Monday, September 17, 2007

New "Sheriff", but Fewer Docs in Town...

"Amazed" offers the following:

Delta Regional stays a topic on the tongues of deltans. What's happening in the ER is an even hotter topic. For some, it's because of the eyesore administration claims will be the "NEW ER" in the spring. For others on the inside, it's because, internally, the new administrative supported ER has arrived like tsunami.

Let me start by reminding readers that Healthcare professionals are few and far between. Doctors and nurses that are willing to relocate (and stay) here in the delta are almost as hard to find as that beach front property that someone is always trying to sell you in Nevada.

The ER has experienced a mass exodus in doctors. 4 resigned, 4 are left. What a nightmare. Dr. Mcleod is gone. It is a tragedy. She cared about the patients. She cared about nursing. She tried very hard to make a positive change. She worked diligently to improve the skills of the non-ER doctors. She kept the patients moving to prevent backlog. She fought against budget cuts. She went to bat for nursing. Her leaving is mourned by all that worked alongside her. The nursing shortage and vacant positions have been addressed, that's true. The misguided few in charge of this process filled most of the positions by hiring nurses, not based on their capacity to provide emergent care, but because they had a valid license and a willingness to come here. A good bit of them knew not what a crash cart was when they arrived, let alone the indications for usage. Most of them were not even interviewed on site, but rather over the phone. The Human Resources department made grand promises: high pay, sign-on bonuses, flexible schedules, no weekends, etc... A lot of the new hires are new grads. No worries, they hired an education coordinator to bring everybody up to speed. A very talented ER nurse with the experience to back up the position she was hired for. A mountain of a challenge.

Then came the arrival of the new director. A grand entrance, someone endorsed by administration, especially by the new administrator of the ER. Was that the smell of winds of change approaching? Or was that fire and brimstone, I can't tell the difference anymore.

Since the arrival of this new person, Boss Hog, a new plan has been introduced. The rollout of his plan talked about improving patient satisfaction (good), encouraging continuing education (good), balancing the schedule so the same number of nurses were working everyday (good), scheduling one on one meetings with everyone to get to know each other (ok, whatever) and finally a hint to other changes in position structure are coming at a later date (what?)

A "No Tolerance" attitude is thick in the air. "Like-it-or-leave-it" is his motto.

Patient satisfaction is terrible. I agree. the number isn't good. It also may not be the absolute indicator. The posted information via Avatar shows that the score is reflective of 37 respondents. The ER sees an average of 5000 patients a month. It seems that if one person looked at the big picture, they would see that this survey process is not well received by the community and clearly not responded to. If the administration would like to know what the patients think about the care they receive, here's an idea. Pursue a survey process that will illicit a better response. The current survey is lengthy. It has questions that are phrased in a manner that prompts negativity. It uses language and grammar not readily recognized by the average respondent. That should be blatantly obvious by the dialogue posted by patients that used the comments section of the survey. It presents in an envelope that looks like junk mail from Florida. It arrives three months after you visited the ER. Maybe a survey process that is specific for emergency departments is available. Have they pursued this? I doubt it. Better yet, maybe Boss Hog should come out onto the floor and talk to the patients during their visit. Were your needs met? Do you understand everything that happened during this visit? Do you have your discharge instructions? Reinforce the importance of following up with a regular practitioner. Did any of our team members go above and beyond? Can I answer any questions for you? It's so much easier to take the number at the face value and start the condemnation...

I feel that the majority of nurses do a great job meeting the needs of the patient. No matter what the complaint. Departments that are specifically developed within hospital organizations to ensure quality improvement are not often in the ER investigating sentinel events. At the end of the patient visit, the patients issues and ailments have been investigated. They have been addressed, when valid. They have received medication appropriate for the diagnosis. They have received prescriptions and explanations. They have received referrals to primary care providers, or to specialists. If warranted, consultation for the same have been conducted during the visit. Amazingly, all of this has occurred in a very short turn around time, in comparison to other same sized facilities. The patient may not have received a pillow or warm cocoa. Those items are in short supply. They may have heard talking at the nurses station. A lot is happening out there. They may have even seen a employee with a beverage at the nurse's station. They are thirsty. They are working hard for the patients. They aren't doing it for the recognition from the hospital. It doesn't exist. They aren't doing it for administration, that's for sure. They learned a long time ago that no positive recognition comes from down those back hallways. No eating, No drinking, No talking loud, no laughing. Don't you complain about it, either. No tolerance. Straighten up, or else. Like-it-or-leave-it.

Yes, there are some folks with a bad attitude. There are some that are unpleasant to the point that everyone around them is miserable. There are some who lack the inclination to do much at all. There are some who think that "it" is not there job. There are some who wouldn't help out a fellow employee in any circumstances. There are some who call in often and for no apparent reason. They are unreliable. They are unpleasant. They are not the one you want standing next to you in a trauma. They are bad apples. I'm not one to say that it is advisable to foster an environment where the bad apples have spoiled the bushell. I would lean more towards the inclination they be plucked out, should they prove incapable of positive re-enforcement towards a more suitable disposition. Most team members agree with this ideation. They would rather work short that work with a bad apple. Boss Hog wants to rid the department of the bad apples. Great. Find them, pluck them, toss them. Do not accomplish this by encouraging a tattle tale relationship internally. They don't need a mole. They need support and encouragement. Here's a thought. Maybe boss hog should come out onto the floor. In scrubs. Ready to work alongside. He'd see the issues. He'd see the lazy. He'd see the bad apples.

