Parkland Hospital in Dallas is making significant enough progress on its federally mandated improvements to quality and safety that it is preparing for two mock surveys, in advance of its next inspection by the Centers for Medicare & Medicaid Services.
The mock surveys will serve as practice for CMS's actual survey, which it will conduct to determine whether the safety net hospital is eligible to continue receiving Medicare and Medicaid funding.
That announcement at Parkland's board of managers meeting Tuesday is one of several benchmarks Ron Laxton, RN, chief implementation officer and interim chief operations officer, pointed to as proof that Parkland is moving forward under the hospital's Corrective Action Plan . The board is briefed on developments monthly.
"This is a different organization than when I walked in ...in March," Laxton told board members at the end of his 30-minute presentation. "Are we doing everything right? Not yet. Are we working towards our goal? Absolutely."
October's corrective action plan progress report
The consulting firm Alvarez & Marsal developed Parkland's CAP and is overseeing its implementation. Peter Urbanowicz, who heads the firm's healthcare compliance arm, was also at Tuesday's board meeting to brief members on Parkland's steps forward. He called the hospital a "very changed organization," from when his firm was hired in 2011 to develop the CAP.
"We're very impressed with progress; [there is] lots of work still to do, but where we are today versus where we were when we came in ... is markedly improved," says Urbanowicz.
Of the 499 recommendations in Parkland's CAP, the hospital has completed 454, or 91%. Among the accomplishments Laxton highlighted are new resources for Parkland's emergency department . As recommended by Alvarez & Marsal, the hospital has added:
- 4 triage rooms
- 27 seats to its waiting room (18 reclining seats to be added by end of December 2012)
- Physicians to staff main ED on weeknights
The hospital also just signed a contract with EmCare for an urgent care clinic that is estimated to decrease a patient's length of stay in the ED by 75 minutes, or 20%. Already, ED LOS is down 28 minutes. "We are eating away at long wait times," says Laxton.
Changes in the ED are also expected to have a positive effect on patient flow, which had been an area of concern. Other progress noted by Laxton included:
- Revised nursing policies and procedures
- Implementation of a patient relations dashboard to resolve grievances and complaints
- Filled vacancies in nursing leadership
- Executive rounding throughout the hospital
"We're not finished"
There are still major hurdles Parkland must overcome before its CMS survey, which will be unannounced but complete by April 2013.
For example, the hospital still hasn't found someone to fill the position of a newly-created Chief Patient Rights and Safety Officer (CPRSO), which according to Alvarez & Marsal's CAP analysis would help Parkland "elevate the role of protecting patient rights and safety within the organization."
The CPRSO will head, also newly-created, the department of Patient Rights and Safety, which requires a reorganization of the hospital's Quality department. Laxton says Parkland is actively interviewing recognized leaders for the CPRSO position; however, even job candidates are questioning exactly what they'd be responsible for since it requires gathering so much information that isn't currently shared.
Laxton says the hiring delay is purposeful. "So that we get the role right; we are not alarmed by it."
Other, more serious recommendations that haven't yet been implemented are in the case management area. Parkland hasn't been able to improve the volume of patients discharged before 11 AM, and it has only completed 17% of measures recommended to improve patients' continuum of care beyond the acute setting.
Next Steps
CMS put Parkland under a systems improvement agreement in September 2011. It's a rare course of action saved only for those healthcare organizations that are in danger of losing Medicare certification and funding because of serious infractions that could harm patients. Cape Fear Valley Medical Center in Fayetteville, N.C., is the only other hospital currently operating under an SIA.
When asked about Parkland's progress, CMS spokesman Bob Moos emailed a statement indicating the federal agency was pleased with what the hospital had accomplished.
"Parkland is continuing to progress through the elements of the Corrective Action Plan. The focus now shifts toward making sure that those practices are embedded into the hospital's operations to ensure sustainable compliance with federal requirements."
CMS gave Parkland an April 2013 deadline to improve its performance or lose certification and therefore funding. That's just four months away, but Laxton and Urbanowicz are doing everything they can to hammer the message that Parkland is a safe place for patients.
They're training hospital staff to be ready to respond to a pair of mock surveys. The first one is to take place next month, the other in February.
"We're trying to emulate the kind of activities a surveyor would do, such as going out to each unit at all shifts. We have people on our team who will come in Saturday night at 9:00 or early morning hours on a Monday morning," says Urbanowicz.
Board members were generally pleased with October's progress report.
The board also approved a two-month extension of interim Chief Executive Officer, Robert "Bob" Smith's term. Smith is a retired executive from Dallas-based Tenet Healthcare Corp. His original four-month contract will now last for at least six months, with the option to be approved on a monthly basis after February. Smith is Parkland's second interim CEO.
He declined to be a candidate for a permanent CEO, in a recent interview, saying "... it's not something I am interested in. If I were at a younger stage in my career it would be an attractive position."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.