What to do about King-Drew Medical Center?
“To achieve great things, two things are needed: a plan, and not quite enough time,” once said the late Leonard Bernstein, renowned composer and orchestra conductor. This aptly describes the situation Los Angeles County officials face as they grapple with the looming loss of $200 million a year in federal and state funds to support King-Drew Medical Center in south Los Angeles. On the heels of learning that the hospital had lost its Centers for Medicare & Medicaid Services certification, each county supervisor expressed his or her commitment to preserve this desperately needed community resource, which is relying on health department leaders to provide them with what needs to be a very real miracle.
With funding scheduled to be cut off on Nov. 30, the task of producing a miracle cure is daunting, but not impossible. Bruce Chernof, MD, the health department’s director and chief medical officer, need only remember what he and all physicians learned in medical school. When diagnosing and treating patients, the simplest explanation and the most direct treatment plan almost always is the most likely explanation and the best treatment plan. To save King-Drew, the most direct treatment plan is to consolidate the license and operations of King-Drew with Harbor-UCLA Medical Center, a nearby county hospital. Obviously, this plan is not free of risk, especially for Harbor-UCLA, but it is the best plan with the greatest chance of being implemented before time and federal money run out. The fallback plan would be to contract out the hospital to a private operator. But officials must focus on what can be accomplished in the next 30 to 60 days, and it is unlikely that a private operator plan could be negotiated and implemented in such a short period of time.
This is crunch time for county officials. They need our support and our prayers. I’m sure they, like all their detractors, are reflecting on what they could have done better to thwart this circumstance, but the truth is that the loss of federal approval may have been unavoidable in spite of all the time and money put into turnaround plans over the last three years. To that point, I have asked other hospital executives how well their hospitals would fare in an evaluation like the one King Drew just underwent. Running a hospital well relies greatly on teams of people doing a myriad of complex tasks by a prescribed set of rules, getting it right 100 percent of the time, and documenting everything they do for scrutiny later by state and federal regulators. Hospitals do a terrific job under such rigorous oversight, but no system that relies mostly on human beings to provide services gets it right all the time. Many hospitals would have a hard time passing a white glove test like the one King-Drew went through; i.e., 16 surveyors looking everywhere, including under ceiling tiles and the lint on tables, for two weeks. The fact is King-Drew is a much, much better hospital than it was a year ago, but it hasn’t improved enough to pass such an unprecedented, lengthy and rigorous inspection. The hospital is turning around, but like an overburdened aircraft, it simply ran out of runway before it could gain enough lift for take-off.
While there is no one silver bullet cure for what ails King-Drew, one thing that must be given priority in any restructuring plan is the hiring of permanent hospital staff to replace the hospital’s over-reliance on temporary workers, starting with nurses. For too long now, King-Drew has staffed many of its medical and surgical units with more than 50 percent temporary workers. Having a stable, permanent staff of health care workers is key to establishing and anchoring a culture of accountability to the framework of the institution–the lack thereof is the bottom line of the root cause analysis for what ails this hospital. Our hospital human resource management experts say the overuse of temporary workers contributes mightily to most any hospital’s quality of care problems. For this reason, most private hospital managers try to limit their use of temporary nurses to less than 20 percent of their workforce.
County officials must do whatever it takes in their restructuring efforts to turn this around.
What do you think?