Members of a Bartlett Regional Hospital board committee formulating a plan to improve the hospital's working culture continued their discussion Tuesday in response to an independent evaluation released in late June.
CEO Shawn Morrow presented a second draft of an action plan responding to the Foraker Group's report, focusing on internal processes, internal communication, productivity and trust.
Much of the discussion focused on words and the intent behind them, with several board members indicating they'd like the language Morrow used in his presentation to change. That brought on some debate about the issues themselves.
"Sometimes just the way you present things sometimes and talk through it ... explaining why you're doing something helps, or terminology that's slightly different," said committee chairwoman Linda Thomas, adding that word choice can change something from a positive to a negative.
Assembly member Jonathan Anderson, who attended the meeting, said, for example, that "discipline," which he said carries a unidirectional sense, could be changed to "dispute resolution."
Another was "accountability."
"Our problems are getting good people up here who want to stay, not tons of people running around doing a poor job," board member Alex Malter said. "I would push the board to soften up any of that kind of language as well."
Morrow said he agreed with Malter, and that Malter was misunderstanding his intent. Malter said this could also be a learning opportunity, as other people might misconstrue it the same way.
Morrow said leadership has been putting an emphasis on accountability for the last three years, and has been holding people accountable for things such as viewing pornography on hospital computers.
"There are some employees that feel like what we've done shouldn't have been done. They don't know the details, and they never will - they're human resources issues," he said. "We don't promote them or parade them.
"If you look at events of the last 12 months, there have been ... complete and total disincentives to continue on a path of holding people accountable," Morrow said. "It has created nothing but massive headaches for us. We do hear from managers who say they're not sure they want to do any disciplinary action or corrective action, if this parade and circus is going to ensue. That's the reality that we work in every day."
Hospital Community Relations Director Jim Strader said the hospital is working on an intranet website, a Facebook page and a Twitter account, as well as a regular paper newsletter and e-mail to help communication.
Board members said administration should also emphasize listening and personal interaction.
"I'm a little skeptical that the problem is we don't have a Facebook account or a Twitter account," Malter said. "When I hear Foraker's report about communication - the staff really wants to believe management is listening to them."
Productivity improvement measures, which The Foraker Group report recommended the hospital slow, was also a focus of discussion. The report found a widely held perception there is too much focus on productivity and not enough on patient care.
"The change toward increased productivity does not seem to be working for many employees, perhaps the majority of employees," the report said. "Some or all of that change may be needed but may be moving too fast."
In response, Morrow suggested the administration begin to discuss the quality improvement side of productivity over financial measures, and could do further staff education on those measures.
"As I read the Foraker report, ... they're telling us that productivity is something that should be de-emphasized. I don't see where they say we need to help employees understand it better," said board member Reed Reynolds.
Morrow said productivity is "a catch 22."
"I don't know personally, from my leadership experience, how I can go any slower," he said. "I don't know that we can go much slower ... and still make progress. That's just the way I'm wired. But if the board says 'no productivity system...' my job just got ten times easier, and that goes for every other (plan) we've got. ... But when we're the lowest performer in the state, somebody's got to push it, and unfortunately that's been your senior leadership team."
Morrow said the hospital has moved from a 25th percentile productivity ranking for comparable small, rural hospitals to the 50th percentile.
"Twenty-fifth percentile is a problem. It is. Something had to happen with that," he said.
Morrow also said the hospital has too many action plans.
Thomas said she thinks the board needs to revisit the hospital's productivity benchmarks.
"Whether it's true or not, what you're trying to do is improve communication," she said. "Financially, we need to measure certain things to make sure we're viable and we can continue with our mission, but I think we need to revisit these a little more often, as a board."
One of the concrete steps the hospital administration plans to take so far is putting disciplinary procedures in writing. Grievance procedures are in writing, but disciplinary procedures are not, something Morrow said "shocked" him and that Human Resources Director Kyla Allred said could lead to a perception that the disciplinary process isn't equitable.
"It should have been in writing years ago," Morrow said. "To not have it in writing is not good."
Another likely concrete step is to have either Quorum Health Resources, which holds the management contract for the hospital, or another entity conduct a review of HR policies. Morrow said Quorum would do the review for free.
Thomas said she is hoping to identify outcomes and benchmarks that the board could use as a reasonable measure of success for the changes that are implemented, something Morrow said would be "tough."
"I think we need something that we're all accountable for that we can measure as a clear improvement of our communication," Thomas said.
She also reiterated from the last meeting that she'd like to know what's necessary for unfunded aspects of the plan to get funded.
"We want to make sure we build in a path to keep this moving forward," she said.
By the next board meeting, Thomas said she'd like the committee to present and be confident in the action plan.
"I think we're really close, and that's good," she said.
The committee has scheduled public participation for its next meeting July 19 at 12 p.m., at which they time plan to formulate recommendations to the hospital board.