By Dante Petri

In just over a year Central Peninsula Hospital has been the focus of incredible challenges, any one of which alone would test the mettle of any administrator and staff - a prolonged and contentious union-organizing effort, a fatal shooting and a recent call by the hospital's advisory board for an in-depth operational audit by the Kenai Peninsula Borough Assembly.

There has been no shortage of dialogue, often emotional, on the hospital's administration during public meetings, in letters to the editor and other media outlets.

Hospital chief Ryan Smith, however, suggests that the same challenges that have shaken the CPH community have also strengthened it.

In an exclusive interview with the Peninsula Clarion, Smith talked about the past year, the difficulties in meeting those challenges and the lessons learned.

Q: There's been a notable amount of concern raised about tensions within the hospital during the past year. As a CEO and a community member, what have you been hearing?

A: The way I have referenced this at assembly meetings and other public forums is a lot of those tensions arose in conjunction with labor organizing efforts that started a little bit over a year ago with the Laborers Local 341 working to organize the non-professional employees as defined by the NLRB. That started kind of a yearlong progression of union organizers and some disgruntled employees testifying at service area board meetings, and that kind of started a lot of that consternation. I've been here for four years and you know the first three years were pretty quiet I would say, especially at those (service board) meetings. However, when the organizing activity started, then a lot of that stuff happened at about the same time.

I hear a lot of positive things about the hospital in the community. We do, I think, a good job of attending chamber meetings, rotaries and auctions and these things in the community, so we do hear a lot from the community. I think what I hear more mirrors what we've accomplished as an organization for the last four years, which is "I've received great care"; "A family member has received great care." So I hear a ton of positive comments that reflect all of the good things that we accomplish.

I also hear a lot of the negative stuff that's come up and the tensions that have come up as a result of these organizing efforts. So that brought some of these other things to light and so I hear about those in those forms also.

Q: As an administrator, how would you characterize these tensions?

A: I think within the hospital one of the things we've really tried to do as an organization, and I think the majority of our employees have done a very good job of this, too, is keep any the tensions that we have in the hospital. So first of all I'd like to say that I'm very proud of our leadership team and our employees and our board for not engaging in a lot of these public displays that have been taking place. Within our hospital we have mechanisms to deal with the tensions as they come up within the hospital and I think we've done a very good job of that.

I think the vote (against unionization) reflected that and the employee surveys that we do have reflected that. We've taken the overall level of satisfaction from the 35th percentile when I first started to the 70th percentile, and a lot of the great things that we do and the tensions that we try to resolve are born out in those surveys.

Q: How would you categorize the level of tension at the hospital on a scale of one through 10, with one being low and 10 being high?

A: It's very easy for me to categorize it as a one for the first three years that I was here and about a five in this last year. And I think that's directly attributed to -- obviously we've had a tragedy in the hospital, we've had organizing efforts. And so for us to ignore that those tensions exist would be false.

But they've also existed, I feel, in a very civil and professional manner with majority of our 660 employees. We've had a few individuals that have acted uncivilly and unprofessionally, but others haven't bought into that. We haven't sunk to that level.

So I don't think it's a 10, I think its more like a five, middle of the road, and I think since Oct. 15 (the unionization vote) it's back down at a one or a two. It immediately dissipated once the union organization was over.

Q: Shortly after the shooting last year there were comments to our stories -- including one person saying the shooting was "merely the tip of the iceberg" of issues at the hospital. What do you make of the dialogue that's come out in the media, through blogs, comments, advertisements and letters to the editor on some of the issues the hospital has faced?

A: I think I've been pretty vocal when I have spoken that we have a few individuals who have pretty strong feelings. Those feelings, when they're portrayed in those fashions, do a lot of damage in a hurry. However, I don't view it as a tip-of-the-iceberg issue. I think that we're a very open and transparent organization because we are a community owned organization. There is no corporation in an Outside state dictating what we do and how we do it. So I have a lot of flexibility as an administrator to be extremely open. I think that's what we do. If there is anything under the tip of the iceberg, I think it would be very easy to find it here.

