10.29.2018

Former Hospital CEO Explains Care Team Dynamics

In “Here’s why more nurses don’t mean better care,” also in CommonWealth, former Beth Israel Deaconess Medical Center CEO Paul Levy describes the often overlooked issue of how entire teams actually deliver care in a hospital unit.

“Beyond the attending physician and bedside nurse, there are other people in patients’ rooms: consulting doctors from other specialties, residents, patient care technicians, respiratory therapists, radiology technicians, physical therapists, occupational therapists, pharmacists, phlebotomists, and even transporters, housekeepers, and food service personnel,” Levy writes. “And beyond the bedside nurses, there are the nurse managers, resource nurses, and other specially trained nurses on call for special situations. It is the allocation of all these expert professions on each floor and specialized unit that creates the clinical team that assures the care you expect and deserve.  Yet, Question 1 takes just one of these categories and sets in stone the ‘proper’ number of nurses in each type of unit.”

Levy adds that if a facility is forced to hire just more nurses, “the hospital’s only course of action would be to allocate fewer of these other categories to patient care over time, or—if the law is read to preclude that–to cut back on other essential operating and maintenance expenses in the hospital. Which hospitals face financial limits? Well, virtually all of them do, but especially community hospitals and safety-net hospitals (i.e., those serving lower income families).”

He continues: “Beyond the question of whether the bill’s numbers are correct, in a general sense, we have to wonder how they can be correct in the specific time and place that corresponds to your personal stay in the hospital. There is a constant need in hospitals to modify personnel assignments depending on the number and acuity of patients in any given part of the hospital. And yet, under the proposed law, if a hospital moved, say, two nurses from a unit experiencing very low acuity patients to one with a temporary need for help in caring for higher acuity patients, that hospital would be subject to a fine of $25,000 per day. The bill says that the state cannot permit any waiver—temporary or permanent—in the nurse staffing requirements.”

Read Levy’s thought-provoking article here.