After a tumultuous period at Swedish's neuroscience institute in Seattle, leaders addressed internal angst about the organization's culture. Some staff who had raised concerns about patient safety say they've seen significant improvement.
Two years ago, Bernedette Haskins left her job as a nurse inside Swedish Health’s acclaimed neuroscience institute, alarmed that her concerns about surgical scheduling, staffing and patient safety weren’t being addressed.
But after internal turmoil and a 2017 Seattle Times investigation that exposed concerns about the organization’s culture, Swedish implemented changes that assured Haskins she could again care for the brain-surgery patients who have long been a passion of hers. She returned to the neuroscience institute a year ago and says the culture has undergone a substantial overhaul. She said managers are more responsive to concerns, scheduling of cases has improved, doctors have better relationships with staff, and leaders are strictly enforcing new policies around surgical caseloads.
“Overall, I would have to say things are much better,” Haskins said.
Swedish’s new CEO, Dr. Guy Hudson, said five staff members who had departed the neuroscience institute in recent years have now returned amid the changes happening at the organization.
“That’s the biggest testament, to me, is the people coming back to work at Swedish because that’s where they want to work,” Hudson said. Swedish later updated the number of returning staff members to seven.
Hudson, who took over the CEO job in the wake of the initial Times articles, credits new policies and personnel for setting the improved tone at Swedish. He said patients’ perspectives are at the center of everything Swedish does, and board meetings now include the presence of a blue chair labeled with the word “patient” to remind the organization’s leaders of that priority.
The Times series about the Swedish Neuroscience Institute detailed rising surgical volumes, surgeons who ran multiple operating rooms at the same time, complaints about a top doctor and concerns about patient care.
In the wake of the initial Times stories, Swedish’s CEO Tony Armada resigned, as did Dr. Johnny Delashaw, a leader in the neuroscience institute who had been the subject of internal concerns. Regulators later identified “numerous” patient-safety issues at Swedish’s Cherry Hill campus, where the neuroscience institute is based. The state suspended Delashaw’s license indefinitely, but the medical commission recently reinstated the license, with restrictions. Delashaw is now suing The Seattle Times and a Swedish surgeon for defamation.
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Ron Cole, a nurse who works in various parts of the Cherry Hill campus and also helps lead a staffing committee for the Swedish system, said he has seen some policies and personnel change for the better at the campus.
But looking around the Swedish system as a whole, Cole still sees a lot of aspects that haven’t improved. He said Swedish still hasn’t fully addressed understaffed units, favoritism in the workplace, workers who remain fearful of retribution if they raise concerns, and other issues.
“It doesn’t feel like things have changed a whole lot,” Cole said.
Last month, Swedish announced a reorganization that would impact hundreds of workers and involve layoffs across the system. That set off a round of new concerns among caregivers about whether the organization was focused primarily on the bottom line.
In interviews and through their union, nurses have expressed particular concern about the labor-and-delivery sections at Swedish, saying the cuts in that area will mean laboring mothers will receive less one-on-one care. Swedish said the organization had in some areas exceeded national guidelines for staffing labor-and-delivery units and will now be more in line with those recommendations.
The guidelines from the Association of Women’s Health, Obstetric and Neonatal Nurses allow for one nurse to care for two mothers in labor when they don’t have complications. The guidelines call for one-to-one care for other situations, such as women with medical issues or those laboring without pain relievers. When a birth is happening, two nurses are expected to be present.
Hudson said the realignment is needed due to the shifting health-care landscape, in which health organizations face declining reimbursement rates and more patients covered by Medicare, while patients face higher deductibles and more out-of-pocket expenses. He said Swedish is positioning to better serve patients with more outpatient care, more care closer to people’s homes and more cost-efficiency. Swedish plans to allocate additional resources in some areas, such as more advanced-care practitioners in primary care clinics.
“We did not do these adjustments due to budgetary shortfall. That is a key message,” Hudson said. “We felt it was what’s best for the organization to continue to move forward and provide more options and care for the people that need it out in the community.”
Hudson has acknowledged past problems with the organization’s culture and said Swedish has worked to improve how internal complaints are addressed so that staff members feel they can raise issues. He pointed to patient-safety data to show that brain and spine patients had consistently fewer deaths and readmissions than national expectations over recent years.
“Were we having leadership and communication issues? Absolutely. But it was the caregivers that held the quality and safety standards to the highest level,” Hudson said.
Last year, Swedish brought in the Institute for Healthcare Improvement to help the organization identify changes. Hudson named a variety of changes since, including increased interaction with patients through advisory councils and at board meetings, a new data system that raises concerns to leaders, and more interactions between leaders and staff.
He also cited some focused improvements. For example, the neuroscience institute had three wrong-sited spine surgeries in 2015, which could include a surgery at the wrong place on the spine. That improved to zero in 2017, Hudson said. He provided numbers showing a significant drop in surgical-site infections from 2016 to 2017.
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In part, The Times stories documented how some surgeons ran multiple operating rooms at the same time and that patients were unaware of the practice. A year ago, responding to feedback from patients and medical workers, Hudson announced a new policy that largely bans double-booked surgeries at Swedish. The policy requires surgeons to be present for the “substantial majority” of each case, allowing a second case to begin only when the first case is coming to an end and the surgical site is being closed.
That standard gives Swedish more stringent policies than at the University of Washington or Virginia Mason, where officials have continued to stick with a more generic policy that requires surgeons to be present only for the “critical” portions of each case — a standard that is largely undefined and left to the discretion of doctors.
Hudson said Swedish is closely monitoring surgeries, conducting reviews when cases violate the policy by even a minute. He said surgeons have been some of the main supporters of the rules and that patients still get timely access to sought-after doctors.
“I’m very happy and proud of where we are right now,” Hudson said. “I really feel we’re leading the way in this. And, also, it’s what our patients want from the feedback I’ve received and what they expect.”
With a jump in volume of surgeries at the neuroscience institute, Jenae Knapp, a nurse at the Cherry Hill campus, had been quoted in The Times in 2017 raising concerns about the hours that nurses were being forced to work, along with nurse-to-patient ratios and other issues.
Knapp said in a recent interview that she’s seen improvements, including in scheduling of the operating room. Nurses are not seeing as many days with extended hours.
“It’s safer for the patients,” she said.
Knapp said communication with doctors also has improved, and managers have been more attentive to concerns and more willing to involve nurses in decisions. She also cited the overlapping-surgery policy and noted that fellows are being monitored more closely. She has ongoing concerns about staffing levels and the impact of layoffs, and she cautioned that the organization may slide back to previous ways.
Hudson, meanwhile, said Swedish will focus in the opposite direction — on more progress to make.
“We’re a continuous learning and improvement organization,” Hudson said.