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1990-11-14 Regular Meeting( / o 3- 08-0:x.� KODIAK ISLAND HOSPITAL ADVISORYBOARD MEETING NOVEMBER 14, 1990 PRESENT: Ben Ardinger, Jon Hlavinka, M.D. , Gretchen Saupe, Wayne Stevens, Betty Springhill, Jeannie Volker, Lorne White; John Salness, Administrator; Jim Greer, OR Supervisor; Kate Fitzgerald, Director of Nursing; and Keith Vorachek, Ac- counting Manager. The meeting was called to order at 7:00 P.M. Wayne Stevens moved and Gretchen Saupe seconded the motion to accept the amended agenda. Motion Carried. APPEARANCES AND COMMUNICATIONS Ms. Springhill shared a letter which she had received from Joe Smith, Director of Operations, LHS Management Company. STAFF REPORTS A. Kate Fitzgerald, Director of Nursing There are ten sub -departments in the largest department in the hospital. Ms. Fitzgerald presented the department's organiza- tional chart, and reviewed the values and decision making pro- cess used by the department. She shared the Commitment to Co- worker's statement. She stated that the turnover rate has been reduced greatly since Mr. Salness began and that she felt very positive about her department and the hospital. Difficulties in nursing recruitment include housing, salaries, and placement. A. Jim Greer, Nurse Manager, Surgery/OR/PAR Mr. Greer reviewed the duties and responsibilities of his multi- faceted department and how it interacts with the emergency room and obstetrics. Donna Vazquez is the other nurse in the depart- ment, dividing her time equally between OR and infection con- trol. In 1989, there were 297 surgeries, of which 73 were emer- gencies. In 1990, there have been 229 surgeries thus far, of which 58 have been emergencies. The department is on call 24 hours a day. Mr. Greer stated that he felt his department's major accomplishment this year has been to maintain the continu- ity to surgical services. Goals for the department include in- creasing the number of laproscopic surgeries, including the possibility of doing gall bladder surgery. Advisory Board Meeting November 14, 1990 Page Two Equipment needs of the department include a OR table, and a camera for laproscopic surgery. Staffing needs of the depart- ment including getting additional OR call coverage support. Dr. Hlavinka asked what crosstraining was being utilized to assist in coverage. Mr. Greer stated that the department has utilized Mike Black, a Certified Surgical Technician from the Coast Guard Base, and an LPN, Linda Mullins. The hospital has recruited a new RN from South Dakota, LaDonna Bender, who will work part- time in the OR and part-time in ER. Mr. Greer reviewed the pattern of surgeries and the most common procedures (inguinal hernias and gynecologic procedures). Dr. Hlavinka complemented both Mr. Greer and Ms. Vazquez for the job they are doing. The question was asked as to how Mr. Greer was recruited. Mr. Greer had worked for the hospital previously and his wife was raised on the island. Mr. Ardinger asked if the equipment needed was on this year's capital equipment list. Mr. Greer indicated that it was. Mr. Stevens asked why the present OR table was not acceptable. Mr. Greer explained that various interoperative x- ray procedures could not be done during surgery with the present table, nor was the table versatile for use in some gynecologic procedures. Mr. Stevens asked about the department's working relationship with Dr. Alvarez. Mr. Greer indicated that his department has a very good working relationship with Dr. Alvarez; that the surgeon is well educated and in his opinion, competent. Dr. Hlavinka asked Ms. Fitzgerald to explain her productivity system more thoroughly, which she did. Mr. Ardinger asked about nursing recruitment. Ms. Fitzgerald explained that the hospital recruits as much as possible local- ly, but that the pool of available staff is not large enough to cover the hospital's needs. Expenses included in nursing re- cruitment include travel costs for interview, a rental car for the interview period, and housing assistance. She indicated that the turnover rate had been 89% twelve months ago, and that it was now down to 5%. The Advisory Board thanked Ms. Fitzgerald and Mr. Greer for their presentations. Advisory Board Meeting November 14, 1990 Page Three Wayne Stevens moved and Lorne White seconded that the meeting minutes of October 24th be approved in their entirety except that the first sentence under Administrator's Report, A., be amended to read: "There have been several applicants for the position of Human Resource Manager." Motion Carried. NEW BUSINESS