11/26/08 — Hospital: Cameras offer look at issues

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Hospital: Cameras offer look at issues

By Phyllis Moore
Published in News on November 26, 2008 1:46 PM

Security surveillance cameras, initially installed at Cherry Hospital to ensure patient and staff safety, have become a centerpiece in the ongoing discussion about the institution.

Over the past year, a patient death captured on those cameras resulted in the dismissal or reassignment of several workers.

Cherry is under increasing scrutiny these days, especially since federal funding was pulled in September and a national firm was hired to aid in the transition to reinstate Medicaid and Medicare monies, estimated in the range of $800,000 a month. The state is currently picking up the tab for the lost reimbursements.

Officials maintain everything is being done to improve the atmosphere and keep the hospital in compliance.

Mistakes have admittedly been made, said Dr. Jack St. Clair, hospital director. But the security cameras are part of a move to become a "transparent operation."

"We learn from our mistakes. We build on the foundation that we have seen at Cherry Hospital that works," he said. "We have the likes of the Compass Group that can come help us do that. .... We don't want to sweep anything under the rug. We don't want to cover anything up, and this video security system is helping us do that."

Consultant Carl Fitch of Compass Group Inc. has been on-site for nearly a month, closely monitoring practices and policies to get the hospital up to speed.

And while his priority is to get Cherry's accreditation back, it will take time.

"It's definitely not a three-week fix, and it's easy, it's very easy for people on the outside to point the finger at various people inside the organization," he said. "It's very easy to blame people for the problem. ... As a consultant, we're taking a very objective look at this hospital from the bottom up, from the top down. However, you want to look at it because we don't want to invite the Centers for Medicare and Medicaid to come back until we have everything lined up and feel comfortable that we'll pass that survey when they come in."

Nothing he has witnessed so far -- low morale, disgruntled employees, resistance to change -- is unique to Cherry, he said.

"It's certainly not unusual. I have seen it in every hospital I have ever worked in," he said.

"I have been in the business for 38 years. I have run a half-dozen acute care hospitals and been interim CEO in four of them. I'm not the interim CEO here. I'm working with the administrative team."

But no matter what the business or organization, a common problem boils down to having "really good employees and a few bad apples."

"There's a problem," he said. "It's difficult to predict when an employee is going to do something unpredictable. The policies are there, the policies are taught and the policies or practices are reinforced over and over again. But you don't know what they're going to do until they do it.

"And when they do it, there are very clear and very strict procedures to follow to either discipline or fire the individual."

Just as unpredictable, Fitch added, are the patients. And at an institution like Cherry, where most patients are committed and don't want to be there, it's especially challenging.

"We have to provide care. When they don't want care, we have to use techniques and methods taught to employees to help them make the right decisions about getting care," he said.

Citing the example of the patient who died in April after being unattended for 22 hours and reports that medical records contained errors, Fitch said that only contradicted and delayed the investigation process.

"You can tell employees that you're not supposed to fabricate anything in the medical record," he said. "But it's happened, and if you don't know that it's fabricated, then the acts or decisions are based on something erroneous. These things eventually come out, but it might take some time to review those incidents before it happens.

"If a bad employee is fabricating to cover for his actions, our job is to find that out. But that isn't always easy because No. 1, you don't expect it to occur anyway. And it's only through investigation that you might find those things."

One of his first recommendations for Cherry, Fitch said, would be to shore up its hiring process.

It's about more than education and qualifications -- it's about heart, he said.

"It's very difficult to teach people to be caring, compassionate individuals, so the best we can do is try to find out if they're that way before we hire them," he said. "But you can't always discern. If someone has a perfect hiring technique, I would like to know what it is."

At the same time, he is quick to point out the fact that Cherry boasts a work force of people who have been there for up to 30 or 40 years -- good, hard-working people.

"Because of the actions of a few they all get stigmatized and that hurts our employees, it hurts them terribly," he said. "And so on their behalf, we really would like, we need to screen out the bad eggs, in order to recreate the image that the vast majority of our staff are holding up and providing every day. The few cause the negative media coverage and the vast majority have no say."

Recent negative publicity has been hardest on those at Cherry who had nothing to do with the incidents, St. Clair said.

"It has been quite demoralizing to the staff to rehash the event. It's most regrettable and none of us would have wanted any of this to happen to anybody," he said. "We have learned a lot from it. We're continuing to learn from it. ... But we'll get through it and there will be a better day."

One way Fitch is targeting his efforts is through employee meetings and opportunities for staff to share their concerns with his office. Or as St. Clair said, encouraging employees to become part of the solution rather than the problem.

"I think the folks who want to remain anonymous should be encouraged to step up to the plate and help us solve some of the problems here at Cherry Hospital," St. Clair said. "Those are the people with some of the best ideas."