The point I’m raising and highlighting here is not meant to be political or partisan, but really one about nursing workloads, management decisions, and what’s right for patients.
We’ve seen recently that American healthcare spending is UP about 10%(the biggest increase in spending since 1980) – mainly due to newly insured patients getting care. The point is to get people care and treatment, but maybe the law should have been called the “More People Getting Healthcare Act?” That’s a noble goal.
From the TIME article, an opinion piece written by a nurse from California:
“… I worry that the switch may compromise the quality of the care our patients receive.”
The nurse talks about patients who are sicker due to not getting good healthcare previously. These patients require more attention and more nursing time.
In any workplace, the staffing levels should be set based on the total workload. Using “number of patients” is not a good basis, since the acuity of patients (and the resulting workloads) aren’t equal. Not every patient is the same.
Hospitals, due to other industries, do a really poor job of “industrial engineering” work that would establish the right staffing levels based on workloads.
Staffing levels are often set based on:
- Budgets (how much money is available, instead of what the workload demands)
- Benchmarks (if every hospital is similarly understaffed, we have a race to the bottom)
- BS (who knows — wild guesses or staffing based on what we had before)
I fully realize that hospitals are more complex work environments than a car factory. It’s relatively easy to determine the staffing levels for a car factory because the work is very repetitive and pretty predictable.
But, if a hospital sees that nurses are having trouble getting their work done… if patient safety and quality really came first, they would react by ADDING staff, at least in the short term.
Sometimes, saving money by keeping staffing levels low might cost us some larger amount down the road. But, the short term costs of increasing today’s labor costs are very known. The potential savings is a prediction and is not guaranteed. It’s a hypothesis and a bet many leaders are not willing to make.
So the nurse complains:
“During that shift, one of my other patients said, “You must be busy. I haven’t seen you all night.” My heart sank. He was fine physically, but I could tell he needed someone to talk to for a few minutes. Unfortunately, I had to get back to my diabetic patient. Preventing her blood sugar from dropping took priority over spending time with my lonely patient. Unfortunately, there were no extra nurses to care for my other patients.
In fact, executives at my hospital recently proposed reducing our inpatient nursing staff. They note that the number of patients admitted for overnight stays has decreased in the last few years.
This new burden is falling heavy on the hospitals and staff. Nurses are working harder than ever with fewer resources.”
The full name of the law was the Patient Protection and Affordable Care Act. I’m pretty sure that overburdened nurses is NOT the way to safer patient care and better outcomes.
We need to, in many cases, add people to a process to make sure it can be done properly. If that’s not possible, we HAVE to reduce waste by improving processes and improving systems. If patients are to be protected and costs are to be reduced, we HAVE to free up time… that can have the same effect (more nursing time) as adding more nurses would have… but that’s the only affordable and sustainable way to get there… through Lean, waste reduction, and process improvement.
Our patients and nurses deserve it.
Mark Graban (@MarkGraban) is a consultant, author, and speaker in the “lean healthcare” methodology. Hes is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Innovation and Improvement Services for KaiNexus. Graban blogs regularly at Lean Blog, where this post originally appeared.