MOSES LAKE - Tension over staffing, hospitalists and communication with administration at Samaritan Healthcare dominated the hospital's Board of Commissioners meeting last week.

Some doctors in attendance expressed concern over what they felt was inadequate staffing at the hospital.

The hospital has eliminated several positions through attrition, opting not to fill positions as people leave or retire. In January and February, the hospital laid off 13 people in several departments, said Samaritan CEO Andrew Bair.

These cuts have resulted in inadequate staffing, said Obstetrician/Gynecologist Hollie Matthews.

"We have a crisis right now with our nursing staff in this hospital, the way I gauge it," she said. "And I'm not here every day, but every time I am here it makes me want to give up doing OB, which is my love."

For three consecutive years, Samaritan has lost close to $2 million annually, Bair told the Columbia Basin Herald. The hospital hired Huron Consulting Group to analyze what changes could make the hospital profitable. The organization uses a model that pushes five years of financial performance improvement into a period of eight months, he said. Based on Huron's suggestions, the hospital brought its staffing levels down to the national average, he said. But soon thereafter, the hospital experienced a surge of patients.

The hospital administration is evaluating the situation and if new hires are needed to meet demand for hospital services, they will be made, he said.

While Huron's suggestions for the hospital have frustrated some doctors, their implementation is having the desired effect, said Bair.

"It looks like we're on a course to make money," he said. "Public hospital districts don't live to make money; we're here to provide up-to-date health care services for this community, so that money gets reinvested into the organization and back into the people of the community."

Health care organizations need to make at least a five percent profit to maintain the hospital facility and invest in new technology, he said, adding that the hospital hasn't had the money in the past few years to adequately meet those needs. The hospital is just starting to invest in technology such as monitoring equipment, he said.

Some doctors feel their voices aren't being heard by the hospital administration.

Dr. Dan Canfield of the Moses Lake Clinic felt that Huron didn't adequately consider medical staff input before giving their recommendations.

Dr. Jill Dudik Bross echoed Canfield's comments about not feeling heard.

"There have been many times that we as a medical staff at our meetings have addressed issues and made our voices known about things that Samaritan was going to go ahead with, plans that you have had, and even though we have voiced our opinions and our objections to those plans going forward, such as this new hospitalist group coming in, it didn't even matter what we said," she said. "You had made your plans and you were going to go ahead with them."

The hospitalist program refers to Samaritan's new contract with Rural Physicians Group, an organization that provides hospitalists who are on call 24 hours a day for seven days, then off seven days. Hospitalists are doctors who see patients in the hospital. Moses Lake Clinic has its own hospitalist program.

Dr. Marcus Kubosumi, a hospitalist with Moses Lake Clinic, was concerned how the new hospitalist group's seven-day schedule would affect patient care.

"Nobody can be on call for seven days in a row, 24 hours in a day and maintain the type of sharp efficiency that is required to care for a patient - any patient, much less patients in the hospital," he said.

Commissioner Katherine Christian said the organization's format has been successful at other organizations.

"It is different, but those doctors and those staff that listened and investigated it found that people were very, very satisfied with their system," she said.

Joint Commission, a not-for-profit organization that accredits and certifies health care organizations and programs in the United States, has rated Rural Physicians Group as "best in patient safety practice," said Bair.

Some doctors were concerned the existing hospitalist group was reluctant to admit patients to Samaritan and favored transferring them to other facilities.

Hospitalists are important for emergency room physicians, said ER doctor Alfred Roller. But working with hospitalists can sometimes prove difficult, he said.

"I need a group of hospitalists that when I pick up the phone and have a reasonable patient admitted to this hospital, I get a 'Yes, how can I help you?' not a million reasons why it's too difficult to admit that patient here ... If I keep sending patients out of town, not only are the patients unhappy and the families unhappy, but it can't be good financially for the hospital."

Dr. Lynne Flaherty, an emergency room physician at the hospital, had good things to say about Rural Physicians Group.

"I had my first experience with the new hospitalist group yesterday. Admitting a patient and it was the doctor's last day of his week on call and it was delightful," she said. "I received a warm reception, I got a very helpful discussion with the doctor who had some good ideas for the treatment and care of the patient and who was very, very cordial and even offered to come down to the emergency room, see the patient and write the orders there. I was absolutely thrilled."

Another issue brought up at the meeting was the hospital's Electronic Health Record (EHR) software made by Meditech.

The hospital implemented the software to meet federal requirements and receive a $2.2 million incentive.

The software is "a source of angst to almost every physician on staff," said Bross. "It is time-consuming, it is frustrating, it is archaic, it's hard to work with ... It didn't matter what we said, you were going to go ahead and implement this because there were the economic benefits being reaped by the hospital at our expense and I don't think that that is good for the health care of our community. I don't believe that that helps the morale of our nursing staff or of our medical staff and that in and of itself drives patients out of this town. If we aren't happy, if our nurses aren't happy, our patients aren't going to come here."

Bair acknowledged at the meeting that the software is not ideal, but said the hospital wanted to take advantage of the monetary incentive.

The $2.2 million the hospital received will be used to purchase new EHR software, he told the Columbia Basin Herald; adding that a group of physicians is working with the hospital's Information Technology department to select the new software system.

As for improving communication between the hospital administration and medical staff, the administration and Board of Commissioners are working to create a focus group to address physician needs, said Bair.

"I think our physicians are frustrated and we have to take a look at their frustration ... We have a responsibility to ensure that safe, high-quality care is provided here for the citizens of this community," he said. "That is our mission and our calling here, that we provide the safest care and high-quality care and it doesn't save any money to skimp on staff for financial gains. So, I'm very committed to addressing the physicians' concern on that point."