Silencing Employees? Is that Good for Patient Safety at the VHA?

From Beyond Chron

New Threats to Patient Safety at the VHA

by Suzanne Gordon on March 9, 2017

VA Hospital in Washington DC

VA Hospital in Washington DC

Ever since a physician at the Phoenix VA Health Care System reported that Veterans Health Administration (VHA) administrators had been gaming data on wait times for patient appointments, VA whistleblowers have been embraced on Capitol Hill. There may be disagreement in Washington about the future of the VHA, but there is bi-partisan agreement that VHA employees should be supported and rewarded when they act to protect their patients.

Unfortunately, not enough legislators and veterans advocates understand that acting to create real patient safety involves far more than being a traditional whistleblower, which, as Webster’s dictionary explains, is “one who reveals something covert or who informs against another.” Or as the Federal Whistleblower Protection Act defines it, involves reporting a “violation of a law, rule or regulation; gross mismanagement; gross waste of funds; an abuse of authority; or a substantial and specific danger to public health or safety.” 

As an extensive literature on patient safety documents, patient safety depends not primarily on the acts of heroic whistleblowers, but on the creation of a workplace environment where you don’t have to be a hero to voice concerns or criticisms, share insights, and make suggestions for change on a daily basis. READ MORE

A Key to Patient Safety — Don’t Just Listen, Solicit Input

New blog post in BMJ

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suzanne_gordonWant to be a better physician or nurse leader? Enhance patient safety? Effectively lead teams? One of the current consultant prescriptions is the recommendation that leaders spend more time listening than talking. Whether in the larger management literature or in the articles and books that specifically target healthcare, listening is portrayed as a key to leadership.

I am all for listening. Of course people have to listen to each other rather than silence, ignore, dismiss, or denigrate one another. When it comes to the implementation of genuine teamwork and patient safety within the hierarchical environment of health care, I don’t think listening is enough. As Amy Edmondson has written in her book Teaming, “Research shows that hierarchy, by its very nature, dramatically reduces speaking up by those lower in the pecking order. We are hard-wired, then socialized, to be acutely sensitive to power, and to work to avoid being seen as deficient in any way by those in power.”  READ MORE

Hey Manners Matter: Say Hello My Name Is Not Just to the Patient

Why Introductions Matter Is a New Post I did at the BMJ

suzanne_gordonThe other day, I was invited to give a seminar on interprofessional teamwork to a group of residents and attendees at a prestigious university medical center in Europe. The first thing people did when they trooped into the room was introduce themselves to me. Since there were about 25 people in the room, no one really expected me to remember their names. But each and every one of them went through the drill.

These introductions did more than convey instrumental information about who we all were and what roles we had. At the most fundamental level, what people are doing when they acknowledge a stranger walking down a street or shake the hand of a person whom they have just met is create a psychologically—not to mention physically—safe environment. Read More

 

Jeff Miller Doesn’t Believe Veterans Deserve the Healing Arts

Another blog post on how low people will stoop to deny veterans excellent care.

In Defense of Art in VA Hospitals

Conservatives are mad about spending government money on art, but it provides real medical benefits.

The Veterans Health Administration (VHA) has taken a lot of heat lately about using money to purchase art for its hospitals and other facilities. Last week, Gail Collins, in a column in the New York Times, joined in the pile-on. While Collins defended the VHA and opposed its privatization, writing that veterans “are satisfied” with its services and that “the care is in many cases excellent,” she couldn’t resist a jab at the VHA for spending $670,000 on two sculptures that were placed in a blind rehabilitation center. Her conclusion? “Veterans healthcare for everybody! But maybe with less art.”

The issue of spending on art first emerged last year when Congressman Jeff Miller (R. FLA) , Chairman of the House Veterans Affairs, a staunch advocate of VHA privatization, lambasted the VHA for spending $483,000 for a sculpture in a hospital courtyard. For Miller, whom Donald Trump has promised to appoint to the post of Secretary of Veterans Affairs should he be elected, the issue was not the quality of the art used at VHA facilities but the fact that the VHA was using taxpayer money to spend on art, period. Miller called such spending “wanton and abusive.” 

