Efficiency vs. Quality: Never the Twain Shall Meet?

One of the unintended consequences of health care reform has been nervous anticipation about the financial consequences of revised reimbursement policies. As federal programs adjust their reimbursement standards from procedure-based to outcome-based (and private insurance companies eventually follow their lead), a lot of hospital and hospital systems that were making a HUGE profit from procedures will be taking a hit. Mine included. They are expecting this hit to occur as Obamacare takes effect in 2014, the middle of the upcoming fiscal year, and they are adjusting projected budgets accordingly.

Unlike some of my co-workers, I am a supporter of the Affordable Care Act and I do believe that it will result in important and beneficial changes within our health care system. In the long run. But that doesn’t mean there won’t be growing pains. As we move through this transition process, an unfortunate side effect may will require budgets to be cut. This reality has caused quite a stir at my workplace and among nurses I know, as people worry about jobs. Luckily for us, it doesn’t appear that any clinical jobs will be eliminated. But on the other hand, they probably won’t be chomping at the bit to hire new folks, nor will they want to staff us very generously.

We are already feeling the pinch. Our “typical” nurse to patient ratio has been 1 nurse to 4-5 patients (usually 5 on nights). 6 patients is our max. But we are being told to expect that 6 patients will probably become our new normal on nights. And lately even day shift has been saddled with the same ratios. The last month has been completely exhausting for everyone, and we can tell people are starting to burn out already.

At the same time, however, there is a huge push to increase patient satisfaction scores. We want our patients and their families to have good outcomes and positive experiences. Especially knowing that reimbursement will be tied to clinical outcomes. And better outcomes go hand-in-hand with better care.

Which brings me to my question… Can more “efficient” staffing ratios ever be compatible with better care? Are we shooting ourselves in the proverbial foot to expect our clinical providers to do more with less, and expect the same outcomes? And if/when we fail to produce the same outcomes and we therefore lose money, and are therefore forced to do even more with even less, will evermore impossible standards hurt our patients?

I have high hopes for Obamacare. I firmly believe that the status quo was running our economy into the ground. I just worry about the short-term consequences of a long-term vision. What tools will be in place to make sure that we don’t find ourselves in a vicious cycle of efficiency battling quality care? How can the two goals go hand-in-hand, rather than face a neverending standoff?

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