Instead, he has encouraged the employees to tell him if anyone is unpleasant. They will be issued counseling memos. No need to investigate claims, counsel away. Like-it-or-leave-it. He has balanced the schedule by changing the nurse's shifts and not telling them. Be at work, or else. Like-it-or-leave-it. He has done away with the nursing educator position. No need for the new grad and the non ER nurses to have any sort of education or orientation. Like-it-or-leave-it! He has chopped ancillary staffing, making all of the tech's and unit clerks, reapply and interview for the 8 positions of the 16 or so originally available.

That's a major disruption in the functional capacity of the team. Not to mention the 8 people will lose their job. No worries. Like-it-or-leave-it. The changes are repulsive. There are 460 odd thousand nursing positions available across the country. They are located in places where people are grateful for care. This is the delta, number one in STD's, poverty, teen pregnancy, illiteracy. High on the stats lists for gang violence & frivolous law suits. I think you might be overstepping a little by "like-it-or-leave-it." You may be surprised at the number ready to leave it. How do you think patient satisfaction will be then? How balanced will the schedule be?

"Like it or leave it" has always been the mantra of Ray and his lot. He has duped the entire county into supporting his personal empire. Anyone who questions his authority is either terminated (with hush money) or put on the payroll (with even more hush money).

Not only have 4 of the ER docs fled, but the 4 that remain are not truly emergency care physicians. So, while DRMC continues to bill itself as a level II trauma center (for state funding reasons), they are little more than a "Doc-in-the-Box" when it comes to actual patient care... a little scary?

"Leadership" starts with understanding what truly motivates people to work. Even before wages, the first concern of most employees today is flexibility in the workplace. Health care professionals are scarce and as the writer notes, they can work anywhere they choose. So, the "like-it-or-leave-it" approach simply won't work in the Mississippi Delta! Any nurse who cannot find another job within 2 hours of his/her resignation... is simply not looking.

Ray and DRMC are in BIG trouble. I am sure that the new "Sheriff" is just another attempt for Ray to exhibit his rule by intimidation and remind us all that He is the boss! There are many excellent, long-time employees of DRMC who have suffered under Ray's tyrannical rule for far too long. It is time for a change!

If you wake up each day and dread going to work... there is a problem. Become active in changing things for the better and DRMC can once again become a quality health care facility AND a good place to work. This blog is dedicated to inspiring people to make positive changes for themselves and their communities.

DRMC will never improve until the employees, citizens and public officials get actively involved and demand change.



Anonymous said...

DRMC and Washington Avenue seem to never go away. Who is surprised that the Washington Avenue project is over budget? Now would be a good time to revisit the street design. The two-way, four-lane, parallel parking is not going to "grow" downtown. If you think it will, try finding a parking space at the Federal Building/Post Office or any of the other buinesses on that block. A better idea would be two lane with diagonal parking. Is it fair to the businesses, banks, and churches who choose to stay downtown on Washington Avenue not to have sufficient parking for customers?

Anonymous said...

Who is the new ER Director at DRMC and which member of administration is he/she related to?

Semi-Regular Reader said...

This shouldn't be construed as an Internet flame, but since the DRMC discussions definitely draw lines in the sand, I have one question.

Of what professional quality are the doctors of DRMC or can that NOT be determined?

The rankings suggest you get mixed medical care. The outward migration numbers suggest the medical staff isn't trusted by non-emergency "customers." People planning heart surgery or other major treatments aren't weighing the corporate philosophy of hospital management into their decision of where to seek treatment. They want the best doctor they can find, not a good doctor backed by decent local marketing and town word-of-mouth.

Doctors departing DRMC in large numbers isn't good UNLESS replacements can better the medical care. That's no given - and unproven under hospital management - because DRMC's paid very high salaries in recruiting only to maintain sub-par results. If customers aren't seeking DRMC treatments, even under a monopolized local healthcare system, then those in the "trench" should look in the job performance mirror as well. It's only fair and is a reasonable request.

Another note: If you get up in the morning and absolutely dread going to your job, you owe it to yourself to, at least, look for other job opportunities. Your personal health and wellness isn't worth it and the services you're providing innocent patients can only suffer given the unconscious distraction of mental misery.

If you choose to "like it" and not leave it, then chew the hay and spit the stubbles. Enough workers must obviously "like it" because the debate water is barely rippling except for Forthright's interest in the issue - which is good reading and a good communication forum (but not a journalistic outlet). It's a soapbox.

By the way, I like the idea of "Boss Hog" walking the ER and asking such customer service questions if privacy law permits. The questions posted by the commentator that should be asked by "Boss Hog" to patients should be asked by the nurses and doctors too.

And if patients complain of chatting, drinking and eating at the nurses' station - most of it is likely to be work related, but I'm not buying that there isn't enough loafing going around to make such patient complaints legitimate. The "High Horse" ain't that high, staff! Remember, the front line medical staff gives patients the impression of the care they're given. Hmm, on that one.

We should continue this discussion of alleged tyrants, tinker-bells, Bosses Hog and medical care. A "ship" as large as DRMC needs many oars and many rowers. Don't look exclusively at the Captain - but keep an eye up there!

Anonymous said...

kudos to you amazed...

Anonymous said...

this semiregular is clearly off kilter if they think there is no "ripple" over this article among those in the trenches of the ER. There is barely anything else being discussed.....

Anonymous said...

right on, amazed... it's getting worse and worse. where does administration pick up their rose tinted glasses?