LOCKPORT – Fewer than half the patients who are admitted to Eastern Niagara Hospital would recommend it, according to state and federal surveys cited by Melisa Niver, who resigned as a member of the hospital board in late May.
“That less than half the people in this community would recommend this hospital is shameful,” Niver said.
But hospital CEO Clare A. Haar said a closer look at the numbers tells her it’s not that bad. She said that while only 49 percent of patients surveyed “definitely” would recommend Eastern Niagara, another 41 percent “probably” would. That makes a 90 percent positive score, she said.
Haar also said 85 percent of respondents, asked to rate the hospital on a scale of 1 to 10, give Eastern Niagara a 7 or higher. The results were taken from federal surveys returned by 790 patients in 2014 and 2015, which was a response rate of 27 percent.
The 134-bed Lockport facility falls below state and national averages regarding patient satisfaction, even though its scores on clinical performance are generally near or above those same national and state averages.
Hospital Compare statistics posted by the federal Centers for Medicare and Medicaid Services give Eastern Niagara only two stars on a scale of 1 to 5.
“Why settle for average or below average?” Niver asked.
“Of course, we would like to be higher,” Haar said. “We’re consistent with every hospital in Western New York except for a few.”
In fact, every hospital in Western New York received either two or three stars. The other two-star hospitals include Niagara Falls Memorial, Medina Memorial and the entire Kaleida Health system, including DeGraff Memorial in North Tonawanda. Mount St. Mary’s in Lewiston is Niagara County’s only three-star hospital.
The reasons behind the low patient satisfaction score seem to stem from inadequate communication between doctors and nurses and the patients. In a 2015 federal survey, 69 percent of patients said nurses always communicated well, and 73 percent said so about doctors. The national average score is 80 percent for nurses and 87 percent for doctors.
Eastern Niagara patients also said they always received help when they wanted it only 51 percent of the time. The national average is 68 percent. Patients in the Lockport hospital said their pain was always well controlled 58 percent of the time, versus a national average of 64 percent. Only 66 percent of Eastern Niagara patients said staffers always explained medication before it was administered; the national average was 78 percent.
Those surveys, which led to the two-star rating, emphasize the “always” answer to the questions. But Haar said if “always” and “usually” are added together, the picture is much more positive. The score for nurses and doctors communicating well rises to 94 percent for each. The positive response for receiving help quickly jumps to 87 percent, and pain control rises to 89 percent, and the score for adequate explanation of medication rises to 75 percent positive.
Ranking called average
“I don’t consider that so bad,” Haar said of the overall results. “On a substantive basis, we are at the New York State average. If that’s average, that means there are a number of people in New York State below us.”
She acknowledged that there seems to be no correlation between the clinical results and the patient satisfaction numbers.
The hospital administration’s report to the board about the survey results seemed to blame the doctors for the scores. “Eastern Niagara has a higher proportion of independent physicians than other facilities in the region,” the memo obtained by The Buffalo News said. “Many of the hospitals in Western New York have a higher proportion of care by hospitalists who tend to be more willing to take the steps necessary to achieve compliance with guidelines.”
Hospital spokeswoman Carolyn Moore said in an email to The News, “The hospital is definitely not blaming physicians. In fact, physicians have been instrumental in achieving some of the progress in quality scores. Many facets of care are evaluated in the hospital’s ongoing effort to improve quality and patient satisfaction.”
Niver said she thinks the subpar results on communication stem from understaffing. “They can start by having an active recruiting effort to hire more staff. It’s obviously short-staffed, and communicating effectively with the staff and listening to their concerns, and not only listening but responding to them and providing the resources they need,” Niver said. “There’s nothing worse than a dissatisfied employee because they feel they’re not being listened to.”
The surveys show, however, that waiting times in the Eastern Niagara emergency room are less than the national average, although generally more than the state average. It’s the only statistic in the survey that seemed directly connected to staffing levels.
On measures of “timely and effective care,” the state and federal surveys show Eastern Niagara almost always at or above the national averages. One exception was the number of surgery patients “given the right kind of antibiotic to help prevent infection.” That figure was 92 percent for Eastern Niagara; the national average is 99 percent.
Asked if a result like that is Haar’s fault, Niver said she thinks Haar should work with the doctors to improve it.
“Quality and patient satisfaction measurements are a tool in process,” Moore, the hospital spokeswoman, said. “We are proud of the overall satisfaction of our patients and thank our staff for their efforts and the progress that has been made in some areas. The hospital is embarking on a number of additional initiatives to score better on other specific metrics. The hospital is enhancing its commitment focusing on quality and satisfaction.”
