have been possible. And finally thank you from the bottom of my heart for everyone else who was involved, especially our director Dr. Smith. Because of your hard work you have made a huge difference in my life, my fellow classmates with me here today, and those who will follow us into this new growing program. The lives of many and the future of pharmacy in the upstate will forever be changed for the better because of you.

I have written about the Rating Agencies in the past and will give an update about where we are in a bit. What caught my attention recently was an email I received from the American Hospital Association that addresses national issues dealing with hospitals and healthcare. In the email they referenced one of the Rating Agencies with the following headline and analysis:

Moody’s: State Medicaid cuts strain hospital credit ratings

State budget pressures, the slow economic recovery and the recent expiration of federal stimulus funding are placing downward pressure on credit ratings for not-for-profit hospitals that rely heavily on Medicaid, according to a report released today by Moody’s Investors Service. “We expect Medicaid funding pressures will significantly stress hospital credit quality for at least the next several years,” the report states. Based on Moody’s preliminary data for fiscal year 2010, not-for-profit hospitals struggled with the lowest revenue growth rate in more than a decade. “Revenue growth has been stymied on numerous fronts: declines in patient volumes, higher levels of uncompensated care, less favorable contracts with commercial payers, and, most significantly, reductions in federal Medicare reimbursement rates, a challenge which we believe will likely intensify given ongoing federal budget challenges,” the report states. “Medicaid reductions are creating yet another strain on top-line revenue growth that hospital management teams must address.”

So, how do the Rating Agencies View GHS? We went through several days of presenting our story and answering questions to panels of smart analysts in New York. In a way, it was like interacting with a group of consultants. Here are some of the strengths and concerns that came up:

•Strengths
-Strong business position and market share
-Strong debt service coverage
-Adequate financial performance and margins
-Large and growing employed physician network
-Strong and diversifying economy
-Leading market share and wide array of services
-Significant number of employed physicians providing multiple access points
-Improved FY2010 and FY2011 YTD operating performance and margins
-Improved debt to cash flow and debt service coverage
-Solid operating platform that includes large group of employed physicians and leading market share
-Good service area with below average unemployment
-Steady improvement in liquidity
-View the medical school as strategically positive

•Concerns
-Costs associated with Medical School
-Payor mix that includes16% Medicaid
-Thin operating margins
-High level of Medicaid, bad debt, and DSH payments which leaves GHS vulnerable to changes in governmental programs

The good news is there are a lot more strengths than concerns and the ratings bear out that fact. And, the To Do list for this coming year is pretty focussed and we are on it. How did we do? Really well:

•Standard & Poor’s (S&P) – Rating and outlook affirmed at AA-
•Moody’s Investors Service – Rating and outlook affirmed at A1/Stable
•Fitch Ratings – Rating downgraded from AA to AA-

What is the context for these ratings? In other words, how do we compare to other Healthcare Systems’ ratings S&P, Moody’s, Fitch. I have laid out their ratings and put my comments in the parentheses next to the categories:

Regional Competitors: (These are the systems I think about the most from a strategic, competitive standpoint. We are slightly below Carolinas and above Novant)
Carolinas Healthcare System – AA-, Aa3, NR
Novant Health – A+, A1, AA-

Local Community Hospitals: (All have solid ratings and we are above all of them)
AnMed Health* – A+, NR, AA-
Spartanburg Regional – A, A1, A+
Bon Secours – A-, A3, A-

Academics Health Systems: (This is the group that we will increasingly be compared to, but it is hard to tell, since some do not report or their rating is related to their respective University)
Duke University Health System – AA, Aa2, AA
Emory University Hospital ** – AA, Aa2, No Rating
University of North Carolina Hospitals – AA-, Aa3, No Rating
MUSC – No Ratings

To summarize, we are strong, stable, with the best ratings in the state, positioned for the future, and we have our work cut out for us – especially when it comes to state and federal funding.

