Radiology--Out of the Closet?--5/3

What fun x-ray is having. It's not every administrator that has his roommate working under him! All joking aside, the issue is: Can an administrator properly have a live-in work under their span of control. It would be interesting on the 90 day eval for the administrator to be perched over Mr. Neal's shoulder...watching....

But it sure does cut down the bit@hing in the fileroom, or does it? Guess it moved to the reading room where two female radiologists were "discussing" a difference of opinion--and had to be moved to separate rooms. What a comedy act.

But it ain't over, it seems that one of the cardiologists stroked out a patient a few days ago doing an incidental "drive by" carotid arteriogram...the brain is much less forgiving than the heart....

...and those emails just keep coming....

I just want it to be better....4/11

...my patients have been my reward.... I want...to be able to stand up for the patients, and do the right things, and not get beat up for it.

I just want it to be better. I know that's your goal too. ...a former PRMC nurse.

As I've said, the only way I can see the hospital(s) surviving is an employee ownership situation. North Campus is preferable because it would be a smaller-tighter running unit, and more practical in a later expansion.

The physicians have the possibility of pulling the greatest amount of funding, but the employees have to be vested to make it work and generate the loyalty, because right now, there is none.

One of the biggest faults that both McCu/StJo had was attention to detail, or lack of it when it came to finances. When they affiliated with larger corporations, their overall tone changed--the wrong way. Their philosophies were take it-or leave it to the physicians. In this area, that doesn't work. However, what compounded it was the fault--that was still there.

To make this work, someone has to be running billing like the billing manager from Red River; the people that are entering the orders have to be more mindful of the importance of their jobs, and be paid more because of it.

There are a number of things that could be corrected in the model that is in play, but Essent is firmly committed to the way they do business. And their arrogance is what will eventually be their comeuppance.

Rumblings from Within--4/1

I get a fair amount of email, a lot from employees that list specifics...that would get them terminated if I wasn't watching for it. But, then sometimes I get strategies, and pull ideas:

Date: Sun, 26 Mar 2006 23:03:17 -0800

Between you and me, I think that Hud has his hands full and he's not managing things very well.

1-6. --for later
7. Perhaps some pressure from the investors would promote another sale, maybe getting Capstone capital and Petra Capital (the Arcon investors out to the tune of $50 million) to talk to the current investors
8. The whole thing really DOES fall apart without Hud. If he wasn't in the picture the investors would force a sale of all the hospitals. I'm not saying he should be done in, but if we can somehow put some pressure on him, a few lawsuits against EACH of his hospitals may be enough for the investors to force a sale.
9. How many lives did he ruin with Arcon?
10. How loyal are his current executives? Can they go elsewhere, or are they also losers?

In order:
#7
Hud actually gives presentations on the changed climate for getting capitalization. With the changes in IPO requirements, I'd imagine that investment capital had to go somewhere, but the ROI has got to be far poorer.

#8
There is no way to really tell from the outside, but Vestar should have rumblings. The capitalization for the projects that E$$ent has committed to should be an indicator as to their willingness to prop Hud up...if the monies actually materialize. But, they have $80 million invested, so putting up some to save the current investment might be their plan. However, I'd look for delays in the projects.

#9
There were clinics that had just opened that year, so imagine starting work and being laid off with no notice. Nine facilities closed, I believe, and the month before, Hud was saying, "We believe that the company simply needs more time to allow its concept to mature and to grow its market share and revenue base." Time certainly wasn't on their side....

#10
Dropping one or two doesn't make you unemployable in their world, and I really think the exec shuffle is coming up. You may see some wanna-be's picked up--they would be the ones put into positions that their resumes don't justify. The trick is in the timing...too long and they might drop with the stock options, too short and it does them no good--and makes it look like the job was too much for them.

Several folks have dropped off the radar, and it might be other reasons, but generally they hit the news if only to calm investors. Maybe that's part of the reason for the "Hud and bud" show, crisis management.

Andrei Soran was top notch, then again, he pushed several programs that would have been excellent here...it's a shame he wasn't. It might be telling, however, that he bailed prior to committing to a building program that would have locked him in with E$$ent for the next five years. And, that he didn't take a corporate move-up. Or, he just wanted to stay in the Boston area... Framingham...in Feb???? Yeah, right! Butt deep in snow going around roundabouts!

