Washington health system rebuked for offering COVID-19 vaccines to ‘major donors’

Overlake Hospital Medical Center (Bellevue, Wash.) | 100 hospitals and  health systems with great orthopedic programs 2017

Overlake Medical Center & Clinics invited about 110 donors who gave more than $10,000 to the Bellevue, Wash.-based health system to receive COVID-19 vaccines, drawing criticism from the state’s governor, according to The Seattle Times

Molly Stearns, the chief development officer at Overlake, emailed the “major donors,” as they were addressed in correspondence, about 500 open appointments in its COVID-19 clinic that were set to open Jan. 23. According to The Seattle Times, donors who received the email got an access code to register for appointments. 

The vaccination appointments weren’t exclusive to donors, but were open to some 4,000 people who were board members, some patients, volunteers, employees and retired health providers, Overlake told the newspaper. All registrants were supposed to meet state-specific eligibility requirements for the vaccine, according to The Seattle Times.

Tom DeBord, Overlake’s COO, told the newspaper that the invitation was sent after the hospital’s scheduling system stopped working properly. To speed up distribution, the system began contacting people whose emails they had access to, which included donors, retirees, some patients and board members.

“We’re under pressure to vaccinate people who are eligible and increase capacity. In hindsight, we could certainly look back and say this wasn’t the best way to do it,” Mr. DeBord told The Seattle Times.

Once Gov. Jay Inslee’s office found out about the “invite-only” appointments, the office asked Overlake to shut down the sign-ups, which the system did.

In a Jan. 27 statement posted to the health system’s website, Overlake said all communications with people invited to sign up for the vaccine “made clear that people must show proof of eligibility under current Washington State requirements to ultimately be vaccinated, no matter who they are or how they are affiliated with us. We recognize we made a mistake by including a subset of our donors and by not adopting a broader outreach strategy to fill these appointments, and we apologize. Our intent and commitment has always been to administer every vaccine made available to us safely, appropriately, and efficiently.”

Read the full report here.

Trust issues plague the relationship between Ascension St. Joe’s and the community it serves


Image result for ascension st joseph hospital milwaukee

Three empty chairs at a community meeting epitomized the mistrust between the leaders of Ascension Wisconsin and the St. Joe’s Accountability Coalition.

The coalition, composed primarily of community leaders from Milwaukee’s north side, invited Ascension Wisconsin to that Oct. 1 meeting to press the health system to sign a legal contract binding it to a list of commitments. The commitments included keeping Ascension St. Joseph hospital open and providing an urgent care clinic, affordable housing assistance, local hiring, more employee training and living wages for all employees.

Ascension didn’t show.

For one, Ascension Wisconsin officials said they were told they would not be allowed to speak at the event. For another, they said signing a contract was unnecessary because they have promised to keep the hospital open, already hire locally and provide employee training.

The hospital, which employs about 800 people, is one of the neighborhood’s largest employers.

The coalition wants the hospital to sign a community benefits agreement, known as a CBA, which is a contract between community groups and real estate developers or government entities.

Reggie Newson, Ascension Wisconsin’s vice president of government and community services, said the health system is proving its commitment to the community by expanding and adding services to St. Joseph.

For example, two certified nurse-midwives were just hired for the hospital’s new midwifery clinic and a third is being recruited. The hospital is also planning to hire a cardiac nurse practitioner and cardiologist.

But members of the coalition aren’t convinced, because they say there is no legal penalty if Ascension fails to follow through on its promises.

Nate Gilliam, an organizer with the Wisconsin Federation of Nurses & Health Professionals, advisory board member of the University of Wisconsin Population Health Institute and coalition spokesman, said the coalition just wants accountability.

“It’s good that they’re saying all these great things on paper and to the media,” he said. “But if they are going to do that, they shouldn’t have a problem with signing a CBA.”

Future bright despite history of mistrust, Ascension says

The lack of trust between the coalition and Ascension Wisconsin started 18 months ago, when hospital administrators — citing losses of roughly $30 million a year — proposed cutting some of Ascension St. Joseph’s surgical and medical units and other services, such as cardiology support.

The hospital, at 5000 W. Chambers St., serves a majority African American population on the city’s north side, an area facing steep socioeconomic disadvantages. Decades of limited access to health care have contributed to higher rates of chronic disease. Higher rates of poverty means many residents rely on Medicaid for health insurance.