A. Kodiak Island Mental Health Center Agreement Mr. Salness explained the services covered under the agreement. After extensive discussion, Mr. White moved that the agreement be amended to reflect billing on an hourly basis for services used both by the Hospital and by employees at the Center and that the agreement be reviewed at the end of three months to determine whether the flat monthly fee proposed in the original agreement, or a billing basis based on actual hours used, is more advantageous to the hospital. Ms. Saupe seconded the motion. Motion carried. B. LHS/KIH Mission Statements Mr. Salness presented the statements for the Board's review. After review, the Board adopted the following KIH Mission Statement: KODIAK ISLAND HOSPITAL AND CARE CENTER "Kodiak Island Hospital and Care Center is a voluntary, not for profit facility providing a range of primary care and long term care services to residents of Kodiak Island Borough. The foremost goals of the facility are to provide the best possible long term care services, and comprehensive primary health care services and diagnostic treatment capabilities, with referral of very specialized secondary and tertiary care to other health care facilities. As the focus for health care leadership in the community, the Hospital and Care Center will provide quality acute and long term care." C. Quality Service Program - Kate Fitzgerald Ms. Fitzgerald presented the first draft of the Quality Service Pro- gram which Mr. Salness had asked her to develop. The Board expressed its enthusiasm for Ms. Fitzgerald's program. Mr. Salness asked the Board if it would be willing to allocate Ms. Fitzgerald's time to work half-time on the program. Advisory Board Meeting November 14, 1990 Page Four There was discussion as to how reallocation of Ms. Fitzgerald's time would impact on nurse managers who would be required to integrate administrative tasks into their job duties and if by reallocating duties patient care would be negatively impacted. The question was asked if there were programs in other Alaska hospitals or which could be provided by LHS which covered quality service programs. Ms. Fitz- gerald indicated that the LHS "In Touch" program was not as indepth a program as was needed here. Mr. Stevens moved that Mr. Salness direct the staff to develop the necessary budget and that one-half of the time of a staff member be allocated toward implementation of the quality excellence program. Mr. White seconded the motion. Motion carried. D. ComFish Mr. Salness asked the Board for direction as to whether the Hospital should participate in this event. Dr. Hlavinka moved that Kodiak Island Hospital & Care Center participate in the upcoming ComFish event. Mr. Ardinger seconded the motion. Motion carried. OLD BUSINESS A. Jackson & Coker Mr. Salness stated that the contract with Jackson & Coker was under review by LHS attorneys as it appeared to be more beneficial for Jackson & Coker than Kodiak Island Hospital & Care Center. The letter which had been sent to Dr. Alvarez was read for the board's informa- tion. Mr. Salness indicated that the physical placement of the sur- geon's office would need to be reviewed by the board at a later date. B. Fire Marshall Reallocation of office and storage space is nearly complete. All violations will be remediated by the December 4th deadline. C. 1991 Budget Deferred to the Finance Committee. D. Fund Feasibility Study The final report will be presented by Bryan Bowles on November 19th in the conference room. Neither the Assembly nor the mayor will attend the meeting. Indicating that the Assembly had previously videotaped meetings, Mr. Ardinger asked if the meeting with Mr. Bowles, could be videotaped. Advisory Board Meeting November 14, 1990 Page Five ADNIMSTRATOR'S REPORT A. Off Island Mr. Salness will be off island from December 22 - 31, 1990. B. Human Resource Manager Position Mr. Salness reported that this position has been filled, but because the local applicant had not yet given notice, he was honoring their request that the appointment not be made public. C. Borough Budgeting for Building and/or Major Remodeling The list of major remodeling projects, i.e., roof, facility piping, freezer space, has been forwarded to Ray Camardello at the Borough. Mr. Salness is still working with the Borough on a policy which would define which improvements would be maintenance and which would be capital improvements. Preliminary indications are that the Borough would be amenable to being responsible for those improvements which would last five years or more or which would