Posted on Mon, May. 07, 2012
Jackson Chief Executive Carlos Migoya says quality of care “continues to improve,” even during three months when many employees were required to take furloughs.
The latest quality report, prepared monthly for Jackson’s board, shows that for three critical measurements of infection rates — involving catheters, ventilators and lines into the bloodstream — Jackson’s performance in February was in the top quarter of hospitals nationwide. In all three categories, Jackson rated considerably better than it had in February 2011.
The rate of medication errors was 2.4 per 1000 patient days in February — compared to 3.7 per 1,000 patient days in November, before the furloughs began.
Not all of Jackson’s quality measures are top rate. Patient fall rates with injuries through March was 12 percent higher than a year before.
“We are improving” on most fronts, “but we aren’t where we need to be,” Kevin Andrews, Jackson’s vice president of quality and patient safety, told Jackson’s board last month.
Another challenge lies ahead. This month, Jackson starts a major new staffing arrangement after laying off 920 full-time employees in April and hiring 350 part-timers to allow for more flexible staffing to adjust to varying patient levels.
The layoffs mean that virtually all nurses at Jackson Memorial Hospital will be shifted to new jobs requiring retraining. Martha Baker, head of SEIU Local 1991, which represents Jackson’s nurses and other healthcare professionals, says she hears stories from union members indicating that quality decreased during the furloughs and will probably get worse following the layoffs.
“I just can tell you that the word from the trenches is that medication errors” and other quality measures are suffering, Baker said. She said nurses may be afraid to report errors for fear they’ll lose their jobs: “My guess is they’re just under-reporting. Times are tougher.”
Baker said the Joint Commission, the national body that accredits hospitals, recommends management not punish nurses who report errors, but she said Jackson does punish those who report.
Jackson’s Andrews said that’s wrong. He said the Joint Commission does recommend that employees should be punished if they make egregious errors because they ignored proper procedures, but he said Jackson does not punish those who simply report an error and Jackson goes out of its way to urge employees to do so.
“Nurses under-reporting is a national problem,” said Andrews, speaking from Chicago, where he was attending a national meeting to discuss ways to encourage employees to report when they make errors and to create a “just system” in hospitals so that nurses don’t fear reprisals.
Andrews told Jackson’s board last month that he sets the goals high. But in some measures, such as scores for treating heart attack and pneumonia patients, he said Jackson will likely always rank worse than regular community hospitals because Jackson treats higher risk, uninsured patients who often come for treatment when they’re already very ill.
Questions about quality of care have been raised repeatedly in recent months by county commissioners and others, often in response to the union’s concerns that cuts are likely to affect patient safety.
On May 1, State Rep. Cynthia Stafford D-Miami, told a rally on the grounds of Jackson Memorial that labor reductions “will disrupt patient care and patient safety,” while a person in the background held a sign: “Mr. Migoya: Don’t Take Quality Care Away from the Patients.”
Migoya insists he hasn’t done that, but he acknowledges that a huge retraining job is now taking place, with almost all nurses at Jackson now in new roles, many involving complex expertise.
“This is major musical chairs,” said SEIU’s Baker, who called the process “kind of crazy” and a waste of taxpayer money. She thinks it would have been far simpler and cheaper to do fewer layoffs.
One example offered by Baker: In the Jackson Memorial West Wing 5 telemetry unit, 17 of the 21 full-time clinical nurses were told their jobs have been eliminated. Nineteen part-timers will be hired to take their place.
Since most senior nurses don’t want to accept part-time work, that means four experienced nurses would be left in the unit. The 17 who lost their jobs in the unit then start a “bumping” process, displacing nurses in other units with less seniority.
Baker said many of those 17 were likely to end up at Jackson North, where most nurses’ seniority goes back only to 2006, when Jackson purchased the facility from Tenet. In turn, those Jackson North nurses, if they couldn’t find other work, could become part-timers in the telemetry unit, where they will need new training.
Chief Executive Carlos Migoya agrees with that assessment of job changes. “Blame civil service,” which requires the bumping ritual. “If the union gave up bumping, that would mean a lot less retraining.”
Baker calculates the retraining required by the layoffs will be $1.3 million per two-week pay period and will go on for several pay periods.
Migoya said he estimates the total cost of retraining will be about $2 million — a fraction of the $69 million that his team estimates Jackson will save annually with the layoffs and new part-timers.
