Editorial: DMC not likely to fix itself

The Detroit News

Hospitals of the Detroit Medical Center have failed for 11 years at the simple tasks of cleaning, sterilizing and properly packaging surgical instruments. It’s doubtful they can get it right in just two months.

That’s the time frame the DMC is on to resolve these critical issue or risk losing Medicaid and Medicare funding, a loss that would cripple its operations and deny care to the poorest and most vulnerable patients.

In reality, the only way the deadline can be met is if state auditors give the hospitals a pass on a sustainable solution and settle instead for short-term fixes.

Michigan’s regulatory agency, the Department of Licensing and Regulatory Affairs (LARA), has failed to catch most of the DMC violations in a two-day inspection in August, they include returning to operating rooms surgical instruments that still have on them dried blood and pieces of other biological material. The poor sterilization puts patients at risk of infections that could become fatal.

It is LARA that will determine whether DMC is in compliance by the Dec. 14 deadline. Frankly, it can’t be trusted to get it right.

The problems at DMC are massive, are shared by both management and the four unions who represent workers in the sterilization departments, and the only plausible explanation for why they haven’t been resolved after 11 years of complaints is gross incompetence.

Management did not provide adequate training to workers, and did not measure to determine whether training programs were effective.

The task force appointed by the DMC to come up with recommendations contains only senior executives; it could benefit from input by staffers supervising and carrying out the work.

And while the task force is charged with putting together performance measures, it is the processes at the hospitals that also must be addressed.

A report by the Centers for Medicare and Medicaid services, triggered by an ongoing Detroit News investigation, cited DMC for no infection control audits and poor worker training.

It also found that operating room technicians failed to soak equipment and found outrageous neglect by workers in doing their jobs, including putting dirty gloves in with clean ones and not cleaning blood-stained floors.

It shouldn’t require a whole lot of training to know better than that.

Four unions represent the sterilization workers. Management complains that union rules make it extremely difficult to fire incompetent employees. There’s no evidence that any union-represented staffers have been dismissed for poor performance, although several managers have lost their jobs.

That creates a culture of unaccountability.

There’s also, according to the federal report, a reluctance among staff to speak up. Hospital workers should not be afraid to sound the alarm about conditions that threaten patients. That, too, speaks to a rotten culture at DMC.

The DMC has brought in a private contractor to oversee compliance efforts. But that’s an uncertain fix.

What the hospitals must have to ensure it can sustain good practices for the long-term is a complete reworking of its processes and culture.

Frankly, that’s a goal that appears beyond the DMC’s reach. At this point, the best option would seem turning over the cleaning of instruments to a private contractor that would be accountable for the results.