{"id":3079,"date":"2020-12-20T11:00:09","date_gmt":"2020-12-20T11:00:09","guid":{"rendered":"https:\/\/www.radiofree.org\/?p=141466"},"modified":"2020-12-20T11:00:09","modified_gmt":"2020-12-20T11:00:09","slug":"hospital-ceos-have-gotten-rich-cutting-staff-and-supplies-now-theyre-not-ready-for-the-next-wave","status":"publish","type":"post","link":"https:\/\/radiofree.asia\/2020\/12\/20\/hospital-ceos-have-gotten-rich-cutting-staff-and-supplies-now-theyre-not-ready-for-the-next-wave\/","title":{"rendered":"Hospital CEOs Have Gotten Rich Cutting Staff and Supplies. Now They\u2019re Not Ready for the Next Wave."},"content":{"rendered":"
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In 2006,<\/u> Montefiore Medical Center in the Bronx had healthier patients, just enough nursing staff to take care of them, and a CEO who was earning $2 million a year, a senior nurse and union leader told The Intercept. Fifteen years later, its patients are sicker than ever before, its staffing levels are inadequate, and, as of 2018, its new CEO is earning $13 million per year.<\/p>\n

The nonprofit hospital, like hundreds of others across the nation, has been cutting costs, progressively going leaner on staffing and supplies over the years. This accelerated approach has meant that the pandemic has hit the hospital, especially health care workers, doubly hard. The nurse, Karine Raymond, has provided care at the facility for 27 years. In the second wave of Covid-19, as in the first, she and her colleagues are taking care of double the patients that they typically do.<\/p>\n

\u201cIt\u2019s untenable and unmanageable and left us feeling very concerned that perhaps we might have done better if circumstances were different,\u201d said Raymond. \u201c[Our CEO] makes $13 million. How many nurses would his salary pay for? I do have a problem with seeing the suffering of the community I\u2019m supposed to serve while others are collecting funds that have been provided by state and federal governments just because they can.\u201d<\/p>\n<\/div>\n

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Nurses were overworked before, but since March, many nurses have left the industry entirely, retiring early or seeking other work. While personal protective equipment supplies are more abundant now than in the spring, nurses are more burnt out than ever \u2014 just as hospitals are getting ready for another wave of Covid-19 patients.<\/p>\n

The executives who typically make the decisions at the United States\u2019s hospitals, whether for-profit or ostensibly nonprofit, are uniquely unprepared for the coming deluge, experts say. A decadeslong failure to recruit and retain health care workers like nurses, technicians, and nurse\u2019s aides has made U.S. hospitals less able to manage the scope of a pandemic, and makes it much more likely that hospitals will break down, as they did in the spring in Wuhan, Italy, and New York City.<\/p>\n

\u201cEven before the pandemic hit us so hard hospitals were using a policy called \u2018Lean,\u2019 which is just-in-time staffing and supplies,\u201d said Linda Aiken, a professor of nursing at the University of Pennsylvania who has long studied the relationship between nurse staffing and patient care. The concept of lean hospitals was developed by management consultant Mark Graban in 2009, but business practices imported from manufacturing based on lean staffing began to be introduced in health care starting in the early \u201990s. \u201cAll of our research shows those policies were a failure well before Covid and now they are a disaster during this national emergency,\u201d said Aiken.<\/p>\n

Bonnie Castillo, executive director of National Nurses United, the largest union of registered nurses in the U.S., lambasted \u201cLean\u201d in a statement at the beginning of December, saying, \u201cLean industry practices slashed preparedness. They treat safe staffing and needed supplies as a drag on budget goals and profit margins, rather than the prerequisite for a humane, fully prepared patient-oriented health care system.\u201d<\/p>\n<\/div>\n

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Nurses from Montefiore New Rochelle Hospital protest working conditions, staffing shortages, and lack of contract amid a resurgence of Covid-19 infections outside the hospital in New Rochelle, N.Y., on Dec. 1, 2020.<\/p>\n

\nPhoto: Anthony Behar\/Sipa USA\/AP<\/p>\n<\/div>\n<\/div>\n

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Lean policy has had concrete results on the ground. \u201cDuring the current surge, nurses are seeing patients die who could have been saved, if they had the proper staffing and supplies,\u201d National Nurses United said<\/a> in a recent statement. Staffing shortages at hospitals have been reported in California, New York, Pennsylvania, Kansas, Maryland, Texas, Alabama, Idaho, Massachusetts, Arizona, Louisiana, Oregon, and Nevada in just the past two weeks. While the staffing crisis at this point is similar to the spring, it was supposed to be a once-in-a-lifetime event, and now it\u2019s happening again. The result, Raymond says, is that \u201cthe older nurses are retiring out and the younger nurses aren\u2019t staying\u201d at a pace more rapid than pre-pandemic.<\/p>\n

A majority of U.S. health care goes through hospitals that have been set up as nonprofit, which means that they are exempted from federal, state, and nearly always local taxes, and are obligated by their charter to operate in the public interest. (Those charters, however, don\u2019t get in the way of handsome executive compensation packages.) Fifty-eight percent of hospitals are nonprofit, 20 percent are public, and 21 percent are for-profit, dominated by big chains like HCA Healthcare, Tenet Healthcare,<\/a> and LifePoint Health.<\/p>\n

