Lund reveals plans on how he expects to proceed
Marianne McGee, MA/ABS
The Friends of the Hospital are a group of people who are interested in saving both our hospital and having appropriate health care available in our community. Loosely organized, many motivated by the ongoing Obstetrics crisis, they have met over several months to figure out ways to help the ongoing Mendocino Coast District Hospital (MCDH) financial crisis.
The Friends invited President Steve Lund and CEO Bob Edwards to a meeting on September 7, bringing forth a series of requests for information on the potential tax proposals and to explore how this group could help. Unfortunately, word got out about the meeting and many people, who had not been involved with either the Friends or had attended MCDH meetings were there and dominated the conversation to such an extent that the prepared questions were never discussed. Most of the time was spend with questions from these people that were readily available either on Mendocino TV or by just following MCDH official documents. A number of us, became frustrated and expressed specific issues we had with MCDH, which were also never followed up on, although the new Director of Nursing was also there.
So, after not having any response to the original questions provided at the meeting on September 7, the group met again and sent a follow up letter to President Lund on September 25 and in October he provided the following two letters. The Friends letter on September 25, 2017 can be viewed on the following link. I have not corrected or edited his responses in any way!
Response to “Friends of the Hospital” Letter of 9/25/2017
Dear Friends of the Hospital,
- We plan to hold as many community Meetings to discuss issues facing our hospital and, through this process, gather critical information from the participants prior to moving forward with some form of a survey.
Regarding our request to participate in the development of a survey, it will depend upon how we decide how to proceed – though we will invite input from all major steakholders (of course including the Friends of the Hospital) about the content of the instrument. Generally, though, I would recommend a professionally administered survey which may involve proprietary elements and will likely be ‘prepared’ by an established voter opinion survey firm. Then, once it is decided to move forward, a significant effort will be made to contact every registered voter in the District and gather responses from a representative sample to determined broad based sentiment regarding any proposed measure.
- You are correct, this is a critical component of any successful ballot measure and will need to be articulated moving forward as we engage the community in dialogue – even before the Board formally ‘calls’ the election. I do not think it is a good idea to begin this dialogue with a preconceived proposal. It is obvious we have immediate, mid and long-term needs, all of which can only be achieved with community support.
- We are committed to improving the ER experience and are engaged in a number of initiatives to ensure continuous progress is being made and maintained. If you are interested, you may contact Mr. Bob Edwards for a list of specific initiatives.
Our ER experience improvements are reviewed retrospectively in three areas: timeliness of access; patient perception of care; and medical staff review of transfers and mortality (death review). We publically report the timeliness measures (Door to Doctor and Door to In Patient Admission) and use medical staff committees to evaluate patient transfers and 100% of mortality outcomes. In addition we use internal data trends, for Emergency Room metrics, and discuss our progress toward these metrics in our Performance Improvement committee (medical staff committee). Peer review of the Emergency Room Physician staff is two pronged, and includes initial (probationary) reviews and focused reviews as variances in care occur (discussed in medical staff committees).
- 4. We are not “selling” the idea of a parcel tax. We are working to inform the public about our many challenges and the need for additional revenue to both maintain and improve the hospital and healthcare services. I am aware you have reviewed a number of articles concerning the closures and challenges facing small rural healthcare facilities. This is a serious problem nationwide and our community deserves an opportunity to engage in a discussion locally to determine what is desired in terms of services, programs and associated costs – so of course you are correct about listening to the community! At every stage of our outreach process, we will be inviting feedback and dialogue from every resident who would like to provide it and engage in a conversation about making the Hospital better.
- Understood, this plan and vision needs to be refined from our existing Strategic Plan through the process of having “stakeholder” input. We hope to achieve this by having a series of conversations with a wide variety of groups and individuals over the coming weeks. All of the issues you correctly describe herein are critical moving forward, and must be the primary focus of these conversations. The landscape of healthcare is constantly changing and I feel our Board and staff are working hard to ensure all the issues you mention are being addressed to the best of our ability and available resources.
We too are invested in our Hospital, and appreciate the interest and participation of the “Friends of the Hospital” in this process. I believe our mutual interest to engage the broader community in dialogue to improve clinical practice and maintain desired programs is the key element as we work together to determine how best to move forward.
Response to Letter of 9/7/ 2017 from “FRIENDS OF THE HOSPITAL”
- Parcel Tax Explanation
Yes, we will always be happy to provide a financial breakdown of information that you require to better understand the challenges we face in relation to reimbursement, utilization and department services as best we can. I am in full agreement that the more information we provide to the community the better.
