Thursday, March 29, 2007

11 Things...4/12

These are patient resources.

Ten Things Your Hospital Won't Tell You
These are some eye-openers, for the patients. Watch the fur fly!

TX Price Point
A listing of charge data on the most common inpatient services, links to quality data and general and contact information for Texas hospitals

Wednesday, March 28, 2007

Getting Lean...4/23

Here at PRMC, we hear efficiency, and we hear cuts....
I caught a guest post from Hospital Impact, a hospital blog that not only have I contributed (comments) to, and that I've read when I have the chance. The post is in the realm of what needs to be done...but it seem unlikely that Essent will ever do it--because it takes far more effort. Cutting FTEs is easy, making this a quality organization isn't in the cards...for them.

The balancing act of efficiency and quality
February 23rd, 2007
Guest post by Carolyn Kent

I'm going to venture into contentious territory and address what can be a touchy subject for hospital administrators: the application of lean manufacturing to a hospital setting.

First, a brief review. There are 5 basic principles to Lean (continuous process improvement):
1. Define value from the customer's perspective
2. Identify the value stream
3. Eliminate waste
4. Flow the process
5. Pursue to perfection

Is this management style transferable to a hospital environment? Cynics are quick to squash this idea, citing reasons such as "We don't make cars; we treat patients." (Harvard Business Review: Virginia Mason Medical Center) These individuals support personalized healthcare; after all, every patient is unique and by virtue of being such, deserves distinctive care. (No argument here)

Since, according to the cynics, achieving a lean state in a hospital is impossible due to the obligations to provide personalized care to every patient, one could naturally conclude that the hospital's management style should be one directed at increasing the quality of service, optimizing the patient experience, and improving customer satisfaction.

Again, cynics remind us that while this may be nice in theory, consistently delivering superior service across the board can be inefficient, as this approach to service consumes more personnel and time resources - things that are already limited.

So it appears that we are at an impasse. Lean process v. superior service quality - it's got to be one or the other in a hospital setting. Achieving lean presupposes standardization, which is nearly impossible in a hospital. Delivering superior service necessitates employee training, personal attention, significant time investments, regular performance measurement, et,c. all of which are counter to lean, right?

Let's revisit the first principle of continuous process improvement: Define value from the customer's perspective. It appears that lean and superior service delivery are inextricably linked thanks to the customer. Does this mean that they can co-exist after all? Is it too much of a stretch to assert that they may even complement one another?

How would we impart both continuous improvement and superior service quality into our process? Here are 7 quick steps to merge these seemingly dichotomous objectives:
1. Management must commit to the strategy
2. Determine the product line/department to start with
3. Gain a good understanding of lean (Lean Enterprise Institute)
4. Draw the current-state map of your selected process (MAMTC - Lean Building Blocks)
5. Determine the goals to strive for and the metrics to monitor
6. Draw the future-state map of your selected process (see "Lean Building Blocks")
7. Implement with a specific plan that includes benchmarking

Is it possible to achieve continuous process improvement in a hospital environment?

Is it possible to consistently deliver superior service to patients?

Is it possible to do both?

Carolyn Kent is Creative Strategy Specialist at Cleverley & Associates.

Sunday, March 25, 2007

Surgery by the Numbers....3/26

I received an interesting letter, raising some questions. But first, the letter:

I attend church with a large number of Hispanics, some here legally, some illegally, and many with papers SAYING they are legal, any rate, most are employed in places that are less concerned with paperwork and immigration status but more about your qualifications with these mainly being able/willing to work harder for less money than others who might demand more money, better conditions, etc (sound familiar?)

Tonight the Hispanic members were all talking about another member who works(ed?) at PRMC and has done so for several years now despite everyone knowing her documentation is falsified and she is in the country illegally. She worked in the indigent care office with something (begins with a c, maybe Cardizen???) CARE which I don’t think is owned by PRMC but helps with assisting persons who need help paying etc., and she also has been used as a translator at PRMC when needed. Seems the F.B.I. arrested her and she is in Sherman, TX at federal court jail facility and charged with, among other things, performing surgery on people in their homes!

