Does HCA Follow Best Practices?

The healthcare industry consolidation is booming, driven by the need for hospitals to find financial strength by expanding market share and reducing costs. Still, too much organizational growth brings challenges. HCA is the second-largest healthcare organization in the U.S., second only to the U.S. Department of Veterans' Affairs, which has struggled with its own quality issues over the years.

HCA says more than 80% of its hospitals rank in the top 10% for federal quality measures, versus 13% in 2006. That means about 130 of their 163 hospitals are doing quite well, but the other 33 can easily besmirch that record through less-than-stellar practices. The New York Times reports that HCA owned eight of the 15 worst hospitals for bedsores among the 545 profit-making hospitals.

Bedsore statistics can reflect a nursing staff shortage, which is a dangerous problem. HCA uses a flexible nurse staffing system that fluctuates with patient volume, a practice that is not uncommon. In fact, I've even written about it as a cost-cutting mechanism, and more than a few hospitals nationwide use flexible staffing practices.

Some HCA nurses report that important areas are inadequately staffed. That could very well be true, but is that a consequence solely of flexible staffing, or could the nationwide nursing shortage also be a factor? I will venture to say that HCA isn't the only hospital, regardless of tax status, that has been or will be accused of insufficient nursing staff.