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No Gain in the Press-Ganey

6/19/2017

30 Comments

 
​Once again, for those new to this blog site, at present there are 41 posts on the blog and each has its own set of comments. To read the comments you have to hit the word "Comments" at the beginning or end of the post. Somewhat confusing is that when you bring up the comments for a specific post it eliminates the other posts from the screen. To bring the other posts back up simply go back to the top of the page and click on Blog. Feel free to comment should you wish. No email address is required to make a comment so anonymity is strong. Due to some previous abuse of this right to anonymously comment, I have had to include an approval option, but I try to approve within 24 hours. To understand the development of the blog it is best to read it from the bottom post (Dr. Paul Kearney Case) up. One point of note here, to read the earliest posts you have to click on the word "<<Previous" at the very bottom of the posts available. Finally, for those just looking for a good summary of the Dr. Kearney case, simply scroll down three posts to the 12/10/2016 post. For social media developments on the Dr. Kearney situation I would encourage you to also visit the excellent "Save Dr. Kearney Facebook Page": 
https://www.facebook.com/search/top/?q=save%20dr%20kearney



The comment section of the previous blog post ended with discussions of the poor performance of UK hospital in the 2016 Press Ganey Physician Engagement Survey (see the blog posts on 6/6/2016: Press-Ganey Employee and Physician Engagement Survey, and on 6/29/2016: “Spinning the Press-Ganey Survey”). You will remember, in this survey of the over 1,200 hospitals and 63,000 physicians, UK ranked in the bottom 1% for administration engagement with physicians and faculty (See Survey).  Following these horrible results and the leaking of the results to the UKHC community, EVPHA Dr. Karpf, on June 8, 2016, sent a broadcast email to the UK physicians claiming, "We've Heard You" and "we need to understand the issues." 
 
Well a year has passed, and you guessed it, the 2017 survey results have surfaced. Unfortunately, I do not have the complete survey results, but Dr. Davy Jones has forwarded an email on this subject matter that he has sent to the College of Medicine Faculty Council, as well as a variety of other university administrators. This email discusses some of these results, and Dr. Jones has been kind enough to okay the posting of the email on the blog.
 
Dr. Jones' Email

From: Jones, Davy
Sent: Thursday, June 15, 2017 11:56 PM
To: Jicha, Gregory A; Erickson, Deborah R; Kiessling, Stefan; Peterson, Martha L; Kilgore, Michael W; Bailey, Paula D; Martin, Julia E; Kelly, Thomas; Sloan, Paul; Iocono, Joseph; Sullivan, Patrick G
Cc: DiPaola, Robert S; Rowland, Michael L; Huddleston, Alyssa A; Tracy, Tim; Karpf, Michael; Capilouto, Eli
Subject: RE: FC agenda 6-20-17 re: Implications of Press Ganey Survey Results
 
Greg, 
 
May I please recommend that an item expressly shown on the College Faculty Council agenda be something to the effect ‘Press-Ganey Survey Results.’  Dean DiPaola has (refreshingly) candidly presented at an open forum last week, and to the Board of Trustees HealthCare retreat today, the (again) dismal results for the faculty ‘satisfaction’ survey part (bottom 6% nationally) and for the survey part on the faculty’s view of lack of administrative engagement with faculty (for the second year in a row, bottom 1% nationally, both down from the previous bottom 2% national ranking).  However, as far as the COM faculty-at-large can tell (most of whom could not attend the forum last week or the retreat today out at Keeneland), there continues to be a hopeless disconnect of the in-a-bubble mid/higher administration to the in-the-trenches faculty. To wit, 
 
(1) the announcement (senior signed by Dr. Cofield) for the forum last week had the disingenuity to characterize the miserable bottom 6%/1% results as “we saw a slight improvement in both the employee engagement survey and the physician engagement survey”                   
 
and 
 
(2) the email we just received from EVPHA Karpf, whose spin control could only say “Key insights on employee and physician engagement survey results were shared by Cofield and Dean Bob DiPaola, MD, which have already been shared within UK HealthCare and the College of Medicine.”   
 
Given that our College Faculty Council minutes circulate to all basic science and clinical faculty, I would like for our minutes to show (untarnished by (1) and (2) above) what Dean DiPaola has candidly described publicly about these survey results and what his plans are to move the college beyond the ‘bottom 1%’ administrative ambiance he inherited.
 
Tx.
 