The subject of unionization has cropped up. Fine, if we were in the Northeast. Here, we already have had two sales because of balance sheets. PRMC is weighted down with a lot of property that just isn't profitable. The insured/uninsured mix is poor. And now we throw in a union to deal with? This is a right-to-work state, and there are bound to be several opportunities for investment that don't have as many fleas. If E$$ent went defunct or just sold us, who would buy?

In a breakup, we would be far better in the long run...but short term...oh baby, those that live paycheck-to-paycheck would be slapped in the face--hard.

Sinking Ship?--4/24

There was a reference to a couple E$$ent folks leaving that got me wondering:
Hal Andrews and Joe Pinion were both players in the Essent matrix, Executive VP of Planning and COO, respectively.

Now, Nashoba Valley Medical Center's CEO is bailing in the middle of the planning phase for new construction. CEO Andrei Soran gave his two weeks notice.

I wonder....

Since it's a private corporation, there is no way to tell what options he loses by leaving. There is no open public record of their profit/loss--just to their investors...which were here this month evaluating their investment....

Probably a good thing....

Company Policy--4/3

Start with a cage containing five monkeys. Inside the cage,hang a banana on a string and place a set of stairs under it. Before long, a monkey will go to the stairs and start to climb towards the banana. As soon as he touches the stairs, spray all of the other monkeys with cold water. After a while, another monkey makes an attempt with the same result - all the other monkeys are sprayed with cold water. Pretty soon, when another monkey tries to climb the stairs, the other monkeys will try to prevent it.

Now, put away the cold water. Remove one monkey from the cage and replace it with a new one. The new monkey sees the banana and wants to climb the stairs. To his surprise and horror, all of the other monkeys attack him. After another attempt and attack, he knows that if he tries to climb the stairs, he will be assaulted.

Next, remove another of the original five monkeys and replace it with a new one. The newcomer goes to the stairs and is attacked. The previous newcomer takes part in the punishment with enthusiasm! Likewise, replace a third original monkey with a new one, then a fourth, then the fifth.

Every time the newest monkey takes to the stairs, he is attacked. Most of the monkeys that are beating him have no idea why they were not permitted to climb the stairs or why they are participating in the beating of the newest monkey.

After replacing all the original monkeys, none of the remaining monkeys have ever been sprayed with cold water. Nevertheless, no monkey ever again approaches the stairs to try for the banana.

Why not?

Because as far as they know that's the way it's always been done around here.

And that, my friends, is how company policy begins.

Nice catch, thought it needed to be up front!

To those physicians who continue to remain silent ...4/25

To those physicians who continue to remain silent about what is going on at PRMC... I say shame on you! E$$ent and folks like J.R. may have a Teflon coating, but you are just as liable and responsible for tolerating what is going on inside these walls as they are... if not more so.

This is precisely the time one must remember taking the Hippocratic Oath:

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

…or were these just fleeting words, merely to suit the moment?

Do you think that E$$ent will support you when the walls come crashing down? When the lawsuits start? Will they even be here? Ask Wentzville, MO.

The doctors in this community MUST put aside their trivial North/South differences. They might have had some value prior to the merge, not unlike school spirit, but at this point the pathetic political tirade has gone on long enough! We all lost! Soon, none of us will have a place to practice medicine! Is that what you want..?

This is a pull from a comment, but is heartfelt. Years ago, I heard something about Pogo logic, and did some searching. Can't say if "the enemy of my enemy is my friend" quite fits, but this has to go to basic loyalties. The rape and plunder of the Paris healthcare system is all of our concerns, and I can't see that north or south means a lick of difference.

Would you let a loved one go through our system without monitoring? I wouldn't in any case, but now it is just plain scary. What if you are on vacation or out of town on business?

More and more of our patients' family members mount vigil over them. Transfers to Dallas facilities have skyrocketed for things that could well be treated here. They don't blame the staff, for the most part, only the administration. But that can change, given our tolerance for what has transpired.

There is a lot of griping, but little dedication to finding a solution. I challenge the physicians:

You enjoy the position of respect for what you have accomplished, and for the care you've given. Now it’s time for some leadership to appear, as well.

Do you enjoy the quality of medicine that is currently equated to the medical community as a whole? In your judgment, is this harm or an injustice?

Step up to the plate.

Posting: A how-to-approach--4/18

Actually, posting is what I do, and you have the option of commenting. Mind you, I might take a comment and copy it into a post if it reflects an interesting point of view, or it sheds light on a fairly obtuse subject.