Don’t have any specifics besides what I have given here, but (bear with my off humor) I told someone that if F.B.I. were to read (the) blog, see care given to patients at PRMC, realize the risks faced if undergoing surgery at the hospital, etc. they would certainly release her and maybe make referrals to her as this might prove less dangerous than seeking surgery at PRMC.

Wonder if Hud will want some of her profits?
Truly gives a new meaning to home health. Want some of the profits?...he would demand a franchise fee! You know that the hospital would be able to check immigration status, so why haven't they? They run police checks on all of us, how could they not know???

Friday, March 23, 2007

Essent Drops Kessler....3/25

One might say it's good news for Hammonton:

"As previously reported in The Hammonton News, Essent Healthcare of
Tennessee was apparently interested in Kessler. However, Gonnella testified
Tuesday that Essent withdrew its letter of intent last week." ...the Hammonton News.

As was brought to my attention, Kessler laid off 25 FTEs...and Essent lost interest. Their secret strategy is a secret no more.

So what's next in Hud-land? He sold the Merrimack medical building. They're building one in Ayer (as part of the new hospital.) I wonder if that will be counted as part of the investment they have to the next two years....isn't it? Does it really add to the hospital, or is it just office space?

Depending on the sale price, he might just have funded it...well, not really. He does have investors who have been very patient.
One expects a certain amount of return for the kind of outlay that Essent has had. Hopefully they're getting it up front, and not like the Arcon deal.... Only time will tell.

Thursday, March 22, 2007

Who's Holly?....4/5

Holly is apparently a very caring individual. (You don't get into healthcare at the paramedic level unless you are.) She wanted to help her city, her hospital, so she emailed the interim CEO (feeling that she had somewhat of a connection with him, having worked in a previous position in Austin when he was in charge) offering what help/insight that she could give. She was offering--volunteering--to help.

-----Original Message-----From: HOLLY PETERS []
Sent: Friday, March 02, 2007 3:07 PM
To: Salerno, Richard
Subject: Welcome to Paris
Hello Mr. Salerno,

My name is Holly Peters and I worked with you on occasion, at the Austin Diagnostic Clinic and Medical Center under Jim Thomas. I was a Team Leader in the Clinic and my husband actually worked in the Radiology Department and the Nephro-vascular Lab.

I have to say that I have been very troubled with what has been going on, at the hospital you are now managing, since we moved here four years ago. Because my husband did at one time, work there in the cardiovascular lab, I am all too familiar with the problems you face.

My concern is, of course, for the community as a whole and my family's need for future medical care. I want to see you achieve the greatness, I believe the medical community of this area is capable of and deserves. I will tell you, that based on my experience, I believe management, insurance contract negotiations, as well as improper coding for services are ultimately the cause of the dilemma the hospital is in.

I would be happy to help, in any way I can and provide you with my honest opinion regarding a number of challenges you face, if you are interested. I am sure my husband would also gladly provide you with any knowledge he may have too.

Holly N. Peters

When it was clear to Salerno that she was not a consultant, person of influence, or consequence, he emailed her to not contact him again--I wish I had a copy of that email. It was apparently at that point she emailed me. I dropped the ball.

At that point, the vindictive nature of Mr. Salerno came out. He called Holly's husband's employer, and banned him and his company, from the hospital. He may lose his job.

This exposes Mr. Salerno's (and Essent's, apparently, he does represent them, after all) opinion of women: Pre-suffrage, women are chattel, unable to think independently of their husbands. James Carville might disagree, being married to Mary would many husbands....

But, what does this say about Essent? Or the company that Holly's husband works for? The sins of the fathers--or in this case, those of their wives? Hardly seems fair, when the intent from the beginning was to help.... But Essent has hardly been accused of being fair...and Dick, well, he's just being himself....

PSAs (Public Service Announcements)...3/27

There have been several organizations that have had what I would consider worthy causes to promote, and would like to take advantage of the popularity of the site. I don't really want to get off focus, but I will place time sensitive messages and links if they are sent as comments to this post.

I'll try to keep it within a month of the current date so it is fairly high on the list of posts.

Dated material I will delete.

