ETRAC (Equity Taskforce Recommendations Action Plan

In spite of missing the meeting, and being confused for days about who or what the "Equity Taskforce" is or was, some kind soul provided me with the "Recommendations Action Plan" that was, as I now understand it, generated at the last Director's Forum. I'm told that this HMG version of the recommendations is, perhaps, not an entirely accurate reflection of what was said at the meeting, (and readers are certainly invited and encouraged to point out what the plan missed/omitted/spun), but still, there it is, and it deserves comment and discussion.

The first item :
1. F* L* homepage
a. Keith has discussed resource and other issues with
R* B* to determine if it is feasible to
maintain a more active web page that could include
links to important resources (e.g., job openings, EAP,
employee benefits), and to post organizational events
and messages.
- It appears at this time that we cannot use the
intranet (meaning a page with access limited to
hospital employees) for this purpose, due to CDHS
Information Technology issues. We plan to pursue the
possibility of using a shared folder on the “R” drive,
and researching ways to make it more
accessible/visible. Certain identified staff could
update this folder on a regular basis.

Why spend money and hospital resources to provide what we already have for free? I'm really impressed by the discussions already ongoing on the Blog. The blog has the advantage of providing secure annonymity to its users, which allows for genuine, open communication about problems and issues that have not previously had a full airing. What are the chances, for example, of someone discussing the staff raises (RN 3's and above get raises, the line staff won't because we've spent too much on patient care)as they did on "Why Staff Don't Stay", if the discussion was conducted on an "official" webpage that could identify users? Slim to none, I think.

I would very much like members of "HMG" to comment on the blog, and promise to publish their comments (as long as they don't reveal protected patient information) faithfully without censorship. If users would like a page of "links to important resources" just let me know...be glad to post it. As for "organizational events and messages, HMG staff should just blog it in as a comment, and there it would be! Free!Easy! Widely read!

2. Supervisor Competencies
a. HMG has collected and reviewed articles concerning
supervisor competencies, and has discussed these
during two meetings. On the agenda for an upcoming
HMG meeting is to define the critical supervisory
competencies for the hospital. Once this is
established, it will be circulated for comment.
b. HMG plans to research available resources (e.g.,
LDI, staff development) to access for training
regarding supervisory skills and competencies.
c. HMG plans to research the existing supervisor
feedback forum through CDHS, including the possibility
of increasing utilization of this resource and the
feasibility of using it as one measure of performance
regarding competencies.
d. HMG plans to identify staff responsibilities
regarding supervision (i.e., what staff is responsible
for doing to improve their own supervisory
experience).


Where did this one come from, I wonder. Makes me wish I'd been at the meeting. No one's written about this on the blog (with the possible exception of a few remarks on the very first page). I have to say that it sounds like more forms to fill out...which means less time for actual human interaction. Not to mention the time and energy demands of "collecting, reviewing, researching" in order to develop "competencies"...and the cherry on the sundae, "staff responsibilities regarding supervision".

That "staff responsibilities" paragraph reminds me of the PMAP system currently used to "evaluate" staff...over the years, it has developed into a system in which the supervisee must think up, then document, some aspect of his/her work performance that is "over and above" his regular job duties if he/she wants to be eligible for any raises that might occur. If you don't care about getting a raise, you don't have to do this. If you do it, you still might not get a raise..actually, it looks like for sure you won't if you're line staff (see the comment on Why Staff don't Stay). As one of line staff, I find this mightily insulting...doing a good job will not get me a raise. Even more insulting, I am required to think up "extra" things to do and then write them up. Most insulting of all, after I've done that, some unnamed group above me will review my write up and decide if its good enough for a raise. Very often (I'd like to see the stats on exactly how often) the write ups are rejected (The posse has heard of very few that have been accepted). I had a couple of experiences in which I went so far as to come up with something, was allowed to believe that I was qualifying for a raise as I actually did the "extra" things I'd agreed to, then was told that, in one case, I'd have to do a write up in order to be considered (after the fact...a summary of what I'd already done), in the other, that even though I'd been doing what I described for 2 or 3 months, it wasn't approved...I'd have to come up with something more. Whew! Now there's a system for you...just friggin designed to get the employees going....and then we find out that everyone above us is going to get a raise...but not us...because we've spent too much on medical care for our patients....oh golly...

