University Hospital in Newark, the state’s only public hospital, needs a transformational leader, new vision and management team focused on quality improvement and safety, according to a report by veteran health care executive Judith M. Persichilli.
In the five years since University Hospital separated from the former University of Medicine and Dentistry (UMDNJ), the hospital “has not leveraged its unique position to focus on developing a culture of high performance,’’ according to Persichilli’s report.
Persichilli was appointed by Health Commissioner Dr. Shereef Elnahal in July to review expenditures and assess the level of care provided at the 467-bed hospital. An executive order signed by Governor Phil Murphy directed the appointment of a monitor after the hospital received a failing grade on quality of care from the Leapfrog Group, had its bond rating downgraded four notches due to financial difficulties, and attempted to reduce the number of pediatric beds without state approval.
**Five overarching themes are outlined in the 30-page report to explain the hospital’s performance issues:**
Need for a transformational leader focused on creating a vision and building teams to execute the changes necessary to be a high-performance organization
Absence of a strategic plan as a foundation for a shared vision and alignment on critical goals and objectives
An organizational culture not focused on a relentless pursuit of excellence
Board oversight not focused on holding leadership accountable for underperformance
Inconsistent leadership due to turnover resulting in a lack of alignment on strategy and performance objectives
**Among other recommendations/findings:**
Develop a strategic plan and medical staff development plan
Make the hospital’s board representative of the community
Hospital board must hold the CEO and executive team accountable for quality/safety outcomes
Recommit to the Community Oversight Board and solicit its input on significant issues/actions under consideration such as changes in services/staffing
Hospital executive and management team needs to embrace a benchmarking system as a management tool to maintain and enhance staffing and productivity levels
Engage Emergency Department (ED) consulting specialists to do a complete review of the Emergency Room (ER)
Consider opening an urgent care center on site to relieve ER overcrowding.
The ED is crowded with 80,000 visits annually, in addition to 3,000 patients treated in the Level 1 Trauma unit of the ED.
Develop community engagement activities that support the hospital’s mission in Newark and provide a forum for partnership with the city.
If regulatory compliance and financial and quality performance does not improve, consider placing a full-time Department of Health representative at the hospital.
The monitor’s report was released just days after University Hospital President and CEO John N. Kastanis announced his departure, effective Dec. 14, 2018.
“I want to see the state’s only public hospital succeed for the patients who need care, for the broader community in Newark and for the frontline clinicians and employees who strive to provide the highest quality care every day,” Commissioner Elnahal said.
While conducting interviews for the assessment, Persichilli said she met “many Board members, medical staff, executive team members, stakeholders and employees of University Hospital who are dedicated to the mission and embrace the trust invested in them to care for the most vulnerable of the community with the highest possible standards.
It appears that the front-line caregivers and employees are using techniques and processes to improve care at all levels.”
She also said it is imperative that University Hospital “improve quality outcomes and finances to position itself to be a worthy partner with the community and other organizations such as Newark Beth Israel Medical Center.”
The monitor’s assessment is based on interviews with members of the board, executive management and key directors, and reviews of financial management, benchmarking data, quality processes, meeting minutes, community engagement and employee engagement surveys.
The report notes University Hospital is “an indispensable asset to the vulnerable populations of Newark and the surrounding community,” serving 17,000 inpatients and 250,000 outpatients in its campus-based clinics each year, according to the report.
It employs 3,300 staff and has a $670 million budget. Two-thirds of its patient revenues are Medicaid, charity care or self-pay, giving it the lowest percentage of commercially insured patients in the state. It is a Level 1 Trauma Center and is one of only two hospitals in the state performing liver transplants.
The hospital receives more than $150 million a year from the state for charity care, Graduate Medical Education, mental health and reimbursement for employee pension expenses and fringe benefits.