INDIAN RIVER COUNTY — The long-awaited top-down review of operations at the Indian River Medical Center finally saw the light of day at a public meeting of the Hospital District Trustees last week.
The study cost $75,000 to prepare, but Hospital CEO Jeff Susi said immediately that it didn’t tell him anything he didn’t already know – namely that the Emergency Room still needs substantial improvement.
Besides the need for improvements in the performance of the emergency department, the highlights of the report, delivered by Stuart McLean, the Westchester, NY-based Managing Director of the national Alvarez and Marsal healthcare consultants, were that:
The hospital is well-managed, which McLean, upon being pressed for details, said only means that hospital management is doing a good job staying more or less close to breakeven and debt-free in a challenging healthcare environment, with the help of generous local donors.
The hospital’s clinical performance is “undistinguished,” meaning it is neither good nor bad.
The hospital has serious problems with patient satisfaction and physician engagement, and has failed to address such basic complaints as too much noise and lack of cleanliness.
The District Trustees had insisted on the top-down review as one of the conditions for their approval of management’s plans to build a $30 million cancer center, but they had to fight over the past few weeks to get to hear even the executive summary of it.
From their questions, it appeared that some of the trustees were a little disappointed that the report was short on specific recommendations on how to fix the problems. Some Trustees also asked why the report had not addressed the hospital’s “culture” problem.
Critics of the present hospital management team say the culture at the hospital is one of “fear and intimidation,” but Susi himself got emotional when he said that the 1,600 people working at the hospital are fiercely loyal to the institution and have rallied together in a spirit of high morale amid what he called unrelenting attacks by the media.
Susi said the hospital had recently commissioned employee and physician satisfaction surveys conducted by an independent firm. He declined to release the results, but he said the hospital now knows what its baseline is so it will be able to measure progress in the future.
McLean, the consultant, referred to the Indian River Medical Center several times during his presentation as a “lowcost provider” of medical services, which the hospital needs to be to keep its costs down and remain near break-even.
But that creates a catch-22 situation, McLean said. To increase patient satisfaction and physician buy-in, the hospital will have to spend some money, which could once again push it into the red.
Susi himself admitted that the staff cuts he made late last summer “went too deep,” and vowed to reverse some of them.
In an action plan to address some of the deficiencies pointed out by the consultant’s report, Susi also said he would install pillow speakers in hospital beds so that many elderly hard-of-hearing patients don’t run their TVs at full blast, which contributes to the perception of a noise problem.
Susi’s action plan also includes continuing attention to the emergency room, although he said that May was its best month in a long time with an average “door-to-doc” time (the time it takes a patient to get to a doctor after walking in the door) of only 29 minutes. It had been much higher.
The emergency room came in for some of the sharpest criticism in the Alvarez and Marsal report, because 4 percent of emergency room patients leave without ever being seen by a medical professional. That’s double the national average, which is only 2 percent.
McLean said the hospital must find a way to break through the vicious circle in which a patient leaves the hospital dissatisfied and gives his or her primary care physician an earful, after which the physician sends his next patient to Sebastian River Hospital.
“I’ve heard that from physicians here, and there is a negative perception around the hospital in the community,” he said.
McLean did give hospital management one specific recommendation that he said has helped elsewhere. After a patient leaves the hospital, have someone call the patient and give him or her a chance to sound off and talk about their experience.
That extra touch point “doesn’t change what was done, but it changes the score” on satisfaction surveys, McLean said.
Changing the score will be vital in future years, McLean warned, because Medicare will levy increasing penalties against hospitals that do not score well on patient satisfaction.