Davy
 
Cc: Board of Trustees
 
 
Davy Jones, Professor
Dept. of Toxicology and Cancer Biology
University of Kentucky
Lexington, KY 40506

________________________________________________________________________________

Well as this email suggests, it would seem that perhaps Dr. Karpf and the senior administration did not “hear you”, nor did they apparently “understand the issues”. It’s either this, or they really do not give a hoot, view it all as “fake news” and simply make these overture statements to sound good.
 
In the comment conversations with Mole on the previous blog post, he/she asks the important question: “We all know the faculty engagement is horrible but aside from sacking everyone in a management position what can be done to improve it?” I attempted to respond to this question by first looking at factors that might have contributed to this low morale scenario. Some I came up with included:

 
Potential Morale Impactors:
1.  The Dr. Paul Kearney vendetta that has been festering for the past 3 years:  This extremely abusive treatment of a tenured faculty member, talented trauma surgeon and respected teacher reflects an administration that does not believe in due process or faculty rights. Furthermore, it suggests an administration that not only doesn’t listen, but also one that doesn’t want to hear and one that punishes those who speak out.
 
2.  Restructuring of Performance Evaluations:  These dictates that minimized teaching and service credit while emphasizing the importance of RVUs, clearly frustrated many.
 
3.  Staff Restructuring: The $500,000 Price-Waterhouse-Cooper restructuring/reduction of the staffing in the hospital, with its creation of the I.B.Useless clearly had its impact on staff morale.
 
4.  KMSF Secrecy: The denial of open records requests, the many lawsuits against open records requesters and the refusal of a detailed public audit of KMSF suggests potential mismanagement of UKHC revenue.
 
5.  Faculty Exodus: The large number of talented physician faculty that have left over the past 5 years not only stresses the workload of those that have to cover their loss, but also involves the time consuming and expensive job of replacing these people.
 
6.  Administrative Overload: There are 20 or more individuals in the College of Medicine with the word Dean in their title. With this many people barking out orders and creating new burdens, it again becomes difficult to do what one needs to do.

 
These are just a few of the ones that I can think of. Not being a physician trying to balance a patient workload while at the same time teaching interns, residents and fellows, I feel certain there are others that folks out there might wish to add. Please feel free to do so in the comment section.

The next obvious question is "what possible solutions might these contributing factors point to?"

 
Possible Solutions?
1.  Changing of the Guard: As mentioned in the comment section, the replacement of the College of Medicine Chair and the EVPHA might be a good start. As the saying goes, respect is earned. Unfortunately, very few hospital workers and faculty respected the former CoM Chair and EVPHA. I believe this was simply because these two were both very poor listeners. Furthermore, if you view the buildings as much more important than the people occupying them, you can’t expect the people in them to respect you. Some view respect as something that comes with the position, but it is not. Furthermore respect is a central component of morale and therefore “engagement”.  From what I read in Dr. Jone’s email, it at least appears that the new Dean is a bit more open and perhaps responsive to this survey than our previous Dean. Hopefully the new EVPHA might likewise view these survey results with concern rather than complacency.
 
2.  Resolving the Dr. Kearney Case: This thing has been going on for 3 years now and it is nothing but a festering wound. The UK lawyers are dragging everything out in an attempt to drain time and treasure from Dr. Kearney and win the case by perhaps the only way they can. As mentioned multiple times before, a vast majority of Faculty, Residents, Fellows, Staff and the public have voiced support of Dr. Kearney. For me it has never been a question of liking or disliking Dr. Kearney, but rather the simple truth that the the lawyers and administration of this university have conspiratorially tried to fire someone for a behavior they have endorsed for over 25 years. Many of the conspirators that created this monster have moved out, or soon will be moving out. It is time to resolve this thing. Some have expressed the opinion that the only resolution is the returning of patient privileges, rescinding the sanctions imposed on Dr. Kearney and restitution of the financial losses incurred by this drawn out legal battle.  I am not sure all of that is totally necessary. I know the university lawyers tried to threaten and lowball Dr. Kearney into “taking the deal or we will ruin your career”. Maybe an acceptable deal might be worked out if they brought in some less arrogant, threatening and biased lawyers. Have they ever really asked Dr. Kearney what it would take to settle this?
 
3.  Ask the People: If the new Dean really wants to know the mood of his people and what might be causing discontent and morale problems, ask your faculty, physicians and staff.  One possibility is Surveys (e.g. hire an outside group to do it, start a personal blog like this one, etc.) in which folks can comment on issues or even raise issues of concern in an anonymous fashion.
 