Residents interpreted Ascension’s proposal as a precursor to closing the hospital and — in an area where transportation is scarce — feared they would have to go farther for health care.

The proposal was criticized by Mayor Tom Barrett, several aldermen and community leaders, including George Hinton, CEO of the Social Development Commission and former president of Aurora Sinai Medical Center, who wrote an op-ed in opposition.

Ascension dropped the proposal.

But that was 18 months ago.

Since then, Newson said the hospital surveyed more than 1,000 people by telephone and held five community listening sessions. The information was used to develop priorities for the hospital and corresponding programs, such as the midwifery program and heart and vascular community care center.

Similarly, members of the coalition conducted their own survey, knocking on hundreds of doors and collecting 584 detailed responses.

When surveyed on non-clinical services, over 40% of residents said housing assistance, local hiring and living wages were their top priorities. From the coalition’s survey on clinical services, 61.6% said access to urgent care was most important to them.

Kevin Kluesner, Ascension St. Joseph’s chief administrative officer, said he and others are well aware of the health disparities and disadvantages within the community they serve.

He said Ascension Wisconsin’s push to expand services is proof the hospital isn’t going anywhere.

That commitment is despite the hospital’s having lost roughly $150 million since the 2012 fiscal year. In the 2018 fiscal year, the most recent for which information is available, Ascension St. Joseph lost $31.6 million.

By comparison, Froedtert Hospital reported $134 million in profits for the 2018 fiscal year, according to information filed with the Wisconsin Hospital Association. Aurora St. Luke’s Medical Center reported $166 million in profits in 2018.

Gilliam said that since the hospital is a non-profit venture, lost profits shouldn’t matter. He also said that Ascension Wisconsin has more profitable locations across the state, that can offset the losses at St. Joseph.

Coalition wants accountability

The results from the coalition’s survey mirrored what residents at the Oct. 1 community meeting described.

Charles Hawkins said he likes his primary care physicians, but said they keep leaving.

Another resident who lives blocks away from the hospital, Arkesia Jackson, said when her brother-in-law experienced a flare-up of his COPD, or chronic obstructive pulmonary disease, she was thankful a community hospital was nearby.

“He ran inside the emergency and collapsed, car running,” she said. “He is a patient at St. Joe’s. They had all his records, they knew who he was, they knew what he was suffering from.”

Newson said the goal is to provide consistent, quality care for all patients.

Gilliam acknowledged that details of what the coalition is asking for, such as racially equitable health care and helping with housing assistance, are somewhat vague. However, that’s because its members said they want to sit down with Ascension and hammer out an agreement — as long as Ascension commits to signing one.

Coalition members argue that other hospitals have worked with community groups on similar initiatives.

Robert Silverman, a professor in the Department of Urban and Regional Planning at the University of Buffalo, said there are some rare examples of CBAs being used in the health care field.

For example, Yale University signed a CBA with the Community Organized for Responsible Development group in 2006 regarding the construction of a new cancer center.

It still remains unlikely that Ascension, a national organization, would willingly set such a precedent for its hospitals.

Gilliam said he thinks it’s important for hospitals to be accountable to the community.

“I don’t see why they see a community benefits agreement as adversarial off the top,” Gilliam said. “Whenever they’re ready to come to the table in earnest, we’ll be there. That’s it.”

But with the addition and expansion of several new programs, Kluesner said he’s not sure what else hospital officials can do to prove they are serious about being a reliable anchor institution on the city’s north side.

“We’ve signed 11 new providers. That’s the best proof we could give of our commitment to growing services here at St. Joseph. If people are wondering what are we doing at Ascension St. Joseph, I think that actions speak louder than words,” he said.


The Critical Role of Trust In Avoiding a “Charge of the Light Brigade”

The Critical Role of Trust In Avoiding a “Charge of the Light Brigade”

The importance of leadership trust increases as the pace of change accelerates. Leaders in hyper-competitive and turbulent business environments need employees to support decisions without a lot of extensive explanation and back and forth discussion. It is not that change management topics like “what’s in it for me” are not important. It is simply a matter that when you need quick action, you may not have time to fully explain why this action is critical.