Read More

 

Bad News on Patient Safety from Ontario

Doris Grinspun head of the RNAO just sent me this article about the firing of a Chief Nurse who spoke out to protect patients.  Any Canadian nurse reading this should immediately join the protest.

The only good news here is that nurses are protesting this.

An Ontario nursing group contends Vanessa Burkoski was fired to silence her about changes affecting patient safety

By Jonathan Sher, The London Free Press

Vanessa Burkoski, past president of the RNAO (Postmedia Network)

Vanessa Burkoski, past president of the RNAO (Postmedia Network)

The boss of London’s largest hospital has sacked his chief nurse to stop her from speaking out against changes that put patients across Ontario in harm’s way, the head of a powerful nursing association claims.

Murray Glendining, chief executive of London Health Sciences Centre, tried to buy the silence of his chief nursing officer, Vanessa Burkoski, offering her cash if she would resign quietly, but she refused and was fired, Doris Grinspun, chief executive of the Registered Nurses Association of Ontario (RNAO), said Friday.

“It’s the most disgraceful thing I’ve seen in my 20 years at RNAO,” Grinspun told The Free Press.

Glendining fired Burkoski not for her work at the London hospital, where she received stellar reviews, served as a vice president and looked after safety and quality of care, but because she was serving as president of the RNAO when in May it produced a report that exposed how Ontario hospitals had harmed patients by replacing registered nurses with cheaper and less educated health care workers, Grinspun said.

Glendining isn’t the first Ontario hospital boss to try to muzzle hospitals’ top nurses, Grinspun said.

“Patients suffer the consequences because chief nurses are the safety valves,” she said. “We are outraged about this level of intimidation of nurses by CEOs who treat their hospitals like private organizations.”

But the London hospital boss went further by firing a nurse whose leadership in Ontario was almost unrivaled — before coming to London in 2011, Burkoski was the longest-serving provincial chief nursing officer, advising three Ontario health ministers.

“(Burkoski) is a person of stellar integrity, judgment and experience,” Grinspun said. “(Her firing) is just unconscionable.”

Asked by The Free Press about Grinspun’s concerns, Glendining sent a brief email: “We can confirm that Vanessa Burkoski is no longer an employee at London Health Sciences Centre. LHSC does not comment on any personnel matters.”

But Burkoski spoke to The Free Press about what she says happened — she says she was called into Glendining’s office June 8 to discuss the report produced by RNAO, called Mind the Safety Gap.

When she arrived, she said, she was met by Glendining and his vice-president for human resources, Stephen Coulahan and offered a cash settlement if she would resign.

When Burkoski refused, she said the two men asked her to reconsider, then meet with them again Monday.

Two more times, Burkoski said, she refused to resign with a cash settlement.

“After three requests for my gracious exit, they asked me if I understood what a termination meant in terms of (my) reputation,” she said.

Glendining fired her, and then on Tuesday, sent to senior hospital leaders a vague email to announce that Burkoski was gone.

“Vanessa Burkoski, Chief Nursing Executive, and Vice President, Professional Scholarly Practice is no longer with London Health Sciences Centre. We thank her for her contributions and wish her the best,” the hospital boss wrote in an email obtained by The Free Press.

The sudden departure and terse note left some wondering if Burkoski had done something untoward or even illegal, Grinspun said.

Under Grinspun’s leadership, the RNAO, which is not a union, has played a growing role — she led the successful push to get the province to scrap costly home care bureaucracies, called community care access centres.

The Free Press tried to reach Ontario Health Minister Eric Hoskins, but a spokesperson said he was unavailable Friday.

 

IN A NUTSHELL

The Registered Nurses Association of Ontario says the chief executive of London’s largest hospital sacked its chief nurse because she was the public face of a report critical of hospitals. Here’s a summary of the report:

“In an effort to cut costs, health organizations across the province are replacing registered nurses with less qualified care providers . . . the RN share of the nursing work force has dropped significantly in recent years. This has left Ontario’s health system unprepared to meet rising levels of acuity in hospitals and in the community, and put the safety of Ontarians at risk.”