4.  Review Administrators: Under the former EVPHA and Dean, 3 and 6-year administrator reviews were basically rubberstamped. Here again, if the new Dean really wishes to know what’s happening, afford the faculty and staff the opportunity to anonymously voice their perspectives with regard to how the various Deanlets, Chairs and Division Chiefs are performing.
 
5.  A Public Audit of KMSF: Silence all of those KMSF critics by having that detailed public audit. This might also help resolve some of the open record lawsuits.

 
Well once again, these are my limited suggestions and thoughts on the matter. Feel free to offer constructive ideas that I may have overlooked.
 

30 Comments
Mole
6/20/2017 07:11:21 am

I would add the insistence on non compete contracts that prevent clinicians from taking positions at other local/regional hospitals even when they are being squeezed to do more work for less money and forced to work in an unpleasant environment is also a contributory factor. And on top of that the non compete contracts are non enforced or insisted on in a consistent way. I am sure other blog readers have opinions about this.

Reply
Dan Noonan
6/20/2017 07:28:46 am

Thanks Mole for this addition.

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LJ
6/22/2017 06:54:39 pm

Riding the wave, as most everyone already knows, Sean Dineen, another talented surgeon, is leaving. Pressing on, or should that be "Press-Ganeying" on...

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Dan Noonan
6/22/2017 06:56:51 pm

Thanks for the comment LJ. I think it is as an earlier blog commenter put it, "physicians speak with their feet." From what little I understand of it, Whipple surgery is an expertise that takes years to master, and Dr. Dineen is one of the better surgeons performing it. Dr. Dineen will be missed.

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Son of the mole
6/22/2017 06:59:30 pm

And cv surgeon hassan reda is leaving because he got sick of dealing with saha and zwishenberger...surely the new evpha will get rid of these clowns

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Dan Noonan
6/22/2017 07:03:07 pm

Thanks Son of Mole for the addition. I know nothing about Dr. Reda's expertise, but I do know that retention of quality physicians is becoming a major problem in Dr. Zwishenberger's department. Rumor has it that his 6 year review is coming up. Hopefully the new Dean will see the obvious and hold him accountable for these departures as well as the bottom of the barrel score that this department received in the Press-Ganey survey..

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El Hijo del Topo
6/23/2017 11:07:06 am

Saha has been told to retire and I am sure Zwishenberger has been told that he can either return to the faculty or get another job. But as someone else pointed out given the difficulties in hiring division chiefs and department chairs and the number of vacant and interim positions we already have there is a reluctance to drawing further attention to this talent/leadership vacuum by creating even more vacant/interim positions. For example, how many more times will they have to reappoint Carmel Wallace as Peds chair?

On a non clinical note I have also heard that the Chinese grant enthusiasts that were supposed to be moving here so the husband could be chair of cancer/tox are not coming. This was supposed to be a big win for our new dean. He has certainly managed to create lots of deanlet positions but has he actually hired anyone from the outside yet?

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Dan Noonan
6/23/2017 12:17:32 pm

Thanks Señor Son of Mole for the comment and information. One can only hope that the new EVPHA will solve all of these problems. :-)

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Dogwood
6/23/2017 12:21:03 pm

To tell you the truth, I am not sure how much any of this will matter if the US Senate passes the new healthcare bill. Being a state hospital and about the only game in town, all those less fortunate people no longer carrying medical insurance will be, by necessity, knocking on our doors for their free healthcare. Who knows, maybe then some of these administrators will be forced to begin seeing patients. Now wouldn’t that be something. Furthermore, I doubt that this bill will positively impact our Press-Ganey numbers. Oh that’s right, I forgot, there is already no place for those numbers to go but up.

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Mole money mole problems
6/23/2017 01:32:52 pm

Yeah..what sort of person would be shepherding the healthcare bill through the senate..must be someone from one of those rich states like NY or MA where everyone already has lots of health insurance...

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Dan Noonan
6/24/2017 03:15:38 pm

Thanks Dogwood and Mole money for your contributions. I think we all know who is waving the conductors baton in this senate, so to some extent the state of Kentucky can't blame anyone but themselves for the eventual increase in state taxes that will be required to pay for these services once they transfer this responsibility to states. Ranking 47th in the 50 states for average household income, ($40,141), we will be hit hard should this bill pass. But then again, Mitch and the boys aren't worried too much about that because their expenses are paid in full.

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Sly
6/25/2017 12:26:20 pm

The first candidate to replace Karpf has been announced and will be at UK tomorrow morning. He is from Duke and here is a little about him from when he became president of their faculty practice plan

Newman Named President of Duke Faculty Practice
Published February 12, 2014 | Updated January 20, 2016




Contact

Duke Health News
919-660-1306
DURHAM, N.C. – Mark F. Newman, M.D., has been named president of the Private Diagnostic Clinic (PDC), the faculty practice plan of the Duke University Health System. Newman will succeed Carl Ravin, M.D., the inaugural PDC president, in the first week of April 2014.

