On December 14th, 2021, hospital CEOs met under the guise of The Transformative CEO Healthcare Summit to brainstorm novel ideas in health care and to create “a new world ecosystem.” Themes included how to utilize medical data, how technology can transform health care and expanding at-home delivery systems of care.
Leaders in health care met just weeks before hospital admissions skyrocketed to an all-time high of coronavirus cases with unprecedented levels of staffing shortages due to the Omicron variant, which virologists and epidemiologists had been predicting around the time of meeting.
Frontline health care workers know all too well the reality of the crumbling American health care system, which has been ravaged by the coronavirus. While access to health care has always been an issue that falls along socioeconomic and racial lines, the coronavirus pandemic highlighted the realities of racism and economic privilege in medicine — Black and Latino Americans have consistently disproportionately higher rates of coronavirus infection and higher COVID-19-related mortality. The etiologies of disparity are multifactorial including decreased health care access, increased exposure risk, and increased risk of misinformation.
To this point, Dr. Tom Mihaljevic, CEO at the Cleveland Clinic stated, “A century from now will bring us to an even better place depending on how successfully we address the following four fundamental questions: 1. Can we reach more patients? 2. Can we improve access for more patients? 3. Can we treat all patients equally regardless of their background? 4. Can we leverage technology for the greater good?”
While equity in patient safety was discussed at The Summit, there seems to have been a lack of discussion on staff or patient safety. Since the start of the pandemic, 1 in 5 health care workers have left medicine due to workplace difficulties.
Multiple studies have shown a high degree of insomnia, depression, anxiety, and post-traumatic stress symptoms in health care workers during the time of coronavirus. Lack of administrative support, lack of proper personal protective equipment (PPE), and overworking are cited as highly associated risk factors for developing mental illness in frontline health care workers. Patient safety is directly related to hospital staffing, with risk of patient death increasing by nearly 7 percent for every additional patient a nurse must care for over the average ratio of 1:6.
In addition to mental health, the prevalence of violence against health care workers is increasing. In response, Robert C. Garrett, CEO of New Jersey hospital chain Hackensack Meridian Health, has announced a no-tolerance campaign to decrease verbal and physical misconduct by patients within hospital settings. Additionally, Warner Thomas, CEO of New Orleans-based Ochsner Health, has called on lawmakers to escalate violence against health care workers a felony.
While workplace violence is starting to be addressed on an administrative level, why are hospital administrators not advocating for safe staffing? Most health care workers believe the answer is simple: greed.
Hospitals financially profit from understaffing. Currently, only California has a robust legislature regulating minimum nurse-to-patient ratios, passed in 2016. A similar bill was set forth in Massachusetts in 2018. The Massachusetts bill was supported by nearly 90 percent of registered nurses in Massachusetts and the Massachusetts Nurses Association. However, with nearly $27 million raised largely by the Massachusetts Health & Hospital Association to campaign against the proposition, it was not passed.
Currently, a national standard for the minimal nurse-t0-patient ratio is set before Congress, S.1567, the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2021, proposed in May 2021. Impact In Healthcare, a multidisciplinary nonprofit aiming to transform the health care system, is asking for sweeping changes to hospital policy, including minimum staffing ratios, and has put pressure on the Joint Commission to do so.
Two of the largest problems facing the American health care system remain equity in access to health care and staffing safety. During a time when the United States ranks amongst the highest coronavirus death rate of all developed nations, it’s time to go back to the basics. Hospital CEOs must tend to the very building blocks of their institutions when thinking ambitiously about the future –and it is vital to listen to the voices at the frontline when doing so.
Ammura Hernandez is an internal medicine resident and author of An Eschatological Isolation.
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