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Updated: Problems at JPS Hospital, Part 1

Update 5/1/08: The CEO is being forced out, “retiring” in September

Star-Telegram.com: | 04/27/2008 | JPS patients get shortchanged as cash surpluses keep growing

Secondary article summarizing some of the problems

I linked to this on Monday and I’m revisiting it to quote and comment on the first article of the series of articles about problems with JPS Hospital in Fort Worth.

The first article questions why a taxpayer-supported, not-for-profit hospital has a large surplus (another term for profit) yet is deficient in terms of having working equipment, space, and staff to properly care for patients who come to the “safety net” (meaning people who have no place else to go) hospital.

Boosted by tax funding other local hospitals don’t get, JPS has been racking up fat surpluses — nearly $97 million last year alone. But the cash has not helped a dedicated core of doctors and nurses overcome the system’s callousness, ineptitude and filth.

Ouch. The paper’s words, not mine.

Overwhelmed nurses no longer ask for the help or equipment they need, resigned to the fact that management won’t listen.

“The system will transform you, so you either leave, do less than the kind of job you would like to do, meaning you have to spend less time with patients or you have to be curt because you know there is a never-ending cascade of people,” said Dr. Bernard Rubin, a JPS board member and network physician.

Again, ouch. I’ve heard this before in some hospitals, that employees and staff don’t feel listened to. That’s something we work to turn around in Lean engagements — getting administrators to listen to their staff, engaging them in improvement efforts, working more toward becoming “servant leaders.” It’s bad when nurses have gotten to the point of “giving up.”

Administrators commissioned a consultant report that outlined deficiencies:

Even Houston-based consultants hired by JPS to study the efficiency of the hospital and clinics last year were struck by the coldness.

“Where’s the caring and compassion?” asked observers from InSight Advantage, which detailed hospital conditions in nearly 600 pages of reports.

The reports were authorized by hospital administrators and cost $657,618 plus expenses, but were never presented to the JPS board. The Star-Telegram recently obtained a copy.

You’d think if you spent that much on a consultant report (not IMPROVEMENT, but just a REPORT), the CEO would be interested in the findings.

When Cecero was asked about the reports’ findings, he said he couldn’t answer: He hadn’t read the documents or been briefed on them.

“I don’t think it’s my job or my role to read every report that comes through this organization,” he said. “That’s why we have an executive team.”

What??? What a ridiculous abdication of executive responsibility.

Some more details:

Some JPS doctors explained in the survey why they wouldn’t recommend the hospital. “Dignity can’t be present with a small room and no curtains. The ER situation impacts this; Foley [catheter] bags showing, beds against hallways, legs hanging out, etc.,” one physician wrote.

At the “Rapid Assessment and Treatment” area of the emergency department, at times 45 patients were jammed into a room with chairs for 19. The space was hot and reeking. Patient privacy was not a remote possibility, InSight reported. (See supporting document as PDF.)

“What is even more concerning is the acceptance of these conditions by management and the staff,” the report says.

To counter negative opinions, JPS hired patient advocates for the emergency department. InSight called that move “sad” and a waste of resources — customer service should be everyone’s job.

That last part sounds like something Deming would have said. “Patient advocates” typically respond to patient complaints after the fact… trying to soothe over situations. I think the consultants are right that the money would be better spent on preventing problems from occurring.

In the Short Stay Unit, InSight reported that some patients spent 10 days in a hallway bed, with only a thin curtain to separate them. Up to 26 patients shared one bathroom with one sink, one toilet and no shower. Patients not strong enough to go to the bathroom had to share one portable toilet.

As for basics like thermometers, wheelchairs and IV poles — there weren’t enough to go around.

Cynthia Brannon said her sister spent a week and a half in a hallway bed waiting for surgery.

Yes, the “Short Stay Unit” is very inaccurately named. If the hospital has a huge surplus, it’s a shame that they don’t have enough basic supplies (or such poor organization that they can’t be found). Mattresses are stained and torn, which creates infection control problems — problems that can directly lead to patient deaths.

There are problems in the O.R. — significant cleanliness and safety issues:

In endoscopy, where doctors look at internal organs using a scope, a patient was treated in a room that hadn’t been cleaned from a previous case. That’s a serious error, said Dr. C. Glen Mayhall, who studies infectious diseases at the University of Texas Medical Branch at Galveston.

Likewise, “on more than one occasion,” nurses didn’t realize an operating room hadn’t been cleaned until they were preparing for a patient and saw blood, bone and globules of fat on the floor, the wall and the wheels of carts, InSight Advantage reported. (See supporting document as PDF.)

The CEO commented:

Cecero said that JPS has the best interests of patients at heart but that mistakes do happen. “When you see the volumes of patients we’re seeing, with some of the inadequacies of our facility, it’s going to happen. It’s going to happen in any hospital,” he said.

