Update 5/1/08: The CEO is being forced out, “retiring” in September
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.
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus. He lives in San Antonio, Texas.