Newman, the Merel H. Harmel Professor of Anesthesiology, has served as chairman of Duke’s Department of Anesthesiology since 2001. Since that time, he has served in several important leadership roles within PDC, including two, two-year terms as chair of the PDC Board of Managers, a term as vice-chair, and has also served as the chair of the organization’s finance committee.

“Mark has been an integral part of the success of the PDC over the past decade and will be able to hit the ground running in this new role given the depth and breadth of his service to PDC in the past,” Ravin said. “He is a proven leader and will no doubt continue to strengthen the collaboration between the PDC and the Duke University Health System.”

Newman will maintain a limited clinical practice and continue to pursue research interests that include cognitive dysfunction and quality of life following coronary artery bypass graft surgery. Since joining Duke as an assistant professor of anesthesiology in 1992, Newman has trained and mentored more than 34 anesthesiology fellows.

“The PDC has experienced tremendous success over the years and it will be important for us, as physicians, to adapt quickly to the rapidly emerging demands for value-based care and population health,” Newman said. “I’m excited about this opportunity and serving in this role.”

The PDC is a for-profit professional limited liability company, which has approximately 1,400 physicians and 1,000 staff members. The practice is responsible for ambulatory clinic operations, business office functions, managed care contracting, compliance, and physician compensation and benefits.

Joseph P. Mathew, M.D., MBA, MHSc, will serve as interim chairman of the Department of Anesthesiology beginning in April. Ravin will remain at Duke and will continue to pursue his research and educational interests within the Department of Radiology.

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Dan Noonan
6/25/2017 12:49:18 pm

Thanks for this Sly. Great information.

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Sly
6/25/2017 01:55:19 pm

thanks.
He was born in Owensboro and went to undergrad at WKU and medical school in Louisville, so he has Kentucky ties which may be one reason he would come back

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Mole
6/25/2017 03:49:18 pm

The other two candidates are much more impressive with far stronger academic credentials and far greater experience in administration of highly regarded academic medical centers and academic healthcare systems. This is really the warm up act for these ones later in the week, Needless to say I am sure that Dean Dipaola is hoping that we end up with this guy because I am not sure that either of the other two will want to work with an existing dean.

Unlike KMSF which is "not for profit" the Duke practice plan is for profit so a good question to as Dr Newman would be to discuss the benefits and limitations of the two arrangements :-) Maybe Kearney could show up to one of the forums?

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Dan Noonan
6/25/2017 04:52:19 pm

Sly and Mole, great information folks and thanks. You both appear knowledgeable about these candidates, so just as a point of interest, if you were limited to asking these candidates 3 questions, what would they be? Anyone else who might wish to contribute please feel free to comment. It would be nice to accumulate something to maybe pass on to those with the capabilities of asking these questions.

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Mole
6/26/2017 03:46:41 am

All of the Newman info is in his CV or can easily be found online.

Why do you want the job? What impresses you about UK/UKHC?
What do you think could be improved?

Someone should ask these candidates about their approach to faculty compensation.

Newman would probably take the job- its a big upgrade for him. I am not sure that either of the other two would risk coming to UK.

Reply
Bill
6/26/2017 09:54:32 am

1. In your career as an administrator, what was the toughest decision you have had to make and what was the logic you used to make that decision?

2. What do you perceive the role of the Executive Vice President for Health Affairs to be in university teaching and research.?

3. Do you believe hospital income in a public state university should be privately managed, and why?

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Dan Noonan
6/26/2017 02:54:30 pm

Thanks Mole and Bill for your questions. They sound reasonable to me.

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Ann
6/27/2017 07:59:50 am

1. I see where you have been president of the PDC at Duke for the past 3 years. Why is it that you are looking to leave that job?

2. Which do you believe to be more important, the hospital buildings or the people working in them?

3. What are your perspectives with respect to transparency in so far as it applies to how the hospital operates and how the hospital utilizes the income it brings into this university?

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ST
6/27/2017 09:05:43 am

What do you feel is your greatest strength as an administrator and leader?

What do you feel is your greatest weakness as an administrator and leader?

What unique strengths do you think you bring to this EVPHA position that separates you from other applicants?

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Dan Noonan
6/29/2017 08:56:11 am

Thanks Ann and ST for your questions. They also sound reasonable to me.

