The head of the board of directors at Bartlett Regional Hospital led a discussion at Monday's City Assembly meeting, discussing improvements made in the hospital both before and after staff members complained about the work environment at the hospital in April.
Dr. Nathan Peimann, president of the board, outlined the past three years' focus on quality, including implementations of physician peer reviews, successful completion of an unannounced survey designed to find major violations and the board's focus on different quality measures that staff can identify.
This year, a cross section of employees will go through clinical microsystems as a means of continuing education for improvements in methodology.
Peimann went on to list several quality improvement measures and the effects they would have on patient care. Some include the formation of a quality committee, engaging the board in advocacy for a patient perspective, placing more employees in the quality department to make sure complaints or issues are dealt with reasonably and focusing on quality at the board level.
"Patient complaints are individually reviewed and addressed or corrected," Peimann said. "We don't want to be a black hole."
The microsystems process will also change the way occurrences are reported. A new program will show if a problem persists over a larger time period and how often it occurs, Peimann said.
He gave the example of a room being too warm. If one person complains, it may not be an issue. If three people complain over a period of a couple of weeks, there may be an issue and that can be addressed. Peimann said it gives departments the information to realize there is an issue and how to address it.
Staff will also be able to give input on how things can be better done, Peimann said in response to a question from Assemblyman Merrill Sanford. Hospital data is also available to anyone because it is publicly operated, and much of it is available on a third-party website, Peimann said in response to a question from Assemblyman Jonathan Anderson.
The hospital also assessed the employment environment at Bartlett in a study by the Foraker Group. This evaluation came after several employees gathered before the Assembly and raised concerns about an environment where employees risked their jobs if they asked questions or disagreed with management. The study showed some employees shared this perception, but they were not in the majority.
Board member Linda Thomas said the study focused on employee perceptions, not necessarily truths. About 50 percent of the staff responded and their top three issues were lack of trust in management staff, misunderstanding of processes like grievances and a focus on productivity with a potential to downplay quality care.
One avenue Bartlett is considering is sharing governance of the hospital with staff. Peimann said at this point there isn't much feedback to be given as far as staff reaction goes. Cathy Carter, Bartlett's chief nursing officer, said it will take about six months to implement a good service model.
Bartlett is also increasing focus on supervisory education and leadership, nurse manager training for all nursing managers and improved communication, Thomas said.
Assemblyman Robert Doll raised concerns with the study itself. He said the hospital board missed the point and wrongly focused on employees instead of why the perceptions arose to begin with.
Hospital board member Robert Storer said he agreed there are broader issues than the study addressed, but pointed out the study did provide value by pointing out problems the hospital needs to address.
Assemblyman David Stone, the hospital board liaison, said he was very impressed with the report and appreciated the board is "taking the charge very seriously."
Assemblywoman Ruth Danner said she wanted to know why two departments in the hospital refused to participate and seven others couldn't.
Thomas said the departments that did not participate were relatively small, and Foraker was not concerned about the departments that did not participate since there are more than 30 departments at Bartlett. Additionally, because there was a short time frame in which to respond to the employees' concerns, the participation was lower than it could have been, she said.
Peimann noted while most participants were randomly selected, anyone who wanted to have a personal survey interview was welcome to do so.
Anderson said several issues were found through the survey which leads them to the "what now" factor. He said he was interested in seeing how the employee input and shared governance would work and wanted to know what specifically would be done to improve the hospital culture.
Thomas said there is a complete Human Resources department review going on.
Peimann said the report talks about a second "bottom line" that includes quality of patient care. He said they've stepped back from the productivity focus and are interested in how departments function.
Assemblyman Jeff Bush said he appreciated what the hospital board has done, but his frustration still remained in the next steps.
"If I had an employee response that looked anything like this I would be horrified," he said.
Even with changing the way senior management operates and responds to issues, that doesn't mean employee perception will shift easily, Bush said.
"I don't envy the problems you guys have identified," he said. "I don't know where we go from here."
Mayor Bruce Botelho admired the dedication of the board.
"There is no other board that has undertaken the kind of searching self-examination this board has undertaken," he said. "Wherever we fall on the spectrum of where things should go, we all admire the work you've done and continue to do."
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