I'll probably put up a different graphic if I think that it could use it, or I do take submissions by email (logos or appropriate links--keep it clean, boys and girls). All this is subject to change, if change is needed, something like our hospital....

The Powerline195 folks get the next spot.

Wednesday, March 21, 2007

Deck Chairs on the Titanic....3/23

Hospital's new medical office building sold
It is truly interesting how a medical office building can go from 54,000 sqft to 83,000 in a single bound...err...article. Also, from $6M (Sep figures) to $13M is quite a cost overrun. (Same paper--and the fact checkers are where???) I wonder if the purchase provisions reflect that? You know, the ones that say Essent has to pump in x-dollars into the facility. Well, looks like they managed to dodge the bullet and pick up some pocket change. Probably to pay for the same at Ayer. Maybe they'll sell to the same anonymous group...after settling the lawsuits.

Hospital loses boss, looks for another
It would appear that Essent has another interim CEO in one of their facilities.... The CEO of Merrimack Valley Hospital is leaving to take a COO position with a not-for-profit. Maybe he got tired of playing cheap-to-keep with Essent...and it only took 17 months. If the position is over the corporate operations, it would be a move up--if just a hospital, it's movin' on down....

This isn't the first Essent exec that has jumped to a NFP hospital. Several have made the transition. Maybe after Essent they had to pay penitence...or just get the taste out of their mouths.

Tuesday, March 20, 2007

When help is offered.....3/21

That was a big whoops. I misinterpreted an email and published prematurely. Apologizes to Holly.

Friday, March 16, 2007

Hospital Acquired Infection....3/22

This a double YouTube, so if you are unable to view the streaming video, it's going to be fairly frustrating...but I'll try to explain. This clip is a presentation for Planetree affiliated hospitals. They say they "demistify" healthcare and have a far different perspective on care. The hospital he tells about has a condo-style senior citizen facility--attached to the hospital.

They have 24hr visiting, pajama bottoms, room service, and more...and they have a less than 1% hospital acquired infection rate...national average is about 10%. I don't know what ours is....

That folds into a clip dealing with MRSA...and if you walk down the halls of the South Campus, you will generally see isolation carts. However, with staffing shortages, and the increased push towards taking on more, are we taking the proper steps?

The clip talks about sharing information with other community hospitals, to slow the spread. The full isolation procedures will help...if everyone uses them. When you see isolation rooms multiply to other rooms on the same hall which haven't admitted new patients, then it's the hospital's training, staffing, or procedure....

Why do you think that hospital workers get sick so often? Because they're exposed to a concentrated mass of sick people...and they've built up some immunity! Think of the poor patient that hasn't, and has second-hand exposure to all those bugs...while already weak from an illness or surgery....

Privacy Issues

Medical blogs are becoming more, shall we say risqué, as time goes on. A Detroit Free Press article cites blogs by doctors violating patients' privacy. I don't have much sympathy for the outcome in any case that does so without the permission of the individual. In most cases in this blog, the events are so generalized that the patients are unidentifiable, except when the actual patient is posting. Of course in such a large population, we could be talking about your next-door neighbor, and not know it. With 25,000 people, it's a totally different scenario.

I've pulled a few, but generally comments are sticking to HIPAA guidelines. A couple of the ones I pulled were by the patients, but what I felt might have been regretted later. Some were employee/patients which might have gotten them in trouble, and one was a serious breach, which I couldn't condone.

I did publish one employee/patient issue, which was only identifiable through her medical treatment, but the last I heard, she was still employed. That might have changed...but she gave permission. Proving the reason for discharge in a right-to-work state is almost impossible, since they can discharge you for the color of your socks...or pure convenience, as has been demonstrated as of late....

I have had several emails that have given me backgrounds--most have been by the parents. Children, it seems, are common victims. They ask me not to publish the full story, but include it for context. The little ones are totally dependent on what is available--and who feels responsible for their pain, if the wait is long, the quality of care--if poor, and the outcome. As a parent, you have the feeling of responsibility for illness/injury, as well as everything that goes on during the treatment process. You want the best--from caring or guilt (deserved or not)--and this certainly isn't.

