DaVita

The following is an article on all DaVita does to micro manage itself. Yet, with all of this, the DaVita units I was in were dirty, violated infection control and had many other violations. What does this say?

In the Lead: Execs who build truth-telling cultures learn fast
Tuesday, June 13, 2006

By Carol Hymowitz, The Wall Street Journal

The higher executives climb, the easier it is for them to distance themselves from problems. Top company officials are often surrounded by yes people who filter out bad news. They then convince themselves their strategies are working, even when they aren’t.

But Kent Thiry, chief executive of DaVita of El Segundo, Calif., the No. 2 dialysis-treatment operator, starts worrying he is out of touch when all he hears is good news. In April, thousands of employees at an annual staff gathering said yes when he asked if integrating recently acquired Gambro Healthcare was “a fun process.” His response? “Either you’re all on drugs or better than me because integrations are a god-awful nightmare.”

He also told employees how much he depended on their frank feedback to avoid “messing up” the Gambro integration. He said he was paying attention to complaints from former Gambro managers who were being asked to adjust to dozens of new systems and employee practices. Among the issues: an order to assign one employee at each center to greet patients or sit with them in the waiting room. “Gambro people told us to grow a brain” about greeters, he said, and that prompted him to rescind the directive.

Mr. Thiry’s effort to build a truth-telling culture offers lessons for executives who sense they don’t actually know what is and isn’t working at their companies. DaVita was a mess when Mr. Thiry took the helm nearly six years ago, in default on its bank loans and barely able to make payroll. Turnover was a steep 45 percent a year, and it included employees with the most knowledge about which problems were most acute and what needed to be fixed first.

Mr. Thiry’s encouragement of frank feedback has helped the company cut employee turnover by 50 percent and grow revenues to more than $5 billion and achieve the industry’s best clinical outcomes. At the outset, he sold off assets and overhauling payment systems. Rather than issuing orders, he made front-line employees an integral part of turnaround decision making, seeking their views on equipment maintenance, inventory management and cutting costs by reusing supplies.

In a program dubbed Reality 101, Mr. Thiry also had every manager spend a week working in a dialysis center, seeing firsthand, he says, “how relentless and hands on and challenging this work is.” Dialysis, which replicates the kidney’s function of removing toxic wastes from the body, takes about four hours, and many patients must do it three times a week. What is more, about one in five dialysis patients, many of whom have chronic illnesses, die each year.

Nonetheless, pay scales are low, with technicians earning about $14 an hour and nurses, who are in short supply, about $26. DaVita, which has 27,000 employees and operates about 1,200 dialysis centers, can’t raise wages much and still stay competitive, Mr. Thiry tells employees who ask why pay isn’t higher.

The company faces legal difficulties as well. Medicare and Medicaid pays for dialysis for more than 85 percent of its patients, and DaVita is the target of several government investigations, including two involving compensation for medical directors. (Other dialysis providers are also being investigated for allegedly fraudulent billing.) Mr. Thiry says DaVita has “systematically and conscientiously” tried to assure compliance with laws and regulations since he took charge.

How do top executives like Mr. Thiry know they are getting accurate feedback? Some comes from worker surveys, but most is culled at town hall meetings. Mr. Thiry holds about 20 a year and tells each of his vice presidents to convene one whenever they are with at least seven “teammates,” or employees. “You can ask for a show of hands and find out immediately if your new scheduling software is terrible,” says Mr. Thiry, who tells workers to think of DaVita as a “village where there’s shared responsibility and a shared vision of reality.”

Managers collect reams of data to further pinpoint problems. Every month, treatment center managers get reports on operations and quality of care, including treatments per day, labor hours per treatment, and the retention of employees and of higher-profit, private-pay patients.

Top executives routinely revise practices that employees say aren’t working. Recent “course corrections” have included simplifying the approval process for expensive pharmaceutical supplies and providing more training.

The 49-year-old Mr. Thiry believes that just having executives stay informed can reduce employee angst. “When our procurement process or scheduling software or other things were screwed up, employees knew we knew about that, which eliminated half their concerns,” he says.