See how that just doesn't help morale, attitude, team spirit?...surely HMG can see that? Surely they can see why we'd feel chagrinned that the Director would get a 33% raise and we'll get nothing...with the explanation that we've spent too much on patient care...our reaction to that doesn't take rocket science to figure out.

And in the area of "Supervisor competencies"...are we not a mental health facility, staffed with "mental health professionals". Don't we know how people work? Already?..why do we need new research, new forms, new methods...why don't we use the skills we already have...don't we know about motivation, conflict resolution, problem solving, nurturing, supporting, even educating...The approach described makes me tired. This kind of approach...used now on everything in the hospital for all the years of the current regime, does not work. And, making supervisees responsible for the quality of their experience in supervision just sounds like we're in a George Orwell novel.

3. Hospital Management Communication/Presence
a. Keith will continue current changes and
improvements to the Director’s Forum, including
continuing to commit to the regular meeting times,
sending out reminders and agenda via email, and
publishing a summary of each Forum in the Fort in
Short.
b. Keith is researching ways to increase more direct
input from direct care staff to hospital management,
and plans to discuss this further in several forums,
with the goal to establish a liaison or liaisons to
hospital administration to facilitate this
communication.

I think Keith should just use the blog...read it, write to it. He should also hang out with patients more...but I think that about all management staff. If you don't hang out with the patients, you can't know what the hospital's needs are...we're in the business of caring for patients...you gotta see and experience what it is that caring entails...at least if you're going to be able to focus on that priority properly. Go to some groups, talk with some of the grievance filers, do snacks some evening...be there enough to find out first hand what's going on...I've said for years that all Nursing Services Supervisors should be required to work two shifts a month on a unit...I would broaden that to include the entire Hospital Management Group. They should join the team, as it were, get to know the hospital at ground level.

4. Hiring Practices
HMG plans to form a workgroup, possibly including
members of the Equity Taskforce, to develop an
Employee Handbook that would be given to each staff,
possibly placed on the shared folder if possible, and
updated. Included in the Handbook will be information
about hiring practices, disciplinary actions, employee
resources, etc.


Ah. An employee Handbook.

See above. Same old s**t. Just doesn't work. If anything, it's alienating to have the managers off in the corner creating a workgroup to create some handbook, while the milieu is going to the dogs...

Something is needed re: hiring practices, apparently (see various, multiple blog comments)...but it's probably not a handbook.

5. Staff Appreciation
HMG met regarding ways to express staff appreciation,
and decided to poll staff via email regarding what
kinds of staff appreciation efforts are most highly
valued. M* G* consulted with devising and
distributing the survey. While the response rate to
the survey was not high (except for on one or two
teams), HMG did review it, and decided to reframe the
question in an attempt to get more feedback before
developing its own plan that may or may not meet the
needs of most staff. This survey will be distributed
via email, via Team Leaders to the teams, and will be
discussed at the next Director’s Forum.

Oh dear. Really. I'm tellin' ya...HMG needs a new, fresh perspective on everything.

Let's see if I can find a metaphor here..the situation seems to call for a metaphor.

Say you're out hiking in the mountains. You're out in the woods, experiencing the wonders of nature, when you come across a lost hiker...this guy's been out there for days, no coat, no food; he's dirty, hungry, freaked. What do you do? HMG would ask him if he'd rather have a coupon for McDonalds or free movie tickets.

OK, Bloggers, there you have it. And please see the great new comments on From Military to Mental Health, Why Staff Don't Stay and Inspected, detected, reflected. I hope everybody, top to bottom, comments...I have high hopes about the potential for this medium...change could happen...change for the better. Oh boy!!

