Minutes 2/5/08 HOSPITAL MANAGEMENT AND OPERATIONS WORKGROUP

MINUTES

HOSPITAL MANAGEMENT AND OPERATIONS WORKGROUP

ADAMS BLDG, ROOM 264

Tuesday, February 5, 2008

ATTENDANCE:

Dr. David Rubinow, Mike Pedneau, Dr. Stephen Oxley, Cliff Hood, Peter Mumma, Iris Rubin, Rickye Collie, Mike Hennike, Laura White, Dr. Jack St. Clair, Deby Dihoff, Dr. John Esse, David Womble, Laura Thomas, Carmen Vincent, Dr. Donald Baucom, Pamela Graham, Dr. Michael Zarzar, Dr. Patsy Christian, Barbara Whitaker, Kathryn Davis, Walker Wilson,

Patti Henke

ITEM	RECOMMENDATIONS/ CONCLUSIONS/ACTION	FOLLOW-UP
Welcome and Introductions	Mike Pedneau welcomed the group and requested everyone introduce themselves. He asked that any revisions to the minutes from the last meeting be given to him outside the meeting.	N/A
Central Regional Hospital Staff Model	Dr. Patsy Christian and Dr. Steve Oxley provided information on the CRH Staffing Model in a power point presentation. This same program had been shared previously with Secretary Hooker Odom and Central Region Hospital Steering Committee. Copies of the presentation will be provided with the minutes. The presentation included information on benchmarks from other state hospitals nationally and in North Carolina. There are very few states with psychiatric hospitals that admit the volume of acute patients as North Carolina, so comparison data is limited. One expectation during the development of the model was that the consolidation of DDH and JUH would result in savings that could be transferred to the community which limited the number of staff that could be included in the staffing plan. The staffing ratios are consistent with the current ratios at the 4 state hospitals. Specifics of the staffing plan include: formula for HCTs based on current staffing for DDH & JUH as bench mark and does not include positions for 1 to 1 coverage. Nursing staffing including RN, LPN and HCTs do not have enough positions to allow for time in training without the use of overtime. Dr. Oxley indicated that the number of psychiatrists for CRH is based on the number of admissions rather than census. Dr. Christian was asked if there were areas that CRH will be short staffed and she indicated that there is not staff dedicated to the treatment mall, which may make coverage of the 120 daily groups difficult. Dr. Rubinow asked if CRH staffing model is adequate to meet regulatory requirements. Dr. Oxley answered that, in his opinion, it is not. Several members of the group concurred that the staffing presented was inadequate and had potential risk and liability implications. Discussion followed that staffing at the hospitals has not increased commensurate with the increased volume and high acuity of patients. Dr. Christian discussed recruiting activities for CRH including job fairs and billboards (first time this has been done by state operated facilities). Recruitment of nurses is expected to be the biggest challenge. Attracting enough male HCTs is also problematic. CRH is currently expecting to have 5 – 6 vacancies for psychiatrists. The staffing model for CRH is intended to be replicated at Cherry and Broughton Hospitals once the new facilities are constructed. Dr. St. Clair and Dr. Esse both indicated that Cherry and Broughton Hospitals have many of the same staffing issues that Dr. Oxley and Dr. Christian discussed. Both Cherry and Broughton also have significant challenges recruiting psychiatrists.	Staff to the Workgroup to provide requested data (also see next section)
Metrics	Several members of the workgroup requested data related to staffing and hospital operations. The following was requested: restraint rates, patient injury rates, 30 day readmission rates, temporary employees – number and cost, vacancy rates, nursing staffing by hospital x discipline x unit x shift for Oct. 2007, lost work days, turnover rates for RN, LPN, HCT, SW, Psychologists, Psychiatrists, staff and patient satisfaction survey results, education levels of current nursing staff, discharge destination data, diversion and delay data, admission/discharge rules, facility/LME contract, denial rates, percent of patients seen within 7 days of discharge, percent of discharge planning that was done jointly between hospital and LME, number of CON and operational psychiatric inpatient hospital beds in the community.	Staff to the Workgroup to provide requested data
Centralized and Standardized Policies	Laura White handed out a list of Corporate Policies that are in place, being developed or to be reviewed. In addition to the policies, Governing Body Reports will be standardized across the hospitals. An example of a draft Corporate Policy, State and Federal Death Reporting, was also handed out. Each hospital has participated in the development of the Corporate Policies or will have the ability to provide input prior to finalization. Corporate Policies are based on philosophical underpinnings, regulatory requirements and existing DMH/DD/SAS policy. Each hospital then develops an operation procedure detailing how the Corporate Policy is carried out. Some policies apply to all state operated facilities, not just hospitals. Mike Pedneau asked for volunteers to review the draft Corporate Policies.	M. Peadneau and other interested workgroup members will review policies and provide feedback.
Accreditation Issues	Iris Rubin handed out and discussed the report North Carolina State Hospitals Regulatory Report Summary. The report lists deficiencies identified by DHSR/CMS, JC and USDOJ. The report does not contain information about Plans of Correction and steps that have already been implemented to address the deficiencies.
Next Meeting	February 19, 2008 at 1:00 p.m.

There being no further business, the meeting was adjourned at 3:05 p.m.