Open Letter to
Hospital District One Board of Commissioners:
The raises given to upper management of Skagit Valley Hospital are out of line.
Almost everybody I talk to wants to make a sarcastic remark about those raises. Even people in the community have stopped me to ask, “What is going on at our hospital?” It is especially galling to the employees who have had their annual leave accrual reduced; “I sure hope they are going to enjoy being on the beach in Hawaii using the annual leave money that has been denied to me.” The anger is palpable.
Your letter of Jan. 27, 2012 goes on to justify additional bonuses to upper management based on:“… an incentive plan based on predetermined metrics including organizational operating margin…days cash on hand…value base purchasing…provider productivity…and growth in key service line volume. Incentives are the standard in larger health care organizations. All the metrics are objective, measurable and put focus on maintaining the health of the organization and, most importantly, providing quality patient care.”
All that emphasis on “metrics, margins, cash, value base, productivity, growth, health of the organization is followed up at the very end, with just a small soupçon of reassurance about “quality patient care.” What if that last paragraph had talked about, “Quality patient care as defined by: improved patient satisfaction scores, lower infection rates, improved staff knowledge measured by before and after surveys, higher staff morale, etc.”? You know — why not emphasize the reason people come to the hospital or the clinics — the stuff that actually makes a difference in life vs. death, recovery vs. lingering, and pain vs. comfort?
I can truthfully and proudly say that there is a lot of care that goes very well at Skagit. E.g. the institution of the sepsis protocol has had a great positive impact. I was in the ER the other day and a patient came in having a heart attack and was whisked to the cath lab in well under the “door to balloon” goal time. The STAT Nurse program has resulted in a dramatic reduction in Code Blues outside CCU, etc., etc. These and other programs would not be in place had they not been supported by our management team. They deserve kudos for getting these things going, but let’s not forget the employees who are actually implementing this good work. Where are their comparable raises?
Why is staff morale so important?
Speaking from a nurse’s point of view, high quality patient care is a thoughtful, creative process that needs one’s muse inspired and fired up. We need to be physically, emotionally, and even spiritually well. Studies show that outcomes worsen if nurses are burned out. Under trying conditions we can still feel like we are doing our “absolute best,” but from your leadership vantage point please think about the “absolute best” performance from a positive minded, well supported nurse vs. the performance of a nurse who feels insulted and rejected. It’s your call.
I hope you will exert leadership to ameliorate our morale problems. There are things you can do right away if you are willing to break out of the box and really try to improve things. Here are my suggestions:
Because of the state law that was passed at the instigation of Dick Goldsmith, a lobbyist for the Association of Washington Public Hospital Districts, a nurse employee was unable to serve on the board unless she gave up her job, even though she won the election. Now that you know the will of the people, use your influence to have the lobbyist go through the same motions and get that law changed back to where it used to be.
Develop a 0.1 – 0.2 FTE position for a staff nurse to advise the Board on how your decisions impact patient care. Staff nurses and nursing administrators have different perspectives. It would be useful for you to get a staff nurse perspective.
A good move to counteract some of this would be to return the employees’ lost annual leave accrual.
Revisit the Vision, Mission and Values statement and look at how much is said about,”… compassion and dignity, one patient at a time….patients first…safe and healing experiences…excellence and highest standards…culture of respect…listens well…team and patient focused” etc. Please examine how much of your time and leadership effort is spent on quality of patient care and developing strategies to keep staff morale, and therefore productivity, at a high level
Summary:
In our tough economic times, big raises for people who are already in the upper income range have generated cynicism, hard feelings, and lowered morale.
Lowered morale potentiates staff burnout, which lowers quality of care and productivity.
The Board has the ultimate decision-making power to turn this around.
If the Board has the courage to make changes and is willing to display Leadership with a capital “L,” this drop in morale can be turned around and have a very long term positive effect.