What it boils down to is the public only sees the tip of the iceberg, even here. Staff becomes used to giving sub-standard care, and hardened to suffering--you have to. But the degree or level is changing, and not for the better. Standard of care is dynamic, why not standard of suffering, or indifference?

This blog is the only outlet for many of the staff, and it does have an effect: Having someone watching administration has changed several public policies...whether it has an actual impact on conditions...only time will tell....

Tuesday, March 13, 2007

More Letters of Wisdom....3/16


O is for Organization

This Organization is near desperation.
We're fighting inflation and new legislation.
Our profit quotation has bad aberrations,
And sales in the nation need much orchestration.
Our labor relations have caused indignation,
And plant operation needs much maturation.
Our anticipation is now resignation,
And all innovation has turned to stagnation.
Oh, what's the salvation for our situation?
I have inspiration! REORGANIZATION!

L is for Leadership
The CEO's and Presidents, directors and the bosses
....Are here to lead the company and minimize its losses.
They get the bucks and bonuses and other perks galore,
....To sit in comfy chairs and crank out memos by the score.
And if, by chance, they lose their jobs, their Golden Parachute
....Ensures they'll make an exit with a monstrous load of loot.
Though some aspire to "leadership," I'll call a spade a spade:
....I'd rather work an honest job and earn each cent I'm paid.

P is for Paradigm Shift
Knizley had a paradigm, if you can get my drift,
And every time things got too slow, that paradigm would shift.
It shifted on the nurses, the techs and such.
It shifted left, it shifted right, and all without a clutch.
It made the President rejoice, for each new paradigm
Meant he could use that buzzword in a memo one more time.

R is for Responsibility
When a new vice-president is put in charge of you and me,
....They send a memo naming his responsibility.
And when his business plan goes "plop," and people curse his name,
....Responsibility goes "poof" --subordinates get the blame.

M is for Manager
This guy couldn't engineer a tack out of its hole in the wall.
He answered the phones in Customer Help and he fouled up every call.
We tried him in sales and he couldn't sell, no, not a single cent,
So where can he go? That's it--I know! We'll put him in Management!

C is for Customer
A Customer! Oh, what a wonderful thing!
....The thought of a Customer makes my heart sing!
To get all His business, we'll do anything--
....We'll bow down before Him and then kiss His ring.


One thing about the internet: It just keeps on giving. For example take Andy Knizley. Asked to resign (fired, terminated with great prejudice, gone, liquidated) by Hud, who put it in an interview that he had no immediate prospects. He's had several searches that have lead back to companies in healthcare. And they've looked long and hard. ...and that will be there for a long time in archives, which will be pulled up by any prospective employer.

Soran got out with barely a scratch, but his parking lot monitor replacement should be coming into numerous sights (and sites.) "The new CEO Steve Roach (previously the CFO) is a 33 year old bean counter who spends his time photographing employees as they drive up to the back door to punch in." Not terribly impressive on a background search....

David Kreye has had enough said about him in this blog that it would be safe to characterize him as the type that would pull the wings off flies.

Anna Jean O'Neil, an Essent golden child, and mobile mouthpiece for Hud is also gone. Haven't hung that much on her...but some things did cross my email that I haven't been able to verify yet. Time will tell...and tell...and tell....

There are enough people that work for Hud and absolutely despise him, that I could hold out as long as he did with Crossroads...and we do remember Bill Hepburn: ... said Essent stuck $38.5M into improvements there. SSM has on their site that they've dumped several million into it as well. How can a hospital that new (the physical plant was what, less than 13years old when Essent bought it?) need that much capital investment and lose that much...(in four out of five years)....and still have the same CEO at corporate? Amazing, truely amazing. Apparently what they say around Nashville is true...just not able to be published...

  • Starting your own corporation---$80M
  • Buying a mis-managed not-for-profit---$110M
  • Watching it trickle down the drain because of a free blogsite---Priceless!

Monday, March 12, 2007

10 Percent...3/6

The original post came out on 1/16/07. The meeting with directors/supervisors was the 12th of Feb, with the RIF (reduction in force) news distributed to the personnel on lucky 13th. It goes in two phases: Voluntary--with severence, and involuntary. So you can do it to yourself, or have it done to you.