Q: On Oct. 12 the Central Kenai Peninsula Hospital Service Area Board voted unanimously to advise the borough to conduct an operational audit. Where do you stand on this recommendation?

A: Last night (Oct. 27) at the assembly meeting I spoke about the recommendation that the service area board has made to the mayor and assembly, and what I've told them was a couple of things.

My point was, that the service area board recommendation really didn't even get at the point of what they really wanted to know which was, are there bullying activities or, what is the management style of the leadership of the hospital that might be impacting these few individuals. So, I proposed a couple things.

One, most of the testimony that was provided was provided by two distinct groups. One was eight current and former disgruntled, I'll call them, employees, and then eight union organizers and or supporters with the orange shirts on.

So I'm willing to talk about the concerns of these eight individuals -- current and former employees -- but I can't talk about it in that forum because of the confidentiality of those issues. So I've offered to the assembly, with employee consent, to talk about any of those issues with them in executive session so they can make a determination whether there's probable cause to continue.

The second thing I've done is we do have a single employee who's constantly linked my management style to workplace bullying and has encouraged people to go to this workplace bullying institute Web page.

So I did (go to the Web site), and I've talked to the owner, and he's going to come and spend time here on the week of Dec. 7 and he's going to be here for five days and he's going to help our organization do a couple of very important things. One is create policy about workplace bullying, create some peer groups within our hospital that anyone who feels like they would be bullied would be able to go to at a peer level. Then, really work to educate, not only our employees but our community, on this issue of workplace bullying.

I offered those two things as a compromise, my own compromise to the recommendation from the service area board.

I think (the audit) should be focused on what the service area board really wants. What they really want to know is they want to have some assessment of this management style and I think this is a better way to get at that than what they've asked for.

Q: Some who spoke at the Oct. 12 meeting suggested that the audit be conducted for the sake of clearing the air of some of the accusations that have been directed toward your administration. Do you believe it will have this effect?

A: I think that really we have nothing to hide. We're not afraid of any external audit. I would want, though, an operational audit to be done that really focused on what I think (the board) wants to have done.

I'm not going to stand in the way of any audit, I'll continue to work with the assembly, I just want to make sure that they're getting at what they want to have audited.

Q: The recommendation also calls for an investigation into the Nov. 26 shooting. Do you believe an audit of this nature will differ from the internal investigation the hospital launched following the tragedy? If so how?

A: There were three groups that came (in to investigate). Some helped us and they all issued a report, relative to the shooting incident. Two of them the hospital paid for (Craciun Research Group, K&L Gates). They came and interviewed employees, individuals, and they issued a report to the board of directors. The third one was an external investigation with the Alaska State Troopers. They interviewed senior leaders and employees and those in the organization and they also have a report on that incident.

So do I think that an external audit would find anything different? I don't. But again, I wouldn't be willing to stand in the way of having that happen if that's what the assembly wanted to have happen.

My recommendation would be that we not do that in the interest of our employees, our physicians, our volunteers, our community. I think since we're so close to the one-year anniversary, we've worked so hard as an organization to heal from that tragedy that bringing somebody else in to investigate that, and putting our employees through that would not be fair to them. I think the super majority of people who work here would agree.

Q: Given that hindsight sometimes offers clarity, is there anything the hospital might have tried to do differently in the days and weeks leading up to last year's shooting that might have prevented it?

A: I've probably had that question asked of me two dozen times in the year since it's happened. Back to the old hindsight is 20-20, I do think there are still some things as an organization that we can do, no matter what expert comes here and tells us there's only a one in a million chance of that ever happening again. There are still some things that we can do to eliminate the one in a million.

Q: From a safety perspective, what measurable steps have been taken to prevent a future tragedy of this nature?

A: We definitely learned some things about our organization from the incident. We certainly stepped up some security measures at the hospital. We used to have a 24/7 security guard at the hospital; now we have two security officers at the hospital. We have one that monitors a control room, we've improved the number of cameras was have in the hospital, we've improved our ability to be able to page to all areas of the hospital from the control room that always has somebody in it while there's still somebody else who's on a patrolling basis. We learned some things about our code red alarm and paging system that we've rectified since the shooting. We've had a security consultant who has come to our hospital and is giving us a formal recommendation of security measures that we could take organizationally.