Inspected, detected, reflected

I swore I wasn't going to blog about this. But I find I just can't help myself. The provocation is too intense.....I MUST blog!

Does anybody else find it odd that Joint Commission inspectors complete their rounds surrounded at all times by management staff? Wouldn't one have thought they'd want a few private moments with line staff? or (imagine!) patients? I had no chance to say "read THAT chart", or discuss with a representative what I see as the commission's inappropriate intrusion into clinical decisions, or to slip them the blog address. They were surrounded by a covey ( or should that be "coven") of important people at all times, carefully protected from the reality of the environment. And they concluded, apparently, that all is well. Some one of them, we are informed, would feel fine about having their loved one cared for there.

Well...for me, it depends which loved one. I have some loved ones I wouldn't mind having there...the loved ones I don't like very much.

I know I, Myself, wouldn't want to be a patient there.

Particularly with the kind of descriptions I've seen in the charts. I've seen a chart refer to a patients behavior as "sexually predatory", even though the patient has never had a incidence of such behavior in the community or in the hospital. That's going to follow him his whole life.
I've seen patients kept here, in locked settings for multiple years, apparently because their private insurance ran out...(prior to that time, the patient was considered managable in the community)..now he's a threat to himself and others. Depending on your social worker your life can change substantially ... and not always for the better, after being admitted to our establishment. It's amazing how someone's description of you can change your life...it's the power of the word!

There's really no appeal possible when your social worker or psychologist says you're a danger...who's going to believe you if you object to that view? Someone would, in the first place, have to be listening to you (which is rare) and then that person would have to take your (crazy person that you are) word over the (sane and salaried) social worker's word. Ain't going to happen.. So if that Social Worker sees you as a potential sexual predator...well, too bad. That's who you are and there's really nothing you're going to do about it. Gosh, I hate to think what a description of me would sound like about now...

OK, I've gotten off track. JCHO is where I started. I heard it costs money to have a JCHO inspection. I also heard that in the years when no inspection is slated, we pay for a "consultant" to tell us how to pass the next inspection.....so that the process costs us substantial money every year, whether we're inspected or not. Don't know if that's true, but that's what I heard...maybe someone can correct me about it if that's wrong.

Silly me would rather see that money spent on actual patient care, or even staff retention, instead of paying a regulatory agency to tell us we're OK to do business after being ushered around for a few days by management staff. I know there are certain perks that come with accreditation...I wish quality patient care was one of them.

I know I'm badly informed about all this stuff and hope someone will take the time to correct me. Maybe we could have another special edition of the hospitals' paper that can illuminate the accreditation process, its importance and its internal ( & the publics' external)oversight mechanisms. Why should the public trust the process? How much do we spend on it? Doesn't JCHO spend quite a lot of time thinking up things to keep itself in business? Why does it think it should regulate clinical interventions? Why don't we object to that? Aren't we more "expert" about that than they are?

OK, enough. I think I'm done now with the JCHO inspection. After comments, we can all move on.

New comments since last post on 78 comments and Why Staff Don't Stay <

Why Staff Don't Stay

So Many Issues, So little Time. This is only one aspect, I'm sure, of why staff don't stay, but working around the hospital lately has made me think about the problems that result from our inability to retain staff.

In the olden days, all the staff on a given shift knew one another. They'd been through a thousand variations of every situation together; they knew what the possible outcomes were, the possible interventions. When a patient began to turn over tables, for example, the staff could communicate with each other with a look...You, get the others out of the milieau, You call safety, You and me go get this guy... I'll do the talking, you back me up...

Or, the milieu is getting revved...we need to calm it down...and with a few brief words, each member of the staff agrees to the necessary action and executes it.

Coordinated responses are possible because the staff are experienced and know one another,know policy, know what their choices realistically are, know what works, know who is capable of doing what. Safety for patients and staff is maximized, disruption is minimized, treatment is able to progress with reasonable efficiency.

