In the four months since a scathing report on conditions in Quincy Medical Center’s geriatric care unit, the game plan has been all about change.
The hospital now sports a renovated geriatric unit, a new chief executive who will be appointed permanently this Sunday, and initiatives to improve patient satisfaction — things that administrators hope will satisfy state inspectors during a planned visit Thursday.
Meanwhile, concern has lingered at the local level about the financial well-being of the hospital, which, according to state filings, is still operating at a loss.
“They are a linchpin in terms of the best interests of our city. Their viability long-term is obviously something that we all should be aware of and concerned about,” said City Councilor Kevin Coughlin.
Both the quality of care and financial well-being have been in the spotlight since 2011, when Quincy Medical Center filed for bankruptcy protection as part of a reorganization and sale to Boston-based Steward Health Care System.
Executives have since gotten to work on more than $15 million in upgrades.
A gleaming lobby opened on Oct. 9, a robot-like device was brought in to assist in orthopedic surgery, and an orthopedic surgery recovery unit was created.
Elsewhere, patient rooms have been outfitted with new beds and televisions, the parking lot was redesigned, a new program now allows remote monitoring of intensive care unit patients, and information technology upgrades have been made to better track patients and their care.
While facilities were being upgraded, management was engaged in a tense contract dispute with the Massachusetts Nurses Association.
The reduction of surgical beds and some staff layoffs heightened problems, leading to a one-day nurses’ strike in April. The acrimony had subsided by June, and the parties shook hands on a one-year agreement.
“I think the strike certainly brought a positive change and a willingness for Steward to sit down and talk with us,” said Paula Ryan, a recovery room nurse at Quincy Medical and chairwoman of the local union.
But soon afterward, the hospital was chided in a report that outlined squalid patient conditions in the Geriatric Behavioral Health unit. The findings resulted from a surprise inspection in May by the state Department of Mental Health.
According to the report, the unit was in disrepair, with privacy curtains missing and dirty dining room floors. Patients were crying and depressed, one was sitting in her feces. Nurses had a haphazard understanding of who was responsible for what, the report said.
In response, the hospital provided weekly corrective action plans to the state, which recommended improvements and recorded progress.
Staff has since been retrained and previous patient activities and programming have been reinstated and regimented.
According to Christopher Murphy, spokesman for Steward Health Care, a new chief nursing officer with a background in behavioral health was hired, as was an experienced behavioral health program director and an occupational therapist.
The geriatric unit has also since been cleaned and completely renovated. Older common room furniture and all patient beds have been replaced.
All this occurred under the leadership of interim chief executive officer Donna Rubinate, who stepped into the role after the resignation of David Knell in July.
Rubinate’s position will become permanent Sunday, solidifying the new direction of the hospital and bringing a wealth of experience in hospital turnarounds, Murphy said.
“Hospital leadership continues to meet with the new Family Advisory Council unit to identify and address any issues,” Murphy said in an e-mail. “QMC has also implemented a new patient satisfaction engagement program . . . The response to this new engagement program has been very positive and patients and families have expressed very high satisfaction with unit staff and quality of care.”
After five unscheduled visits during the last four months, the state relaxed its tight management, and weekly reports have shifted into monthly updates. Thursday’s visit will be a regularly scheduled biannual inspection.
With so much change, and reports of the hospital’s fluctuating performance, some city officials have begun wondering where the hospital stands. That doubt prompted City Councilor Doug Gutro to prepare a resolution asking for a general and financial update from the hospital.
“What I do know is we need a community hospital in Quincy,” said Gutro. “And rather than speculating where it is based on a flurry of news reports over the last year, I elected to invite the hospital to come before the council and bring some clarity to where things stand.”
Council president Mike McFarland objected, saying the measure went “beyond the council’s job to discuss a company’s profit and loss statement.”
Several other councilors, including Brian McNamee and Kirsten Hughes, echoed McFarland’s sentiments.
“I’ve spoken to the hospital on a couple of occasions recently, and I feel good that they are getting things in order themselves up there,” Hughes said.
Councilor Margaret Laforest, who chairs the Environmental and Public Health Committee, could bring the subject before the council, but said she has not decided whether to do so.
Councilors Brad Croall, Brian Palmucci, and Coughlin supported the idea of giving the hospital a platform to speak from, if it so desired.
“They are our community hospital, and I think any time we can have a public conversation in front of the community with them about the things they are doing, I think that’s a good thing,” Palmucci said.
A visit could help clear up the questions some councilors have over the longevity of the hospital.
According to September filings with the state, Quincy Medical operated at an $18.5 million loss in fiscal 2011; a $5.4 million loss in fiscal 2012; and an estimated $10.4 million loss in fiscal 2013.
Murphy said it will take more than two years for the hospital to become profitable again and long-term investments in the hospital, both physical and through relationships with local primary care physicians, are paying off.
“This long-term approach is beginning to impact the hospital,” Murphy said. “Patient volume has increased significantly in the last few months and as a result the monthly financial losses are shrinking. Steward’s continued investment in the hospital and growth of the local physician network will result in long-term patient volume growth and financial stability.”