Many healthcare facilities do not focus on achieving the objective of providing high quality healthcare to patients. Some of these facilities are primarily focused on profit making. Many of these companies employ business savvy individuals to run their operational departments/business departments. Consequently, the operational managers at some hospitals, nursing homes or home care agencies may not have clinical backgrounds.
The decision to hire business savvy operational managers who have no clinical background may have an adverse impact upon the quality of healthcare in many settings. These individuals usually do not prioritize patient safety or optimal patient outcomes. Some operational managers may strategize and assign some of the functions of an operational manager to nurse managers while dictating all actions that must be taken by the nurse manager. A nurse manager who is deputized to this role may be constantly pressured by his or her non clinician superior to ensure that the facility shows a profit, or else.
High quality healthcare and profit making can co-exist. However, this seldom occurs in many places. An appropriate business model must be implemented in order for high quality healthcare and profit making to co-exist. High quality healthcare means providing care that is tailored to meet the needs of patients. Well structured health care environments have successful business models in place whereby appropriate and highly trained individuals are placed in key positions.
Individuals in key positions are those individuals charged with making important decisions within the company. Failure of healthcare businesses to utilize appropriately trained individuals within their business models may lead to dissatisfied patients, debilitation or death.
Patient Safety May Be Compromised in order to make the Numbers
The clinical staff in some settings may find themselves on different trajectory courses from the operational department. An operational manager focused on making a profit may disregard the safety needs of patients. This may not be surprising to those who work in the healthcare arena.
Nurses and Certified Nurses Assistants (CNAs) over the years have found themselves with fewer resources. Despite limitation in resources they are still somehow expected to achieve positive results. Decisions to limit resource to staff are usually made by operational managers or by nurse managers deputized to these roles.
Focusing on profit making at the sacrifice of high quality care is a common practice in healthcare settings. Some time ago, staff members in a dialysis unit were each given several pairs of gloves in a Ziploc bag. The staff was told by the non clinical operational manager that this was their quota of gloves for the day. The high risk of infection and high probability of cross contamination from blood was never factored into that decision.
One nursing home apparently pressured into cutting costs was known for its chronic absence of gloves and soap. Certain floors at that facility had the permanent smell of feces and urine.
In order to save money, the operational department at a home care agency refused to comply with the clinical manager’s directive that more than two hours of paid field training was required prior to thrusting nurses upon innocent patients. The operational manager/ account manager at the same home care agency opposed Child Protective services to be called into a home out of fear that the child’s family would get upset and remove the contract from the agency.
One nursing home advised staff that certain depleted supplies that were needed for daily patient use could not be shipped over night as the company would not pay for them. A CNA in that nursing home poignantly asserted; “The only time that we have adequate staff and adequate supplies in this place is when the State is expected to show up.”
The aforementioned acts may sound egregious to an individual with clinical training but not to someone focused on making a profit.
Cutting cost at the expensive of patient safety may result in great savings. However, the individuals who make these decisions cannot in good faith contend that their overall objective is to provide high quality healthcare to patients. Moreover, the ability to make decisions that affect patient safety and comfort also shows who has the power within certain healthcare settings.
Clinical Department’s Dilemma in not meeting the Expectation of the Operational department.
Where patient safety is compromised due to business decisions, many nurses are afraid to make reports to outside agencies. This is often in conflict with the training that nurses receive in nursing school.
Some nurses may recall that while in nursing school, there were professors who constantly emphasized that; “Nurses are agents of change.” After real life exposure to the healthcare system, some nurses may actually question this idea or refuse to believe it.
How much change can an individual nurse implement within his or her place of employment? Healthcare facilities focused on profit making are unlikely to change their policies and procedures due to a nurse’s recommendation. Often, when changes are implemented in healthcare settings, it is due to a law suit by a patient, or because of aggressive intervention by a state agency.
One New Jersey nurse was told by her nurse manager not to cause trouble when doctors refused to comply with a particular state regulation that required doctors to be present during the emergency performance of a certain procedure. The justification was that the company could not afford to lose contracts with certain facilities where those doctors had their patients. When the nurse refused to comply, the supervisor made the nurse’s continued employment with the company unbearable. Here, profit making was prioritized over patient safety.
On another occasion, a nurse was told by her manager that she was required to be productive. As such, she was instructed to leave patients during the performance of a medical procedure to do routine cleaning of equipment in another part of the department. When the nurse refused, the supervisor retaliated against her.