That really sounds like excuse making, doesn’t it? Is it inadequacies with the facility or inadequacies with administrators? I know I’m being tough on JPS, not having walked in their shoes…. but you’d have to think things COULD be much better there. Is there any need to have “squalor” in this country, in any hospital? Sure, every hospital has complaints and hospitals can’t just spend money blindly — they need to run a surplus to be able to invest in their future. But it sounds like JPS isn’t investing in today’s needs — safe, compassionate, quality care. Sad.

As with many articles like this, the reader comments are interesting reading, as well. If you think I’m being hard on their leadership, take a look. The number of readers calling for the JPS leadership to be fired (or accusing them of bribing Congressmen and othe) far outnumber those who say the paper is being too hard on the hospital.

Some hospital staff members are commenting how we shouldn’t blame the staff members. I’m certainly not. When people bring safety concerns to management and they’re not acted on, that’s a crying shame. It’s understandable why employees would get “hardened” and be “rude” in a bad environment. The culture and attitudes are set from the top.

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8 Comments on "Updated: Problems at JPS Hospital, Part 1"

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  1. AZReam says:

    Sounds as if there might be a simple solution; spend that $97m on equipment and supplies, cleaners, and administrators to co-ordinate the whole thing properly.

  2. Anonymous says:

    I will assume your rant has something to do with lean transformation of healthcare or perhaps your forthcoming book – Lean Hospitals, but so far I can’t quite get the connection. Obviously JPS is a troubled public hospital – though finances is certainly not one of their issues.

    The fundamental issue would seem to be a huge disconnect between the clinical staff, the executive team and the community they serve – such that the clinicians (doctors and nurses) believe they can publicly criticize their administration and the administration can issue an equally retarded public response – and this will move things along toward positive change. I frankly doubt it. Certainly no improvement initiative would stand a ghost of a chance in the current JPS organizational culture.

    The potentially good news is someone – most assuredly highly placed on the executive team – authorized an expenditure of $650,000 for an objective outside assessment that must be more than a simple laundry list of what’s broken. Accordingly, there must be some level of intention to address the issues.

    One mystery is how the current administration survives. Perhaps the clinical staff and the Board are all hypnotized by the CEO. I look forward to how this unfolds.
    /Dr. Pete

  3. Mark Graban says:

    Dr. Pete — You’re right, it’s more of a rant than a suggestion of solutions. As I said on Monday, I’m not suggesting “lean” as the solution… the problems at JPS appear to run much deeper than that. They got that report two years ago and there’s not much of a case that anything has really improved.

    I guess I’d try to make the points:

    1) For all of the complaints and discussion about how we pay for healthcare, we need more focus on how badly some are run – the lack of leadership and operational competency.

    2) No amount of “lean tools” can fix what appears to be a fundamentally broken culture and organization. You’re right, you probably shouldn’t even try.

  4. Anonymous says:

    I benefitted from this article, as an operations person who has really never been in a hospital, in the sense that I now realize I can’t trust that hospital people know what the heck they are doing.

    Better to learn this NOW then before some hospital kills me.

    Now I understand those statistics about how many people are killed by bad healthcare. I bet the numbers are concentrated in hospitals like this one.

  5. Anonymous says:

    At the risk of piling on, the one PDF page says:

    “staffing should reflect trends in patient volumes during the day.”

    Duh.

    It also says the ER volumes are predictable, yet they basically overstaff on the overnight. That’s “waste”!!

    This isn’t “lean” that teaches us to match staffing with volume. Any McDonalds manager knows how to do that. That’s business 101.

  6. Anonymous says:

    …you probably shouldn’t even try… What would you do shut the hospital down? What about the respect for people aspect of TPS? If for nothing other than for the employees’ sakes, I think this is another problem that could be tackled with Lean, but I don’t think Cecero ever would or could – he sounds like an ivory tower guy that doesn’t care one whit for the people in his employ or for his customers. Is there a Board of Directors over him? If so, then it sounds like it’s time for them to step in and push him out of the plane (let him use his golden parachute).

  7. Mark Graban says:

    News flash– the CEO will be “retiring” in September.

    Funny they would announce during the week that these news stories are appearing.

    ARTICLE HERE

    He is getting a “silver parachute: at the least — getting paid through July 2009 at a pace of $700k a year.

  8. Neutron Jerk says:

    Good news on the CEO departure.

    He said:

    On Wednesday, he criticized the Star-Telegram coverage, saying the “local paper has strung together a list of anecdotes that don’t represent an accurate picture.”

    Well that was a pretty lousy string of anecdotes.

    Sort of like Rev. Jeremiah Wright’s words were “taken out of context??”

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