I'll make the next prediction: That new grads will be hired to replace those RIF'ed out at lower wages. These people are obvious....frank

Rumors fly, and 10% seems to be the most consistant number quoted for cuts in personnel. But we already have taken cuts, and service has suffered because of it.

Floggings will continue until morale improves. How short-sighted can we be? Apparently far more. Essent has implemented cuts at Merrimack Valley Hospital, and it doesn't seem to help in the long run...but then I forgot: Essent works in quarters! Longterm is not their middle name! So, if this next quarter is fine, but the ER will be short of nurses again during the peak months, but low census, tough Wendell! But Dick gets his bonus!

Right now would be the time to have the staff get up to speed, since attrition will take its toll. As it already has with the people that dropped their notice right before the holidays. There are around 35 nursing spots open--a couple haven't made it to the list. Merry Christmas, Cheryl!

These aren't just the run-of-the-mill positions, either. 2-surgical, 7-CCU, 11-ICU, including a clinical supervisor. And you wondered why all the agency nurses were here?

So, as a patient, I can expect to have completely trained personnel caring for me? Yeah... R-i-i-g-h-t! And there's a reason that I want to come here, rather than go to Dallas? Well, if proximity counts over keeping dear old dad alive, I suppose it's better than having to take off to drive to see him...let's see, with all the gas I save, I can have a heck of a furneral.

And maybe those last 10%, you know, the ones left from the original staff...maybe they can attend as well!

Friday, March 09, 2007

X Marks the Spot...3/12

X is for Ex-
You used to work there? Yeah, I know, same with me.....
This region is crawling with ex-employee(s).
But who is worse off--us, with nothing to do,....
Or those still employed, doing work meant for two?

Just thought you'd be interested in the "cost-cutting measures" that Hud is going through. He did put his house up on the market, I guess 5000 sqft is a bit much to rattle around in. Thought you'd be interested in the house, and the price tag: about $1.8M! I thought that a bit much, but heck, it even has a stone doghouse! Where else can you get that for just shy of $2M?

The people his organization has let go are not in such rarified settings, however. Healthcare has never been a wildly profitable endeavor except for the physicians and the top administration.

Sitting on our raises bought that house, letting go experienced healthcare workers paid for that doghouse...and did cutting the quality of care for patients pay for the bonus room? ...or just the bonuses of Andy and Hud's new trick pony, Dick?

Think about that when you're attending the next weenie and burger bonding experience.

The house that pain and suffering built....

Thursday, March 08, 2007

More Cuts...3/21

If you've noticed an absent face at West Paris Clinic, you might be wondering what happened. Jane Tijerina was let go. Another victim of hasta-la-bye-bye management.

But is it a difference with Jane or T (Dr. Tijerina)? Essent has already sued him as a partner in the original imaging center. (Which is laughable, since he only went in as a favor.) And, he's long since lost his head of med staff to Bercher (maybe it's in the name--Dick.)

T has become disillusioned, as have many of us, with Essent's behavior over the last few years, and is not the staunch supporter that he was with St. Joseph's. I guess the reflection possibly fell Ms Jane.

Or, are the Rural Health Clinics in danger of being closed? Doesn't take a rocket scientist to realize that they are marginally profitable at best...Health Solutions closed two, and they were far from that level. Maybe that's why three of the NPs have moonlighted--keeping their options open.

But that would diminish the hospital's patient base that has already gotten thinner. As it is, Cooper Clinic's patients are looking longingly at Greenville's Presby, and Bogata's at Clarksville. Without those referrals, things might slip even more. What a pity....

Wednesday, March 07, 2007

Calling it Right...3/12

Dave found out there is no job security, and it was mentioned that a lot of us had a Christus Hx. Guess Christus figured it out as well! Check your mail lately?

Maybe we can negotiate our seniority... since they're using it as a hook....

Tuesday, March 06, 2007

The Letter Game...3/11


E is for Employees
Employees are our most important resource.
....We say it's true; we know that these are facts.
But when things tighten up in the finances,
....Our most important resource gets the axe.

