Report: Ore. hospital change creates confusion
SALEM, Ore. (AP) – A floundering, scatter-shot approach to solving massive problems has created confusion, disorganization and frustration at the Oregon State Hospital, state-hired consultants say.
"It is paradoxical that the very efforts to improve the hospital have contributed to the current confusion because changes have been implemented on so many fronts with such rapidity," says a draft report obtained by the Statesman Journal in a public records request.
"The sheer volume of change at OSH would overwhelm any organization, but we believe that the essential problem has been a lack of adequate planning and coordination of these improvement efforts."
The report, prepared by a firm getting paid $175,000, describes the Salem psychiatric facility as rudderless and reeling from "paralyzed decision-making."
"Staff at all levels are hampered by uncertainty about who is in charge and who is making decisions with regard to different functions," it says.
The consultants also rapped the hospital for assembling a collection of 28 standing committees, all attacking problems in uncoordinated fashion.
"Committees and teams are working in isolation and ignorance of each other's goals and interventions and there is serious confusion about which entities hold the authority to resolve issues and are accountable for results," the report says.
Hospital managers and professionals "universally complain about having to attend too many meetings, which translates into a massive drain on clinical staff resources and detracts from the primary mission of patient care," states the report.
Liberty Healthcare, a Pennsylvania-based firm, issued the draft report after a review team spent four days at the hospital in July, toured 26 units and met with more than 300 people.
A final report is due by the end of the month.
The arrival of a new superintendent should add stability, according to the consultants. Greg Roberts, a longtime New Jersey psychiatric hospital administrator, is scheduled to take the reins on Sept. 20.
Many hospital employees had trouble answering a basic question posed by the consultants: What are the top goals at Oregon's main mental hospital?
"During multiple interviews with a variety of clinical and direct care staff on the units and in the treatment malls, no one could answer the question, 'What are the two most important hospital goals or quality improvement initiatives that OSH is working on this year?"' the report says. "Many staff said they didn't know, some cited the (Department of Human Services) core values, some flipped their ID badge over and recited the National Patient Safety Goals, and others made a guess that it was 'ensuring the safety and security of the patients?"'
The consultants also reported that hospital managers tolerate poor performance by bad employees because "there is prevalent thinking that managers can do little to discipline or remove problem employees."
"Clinical managers have looked to HR to handle personnel issues, while HR declines such responsibility because it is a management issue," it says. "At the same time, undue fear of union issues and the lack of management knowledge concerning the personnel system have re-inforced the conviction that it is exceedingly difficult to remove problematic employees. Reluctant to act, managers retreat into helplessness and tolerate continued poor performance from problem employees whose behavior hurts team cohesion and morale."
The draft report spells out dozens of recommendations for hospital improvements such as shrinking the number of committees, defining the hospital's mission, vision and values and communicating them to the staff, establishing hospitalwide quality goals and improving the patient grievance process.
"Patients have little to no faith in the grievance process," the consultants reported. "Staff has been lax in reviewing, investigating and providing a reply to patients about complaints within the set time requirements. All too often complaints simply 'drop into a black hole' by being lost, destroyed or ignored entirely."
Interim hospital superintendent Nena Strickland said this week in an e-mail to hospital advisory board members that the consulting report "accomplishes what we have asked Liberty to do."
Strickland said Liberty's final report might be different.
"It is important to remember that this is a draft and there are a few places we want to work with Liberty and provide them more information." she wrote. "Liberty's analysis and recommendations may change as a result. As we are in the draft stage it is too soon to be talking about specifics."
- Information from the Statesman Journal
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