...are the ones that make the biggest difference



These articles are a few days old, but they caught my eye and, in large part, are confirming what I'm currently experiencing at work. The first article reports on a study that finds non-profit healthcare providers consistently outpeform their for-profit counterparts.

Authors writing in the journal Health Affairs found that a systematic analysis of 162 studies of nonprofit versus for-profit health care providers supports the concept that a facility's ownership status makes a difference in outcomes and in the cost of health care....the analysis found a pattern of differences between nonprofits and for-profits in cost, quality and accessibility...In what they called the biggest review of the literature to date, authors reported that eight studies found nonprofit hospitals have lower mortality rates, versus one study finding for-profits have lower rates of death.

There are many factors that enter into the relative quality or "success" (a difficult to define term in medicine) of healthcare, but a huge factor is the morale of the direct care providers and their ability to effectively do their jobs. Which is why the second article, which discusses a lawsuit filed by the countries largest nurses union against some of the bigger hospital chains for intentionally colluding to depress wages, is so troubling. Even though the nursing shortage has increased over the last decade "....[w]age increases for nurses have been insignificant during the decade-long shortage, experts said. Wages stagnated in 2003 and then fell 6.4 percent in 2004, leading to a decline in nurses working at hospitals..." Which is unfortunate, because that is precisely where the patients who need the hightest quality of care actually are.

Which brings me to my current employment situation. Our clinical director (basically the head nurse) and corporate director both recently quit at the same time. We currently have 2 interim people from other hospitals filling those roles who are, to say the least, corporate lap-dogs. They have instituted a variety of changes, including pressuring our clinical educator to leave by cutting back on his hours, cutting back on staffing (the cause of my being downstaffed each of the last 3 Fridays) and trying to push down costs on needed patient-care equipment. As an example of the last, we have a patient that needs a specialty bed & mattress due to some very aggravated wounds on his hips, lower back and butt, but since this rental is very expensive they wanted to discontinue the bed even though lower cost beds were not helping him. The staffing cuts, however, have been worse. Most of our patients are coming directly out of the ICU and have a high acuity level, which basically means they are in pretty bad shape - lots of meds, lots of labs to be drawn, IV's, vents, you name it. Our nurses normally handle 3-4 patients, 5 in those instances where the patients are in good shape (ICU nurses generally only handle 2). Now, regardless of their acuity level, corporate has mandated each nurse will carry 5 patients. This makes the nursing staff much, much busier, means there are fewer nurses on the floor to help each other with difficult procedures or to watch patients during a break, and greatly increases the stress level of everyone on the floor. Morale is down, people calling-in for work is up, and for me personally, I'm being run ragged most days of the week - and what I do doesn't have the potential to kill anyone.

So connecting the dots between the quality level provided by for-profits versus non-profits isn't hard to do. Where cost is the prime concern, neither patients nor the staff can be. The staff is too busy to provide high quality care though they'd like to and are more likely to make mistakes or miss something important in a patient's status. A humanitarian endeavor like medicine can be very poorly served by becoming a business.


The Scrivener said...

Alive and well, Nathan? Just checking in.

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