We have over 600 managers at GHS. They arrive here from internal promotions and from other organizations. Some are seasoned and some are first time managers. We spend a lot of time and money training them with regards to finances, procedures and policies at GHS. We have also started training them to think outside of GHS and become more attuned to what is going on in the community. I like the broader perspective and connecting our managers to the bigger why. The techniques of simulation and experiential learning are proven effective techniques for adult learners. The following write up came from Venice McCall, one of our educators in Human Resources….I think it is pretty neat.

‘Simulations and an actual poverty tour will offer one an opportunity to experience first-hand some of the challenges that families in our communities experience every day.

GHS’ Mission is to heal compassionately, teach innovatively, and improve constantly, and our Vision is to transform health care for the benefit of the people and communities we serve. With those tenets, as we connect to our purpose, these simulations will help one experience first hand some of the challenges that families in our communities experience every day. It will help provide a better understanding of the day-to-day realities of those in our communities who are living in poverty.

The Rev. Beth Lindsay Templeton will lead the Poverty and Medical Access Simulations, which will highlight the state of chronic crisis of living in poverty. She is the Director of Our Eyes Were Opened – United Ministries. Beth shares fresh insights, thought-provoking lessons, and timeless wisdom that exemplify an organized and compassionate process that include various approaches designed to help others to decide how, when, and whom to help in times of need.

Poverty Simulation
This simulation can open one’s eyes to the human cost of poverty. The power of this unique learning resource is that it creates, like nothing else, insight into the state of chronic crisis that consumes so many working, poor families. Participants experience one month of poverty comprised of four fifteen-minute weeks. Afterwards, in the debriefing, they share insights of extraordinary vividness and intensity.
During this 2 hour simulation, one will experience the challenges of keeping your family fed, housed, and safe when resources are limited. Participants are grouped into one of these family situations and are then given the task of providing for food, shelter, and other basic necessities. A minimum of 25 participants required.

Medical Access Simulation
Even if we have universal healthcare, access to medical services will still be a problem. This simulation will focus on just some of the challenges faced by people who need healthcare. It will help us to better understand the many challenges some of our neighbors face each day and access to medical care is one of the many hardships. A minimum of 10 participants required.

Poverty Tour
GHS’ Values are compassion, respect, caring, honesty, integrity, and trust. We live our values through open communication, forward thinking, creativity, continually striving to improve, responsiveness, a willingness to change, education, research, and clinical quality. As we reflect on our values and connect to our purpose, this tour will help open one’s eyes to neighborhoods with limited choices. A tour through less fortunate neighborhoods will highlight the limited choices, which some of our neighbors experience every day. This tour will accommodate up to 28 participants.’

As background, I have copied some public information that helps to describe the what and why of Rating Agencies.

Overview: Rating agencies assess the financial strength of companies and governmental entities, both domestic and foreign, particularly their ability to meet the interest and principal payments on their bonds and other debt. Rating agencies also carefully study the terms and conditions of each specific debt issue. The rating for a given debt issue reflects the agency’s degree of confidence that the borrower will be able to meet its promised payments of interest and principal as scheduled. The rating for a given debt issue may differ somewhat from the overall credit rating for the issuer, depending on its specific terms.

Impact: Debt issues with the highest credit ratings from the agencies will incur the lowest interest rates. Investors’ confidence in borrowers’ ability to meet their payment obligations is highly influenced by the rating agencies’ analyses. Meanwhile, the interest rate demanded by investors on a given debt issue is inversely correlated with the creditworthiness of the borrower: stronger borrowers pay less, weaker borrowers pay more.

Analogy: The credit rating agencies perform similar work to consumer credit bureaus. The credit scores that the latter produce for individuals similarly influence the rates of interest at which individuals may borrow.

Leading firms: The leading firms in this sector are:
Standard and Poor’s (also commonly called S&P)
Fitch
Moody’s
A.M. Best

Rating Agencies Visits
Last week, I joined Terri Newsom, CFO, Greg Rusnak, COO and Larry Gosnell, Treasure on a trip to visit Moody’s Fitch, and Standard and Poor’s in New York. These meetings were scheduled at our request and they offered an opportunity to update the agencies on progress with key strategies, introduce our new CFO, and review current operating performance.
We structured our presentations around the five multi-year goals and stressed the consistency and connection to the strategic plan that we shared at our last visit in 2008 and showed progress in working that plan. I have attached a copy of the slide presentation. Key themes/messages included:

* Total Health –as the foundation of our approach to healthcare delivery.

