Friday, April 27, 2001

Maui Memorial
Hospital cutbacks
upset staff

Financial losses, a $38 million
bond delay and personnel changes
have caused hospital hardship

By Lyn Danninger

Planned improvements at Maui Memorial Hospital have been put on hold while the hospital cuts costs to make up for an unexpected drop in the number of patients near the end of last year.

The cost-cutting has upset some employees and physicians, who complain they were left out of the process.

A long-anticipated $38 million revenue bond previously approved by legislators for expansion and renovation at the hospital was tabled after the hospital recorded unexpected losses during the last three months of 2000.

Until then, Maui Memorial had long been one of the only hospitals to be consistently profitable in the chain of community hospitals run by Hawaii Health Systems Corp., a quasi-independent parent company set up by the state.

But because of the unexpected losses at Maui Memorial, the state Department of Budget and Finance froze the bond.

Maui Memorial Chief Executive Officer Boyd Kleefisch said the hospital was caught short during the final months of last year with an unexpectedly large drop in the number of patients. Anticipating patient increases, the hospital had hired additional temporary staff and brought in nurses from the mainland on short-term contracts.

Not knowing whether the drop in income indicated worse things to come, as has been seen in other Hawaii hospitals, the bond was put on hold, Kleefisch said.

To improve the hospital's bottom line, Kleefisch began cutting costs. Not all the changes were popular.

One measure eliminated the position of head nurse at the facility. The departure of longtime head nurse Elaine Slavinsky on April 17, as well as other changes, upset some nurses, physicians and members of staff who felt they had not been consulted and feared further cutbacks.

Slavinsky's duties were assumed by Leann Strasen, also a nurse, but recently appointed to the new position of chief operating officer at the hospital.

Kleefisch said the hospital's budgetary problems may have been the driver that created the impetus for change, but streamlining the existing process had been in the works for some time.

He said he had been meeting for quite some time with hospital employees, including representatives from the Hawaii Government Employees Association, the union representing hospital workers, about needed changes.

"Not everyone knew about that," he said.

Some of the changes at the hospital include creating an on-call nursing "float pool" and hiring contract nurses on a per diem basis to accommodate ups and downs in the number of patients and severity of patient illnesses. The same practice already occurs in Hawaii's private hospitals.

Prior to that change, Kleefisch said staffing levels remained fixed, regardless of patient numbers and levels of care required.

"In the past, if a ward was supposed to have 10 nurses, those people showed up regardless of workload," he said. "We felt we couldn't deviate from the existing matrix. Now we are trying to shift to a model similar to what is done in Hawaii's private hospital system."

Kleefisch said he also wants to cut paperwork involved in nursing care to allow nurses to focus on patient care.

Another change was to develop a transitional ward for patients awaiting placement in nursing homes. Right now, those patients are held in acute care beds throughout the hospital, he said.

Maui Memorial Hospital Chief of Staff Dr. Barry Shitamoto said while physicians understood budgetary pressures on the hospital, there are those, especially long-time physicians, who are frustrated.

"We understand the money crunch, but there's a bigger problem," Shitamoto said. "On one hand, the community expects more, but no one is willing to pay for it."

Hospital Medical Director Dr. John Weisel said he believes what the hospital is experiencing now is similar to what has already occurred in some of Hawaii's private hospitals.

"We are just going through some of those changes now as have other hospitals. It's just taken a little longer," he said.

Lee Matsui, senior agent with the HGEA, has been meeting with hospital administration on behalf of nurses and staff.

"They have been coming to us and talking about what they want to do and we are trying to work together to resolve any issues," he said.

Matsui said he is aware of employee concerns and has been working to make sure everyone is on the same page, but acknowledges change can be difficult.

"There's always some resistance to change and some miscommunication," he said. "Sometimes, it's how things are communicated and how you work through it. You have to be careful."

But Matsui believes in the end, all parties want the same thing -- even if there have been some complaints and hurt feelings.

"It's about maintaining and guaranteeing quality health care. The number one priority for everyone is to ensure the appropriate level of care," he said

Maui is the fastest-growing county in the state. Moreover, strong tourism numbers for the island mean around 40 percent of emergency room admissions are visitors. That increase has put strain on the hospital, Kleefisch said.

With the increase in both residents and visitors, renovations and expansion are needed to keep up with the increase in numbers and upgrade facilities, said Kleefisch. The last renovations at the 50-year-old facility took place in 1980.

Some of the changes planned prior to the hospital's financial downturn will still go forward, Kleefisch said.

Already improvements have been made to both the physician and employee parking lots and an additional magnetic resonance imaging machine has been purchased.

Kleefisch still plans to go ahead with the creation of a second angiography unit and another endoscopy suite. He is also moving forward with a plan to begin an internal medicine residency training program at the hospital.

He also wants to decrease the number of times patients must be moved around at the facility while they wait for a permanent bed.

"Patients come to the emergency room and we don't have a bed so we have to move them around a lot," he said.

As for re-gaining the $38 million bond financing, Kleefisch said it will continue to remain on hold until the hospital can show it is fiscally responsible.

"I'm hopeful they'll look at it again in another six months, but we have to show we can pay this back," he said.

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