UTSW-Parkland cage match

@dallasnews The Dallas Morning News has been deeply involved in following the many troubles of Parkland Memorial Hospital, and recently offered a story of deep divisions between the hospital and its affiliated medical school, University of Texas Southwestern Medical Center.  The picture given of this relationship provides an extreme example of dysfunctionality, but the underlying pressures that exist to create that strife exist to a greater or lesser degree in many cities in the US.

Academic medical centers are the crown jewels of American medicine, where extremely well intentioned people provide innovation in patient care, research, and education.  But they can also be the intersections of the worst characteristics of two sectors--medicine and academia--with people of great intelligence, big egos, and poor interpersonal skills.  If issues of governance and priorities are not addressed explicitly and with good will, there can be dangerous results for patients and unpleasant working conditions for all.

An excerpt:

Publicly, Parkland Memorial Hospital and its affiliated medical school, UT Southwestern Medical Center, present a united front.  Behind the scenes, however, the reality has been far different

The tension between the two institutions reflects their tangled relationship. Parkland actually has little control over the doctors working under its own roof. Most are employed by, or answer to, UTSW. Parkland’s priority is supposed to be patient care. Yet UTSW lists its missions as medical education, research and patient care — in that order.

The organizations’ divergent missions, business interests and turf battles contributed to a dysfunctional culture at Parkland over the last decade, jeopardizing patient care. Federal safety monitors have flagged the culture as a major factor in plunging Dallas County’s hospital for the poor and uninsured into its safety crisis.

Many times over the last decade, UTSW faculty physicians have failed to show up to care for Parkland’s patients. Instead, they see privately insured patients at the medical school’s separate system of hospitals, or focus on research. Resident doctors-in-training at Parkland often have been left with little or no faculty supervision. And front-line caregivers who report to the doctors, especially nurses, have felt powerless to resolve patient-care breakdowns.

Trust and transparency issues abound.

And further into the story, we get some details:

In reality, there are two separate chains of command inside Parkland.

Parkland’s chief medical officer, for example, is supposed to provide leadership over clinical affairs and quality of care at the hospital. Yet the UTSW president “is actively involved in the selection, regular evaluation and decision to continue or terminate the employment of the CMO,” according to the affiliation pact. The current interim chief medical officer is a UTSW faculty member paid by the university, not Parkland.

Employees say the system — what some call the “two-headed beast” — fosters confusion and chaos. UTSW medical directors, for example, are expected to collaborate with Parkland department directors on decisions. But the structure stymies cooperation.

“Ideally, they’re supposed to meet and discuss the best approach to provide the best of care for patients,” said a former Parkland nurse who has filed a legal claim against the hospital and requested anonymity for fear of retaliation. “What occurs is: they collide. Both have power and both want control.”