Health

Our healthcare workforce crisis is also a patient safety crisis

As the COVID-19 delta variant spans the entire country and labor shortages affect every industry, the implications for health care providers and the implications for the quality of care are urgent.

Public discourse on this issue is mainly focused on increasing the costs of health care facilities, as the retirement affects health care. Indeed, hospital costs per discharged patient have increased by more than 15% YTD compared to 2019, and much of this increase is directly attributable to contract temporary work, the cost of which has skyrocketed by more than 100% for both full and for part-time staff.

But the ensuing consequences of a health workforce shortage create more direct problems for patients and their families. The University Hospital predicts an overall staff turnover rate of 17.5% this year, a record high, mainly due to the retirement of nurses and technical staff or the use of lucrative agency opportunities. Meanwhile, our agencies tell us that even updating our payment schedules to “crisis” levels may still prevent them from fulfilling more of our requests.

As a result, we have made every effort to fully staff the clinician and support staff in the critical areas of our hospital. Our ideal emergency room nursing staff was elusive. While we maintain safe staffing standards in our ICUs, we often have to exhaust all temporary or regular staffing capacity to do so, and we are very concerned about staffing as the number of censuses is expected to increase during the winter months. Unfortunately, our experience is not unique – it is on the agenda of local and national hospital associations across the country as it poses the greatest systemic risk to hospital operations this year.

National human resources trends could pose a safety risk to people seeking care at any hospital in 2021. A shortage of nurses in key areas of the hospital can increase the risk of death, cardiac arrest, failure to rescue, and hospital-acquired infections, especially in intensive care units. … Moreover, as highly reliable structures begin to dominate our collective thinking about how best to achieve zero harm in the healthcare environment, experts agree that team learning and dynamics are critical. I know firsthand that the core elements of high-functioning teams – trust, psychological safety in identifying problems, and a common understanding of policies and procedures – are extremely difficult to achieve in a high turnover environment.

While I share the hope that decreasing the number of cases after the delta phase can help solve problems with hospital staff, there is reason for skepticism. A study by the Centers for Disease Control and Prevention, published in September, found a significant increase in hospital-acquired infections throughout the pandemic, and suggested that staff problems due to the increase in the number of patients were the main cause. While COVID-19 is abating, hospitals are still extremely overwhelmed with patients with other illnesses due to delayed or delayed care, with some indications that emergency departments are now more full than before the pandemic.

From a political point of view, we can do a lot to address these problems. First, the federal government must expand the recruitment and deployment of the US Public Health Commissioner, a program led by the Surgeon General, which consists of health professionals who are uniformed officers and can be deployed in the same way as the National Guard or military reservists. These professionals have already done a lot to support health systems and communities during the surge in disease during a pandemic, and their funding needs to be even greater.

Second, governments at all levels must increase their investment in the health workforce to encourage people from vulnerable communities to move to education and training courses that fill critical vacancies.

Third, the DOJ and the FTC should consider investigating the behavior of contract recruiting firms to ensure that most of their higher prices go to the employees themselves and not to the agency’s profits. The implications for patient safety and quality of care require such careful study.

Finally, healthcare leaders must focus on burnout and support doctors who have gone through an unprecedented period in the past 20 months. We offer peer support, chaplaincy services, and direct mental health care to the staff who need it most. This is the right thing to do, but it can also dramatically improve retention.

As health leaders, it is better for us to focus the discussion of health workforce shortages around the consequences for patients and their families. It is a strategy that is more likely to lead to solutions that both our communities and our employees deserve.


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