We had a proposal that went forward to the assembly to improve the badge access in the hospital with about a $450,000 capitol expenditure. We were about 50 percent badge and 50 percent keyed access to the hospital and we wanted to get closer to 100 percent badge access, so we're spending about a half million dollars to improve the badge access.

We're still working on the people issues. We think we do a good job of that, we're surveying our staff all the time, we did a culture of safety survey with our nurses that's actually a Joint Commission requirement to get feedback from our nurses on things we can do to improve safety.

Q: Getting back to some of the tensions at the hospital, some concerns have been raised about the administration's management style. Can you point to any key policy decisions or turning points that have raised the level of tension at the hospital?

A: Certainly I would say one of the policies that's recently been put into place was an attendance policy that was put into place at the hospital. That's created a lot of thoughts from a lot of people about having an attendance policy and one that we hold employees accountable to. It was a policy that I will say that we came up with that we negotiated with our employees over a long period of time.

Anytime you do major policy revisions in hospitals, especially a community hospital like this, you're going to have eight out of ten that might like it and two out of ten that aren't going to like it. We're trying to do the most good for the most amount of people with these policies. Inevitably that's going to create some tensions.

Q: What do you do as the leader of the hospital do to address these tensions?

A: My personal philosophy has been what we have always done here is that we have held employee forums. I do them quarterly, however, depending on the last year I've been doing them monthly, sometimes twice monthly as tensions do arise.

Our employees aren't shy about providing us feedback on policies. I view that as a negotiating session between us and the employees on what these policies are going to be like.

The union vote was a huge vote of confidence from our perspective, that that process works in our organization -- that they would rather negotiate things and policies directly with the leadership than they would through a third party.

Q: Workplace bullying tactics have been brought up repeatedly in recent weeks, but at the Borough Assembly meeting on Oct. 13, you said that complaints about workplace bullying didn't come up until union representatives arrived at the hospital. Why do you believe their arrival served as the catalyst?

A: I wish I could answer that question. First of all, there are tactics that those union organizers have used and that management uses. We both have our set of tactics at our disposal to accomplish what our objectives are in that realm and I think that some of these things that took place relative to claims of workplace bullying were really again, I want to stress, a limited number of individuals who are trying to advance a cause.

Q: How would you respond to those who might argue that those complaints were couched for job security fears?

A: I think a couple things, one is that I'm willing to and have been willing to sit down with those individuals and talk about any kind of process that we can put in place in this organization that people would feel comfortable bringing those concerns forward. Maybe those haven't always been 100 percent successful and maybe some of the things we're going to do in the future will help address that.

We have lots of mechanisms, I think, already that exist in formal policy formats where there are no retribution or retaliation provisions within these policies for employees.

Q: As the hospital's leader, how do you lead your institution onward after a year that entailed so much turmoil?

A: Obviously, the biggest concern when you go through an organizing effort is that there were individuals who did vote yes and didn't get what they wanted, but we don't want to alienate those individuals. We want to invite those individuals to help us make this the best place to work. We have a culture and communications team that's working on a value statements for our hospital. We've had value statements in the past but they've really been more of a regulatory requirement, they haven't really defined how we're going to operate culturally as an organization, and we want our employees to help us define what that's going to be so we can hold each other accountable to operating this hospital within that culture of those values. So that's one initiative we've been in that process for three or four months and we want to continue that process until the end.

Q: Are there any lessons learned or insights you've gained from some of the events of the past year?

A: I think the things that we've been through in a year are unprecedented for a hospital CEO.

The lessons for me, personally, and for our organization, have been incredible, and I keep telling people that through the height of the most tense times of the organizing and after the shooting incident at our hospital, we've had the highest patient satisfaction scores that we've ever had in our organization. What a credit to this organization and our employees to have not allowed those things to interrupt the care that they're delivering to patients in their community hospital. They have not let those things interfere with what they're doing.

But the lessons abound. We realize that we're not perfect and there are a lot of things we can do better. And we're trying to do them better, because the last thing that we ever want to have happen is some of the things that have happened in the last year.