CEO: Hospital ‘must and will change’
It may be too early to tell whether things are changing for the better at beleaguered Enloe Medical Center, but they certainly are changing under new CEO Debi Yancer.
The latest in a series of recent developments occurred Tuesday (April 17), when the hospital announced that Yancer had decided to reinstate, with back pay, some 60 service workers laid off in March. Most are certified nurse assistants.
This followed a busy week in which Yancer went public with some negative findings by a state review team and had two significant meetings with physician groups.
According to a press release, the reinstatement action was taken in response to an anticipated lawsuit on the part of the service workers’ union. After a three-year battle for recognition, the Service Employees International Union last month won an appeals court decision validating its right to represent the workers.
“Hospital leadership indicates that they want to begin their relationship with SEIU without bogging it down with protracted litigation,” the press release reads. It adds that the hospital still intends to restructure operations in a manner designed “to bring the medical center workforce in line with industry standards” and to put future layoffs on the table when it begins bargaining “in good faith” with the union.
This followed news last week that a state Department of Health Services review team had found failures to meet standards in several key areas of the hospital, something that didn’t exactly bolster public confidence in Chico’s only hospital.
Just as telling, perhaps, was what Yancer did with the information. Instead of keeping it private, she set up interviews to brief local newspaper reporters on the review team’s findings. And she met with the entire medical staff and, later, hospital surgeons to discuss those findings.
The findings, she told the CN&R during an interview Monday (April 16), were delivered orally on Monday, April 9, following the review team’s six-day investigation. (The hospital will get a final written report sometime soon.)
The next day, Yancer met for three hours with the hospital’s medical staff. About 120 doctors attended the meeting, “a huge turnout,” as Dr. John Howard, the medical chief of staff, put it during a phone interview.
Yancer and the doctors discussed the survey findings and what they could do together to make the hospital a better facility. At one point, she told them she was thinking of going public with the information. Do it, the doctors said.
“I would have released the information anyway,” Yancer told the CN&R, “but it made me feel a lot better knowing I had the support of the medical staff.”
Howard characterized the meeting as “very positive.” The doctors knew the inspectors had been on campus and were interested in how Yancer would handle the situation. They were impressed that she asked their opinion on whether to go public, he said.
The review team—a doctor and a nurse, both expert investigators—came to the hospital unannounced on April 3 at the request of the federal Centers for Medicare and Medicaid Services (CMS). The review was in response to the hospital’s own earlier report of the unexplained death, possibly as a result of an anesthesiology error, of a 44-year-old patient during routine outpatient shoulder surgery.
The team’s findings, however, had little to do with that death. What the duo discovered, after studying past and present case records, was that there were problems in six of the 23 areas in which hospitals must be proficient in order to participate in the Medicare program: anesthesia, surgery, nursing, medical staff, quality and governance.
At least one deficiency was found in each of the areas, and in two of them the problem was severe enough to put patients potentially in “immediate jeopardy.” One involved a nurse who didn’t monitor use of the anti-nausea drug Droperidol for as long as required; the other involved doctors’ inadequate updating of patient medical histories prior to surgery.
In the first case, hospital medical staff immediately decided to stop using Droperidol; in the second, Yancer informed the medical staff that henceforth patients would not be allowed into surgery unless their histories were updated to meet standards.
With the exception of the Droperidol incident, Yancer said, all of the problems resulted from failures to follow existing hospital policies and procedures. That must and will change, she said.
“Systems of care are there for a reason—to protect against human error,” she said bluntly. “There is no option not to adhere to them.”
Most recently, on Monday (April 16), Yancer met with the hospital’s surgeons to work on improving procedures. Howard said they went over the pre-surgery checklist and, discovering some discrepancies, agreed on a uniform system. Nurses are in charge of the lists, Howard explained, and the goal was to create a consistent system so they weren’t “put in a position of having to police the doctors.”
“It was very significant,” he added, “that the surgeons participated in the process.”
Yancer theorized that, because the hospital has been going through a difficult period in the last year or so, lines of accountability had weakened somewhat, with resulting errors. She wants the public to know those days are over.
For her part, she welcomes further outside reviews. “They’re a fact of life” for hospitals and can be expected to occur more frequently when a facility is struggling, she explained. “My view is I always welcome fresh eyes.”
When the review team’s final report arrives, Enloe will submit a “corrective action plan,” Yancer said. Then, within the next 90 days, the review team will make another unannounced visit.
“Some people might feel defensive about it,” she said, “but anybody who helps us do a better job is welcome here. … I want a hospital where we’re continually looking for ways to improve.”
That’s fine by Howard. “Debi is completely honest and upright, and her views are exactly what we need here,” he said.