New report labels Oregon State Hospital ‘rudderless’

From The Salem Statesman Journal, September 4, 2010

A floundering, scattershot approach to solving massive problems has created confusion, disorganization and frustration at the Oregon State Hospital, state-hired consultants say in a new report.

Read the draft report from Liberty Healthcare.

“It is paradoxical that the very efforts to improve the hospital have contributed to the current confusion because changes have been implemented on so many fronts with such rapidity,” says a draft report obtained by The Statesman Journal.

“The sheer volume of change at OSH would overwhelm any organization, but we believe that the essential problem has been a lack of adequate planning and coordination of these improvement efforts.”

The report, prepared by a firm getting paid $175,000 to evaluate the hospital and recommend improvements, describes the Salem psychiatric facility as rudderless and reeling from “paralyzed decision-making.”

“Staff at all levels are hampered by uncertainty about who is in charge and who is making decisions with regard to different functions,” it says.

The consultants also rapped the hospital for assembling a collection of 28 standing committees, all attacking problems in uncoordinated fashion.

“Committees and teams are working in isolation and ignorance of each other’s goals and interventions and there is serious confusion about which entities hold the authority to resolve issues and are accountable for results,” the report says.

Hospital managers and professionals “universally complain about having to attend too many meetings, which translates into a massive drain on clinical staff resources and detracts from the primary mission of patient care,” states the report.

Liberty Healthcare, a Pennsylvania-based firm, issued the draft report after sending a review team to OSH in July. The consulting team spent four days at the hospital, toured 26 units and met with more than 300 people.

Liberty is scheduled to deliver a final report by the end of the month.

The Statesman Journal obtained the preliminary report through a public records request filed with the state.

The pending arrival of a new superintendent should add some stability to the hospital, according to the consultants.

“Presently, OSH is also floundering under capable, yet reluctant and disorganized leadership,” the report says. “The Liberty Review Team believes that the expected hiring of a high energy, competent superintendent will provide much more stability and direction to the organization. The new superintendent will be the final authority for enforcing compliance through standardized operations across units.”

The incoming OSH superintendent is Greg Roberts, a long-time New Jersey psychiatric hospital administrator. He is scheduled to take the reins on Sept. 20.

Staff stumped on goals

Many hospital employees reportedly had trouble answering a basic question posed by the consultants: What are the top goals at Oregon’s main mental hospital?

“During multiple interviews with a variety of clinical and direct care staff on the units and in the treatment malls, no one could answer the question, ‘What are the two most important hospital goals or quality improvement initiatives that OSH is working on this year?'” the report says. “Many staff said they didn’t know, some cited the (Department of Human Services) core values, some flipped their ID badge over and recited the National Patient Safety Goals, and others made a guess that it was ‘ensuring the safety and security of the patients?'”

The consultants also reported that hospital managers tolerate poor performance by bad employees because “there is prevalent thinking that managers can do little to discipline or remove problem employees.”

These managers “retreat into helplessness,” partly based on their false perceptions and lack of knowledge about how the personnel system works, the report says.

“Clinical managers have looked to HR to handle personnel issues, while HR declines such responsibility because it is a management issue,” it says. “At the same time, undue fear of union issues and the lack of management knowledge concerning the personnel system have re-inforced the conviction that it is exceedingly difficult to remove problematic employees. Reluctant to act, managers retreat into helplessness and tolerate continued poor performance from problem employees whose behavior hurts team cohesion and morale.”

Sweeping changes proposed

The draft report spells out dozens of recommendations for hospital improvements.

Among them:

    -Shrink the number of committees.
    -Define the hospital’s mission, vision and values and communicate them to the staff.
    -Establish hospital-wide quality goals.
    -Direct managers to spend more time with staffers on the treatment units.
    -Provide training for managers to help them manage problem employees.
    -Consider hiring a full-time labor relations expert to serve as a liaison between hospital management, human resources and the unions representing employees.
    -Provide mentoring for new line staffers to help them feel comfortable in working with an aggressive population.
    -Improve the patient grievance process.

“Patients have little to no faith in the grievance process,” the consultants reported. “Staff has been lax in reviewing, investigating and providing a reply to patients about complaints within the set time requirements. All too often complaints simply ‘drop into a black hole’ by being lost, destroyed or ignored entirely.”

Interim hospital superintendent Nena Strickland said this week in an e-mail to hospital advisory board members that the consulting report “accomplishes what we have asked Liberty to do.

“The consultants interviewed dozens of staff on all shifts. They brought in a team of people and completed an in-depth review. This work provides us with an objective and helpful view of OSH operations and helps us stay on track with our relentless pursuit of continually improved patient care and safety.”

Strickland said Liberty’s final report might be different than the draft.

“It is important to remember that this is a draft and there are a few places we want to work with Liberty and provide them more information.” she wrote. “Liberty’s analysis and recommendations may change as a result. As we are in the draft stage it is too soon to be talking about specifics.”