It takes a certain preponderance of "old" staff to train "new" staff. This is because there is an entire culture that gets (or needs to get) transmitted to the new person. The new staff needs to be immersed in the culture for an extended period before he/she fully integrates it and can act as a member of the "team". I've worked shifts where there were two new grads and two pool staff. There's no one there to transmit the experience. The staff are winging it, making it up as they go along, hoping to survive the shift; the patients are insecure, get different answers from different staff, start testing limits. This is all worse in the evenings after the day shift goes home and worst of all on the weekends. The new grads.....alone....with all those crazy people.....

It reminds me of the nations' problem with immigration. Any group can create new members if it's large enough to predominate...(or is that preponderate) A lot of people worry now that the number of immigrants is so large that they can't become integrated into the original group...immigrants remain separate, culturally...living in the midst of but not a part of "America", for example, or "Italy". They remain identified with the country of origin.

Similarly, at the hospital, the new employees need a year at least, in the constant company of a preponderance of "old" employees, to become "old" employees themselves.

New staff don't know when the social worker's descriptions are biased and inaccurrate, when the treatment plan isn't making sense, when the dispo is bad. They often don't know if the patient is over medicated, under medicated, or inappropriately medicated. They don't know how to get a doctor who's ignoring medical concerns to take an interest...they often assume the doctor is right. Since they don't know, yet, the subtleties of what's going on, they don't complain as much and aren't as generally troublesome as older employees. They're also cheaper on the whole and more attrative. They're a good deal for management.

It's hard to find a good come back for that....the only possible grounds is quality of care.


Comments since last post on 78 comments and on It's Private

78 Comments

I've just been re-reading "It's Private" and all the subsequent comments, trying to figure out where I'm going with all this...and, frankly, I have no idea. I think my point is just that there are other ways to do things, and it behooves us to be the best at what we do.

Or maybe I want to build a conspiracy theory about Wakkenhut...what a weird organization THAT is...

There are been 78 comments (not counting my own)posted on the blog to date...I went through them to see just what the themes are. I put each comment into one of six categories; of course the decision about where each comment went was subjective, and could be disputed..often comments touched on more that one category...still, I think its revealing to see what people are most concerned about.

1)Administration/Management Issues (i.e. who's running this place and why are they doing such a lousy job) 21 comments
2)Mental Health Issues in Society (i.e. how are current political priorities affecting mental health treatment today, funding, etc.) 19 comments
3)Quality of Treatment Issues: (i.e., bad doctors, bad policies, bad ideas etc.)18 comments
4)Other: (a lot of these were comments about the blog itself) 11 comments
5)Staffing Issues: (quality, quantity, distribution) 6 comments
6)Facilities Maintenence Issues: trees, mice, ants, mold, etc. 3 comments

So one thought is that if we are to be competitive in the modern world, we need much better management...we need people who see clearly that quality treatment depends on quality staff, who have patient-oriented priorities in budgeting, who can provide a dynamic, effective presence in political settings, where funding decisions are made. We need someone with a vision of how we could serve the community and become, again, a model for quality treatment. We need someone who is interested in what the line staff know and can include them in problem solving.

Can we affect this? Can we have any influence on the whos and hows of management?
What would it take to change directors? Ideas, anyone?

Comments since last post are on: "It's Private" and "A House is not a Home"

It's Private!

Disclaimer, blah, blah...not real, not me, don't worry, etc. etc.

I've always said that governments MUST take care of the mentally ill, because they're unprofitable... so no for profit business would touch them.

I was saying it again recently in a conversation with a collegue who responded,"You're wrong." (I was, of course, aghast. Wrong?! is that possible?) "A private company is making money at it", he said, "and I'll tell you how they're doing it."

