Sen. Mark Miloscia on improving accountability in Washington health care

State of Reform sat down with Sen. Mark Miloscia (R-30), candidate for Washington State Auditor. Sen. Miloscia spoke about improved accountability for health care in the state, especially regarding Western State Hospital and homelessness.

Mary Powell: You’ve been active regarding the improved integrity of Western State Hospital. Tell us the approach you’d take to try to highlight issues at the hospital as well as potential solutions as Auditor.

Sen. Mark Miloscia: The approach I would take is the same approach I’ve been using my entire legislative and professional career: Ensure all organizations have a sound and professional quality management system in place that’s valid, reliable, and focuses on continued improvement. I’ve been a part of the quality movement since the late ‘80s. In fact, regarding Western State Hospital, I’ve actually done an internship at a psychiatric hospital and I’ve actually done reviews and been a part of teams that have assessed hospitals and other health care organizations. I use the Baldrige excellence criteria as the tool to evaluate performance. Many in health care know that a number of hospitals and other organizations across the nation use the Baldrige criteria as their path to make sure they meet CMS standards.

Unfortunately, despite my repeated urgings, Western State Hospital refuses to use this common improvement practice.

The role of the Auditor is to ensure any agency has the right management, with the right plan in place, and skills to improve. An Auditor can’t improve an organization; an auditor can only point out areas where they can improve, and recommendations on next steps. It’s up to that agency to actually implement the improvement.

Obviously, with Western State Hospital there are two issues we have to work on, first finding the root causes of why Western State Hospital failed – and it’s clear they don’t have a quality management system in place and have no active plans to implement one, that would identify the root causes.

Secondly, why did the Governor’s Office and state managers fail to anticipate or fix this problem that was going on almost a year and a half or longer? Why did the management systems above Western State and DSHS fail? Those are the issues that I, as chair of the Senate Accountability Committee, was trying to get answered. The Auditor, as the Senate is doing, should continue to urge WSH, DSHS and the governor’s office to use that approach.

I introduced a bill, which identified a quality improvement approach, and the Governor did not support it. Today, we are seeing the results of the Governor failing to implement a viable and reliable quality management system at all levels of government.

MP: The Senate Republicans raised questions of management at the HCA and the Medicaid program this year.  Should the Auditor have more of a role in auditing the agency, or its health plan contractors which run Medicaid?

MM: When an agency fails, you look at the people who are supposed to be checking up or managing this agency. Who in the Governor’s Office is responsible for reviewing this agency? It could be the Medicaid contractor, but I don’t know. But at some point there are enough people in the loop that you have to find the root causes of the failure of the monitoring or assessment processes. Maybe the contractor did a good job- but I don’t know.

At the end of the day, I’m here to see that the state agencies are doing well. The Federal government is supposed to be managing their Medicaid contractors. As an aside, I know some of the Medicaid contractors use the Baldrige performance excellence model.  I’m more interested in improving the state managers and organizations that are responsible for this budget debacle.

MP: You have been active in addressing homelessness in the area, but recently criticized the region’s approach to this issue and lack of accountability. What types of accountability measures would you like to see in place to ensure people are receiving services, particularly mental/behavioral health, and substance abuse treatment?

MM: I was the author of the Homelessness Housing Planning Act 10 years ago that set a goal to reduce homelessness. The accountability measures in the bill have never been fully implemented. So, these need to be improved and fixed. You’ll never get good accountability measures and systems unless the people in charge actually have the knowledge of how to implement this correctly. For example, the Department of Commerce had the authority to evaluate the plans and measures and they are not doing it.

You asked how I’d like to ensure that people receiving services for mental and behavioral health and substance abuse treatment. As you know, we’ve increased spending in both areas by over 47% in the last three years. So, there is a tremendous amount of money. We’ve had numerous discussions about whether we are getting value or results for these services.

You can look at the headlines of the failure of the mental health system over the last 10 years and the number of leadership changes at DSHS on this. The heart and soul of improvement on this problem is the same as the other problems. You need good leadership who understands performance management and they have the will to enforce accountability correctly. Right now there is no leadership in the executive branch and the State Auditor has not focused on this per se. Accountability is one of those issues in state government that is always the last funded. Unfortunately, as we are seeing right now, if one fails to properly fund these measures in health care, substance abuse, or social services, or homelessness, people die.

Even worse, you lose the trust of the public. Nobody has answered the basic question of why homelessness has gone up with record increases in social spending and record business growth. Why is this going up? The people managing homelessness at all levels aren’t managing this correctly.

MP: Tell us something interesting about yourself that is not commonly known.

MM: Some people may not know that I actually spend somewhere in the neighborhood of 200 hours auditing people and assessing their quality systems pro bono. So, I’ve looked at the performance systems of hospitals, colleges, nonprofits, and for profit businesses in pro bono work. There is a whole group of people across this nation who are excited about making organizations more effective, efficient, and ethical, and do it for free. I enjoy my work and dedicate my free time doing this every year.

MP: What are some of your priorities for the year ahead, particularly if you make it to the seat of State Auditor?

MM: My goal is to make sure Washington state government and local government a considered world class in performance and the best run in the nation. That has always been my goal and I continue to try and work and be a spokesman on these issues. I’ve audited Boeing and feel that state governments properly run and managed can be run as well, and efficient as the best in the private sector.