* Highly Integrated Delivery System – we emphasized physician-led, leadership development, improving operations, and growth. We linked physician integration to key process improvements and also discussed GHS’s readiness for value-based purchasing and qualifying for meaningful use.

* Accountable Care Organization – We described ways that we are preparing for risk-based payments, and piloting these approaches with GHS employee health plan. We also communicated that we have not made a final decision regarding early adoption based on concerns regarding uncertainty of downside impact and cost to establish and maintain the required ACO structure.

* Academics and School of Medicine – We described these initiatives as good for patients, and families, our community and GHS. Analysts had done their homework and questioned local support. We described local support, emphasizing the difference in the Upstate support and noted MUSC’s competitive concerns.

* Financial Sustainability – We focused on payer strategies and financial performance between 2008 and 2010. Payer mix has remained stable and attractive with increases in revenue from all payers but more so from Medicare due to aging population and the growing retirement community in Greenville County. The combined self-pay, Charity, and other categories increased almost 1.5% due to the impact of the recession. Financial performance over the presentation timeline was positive, showed growth in volume and improvement in operating margins. All financial ratios are trending in a positive direction.

All the agencies have rating committees that will determine the GHS rating for this year. The analysts will present our information to their committees over the next several weeks and we should know our rating positions from all three agencies by late June or early July.

If you cannot view this slide presentation below, CLICK HERE to download the PDF.

I have shared the quarterly Town Hall Meeting information on my blog in the past. These Town Hall Meetings are an important part of our internal communication and I have included the deck for your review. The majority of the presentation dealt with the results of our employees opinion and there are some neat updates about the community and the economy. However, I want to use this post to share highlights about the survey. My reaction to the results was a combination of disappointment (sadness) and motivation. I wish the results were better and I am energized to improve them next year.

This was the fifth annual survey of employee opinions and the second time that employed and closely aligned physicians were invited to participate. Participation in the survey continued to be strong with 7,842, or 79% of GHS employees completing the survey.

Each year, our survey results are compared to a national health care database including approximately 350 other highly engaged hospitals and systems (comprised of about 850 facilities and more than1.5 million health care workers across the US) answering the same set of questions. When we reference the “National Health Care Average,” we’re talking about the average score of this large database.

Workforce Commitment

Workforce Commitment is the score that we reference in our System-level People Goal and it reflects the degree to which employees are engaged in and committed to the organization. Our workforce commitment score is the combination of a subset of seven questions from the annual survey. Compared to the National Health Care Average, our score of 4.21 (on a 5.0 scale) was higher by a statistically significant difference of 0.05 points. However, the more important story is that compared to our own results from 2010, this score has dropped by 0.08 points. This result is also below the target we set for 2011. This year, GHS ranked in the 72nd percentile of all participating hospitals and our goal was to be at or above the 85th percentile.

Digging Deeper

There’s a lot more information in the survey results that adds perspective and understanding to the overall score. For example, our very highest performing items speak to the how well team members work together; the responsiveness of managers in following-up on concerns raised in rounding; our role as a valued community partner; and our commitment to employee safety. The way our physicians and staff work together is also a real strength for us – and, our employed physicians are one of the most highly engaged professional groups at GHS.

Employees also expressed clear and specific concerns about pay and benefits. Many also reported additional levels of stress related to workload. All three of these issues make sense to me. We’ve made some difficult decisions in the last two years and the Employee Opinion Survey offers every staff member a method for communicating the impact of these tough decisions. In addition, we are an organization that is moving ahead in a rapidly changing environment.

Next Steps

Every year, the survey provides important information that helps focus action planning at the work unit and also for the entire system. I have begun reviewing these results in detail with the senior management team and we’re developing system-level action plans much like many departments are doing with their results. I expect to talk about t system-level planning at the next Town Hall Meetings in August.

I would welcome any thoughts or reactions you may have. If you cannot see the slide presentation above, CLICK HERE to download the PDF.