The Geo Group, Inc. has figured it out. They (the group)includes a construction company; they agree with the state to issue bonds which finance the building of a "tree design" hospital facility. Geo makes the standard bundle as a construction company. The deal with the state includes the return of the building to the state after 20 or 30 years(?)in exchange for which, Geo gets an incredible tax break from the state for all that time. The "tree" design of the facility allows for a central nurses station which oversees several "units" worth of patients...thus, many fewer staff can care for many more patients. The facility is expressly designed for its efficiency and ease of operation. The hospital has an agreement with the state to get payment on X number of beds, regardless of whether or not the beds are filled...Thus several financial elements are dealt with at once (low overhead, lower payroll, low taxes, guaranteed income) and the private company makes a profit. Since it is a private company, it is apparently not subject to various state level regulatory requirements involving disclosure...when I asked, "how're they doing?" my collegue said, "we don't know...they're private...they don't have to tell us." The State, for its part, is relieved of a bunch of expensive pension holding (not to mention blogging) employees, the headache of administering the thing, various legal liabilities and so forth and has a predictable expense each year.

So there you have it...how to make money off the chronically mentally ill....Here's Atlantic Shores website...looks like a great place...

Well. The government is still "paying for it", if I understand the deal...it's just that government pays a private company to provide the service in such a way that the company makes a profit...(we're back to outsourcing)....but government still pays...you and I still pay to have this social service provided...but a private company makes a profit providing it...there's a new layer there...some of the government money leaks out into the private sector...

This starts to look good when the government agency is run poorly, when its financial and managerial inefficiencies begin to reflect badly on the administration...when its become a headache instead of a jewel...government becomes willing to pay to just get the thing off its hands....but, surely, in a well ordered world, eliminating the profiting middle man would be cheaper.(?)

I'm curious about what the treatment is like there at Atlantic Shores...do the patients like it? And do they like it better? I'm curious about what the staff is like and how well they like their jobs....and about what the hospital's community placement options are...where do they send their patients when they leave?; is society getting a good deal here? How much profit is being made and who is enjoying it?

Why does the idea of a private company profiting from the treatment of the chronically mentally ill bother me? I kind of gives me the creeps, though.

Comments since last post on "Priorities, priorities, priorities"

Priorities, priorities, priorities

Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental.




Yikes! I'm overdue for a "blog". Here goes.

This morning I was listening to Senator Obama on "Meet the Press: and he was articulating the Democratic Platform in response the a question from Bob Scheiffer ('scuse me if I'm misspelling the names here)..and he listed "Energy Independance"first. After that was Health Care. There were probably other things, as well, but I was thinking so hard about this focus on Energy Independence that I missed them. But I think it's pretty darned exciting to have government put alternative energy on the top of the priority list. If nothing else good comes from our war in Iraq, this new, focused determination to become free of foreign oil is an absolute good. People of my generation have been squawking about alterntive energy all of our adult lives and now, finally, everybody's getting on board!!! Whoopee!!!!! It seems to me that in addition to all of the other, obvious advantages to this American Agenda item, it creates new industry, new jobs, new manufacturing and export products...it give Americans something to be good at again...something to be beter at than anybody else in the world. We can create and make the technology to replace oil as our primary energy source!!! Yea!!! I can support that. It's good!!! It's very Good!!! Let's all get to work!! This could be our salvation.

And then there' Health Care". I'm glad Obama named it on the "issues" list, because....we know it's an issue. I can't help but think that a big part of our "issue" here in America has to do with attitudes as much as anything.

When I think back about my "relationship" to "health care" in the course of my life, I'm struck by the fact that as a fairly impoverished single parent of two, I was able to acquire and pay for the health care of the children and myself for years...through childhood hospitalization for tick fever, for two tonsillectomies, several episodes of stitches, childhood immunizaion...I could always access a doctor, who would always accept monthly payments against a tolerable bill...the hospitals were the same way...I paid them so much a month...the bill was of a magnitude that I could pay it off...

And then, something changed.And suddenly the same care was so fabulously expensive, that no ordinary person could pay off two tonsillectomies in a lifetime....and pretty soon businesses couldn't afford the insurance costs..and new fancy hospiitals were going up,and nurses were freaking out about the undoable case loads and care seemed to get worse, but nobody could afford it anyway, but drug companies were pushing viagara and antidepressants on the evening news. And..well,here we are today...wherever this is.

