Hospital not only staying but settling in for long term

ST. VINCENT’S BLOUNT

Questions have been phoned in to the newspaper about St. Vincent’s Blount for more than a month. Basically they’ve fallen into two (1) treatment of employees and (2) whether St. Vincent’s plans to continue operating the local hospital.

It wasn’t a mountain of questions, but definitely more than the newspaper normally gets about any particular local employer or institution. So we assigned a reporter to meet with top local management to explore both topics.

Before that article was completed, a second flurry of more strident questions came in, concerning whether St. Vincent’s is planning to end its local partnership with the Blount County Health Care Authority, which leases them the building. That led to last week’s breaking news article in which Evan Ray, the hospital’s local director, responded that “nothing could be further from the truth.”

He elaborated by summarizing the hospital’s near-term plans to add services and physicians to the hospital’s offerings, and to add two new programs – the Critical Access Hospital designation and swing bed capability which will strengthen the facility’s long-term financial position as a rural health provider, as well as aligning it to better meet health needs in the community. More about both of those elements later.

Readers can reach their own conclusions about the response, but overall, it doesn’t sound like an outfit getting ready to leave town. News Perspective

The remainder of this article is the one we started to write in the beginning. Here’s how it lays out. First will be a profile of the hospital, just so everyone sees the same overall picture. Second, will be an abbreviated section of questions and answers: what was asked when we talked to top management, and what was answered. These two areas will be covered in this article.

Third, we’ll describe the two major enhancements the hospital is preparing to make now, in the next month or so: the Critical Access Hospital designation and the Swing Bed concept. And fourth, we’ll provide an indication of three recent measures of success. These areas will be covered in the conclusion of this article next week. Part I: Hospital profile Hospital type: local area community hospital, non-academic, non-teaching Number of beds/rooms: 40/40 Total employees: 191 Nurses (RNs and LPNs): 64 Number of physicians on staff:

Active (more than 12 admissions /year): 20

Courtesy (12 or fewer admissions /year): 40 Occupancy:

Average daily: 50 percent

Avg. admissions/month: 120-125 Facilities:

•emergency room

•three operating rooms

•six-bed intensive care unit

•outpatient clinic providing specialized therapy physical, occupational, and speech

• lab facilities – fully accredited providing all normal testing blood, urine, tissue, clinical, pathology, and other

•imaging x-ray, MRI, CT scan, digital mammography, ultra sound

•on-site pharmacy Services provided: emergency, in-patient surgical, outpatient surgical, gastro-intestinal lab, intensive care, medical/surgical care, echocardiology and vascular, Holter monitoring, respiratory care, orthopedic, neurological, wellness, pain management, Dial-A-Nurse, nuclear medicine, cardiac stress, bone density screening, pulmonary function testing, neurology (EMG and EEG) Medical specialities represented (25): anesthesiology, cardiology, colon/rectal, dermatology, emergency medicine, endocrinology, family medicine, gastroenterology, general surgery, internal medicine, nephrology, neurology, neurosurgery, opthalmology, orthopedics/surgery, otolaryngology (ENT), pain management, pathology, pediatrics, pulmonology, radiology, urology, vascular surgery, vascular/vein Part II: Questions and Answers

Q.The Blount Countian: The hospital is said to have carried out a restructuring or reorganization in recent weeks. Can you describe when and how it was carried out?

A: Evan Ray, St Vincent’s Health System president – rural hospitals, head of St. Vincent’s Blount and St. Vincent’s St. Clair:

“We had a restructuring in nursing in early March this year. In effect, we reallocated resources, putting more resources at the bedside for patient care and reducing the number of supervisors.” Ray said that the number of supervisory positions was reduced from 10 to four. Four of the supervisors were retained as supervisors, and six became staff nurses. All employees met with a human resources representative and were given three options, he said. They could retire, change roles, i.e. become staff nurses, or apply for one of the new supervisory positions.

Q.TBC: Were any employees laid off or separated from employment?

A. Ray: “No, there were no separations. This hospital far exceeds targets in employee turnover locally, regionally in the Birmingham SMSA, and nationally,” he said.

Q. TBC: What are those turnover rates, here, and say nationally?

A. Ray: “8 percent here vs. about 20 percent nationally.”

Q: TBC: We’ve been told that laid-off employees lose whatever seniority or time in grade they had accumulated and that if and when they are rehired, it would be as new employees as far as salary and progress in grade is concerned. Is that true?

A. Ray: “I have no knowledge of that situation. It was not the case in this restructuring since no one was laid off. If a supervisory nurse moved to a staff nurse, that transition didn’t affect years of service; benefits were not affected at all.” (It would appear that the employees who accepted staff nurse jobs would have taken a cut in pay. But that question was not asked at the time of the interview. When it was asked later by phone as a follow-up question, hospital spokespersons did not wish to respond to that question or to a related question about exactly how many people, if any, were affected by a reduction in pay. St. Vincent’s Blount provided the statement that follows concerning the restructuring. -Ed.) Statement of Cindy Williams, RN and Doctor of Nursing Practice, who served as Interim Vice-President Patient Care Services, Rural Operations, during the restructuring.

“The nursing restructuring was done to provide an innovative model of care to better meet the needs of patients within our hospital and also offer cross-training opportunities for our staff. The change moved administrative and supervisory functions from 10 nurses to four, allowing six nurses to focus exclusively on bedside patient care. We believe this was the right thing to do for patients and it brought St. Vincent’s Blount’s structure in line with our system standards and with that at most other hospitals.

“All impacted nurses were invited to apply for posted positions at the hospital or with St. Vincent’s Health System, which at any given time has multiple open positions. Many times where there is a change in overall structure of a department or function, our practice is to evaluate the possible need to have associates ‘apply’ for the restructured positions. Specially, in cases like this, where there is a difference in the pay rate between charge and staff nurse positions, this application process provides for fairness and equity for all impacted associates/applicants. Providing a re-application process for associates is dependent on the type of restructure, roles being re-designed, and business need to meet the patient care requirements.” Resuming Q&A

Q. TBC: I was once promoted and asked to move to another city by my employer. Within a month after I moved, the job there was downgraded to the same as my original job before I moved. I objected, and was told my choices were to remain on my new job or resign. Is something similar to that – without the promotion and move – what happened to the supervisory nurses who became staff nurses?

A: No clear answer was given; both Ray and Williams spoke at the same time after a moment’s hesitation. The following sentence is an attempt to render the fragmented responses communicated, not the words that were spoken. Managers sometimes have to make necessary resource allocation decisions for the good of everyone. That is not a quote from either Ray or Williams.

Q. TBC: Is St. Vincent’s considering brokering its lease on this hospital building to some other hospital operator or corporation?

A: Ray: “No. We’re working extremely hard on several initiatives that will be very advantageous to this hospital, and we’re expending a fair amount of resources to achieve that.” He mentioned both the swing bed and critical access initiatives as crucial to improving the hospital’s financial performance it and moving it toward operating in the black in the near future.

Q. TBC: St. Vincent’s Blount has sometimes been referred to – perhaps erroneously – as a not-for-profit hospital. Does the hospital operate at a loss?

A. Ray: “No. Through the end of January, we were hitting our financial goals. By going through the Swing Bed and Critical Access processes, it will enable us to improve our financial performance.”