Parkland has been under intense scrutiny by federal and state official since mid 2011 and the report authors expressed surprise at the number of negative patient events encountered there since Nov. 2011. "The frequency and number of potential trigger events suggest that self-corrective actions taken by the hospital in response to the CMS surveys…have not been effective in creating a safer care environment."
While Parkland officials have declined to comment on any specifics of the gap analysis, Tom Royer, MD, interim CEO of Parkland Health & Hospital System, told HealthLeaders Media in a recent telephone interview that he has already implemented several changes designed to address some of the consulting firm's concerns. Royer said the hospital has started
- A daily huddle. The management team meets to review events of the past 24 hours to make sure any necessary corrective actions are taken, that the right policies are in place and that the staff is abiding by the policies. Royer says this has helped with what he calls "rapid cycle improvement."
- Reorganization of nursing services. A new chief nursing officer is in place and charged with developing a systemic and consistent approach to nursing practices. Royer notes that about 75% of Parkland's problems involve inconsistent nursing practices across the system. He wants to see more empowerment for nurses and more team building among the nurses, lead physicians, department chairs, and administrators.
- Reorganization of management team. The team now includes the head of human resources and the head of communications. Royer says human resources will make sure the hospital hires the right people, that employees are disciplined in a consistent fashion and that an accountable culture develops across the health system. Communications will help make sure that the health system has a consistent message across its departments.
- Creation of a medical executive committee. This group has responsibility for physician improvement issues, including resident training. The gap analysis report is very critical of the resident training program and attributes the "current operation of Parkland's resident training program" as contributing to the hospital's deficiencies in meeting all standards of the conditions of participation."
- Hiring of an Implementation officer. This position will be in place for the life of the SIA—six to 12 months—to make sure the improvement plan stays on track.
Royer says he plans to stage a mock CMS survey in a couple of months using two or three people familiar with the work of the CMS and Joint Commission. "Once we're satisfied that all of the improvements are in place we'll schedule a real survey," he said.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.