Niver, a former assistant principal at Lockport High School who served two years on the board before stepping down, charged that the board and Haar refused to engage with employees or the community. She also accused them of wasting money and not taking effective steps to improve hospital performance.
Niver wrote in her resignation letter, “Rather than work toward gaining consensus of all the stakeholders, their opinions are consistently dismissed as irrelevant. This is not a leadership style that I condone or am comfortable with, and thus feel the board will be better served by another candidate.”
Haar said she intends to hire a manager soon whose assignment will be to improve the patient satisfaction scores by educating employees about “how the survey measurements work so that we achieve better adherence by greater understanding.”
Niver said that soon after she joined the board, she found that employees were placing copies of their complaints in her mailbox. Some nurses complained that they had to work as long as 20 hours straight because of understaffing.
“I knew a few nurses, but they were always afraid to push it further because they felt Clare would use bullying and intimidation techniques,” Niver said. “I felt if they were putting things in my box, they weren’t getting anywhere with their union rep. I just couldn’t be part of it anymore, because I felt I was the only one standing up for what I thought was right.”
While Niver said the board needs term limits to produce new perspectives, Haar said experience is a benefit to the hospital.
“This organization is blessed with a board that takes their duties very seriously,” Haar said, calling the members “very engaged.” She said four of the 15 members have changed since 2013.
In her resignation letter, Niver wrote, “It is obvious that I am unable to effect positive change and that a new member will bring fresh ideas, experience and a new perspective. Years of extended service on a board without term limits can cause blurred boundaries, redundancy and complacency.”
Moore said, “The board of directors and administration take concerns of the community seriously and evaluate them. The allegations to the contrary are not appropriate – particularly when compared to the many good things that are currently happening at the hospital.”
Criticism of CEO
Complaints about Haar’s leadership style have been a constant with hospital employees and outside critics throughout her 17-year tenure in Lockport. “There’s a reason that there’s dissension between the administration and, I’ll say specifically the nurses, but other staff as well. It starts at the top,” Niver said. She said Haar’s style “is more reactionary than proactive. She waits until there’s a problem and then handles it rather than being proactive.”
Haar said she has been proactive in starting an outpatient surgery and express care center on South Transit Road, opening a behavioral health program for children and adolescents, and in starting a new residency program for physicians, the first of whom arrived last week. She said in some cases, new programs have been suggested by board members “who very aggressively represent the community in their decision-making.”
There’s no way to confirm how the board functions, because its meetings are always closed to the public and to hospital employees.
Niver said she tried to persuade her board colleagues to meet with employees, but received no support. “Why not? Why are we there if we can’t communicate?” Niver asked. She added, “The board wanted to pick who they were going to talk to. I thought every meeting, they should have allowed five or 10 minutes for community members, too, to speak up.”
Board failed to act
Niver told The News that she voiced her views to other board members before resigning. “A lot of them would agree with me, but when it came to the vote, they wouldn’t stand up,” she said.
“The board needs to make policy, have its deliberations and function as a unit, and they do that appropriately,” Haar said. “I’m not sure that having open meetings does much to enhance the quality of decision-making.”
Niver said one of the few times where the board rejected a Haar proposal was when it defeated a request to hire what Niver and others considered a high-priced consultant to work out an affiliation agreement with Kaleida, which was announced April 8 as a means to make more medical services available to Niagara County patients. Kaleida has been making a string of such agreements with small hospitals in outlying areas of Western New York.
Niver objected to a board decision to spend $400,000 on a new computer package for patient record-keeping, saying she thought that was a service that could have been shared with Kaleida.
Haar said, “The $400,000 replaces the storage unit for all of our business and electronic medical record data. It was an absolutely essential expenditure. The prior equipment had reached its end of life and would no longer be supported.”
She said the Kaleida deal doesn’t give Eastern Niagara access to computer storage capacity. But she said, “It’s an affiliation that can go anywhere both parties want it to go.”
As The News reported last September, federal Medicare officials penalized Eastern Niagara financially from 2012 through 2014 because too many patients were readmitted to the hospital within 30 days for the same problems. The enforcement mechanism is part of the Affordable Care Act and cost the hospital an estimated $376,000 in 2014. Detailed figures have not been released by the hospital, which Moore said ran in the black in 2015. However, the hospital also received a $3.7 million state grant in March for debt reduction and financial stabilization.