Community, employee, physician opinions reveal little confidence in VVRMC administration

December 13, 2007
By Bill Sontag
Feature Writer

A sparse audience attended a mid-afternoon session, Wednesday (Dec. 12), to hear Susan Korbel, PhD, owner, Core Research, San Antonio, unveil results of her investigation into employee, physician and public attitudes about Val Verde Regional Medical Center.

The gathering was a special meeting of the Val Verde County Hospital District Board, assembled in a public session to allow Korbel to present her findings derived from 20 commenters at two Nov. 1 public forums and 222 questionnaires filled out and submitted for anonymous participation online or in print.

Korbel said questionnaire respondents gave administration failing grades, with 62 percent (137 respondents) giving management administrators a “D” or “F,” while only three percent (six respondents) said the top brass are “A” rated. Moreover, among 63 hospital employees responding, more than half (59 percent) said their perception of support from “management” is either “not much” or “none.”

Though only 27 found time to attend the 2 p.m. session (compared with 98 who attended the forum sessions), the emotion-charged atmosphere in the Ramada Del Rio Sunblossom Room was truncated by Korbel’s clipped, concise presentation of trends, generalized from the body of collected data. Korbel said far more extensive information was provided in total confidence to the Hospital District Board, all of a personnel and confidential nature she feels confident will receive positive attention and public notice in the near future.

Hospital District Board members present included President Bob Boland, Vice President Rachel Beavan, and members Frank Larson and Barbara Plyler. Absent was Secretary John Plumb and members Eulalio Calderon and Tony Sotelo.

Introducing her complex and sensitive topic, Korbel explained that her task was to examine stated issues of concern, identify VVRMC strengths and weaknesses, how patient care could be improved, how local and county residents perceive the hospital, and whether public attitudes influence use of the facility. Moreover, Korbel said the job evolved into an assessment of trust felt by people who use the hospital and employees who work there.

Korbel’s research contract arose in October from a board that sensed those levels of trust threatened by a rising crescendo of public and employee outrage and physician indignation. The employee segment of respondents included physicians (eight percent), administration (eight percent), nursing staff (43 percent) and “other” (31 percent).

 Attention was focused on the hospital’s emergency department, with strongly divergent evaluations there between hospital staff and residents (non-employees). Twelve percent of hospital staff members see the ER as “poor” in performance, while 39 percent of public respondents called the department’s record “poor.”

But respondents had favorites among the hospital departments, too. “Best features” of VVRMC included the hospital’s “caring nursing staff,” a facility boasting a renovated building and new equipment/technologies, a central, accessible location, and the hospice department, Korbel called “the highest rated of all services tested.” Korbel found hospice, the volunteer cadre, surgical services, and respiratory care to be the top-rated departments.

“These are some of the things we can hold onto,” enthused Korbel. She quoted one resident respondent, “As a patient, I found the nurses caring and responsive. True angels, in fact. I could not have asked for kinder, more caring folks.”

Korbel remarked that the poor perception of the emergency department is not unusual among people in communities surrounding nearly every hospital in the United States. She also found discord among employees with the hospital’s personnel management. “There is a great deal of disenchantment among employees regarding the personnel [human resources] department, specifically hiring and firing, and communication of policies and procedures.” Thirty-five percent of respondents gave the department an “F” failing grade.

 But Korbel admonished that employee feelings of satisfaction and support from management are an area of profound concern. Fifty-six percent of employees with prior experience in other hospitals (47 total respondents) said that all other hospitals in which they worked were better than VVRMC. “We heard this over and over again, that people are having a hard time doing their jobs,” Korbel said.

 

“If you don’t have [an atmosphere of] trust, the way we saw here, if people are scared … what’s going to happen to their bodies,” Korbel said, becoming emotional with tears, recalling the interviews and stories she heard during her investigation. Both employees and patients need to feel, Korbel adjured, that they are giving and getting the best care that can be offered. “Apparently working conditions are straining performance,” Korbel reported. Among resident respondents, Korbel observed, “Many do not trust the hospital to provide needed services, so they are going elsewhere.”