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MC Moley Mole
6/29/2017 07:11:49 am

Well that was interesting. In the >10 years I have been at UK this is the only time I have seen a search where all of the candidates are all really impressive. You could for example contrast this with the COM Dean search. I think this is a reflection of the fact that these kinds of jobs don't come open that frequently. And this job controls a lot of power and money.

These candidates are all very different. Burke is the real deal. He works for Bill Roper at UNC who is one of the nations top university health system administrators. The other people who have had the UNC executive dean position are now running the U. Michigan and U Wisconsin COM/Healthcare systems. He is a researcher. He knows how to run the hospital and the COM. The only downside is that I am not sure he would take the job.

Newman on the other hand would certainly take the job. He would also be able to fix the engagement issues. He does not have the same level of experience running the Duke COM or Hospital (but he has been around people who do this). He might be OK but not my choice.

If/when Burke decides to withdraw Patterson would be a strong choice. He also comes from the UNC system and he has been running a successful hospital and working for people who run a successful academic healthcare system. He has a strong academic background as a researcher and leader of research and educational programs. He might take the job.

What I am more concerned about is that I worry that none of these people were really appraised of all of the problems here. For example a continued lack of strategic planning and the need to recruit people from outside the institution to fill the positions that are currently occupied by interim or otherwise obviously stop gap individuals. Doe they really know how difficult this will be?

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Ditto
6/29/2017 02:25:50 pm

All 3 candidates are highly qualified, so a true breath of fresh air. Burks is a 5 star recruit, and if the deal is suitable, including organizational and reporting structure options on the table, I think it could happen. It would be transformational for UK to get him. Patterson is 4 star, but not sure why he is a COO with his stellar academic background. Strange career move, but maybe he is now looking for a correction to a job misadventure. Newman 3 star. He manages a large for-profit group practice with a Duke shingle (been there, done that). Go to the polls and vote. They close tomorrow at 5!

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Dan Noonan
6/29/2017 09:09:51 am

Thanks MC Mole for the contribution. If I am reading your comment correctly, the 3 finalists are:

Mark F. Newman, MD, president of the Private Diagnostic Clinic at Duke

Cam Patterson, MD, MBA, Associate Dean for Medical Entrepreneurship at UNC

A. Wesley Burke, MD, Executive Dean for the UNC School of Medicine at UNC

If so, I think it is interesting that the 3 top candidates all live perhaps within 20 miles of each other. Is this just coincidence, a bias in the selection process, something driving folks out of this area or something else I am missing?

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Mole
6/29/2017 09:42:55 am

Newman works at Duke, Burke works at UNC. I am sure they both live in or around Chapel Hill and its environs like most of the Duke and UNC faculty. Patterson was at UNC - his primary role was director of their heart hospital and associated programs but about 4 years ago he left to be COO of Weill Cornell Hospital in Manhattan so he lives in NY (and if you want to know why healthcare is so expensive see if you can google his house and how much it cost). I think the common theme here is that these people are from top academic medical centers/healthcare systems. Its a coincidence that they share some geographic/institutional associations.

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Dan Noonan
6/29/2017 03:03:27 pm

Thanks Ditto and Mole for this information on the candidates. I am not familiar with these candidates, but It does sound like they might be good replacements.

I wonder if they will be afforded the opportunity to read the recent Herald Leader article entitled:

"Judge says UK violated open records law, orders documents released"

http://www.kentucky.com/news/politics-government/article158843224.html?#1

This article by John Cheves describes the verdict handed down Tuesday by Fayette Circuit Judge Pamela Goodwine. The judge declared:

"The University of Kentucky violated the state’s Open Records Act by improperly withholding documents about a failed business deal between UK HealthCare and a Hazard cardiology firm from the Herald-Leader"

and

"UK also violated the Open Meetings Act with an unannounced Power Point presentation about problems with the business deal to the UK Board of Trustees during what was supposed to be an informal dinner in May 2016, Goodwine ruled. UK failed to keep minutes of that meeting and refused to provide a copy of the Power Point presentation afterward once the Herald-Leader requested it."

and

“The court agrees that there appears to be some sort of intent on the part of the university to mislead the public about the nature of the May 2, 2016, ‘dinner’ meeting, implying that it was merely a social event”

It will be important that the candidates know fully what they are signing on for.

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DT
6/29/2017 03:25:07 pm

Ah common now, we all know that reporters are "among the most dishonest human beings on earth". It's all "fake news".

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Dan Noonan
9/3/2018 03:44:19 pm

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https://www.uky-com-critique.com

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