Report on Cherry targets bosses, structure
By Phyllis Moore
Published in News on October 8, 2008 1:46 PM
An "environment of suspicion" and "fear of retribution" from management were among the findings reported at Cherry Hospital by the Ohio-based health care consulting firm hired last month to assess conditions after a patient death and questionable safety practices resulting in the hospital being decertified for Medicare and Medicaid funding.
A team of senior health care executives conducted an assessment at Cherry Sept. 10-12, with its report released Tuesday by the Department of Health and Human Services.
While the initial intent of the consultation was aimed toward recovering the hospital's federal funding -- estimated at $800,000 a month and which the state has had to absorb in the interim -- the assessment's focus also targeted "the resiliency of the organization to respond to the need for change."
Hospital management, which includes Dr. Jack St. Clair, hospital director, came under fire as being uncommunicative and unresponsive to complaints.
Leadership tends to "operate in isolation," the report said, with little regard as to how such actions affect other departments or groups.
Citing "heavy use of e-mail to communicate important message to staff," the director was reportedly "rarely seen 'walking around' the clinical areas'" of the hospital.
It is clear, the report said, that management at Cherry needs help "to alter the culture and become a more effective leadership team."
Personal safety was also a common complaint expressed by staff members -- physically as well as in terms of morale.
According to the report, "Even the biggest and most loyal employees expressed a sense of fear for their personal safety," with senior leadership blamed for ignoring the need for better procedures for dealing with combative patients.
Such issues impact how reports of incidents are made.
"Staff members stated that fear of retribution from other staff members allows events to go unreported," the Compass said. Lower incidence of reporting problems has also been influenced by the perception that "nothing will change," it continued.
"There seems to be little pride in working for the hospital. Long-term employees express embarrassment over the newspaper articles and admit to not wearing their badges in public ... without pride, employees feel disempowered and hopeless."
Recent installation of cameras in public areas of the hospital have also created an "environment of suspicion," some said. While management initially announced the system was added to investigate complaints, the report indicated some employees viewed them as a means "to catch someone doing something wrong."
Three other areas, in human resources, were also cited in the report as being "weak" -- recruitment and adequate screening of personnel to work in such an environment, providing education and coaching and retention practices.
Both leaders and staff expressed "a great deal of hopelessness" regarding disciplinary matters.
"There is widespread belief that appropriate disciplinary actions have been overturned at the upper management or state level."
When such occurs, the report stated, the perception is that those identified as a "bad apple" are returned into the patient care environment, creating not only a risk for patients but also sending the message to other employees that management lacks the ability to take action.
Despite the findings that leadership is inadequate in some areas, Compass did not recommend action be taken to replace anyone at this time. In fact, the report said, during the assessment, leadership expressed a commitment to the organization and a willingness to accept help.
"We do not believe that this team created the problem, although they also did not flag significant issues for problem intervention," the report said.
The existing problems have developed over the years, it continued, and the current team is "overwhelmed by the magnitude" of reversing it.
The consultants have recommended building a new administrative reporting structure, with a board appointed to oversee regulatory requirements. Committees could also be created to delve into greater detail on such issues as human resources, professional affairs and clinical quality.
As for the reapplication process for Medicare decertification, the report explained that a thorough assessment of the organization's readiness is needed, and "significant changes" must be made.
After a hospital is decertified, the report explained, it must undergo a full survey before it can be certified as a new provider.
"Identified deficiencies and vulnerabilities will need to be corrected," it said. "The improvements in organization structure, leadership, governance and culture will facilitate management's efforts to implement the final changes and validate effectiveness prior to CMS's (Centers for Medicare and Medicaid) return."