George D. Powell

I found the recent article, “Providers: CMS should first fortify skilled nursing workforce before imposing minimum staffing measures” very interesting.

As you follow this issue, please understand and recognize the unintended consequences of minimum staffing requirements.

I was an industrial engineer for a large municipal hospital system in Colorado from 2006 to 2009, and I spoke for my organization at Colorado legislative hearings on the topic.

I told the legislators that my observations are that these minimum staffing requirements often result in increased nurse staffing costs that are balanced by budget cuts in other hospital departments.

For example, when Pharmacy was required to take a budget cut, they reduced one pharmacy tech position. Without the pharmacy tech, they were no longer capable of compounding various medications in pharmacy and began sending the components to the nursing units for the nurses to complete the compounding. This added workload on the nursing staff and negated, in part, the intention of the minimum staffing requirement.

It’s the old “squeeze the balloon” problem. Unless you actually reduce work or increase resources, you won’t improve patient care. There are plenty of opportunities to reduce “non-value added work” in healthcare. Incentivize waste reduction, let care organizations experiment with staffing models, and hold them to metrics that reflect patient outcomes, not intermediate deliverables.

We all want to improve patient outcomes. The obstacles are many and seemly intractable.  Healthcare is notorious for applying Band-Aids to stop the bleeding rather than identifying and solving root causes. Legislators, under pressure from constituents, public and institutional, attempt to use what levers they have, such as minimum staffing requirements.

My experience tells me that frontline staff know best how to reduce waste, and focus resources on what matters in the moment. Administrators need to empower frontline staff and ensure that staff have the flexibility to solve problems within guardrails.

Leaders need to resource caregiving adequately or reduce capacity (care for fewer patients). Legislators need to face the truth that caregiving in many segments, at the standards that the public expects, may not be profitable without subsidy.

George D. Powell, MBA, PE, is an industrial engineer, with 40-plus years of experience in healthcare, manufacturing and professional services.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.