A new report about the flagship hospital of the National Institutes of Health has found the renowned clinical center suffered from low morale and continuing patient safety concerns following a highly publicized outside review last year into patient safety.
Among the patient safety issues highlighted in the latest report, presented Friday to the board of NIH’s Clinical Center, are staff concerns about poor management and communication, lack of accountability, and outdated equipment. In some cases, equipment is so old that parts are no longer available, and technicians “must cannibalize some devices in order to keep others operational,” the report said. Some operating rooms have frequent water leaks.
When patients at the 200-bed research hospital need emergency transfers to other hospitals for care that the NIH facility cannot provide, it can take as long as 45 minutes for outside ambulances to clear NIH’s security, the report said.
The Clinical Center, also known as Building 10, is where research for 17 different NIH institutes takes place. That means patients are taking part in different research protocols, and as a result, “it can often be very difficult to identify the medically responsible physician at any particular time,” the report said. In addition, those research protocols may mean a patient needs a novel therapy, but patients who develop other medical conditions may need to be treated under prevailing standards of care, which can lead to confusion for the staff, the report said.
Staff at the Clinical Center are also frustrated by the lack of transparency about “misadventures and unexpected events.” Several staff members interviewed for the report said they often learned about patient-safety related events from news reports.
The Clinical Center is the nation’s premier biomedical research institution. It sees thousands of patients every year from across the United States and around the globe. Many are desperately sick with rare or intractable conditions, and the research hospital is often their last and best hope. It provides free care as part of studies that have saved lives and led to medical breakthroughs.
The report comes at a time when NIH has been in the spotlight because of the Trump administration’s proposed cuts to its budget. The administration has proposed cutting NIH’s budget by $7.5 billion, a drop of 22 percent from this year’s level. Congress appears unlikely to endorse that plan; a House committee this week instead proposed a modest 3 percent increase.
Last year, an extensive outside review of patient safety at the center found that a culture and practice had gradually and unintentionally evolved “where patient safety had become subservient to the demands of research.” That report, known as the Red Team report, had “a profound, negative impact on staff morale” at the hospital, and many hospital staff felt they had not been consulted sufficiently.
After the Red Team report was released, the average daily census of research patients receiving treatment at the hospital fell sharply from about 127 patients last year to 110 patients so far this year.
Source: NIH Clinical Center
That Red Team report prompted NIH Director Francis Collins to overhaul the leadership of the Clinical Center, replacing longtime leadership with a new management team that he said would focus on oversight and patient safety, similar to the top structure at most hospitals. A new chief executive position was created, and Maj. Gen. James K. Gilman, commanding general of the U.S. Army Medical Research and Materiel Command, Fort Detrick, Md., was named to the post in December.
In response to hospital staff reaction to the Red Team's report, Collins asked a former U.S. Health and Human Services official, Stewart Simonson, to lead focus group discussions on ways to improve the clinical center. Simonson’s report is based on 70 interviews of more than 600 NIH participants between September and January.
Despite staff concerns about a fragmented organizational structure, inadequate information, and declining infrastructure, the staff “state that it is an honor and privilege to be part of a place where the frontiers of biomedical knowledge are advanced every day,” Simonson's report said.
NIH officials, who have been regularly briefed on the findings, said they have already begun to address some of the recommendations to improve governance and communications, and address immediate and urgent facility repairs.
Simonson said the process had led him to have a more realistic understanding of the problems confronting the research hospital.
“There is no other place in the world like the CC,” he wrote. “In spite of fragmented organizational structure, sub-optimal and uneven communications, the declining state of infrastructure and equipment, and no comprehensive strategic plan, the CC is a great research hospital.”
Referring to these deficiencies, he added: “Imagine what could be achieved in Building 10 if they were corrected.”