Inspired by Dr. Gawande’s thoughts on waste in the healthcare system and what we can do about it.
Did you catch Dr. Atul Gawande’s recent article in The New Yorker (May 11, 2015). It’s entitled, “Overkill. An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?” It’s a follow-up to an article he wrote six years ago called “The Cost Conundrum: What a Texas town can teach us about healthcare.” Both articles tackle the issue of healthcare costs in the United States. As I read his latest article and went back to recall his earlier one, I found myself admiring the courage it took for Dr. Gawande to write them. As a healthcare provider himself, you might think he’d like to brush the topic under the rug and hope that people don’t give it much thought. But he does exactly the opposite.
In “The Cost Conundrum” (2009), Dr. Gawande had reminded us that “Our country’s health care is by far the most expensive in the world. In Washington, the aim of healthcare reform is not just to extend medical coverage to everybody but also to bring costs under control.” Likely to the dismay of many in McAllen, Texas, Dr. Gawande looked to that community for answers since McAllen was at the time one of the most expensive healthcare markets in the country. Dr. Gawande had written that “In 2006, Medicare spent fifteen thousand dollars per enrollee here (McAllen), almost twice the national average” and “three thousand dollars more per person here than the average person earns”. He compared McAllen to El Paso, another Texas community with essentially the same demographics and generally the same healthcare offerings and services (“neonatal intensive care units, advanced cardiac services, PET scans, and so on”) but with Medicare expenditures (which he cited as ‘our best approximation of overall spending patterns’) in 2006 at about half as much as in McAllen. Continue reading the complete article on GE Health IT Views.
Because I work at a company that focuses on nurse staffing, I often myself find doing a little bit of ‘research’ when my daughter is hospitalized. One of the things I’ve paid close attention to during her hospital stays is the nurses’ shift length. In fact, I’ve noticed that almost all of the clinical staff at the children’s hospital where my daughter receives care work primarily 12-hour shifts.
I’ve seen the studies that show the risk of medical errors increases after nurses spend more than 12.5 hours on the job. But, I’ve also experienced firsthand the benefits of 12-hour shifts – fewer disruptive shift changes, fewer nurses that have to get to know my daughter, the opportunity for nurses to develop more of a relationship with their patients and the patient’s family, more consistency of care. And, I know that some nurses find that working 12-hour shifts provides them with the opportunity to find a better work/life balance.
I don’t think that a blanket statement that says 12-hour shifts are “good” or 12-hour shifts are “bad” is accurate. Instead, maybe we can look what can be done to make 12-hour shifts, and in fact a shift of any length, as safe as possible. For example, 12-hour shifts should not turn into 13+ hour shifts as the nurses finish their documentation at the end of their shift. Instead, taking a closer look at shift change procedures could shed light on process changes to streamline the shift change and help ensure nurses can leave after their 12-hour shift is complete. And, making sure nurses get at least a half hour lunch break can also help them stay refreshed during their long workday.
The distinctive dynamics of the staff, unit and patients in each situation mean there is not a one-size-fits-all answer to the questions surrounding 12-hour shifts. Instead, the solution is dependent on engaging staff to get their input as well as harnessing data analytics that can pinpoint the specific issues and point in the direction of a solution that helps improve patient care safety and staff satisfaction in each unique situation.