Most important, says Mr. Thiry, is for executives who seek frank feedback to be candid about their own shortcomings. In the performance review he recently received from his 13 senior executives, he got a “bad grade for giving too much negative feedback,” he acknowledges. “They say I’m not harder on them than I am on myself, but my negativity isn’t constructive,” he says. It’s the third year in a row he has received the same poor grade, he adds, so he plans to start giving himself a “daily score about feedback, to remind myself – and change.”

Hi y’all,

Jane wrote:

The following is an article on all DaVita does to micro manage itself. Yet, with all of this, the DaVita units I was in were dirty, violated infection control and had many other violations. What does this say?

I’m sorry that you’ve had this experience with DaVita (or any other dialysis provider). In a perfect world, this would never happen. What I’ve heard is that large dialysis organizations have ways to rank each of their centers, based on various criteria, from 1 to 1,000 or however many centers they have. The top centers are rewarded in some way for their excellent quality, and lower-performing centers may have action taken to replace an ineffective administrator, build a team, etc. It’s not a perfect process, and it takes time to get the lower-performing centers on par with the better ones. You may have had the unfortunate experience of encountering multiple lower-performing centers. In general, the feedback I hear from DaVita patients is very positive. As a company, DaVita has a very pervasive, positive culture where teammates are highly valued, support each other, and support their patients.

Davita is a business, they are there to succeed and it seems they really mean it.

I did dialyze in a Davita clinic once and must say it was very different than the in-center clinic I was in…

The staff acted very different… their attitudes were different…they had warm blankets for patients!

The social worker made rounds on every shift and would pass snacks to patients…

hmmm “Mr. Thiry’s encouragement of frank feedback has helped the company … achieve the industry’s best clinical outcomes.”

And FMC with Ultra Care has above average clinical outcomes.

So the two companies that dialyze over 70% of the dialyzors in US are both above average. That is remarkable.

It’s great to be living in Lake Woebegon.

I have been in two units now, neither Davita run but both very good with pt. care. Note I didn’t say perfect, exellent ect… I guess there is always room for improvement; this being more true in some units than others. Both units I’ve been in have staff that turn up the pump speeds on lab days (just one example) to get better clearance rates, not because it’s better for the pts. to have better rates once a month, but because it looks good on paper for them; that’s really what it’s about, looking good on paper! It’s not about being better for the pts. unless it’s also better for the company. That is precisely why I want to do home hemo. I want to feel better and have more energy all the time, and not just on paper.

Jane, How many Davita units have you dialyzed in? Have you written a letter or sent any emails to Davita? I would if I were you! You don’t have to sign if you don’t want to but typing up a letter to the top execs. would perhaps bring a dose of reality to their dream world! When do you start home hemo? I’ll bet it can’t be soon enough.

Bill, Couldn’t have said it better! Just wanted to say also that I like the way you get things done. Lin.

So what are you trying to say? All they doing is pretending? Make belief or just positive attitudes in time of suffering?

Dori:

I’m sorry that you’ve had this experience with DaVita (or any other dialysis provider). In a perfect world, this would never happen. What I’ve heard is that large dialysis organizations have ways to rank each of their centers, based on various criteria, from 1 to 1,000 or however many centers they have. The top centers are rewarded in some way for their excellent quality, and lower-performing centers may have action taken to replace an ineffective administrator, build a team, etc. It’s not a perfect process, and it takes time to get the lower-performing centers on par with the better ones.

I think if the top management of the DaVita units I was in were really concerned with patient care, they could of easily found out what went on in their units and what the patients thought of their service simply by directly asking them. I saw DaVita uppercrust walk through my first unit inspecting things on a number of occassions. They did not even look in the direction of patients let alone introduce themselves. Makes patients feel like a piece of meat on an assembly line. So, the regional ppl certainly saw the conditions and knew how that unit looked.

Then in another DaVita unit I was in, regional ppl came in and did speak to patients. One of them spoke to me along the lines of isn’t our DaVita unit great, don’t you just love it? I replied with something like well it has it’s good and bad points, would you like to know what I think of it? The person got antsy and took off so fast it wasn’t funny! I’m very serious, it was like she didn’t want to know what a patient really thought and took off as fast as she could. Oh yeah, she said she would come back later but never did lol!

In another DaVita unit, a DaVita regional SW came to my chair and told me she was going to start an intensive patient education program and said she heard I was an educated patient so would I like to take part? I thought I must be dreaming. The lady was very nice and seemed so sincere. Sounded too good to be true and must of been as I never saw her again either.

