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
Part 4. Diffusion – Proliferation of committees and diffusion of leadership authority
Summary: In its earnest initiatives to correct problems and improve health delivery as quickly as possible, the hospital has initiated multiple committees and workgroups to take action. Unfortunately, this proliferation of committees has contributed to the disorganization. With approximately 28 standing committees, nine MAHPS committees and eight transition workgroups, it is nearly impossible to communicate and coordinate efforts. 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. Personnel universally complain of attending too many meetings, which translates into a massive drain on clinical staff resources that detract from the primary mission of patient care. The excessive reliance on committees gives the appearance of greater inclusion of input from all participants, but has paralyzed decision-making and action. There is a need to greatly simplify and streamline the committees and workgroups, such as consolidating clinically-focused committees, disbanding committees performing duplicate functions and time-limiting the work of performance improvement teams and working groups. Some functions do not require their own committee and can be consolidated. For example, the EBP Committee could be disbanded and include an EBP representative on relevant clinical and QI committees, and the Patient Rights Committee (which meets infrequently and seems to have a rather vague charge) could be eliminated with the Patient Grievance Committee elevated in the organization with reporting directly to the Superintendant. One of the 2010 goals of the Quality Council is to “support, monitor, and evaluate all OSH Committee activities”. The Liberty Review Team questions the utility of this goal, which is an artifact of a cumbersome system. OSH has had to create an entire infrastructure, supported by QI staff, to track its committee activities. The process is labor intensive and ineffective. On the contrary, if the committee system can be consolidated and streamlined as we recommend, it will eliminate the need to have this added infrastructure to monitor the uncoordinated work of multiple committees.
D 4.1 – Consolidation of goals between and across committees: Although each of the various committees has important goals for the year, these goals are not known or understood by other committees or by pertinent clinical and operational personnel. The success of many goals is dependent on staff working together. For example, the Patient Safety Committee has set goals to reduce the use of restraints by 20%, seclusion by 10% and serious injuries from falls by 10%. We recommend using these paramount goals as hospital-wide goals that nearly everyone, at every level of the organization, is aware of and invested in achieving.
D 4.2. – Consolidate clinical committees: Consolidate the committees that primarily address clinical operations and combine functions under a Clinical Services structure. Specifically, at least four of the subcommittees currently under the Care of Patients Committee (Core Curriculum, Treatment Care Planning Advisory Group, Treatment Mall Planning, Recovery Work Groups, and possibly BSP and START as well) should be realigned under and/or the functions incorporated in to a Clinical Services Committee chaired by the CMO, CNO and the Clinical Director.
D 4.3. – Eliminate committees with duplicate functions: The Liberty Review Team recommends disbanding committees that appear to serve duplicate functions and/or combining affiliated functions that can be assumed by other committees.
D 4.3.a. Eliminate the Patient Rights Committee: The Patient Rights Committee has many of the same functions as the Patient Council or Patient Grievance Committee.
D 4.3.b. Eliminate the Patient Care Consults: This is a “one-person” committee that primarily focuses on challenging clinical cases that can be assigned to a clinician reviewer based on the nature of the case. D
4.3.c. Disband EBP Committee: The EBP Committee could be disbanded in favor of including an EBP representative on relevant clinical and QI committees. An EBP expert could also serve as a consultant to clinical services and QI committees
D 4.4. – Apply time-limits to consolidate PITs: There are many subcommittees under Care of Patient and Patient Safety Committees within the QI Program structure. These are reported as standing subcommittees rather than Performance Improvement Teams (PITs); PITs are short-term, focused work-groups that tackle a specific assignment, present recommendations to the Quality Council and then disband. OSH has tried to abstain from initiating any new PITs because there is so much transitional work-group activity occurring on campus at the present time. Nonetheless, OSH has added layers of subcommittees under the Quality Council Committees which should be re-evaluated as PITs or assumed under the direction of clinical leadership.
D 4.5. – Re-classify long-term subcommittees as short-term PITs: The Review Team recommends that the following subcommittees should be re-classified as short-term (e.g., 24 months) focused, time-limited Performance Improvement Teams that report recommendations back to the QI or Clinical Services Group and are then disbanded: Seclusion & Restraint, Diversity, Metabolic Syndrome, Self-Harm and HAP. Additionally, we recommend that these committees should come to QC with specific reasons to justify their existence. See Organization chart in Attachment E for recommended restructuring of committees.***