Three noteworthy elements of the Swedish CEO memo announcing Johnny Delashaw’s resignation

Guy Hudson, the Interim CEO at Swedish Health Services, announced via memo last night that Johnny Delashaw, the subject of investigative reporting by the Seattle Times, was stepping down.  You can read the full letter here, which was initially released by the Times.

From the letter.

Johnny Delashaw MD has stepped down as chair of the Swedish Neurosciences Institute (SNI) and has made the decision to no longer practice medicine at Swedish.

Interestingly, this language clearly communicates that the decision was Delashaw’s and that Providence’s senior leadership had nothing to do with this move.  That may or may not be the case – I don’t have any insight there.  But it’s clear that this communication puts the responsibility for this move on Delashaw, which is somewhat interesting given the clear demands by the Swedish physician community for Providence leadership to take action and to clarify the leadership’s intent.

After many personal conversations and our initial caregiver forums at First Hill, Cherry Hill, Ballard and Edmonds, it is clear to me that caregivers at Swedish have not always felt heard – and this will change.

This is another interesting statement in that I think it probably is smart and responsive to what appear to be long-standing concerns from the provider community.  Except that it’s essentially the opposite of what is communicated in the first quote above:  that Providence leadership had no role in Delashaw’s removal, thus taking no action to reflect the concerns of the provider community given voice previously and particularly through Ralph Pascualy’s letter to Rod Hochman on the subject of Delashaw.

Another point many have made, and I agree, is that we need to do a better job of telling our story inside and outside the organization.  That includes our quality record, our safety record and our commitment to take care of everyone in our community, including the many who are uninsured or underinsured.

I think this statement is also noteworthy.  On the one hand, it embraces the idea that Swedish and Providence need a better communication strategy for both internal and external audiences.  I couldn’t agree more.  Providence does a lot of great stuff, and has a good story to tell.  Generally speaking, the culture of health care is not one that is overly promotional.  It’s a culture that expects to be judged by the merit of a credential and in many cases the quality of the work.  So, health care often doesn’t tell its story.  So, it’s good that Providence is looking to overcome that.

However, the items that are not mentioned in this statement don’t address the issues raised in the Seattle Times investigation:

  • How was something like this set of practices at the organization, SNI, allowed to continue (and earn promotion in the form of Delashaw rising to the chair position) when it was so clearly known by senior leadership?
  • What role does the driver of revenue and financial incentives play at Providence today, and how does the system check those to ensure quality care is elevated over more highly reimbursed care (a question that is the central element of the investigation)?
  • What will be fundamentally different about the reimbursement versus quality care equation at Providence in the future so that this doesn’t happen in the future?  Does that mean physicians will be given a greater voice in care decisions?  That’s implied in Hudson’s statement, but Delashaw was making decisions that led to his putting reimbursement over quality care.  Elevating physician voices wasn’t the answer with Delashaw.  Does this mean that the administration will be given greater authority to make these choices?  That’s not going to go over well with providers, and it didn’t seem to work in this case as senior leadership at Providence knew the concerns about Delashaw but didn’t do anything about it.  On the other hand, isn’t reasonable to put in place administrative measures that can guide best practices based on collective evidence rather than one provider’s opinion (as in the case of the clips that Delashaw used)?

This issue is a mess – for Providence and the communities it serves.

Hudson’s announcement is a good first step.  However, it’s a relatively low bar to get over – Delashaw’s removal from serving as the chair at SNI in particular, but also from practicing medicine at Swedish.  It also doesn’t – yet – begin to address whether anything will be different at Swedish as a result of the Times’ investigation.

Hudson has only been on the job one week.  He deserves more time to work.

But it’s been 5 months since Ralph Pascualy’s internal memo shouting about this problem from the rooftops.

How many other patients had negative medical outcomes during that time for lack of action by the Providence administration?