CEO gets $34,000 bonus, in spite of concerns over patient satisfaction

Poor patient satisfaction at the hospital led two trustees to vote against giving CEO Bob Morasko a scheduled $34,000 bonus.
Campbell County Memorial Hospital trustees Dr. Allen Mitchell and Harvey Jackson voted against the extra pay during Thursday night’s board meeting, citing the poor customer satisfaction ratings the hospital has received.
Trustees Dr. Sara Hartsaw, Nancy Tarver, George Dunlap, Joe Hallock and Chairman Brook Brahnson voted to give Morasko the bonus.
The hospital’s top scores in almost all categories fell below the national 50th percentile ranking, meaning the hospital was below average in all of those categories. In some instances, such as inpatient communication with doctors (sixth percentile) and pain management (eighth percentile), the hospital is only a few points away from reaching the median score.
In other areas, like in whether patients would recommend the hospital to others, CCMH scored in the first percentile and is more than 20 points below reaching the national median.
“This is a punch in the stomach to me,” Jackson said.
In comparison
A “significant culture change” is needed, Jackson said, adding that the board is not blameless.
He pointed out that in comparison to other hospitals in the region, CCMH scored well below its neighbors, something that was of great concern to him.
In many areas, the hospital’s numbers were below those that hospitals in Sheridan and Spearfish, Sturgis and Deadwood, S.D., received, Mary Barks, manager for patient and physician relations and social services, told trustees.
“We are significantly lower than all of those organizations,” Barks said.
When patient satisfaction numbers like these are released, hospitals with higher numbers — like Sheridan — are using them as a marketing tool. Others, like CCMH, are using them as a “springboard to do better.”
Jackson said the numbers also weren’t good when compared to larger hospitals, such as those in Casper or Billings, Mont. Those hospitals are bigger than CCMH, but the public makes those comparisons. He was disappointed that those numbers weren’t included and wants Barks to make sure they are provided to the board for discussion.
“From these numbers ... I can’t justify giving somebody a bonus,” Mitchell said.
As the primary director of the hospital, the CEO should put patient satisfaction and quality of care first, he said.
“At the end of the day, the main objective of this hospital is to provide appropriate quality of care,” Mitchell said.
Hartsaw said she didn’t have a chance to go through Morasko’s contract before the board meeting, but believed that he met the conditions of his bonus and the board’s contractual obligations needed to be met.
But Hartsaw said she still has concerns.
Trustee Tarver said Morasko did meet those benchmarks, which are set annually at the board retreat.
Tarver did agree that a culture change is needed at all levels of leadership.
“Every individual who comes here for care is the most important person that walks through the door,” she said.
Employee turnover
Jackson believed the low scores were in large part due to unhappy employees, something the Studer Group made note of in its initial analysis of the hospital. The hospital hired the outside consulting firm this week to help improve customer satisfaction.
It depends on how many people complete the survey, Morasko said. The last survey showed low scores at the hospital day care. When “drilling down,” it was discovered that only two employees took the survey.
If only two disgruntled employees choose to complete an optional survey, the results can be skewed, he said.
The hospital now has a turnover rate of 16 percent, which Studer said is very high for a hospital.
“There’s a direct correlation between employee satisfaction and patient satisfaction,” Jackson said. “It’s very much really one in the same because they affect each other.”
Morasko said the turnover rate has continuously dropped since he took over as CEO in 2007 when it was 24 percent. Even then, those numbers are skewed because the hospital also includes Pioneer Manor and a behavioral health department. Nationally, both mental health departments and nursing homes have high turnover rates.
When you throw in behavioral health and Pioneer Manor, “16 percent is good,” he said.
Jackson disagreed.
“I have drilled down through these numbers, I looked at the details of this survey, down to every question. I’ve studied it, I’ve looked at it and it’s concerning to me,” Jackson said. “Just as we accept the positive accomplishments of this hospital with open arms, we should also do the same with the bad and accept it and not have a culture of excuses.”
Jackson said he’s heard too many excuses in committee meetings.
“I’ve heard things in committee meetings such as, ‘patients are hard to satisfy’ and ‘what do they think this is, the Hilton?’” Jackson said. “Well, they’re paying three or four times the rate of the Hilton. We need to have our service go up. This needs to change. I want it to change. ... There needs to be a significant culture change with all of us, and I don’t think the board itself is blameless.”
Jackson said he is somewhat optimistic because the hospital’s scores, while in the lowest percentiles, are still within striking distance of reaching the national median.
Customer complaints
As if to drive the point home, two people spoke about the poor service.
Cyndi Silbaugh described three separate instances this year of miscommunication between staff members and poor service received at the hospital by her and her family.