When you say campaign efforts I assume you are speaking about a “Parcel Tax Campaign”, currently, we are not in a position to conduct a campaign as we have not yet formally acted to place a measure on the June ballot. Also, I hope the information that has been provided from the finance committee and the September 23rd meeting provide a reasonably in depth look at our financials. Sharing this information in an open and honest way and gathering community feedback is, I believe, a necessary step in our planning process- and arguably more important than any campaign or “sale” of our story.
- New/Altered Facility
We plan to engage the community in a variety of settings to continue to educate folks about the need to conform with the required seismic upgrades. We are currently doing soils tests to formally establish the path forward to determine if upgrades are possible or if replacement is required. This is complex and time-consuming process, as we will need to review all existing structures as part of this study as well as gather even more input as to what the community desires for either a retrofit or new hospital facility pending the outcome of the study.
Parcel Tax Now
We are currently operating with a challenging budget situation (deficit) as we work to maintain the current range of services. Most independent hospitals in our area have a parcel tax in place to support their budgets. Additional revenue would help maintain existing services and allow for a more concentrated effort on planning for the future.
Plan for 2030 Compliance
We are currently taking the steps needed to develop a way forward. As referenced above, a major step in this process will be having extensive conversations throughout the community both to educate, share potential options and gather public input.
AParcel Tax Amount
We do not have a specific amount other than approximately $1.5 million per year is needed to provide a more stable budget. We plan to survey again as well as conduct public conversations to determine what the community believes is reasonable and hopefully this amount will be sufficient to warrant a ballot initiative.
What is the guarantee?
We will never be in a position to be “absolute” as we are dependent on both federal and state support along with relying on our community choosing to use our hospital for their healthcare needs. However, there are options – such as an independent parcel tax oversight committee – which could be established to review expenditures of parcel tax proceeds to confirm that they are in alignment with what the community agreed to support.
Confusion Regarding Parcel Tax and Bond Issues
We must continue to address the need for both as we engage the public in discussions about the future of our hospital.
III. Transparency and Credibility
Tax Campaign Meetings
Yes, once we formally take action to place a measure on the ballot. Until then, we plan to conduct a series of informational and listening meetings throughout the District up and down the Coast. Additionally, we invite others (patients, staff, community members etc.) to participate in these informational and listening opportunities.
To be determined
We have had numerous changes in administration (both CEO and CFO) over the recent past and these changes, along with the bankruptcy, have neither helped us develop a more comprehensive plan to move forward as well as improved communication and public knowledge about the challenges we face. It is obvious to all concerned that we need to improve our efforts to inform the community about the many positive outcomes that are occurring at the hospital. It is my hope that our outreach efforts and conversations with a variety of community members in the coming weeks and months will help.
Further, changes in leadership would likely create a significant obstacle to achieving success for a ballot measure in 2018. Such a decision would focus all attention and energy of the Board and major stakeholders, and ultimately further delay our ability to implement needed upgrades and changes.
- Successful Models
Yes, we currently partner with Adventist for a number of programs and services that support our efforts. We are consistently looking for strategies to improve both clinical outcomes and fiscal improvement.
The issue of Affiliation will be part of our conversations with the community moving forward.
We formed an AD Hoc committee to look at a reorganization possibility that, due to changes at the State level, proved to be undesirable. We have and continue to look at other hospital efforts at proposing ballot measures and plan to use this information moving forward to guide our situation.
Again, as we conduct our community conversations these issues will be discussed. We are limited by law to certain options. It is also the case that when you begin the process of making measures more complex they often can result in less revenue, and potentially open the door to possible litigation.
Probably from a variety of sources, the usual strategy is to seek funds from a variety donors as no District funds may used for campaign purposes.
This too will ultimately be a Board, and staff decision. Yes, I have significant experience with campaigns and we could also obtain some level of support from a consultant to assist. However, given my experience in this community, I feel that if we can obtain enough volunteer support, the major tasks can all be accomplished without outside assistance. It is a very time- consuming process to do properly and I think using local folks is a much better strategy than hiring outside support to conduct the campaign and get out the vote process.
This too requires a thoughtful and consistent approach. We plan to involve staff throughout the process which I think will provide a significant level of positive support. We are aware of what occurred in 2005 and will work to ensure that that does not happen again.
We will need to meet when the time comes to begin the formal campaign process to determine specific roles and responsibilities that will provide the support needed to increase the probability of success.
In closing, I appreciate your continued understanding and interest regarding the viability of our hospital. We look forward to continuing working with you and the Friends of the Hospital as we engage the broader community.