\u201cNominally nonprofit community-spirited institutions have actually come to operate as profit-maximizing monopolies,\u201d with the excess going to executive compensation instead of dividends, said Phil Longman, the policy director at the Open Markets Institute. \u201cThat has consequences here because a huge part of what happens with consolidation is a lot of hospitals are closed, so we don\u2019t have the surge capacity that we need for this pandemic.\u201d<\/p>\n

Longman has highlighted in particular the role of the University of Pittsburgh Medical Center, or UPMC, the dominant hospital monopoly in western Pennsylvania. When crafting the organization\u2019s future in 1995, its president, Jeffrey Romoff, said, \u201cAt the heart of the matter is the conversion of health care from social good to a commodity.\u201d<\/p>\n

Suzanne Gordon, an independent health care scholar, said that type of thinking has affected hospitals\u2019 ability to manage the pandemic.<\/p>\n

\u201cIf you have an economic view of health care as opposed to a patient care view of health care you\u2019re going to define effectiveness and efficiency not as patient outcomes, but as how few staff can you have to produce this widget which is some version of patient care,\u201d said Gordon. \u201cIf you have a workforce that is overloaded before a pandemic and demoralized and too old, you\u2019re going to have problems with staffing.\u201d<\/p>\n<\/div>\n

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Montefiore is not the only hospital that has seen significant escalations in executive compensation. The CEO of Banner Health in Phoenix, which has 28 hospitals in six states, made $21 million in 2018, while the CEO of Ascension Health, a Catholic health system with 145 hospitals in 19 states and Washington, D.C., also made $13 million. The rising executive compensation is a reflection of the financialization of health care, by which hospitals, regardless of their tax status, become not community-focused institutions but entities whose raison d\u2019\u00eatre seems to be to enrich their executives. A 2018 study <\/span>from<\/span><\/a> Clinical Orthopaedics and Related Research found that hospital executive salaries increased by 9.3 percent annually from 2005 to 2015. <\/span><\/p>\n

An August study<\/a> from the BMJ Quality & Safety Journal confirmed Gordon\u2019s thesis. It found that, in Chicago and New York City, \u201cHospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public\u2019s health. Such risks could be addressed by safe nurse staffing policies currently under consideration,\u201d referring to legislation that would mandate nurse-to-patient ratios. Only California has limits on how many patients can be assigned a nurse. \u201cOver half the nurses in both states experienced high burnout,\u201d the study additionally reported. \u201cHalf gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals.\u201d<\/p>\n

\u201cWhat the research shows is that professional nursing care is the primary service provided by hospitals, but there are many decision makers who are not clinicians. And so they don\u2019t naturally gravitate to science,\u201d said Aiken, the study\u2019s co-author. \u201cThey think it is technology, or the quality of the food, or having more marble in the lobby. But there\u2019s so much research that shows that\u2019s absolutely not the case. The primary service on the inpatient side is nursing.\u201d<\/p>\n

\u201cSo many hospital decision makers don\u2019t read the scientific literature because many of them come out of manufacturing and other business sectors. Nurses are the alarm bells, and we have never figured out anything that replaces the hands-on, eyes-on-the-patient professional assessment that nurses do that allows everybody else to intervene in a timely way,\u201d said Aiken.<\/p>\n

Nurse short-staffing has been found to lead to higher levels of patient infections and mortality overall. Nursing turnover in 2018 was 17 percent, which nursing unions and numerous studies have attributed to chronic short-staffing and poor working conditions.<\/p>\n

\u201cHospitals are being operated for the purposes of maximizing not literally profit, as they\u2019re technically nonprofits, but you can see the luxury cars in the parking lot and deduce what\u2019s going on,\u201d said Longman.<\/p>\n<\/div>\n

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Hospitals have consistently opposed efforts to expand the California model to other states. In 2018, the Massachusetts Hospital Association spent $25 million campaigning against a ballot initiative that would have guaranteed nurse-to-patient ratios. Other state-based hospital associations around the country have consistently lobbied against ratio laws as well. \u201cTaxpayers pay around 70 percent of the cost of hospitals [through Medicaid and Medicare], so we\u2019re paying for people to act against us as patients,\u201d said Gordon.<\/p>\n

\u201cThese hospital executives think there\u2019s a faucet of nurses that you can turn on and off and nurses will come out. It doesn\u2019t work that way; it takes two, four, six, eight years to produce nurses. You don\u2019t just want bodies, you want experienced bodies. You want the appropriate skill mix so you have to have enough nurses there to be able to fill the pipeline of retirement,\u201d Gordon concluded. \u201cI just think this is a completely predictable and avoidable crisis. Do we learn from this or do we go back to the same old, same old?\u201d<\/p>\n

While safe staffing legislation faces an uphill battle in the Senate no matter the outcome of the Georgia runoffs in January, Democrats in the states could take action, following California\u2019s lead. Besides California, there are 14 states where Democrats have control of both houses of the legislature and the governorship, including New York, Illinois, Virginia, New Jersey, and Colorado.<\/p>\n

\u201cIf we\u2019re going to provide the level of care that we need to keep our patients healthy and safe and out of the hospitals or home quicker, we have to have safe staffing,\u201d said Raymond, the nurse.<\/p>\n<\/div>\n\n

This post was originally published on Radio Free<\/a>. <\/p>","protected":false},"excerpt":{"rendered":"

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