Thursday, July 12, 2007

Citizens Commission report to City Council - July 3

From City Council minutes (http://www.danville-va.gov/upload/contents/385/07-03-07.pdf)

Mayor Williams called for a report from the Citizens Commission and introduced Commission Co-chairman Jim Houser. Mr. Houser recognized and acknowledged the presence of Co-chairman Clarissa Knight and Members Arlene Creasy, Dr. David Caldwell, Rev. Samuel Griffith, and Attorney Bob Whitt. Member Linda Green had a prior commitment and was unable to attend.
Mr. Houser reported as follows:
"This is a brief summary of the findings from the three public forums and the survey forms distributed to the citizens of this community. In an attempt to categorize the findings, a simple form of statistical analysis was used. Initially, the findings were placed into three separate categories: staff members, physicians and patients, along with family members. All findings under the hearing of staff included nurses, individual departmental staff and administration. Findings under patients included all other areas, but excluding physicians. These findings are based on my own interpretation as to what was given at the forums as well as what was written in the surveys and what has been said to me personally by others in the community.
The number of responses received was as follows: 27.7% from staff, 25.5% from physicians, and 46.8% from patients/family members/others.

The following is the top five areas of concern for each individual category and final count for all categories collectively.

Staff:
1. Understaffing of experienced nurses on the floors and other departments
2. Low morale among employees
3. Outdated computers and other equipment in bad condition
4. Intimidation from middle and upper management
5. Two areas tied –- poor patient care and poor management.

Physicians:
1. Understaffing of experienced nurses
2. Poor patient care on floors
3. Problems with administration
4. Low morale among employees
5. Two areas tied -- poor management and outdated computers/equipment.

Patients/Family Members/Other:
1. Poor patient care
2. Understaffing of nurses
3. Long waits and poor care in the emergency room
4. Poor housekeeping
5. Bad staff etiquette.

Combined Stats for all Three Categories:
1. Understaffing of nurses and other personnel
2. Poor patient care on floors
3. Issues with the emergency room, i.e., wait times, poor care
4. Poor morale among employees
5. Problems with administration: lack of trust, intimidation, not listening to physician concerns.
Not all responses were negative. Several comments were made by all three categories concerning good patient care and quality of nurses. Areas noted were the cleanliness of the hospital was getting better, good care in the operating room, one-day surgery, outpatient surgery, the open-heart program and the maternity ward.

continued in comments section...

21 comments:

sentinel event said...

