Staffing, Management Issues Plagued Western State Hospital Says Report

Sep 29, 2016

Washington’s troubled Western State Hospital has been plagued by ineffective management, staff reductions and turnover. That’s according to a “root cause analysis” report released Thursday.

The 112-page report paints a bleak picture of Washington’s largest psychiatric hospital. Patients who feel “neglected.” A “culture of helplessness” among staff. And a history of ineffective leadership and oversight.

Budget cuts and staffing shortages contributed to the problems. Western State is now under new management and undergoing a 13-month turnaround plan supervised by the federal government.

Carla Reyes with Washington’s Department of Social and Health Services described a hospital that’s trying to crawl out of the basement.

“It’s been a long history of compounding problems,” she said. “And at this point we’ve just reached the critical mass and we need to institute these improvements so that we can have good quality care in the hospital because patients really need this care.”

Western State has until next April to meet federal standards of care.

In recent years, the hospital has been plagued with violent assaults on patients and staff, the escape this summer of two high-risk patients and scores of unauthorized patient “walkaways.” DSHS said March of this year was the first month in years when there were no reported “unauthorized leave” incidents.

A recent security review by the Washington Department of Corrections found numerous security gaps including 25,000 master keys unaccounted for. DSHS said all exterior doors will be re-keyed by the end of October.

Since April, a new leadership team has been installed at the hospital, including a new CEO and security chief. The “root cause analysis” by New Jersey-based Clinical Services Management credited the new administration with moving ahead with recommendations for improvements.

In a potentially controversial move, DSHS has decided to create 28 mid-level manager positions. These new Ward Program Administrators (WPAs) will oversee day-to-day operations for each of the hospital’s 30-bed wards and be paid $85,000 to $93,000 a year.

According to a DSHS Frequently Asked Questions sheet, “The WPAs promote patient and staff safety and support clinical staff, ensuring the ward runs smoothly and effectively.”

“We need boots on the ground with accountability,” Western State Hospital CEO Cheryl Strange said.

Historically, the patient wards at Western State had a Ward Program Manager, but that position was abolished years ago because of “many issues with their roles, responsibilities, and an unclear chain of command.”

Paul Vilja, is a nursing supervisor at the hospital and self-described whistleblower who maintains a blog called WSHRN.net. Vilja is critical of the new WPA positions calling it a reprisal of the ward manager program.

Instead, Vilja would like to see the money it will cost to hire the new WPAs spent on direct patient care personnel. “We require overtime every day to operate,” Vilja said in an interview. Specifically, Vilja said the hospital needs more registered nurses, licensed practical nurses, mental health technicians and food aides.

DSHS said it has filled 171 direct care positions since July 1 resulting in a net staff increase of 100. The hospital currently has 83 clinical care staff openings which it is working to fill.

Besides personnel and budget issues, the consultant’s report highlighted systems problems that plague the hospital including its “excessive size,” a lack of community-based placements for patients ready to leave the hospital and a shortage of psychiatric workers.

The hospital is currently operating without accreditation and with oversight from the Centers for Medicare and Medicaid Services as it participates in the turnaround agreement. The goal of that agreement is to bring the hospital back into compliance with federal standards and preserve $65 million in federal funding.

Western State is the state’s largest psychiatric hospital with roughly 900 patients and 2,000 staff.