Dori:

You may have had the unfortunate experience of encountering multiple lower-performing centers. In general, the feedback I hear from DaVita patients is very positive. As a company, DaVita has a very pervasive, positive culture where teammates are highly valued, support each other, and support their patients.

How many DaVita patients have you heard from? I’ve read articles about DaVita’s teammate culture and their national rallies, but my 2 DaVita units cut all the corners. Most of the patients I have met in dialysis are blindly trusting of medical ppl and do not know what good care is. They look depressed and sleep through txs. It could be that I just happened to be in two mediocre DaVita units, but I find it hard to believe that uppercrust doesn’t know what is going on.


Jane, Let them know, and then get on home hemo :lol: It doesn’t matter what company owns a unit or what their mission statement is. You know what I’ve been through so I won’t repeat it here. If it didn’t happen to me I might not have believed it myself. Yes Jane, You were dreaming; getting a little loopy eyyy? Lin. (at least at home if I get groped or worse it will be by my husband, not a dialysis tech. :evil: Lin.

Lin:

Both units I’ve been in have staff that turn up the pump speeds on lab days (just one example) to get better clearance rates, not because it’s better for the pts. to have better rates once a month, but because it looks good on paper for them; that’s really what it’s about, looking good on paper! It’s not about being better for the pts. unless it’s also better for the company. That is precisely why I want to do home hemo. I want to feel better and have more energy all the time, and not just on paper.

So true! It’s amazing how dialysis staff get caught up in company schemes and don’t really understand what good, professional patient care is. Some do, but others become company pawns or ladder climbers. There is no way to truly get good care in such an environment- home is the only alternative.

Lin.:

Jane, How many Davita units have you dialyzed in? Have you written a letter or sent any emails to Davita? I would if I were you! You don’t have to sign if you don’t want to but typing up a letter to the top execs. would perhaps bring a dose of reality to their dream world! When do you start home hemo? I’ll bet it can’t be soon enough.

I have been in 2 DaVita units. I have never written an anonymous letter or email to the DaVita uppercurst, because as I have said, I’ve seen them in the units and believe they know what goes on. I know an honest RN who went to the uppercrust regarding unit protocols that were not being followed and she was promptly fired. Also, I do not feel safe sending letters as I feel it puts me in the position to police them and I can’t take the chance by myself as I have to go to dialysis the next day in order to live. In a different unit, I did stand up to management as part of a group of patients. Even that was a risk and we were harassed for it. I will not do it again unless I find a better way that involves more of the community.

I will be starting home txs soon. Yes, it will be a taste of freedom!

I hope home hemo training will start soon and that when you’re finally at home you can type up a letter (no sig.) and send it off to Davita. They ask management if there are any problems and management tells them no, none at all so they don’t always know what is happening. Sometimes too it’s easier to beileve there are no problems; no problems no work to do. These things are the biggest reason why I initially decided to do home hemo, and the other stuff just added to the list. Unless you’re an educated pt. and have been on dialysis any amount of time you usually know what is going on. The other pts. all sleep through their txs. and lots of units don’t allow family members to sit with the pts., as is the case with the unit I’m at. If their families knew they’d be wanting home hemo too. Lin.

Lin:

I hope home hemo training will start soon and that when you’re finally at home you can type up a letter (no sig.) and send it off to Davita. They ask management if there are any problems and management tells them no, none at all so they don’t always know what is happening. Sometimes too it’s easier to beileve there are no problems; no problems no work to do.

If DaVita uppercrust trusted management to tell them what goes on they would have to be pretty stupid. I have no doubt they know exactly what goes on. I will not be writing them any letters anonymous, or not. As I said previously, I believe it takes a larger effort to put a halt to unit violations. And I am not singling out DaVita either- all the units I have been in of different companies, and in different parts of the country, have had the same violations. Dialysis floor staff would not cut corners for one second if they were trained properly and told they would be fired if they dared to cut corners. It is the uppercrust, nephs and administrators who sanction the dirty units and corner cutting. Unit efficiency/profit is more important to them then quality/safe patient care. I think the only way they will stop the violations is when they are forced to through a community level effort such as the petition and rally in Ohio.

I said what I was trying to say. That is remarkable.

The Lake Woebegon link spoke to the mathematical implications of a supermajority of any group all scoring above average.

