How to chart an 'open heart'

Posted: Thursday, July 08, 2010

Bartlett Regional Hospital administrators and cultural assessment committee board members continued their discussion Wednesday of how to address concerns by some employees outlined in a recent report.

The hospital board commissioned the report from the independent Foraker Group, after concerns from some staff members about a "culture of fear" at the hospital became public. The report found that it is a minority of employees that experience fear, but also elaborated on areas in which the hospital could improve, such as communication and trust.

Much discussion centered around how to clearly target problem areas and show improvement without seeming cold or overly numbers-focused.

"This is a great first step, but I caution us not to get so hooked into PowerPoint and processes ... that we kind of miss the bigger picture of what led to this perceived lack of trust," said board member Alex Malter, responding to a presentation of draft ideas from hospital CEO Shawn Morrow. "Part of the problem is that you could put up the best graphs with quality, but if the nurses aren't convinced you're really measuring what they see as quality, they're going to be less impressed."

Chief Nursing Officer Cathy Carter said frontline staff have "a totally different viewpoint" on what "quality" means.

"Quality is what I think I did in the course of the day," she said. "When I go home, how I feel about the quality of the care I gave. That's where nursing-shared governance and clinical microsystems (measures the hospital is currently implementing) will be crucial. I think nurses have not had that voice in the organization for a long time, and I think that's where much of the frustration comes from. That will take time, and it will build trust that we do care about frontline staff's perception of what is going on."

"To be honest with you, we have not been patient-centered in many cases," she said. "Frontline staff - their perception of quality is what really counts. And it's not a number."

Carter also added that "we have a lot to learn about communication.

"We've probably made some mistakes in the past with communication, but... we're working on communication through several different venues," she said.

Morrow said one of the ways in which hospital administration and the board should improve is communicating the importance placed on quality care.

He said staff in the quality department have more than doubled and that the hospital's quality indicators have improved significantly.

"The focus and the effort and intensity that we've put into that has not translated down past the management group," Morrow said.

Morrow also said administration needs to do a better job communicating what its new hires to the hospital, and something "needs to be said" about productivity and the steps administration has implemented to improve it. Many interviewed by the Foraker Group indicated they were worried about money matters eventually being focused on to the detriment of patient care, though they did not indicate they believe that to be the case currently.

Morrow said quality should take up 80 percent of the focus, and financial matters 20 percent.

"Health care reform will put a great strain on those (financial) resources in the years to come," Morrow said, calling reform a potential "storm."

"We have to get prepared for that... I don't want us to look back ten years from now and say 'Boy, did we squander the past decade, the past two decades; and have to ask for a tax subsidy from the community."

Other ideas suggested were regular newsletters, using more forms of media to communicate - such as Facebook, Twitter, and/or video links - training for various levels of staff, the possibility of an independent Human Resources policy review, disseminating guidelines on how front-line employees can access top management, and having a "targeted discussion" with the nursing department on staffing.

Committee Chairwoman and Board member Linda Thomas suggested clarifying the amount of money that has already been budgeted for the attainment of some of the goals and steps Morrow listed, some of which are already under way, and/or what amount might be needed.

"I just don't want things on paper that we might not carry through on," she said. "For us to make sure it happens, we need to commit financially. We need to be aware of it if there are moneys that aren't budgeted."

The committee will continue its discussion at its next meeting at 12 p.m. on Tuesday.

Public participation is scheduled for a committee meeting July 19 at 12 p.m.

• Contact reporter Mary Catharine Martin at 523-2276 or

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