By openly admitting fault in their process and being willing to scrap the existing salary contracts with physicians and other providers and start anew, the Porter management team took a critically important step to improving what rapidly was becoming a toxic environment at the Middlebury hospital campus.
And none too soon. A crisis of mistrust was brewing. A letter to the editor in today’s Addison Independent cites a litany of complaints and is signed by 100-plus area residents — testament to the breadth and depth of community concern.
Discontent first surfaced a few weeks ago when the nurses union at the hospital protested the announcement of sudden layoffs and the manner in which those layoffs were imposed. Next were rumblings among the medical staff about the details of a newly imposed salary contract that dramatically changed the way in which physicians and other providers would be paid, based in part on patient satisfaction and productivity. Then, in just the past week, came word on the street of doctors leaving, plummeting morale and rumors of a culture at the hospital “of fear and intimidation.”
To be fair to the Porter Medical Center board, the crisis unfolded quickly. Just in January, the board held a management retreat with the administrative team, board members and members of the medical staff to go over upcoming changes, strategic direction and goals. In a Wednesday morning interview with the Addison Independent, PMC board chairwoman Maureen McLaughlin and board member Patrick Norton recalled the meeting seemed to go smoothly and that most were aligned with the overall goals expressed.
But the process of getting there was rushed, by the board’s admission, and flawed. As details of the new contracts percolated and providers expressed dissatisfaction, as well as angst with a management style described as “oppressive,” and as community concern heightened, the executive board held successive meetings in the past week to catch up with events and today expressed its “mea culpa” to the public discontent management has engendered (see story Page 1A).
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What now?
First, is replacing rumor with fact. That requires an open dialogue that helps the community understand the hospital’s goals and direction. In today’s front-page story, we start by adding detail to the public perception “that doctors are leaving at an alarming rate,” as quoted in the aforementioned letter to the editor. Indeed, eight physicians are in transition. Three were set to retire; two are moving for “other” reasons and, more recently, three because of dissatisfaction with the proposed contract and management. Lesser known is that Porter has recently hired three new physicians. Part of this churn is the ebb and flow of a 780-person operation and a difficult health care environment, but part is also because of impending changes poorly executed.
There are also larger questions to be raised and explained, including:
• Why the uproar among the nurses’ union and administration?
• What’s the reasoning behind the changes in the providers’ contracts, and why were providers’ not more involved in the process? Are such changes compatible or necessary within this medical community?
• Why not work with frontline service providers in designing solutions to critical care issues while hitting financial targets, rather than handing down decrees from on high that, as the community letter suggests, “appear capricious and arbitrary.”
• In the process of working with outside hospital consultants to find ways to cut expenses, how are those recommendations being vetted within the Porter community and tweaked to fit Porter’s culture?
The good news is the PMC board wants to reset the stage and engage in a more collaborative dialogue, both internally and with the community. Smaller community group sessions are being arranged in the short term, as well as a community-wide conversation to be held at the annual meeting of Porter Medical Center just two weeks from now on March 30.
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As the administration, board, medical staff and community members wrap their arms around the issues confronting Porter, here are a few strengths to value and preserve:
• Foremost, Porter an excellent medical staff and the diminishment of that staff hurts the viability of the hospital. Creating and maintaining a culture that is enjoyable and allows one to thrive creates a value beyond the amount on a paycheck and can be an equalizer compared to higher-paid positions elsewhere. Lose that quality environment, and the ability to attract and keep quality providers will become more difficult. The process that crafts the providers’ contracts has to take that into account.
• In order to thrive, this community and county needs a strong and vibrant hospital. We all agree the hospital must be financially healthy, but it also must have a team of physicians, providers, nurses and staff who embrace the town as their own and love their work. In small, rural towns, it is never just about the bottom line. Culture is an important part of the equation, and for years that has been a strong suit of the Porter community.
• The community loves the hospital. Use that to build an engaged and steadfast client base for the challenges of the future: including a move toward ambulatory care and a focus on wellness.
• Area residents should trust that the PMC board, and Porter management, shares the community’s goal to have a strong and vibrant hospital. The hospital’s mission and strategic plan are transparent for all to see on its website and in its annual report at www.portermedical.org/Annual%20Report%202015.pdf. Getting there is the challenge, and it is an increasingly difficult health care environment in which to operate. It will take a collaborative effort from all sides to keep Porter strong and healthy for the decades ahead.
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To these ends, the board has the central role in setting the direction and it was right to move in quickly, take the reins from management, and reset the stage. Next moves are to set up steps to engage with the community, and direct management to craft a new providers’ contract through a more collaborative process.
Afterward, the board has two primary questions to ask and pursue: Do we have the right plan to ensure Porter Medical Center will be financially healthy and served by a top-notch medical community for the foreseeable future, and do we have the right leadership team to carry out that plan? Those questions should be explored with transparency and vigor.
— Angelo S. Lynn