cost in excess of $5,000. Mr. Salness indicated that he would keep the Board apprised of any developments. D. Miscellaneous Mr. Salness stated that he had met with Fred Zharoff and Ron Garzini and that both of those gentlemen had indicated they felt strongly that funding for a new facility could be forthcoming from the State this year. Mr. Salness indicated that although a lawsuit based on the same principle used in the Molly Hooch suit which the education system used was possible, it was not a desired avenue. Mr. Salness stated that he has been working with Joan Minks of Alaska Home Health Care on the feasibility of Kodiak Island Hospital & Care Center providing home health care services. The Board was very posi- tive in its desire to be able to provide such services. Mr. Salness will be working further with Ms. Minks toward this goal. Mr. Salness said he had been working closely with the hospital's pharmacist on a program whereby the hospital could get a retail li- cense and provide medications for the ICF and home infusion therapy. Concord Health, a subsidiary of LHHS, has indicated their willingness to help set up this program. Advisory Board Meeting November 14, 1990 Page Six Ms. Springhill asked about the status of the C/T Building. Mr. Salness indicated that the foundation was being poured this week and that the building was being shipped from Seattle on November 30th with an expected arrival of December 7th. The target date of December 15th for facility startup is still appropriate. The proposal for the Solarium is at the Borough office. No status has been received. Mr. Salness will contact Mr. Camardello regarding this. Mr. Salness is still talking with vendors regarding specifications for the handicapped van. Ms. Volker expressed concern about staff being sent home when there was a low census at the hospital. She asked that an explanation of staffing patterns be provided. Mr. Salness will prepare a written report for the Board. Dr. Hlavinka indicated that the census was low at the clinics and emergency room as well. He stated that he felt that when a new surgeon is on island that the figures will rise. Ms. Saupe stated that the interior renovations were proceeding very well - that the carpeting and handrails in the hallways was attractive. She asked about the status of the smoke shack. Mr. Salness stated that the windows in the shack were being closed up, that a door was being put on the build- ing, and that the Maintenance Department would be using the shack for storage of equipment such as lawn mowers, snow blowers, etc. Mr. Ardinger asked if it would be possible to direct Dr. Bob to write articles which reflected more of the services provided by the hospital. He asked if the capital equipment list had been prepared. Mr. Salness indicated that the list would be presented to the Finance Committee for their review and prioritization. Mr. Ardinger asked if the contract between Kodiak Island Hospital & Care Center and nurses guaranteed a salary. Ms. Fitzgerald explained that we do not have a "contract", but an agreement which states that if the nurse leaves the employ of Kodiak Island Hospital & Care Center of his or her own volition, that they will reimburse KIH/CC the costs reimbursed to them for their move. Mr. Ardinger asked about the possibility of posting prices in the E.R. Ms. Fitzgerald stated that KIH/CC has been working a new acuity based billing system, but that troubleshooting of the present system is not yet complete. Advisory Board Meeting November 14, 1990 Page Seven Mr. Stevens asked if MICA's going out of business would affect the hospi- tal. Dr. Hlavinka indicated that because MICA had been absorbed into another entity, KIH/CC would not be affected. Mr. White indicated that he would be off island from December 6 - 18th. He stated that he had presented the Board's recommendation regarding major renovation to the Assembly and that he believed it would be discussed at the next work session. A preliminary report will be forthcoming in January regarding the oil spill. EXECUTIVE SESSION The meeting adjourned to Executive Session at 10:00 p.m. to discuss person- nel matters. The EYecu+ive Session ended a# lo: 32pm a.nei*kLZF "ulor Session reconvened. Wayne Stevens moved that the Kodiak Island Borough staff, prior to the end of the existing contract with LHS, advertise a Request for Proposals for management of the Kodiak Island Hospital 6 Care Center. Lorne White seconded the motion. Motion carried. By general consensus the meeting adjourned at 10:56 p.m. Recorded by Debra Raper. L e White, Secretary