S is for Stockholders
Jerry was an employee, and every word he had
....Was all about the Stockholders and why they were so bad.
"They siphon all our profits, skim the cream right off the top.
....There's nothing left for us, and soon this company will stop!"
But Jerry's had a change of heart and ceased his wayward talk--
....He finally saved enough to buy a thousand shares of stock.

S is for Stockholders
So important we say it twice
....ARCON, Essent, is it worth the price?

E is for Employees
So important that we're given time
....but not enough value to give a dime.
A nickle is what says our worth
....since money's tight, it's like a dearth.

N is for New
A brand-new hospital! Now that's what we need
....To make profits rise with an excellent speed.
A new CEO! Yes, that's the thing
....That finally will make the bottom-line sing.
Let's add something new--maybe two, three or four,
....Although we did just fine without them before,
And don't really need them. Oh, yes, it's all true,
....But we still think we ought to have something that's new.

T is for Teamwork
"We must work together," the manager said,
...."Or quite angry the new boss will be.
We all have to march on in lockstep ahead,
....For it's teamwork that he wants to see."
So we all got in step with the slowest of all,
....So we wouldn't leave any behind,
And our group's productivity slowed to a crawl,
....But our manager has peace of mind.

P is for Paradigm Shift
Knizley had a paradigm, if you can get my drift,
And every time things got too slow, that paradigm would shift.
It shifted on the nurses, the techs and such.
It shifted left, it shifted right, and all without a clutch.
It made the CEO rejoice, for each new paradigm
Meant he could use that buzzword in a memo one more time.

I just liked using Paradigm myself....frank

Friday, March 02, 2007

Death-sent, not Essent...3/8

Ok, tell me what kind of drugs these people are on.... Does anyone else remember a certain post last year at about this time? Hint: Was about the Cath lab. Yep, a whole series of comments and another post were generated by the hit and run techniques of the cardiologists.

Well, if that made you leary of hitting our "Welcome to McDonalds, may I take your order" type of medicine, this ought to have you running screaming down the streets.:

The cath lab secretary is going to be reading telemetry and pulling sheaths!
This is not to occur immediately, they are going to train her. Essent-ial training. Wonder how many minutes...or hours...she'll get.

I for one, have some serious reservations. And, all concerned better have their malpractice insurance paid up as well.... Too bad she won't be able to get some. It all falls to the Dr's and hospital's liability. But, she'll certainly be named in the lawsuit.

I can just see it now: "Cath lab, can you hold? I'm holding pressure on a cath site so we don't end up with a pseudoaneurysm, and watching a monitor, but I'll be glad to schedule a day you can bring lunch...."

Yep, just where I want to go, the Chest Pain Center. Would you like fries with that?

You might wonder why the video? Because we don't want those patients to miss waking up to the sound of your voice....frank

Single Payer Response...3/18

The single payer controversy has rumbled through the blog in a couple different incantations. Here is a video response....

I'd like some feedback on the youtube inserts (if you think they're good, praise away. If you don't like them, silence is golden....just kidding....)

Checking the Pulse...3/7

A long awaited face to face with Dick and Dud. Here's the short version:

Attending the lunch with Hud and Rich were (one each) employees from Supply, Aerofit, Radiology, Cath Lab, Pharmacy, ER, Cooper Clinic, 5A, and a person from either CardioPulmonary or RT, not sure which she was from.

The "royalty" attending were Hud, Rich S. and Stacy Etheridge... taking her lil lap dog notes...LOL. Besides the wonderful fast food (hamburgers and chili dogs) the subject was "who wants to rat out their managers and/or co-workers".

The other part was about how Essent saved the day by coming to Paris... with all the $$$ Essent has put into PRMC, why would anyone get the idea that Hud was a flipper??? Besides, "it's these dang rogue physicians that are the real problem...shame on them for not doing enough elective procedures (caths) to pay the bills".

What a relief to know that Dr. Hashmi and Dr. Bercher will be the playground monitors, keeping them kiddiegardners from staying at recess too long...:)

Remember the statement at the beginning of the blog? Something about Stalinist Russia? Looks like chili dogs and burgers were all it took to turn some into informers. The KGB didn't die, it just moved to Paris....frank