From the Salem Statesman Journal, March 31 2009

There also is little sense of urgency, evaluation says

A retired judge hired to evaluate reforms at the Oregon State Hospital reports that the effort has been plagued by a lack of urgency, undefined goals and poor planning.

James Hargreaves recently wrapped up his one-year stint as “special master” overseeing state hospital improvements. Gov. Ted Kulongoski appointed him to the post in February 2008 in the wake of a scathing federal report about patient care and conditions at the psychiatric facility in Salem.

In his final report, released Monday to the Statesman Journal, Hargreaves stated that “some important gains have been made in this transformation project” during the past year.

But hospital management has taken a scattershot approach to fixing flaws identified more than a year ago by federal investigators — without proper planning or goals, he concluded.

“Apparently feeling the pressure from the inspection by the United States Department of Justice (USDOJ), the hospital started ‘doing’ rather than planning,” Hargreaves wrote. “The failure to plan before doing has continued to plague this project ever since.

“Even as I leave my role as Special Master a year later, and despite my best efforts, within the hospital management there appears to be little understanding of the need for or commitment to planning and structuring this project. The result has been the proliferation of projects being undertaken with no overall goals or objectives and no organization that assures that these projects all work together to move the hospital to its goal of being a first class treatment facility for the mentally ill.”

Hargreaves also took hospital leaders to task for failing to communicate the “urgent” need for fast, far-reaching reforms.

As it stands, he said, the hospital has scant time to make necessary changes in patient treatment, staffing levels, training and operations — all before the planned opening of new psychiatric complex, due to be built on the existing hospital campus.

“The longer I have worked on this project and the more people I have talked to, the clearer it has become to me that there is little sense of urgency surrounding this transformation,” he wrote. “There is a pervasive sense that there is lots of time to accomplish what needs to be accomplished to transform the hospital into a first-class operation. From my experience working on large transformation projects this is an entirely inaccurate perception.”

The state is moving forward with plans to replace the 126-year-old hospital with a 620-bed, $280 million facility. The new hospital is scheduled to partly open next year and become fully operational in 2011.

“It is my sense that most people have no concept of how quickly that time will evaporate,” Hargreaves wrote. “I also don’t believe that most people have a realistic sense of how long and difficult the journey through this transformation process will be. It is up to hospital leadership to understand and convey this sense of urgency to all. To date, that has not happened.”

Hargreaves wrote that he was impressed by the state’s planning effort for the new psychiatric facility. He described it as “on time” and “very well managed.”

However, he warned that the new hospital may prove to be too small to meet the need, especially if Oregon’s longstanding shortage of community beds for patients deemed ready to leave the hospital continues to stall discharges.

“The biggest problem with the construction of the new hospital is that there is a substantial possibility that on the day it opens it will be completely filled and will prove to be too small to meet the existing need,” he wrote. “If this does occur, it will be driven by the lack of community beds for those who are ready to leave the hospital as well as the lack of treatment available in communities to reduce the need to send people to the hospital.”

Hargreaves, who spent 18 years as a circuit court judge in Lane County, reported that the inability to move patients into community facilities in a reasonable time makes the state potentially vulnerable to legal action.

READ – James Hargreaves report to Ted Kulongoski about the Oregon State Hospital
READ – DOJ report on the Oregon State Hospital, January 2008