Saturday, November 03, 2007

Dear Board Member:

Apologies to those readers who are tired of the union topic, but there is something going on that deserves public attention. And, if you are on the board of a hospital in Massachusetts, you might want to read closely.

As I have noted elsewhere, a key component of the organizing strategy of the SEIU is to engage in a corporate campaign against a hospital and to put pressure of the board of trustees to agree to concessions during the organizing process. As the situation unfolds at BIDMC, we see the precursors of such a campaign.

Over the last few weeks the SEIU has written letters to board members of Caregroup, BIDMC, and BID~Needham regarding one or another issue -- like accounting, billing, or intellectual property transactions. In each letter, the SEIU will point out a flaw, mistake, or other circumstance that it asserts has occurred. The letter will make the point that the board members have a fiduciary responsibility with regard to the issue raised and the broader issue of supervising the hospital and encourages them to look into the matter in more detail.

Interestingly, SEIU has not sought press coverage or public disclosure of all of these items as they are filed with the boards. Instead they are simply mailed to the board members. What is going on here?

One has to predict that these issues will be raised by the union, but in what forum and in what way? One possible use could be in filings made with federal or state governmental bodies claiming that the boards of the hospital are not carrying out their fiduciary responsibilities and therefore the hospital (1) should not be permitted to issue tax-exempt bonds to support hospital capital programs and/or (2) should not be permitted to continue to receive state or federal reimbursement for patient care and/or (3) should not be permitted to continue to receive federal research funding and/or (4) should be stripped of its tax-exempt status. Another way is to simply try to embarrass the board members in the community.

Now, our boards, like most hospital boards, have all the governing structures in place that are designed to properly fulfill their fiduciary roles: Committees for compliance, audit, finance, research supervision, compensation, and the like. The board members take their responsibilities seriously and work hard at doing the job well for the community. And there are external reviews by accounting firms and audits as well by state and federal agencies, as well as bodies like the Joint Commission that review the actual delivery of patient care.

Nonetheless, in a large organization, there are be certain to be mistakes. When we find them or hear about them -- regardless of the source -- we fix them. For example, last week SEIU correctly pointed out an error from several years ago regarding BID~Needham bills to Medicare (just under two dozen patient encounters were billed incorrectly during 2004, resulting in an estimated overpayment by Medicare of approximately $569,000). Informed of the issue, we reviewed the records, notified Medicare immediately, and asked them for the best way to repay the dollars.

But sometimes we disagree with claims that have been made. A few months ago, for example, SEIU made assertions about our filings under the state's uncompensated care pool, and we readily met with the relevant state officials to explain why we felt their assertions were incorrect.

On this blog and elsewhere, you have seen the utter transparency with which BIDMC conducts its business. This transparency is fully endorsed and encouraged by our governing bodies because they understand that we are ultimately accountable to the public and that we will do a better job for our community if we admit our mistakes and try to continually improve. It would be a sad irony, indeed, if that approach were thrown back in their face in the pursuit of campaign to organize workers.

The particular issues raised by the union and any mistakes that might have been made do not indicate a lack of fiduciary controls by the boards. They indicate that in the complicated world of health care, there can be both actual mistakes and also disagreements about the interpretation of rules and regulations. I think it is fair to say that if the intensely involved and diligent BIDMC boards are accused of not carrying out their fiduciary duties on the basis of the kinds of issues raised by the SEIU, every single hospital board member in Massachusetts is vulnerable to a similar charge.

18 comments:

Anonymous said...

It's incredible that you can predict their tactics, and then watch them occur. One might ask why you don't find your own mistakes, but didn't you say they employ legions of people just to comb through records and find these things? I'm sure they ignore all the mistakes not in the hospitals' favor.
I still believe you are playing a dangerous game here, but a courageous one. At least we, the public, get a chance to see what really goes on inside one of these campaigns.

ed burke said...

I would be very surprised if any BIDMCvirtually board member is in the least way intimidated by SEIU's self-promotion as though it were some kind of quasi-governmental, regulatory body. What is disappointing to me is the total silence and obsequious deference toward SEIU among virtually every elected official.

Anonymous said...

Dear Paul,

I was under the impression that one's salary rate is a function of job duties, education, years of experience, diligence, seniority, expertise. Apparently, I am missing something big as this does not apply to me and my job!

I have encountered this issue numerous times during my years at BIDMC. Every time I bring this up to my superiors, and I am promised a fair compensation somthing else happens, for example, a new employee is hired and my salary again lags behind even though my position is more senior.

I very much enjoy working here and have dedicated my time and effort to make my department a better-running place, by both, providing expedite and thorough work; and by bringing innovation and developing special project in my personal time. Thus, I see myself as a valuable employee, and my superiors also recognize me as such. (every year I have been given peroformace awards)

I am writing to you today highly distressed and disappointed. As you said (and I agree): ..."in a large organization, there are be certain to be mistakes"... and I like to believe your next statement that: ..." when you find them or hear about them -- regardless of the source -- you fix them"...

