WilsonTimes.com - Accreditation ignites debate on improving health department

Wednesday, October 10, 2012 11:51 PM

Accreditation ignites debate on improving health department

By Olivia Neeley | Times Staff Writer

A battle of words took center stage during Tuesday night’s Wilson County Board of Health meeting. Most of that battle involved the "suggestions for quality improvement” that were given to them by the state after the Wilson County Health Department received its accreditation in the spring. The state also required the department to address four mandatory items from that accreditation.

During the Board of Health meeting, chairman Ron Sutton said all four of those issues have since been addressed.

"At this point, it is safe to say to this board that any of the items that we didn’t meet in the accreditation review have been met,” he told the board. "Those are mandatory items that will be judged on in the future.”

Several new policies were also adopted Tuesday that addressed some of the suggestions the state made in their report. Those policies included, a "Workplace Diversity Policy,” a "Non-Discrimination Policy Statement” and a "Staff Development Policy.”

But board members later sparred over how to address remaining suggestions.

"They were suggestions, not requirements,” Sutton told the board before asking if they felt like they needed to have a meeting or study session regarding those suggestions. "That’s what they are, just suggestions for us to consider.”

He also asked if the board felt comfortable letting Health Director Felix Meyer handle those suggestions as he sees fit and report back to them as they are implemented.

Health board member Thomas Lucas, who is also chairman of the Wilson County Board of Commissioners, said he thought a study session would be an "excellent” training opportunity for the health board to be a part of regarding the suggestions. He believed the suggestions offered a prime opportunity for positive health board interaction and ways to better public health in Wilson County.

Board member Dr. Jessica McKee said they all received an email from the state regarding the suggestions that said "these suggestions are simply suggestions,” she said. "They will not be known to the next site visit team. No one will be checking to see if you addressed any or all of them. I think that it might not be particularly necessary that we as a board are involved in that if it’s not necessary that each item be addressed. It’s misconstruing the point of the suggestions.”

"The board still has to take some leadership as to say what we ought to be focusing on,” Lucas insisted.

Board member Melinda Laird suggested that as Meyer worked on those suggested items that he has implemented, he could then bring them to the board. And if the board felt more needed to be done, then they could regroup about next steps.

Lucas asked the board if it was deciding whether or not to let Meyer make that decision on what is worthy and what it not.

Board member Dr. Russell Stone said they all have access to those suggestions.

"If we have an issue with them and we want to bring it forward as an issue, we have that ability,” Stone said. "I didn’t really see anything too troublesome.”

Laird said she has been involved with a lot of surveys similar to the health department’s accreditation process since she is an employee with Wilson Medical Center.

"You are going to get suggestions that you can choose based on your facility,” she said "Surveyors give suggestions based on best practices on what they see in organizations.”

Laird said as Meyer sees what’s applicable to the health department, then that’s what he should implement.

"Then we can see the success of it from the report of the staff as well as from Felix,” she said. "I’m OK with that. We can get really into the minutia if we look at every item of their suggestion. They are going to suggest a variety of different things.”

Lucas said he got the impression from the state that on the next accreditation there is a lot more that’s going to be expected from the health department.

Laird said she would be more worried about those mandatory items than suggestions.

"Because those are things we have to have in place,” she said.

"I would rather err on the side of caution,” Lucas said. "If you are OK and you think that the suggestions didn’t mean anything, then so be it.”

"I think that it meant something in that it gives us a way that we can look at other ways to improve,” Laird said. "I don’t think it’s a make or break us like the other we had to show documentation on.”

Valerie Bulluck, a health department employee whose primary role is to ensure they are meeting all requirements, chimed in on the discussion to help clarify.

"What I’m hearing is that we met the letter of the law for accreditation, but the suggestions mean that some things need to meet the spirit as well,” she said. "This is a working document for me, the suggestions. I go through it every single day and as we make improvements I’m checking them off and making sure we are going to meet the spirit of those recommendations as well as the letter of those recommendations. In four years, it is going to be tighter. They are going to be looking for a higher mark for us to reach. This was the bare minimum to get accredited and in order for us to excel in four years, we have to exceed that minimum. The suggestions will also be met, in that they apply to this health department and that’s my job to make sure that happens.”

Lucas said he appreciated her explanation.

"The consensus of the board is that the board does not need to have a study session on this and we are holding Felix and his staff responsible for addressing these quality improvement suggestions to the Wilson County Health Department,” Sutton said, wrapping up that portion of the meeting.

‘THE PAPER HAS A JOB AND THEY DID THEIR JOB’

Before the nearly three-hour meeting concluded, McKee said she wanted to make a brief comment.

"I was just really distressed on the articles in the Wilson Daily Times about the health department,” she said. "I just really felt that was not the forum in which the matter should be discussed. I felt it was really most unfortunate, because the reputation of the health department, and the reputation of the health department employees that work so hard, was drug through the mud. And I felt like the accreditation, which was such a positive accomplishment, which was a positive for this department was turned into a negative. And again these suggestions were misconstrued, splashed all over the paper as egregious errors that needed to be corrected immediately.”

McKee continued.

"And I think the discussion we had tonight was very helpful in asking questions, having them being answered so that everyone’s questions can be addressed completely,” she said. "And I think the newspaper is not the place to do that. And I think that it harms the reputation of the health department and we all have the interest of the health department at heart. We want to improve this organization. That’s why we’re here. That’s why we’re sitting here for hours tonight — to improve the health department. And we do things that negatively impact it? It’s just regrettable and unfortunate.”

Lucas said he wanted to make sure he wasn’t making an assumption. And he asked McKee if her comments were directed to one person or the whole board.

