Liberty Healthcare report on the Oregon State Hospital – DRAFT, September 2010 (Full Text PDF)
Introduction & Summary
Review Team & Methodology
Part 1, Staff Compliance vs. Quality Management
Part 2, Leadership
Part 3, Decisive Authority
Part 4, Diffusion
Part 5, HIG and the Role of Quality Management
Part 6, Prime Causes of Overtime
Part 7, Improving Personnel Management
Report Attachments A through F
II. Review Team and Methodology
1. Members of the On-site Review Team
The Liberty’s on-site Review Team consisted of the following professionals, who conducted a five-day on-site review during the week of July 12, 2010. Ken Carabello, M.S.W. served as the Liberty’s on-site Review Team Leader. Mr. Carabello is the Director of Operations for the west coast for Liberty Healthcare Corporation. Ken is an experienced clinician/administrator, who has managed delivery of hospital-based clinical and staffing services as well as community-based forensic mental health programs. He is the immediate Past President of the Forensic Mental Health Association of California. Todd Graybill, M.P.H., MSW has extensive hospital management and “turnaround” experience. He currently serves as a senior executive consultant to the State mental health director in Indiana. He has managed two Indiana state hospitals, including its forensic facility. He has had an array of hospital management responsibilities in the public and private sector. Patricia L. Christian, Ph.D., M.S.N. has an extensive public hospital management track record as a CEO. Her clinical and management experience includes new hospital construction, patient relocations, reduction of seclusion and restraint, and certification and accreditation. She is currently in the Division of Health Services Regulation in North Carolina, where she served as CEO at various state hospitals from 1993-2008. She is a CMS surveyor and has taught nursing at the graduate level for nearly a decade. Cheryl Ouimet, M.S.W. is the Clinical Improvement and Compliance Consultant for the Division of Health and Human Services State Operated Healthcare Facilities in North Carolina. She has extensive experience as an expert in USDOJ situations and has held top leadership responsibilities for quality improvement in two large public hospitals for nearly a decade. Jerry Jennings, Ph.D. is Liberty Healthcare’s Vice President of Clinical Services. Dr. Jennings has a broad range of clinical and administrative experience in behavioral health and has published thirty articles and books in the field. He coauthored a highly successful forensic treatment model that is recognized as a best practice by the APA. This program successfully transitioned high risk forensic patients from inpatient to residential to community restoration with nearly zero recidivism. Dr. Jennings visited the campus one day and primarily assisted the Review Team in synthesizing and analyzing its findings and recommendations for this report.
In addition, Liberty’s Review Team conducted an extensive discussion with the following two clinicians who have been acting as clinical experts at OSH for several years: Jeffery Geller, M.D., M.H.P. is a nationally recognized psychiatrist who has been a consultant to OSH for several years. His familiarity with the hospital enabled the Liberty Review Team to accelerate its learning curve and integrate its observations and recommendations with those of the State’s other consultants and current priorities. Kris McLoughlin, D.N.P., A.P.R.N., BC, CADC-II is a nationally recognized psychiatric nurse who serves as an expert consultant to OSH. . She holds a Doctor of Nursing Practice with specializations in psychiatric mental health nursing and substance abuse treatment. Her contributions are well known to the hospital and the State of Oregon mental health executive team.
Dates of on-site review: Liberty’s Team Leader conducted an initial on-site visit to Oregon State Hospital on June 29-30 to meet the hospital management team and set the groundwork for the on-site review. Liberty’s designated Review Team then conducted its on-site review at the Salem campus from July 12 through July 15, 2010. Todd Graybill also reviewed the Portland campus on July 14, 2010.
On-site interviews and observations: The on-site team conducted extensive interviews with dozens of administrators, clinicians, employees and patients. These included scheduled and unscheduled interviews, team meetings, committee meetings, tours of every treatment mall and clinical unit, and even a “surprise” visit to the forensic units in the late night hours. The Review Team endeavored to speak with every key clinical and leadership position or team at OSH, but also make a point of talking with mid-level managers, employees and patients. In total, the Liberty Review Team directly observed over 25 units and met with and/or interviewed over 300 people. A schedule summary is included in Attachment D which shows the range and scope of the on-site unit tours, meetings, interviews and observation activities.
Review of documents: The Review Team requested a comprehensive list of policies, reports and materials for review in advance of the on-site visit and also requested and reviewed other documents over the course of the week. Some of the documents reviewed by the team are listed in Attachment D.
Consolidation of findings and report: During the week of the on-site review, the Liberty Review Team met together each evening to share observations and discuss issues and themes. Based on the progress of each day’s on-site review and the evening team discussions, the team flexibly shifted their focus to best maximize their time and efforts in assessing, interviewing and pursuing clarifying information. In the weeks after the on-site review, the Review Team worked closely to complete the report of its findings and recommendations. An initial draft of the report was shared with the two OSH consultant experts for their critical feedback, including suggested modifications or additional recommendations.
Note regarding the Team Review of the Portland facility: Liberty’s findings and recommendations reflect a predominant emphasis on the Salem campus of OSH. It is the opinion of the leadership and these reviewers that the Portland campus is better staffed and operates more effectively. As a comparative index of effectiveness between facilities, the average length of stay at Portland is approximately 250 days shorter (165 days without outliers) than Salem. Since the greatest challenges exist at the Salem facility, the Liberty Review Team focused the vast majority of its time and attention on the Salem campus. All told, the Liberty team spent approximately 12 hours dedicated to review of the Portland campus. The review process included visits to four representative units at the Portland facility. During the onsite visit, interviews and small group meetings were held with physicians, nurse supervisors, direct care staff and a number of patients. The most notable negatives observed at the Portland facility were deficient numbers of secretaries and Social Workers and some concerns about the low educational caliber of direct care staff (i.e., few college graduates). The team did not view these issues at the Portland campus as being as critical as the pervasive difficulties at Salem. Additionally, the team was impressed with the leadership of the Portland Campus, its clear lines of authority and the consistent, clear communication which is present within the Portland organization.