Report urges changes at EMMC Panel aims to improve staff communications

A year after a large group of doctors practicing at Eastern Maine Medical Center complained about administrative practices, an investigating committee has released an interim report outlining ways to improve communications at Maine’s second-largest hospital.

Trustees convened the Joint Conference Committee, comprising doctors, trustees and embattled CEO Norman Ledwin, for the first time in 20 years last fall to study the complaints. Its report explains changes planned or already under way.

“We were able to talk about difficult issues and handle them in a direct but constructive manner,” said John Woodcock, chairman of EMMC trustees and the Joint Conference Committee. In many cases, the committee asked administrators to develop improvement plans that were brought back to the committee for approval, he said.

The doctors publicly criticized EMMC administration in fall 2001 for focusing more on expanding services and constructing new buildings than on patient care. Some even called for the resignation of Ledwin.

At a medical staff meeting at the time, doctors approved a nine-point letter of complaint for trustees by a vote of 197 to 1 or 2, according to doctors who were present. The letter accused administrators of not working collaboratively with physicians and charged that policies had eroded the quality of patient care.

Woodcock said the committee spent a lot of time trying to understand the doctors’ complaints. It must still address medical staff development, negotiations between the hospital and physicians over coverage and the role of the hospital’s chiefs of service, he said.

Woodcock said the committee spent a majority of its time designing a new position of “chief medical officer.” The position will be equal to EMMC’s chief operating officer and chief financial officer, Woodcock said.

The person in the new position, who will be a doctor, will “infuse” medical concerns “within the administration’s decision making [process],” he said.

The person who fills the job will report to Ledwin, not to doctors or trustees, as originally requested by doctors.

Contained in the interim report is a memorandum written by Ledwin that concedes communications had not been sufficient between administrators and doctors. Under a new communications plan, administrators send work-related letters to physicians’ homes, and assign a patient care administrator to each physician to clarify hospital issues. The new plan also requires representative administrators to attend medical staff meetings for informational purposes.

“The intention of this new communications plan is to increase the sense of involvement and satisfaction among individual members of the medical staff,” Ledwin wrote.

To determine where work force shortages exist, a new committee has been formed under the trustees, Woodcock said. Putting such a committee under the medical staff would have raised antitrust concerns, since doctors have a financial stake. This will be a permanent committee, he said.

Included in the interim report is an Oct. 24 letter from Ledwin to the chief of surgical services. Ledwin wrote that the most critical work force shortages at EMMC are in orthopedics, general surgery and otolaryngology.

Last fall physicians complained that the number of surgeons covering trauma cases was down to eight from about 12, while hospital officials said they counted 12. Last week in describing the hospital’s advancements since his arrival in late 1993, Ledwin said the hospital had implemented a trauma response plan under which eight surgeons are available to cover emergencies when private practice doctors aren’t available.

The administration has said it spent $4 million on physician recruitment in fiscal year 2002 and it plans to spend $8 million in 2003.

Doctors were supposed to discuss the results of the Joint Conference Committee investigation at a medical staff meeting tonight, but on Monday it was rescheduled to next week to accommodate the schedule of Woodcock, who has been recommended for nomination to a federal judgeship.

Dr. James Raczek, president of the medical staff and a hospital administrator, said he believes “there’s been a lot of progress made.” But he said he couldn’t speak for the whole medical staff until after the meeting.

“I think it would be premature for me to comment on the overall feeling of the medical staff,” he said.

An independent committee of doctors headed by Jack Adams, an orthopedic surgeon, is also due to present a report to the medical staff next week. Woodcock said it reflects a different approach than that of the Joint Conference Committee.

“Doctors by training and temperament approach an issue in a very direct fashion,” Woodcock said. “They make a diagnosis and they prescribe a treatment plan and they look for immediate improvement and I wouldn’t want it any other way. That’s the way you want physicians to approach problems, particularly if it’s your health [they are dealing with].”

But Woodcock said that administrators and trustees have “to view the issues presented in health care very broadly and strategically.” The result is “something of a clash of cultures,” he said.

Doctors went public with their concerns at a time when national trends began to hit home at the hospital, Woodcock said. These include a shortage of specialist physicians, inadequate reimbursements for services, and changes to rural health care systems that cause more critically ill patients to be sent to regional medical centers like EMMC.

“The administration response was not as fast as physicians wanted, but it does not mean the administration was sitting on its hands,” he said.