It's a mess.

If we could "fix" those two things...energy and healthcare...this would be Eden, here in American, dontcha think? Now, mental health care is a subset of "health care" and we need to come up with some solutions for that. I've heard about some pilot programs in other states and I'm going to investigate and I'll report back what I find out. I'm a little disturbed that these pilots are the pilots of privatizing state systems, (much like what has been happening with prisons...same company even, I think)...but better to know about them than to just hope it never happens. And I'm hoping to encounter some other creative ideas that I can run up the blogpole for people to comment and think about, etc. I may be overreaching my abilities here.....

Since my last post, there have been new comments on: Housekeeping, Got an Anteater and Too Much Religion. Enjoy!

Housekeeping

Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental.

As I post all the comments, I wonder how any reader would know where to find them!! There must be a better way...but until I find it, I just wanted to tell readers that there are some great comments under the various "blogs"...especially see "The Assaultive Unit", "Black and Orange" and "Why we Blog" as well as the most recent, "Military to Mental Health"...perhaps each time I blog, I could add a note about where I've posted comments since the last blog...so everybody has a decent chance to read what everybody else is saying!

Also want to encourage readers to send their "top three issues"...along with any potential solutions that occur to you. Remember to observe HPPA rules and don't blog at work.

(Now that everybody's paying attention), let's fix this thang!

Blog On!!
Gadde Fly

From Military to Mental Health

Disclaimer: All persons, places and things in this document are imaginary; any resemblance to actual persons, places or things is purely coincidental, except where others are attributed directly.


I just heard Jeffrey Sachs say that we spend 1.4 billion (BILLION) dollars a day on our military...(I was watching the Colbert Report).

That "we" in the "we spend" above is you and me. We go to work; we send in our taxes; those taxes are the government's "income"...that's what is spent on things...like the military and like mental health care. We generate the money; we elect the government; we spend the money.

I much prefer to think of the government as "them"..."they spend" feels a lot better than "we spend"...but the nagging tug from reality whispers "them" is "us". "We" are really doing this...we are spending 1.4 BILLION dollars A DAY on our military...and so we don't have any left over for our poor, disabled crazy people.

And what happens as a result? Crazy people don't stop being crazy because we refuse to help them...often, actually, it makes them crazier. Crazy people disrupt the smooth flow of commerce, of law and justice, of domestic tranquility, probably even of traffic.

In some societies (I like to think) crazy people were thought of as "touched by god"...they were given a respected role in the community, perhaps as a shaman, or a seer, or a magical creature of some sort. They were not expected to perform as the other members of the community did...they were allowed an existence that required support, and support was built into community life. I imagine that the entire community benefited from this...it was as useful to have a crazy person to support as to be one.

In our society, we not only don't have a role for our crazy people, we don't want to support them and can find no benefit to us in their existence...they are singularly unprofitable. Instead, we think of them as having a "biological" problem of some sort and seek to cure them. We seem to think that the cheapest, quickest way to do this is to give them the right drugs. We seem to think that with the "right drugs" our crazy people will stop being crazy.

I don't think it's working.

I ran across a website: www.docdiller.com where this doctor discusses the issues around psychiatric meds for children (he is a Doctor of behavioral pediatrics). And it's not a long step from issues around medicating children to how we medicate adults, really. It's not so much that medications are at fault, as that we behave more and more as though the medications were the ONLY thing that we can do. I think this is really apparent with children, but also true with adults.

We're diminished when we approach one another this way...when we can be "fixed" with a drug...what sort of creature does that make us?

And when we spend 1.4BILLION dollars A DAY for our military, what sort of creature does THAT make us?

Anyhow...I don't believe it. I know "us" to be generous, compassionate, intelligent and creative...we surely can figure out a way to divert a little of that military spending to mental health...and we can find a better way to approach mental health than drugs, drugs and more drugs...

Don't you think?