Unfair salaries at BIDMC is a well kept secret, and BIDMC should address what is going on. Employees are leaving BIDMC because of this and in the last 4 years I have not seen any changes, but just promises.

If you find this situation hard to believe, I wouldn't mind giving you more details.

Thanks you!
LS

Elliott said...

What's incredible is that Paul Levy thinks that when he opines, it should be considered the altruistic, unsullied, unbiased word of someone who only cares about the patient. On the other hand, when the SEIU speaks on something even when they are 100% accurate and it results in a substantial refund to the government, the SEIU are dirty rotten manipulative selfish out-for-themselves only thugs.


By the way, I am not a union shill or anything like that even though you want to paint me as such or did I misinterpret your comment from a previous thread.
"Your points and characterizations are consistent with that approach."

Paul Levy said...

LS,

I'm happy to meet with you and talk about this any time. The door is always open. Actually, over the last several years, the number of people who have choosen to leave BIDMC has gone down -- but we would of course prefer to make it a preferred place for people to work and stay. There is a lot of competition for good health care workers in Boston, and we know that people who are dissatisfied can easily go and work at another hospital just a block or two away. So if you have ideas on that front, I'd love to hear them.

Elliot,

I am basing these comments on the tactics the SEIU has used around the country in its organizing campaigns.

Again, in your comment, you overstate what I have said and how I say it. Of course, what I write is my opinion. What else would it be? While I do care about patients, these comments do not relate to my view of patients or the SEIU's view of patients. They have to do with an organizing strategy.

And, I have not used the kind of language you do about people at the SEIU. By suggesting that I do (or even would), you demean the discussion I am trying to promote on this blog. You are clearly trying to undermine my arguments by making implications about my behavior or character.

Your approach is consistent with comments from that quarter in that you and they impugn my motives and overstate what I have said without dealing with the truth of the description or appropriateness of their tactics.

Elliott said...

Paul, you write to convey a message. you are a skilled communicator. It is unmistakable what your opinion is of the union and its tactics. Now you may want to pretend that you are engaged in a reasonable, rational analysis of the situation, but I have made it clear that, I think, on the contrary, your opinion in this matters betray the opposite qualities.

In response, you accused me of being a union shill. It is dishonest to pretend that the measured tone and style of your posts are not stating exactly what I said above even if you don't use that particular language. I don't know why you have chosen to engage in a public battle that is not convincing anyone that you are going to engage the union organization effort fairly. In fact, you have convinced me of the opposite and, in the process, caused me to revise my previous generally high opinion of you as an honest commentator on healthcare issues.

Paul Levy said...

You are very skilled yourself, Elliott. I guess we'll just leave it to others to draw their own conclusions.

Anonymous said...

Dear Paul,

I will first schedule a meeting with my Director and VP. I will let you know the outcome from my meetings.

Qui tacet consentire - Who is silent gives consent.

Thanks
LS

Paul Levy said...

Thanks, LS. Happy to see you.

Rob said...

Just two things.

1) These tactics are bad faith. It goes to the character of SEIU's agents.
2) But they are, in theory, in support of a reasonable gripe: Nurses do feel overworked.

But the cognitive dissonance occurs when you try to figure out how much of nursing staff's feelings are due to bad-faith tactics versus legitimate problems.

I'm very glad to be a humble bit-pusher and not an executive. My instinct would be to try to communicate my fears to my staff, rather than my hopes.

Michael said...

Dear Mr Levy,
I am an HMS student that was at your talk last week, and I was fascinated by your program to use improving quality and safety as a cost control measure. How can I learn more about this concept? Do you have any articles or books that you would recommend? Thanks for your help and the blog is now on my favorites toolbar.

Paul Levy said...

Michael, please call Ken Sands, our SVP for Health Care Quality for details. But, also, to be clear: We are not trying to improve quality and safety to achieve cost control. While the two go hand in hand, the impetus to improve quality and safety is for its own sake. Fortunately, it also helps control costs.

Marky Mark said...

I find it quite remarkable that SEIU members feel that their hard-earned dues are being used to support the type of "opposition research" and board intimidation tactics you describe in your recent blog. How these campaigns translate into better patient care and advocacy for disenfranchised workers is mystery that is hard to decipher. Perhaps union leadership needs to gain "market share" in order to justify its existence and administrative costs.

Anonymous said...

I cannot leave my name this time because it would hurt my organization on the West Coast. I was always a supporter of "labor" until I experienced the tactics of SEIU. They are a ruthless organization that doesn't care one hoot about patients or healthcare. They manipulate the truth and hide behind the politicians that will never call them on their deceptions. This is not the 1930s. Unions no longer benefit the workers. It is all a game for the organization to make tons of money. If politicians were not so corrupt, the unions would not get away with what they do. Unfortunately the public doesn't know. It is sad for America.

Anonymous said...