Summary:
July 3, 2007
It has become apparent that many problems exist within the hospital and the majority of those problems were created within the past two years. In order for a successful resolution to be accomplished, communication lines need to be open and a positive initiative be put into place quickly in order to regain the trust of the staff, the physicians, and the public.”
Mr. Houser continued that as part of the general challenge given the Commission, private health expert Keith Pryor was hired to assist in the process. After several interviews with hospital administrators, physicians, and other interested individuals, and a review of the information gathered during the forums, Mr. Pryor gave insight as to what he perceived to be the problems -- where things were headed if the problems were not corrected and what directions were needed to address the problems. Mr. Pryor observed that DRMC was at a critical crossroads, that there was a great amount of distrust within the general community and with the staff at Danville Regional. Regaining that trust should be a high priority with LifePoint. It should also be pointed out that LifePoint, in retrospect, realizes its transition leadership was not as effective as it should have been and that led to its rocky start. It was found that the community and LifePoint want exactly the same thing – a progressive, well run, busy, high quality, and financially successful hospital. Now that both sides know what is needed, Mr. Pryor noted that: 1) A sense of trust between the hospital and its community needs to be repaired and that trust can be repaired by the repeated successful accomplishment of stated goals; 2) In order to do this, an ongoing dialogue needs to take place –- a dialogue centered on the issues which are at the core of this lack of trust, the plan for addressing them, and ongoing routine follow-up on the results of implementing that plan; and 3) most importantly, leadership is needed from key parties, sitting at the same table, engaged in dialogue. In this case the three parties needed are physicians, community leaders, and LifePoint to develop a strategic plan to address the issues at hand.
Mr. Houser offered the following recommendations of the Commission and how to address the very serious concerns in a timely fashion: 1) Establish a leadership council to work with the management team of LifePoint, Inc. on an ongoing basis to address the core matters that arose from the Commission’s work. The panel would be composed of physicians and other community leaders. 2) The council should address the following issues within the first 90 to 180 days: 1) Restore the hospital immediately to full accreditation status. DRMC should not only meet JCAH requirements, but also exceed them in every category possible. This would be the first step towards rebuilding trust and confidence in the community. 2) Address staffing needs. This should be the accepted norm for hospitals located in the North Carolina/Virginia area. Identify actions that can be undertaken immediately or in the short term, for returning to original staffing levels where required. 3) Enhance collaboration with medical staff. Address ongoing questions of medical staff recruitment and retention. 4) Impress by repetition the service-
July 3, 2007
excellence mindset, work to create a culture with appropriate systems at all levels and in all departments at DRMC, which focuses on top-level and high-quality clinical care. 5) Review and modify management processes and culture. Many reports to the Commission referenced a management style that appeared insensitive to reasonable employee expectations. This was not a major issue at DRMC in the past and needs to be rectified. Mr. Houser advised there were other areas of concern and it is hoped those problems will be addressed as well.
Mr. Houser thanked the Commission’s support staff that included City Clerk Annette Crane and Consultant Keith Pryor, whose expertise provided tremendous assistance in developing a plan for improving the quality of care at DRMC, and Counsel to the Virginia Attorney General Martin Kent, who offered legal assistance when needed. Most importantly, Mr. Houser thanked the citizens of Danville and surrounding communities for participating in the process and for their expressions of confidence in the Commission that it would be successful in finding ways to address their concerns. In conclusion, Mr. Houser thanked City Council and Mayor Wayne Williams for allowing the Commission Members to serve citizens of the community on such an important matter.
(Clerk’s Note: A copy of the entire report is on file in the City Clerk’s Office).
Mayor Williams thanked the Commission for its dedicated service and asked if any member wished to comment.
Arlene Creasy thanked Mr. Houser for the outstanding job as Co-Chairman of the Commission. Ms. Creasy reported she received a telephone call recently and was advised that many members of the hospital staff would be watching this Council meeting. She said the caller urged her to say “thank you” to the nursing staff at DRMC, who are overworked, understaffed, yet very dedicated. Nurses are working 12+ hours, doing their jobs on a minimal amount of sleep and Ms. Creasy encouraged both patients and hospital management to thank those nurses who are caring for patients under a lot of stress and with very little rest.
In his comments, Mayor Williams said the amount of work that had gone into this project was phenomenal from both the Commission and its support staff. Dr. Williams issued a thank you to Attorney General Robert McDonnell’s office for allowing Special Counsel Martin Kent to take part in the process. Dr. Williams read a letter from Mr. Kent. In his letter, Mr. Kent stated that as a native of Pittsylvania County and with the continuation of close familial ties there, he was heartened by the determination of certain individuals to make improvements at DRMC, but remained cognizant of the work that lies ahead. He encouraged a continuing dialogue between citizens of the community and hospital management. He assured everyone the Attorney General’s office would continue to monitor the situation as to LifePoint’s implementation of recommendations provided by the Commission.
July 3, 2007
Mayor Williams expressed appreciation to Delegates Danny Marshall and Robert Hurt for their participation and thanked Danville Regional Foundation for providing the necessary funds for expenses incurred during the entire process.
Each Council Member thanked Commission Members and all who worked on the project.
In response to Vice-Mayor Saunders, Mr. Houser stated it would be up to Mayor Williams and City Council to form the panel. Mr. Saunders said he hoped the general public would have input into who goes on the panel, stating the members should be made up of leaders who are well respected in the community.
Council Member Tomer said that ultimately, LifePoint would have to step up to the plate.
In response to Council Member Archie, Mr. Houser said the next CEO for DRMC should be someone who was willing to reside in Danville and become a part of the community.
Council Member Hamlin asked if DRMC management took part in the Commission’s work. Mr. Houser replied that Art Doloresco, who was CEO at the time, and Ruth McDaniel, Director of Nursing Services, attended some of the meetings.
Mayor Williams recognized Regional President of LifePoint Jess Judy. Mr. Judy thanked the Commission for all the hard work and its diligence in bringing the report together. Mr. Judy stated he supported the concept of the leadership council and that he would be happy to serve on that council and felt it would an excellent forum for DRMC to talk about progress at DRMC. He commented that LifePoint looked at tonight as a new beginning and the hospital really wanted the situation at DRMC to improve and said the Commission’s report would be reviewed and given thoughtful consideration.
Council Member Oakes asked about new staff members at DRMC. Mr. Judy reported that Mark Anderson from Martinsville would be the new CFO and would be moving to Danville. He advised that Mr. Anderson was also a member of Martinsville City Council. Former CEO Art Doloresco was unable to relocate to Danville and had resigned a couple of weeks ago. Mr. Judy advised LifePoint was seeking Mr. Doloresco’s replacement.
Vice-Mayor Saunders asked about the present staffing including the nurse-to-patient ratio at DRMC. Mr. Judy said that he was unable to give those figures because there were so many variables that applied shift-by-shift, but did say that it was DRMC’s goal to have staff comparable to other hospitals in the Virginia/North Carolina area.
July 3, 2007
Council Member Hamlin stated the report was very well presented and said the community now needs to take this information and move forward so the matter could be put to rest.
Mayor Williams commented that everyone recognizes that Danville Regional Medical Center is an essential asset to a large part of Southside Virginia and a part of North Carolina as well. The facility has truly grown into a regional medical center. Two years ago, there were drastic changes that have become issues that need to be addressed. The Citizens Commission has done a good job in identifying immediate concerns that need attention now and have provided a long-range plan for continued improvement and for assurance there will be follow-through. Referring to Mr. Judy’s comments, Mayor Williams stated that LifePoint is willing to address these issues and in fact, have already started to address some of the concerns with a change in local leadership and expressing a willingness to be part of a panel for doing so. Many would say we have had promises from LifePoint before, but Dr. Williams stated this time some action had already begun and there were many important next steps to take place. An even greater change at LifePoint is occuring in that it is accepting outside guidance. It is time to focus on the future of the hospital and not dwell on the past. Everyone, including LifePoint, wants a better hospital. It will teamwork to bring about these changes. There are good people at DRMC and things are improving. Mayor Williams asked any patient or potential patient at DRMC with concerns to discuss them with his/her physician before reaching any conclusions. LifePoint has agreed to make changes and has taken some action, but there has to be a level of accountability there.
Mayor Williams advised he would like to meet with the Pittsylvania County Board of Supervisors Chairman and the Chairman of the Caswell County Board of Commissioners as well as Delegates Danny Marshall and Robert Hurt to put together the panel that has been recommended by the Commission. He proposed selecting three (3) citizens, one (1) from each community represented, two (2) physicians, and a top level representative from LifePoint. The panel would be an ongoing one to receive concerns from citizens as well as provide progress reports to the public as to what is occurring. Progress needs to continue. Mayor Williams, too, looked at this as a new beginning. With positive action from LifePoint and a chance from our citizens, Danville Regional Medical Center can become the center of excellence that we all expect.
Dr. Williams stated he would review these recommendations with Council Members to receive their input and then take action to form the panel that has been proposed.

