Parkland Makes Progress on CAP, but Safety Concerns Remain

Parkland Health and Hospital System continues to make progress on the hundreds of tasks that it must complete by April 2013 to meet the terms of its systems improvement agreement (SIA), according to the June 2012 monthly progress report from Alvarez & Marsal, the independent safety consultant hired to oversee the process.

The report, however,  notes ongoing concerns regarding the number of patient care, patient safety, and adverse events that have continued to occur at Parkland despite the implementation of a corrective action plan, the daily presence of A&M, and "numerous state visits regarding adverse patient events."

Among the "adverse quality and safety events:" wrong site surgery, medication errors, and EMTALA (Emergency Medical treatment and Active Labor Act) compliance issues.

In the report, A&M consultants lay the blame for these problems on the inability of some members of the hospital’s senior management team to drive "a true operations turnaround situation." In mid-July Parkland announced a new interim senior leadership team, which Debbie Branson, chair of the hospital's board of managers, characterized in a HealthLeaders Media interview as a team with "much-needed turnaround experience in the healthcare industry."

The June report is the third in a series of required monthly updates submitted to the Dallas office of the Centers for Medicare & Medicaid Services by Alvarez & Marsal Health Industry Group, a Washington D.C.-based management consulting firm that specializes in performance improvement.

The 36-page report was released Tuesday by CMS as part of a freedom of information request by HealthLeaders Media. The report itemizes about 400 tasks and action items, as well as completion dates, from the safety net hospital’s corrective action plan (CAP). Parkland has completed approximately 280, or 70% of the tasks.

Among the key goals met in June:

• Analysis of patient volumes in the emergency department, impatient clinics, and outpatient clinics to improve patient access and throughput.
• Study on case management, discharge planning, and related social work.
• Beginning electronic medical record enhancements to help with medication management, administration and reconciliation.
• Revision of crash cart management to improve the cart stocking process.
• Rollout of an informational campaign on patient safety, infection prevention, and patient rights.

In addition, the hospital has hired Mercer Consulting to revamp its human resources department, including a redesign of policies and procedures on performance management and progressive discipline. Additional outside consultants may be hired to help in case management, women's and infant's specialty health (WISH), and board governance.

According the report, problems persist in Parkland's efforts to "stabilize and transform psychiatric care." Deficiencies in this area set in motion a series of CMS surveys and immediate jeopardy rulings that led to Parkland and CMS signing in September 2011 a very rare SIA. Only one other hospital, Cape Fear Medical Center in Fayetteville, NC, currently operates under an SIA.

Parkland has made "only minimal progress" in recruiting permanent leadership, as well as consistent attending physician coverage for its psychiatric services, the report states.

In June, the hospital terminated its interim director of psychiatric services because of a delay in obtaining a current Texas RN license. Parkland has contracted with the University of Texas Southwestern Medical center to obtain locum tenens psychiatrists, but actual staffing has been delayed.

Parkland is also behind schedule in resolving systemic nursing deficiencies. Acuity-based staffing has not been implemented.. Despite recent training in the creation and documentation of care plans, "chart audit results suggest continuing deficiencies," the report says.

Keeping on the CAP schedule is particularly important as Parkland mounts a nationwide search for a permanent CEO. Thomas Royer, MD, was named interim CEO in November 2011. His contract was extended at least once, and his current contract is set to expire in September. Branson has said that she is "hopeful that we will have made significant progress toward the completion of the CAP and that will be a plus for anyone looking at the job."

In an e-mail exchange, David Wright, the deputy regional administrator for CMS Dallas, acknowledged that CMS "had hoped Parkland would be farther along, but we understand the reasons why some of the fixes have been delayed, and we have confidence the hospital will be able to make sustainable corrections within the time period spelled out by the Systems Improvement Agreement."