Employers bent on retaliation may go as far as the Texas doctor who tried to have two nurses criminally prosecuted after they reported him to the Board of Medicine.
As such, many nurses are afraid to make waves and afraid to report matters to outside agencies. Reporting matters to agencies such as the Board of Health or Child protective Services usually result in immediate loss of employment for alleged unrelated reasons.
Nurses who take it upon themselves to become “agents of change” may also find also themselves labeled as trouble makers and unable to find employment with other companies. The harsh reality is that employers still give bad references to employees. In 2013, a home care agency requested an employee reference from the hospital where an applicant was formerly employed. The hospital advised the agency that it had terminated the employee whose reference was requested, because she did not suit its needs.
Conscientious nurses often find that the most that they can do, is to give the best care possible, as there is little that they can do to change company policies and procedures.
More often, giving the best care possible is done through personal sacrifices. One common personal sacrifice that nurses make is working off the clock in order to complete assignments or documentation. One supervisor at a health care facility advised nurses that punching out late was the same as stealing from the company. Some nurses at that facility felt that there were too many loose ends at the end of their shifts and often punched out late. While some of nurses stayed on the clock and completed their tasks, others punched out, then went back to work to complete their assignments.
The supervisor at that facility chose not to understand that where numerous nurses were placed in the same position of not being able to complete their work, that the volume of work imposed was unconscionable. The supervisor told the nurses who complained about their situation, to just find a way to finish the work. Punching out late was not an option.
In another situation, a supervisor made it known that a particular procedure must be completed within a specified time frame. Nurses would start working off the clock as they felt that their jobs were at risk for not completing the procedure within the abbreviated time frame. These nurses punched in to work only after a substantial part of the procedure was completed. By punching in after some time had elapsed, their time cards would not reflect that they took a longer time than was mandated.
Many nurses who are forced into such behaviors often never consider making reports to labor boards.
Cutting of Corners for Survival
Limiting of resources may force staff with weak personalities into bad behaviors.
One nurse reported that during her employment with a specific Nursing home, she frequently was unable to complete her medication pass and dressing changes on time. She found herself working late several days per week. She was able to complete her tasks only by starting these tasks much earlier than recommended. The nurse later discovered that there were other nurses in the same condition who apparently found a way to deal with the situation.
Many years after leaving the aforementioned place of employment, the nurse sat down with a former co-worker to reminisce about her experience at that particular facility. The nurse asked her former co-worker, how was it possible for one nurse to give so many different medications to so many patients on one ward? Many of the medications required crushing and administration via g-tubes. The other nurse explained that such situations were generally managed by giving only those medications that were important. Simply put, some medications were never given. Surprisingly, this behavior still persists today in healthcare facilities.
Arguably, the average nurse does not engage in wrong doing. However, it would seem that facilities that place profit making above patient safety or lose focus as to why they exist, implicitly encourage these bad behaviors.
There is a solution to remodeling or creating healthcare environments where profit making and high quality patient care are equally valued. One solution is to hire only clinically trained employees to manage all aspects of healthcare facilities. This includes CEOs, account managers and administrators.
A Masters Degree in Health Care Administration program may offer courses such as Leadership Skills, Health Informatics, accounting, marketing and planning as part of the curriculum. However, none of these courses prepare individuals to connect with patients the way doctors and nurses are taught to connect. A non clinician is unlikely to lose sleep if a patient is harmed from poor quality healthcare. A non clinician operational manager may be more focused on the financial impact of a medical mistake. Consequently, the clinical training that nurses and doctors are required to undergo may be instrumental in deterring certain profit motivated behaviors that non clinicians are often willing to tolerate.
All health care management training programs that are offered by Universities should include a lengthy clinical component. All students in these programs should be required to get practical training in clinical settings before qualifying for their degrees. In-depth education about disease process, impact upon patients, appropriate nursing and medical interventions may change the mind set of these profit focused individuals.
Similarly, all medical and nursing programs should incorporate a comprehensive business and operational component. This will ensure that all persons who work in health care businesses are equally qualified and motivated to ensure high quality healthcare to patients while making a profit.
High quality healthcare can co-exist with big profits. However, steps must be taken to provide college level clinical training to individuals charged with managing the operational and business departments of our healthcare facilities.