Mission Executives Can Overcome Challenges to Prioritize Patient Well-being - TribPapers

Mission Executives Can Overcome Challenges to Prioritize Patient Well-being

Should Mission sell its logo and/or divest itself of divisions in order to pay for quality care that rebuilds patient confidence?

Asheville – Recently, at a panel discussion organized by Asheville Watchdog, Dr. Clay Ballantine, founding member of Asheville Hospatilists, raised concerns about various issues faced by individuals at Mission Hospital since its acquisition by HCA. Following a comprehensive survey conducted by DHHS, Greg Lowe, president of HCA’s North Carolina Division, acknowledged that Mission Hospital received an “immediate jeopardy” determination from CMS. This meant that unless corrective measures were implemented, the hospital would lose Medicare and Medicaid reimbursements. Thankfully, Mission Hospital has submitted a corrective action plan within the stipulated timeframe.

Addressing Ballantine’s concerns, the solutions are clear: hire consultants, adopt and adapt proven technologies, streamline administrative tasks, and advocate for regulations that prioritize health and safety. Though the specifics of the NCDHHS investigation remain undisclosed, feedback on nine incidents from last year, including two significant ones that posed immediate jeopardy, indicates the need for additional staffing and resources. Mission is already actively recruiting RNs and prioritizing emergency department positions.

A primary issue in Ballantine’s grievances is the existence of self-imposed rules that do not prioritize patient health and safety. One such rule mentioned is that all Mission patients are required to go through the emergency department first, leading to unnecessary congestion and idleness in other areas of the hospital. While this policy does not apply to scheduled surgeries, it is criticized as being inflexible and primarily focused on financial considerations, according to activists in Asheville.

The superficial recommendation would be, “Don’t.” Speculating about why a rule like this would be adopted in the first place suggests the hospital could use greater interoperability features in its software for patient intake. It looks like Mission is already hiring more staff to help with intake. HCA is advertising for 126 openings in its IT group, but just one position for Asheville.

According to Ballantine’s complaint, there is a lack of schedulers at Mission, which is a common issue in hospitals. To address this, Mission can hire temporary schedulers while implementing a new scheduling hierarchy. It is assumed that Mission has already worked with a consultant to determine the most effective organizational structure. One suggestion is to have general schedulers handle non-complex appointments and have specialized department schedulers handle special-case needs. Mission should also explore ways to optimize the use of walk-in clinics and increase awareness of services like Mission My Care Now.

Other large hospital systems effectively manage their procedures and staffing despite having fewer schedulers. Wild vicissitudes in staffing demand plague the industry, but Mission doesn’t appear to be fully realizing the benefits promised by various package solutions. Software like MakeShift allows nurses to customize their availability, swap shifts, and identify open time slots for substitutes with the required skills in real time. It enables schedulers to track overtime and burnout risks, and it integrates well with most payroll software. Mission should have the resources to hire a team to customize, integrate, and scale up available technology.

Does Mission prioritize interdisciplinary training? Are general skill floaters available at all times? Are there agreements with other hospitals for specialist access? Are there contracts with temp agencies? Can Mission hire more traveling nurses? Does Mission have autonomy to adjust systems and schedules, or is it controlled by corporate headquarters?

Replacing the 200 doctors who left Mission after its acquisition by HCA will be a challenging task. According to VITAL WorkLife, 18% of healthcare workers nationwide quit their jobs since 2020, and 20%-50% of doctors and nurses surveyed expressed intentions to quit in 2024. Complaints from doctors who left Mission included administrative staff reductions inundating nurses’ responsibilities, leaving doctors short-handed. Ballantine credited untenable contracts and position cuts for other departures.

A consultant with expertise in contract mediation could help. To recruit the best and brightest, any hospital should respect the fact that doctors have spent a chunk of their lives mastering science and problem-solving skills to make lives better. Good leaders facilitate the implementation of good decisions. The JAMA network, incidentally, just published a brief on how to recruit doctors. Ideas included writing into contracts safeguards for exercising professional judgment and accessing resources for personal health.

Everywhere, quality of care is not keeping pace with the quantity of informatics demanded by Obamacare. Stories abound of doctor inattention and medical records that read like works of fiction. Some of this is GIGO that can be reduced with the Management 101 tenet of giving hires the tools they need to succeed, the most obvious tool here being more time for problem-solving. If the load of state and federal paperwork is proving detrimental to patient outcomes, HCA has the resources to lobby for better laws. According to OpenSecrets.org, HCA spent $3.75 million on lobbying last year.

The advantages of spinning off departments to private practice rather than downsizing should also be explored. Unfortunately, the insurance and legislative infrastructure, with heavy administrative overload and “products” like certificates of need, has been built to protect the agglomerations of large hospitals against lateral entry. HCA cannot, pragmatically, be expected to lobby against regulations that grant it marketshare.

Editor’s Note: We welcome our readers to respond about this article at editor@tribpapers.com