Northwestern Memorial Hospital has quietly purchased a 10-acre piece of undeveloped land for future expansion in Northbrook, IL.
The hospital has spent more than $1 billion to build two new hospitals in the last decade in downtown Chicago, and its
specific plans for the new site are uncertain. Chicago-area hospitals have been engaged in building sprees of late in an effort to attract insured patients in affluent suburbs. Some hospitals, mostly non-profit, say they need to generate revenue by opening hospitals in areas with more insured patients to cover costs of those who cannot pay their bills.
Across the nation, patients are frustrated by lack of access to their doctors and are going to drug-store clinics for basic care. Primary care doctors are so harried that they are abandoning their practices. The "medical home" being created at Union Square Family Health in Somerville, MA, and at many doctors' offices across the nation is an attempt to provide an alternative. The doctor or nurse-practitioner-led team practices are designed to offer patients care when and where they want it and to give the team the money, the tools, and the time to do more than triage.
Over the past three years, some 7,000 M.D.s have flooded into Texas, and experts say Tort reform is the main reason. In 2003 and in 2005, Texas enacted a series of reforms to the state's civil justice system. Texas Medical Liability Trust, one of the largest malpractice insurance companies in the state, has slashed its premiums by 35% and saved doctors approximately $217 million over four years. There is also a competitive malpractice insurance industry in Texas that drives rates down. The result is an influx of doctors so great that the State Board of Medical Examiners recently could not process all the new medical-license applications quickly enough.
The Service Employees International Union and the California Nurses Association, two of the nation's biggest nurses' unions, are engaged in a slugfest over workers. The two unions are seeking to spoil each others' organizing drives with tactics such as ad campaigns, lawsuits, and infiltrating job sites. CNA says nurses would be better represented by a registered-nurses-only union that could focus on issues including nurse-to-patient staffing ratios. SEIU says nurses are better off in a bigger union that would also fight for other hospital workers and improve hospitalwide standards.
For years, lawyers and insurers have counseled doctors and hospitals to "deny and defend" during malpractice cases. Many still warn clients that any admission of fault, or an expression of regret, could invite litigation and imperil careers. But now that healthcare providers are choking on malpractice costs and consumers are demanding action against medical errors, a handful of prominent academic medical centers are trying a different approach. By promptly disclosing medical errors and offering apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes, and dilute anger that often fuels malpractice lawsuits.
Timeouts to wash hands and put on hairnets, a checklist to ensure that precautions are taken, and advertising campaigns directed at doctors and patients have been credited with reducing the number of serious infections at New York City's public hospitals. Since 2005, central-line bloodstream infections have fallen 55% in adult intensive care units at the city's 11 public hospitals, according to new statistics. Ventilator-associated pneumonia declined by 78%.
To keep up with growing patient demand, the University of Kansas Hospital is expanding its emergency department through an $800,000 project. The expansion will add seven beds to the emergency room for a total of 32, and is expected to be completed by the end of the summer. KU Hospital had 41,000 emergency room visits in its latest fiscal year and expects to have about 44,000 this year. Like other emergency departments in its area, the KU Hospital emergency room frequently must divert patients because the department fills up.
Physicians at JPS Health Network, Tarrant County, TX's taxpayer-supported public hospital system, are concerned that co-pays could be a barrier to patient care and has asked the administration to study their impact on the poor. The chairwoman of the JPS Health Network family medicine department has suggested finding a way to reduce co-pays for patients, especially for return test visits or when patients need ongoing treatments. Other physicians suggested that JPS use some of its surpluses to either reduce co-pays, waive them entirely, or find ways to group some payments together.
A mental health patient at Fort Worth, TX-based John Peter Smith Hospital died after the staff summoned an ambulance to take him to the emergency room instead of calling for doctors a little more than five minutes away. The ambulance took 15 minutes to arrive, and the hospital violated state law by its actions, an investigation by the Texas Department of State Health Services found. JPS' policy for emergency care at the psychiatric facility amounted to performing CPR and calling 911, and that was flawed, according to state investigators.
Last week, I wrote about some of the surprises I'm hearing in healthcare when it comes to recruitment and retention—sentences like "turnover is good," "signing bonuses don't work," and "we don't own our nurses." I heard a lot more about this subject over e-mail. Here's what readers had to say:
The med/surg unit should be a destination (not a rest stop). On the subject of "owning nurses," Kristen Baird, an RN and healthcare consultant, points out that external competition isn't the only competition hospital units worry about: "Medical/surgical units have not historically been a 'destination' unit for nurses, but rather the incubator for growing skills to better prepare them for other, perhaps more desirable units. The result is that nurses tend to work 1-2 years on these units and transfer into other areas that require previous med/surg experience. The managers of these med/surg units are in a constant flux and often resent the other departments 'stealing' their nurses. The system or organization may breathe a sigh of relief that the nurse didn't leave them for a competitor, but. . .often, the med/surg director is left scrambling to fill vacancies created by nurse transfers to other departments.
"This revolving door is nothing new, but we never seem to learn from this and haven't created processes and systems to allot for the short-term stint in med/surg and use it as a springboard to grow our future, expert workforce. As I see it, the issue comes down to a myopic view of departments as siloed business units with a finite allocation for FTEs. Wouldn't it make sense to proactively see the med/surg units as both a destination specialty and the training ground for specialties? If we can embrace this mindset, the med/surg units could be funded in part by education and development with FTEs designated as 'training tracks'."
"Stop promoting people!" As Val Kraus from Boulder Community Hospital writes, promotions aren't always good for the organization or the person being promoted. "The biggest thing that my facility is trying to do is stop promoting people just because they do a good job at the task level. I have had to demote individuals because previous people said, 'They are good at ________, surely they will be good supervising that group.' This is a painful process but should start decreasing now that we are setting up controls to hinder that."
"It's us, not them." I've written about bad leaders before, but one reader says it much better: "Most hospitals have leadership teams that have more in common with the dysfunctional parents on a Super Nanny show. The parents are upset with the kids but the reality is the parents are the problem. Unfortunately, the average hospital CEO would not tolerate a Super Nanny 'heart to heart' to face the brutal facts," wrote Daniel King, retired president of a St. Louis-based medical practice.
There's no denying that finding and keeping good employees is a hot topic, so please keep the e-mails coming. Let me know what you're doing, what works, and even what doesn't. And don't forget you can also read and comment online.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
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