• In the first instance, Silbaugh waited an hour and a half for a scheduled mammogram. When she finally gave up on waiting and told the receptionist that she had to go back to work, the receptionist was shocked no one had come to get her.
• The second case involved her husband, who had been exhibiting signs of mini strokes and was admitted to the emergency room. Silbaugh made it a point to say how wonderful the service was in the ER. The doctor there recommended her husband come back and do a sleep study. Silbaugh said her husband’s regular doctor faxed a request for a sleep study at CCMH’s sleep lab. Yet when she called back a week later, the hospital had no record of a request from her doctor. She filed a complaint with the hospital and a spot opened up.
• The third case she described was her daughter-in-law, who shattered her leg while in Sturgis, S.D. After getting her daughter-in-law to CCMH, there were numerous mistakes from the hospital, including having to wait for the on-call doctor to show up after being admitted and being told her daughter-in-law would have surgery on Sunday and then being told the hospital doesn’t do surgery on Sunday.

When the surgeon finally showed up, she said, he started to examine her daughter-in-law’s leg. Then he asked if she had insurance.
“Well, you’d thought she had the plague or something because he dropped her leg,” Silbaugh said.
The doctor informed her he is a sports surgeon and doesn’t do those type of surgeries, and they would have to wait for a surgeon to come into town Monday.
When her daughter-in-law finally got pain medication administered, Silbaugh said she went home to try and do some laundry.
“I never even got home. They had OD’d her,” she said. Her daughter finally had surgery the next day.
Charlie Madson described his friend’s ordeal when trying to get surgery on his hip.
“He went to see one of your doctors that’s drawing a salary from this hospital, and he was asked the same question — whether he had insurance or not. They won’t do the surgery because he doesn’t have insurance. I’d like to know why,” Madson asked.
While he knows the hospital has to stay in the black, the hospital’s mission statement said it is supposed to provide care for the community.
“I personally have been taken care of in this hospital. I have no problem with the care but I feel like it’s a terrible injustice to our community. This man has lived in this community for most of his life,” Madson said.
The board could not yet address Madson’s concerns because they were not familiar with the case.
Making changes
Barks said the tactics now being used in the emergency room — where there typically are lower patient satisfaction scores — for the last four or five months have boosted satisfaction. Those efforts now will be “rolled out” to the entire nursing staff.
Those measures described by Deb Tonn, vice president of patient services, included things like organizing the ER to make sure nurses were not overloaded with critical-needs patients at one time.
But even more important than workflow was making sure every patient feels they are being cared for and not just with their health concern. The staff needs to show compassion for the individuals.
“It goes a long way when we display sincerely those attitudes when making people feel values,” Tonn said.
The focus on compassion and accountability from the top down has helped improve the most current ratings of the ER, Tonn said.
Barks noted that patients also are frustrated when they are asked to register twice in one day. A patient may register for a clinic appointment on the third floor and then be re-directed to admissions to register again before heading to radiology. The hospital is working to streamline the admissions process and the billing process, which can be extremely complicated to follow.
The hospital also is upgrading the billing software for the hospital’s clinics to improve that area.
News Record Managing Editor Deb Sutton contributed to this report