Dear Sir,

I do agree with the letter written by LS about the salary of nurses at BIDMC. But aside from the difference in pay of a more senior nurse to a junior new hire nurse, there's another angle to it. I came at BIDMC from a Community Hospital and I can't believe the pay cut i had to take. True the base pay is about the same but the differential that are being paid by other hospitals puts them in the advantage, however, i chose to work with BIDMC because of its reputation, professionalism, working environment and the responsivenes and dedication of its management to provide high quality of patient care with emphasis on safety and compassion. However, lately, it has become such a challenge to provide this care to our clients. The Nurse Patient ratio and the amount of work that needs to be done at a given time. The amount of paper work that we need to do for admission/discharge etc on top of each client's needs. The patient population's acuity is not the same 10 years ago and the amount of attention they require and the questions the client and family has. Imagine yourself taking care of 8 patients at night 2 confused whom you are trying to re orient every few minutes so the patient wont fall, then an admission either from ed and post op trying to manage their pain and reassess it every 2 hours, then a patient who has a stomach bug you have to clean every hour and another patient who is very sick and is close to being transferred to the ICU with IV antibiotics and electrolyte repletions . To top the scenario, there are only 2 nursing assistants to answer call lights and help vitals for 35 patients!...YOure nurses are overworked and undercompensated and yet we all strive to give the highest care we could, with compassion to each one of our patients and still try to put on a smile on our face. WE go home exhausted anxious that we didnt forget to do something, guilty that we didnt get a chance to spend quality time with each one of them

These are possible reasons why nurses at BIDMC will vote for union despite of lack of knowledge of what a union really does to a hospital. These are reasons why new grads get burnt out, why nurses leave our hospital and go to MGH or BWH. It doesn't help when the person in charge answers back that a nights like this can be handled with teamwork. This is not a question of teamwork. This is unsafe staffing!

This should be a high priority on the things that should be resolved sooner than later if BIDMC is true to its commitment to its clients and employee's/nurses it says it values.

Paul Levy said...

Dear Anonymous (and other readers),

I am posting this letter in the spirit of openness on this blog even though it contains some misrepresentations about our staffing ratios. The actual ratios are posted on http://www.patientsfirstma.org/.

As I have mentioned before, we do not believe our nurses are undercompensated relative to the neigboring Boston hospitals. We have made numerous salary and benefits adjustments over the years to ensure that we stay competitive. The proof of the pudding is that nurses actively seek to work in our hospital: There is a low vacancy rate and a low turnover rate among our nurses. We believe this is also reflective of an atmosphere of trust and collaboration on our floors.

Nursing is indeed a difficult job -- the paperwork you mention is in fact one aspect of that that is required for many reasons -- but we do our best to make BIDMC the preferred place in town for nurses to work.

As I have said to LS, I am happy to meet with you at anytime to discuss your particular concerns.

Anonymous said...

Sir,

The patient's first is not the reality it only serves as a guide. Say on nights the floor is staffed for 26patients with 5 nurses but they could go up to say30, these nurses will take additional patients when the ED is full and waiting for beds not considering the skill mix with new nurses who's been working less than a year, no considering the acuity of the patient's on the floor. The nurses manage (thank God) but they all stay 2 hours after their shift doing their notes, not getting paid for it as we are salaried. It also doesnt help when for unforseen reason there would be a call out and no people on call or people in the float pool to fill these needs

I am a nurse working for this company, im not with SEIU. I dont want a union in a our hospital since I dont see the point when I can see that management listens to our concerns. But it seems these issue is not being addressed. We may not have a lot of turnover yet because people love working with the people who works at BIDMC but im telling you that most of the nurses are getting exhausted and frustrated, so before it comes to the point that there would be mass exodus again, I decided to inform you in case you didn't know the reality.

My suggestions:
1. increase the number of people in the float pool or start an on call program to fill in the staffing needs when census is up.
2.Have more step down units with criteria (or otherwise doctors will be dictating even when some patient doesnt need to go to either one and will just be a waste of resources) that can be followed on who needs to be in the step down vs. the icu.

3. Spend sometime on the busiest floors, dont announce your visit and purpose and just observe and ask questions so you can find out if im speaking the truth. Speak to new nurses and ask them if they feel overwhelmed with the work load on all shifts.

4. I understand that documentation is necessary as a requirement by different agencies and protection to our license. Its been said for a few years that documentation will be computerized and up to now its only being done in the ICU.

My goal for writing to you in this blog is to let you know. As much as i would like to discuss with you this matter in person, I fear that I wont feel comfortable working after my bosses find out that I didnt follow chain of command. They know bout this situation but we don't understand why nothing is changing.

Paul Levy said...

Thank you for your follow-up. I understand the points you are making and I appreciate your writing. I still think you have some misconceptions about our place, and I would like to clarify them in person.

However, this sentence makes me wonder if you really work in our hospital: "As much as i would like to discuss with you this matter in person, I fear that I wont feel comfortable working after my bosses find out that I didnt follow chain of command." Every new employee hears from me personally during orientation that I welcome personal visits and other types of communication, and the managers in the hospital also know that I encourage that. If you are still nervous about doing that, I am happy to keep it confidential. If you work in our hospital, you know how to contact me. Please do that.

Absent that, unfortunately, I cannot be sure that your anonymous comment is not posted on this blog by someone wishing to give false impressions about our hospital's working conditions.