Korbel listed four options for consideration by the Hospital District Board and others who view her findings and conclusions.

“1. Do nothing. The CHC [Community Health Corporation with a contract to run the hospital] contends that you are mere landlords, and they are solely responsible for all hospital functions. Hope that they listen to the findings of this report, and take appropriate action.

 “2. Shut the hospital down. The results of this report indicate that trust between many members of the community and staff is lost, leading to an exodus of citizens to other health care providers and perhaps lack of taxpayer support in the future. When (if) the hospital re-opens, the community will be assured that issues have been addressed, and the team entrusted with your community’s health are ready and eager to serve.

“3. Work with the CHC. Find an amicable forum for reviewing these findings and forging a solution that satisfies the goals of .. both community and corporation. Begin with pending litigation, health care concerns and personnel issues. If the issues aren’t resolved, seek other alternatives to the present management contract.

 “4. Resign. What comes next requires the unselfish commitment of uncompensated citizens to work through a breech of public trust to find a solution that keeps the hospital viable. If you’re not up to it, now is the time to leave. For those not on the board, support for those who remain in the next few months will be appreciated.”

Board member Larson applauded Korbel’s report, calling it “a tool for betterment.” He moved to have the full report text delivered to VVRMC Jack Houghton – present at the meeting, Wednesday – as well as to Val Cadena Sr., chairman of the local Val Verde Hospital Corporation Board – absent from the meeting. Larson also moved to have the Hospital District Board forthwith issue a check to pay Korbel for her services. Both measures passed unanimously.

Board member Plyler, also moved to tears, voiced her concern that the Hospital District Board, though elected by the taxpayers, is relatively impotent under the current contract with CHC to remediate the problems. Plyler lamented that the citizens of Val Verde County are subjected to “representation without representation” because of the current arrangement.

Dr. Emile Glines Abbott rose from the audience to thank the board for their courage and foresight to engage Korbel for her investigative services, but added that his concerns about the hospital abide. “I would like to go to this hospital, but I’m afraid to,” Abbott said, urging “Do something about that emergency room first.” He explained that hospitals in large cities often have extraordinary wait times for incoming patients – as much as 20 hours, in extreme cases. “But in big cities, the choice is around the corner. Here, the next choice is 150 miles away,” said Abbott.

Asked by LIVE! whether her sample was representative of the community, Korbel said she believed her data illustrate trends extant among those interested in the hospital, adding that she conducted additional, informal questioning with a “man-on-the-street” approach. There, Korbel said, “the volume was not turned up very much,” but added that those who did offer opinions showed many of the same concerns reflected in formal responses.

The Border Organization Co-chair Sandra Fuentes told board members, “We have an elected board, but you are almost powerless!” She asked how the Val Verde Hospital Corporation board would become engaged in effecting solutions to the problems identified. Larson could not offer much assurance, saying only that it’s the district board’s hope that results would be pursued “in a progressive fashion.”

Asked by LIVE! if the results could be considered “baseline” information against which future surveys could assess changes, Korbel replied that she only hopes future surveys will not be necessary. “I would hope that this research will not have to be done again,” Korbel said.

Board President Boland offered CEO Houghton an opportunity to comment, and was refused. Korbel concluded with an emotional exhortation to the board: “I would not recommend option two [to shut down the hospital]!”

Following the meeting, community activists and spokesmen Dan Riley and Ron Burton met with LIVE! to offer their observations.

Riley: “We’re getting the short end of the stick as taxpayers, unless they [district board] can restructure this [CHC] contract to get the taxpayers properly represented.”

Burton: “Dr. Korbel did a professional job of quantifying concerns that have been ‘street talk’ for quite awhile. She did a credible job. But the hospital district is not in a position to micro-manage the hospital, and yet the [existence of the] corporate board creates an organizational disconnect between the elected district board and CHC.”