The need for fast action creates a dilemma for leaders. To move quickly, leaders need employees to accept and believe in their decisions without demanding a lot of discussion and justification. On the other hand, leaders do not want employees to blindly accept leadership decisions if they know these decisions could be leading the company down a path of failure. This issue was famously captured in Tennyson’s poem “The Charge of the Light Brigade where he described soldiers responding to a questionable order with the stanza “theirs not to make reply, theirs not to reason why, theirs but to do & die.” While this phrase summons up notions of courage and duty, the story it describes is a tragic example of people following leadership orders they knew were foolish. In the case of the Light Brigade, the unwillingness to question the wisdom of their leaders led to 278 needless casualties of which 156 were killed.

Leadership in fast moving world requires asking employees to trust your decisions while ensuring employees are willing to criticize your decisions. To quote General Colin Powell, “Leadership is solving problems. The day soldiers stop bringing you their problems is the day you have stopped leading them.” How can leaders create the sort of trust that strikes this balance between employees accepting decisions but also questioning them? The following are some suggestions based on psychological research studying trust in organizations.

If you do not trust your employees, they will not trust you.

People are good at picking up subtle cues that show whether their co-workers trust their commitment and abilities. If a leader lacks trust and confidence in their employees, then employees will soon lack trust and confidence in that leader. This is a major issue when companies restructure. It is common to assign leaders to “fix” struggling divisions of a company. If these leaders believe existing employees are to blame for the previous problems, then they are almost certain to fail in gaining the trust of those employees when they most need it.

Trust depends on sharing bad news.

Some leaders believe the best way to build employee confidence is to hide bad results and downplay challenges the company is facing. This behavior damages leadership trust. Employees put more trust in leaders who openly share information with them, both good and bad. This goes back to employees trusting leaders who trust them. Leaders who trust employees with sensitive information about company performance are both educating employees on the realities the company is facing and building leadership trust in return. There is a right way to share bad news to avoid undermining confidence. But not sharing bad news at all undermines trust.

Trust comes from you knowing your employees (not just them knowing you).

One often hears leaders attempt to build trust by saying things like, “Anyone who knows me will tell you I am a person of my word.” What these leaders fail to understand is trust, particularly when it comes to providing critical upward feedback, is often more dependent on leaders knowing their employees then employees knowing their leaders. Employees put themselves at risk when they say things that might be viewed as critical of leadership decisions and behaviors. And employees do not want their only interactions with leaders to be centered on them sharing problems. This is captured by something a colleague once told me, “Why would I tell our division president what he is doing wrong if he doesn’t even know what I do. He’d just think of me as that person who complains.”

Building trust with employees depends on getting to know employees. The only way to know your employees is to spend time with them. Short personal interactions have big effects on trust. One way to see the difference between effective and ineffective leadership in this area is to observe executives at company conferences. The ones employees trust are the ones who spend time with employees two or three levels below them. These leaders intentionally start conversations with employees they do not know. Executives employees often mistrust are ones who spend their time in closed conference rooms or fancy dinners talking with other senior executives and people they already know.

Leadership trust comes through manager trust.

Managers play a critical role in building leadership trust. Managers have more time to spend getting to know employees, and as a result they can build far stronger relationships. What is interesting is that how much employees trust their managers depends in part on how much managers trust their own leaders. There is as a “trickle down” effect associated with trust. When leaders build trusting relationships with their managers, their managers are more likely to build trusting relationships with their employees. This is good news for leaders because it means that they can delegate the role of building trust to managers. But the only way to do this is to spend time with their own direct reports. And increasingly companies are adopting organizational structures where executives will have 15 or more people reporting to them. This increases the risk that executives may not spend enough time building trusting relationship with their own reports, which in turn will undermine leadership trust lower within the company.

It is often said that “trust takes years to build but seconds to destroy.” The first part of this statement is not necessarily true. Trust can be built fairly quickly. This is good news for leaders in a fast-moving world where trust needs to be established in a matter of days or weeks. But leadership trust will not come from leaders simply saying, “Trust me.” The only way to build leadership trust is for executives to demonstrate that they trust the employees, communicate with employees in a transparent manner, make time to get to know employees at all levels, and focus on building strong relationship with the people who actually manage the employees. Building leadership trust may not take years, but it does take active time and attention.