Monday, January 18, 2010

Monterey County officials defend health care effort

Officials respond to grand jury criticism
Herald Salinas Bureau
Updated: 01/18/2010 08:42:30 AM PST

A lack of progress on a year-old effort to better coordinate Monterey County's health care system is a result of a rapidly changing industry and the difficulty of putting in place new electronic systems, the top administrators for the county Health Department and county hospital said.

Their comments came in the wake of last week's critical grand jury report that found a lack of cooperation and accountability between the Heath Department and Natividad Medical Center.

County health officials acknowledged the integration effort had failed to meet previously set deadlines and timelines for progress on six key improvement initiatives aimed at improving coordination between the department and Natividad.

But both Health Department director Len Foster and Natividad CEO Harry Weis said it wasn't for lack of trying, and they said both organizations are still committed to working together.

Both men said the demands of adjusting to a transforming health care landscape at the state and national level, as well as the challenges of installing new information technology systems that are at the core of many of the initiatives, had stunted progress.

At the same time, the Board of Supervisors has already decided to step in to provide closer oversight for the fledgling effort by ordering quarterly reports to the Health and Human Services committee headed by Supervisors Jane Parker and Simon Salinas.

Last fall, Parker had expressed frustration at the lack of progress on the improvement initiatives after a report to the board from a "core team" of county health administrators. She pointed out the plethora of missed deadlines and noted that the report was not only late but "it was almost like it had been copied" from an earlier report delivered several months before.

'Very little progress'

"It felt like very little progress had been made," Parker said, while noting improvement in the coordination of care for pregnant and postpartum women. "That concerned me because that integration and coordination of health care services is fundamentally important to improving the county's system. There has been some progress made but it hasn't been enough."

Hospital and Health Department officials are expected to deliver a report on the initiatives at the next Health and Human Services committee meeting Jan. 27.

The initiatives, involving improved continuum of care, sharing of patient information, and coordination of management between the county's separate health care organizations, were adopted as a kind of alternative to a more sweeping merger of the Health Department and county hospital under a consolidated Health Services Agency, which would have become the county's largest department.

That merger was a key part of a long-range strategic plan for Natividad developed by its consultant, Huron Consulting subsidiary Wellspring Partners. But the proposal drew heavy opposition from scores of Health Department workers concerned about the loss of autonomy and the impact on funding for its operations, especially its federally qualified health clinics.

Instead of the merger, the board agreed more than a year ago to allow local health officials to work on the initiatives they had agreed were essential to a streamlined health care system, and assigned the core team including Foster, Weis, county Clinical Services director Dr. Julie Edgcomb, and assistant hospital administrator Carol Adams, to oversee the process.

Grand jury critical

In its report, the grand jury found that Health Department and hospital leadership had "failed to develop a common vision" for an integrated county health care system, that progress had been slow and team cooperation was "sporadic," and that the two organizations "have not demonstrated their commitment" to implementing the integration.

As a result, nearly all deadlines were missed and the various timelines changed with little accountability.

"As yet," the report said, "little (integration) has materialized."

Foster, who is leaving at the end of March, ripped the grand jury's report for failing to recognize the efforts that the Health Department contributed to the process, and pointed out that it was the hospital's struggles to implement new information technology systems that delayed progress.

"It's not because of any lack of participation or willingness to act on the part of the Health Department," Foster said. "Most of the progress has been pushed by the Health Department. I'm not going to blame Natividad; I think their plate is full. It leads me to believe the grand jury didn't understand what they were looking at.

"These improvement initiatives are important and we enthusiastically support them. I just wish we could see more progress."

Weis, who left Huron to take over as the hospital's top administrator last year, said he appreciated the grand jury's interest and said he believes the public will ultimately be "very excited" when a full report of the progress on integration made thus far is made available. He said a summary response involving such a complex issue is not the best way to go.

He acknowledged that responding to changes in the health care industry, including those in progress and expected such as national health care reform, and difficulties with information technology, had forced hospital leadership to set priorities that helped delay progress on the initiatives. He said some of the initiatives actually could be altered by the changing landscape of health care and that taking a cautious approach is the right way to go.

"We're not being harmed by trying to do this right the first time," Weis said. "Our journey has a considerable ways to go. We're very excited about the future."

While acknowledging the complexity of integrating differing electronic records systems had helped stymie progress, the grand jury suggested simply that more money and attention be given to those efforts so the other initiatives could proceed. More important, the grand jury recommended that more realistic, achievable deadlines be set, that a better integration plan be adopted and that "result-driven, focused work groups" be created for each initiative.

Possible board action

Parker said she hopes the Health and Human Services committee process will create more accountability, but if that doesn't work, she said the board may have to consider what kind of alternative organizational model may be most effective at getting the two organizations to work together.

She said the board has "taken a step back" on the Health Services Agency merger, but is still "moving in that direction" while trying to determine how best to shape such an agency, based on what's best for patients as well as the various health providers involved.

Foster and Weis said a formal response to the grand jury report will be formulated and sent to the County Administrative Officer.

Jim Johnson can be reached at 753-6753 or

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