"The whole board,” she said. "Anyone of us could have written a letter to the editor, we could have made comments to the newspaper. There were comments by some board members or (a) board member in the newspaper and not others. Take it as it may be. These are just my comments. I am speaking just for myself.”

"Let me speak now,” Lucas replied. "I am a county commissioner also. And I have a duty as a county commissioner. And the entire county commission took a stand regarding health department issues. The paper has a job and they did their job.”

"They did,” McKee replied. "But unfortunately the things that were in the paper were incorrect.”

"Specifically?” Lucas pressed.

"Specifically that these accreditation suggestions were things that needed to be corrected immediately,” she replied. "And that was not the intent of them. There was never a follow up article to say this was misconstrued.”

Lucas continued to disagree with McKee.

It was not clear which article McKee was referring to.

McKee at one point reached in her purse and pulled out a newspaper clipping.

"Mr. (Commissioner Rob) Boyette was quoted as saying the quality improvement area, specifically (he) wanted to see what those were and how they were going to be addressed,” she said. "Mr. Boyette was quoted in that aspect.”

The Wilson Times has published three articles referencing the results of the accreditation. Two recent articles that were published explained how the health department received their accreditation and also quoted the site team administrator as saying that the department, "far exceeded the minimum accreditation requirements and did a phenomenal job.”

That article also included mandatory items that needed to be met and "suggestions” that were given by the state. The most recent article was based on a public county commissioners’ meeting in September with an audience of residents in attendance. Those "suggestions,” as noted in the article, were publicly discussed among board members and they received the state report in their agenda packet.

‘RESPECTFULLY DISAGREE’

On Tuesday, the Board of Health also adopted a procedure for the county health director following an Aug. 6 resolution from county commissioners calling for appropriate measures to be taken after a number of firings by current leader Felix Meyer.

Commissioners had voted unanimously for that resolution following a closed session to discuss a personnel matter.

"By drafting the resolution they are giving a no-confidence vote because of how he has handled personnel issues, other things and the costs to the county,” Lucas said in a previous interview in relation to Meyer.

The commissioners resolution itself called for the board of health to "review the acts and actions of Felix Meyer regarding termination of employees and take such actions as may be appropriate.”

The resolution followed several employee firings by Meyer and subsequent legal settlements reached. The county has settled two complaints with two employees fired by the health department by Meyer. One settlement was more than $255,000 and also included attorney and court fees.

Tuesday night’s action appeared to be the health board’s response.

"The county commissioners took two actions in their meetings, that require as I see it, actions by this board,” Sutton said. "Tonight this board has taken independent actions on those actions by the county commissioners. It appears to me, for the appropriate way for me to respond back to the county commissioners is through its chairman ... Therefore you will be getting a letter from me, notifying you as chairman that these are the actions the board of health has taken.”

Sutton said he would be drafting a letter on behalf of the Board of Health.

"Please, don’t represent me as a board member without an official vote from this board that you are going to do that,” Lucas said referring to the letter. "I think if you are going to send a letter on behalf of the board, then the board should be able to see that letter before you do it and approve it.”

"I will be more than happy when the letter is drafted to forward it by email to each board member and I will revise it as many times as I need to until everybody is in agreement,” Sutton said.

"I think that’s the business way to do it,” Lucas said.

"Well, Mr. Lucas, we respectfully disagree,” Sutton replied.

‘IT SHOULD BE’

Lucas wanted to make sure the meeting’s minutes were being recorded Tuesday night on the previously stated comments during the heated exchange.

"Is this included in the minutes,” Lucas asked the chairman, referring to what all had been said.

"Is this included in the minutes?” Sutton then asked. "It should be.”

Lucas replied, "It should be.”

"This conversation should be included in the minutes because it’s been held in open session,” Sutton continued. "There is no reason for it not to.”

Sutton then ended the meeting by saying that there were clearly two different views about the matters among board members.

"And nobody says everybody always has to agree,” Sutton said. "We will respectfully disagree.”

Lucas stands by the decisions commissioners have made in relation to these issues, he said.

"There is a position that the commissioners have taken,” Lucas said. "And I stand with the commissioners.”

Under general "suggestions for quality improvement” the state site team suggests that the board of health minutes be more thorough in documenting discussion and actions taken, and be more organized, according to the approved agenda.

olivia@wilsontimes.com | 265-7879

Mandatory Requirements Met and Implemented in Regard to the Accreditation

• Health department shall ensure that new staff is oriented to program policies and procedures and existing staff receives training on any updated or revised program policies and procedures.

— In the report, the site team found that orientation checklists for two employees hired within the past 12 months were not complete. The orientation checklist for one other employee hired within the last 12 months was not provided.

• Shall participate in orientation and ongoing training and continuing education activities required by law, rule or contractual obligation

— In the report, the site team stated that the department’s Staff Development Plan lists "Title VI" and "Email as Public Record" policies as being mandatory annual training for staff. The team cited that the department was not able to provide evidence of training on those two topics for any of the personnel records selected. According to the report, the department was not able to provide evidence of completion of "Introduction to Principles & Practices of Public Health Nursing" for one of the nurse records selected.

• Implement a non-discrimination policy as required by state and federal law and train staff in its application.

— The department was not able to provide evidence of non-discrimination policy training within the last two years for the 12 records selected.

• Implement a performance appraisal system for all staff

— A performance appraisal has not been conducted for one of the personnel records selected. Additionally, the department did not provide a policy/ procedure regarding conducting annual performance appraisals for all staff.

All of these mandatory items have been addressed and implemented, according to the Board of Health meeting held on Tuesday night.

This past spring, the Wilson County Health Department received its accreditation. The state accreditation administrator said in August that the health department "far exceeded the minimum accreditation requirements and did a phenomenal job."