Unless you put your name into a comment, or make it so specific that it couldn't be anyone else, they are anonymous, and show up as "Anonymous said..." People might suspect, but proving is a different kettle of fish. I don't like to publish those and have been known to change minor identifying remarks.

Another way is to send it directly to me at fac_p@hotmail.com. If you trust me, you can send it with your regular email and I will not give it out. If you are a bit insecure about it, you can always create an account with yahoo, or hotmail, and have the identity as anything: Saving Paris might use saveparis@yahoo.com, pop_prmc@yahoo, or saveparis@hotmail.com. The advantage is, I could send back if I needed clarification.

Commenting from your own home computer is as secure as a bank transaction--from your own computer. Unless you are on a PRMC computer, you don't have to worry.

Yes, I did change the blog a little--shifted the left column over and changed it so clicking on the name in the left side column would open an individual post, complete with comments. Printing or changing them to PDF files is almost painful without it...so it was related in an email to me...and since they couldn't log in from work, they decided to print off the sheets and take them in. If there is too much heartburn, I'll change back...takes 2 minutes.

Happy blogging, and I really would like to hear from you.

Management Strategies--3/25

You can catch the original comment (see Hud and bud), but this is the way things seem to be going.

"This is just the tip of the iceberg. This type of madness will continue and will affect all departments of the hospital. When Essent has finished its departmental cleansing, then we will really see the animal for what it is (We've had a small glimpse, so far). Money mongering at it's best. Healthcare here in Paris will be non-existent. The only way it will change is if the Doctors assemble and finally do something.....like another hospital. Again, we will be faced with a healthcare split, but perhaps it would be best. Sometimes ashes do present a better model by which to work with. And then, maybe,this community can begin to have effective healthcare, with employees that hold their heads, principles and profession high. Without pride in one's work and the employer they work for, it is an ever descending maelstrom of discontent, and ineffectiveness.

The bans have been hung by Essent, and they portend disaster. And NO ONE who currently works for them, OR the community can avert the inevitable end result. The powers that be in this town should be hanging their heads in shame, as they are as greedy as this corporation. For the sake of the almighty dollar, they too are as guilty as Essent in my opinion. So when our local people start the handshaking, and asking for votes, they need to be reminded of their actions. Somewhere, there has to be someone who, in a position of power, will take the forefront, and actively try to end this travesty. But, that too, is never a popular position to hold. It will take a person, or group of individuals with a great deal of wherewithal and courage to make a stand. But, should it ever begin to happen, I think it will be a heavily supported endeavor...much to the dismay of Essent. Money can only buy so much loyalty......and I don't believe Essent has deep enough pockets to take this to perpetuity. Let's hope not anyway!"

As to the money issue, this is probably under scrutiny. When investors show at a location, they're probably concerned--greatly concerned!

Hud and his bud--3/22

Medical Staff was a doozie. Knife fight and all. But, we all know about the guy that brings a knife to a gun-fight...he loses.

One of the things that earmarks a loser is a lie. RRVR had a contract for service: They were not paid by the hospital. Instead, the hospital gave them exclusivity for the reading, and billing, in return, the group provided coverage--weekends included, but far beyond that...as demonstrated by the absence of such, now. When the hospital was in breach of contract, RRVR agreed to stay without a contract, hoping against hope that things would improve. But, that begs the question: Who ended up with the $100,000 per month that they were supposed to have received from E$$ent??? E$$ent is, after all, loaded with bean counters....and bean counters never lie...right!

J.R. led the charge before, happily participating in the "big lie", but since the radiologists' distain for him was plain, that was a given, merely a payback of sorts. He was certainly a prime example of the Peter Principle. As the link references, there is no going back, so he was setup for failure. He might have been competent in one or two areas, his only mistake being that of accepting the promotions as they were lumped on.

But, that typifies this organization, and the one that Hud left. Increase the areas of responsibility and place marginally qualified individuals in supervisory positions. Not necessarily Administration, but directors with only an associates. They have a tendency not to rock the boat, and will never question their marching orders. Maybe that's why the BDU boogie goes on. Not for teamwork, but for subservience.

Can You Say: Show me the money!--4/21

If they can do it there, why not here? This is an Essent Hospital!

