Handwritten Note to Keith Steffen–October 1, 2001--Dec 2019

 

Pediatric Clinic–Haiti 2019 (Photo by John Carroll)

I thought for sure that Keith Steffen, OSF’s Administrator, would be glad to undo what George Hevesy had done during the last week of September 2001. I did not know Keith well at all even though we had both passed each other in OSF’s hallways many times during the previous three decades. However, I thought he should be able to fix the problem.

I spoke with an OSF administrator, Dr. Tim Miller, in early October 2001, and he stated that my concerns about the Emergency Room were right and that “OSF had ignored the main campus”. He was referring to my letter to Keith Steffen regarding the lack of bed capacity in the hospital to accept the emergency department patients. Miller told me that OSF’s focus had been on the opulent Center for Health that OSF had just completed on the north side of Peoria. (Some called it the “Center for Wealth”.)

As opposed to the Center for Health, some of our patients in the ED at OSF’s main campus downtown didn’t even have pillows on their gurneys to rest their heads. At an ED staff meeting, one of our attendings even offered to borrow a pickup truck and go buy pillows. The ER was quite dysfunctional and our patient satisfaction score was 33%–the lowest at OSF.

In early October 2001, I printed off excellent articles from the journal “Society for Academic Emergency Medicine” regarding ER overcrowding and brought them to Administration for administrators to read. I heard back from no one regarding the articles.

On October 1, I wrote a quick note to Keith which is copied below. Even though Dr. Hevesy had placed me on probation for my email to Keith on September 27, I still thought we were all fighting for the same goals–one of them being an improvement of patient waiting times in the ER.

Man, was I wrong.

 

10-01-01

Dear Keith,

As you may or may not know, the ER is in “tough straits” – patient care and waiting time is very lengthy.

I would love to have you or another administrator spend a couple of shifts with me this week in the ER. I work 3-11 and 5-1. You would see patients with me.

The objectives of this would be to:

1. See the ER from “ground zero” – this would prompt ideas on how to solve some of these issues. I will tell you how I see the issues and how time could be saved for the patient (from triage to final disposition). There is a huge crisis occurring in our ER now.

2. Your presence would definitely be a “morale improver” for the ED staff and for the patient when he realizes an administrator is personally concerned as well.

I really believe an administrator’s presence would be a “win-win” for OSF and ER patients.

Please strongly consider joining me in the ER.

Sincerely,

John

 

Well, Keith never responded to this note and when I asked him about it when we met, he said that he would not come to the ER because the other departments would want him to come to visit them as well. And he explained to me that he could not be everywhere.

As I look back at it, I doubt the ER had his full attention compared to other big money-making departments like Surgery and the new Center for Health. The ER and its overcrowding would just have to wait. (A couple of years later, Keith would close the OSF psychiatric inpatient unit because it did not make money.)

Many years later, in the May 15, 2008 issue of the New England Journal of Medicine, is an article written by David J. Shulkin, M.D. who describes making rounds in his own hospital—essentially what I asked Keith Steffen to consider doing seven years prior.

Dr. Shulkin made late-night administrative rounds at the hospital where he was president and chief executive officer. He noted the “stark discrepancy in quality between daytime and nighttime inpatient services.”

His goal was to improve his hospital quality of care during the nighttime hours.

Dr. Shulkin wrote:

“The consequences of service deficiencies during off-hours include higher mortality and readmission rates, more surgical complications, and more medical errors.”

He thought that his midnight rounds proved to be a good way to help him understand and address concerns of off-hours staff.

“In order to identify problems and design effective solutions, it is critical to gather such front-line information, and to do so, senior hospital administrators need to see firsthand the working of the “other hospital”. I strongly encourage my counterparts else-where to conduct at least 1 week’s worth of night rounds each quarter.”

“Close attention should be paid to the needs of patients and their families, any procedural and communications issues among staff members, and most importantly, the quality of dialogue between administration and staff members regarding the organization’s inpatient service and safety priorities.”

 

John A. Carroll, MD

www.haitianhearts.org