sentinel event said...

Just so you don't miss this note:

(Clerk’s Note: A copy of the entire report is on file in the City Clerk’s Office).

Anonymous said...

One thing that needs to be cleared up...the Dell computers that were installed in the hospital 2 years ago are not out-of-date. I know, because I am one of the people responsible for getting them out to the floors. Brand new, straight out of the box.

Anonymous said...

I hope that those who are commissioned to be a part of the leadership council do not become lax in the issues of danger to the community regarding Lifepoint.

It could be important to note here also:Historically physicians who have practicing privileges at Lifepoint Hospitals must sign a confidentiality contract (a copy of which is not furnished to them). This contract is many times used to enforce a closed mouth situation concerning happenings etc. at the hospital in which they practice. Although, it is initiated through standard business practices, many times this situation is used to leverage a hushed environement concerning the hospital's credibility in many areas. Physicians many times rely on their available access to hospitalized patients to sustain their business, so they are quite cautious to make public statements regarding conditions or hazardous practices or things that could be construed as such-which basically covers everything.
If the physicians are put in a position to police the standards of a hospital, we have to understand that it could be stifled. It is not beyond Lifepoint to pick on a physician who they feel is not "appropriately quarantined", and even suspend their access to hospitalized patients for periods of time.
However, physicians should also understand that it is every person's moral and legal responsibility to report any type of abuse, neglect, or concern they have for the safety of others. They should never fear doing what is right.
For Lifepoint to use this type of intimidation through twisting and manipulating the concept of confidentiality contracts, is disgraceful.
Persons voicing their concern to physicians should also remember, that if you are/or have been ignored and feel insulted or frightened of embarrassement in doing so, IT IS NEVER WRONG TO REPORT CONCERNS or MAKE INQUIRIES FOR SAFETY OF OTHERS. Even if a citizen cannot pronounce everything correctly, or make a completely accurate medical analysis of a situation, concern for the safety of others is never wrong.
Thankfully, the physicians here have taken part in improving the situation, however, when the dust settles, everyone should be aware that previously established methods of intimidation will still be in place. It's a "given" in this type of "equation".

Anonymous said...