Nashoba Valley Medical Center First Hospital in New England to Implement Software that Puts Nursing Shifts Up for Bid


Ayer, MA, August 26th 2004 - Nashoba Valley Medical Center (NVMC), is using an eBay-type system to fill open shifts, where nurses work the vacant slot at a pay rate that they themselves set. The medical center is the first hospital in New England to use eShiftT, a Web-based flexible staffing tool, to help clinical managers meet their fluctuating staffing demands in an effective and affordable manner.

eShift allows hospital staff to self-schedule online to meet their weekly or monthly commitments. Unfilled shifts can be re-posted as auctions for staff to bid on the hourly rate, with the lowest qualified bidder being notified by e-mail when the auction closes (usually 2 - 10 days in advance of the shift).

The medical center is having great success using eShift: The program allows nursing professionals to have more control over their own hours and work schedule, giving them more flexibility.

The main benefits of eShift for nurses include improved access, flexibility and control to accommodate nurses' lifestyle priorities, and the opportunity for increased hourly wages, some at incentive rates. eShift also gives nurses the ability to manage personal career objectives, and they like receiving fewer calls asking to work on days off. eShift has helped motivate staff making them better able to meet their personal income objectives. eShift is also easy for nurses to use either from home or at their stations provided by NVMC.

Chief Nursing Officer Carol A. Conroy said, "It allows us to have our own Nashoba Valley Medical Center nurses caring for our patients and is a strategy to decrease our dependence on temporary-agency nurses." NVMC Human Resources Director Wanda Edwards says that even people who are intimidated by computers find the process to be simple and they enjoy using it. She says the program has been a successful recruitment tool. "eShift is a real innovation for nurses.

When potential hires find out about eShift, they become very interested in NVMC as an employer. It's helping us recruit nurses into our system," she said.

Lynn Arsenault, RN, a frequent user of eShift at NVMC had this to say about her experiences, "eShift is very convenient to my lifestyle, but what I love most about it is having the option to pick an extra shift on my terms and convenient to my busy schedule."

According to Karen Tomasetti, RN, who works as a "per diem" nurse in the NVMC Emergency Department, price bidding works smoothly. "Someone can come in and underbid, but most of the time, I get what I bid for," she said.

The eShift process is simple:
After initial scheduling of staff nurses, open shifts are posted online, with a maximum hourly rate that the hospital will pay. Only qualified nurses can bid on the available slot. Nurses then put in bids at the maximum rate or below. The qualified nurse at the lowest bid price wins the open shift. It's like eBay in reverse.

NVMC Andrei Soran said that he is implementing many innovations at the hospital, eShift being one of them. "We want to give our nurses more choices and more flexibility. In the end, that's what's best for our patients," he said.


How much for your women??

"We are pleased with the success of eShift at Nashoba Valley Medical Center," says Rod Hart, President of Flexestaff, which owns and markets eShift. "It shows that a creative and flexible solution like eShift can provide value to an innovative hospital of any size."

Some interesting resources are: Mass Nurse

Uninsured vs insured---3/23

If you click on this , it takes you to the 60 Minutes article on the disparity between what uninsured patients and what insurance companies pay.

This documents that the uninsured are overcharged routinely, and nothing indicates that locally it is any different.

Obviously, if you are local, responsible for your bills, uninsured, and have the option, your regular provider, the Salas Clinic, and then the hospital ER are, in order of increasing cost, your most viable alternatives. With the advent of liens against everyone, one does have to consider the consequences of ill health.

No, most patients do not think that healthcare is free, but pricing it 3-4x that which the insurance companies pay is a bit excessive.

When a test is ordered, you ought to be asking: Is this necessary, or is it just to cover the doc's butt, and who is paying for it, me, or him?

E$$ential Care--3/13

Not terribly timely, but last weekend, apparently the locum radiologist decided that Sunday afternoon coverage was unneeded--and left! X-ray was again without effective coverage for CTs and the like...although, the last time it was just undecipherable reports. This time, no reports!

Until there is a stable group of radiologists for on-site, apparently it is whatever is available--and we see what quality that is. One would assume that they are paid by the day, and not by the hour or exam...maybe that ought to be re-evaluated...or maybe the administrator on call should move their office to x-ray.

The Matrix--3/16

The question to ask: What does team nursing do for the administration? You know that they aren't going to do anything that will cost them money, but how does it save? The mix.

Team nursing while generally a good thing (more balance and less chance of one person stuck with a bunch of Q15s), but misused, it allows administration to use more lower-paid staff in the team. It hides the short staffing of RNs with a higher mix of LVNs and CNAs. It's particularily hard on staff when they float, since the others of the team have to pickup those patients out of their level of expertise (post-op ortho is far different than cancer patients).