Hi y’all,

Jane wrote:

How many DaVita patients have you heard from?

All told? Probably at least 100, plus probably 50 or 60 staff people. We’ve done focus groups around the country where a number of folks (patients in some groups, professionals in others) took part, and I could always pick out the DaVita folks by their positive attitudes and enthusiasm. A number of folks on the Dialysis_Support listserv have also made very positive comments about DaVita, and I’m including them in my total.

Given that there are 300,000 people on dialysis in the U.S., this isn’t really a very big number, but it’s not just one or two.

Gus:

I did dialyze in a Davita clinic once and must say it was very different than the in-center clinic I was in… The staff acted very different… their attitudes were different…they had warm blankets for patients! The social worker made rounds on every shift and would pass snacks to patients…

Appearances can be deceiving. In one of my DaVita units they gave out snacks and provided blankets. But what good is this if the unit is dirty and staff are passing along infections because they do not wash their hands? And anytime we had a visiting patient they were treated extra nice-not that they shouldn’t be nice to visitors, but in order to get repeat business. If the visitors were not educated patients, they did not know that staff did not wash their hands etc.

Jane wrote:
Quote:
How many DaVita patients have you heard from?

Dori:
All told? Probably at least 100, plus probably 50 or 60 staff people. We’ve done focus groups around the country where a number of folks (patients in some groups, professionals in others) took part, and I could always pick out the DaVita folks by their positive attitudes and enthusiasm. A number of folks on the Dialysis_Support listserv have also made very positive comments about DaVita, and I’m including them in my total.

Given that there are 300,000 people on dialysis in the U.S., this isn’t really a very big number, but it’s not just one or two

What were they enthusiastic about? Yes, some of the DaVita staff and management I met were enthusiastic, too, but not about keeping the unit clean, infection control and education. I have read the posts at dialysis_support for about 8 years and don’t recall that many ppl with positive comments about DaVita units.

One of the DaVita units I was in did have a positive approach as far as having some extra perks for the patients, and that may be why patients and staff might think DaVita is a better corp. Even at dialysis_support, until patients get educated, they do not know all the corners that are being cut. They think a unit is good because it offers, snacks, movies or bingo. They don’t realize that there is mold in the unit ice machine, machines are out of calibration. their dialyzer may be reused 50 times or staff may be infecting them as they do not wash their hands!

Jane, I know what your saying but what good does it make beeing a patient pointing fingers all the time? It just makes things worse… :roll:

Probably the most educated patients would be good candidates for home dialysis no?

On the other hand take a look at this…
http://dialysispatients.org/

Gus, It’s better than being in a unit and pretending you’re blind, or worse yet having to “dumb down” or fall asleep just to keep fron seeing things! Lin.

Gus:

Jane, I know what your saying but what good does it make beeing a patient pointing fingers all the time? It just makes things worse…
Probably the most educated patients would be good candidates for home dialysis no? On the other hand take a look at this…
http://dialysispatients.org


Gus,
I am not going to go away on this topic of units that are harming patients/ cutting patients lives short through purposeful, illegal unit violations. I can only hope that more patients/staff will find the courage to join with me to continue to expose what goes on and to find a way to force such companies to become accountable, since they refuse to become accountable willingly.

I, personally, attended several of the meetings of the new group billed as a patient advocacy group, DaVita Patient Citizens, to see what they were about. Several of the ppl who head the group are patients. I was appalled when patients from around the country stood up to the mike to express the true problems they had encountered in their units and the group leader promptly pulled out the proverbial hook and cut them right off! You see, I could never recommend this group as they are about getting higher reimbursements without first being accountable for the violations (very serious violations) in their units!!

It’s the same ole thing- $$$ $$$ $$$ (read the section on dialysis issues and see if there is any mention of the most essential issues of care). As has been said many times and by many ppl- may DaVita and all the other dialysis companies make all the $$$ they want, but first comes the “A” word–ACCOUNTABILITY-- to the patients they serve not to violate regulations of patient care.

Are DaVita and the other dialysis companies unaware of the dirty conditions and numerous other violations in many of their units? Unless they are deaf, dumb and blind…I think they know…

Gus do you consider yourself on the payroll of Davita Patinet Citizens? What does is take to be a partner of dailyhemo?

:roll: