Staff strained by rise in patients and complaints at Carolinas HealthCare System NorthEast in Concord

Carolinas HealthCare System NorthEast in Concord struggled to keep adequate staffing last winter and spring as the hospital experienced an unusually long period of high patient volume and an increase in patient complaints.

In a May-June newsletter obtained by the Observer, hospital President Phyllis Wingate wrote to employees expressing disappointment with “our recent results for inpatient satisfaction” and concluded: “We are not doing our best!”

Wingate described “staffing shortages in the first and second quarters” and said the hospital “simply didn’t have the staff to fill the need,” because of vacancies, turnover and a limited pool of employees who can be called in when needed.

“I understand the pressure staff was under with high volumes and little relief,” Wingate wrote. “The volume increase occurred faster than we could adjust the staffing, sustained for longer than we expected, and teammates are tired and have mixed feelings about how management responded.”

In a recent interview with the Observer, Wingate apologized for any misunderstanding generated by her May-June message. She said she had intended to thank employees for their hard work, but “made a mistake” by mixing that with a message about “our goals around patient experience.”

“We weren’t understaffed,” Wingate said in the interview. Instead, she said, “We weren’t able to flex up” by calling in enough staff to meet the need.

It’s typical for hospitals to get busier during winter months, when complications of cold and influenza viruses cause more people to seek medical care. But last winter, the Concord hospital stayed full long after administrators expected the patient volume to drop.

Wingate said NorthEast typically budgets for 305 filled beds in January, but the number of beds filled this year was 350. It gradually decreased in February, March and April, she said. “But it hasn’t come back down to historical low levels.”

Marcey Stone, a spokeswoman for Carolinas HealthCare, said all of the system’s Charlotte-area hospitals experienced “higher than expected volumes” in the first six months of 2015. She and other officials interpreted that as “good news, that our communities are choosing Carolinas HealthCare System.”

When staffing is insufficient to meet demand, that can lead to frustration, as Wingate’s newsletter outlined.

In a few paragraphs that angered some employees, Wingate appeared to blame an increase in patient complaints on the “attitude and commitment” of employees. “We are not truly putting every patient, all the time, at the center of everything we do,” she wrote. “…We can choose to be patient-focused and show compassion and caring vs. being self-focused and showing frustration and blaming others.”

Wingate wrote that she had heard feedback after a recent “Teammate Forum” about inappropriate staff behavior, such as employees talking on cellphones in front of patients or blaming colleagues “as an excuse for something not being done.”

“Staffing may have contributed to these observations,” Wingate wrote, “but it is not the root cause of this behavior. The root cause … lies within the teammate and their care and concern for our patients, or lack thereof, and attitude towards our patients and their work.”

Wingate’s newsletter prompted an angry response in the form of an “Open Letter to the CHS Administration” blaming “poor leadership” and “understaffing” at the bedside for poor patient satisfaction.

“It is quite appalling that administration would intentionally blame bedside staff for low scores that are a direct result of decisions made by administration,” the letter said. “…It is very clear that understaffing bedside clinical staff is the MOST important predictor of safe patient outcomes.”

A copy of the letter, signed “Carolinas HealthCare System Employees,” was sent anonymously to the Observer. In a recent interview, Wingate said that neither she nor other hospital administrators had seen it before it was shared by the Observer.

The letter referred to an American Nurses Association summary of studies related to nurse and patient safety. “High nurse-to-patient ratios are associated with an increase in medical errors, as well as patient infections, bed sores, pneumonia, MRSA, cardiac arrest, and accidental death,” the letter said.

Wingate said her May-June newsletter could have been clearer. “I can see looking at it now, hindsight’s 20/20, that they (employees) could have read into there that I was trying to be critical of the work they were doing even when we were stretching resources. That wasn’t my intent.”

In a subsequent newsletter to employees, Wingate stressed the point she said she had meant to make in the May-June message.

“Thank you for your flexibility, professionalism and commitment to your work as our industry – and our hospital – move through long-term changes and challenges,” she wrote in the second newsletter. “… I am acutely aware of the personal sacrifices you make and the commitment that comes straight from your heart for the benefit of our patients.”

Carolinas HealthCare CEO Michael Tarwater said last winter’s flu was “heavier than it has been” and that patient volume stayed high for longer than expected, partly because “new people are choosing us” for their health care. He said employees across the system “did a phenomenal job of managing that.”

To prevent future staffing problems, hospital officials have taken several steps. One is to create a central pool of nurses and other employees who can be called on to serve all the system’s Greater Charlotte hospitals, instead of having separate pools for each one. The system is also starting a fellowship program for registered nurses who want extra skills to work in specialty areas, such as the emergency department, and offering a mentoring program for nursing graduates who don’t yet have on-the-job experience.

“We’re trying to give our folks all the tools they need to be able to flex up,” Tarwater said.

This story was originally published September 18, 2015 at 2:00 AM with the headline "Staff strained by rise in patients and complaints at Carolinas HealthCare System NorthEast in Concord."