This starts innocuously enough with an email from Mendocino Coast District Hospital (MCDH) on November 9th announcing the agenda for the November 13th meeting of the hospital's Planning Committee. Stick with it because there will be punch lines.
Emails for MCDH committee meetings go out to dozens of people. A year ago that number was about sixty. In the interim not only has the sender figured out how to send an email without disclosing all the other names on the list, but undoubtedly interest in MCDH politics has risen, so presumably the number of recipients has also.
MCDH committee or board meeting agendas can be lengthy documents to read through prior to the meeting. If contracts with outside companies are involved the board meeting agendas can easily exceed a hundred pages. The November Planning Committee packet ran to 32 pages. The actual agenda took up just over a single page. The minutes covering the October Planning Committee meeting took up four pages. A “Strategic Plan Update” comprised thirteen more pages. Another five and a half pages concerned a draft of bylaws for a Measure C Taxpayer Oversight Committee. Throw in a few pages to divide those topics and the page count still comes up several shy of the 32 total pages.
One has to wonder how many of the recipients of the email read past the first few pages, encompassing the November agenda and the minutes of the October meeting. Somebody did, because at a few minutes past nine a.m., the morning of the November 13th meeting, a new email arrived from the assistant to MCDH Chief Executive Officer (CEO) Bob Edwards. That email stated in bold type, “The HCAHPS Stoplight Report was inadvertently added to your Planning Packet under Tab 2. Please remove and destroy this document.”
For those who hadn't read through to page 23 of the agenda packet before, they probably did at that point. Pages 23-26 of the Planning Committee agenda packet contain an HCAHPS survey. HCAHPS is an acronym for Hospital Consumer Assessment of Healthcare Providers and Systems. The survey was conducted by NRC Health. That company's website states that they help “healthcare providers thrive in a consumer-driven economy by providing holistic customer intelligence essential to designing and delivering care experiences that surprise, delight, and inspire loyalty.”
In other words, MCDH has contracted with NRC Health to survey patients about their care at the hospital. You or someone you know may have received a call in recent months in this regard.
What got stuck inside the Planning Committee agenda are the results of NRC Health's survey of patients covering the first three quarters of 2018 (January-September). Who wanted the document destroyed?
The agenda for MCDH Board meetings is made up by two individuals, the CEO, Bob Edwards, and the President of the hospital's Board of Directors, Steve Lund. The agendas for committee meetings are presumably a product of the chair of the particular committee (Lund also chairs the Planning Committee) with input from administration. In the case of the MCDH Finance Committee we can guess that input comes as much from the Chief Financial Officer (CFO) as the CEO. For the Planning Committee one can only surmise that Lund's partner in agenda responsibility would be the CEO.
The HCAHPS survey allows participants to respond on a 0-10 (zero being lowest) rating as to an overall recommendation of MCDH. The survey also asks specific questions that are weighted on a scale of 0-100%. HCAHPS asks 40 different questions. Examples include: “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it? How often were the different doctors and nurses consistent with each other in providing you information and care? During this hospital stay, how often were you given input or say in your care? While you were in the emergency room did you get enough information about your medical condition and treatment? During this hospital stay, how often did the hospital staff include your family or someone close to you in discussions about your care? During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?”
The HCAHPS survey scores are shown for each of the first three quarters of the 2018 calendar year along with an overall average for the period between January and September 27, 2018. Each quarter score and the overall average is color coded on the chart: Green for a score equal to or higher than NRC's average from other hospitals; yellow for a score less than the NRC average, but may not be significantly less; red for a score significantly less than the NRC average.
In the first quarter of 2018 the HCAHPS survey gave MCDH 17 scores in the green (above average) level, 22 yellow scores (less than average), and only 1 red score (significantly below average). In the second quarter: 23 green, 13 yellow, and 4 red. In the third quarter of 2018: the green scores dropped to 11, the yellow rose to 21, and the red scores advanced to 8. The overall scores for the accumulated three quarters of this year reflected the third quarter scoring, with 11 greens, 21 yellow, and 8 red.
That fairly significant drop in approval scores/ratings in the third quarter might account for why the lead administrator and/or the President of MCDH's Board of Directors would demand that email recipients “remove and destroy this document.” However, the NRC HCAHPS survey provides an even bigger reason. At the top of the survey is an “Overall” category. Scores were derived from this query to MCDH patients: “Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?”
MCDH scored in the red (significantly below average) zone in the first and third quarters as well as in a cumulative average. The hospital's second quarter score was barely above the “Significantly below average” level.
There is nothing in the survey that violates HIPAA privacy rules. It merely contains a series of color coded averages in chart form. This leads to a couple of questions not in the NRC HCAHPS survey. Why are people in MCDH leadership intent on destroying a survey of its patients? Why are they intent on keeping this information from the public eye at an institution paid for by the public?