Wednesday, February 15, 2012

Parkland Memorial: Will transparency finally rule?

I recently reported about the reluctance of the board at Dallas' Parkland Memorial Hospital to make public the consultant's report prepared by order of CMS to review quality and safety issues in the hospital.  Well, it has not been released, but the Dallas Morning News secured a copy and has reported about it.  Here are excerpts:

Among the findings: Patient rooms were found to contain overflowing trash bins, excrement and blood. Hundreds of medications were improperly administered to patients. Dozens of beds remained empty despite crushes of patients seeking emergency care. Senior leaders kept critical information from the hospital’s board of managers. One patient died, apparently after receiving a drug without doctors’ orders

A new problem area highlighted in the report: the main operating room, which supposed to be among the most sterile environments in a hospital.  Monitors found a dirty, potentially unsterile environment that could sicken patients, cluttered by equipment and in need of repair. Staffers told the monitors that they didn’t know the standards or regulations for cleanliness.
The person newly in charge said what you might expect in the face of this kind of report:

Dr. Thomas Royer, Parkland’s interim chief executive officer, declined to discuss the report Tuesday, but released a statement. “We have instituted leadership changes, formulated new policies and procedures and have begun the reorganization of key departments,” the statement said. “We have made it clear to everyone that unless and until we can honestly say that safety and accountability are at the center of everything that we do, our work will not be done.”

And from CMS, we hear:

“This is a chilling account that demonstrates starkly the work ahead,” said David Wright, deputy regional manager for the U.S. Centers for Medicare & Medicaid Services. “For Parkland to be a safe hospital, fundamental and sustainable change is needed. There is a lot of bad information here, but it serves a purpose. We now have a comprehensive idea of problems.”

I would say that the only way structural improvement will happen is if the hospital opens itself up and adopts a policy of transparency of key clinical measures going forward.  Why?  Imagine that you are on the staff.  You have now been buffeted by incredible levels of adverse publicity and you have been working in an environment that apparently did not sufficiently value quality and safety improvement.  To hold your head high for the future, you will want to prove to yourself, your colleagues, and the community that things have changed and that results have been achieved.  Unless the numbers are made public, and in real time, people's loss of trust and faith in the hospital cannot recover.

Imagine you are in a senior administrative or clinical position. Besides the point raised above with regard to rebuilding trust among the staff and community, you need a powerful motivational tool to ensure continuous process improvement.  Transparency is such a tool.  As recognized by MIT's Peter Senge, adoption of audacious goals and transparency with regard to the current state establishes a creative tension in an organization, leading people to apply energy and commitment towards meeting those goals.  As I have said:

Transparency's major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.

I'd love to see someone in Dallas buy into this concept.


Anonymous said...

This scenario happened (minus the 'immediate jeopardy' tag, so not quite as bad) in my former hospital, complete with devastating press coverage as above. The new hospital President followed a course very much like what you recommend, Paul. The situation calmed down somewhat over the ensuing months and achieving re-accreditation. However, now retired and some 13 years later, in another county in the state, some non-medical friends brought up the incident as if it happened yesterday. I wager it will take a generation for complete trust to be regained.

Barry Carol said...

One would think that such negative publicity would significantly increase the number of patients who would prefer to receive care at some other hospital besides Parkland and increase the number of doctors who would refer their patients elsewhere as well. If nothing else gets management’s attention, fewer patients and lower revenue should. Then, even if the problems are satisfactorily addressed and transparently communicated to the outside world, it could take quite some time for Parkland to repair the damage to its reputation.

Anonymous said...

I first became aware of Parkland's shortcomings with the report of a woman who lost her leg due to a series of errors during a knee replacement - including, allegedly - the lack of the attending surgeon's participation in the care of the patient. A 2nd year resident did the surgery without direct supervision and severed something vital - with direct supervision it would have been apparent at the time of the error and corrected. There followed a series of events - no one took the patient's reports of extreme pain seriously, only a medical student saw the patient post-operatiavely, etc. etc.

I was truly outraged - and more so because the hospital did nothing to assist her - she couldn't even get a prosthetic leg. I don't understand why the hospital - knowing it was at fault - did nothing to make things right. Malpractice reform in Texas made it impossible to sue - not enough money for the lawyer's to take the case. Surely those in favor of reform never intended for real victims to be left without remedy. Stay away from Texas.