But we can't talk about being short staffed, or floating nurses from ER to take high acuity patients, or all the temps, or the payscale, or "negative attitude"s (I can just hear the bells going off and the suspension days racking up the counter--I make it out to be 15, don't you?)

When you're pulling 12s, are beat to death, and then on your days off get the constant calls of, "Can you come in??", then you know something's wrong. You got into this because you felt you could make a difference for the patient, not someone's balance sheet. Yes, economics are a reality, but alienating your staff in such a large degree is not the way to promote nurse retention.

What does it come down to: Dissatisfaction. Dissatisfied staff, dissatisfied patients, dissatisfied physicians, and a hospital without a hope. Chicago Hope, nah, Paris No-Hope.

Until there is a radical change, the staff is going to continue to have call-screening a constant thing, and using the heck out of the sick days. (Does anyone remember PTO???) I'd say that folks were a lot healthier back in the days of two hospitals.

Back Channel--3/7

I received an email this morning with an idea that was worth posting.
Apparently a post was characterized as being off-base. Notice the use of apparently. If I am not positive about what is being given to me, I use the typical media disclaimers of: reported, apparently.... and the like. If what I publish is not accurate, feel free to sound off--I'll publish that, an ammendment, or a retraction.

But, you say, there is a "Catch-22": "If I post, then I can be suspended...even if it would have been in Essent's interest." That is where a back channel comes in. The email address allows you non-published access, of which some in administration have utilized, and I provide a more accurate product.

You can use your own email, or if you feel that tingling sensation around your neck when you put pen to paper, go to hotmail.com or mail.yahoo.com and start an account. (Yes, you can have more than one!) If I feel that it is in your best interest not to have a tidbit published (you being the only one that could know, or it is too identifiable), I won't included it.

Hotmail includes the registration name (what you say yours is) so be creative. I have two JRs emailing, and one 'Hud', but I think it's more from another Newman flick, Cool Hand Luke: "What we have here is a failure to communicate"...which is probably the most appropriate reason for this blog.

Don't Thank Me....--3/10

Don't thank me so quickly--any change is going to cost in the short-term. A lot of what has been thrown out is true: I just can't see Essent making the changes necessary to improve the situation. I think that it's a matter of control.

Crossroads lost money through most of its tenure, yet they held on to it as long as they did--five years. If we are still in a money-making situation, then they will be hard-pressed to let go.

Crossroads was an ego thing as well: Their first venture. PRMC is their first 'larger' hospital. It doesn't seem like Hud would take failure well.

Obviously our hospital had to make changes, it was bleeding red because of the attitude of (local) administration and a good many employees. But the idea that Essent had the only ideas for change is insufferably arrogant.

Many of us had noted the waste, the poorly planned projects (Gibraltar Hotel), and above all the phrase, "We're non-profit, we don't have to worry about that." Even non-profits have to watch the bottom line, or the lights go out.

One analyst forecasted one more acquisition before Hud marketed or IPOed the package, maybe he’s right, and Southwestern (in Pennsylvania??? Like calling us Northeastern...) would be the last. If not, maybe this will prove to be more costly than they expected, with as many temps as they are using! (Figure 2-3x what regular staff would have cost.) The balance sheet must be soaked in red ink. If it isn’t, doesn’t that tell you what a poor job Monty and his ’band of brothers’ was doing?

One is drawn back to Crossroads, and wonder if the problems there are resurfacing? With the statement of one of the former administrators that it was only profitable one out of five years, kind of makes you think that their rough-shod ways didn’t go over any better there than here….

HIPAA Violation-revisited?--3/20

Apparently the nurse that had to go to Greenville for care had been written up. (Despite being granted non-FMLA leave for the time she was off work.) Looks like a violation of HIPAA. (See follow-up comment.) They compromised HIPAA protected information: patient lists. The use was obviously not for healthcare, and the most direct way would have been through the ER treatment log for that weekend.

It should be a fine for the hospital, the the assistant to the director of nursing that authorized/utilized it, and possibly damages as well.

From her comments, she knew that there would be follow-up by administration, but I hate that they were able to punish the exercise of free speech. What would Hud's son's take be on that: Suppression by his father's corporation of the very rights that he had sworn to uphold and defend?