No physician should be policing the quality and practices within a hospital. The policing comes from outside venues to include regulatory agencies. The policing comes from posting of measureable outcomes and side by side comparisions with like hospitals. This is all available online. A physician does not offer an objective view, just as the "owners" or staff do not offer an objective view. A physician's livlihood is directly connected to hospital practices and they may not alyways choose the best practices for the patients versus the best practices for their lifestyle. Some are good and some are bad..I do not mean all are motivated by money. But they are human.

Anonymous said...

Just to clarify : The computers are not out of date It's the PROGRAM Meditech that is sorely lacking.

Anonymous said...

MediTech should be thrown in the Dan River!

Anonymous said...

Stop by the city clerk's office and pick up a copy of the Commission's report. I took a look at a copy that a friend got...it's about 75 or 80 pages I would guess. There is some interesting reading in there.

Anonymous said...

Everyone needs to understand that it is impossible for Lifepoint to make quality healthcare it's priority. THEY CANNOT DO IT! It will bring about their own demise. They will simply change strategies on how they convince their consumers that they will.

It's like telling a HUNGRY BEAR to stop eating. IT CAN'T! It will starve to death.

Consumers are walking around with a "bounty" on themselves until it changes. The value of the bounty is determined by their health insurance coverage and how well it is regulated. Regulation comes from subscribers and their ability to evaluate their own care, healthcare fraud investigators-which correlates directly to the strength of the judicial system, community awareness in which "the bear" is operating-which links back to regulatory and financial control.

A key componant to helping correct this "system" is for the staff-whom are educated to address the needs, and working directly within the systems-to find a way to become united, and courageous in voice. If the corporation brings in more "paid yes men/women" then this type of monitoring will be disintegrated also.

For the staff of the hospital, there are two choices. Gain organized strength or go to another hospital that provides a safer environement for their careers.

Anonymous said...

"Consumers are walking around with a "bounty" on themselves until it changes. The value of the bounty is determined by their health insurance coverage and how well it is regulated."

You missed one component of the bounty concept...how long will DRMC survive if its payor mix is only 5-10% commercially insured.
I have no idea what that payor mix is right now (since no numbers are published in a 'report to the community' any more), but there has to be an impact which will only continue to grow.

Anonymous said...

How long will "DRMC survive"????

Get with it. DRMC died two years ago when our "leaders" put it to death.

We now have a Beast called Lifepoint.

unionnurse said...

Well that made for very interesting reading. Thank you for providing us with this report.

Anonymous said...

I'm very impressed with this new Blog. My whole family thanks you. I knew things were a little rough on medical services here in Danville, but this really spells it out.

:A CONCERNED CITIZEN

Anonymous said...

I grew up in a family that hates unions. But that could be our only answer. I think "unionnurse" makes some very persuasive comnments. Would a union at Danville Regional cover just RNs, or would it cover what I guess are generalkly called "health care workers?"

Anonymous said...

A union won't get this dump cleaned up! Why don't anybody on this web care about cleanliness? The stories I could tell.

Anonymous said...

Well, I guess we could just wait until Tenet buys the hospital, and go through the same thing all over again. This is probably what the Bush Brothers want. Maybe they'll put a "Gas-n-Go" in close to outpatient surgery exit for convenience. They could call it "The Chop Shop Gas Tax Rest Stop!- It's the last place in town where they'll smile while they pump you full!"

Anonymous said...

that doesnt make sense......what the hell are you talking about?

Anonymous said...

"Historically physicians who have practicing privileges at LifePoint Hospitals must sign a confidentiality contract. . ."

If LifePoint does have a confidentiality agreement, the only physicians who might have to sign it would be those who are employed by the LifePoint corporation. That group currently consists of the hospitalists, pediatricians, neurosurgeons and emergency room doctors as well as the doctors at the DRMC family healthcare clinics in Danville/Gretna. The other physicians are their own employers and are independent from LifePoint. They can express whatever opinions they desire with regard to LifePoint. Hospital privileges cannot be denied or taken away as a result of critical remarks, etc. concerning LifePoint. That privilege has to do with the 1st Amendment and freedom of speech.

Interestingly, Dr. Richard Smith (emergency room) is president of the medical staff and is employed by LifePoint. Would that not be a conflict of interest? How can he represent the concerns, etc. of the medical staff when his allegiance most likely rests with the LifePoint corporation? Perhaps the physicians need to chose another leader who is not a LifePoint pawn.

Anonymous said...

Wasn't it reported here that Dr. Smith is no longer head of the physicians?

Anonymous said...

It was reported that Dr. Michael Moore was resigning as Chief Medical Officer.

Anonymous said...

Dr. Moore resigning or being resigned as Chief Medical Officer?? "If you can't stand the heat, get out of the kitchen!"