Turnover at TMH: Part 3
Quality of care issues, the board’s role and community communication
December 13, 2012
At the end of the day, what matters to most regarding a hospital is that it meets their health needs without forcing them to leave the community they live in.
With much talk about physicians leaving the The Memorial Hospital in Craig to go elsewhere for employment, those on both sides of the issue — hospital administration, employees and employees who left — have spoken out about the hospital's process for addressing quality of care issues as well as the community impact that results when a physician departs.
The following is part three of a three-part series examining the issue of physician retention at TMH — if the current administration's policies regarding review of quality care issues are causing doctors to depart as well as how the hospital's board factors into the situation — told from the perspective of current and former hospital employees, as well as current administrators and board members.
"I think it's certainly understandable if a physician you were seeing and had a relationship with leaves. That's difficult. We all understand that. But the concern about will there be someone here to take care of me? A good person? Somebody I like? A quality physician? We can answer yes."
— TMH CEO George Rohrich
With physicians leaving, community members may worry whether or not they'll have adequate access to care.
The physicians employed by TMH said there is nothing to worry about.
They've been able to hire a second person for anesthesia to fill in the gap left by former contract anesthesiologist Tammy Rice's departure and the operating rooms run like they always have, Womble said.
"I think one of the great things that the hospital has really been doing is addressing the needs we have here," said Dr. Kristie Yarmer, a pediatrician for TMH. "Because there are needs in this community. That had never been filled, and they're beginning to fill those needs and expand out."
But Dr. Stan Pense, a doctor who recently left TMH, said he's been at odds with administration because of a quality care issue.
"Basically every hospital has a quality of care committee and when things go bad they evaluate doctors," he said. "There are issues they've been sweeping under the rug for a lot of years.
"When I couldn't take it any more I went to the state board of examiners and turned in a doctor. I've been on the outs since then."
Although unable to respond to specific personnel issues, Jennifer Riley, TMH's chief of organizational excellence, said the process for reviewing all issues regarding quality of care is thorough and transparent.
"It's important to understand that any time an issue about the quality of care is raised, we address it — relying on internal and external review processes," Riley said.
Providing documents that explain the process for addressing a quality of care issue, Riley offered five steps that are taken every time, whether the issue is complaint or criteria driven:
- The hospital's Medical Executive Committee — three doctors elected by the entire medical staff — reviews the case, asking detailed questions, examining patient and doctor records, and meeting with involved doctors and staff to see if the hospital's standard of care was met.
- After the above in-depth internal review, if needed, the committee may refer the case to an outside professional review agency unaffiliated with the hospital. A qualified doctor practicing in the same field, but not at TMH, evaluates all information then provides the committee with their opinion.
- The committee combines its assessment with the outside peer evaluation and makes a final decision.
- Physicians involved in any case being reviewed are not allowed to participate in the process unless being questioned.
- Outcomes of the review may include: confirmation the standard of care was met, a recommendation for additional training or monitoring of skills by a qualified physician. Although shared with the physician whose case is under review, the outcomes are protected by law and not shared publicly.
Riley said she monitors and oversees the clinic, speaks with the practice manager every day and keeps tabs on the number of patient medical charts that are released to other health care institutions.
"There really isn't," Riley said about the prospect of many patients requesting transfer. "I mean a few people have requested their charts be transferred elsewhere, but it's minimal. It's not this huge outflow of patients."
And Riley said she's seen far more new patients at TMH since Yarmer came onboard than she has witnessed leaving.
"I think the access issue is being addressed by the physicians in the community," Rohrich said. "They're stepping up and doing whatever it needs to be done to see those patients, as opposed to turning them away."
"I don't know if they feel like they can't or shouldn't. I know George didn't like it when employees or physicians spoke with the board. I answer to the CEO but the CEO should answer to the board, which means the board is my boss as well. There should be open communication. The important issue is the community of Craig. They deserve better and they've been lied to."
— Dr. Troy Phillips
After giving his letter of resignation, Dr. Troy Phillips said he was disappointed by the lack of action taken by the TMH Board of Trustees.
After sending the letter in April, allowing for a four-month notice per his contract, Phillips said he heard no response from any of the board members.
He had hoped for an exit interview, or at least to touch base, but Phillips said he felt the board didn't put forth much effort.
Things were different for Rice.
When she resigned board member Don Cook called to see if there was anything he could do to convince her to stay, but it was too little too late, Rice said.
Don Myers, board chairman, said although it's a problem anytime doctors want to leave, he and the board are working on taking a more active role in physician retention and negotiations.
They formed a medical staff development committee featuring two board members to participate in the process.
"We did this so the board would have a little more input and be more aware of concerns people have," Myers said. "We are concerned about it and trying to take steps to minimize any problems we would have in the future."
Rohrich said the committee allows the board to be involved in reviewing negotiations, including offers, counter offers and deciding on what kinds of benefits packages are offered to physicians.
Although he is not directly involved with the board, Womble said the administration appears to be involved from what he can tell.
"There are checks and balances, just like there are supposed to be in our government," Womble said. "The board is not completely autonomous, George is not completely autonomous, administration is not completely autonomous. You know, they all work together to help the medical community run as best as they can."
"This is more a reflection of a breakdown in procedures and structure, reflected not only in the loss of physicians but also in multiple key staffing areas. I think we need to keep letting the community know that this is a community hospital. It's to benefit our community. The community can help by attending board meetings (and) also talking personally or emailing board members with their concerns."
— Dr. Pamela Kinder
Regardless of whether it is miscommunication or a lack of communication, both invite feelings of hostility.
That's why Dr. Pamela Kinder, a neurologist and operator of Kinder Family Clinic in Craig, said she feels the entire situation is extremely complicated, and thinks the solution lies in voicing concerns and making an effort.
"It will take a lot of work and compromise on both parts," Kinder said. "All of our procedures should be clear and shouldn't vary from situation to situation. It's where we really need to keep communication lines open."
And although no side may agree even slightly on who's at fault for physicians leaving, they all do seem to agree on one thing — doing what's best for the health and well being of Craig's residents.
"The sky has not fallen," Womble said. "We're still going to be able to provide excellent medical care here in this hospital and in this community."
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