"We turned over a lot of positions in the psychiatric and emergency departments where this all started a year and a half ago that had to do with consistency of performance and had to do with management and oversight and so forth," he said.
Royer said the moves have been made as the safety-net system works toward compliance for an estimated $417 million in annual Medicare and Medicaid contracts. CMS ordered a review in July 2011 of the entire hospital facility after identifying dozens of deficiencies deemed so serious as to create an immediate and serious threat to patient health and safety.
In September, Parkland and the Dallas office of the Centers for Medicare & Medicaid Services signed a systems improvement agreement, which requires Parkland to be compliant with all CMS rules and regulations by April 2013.
The hospital system hired Alvarez & Marsal Healthcare Industry Group to guide it through the SIA process. A 300-page gap analysis report prepared by A&M detailed ongoing deficiencies, including systemic issues in the role and organization structure of nursing and nursing practices. Royer has said that about 75% of Parkland's problems involve inconsistent nursing practices across the system.