Continuous improvements hold the key to the effective delivery of care. If they are to serve the needs of their patients in the best way possible, healthcare providers should assess their performance. The assessment should reveal areas that require improvement. With these areas identified, the providers can proceed to implement strategies aimed at enhancing the quality of care. As they conduct the assessment, the providers also need to confirm that their operations are in line with relevant laws and guidelines. Mercy Medical Center is among the providers that have taken steps to promote the wellbeing of its patients. For the most part, the hospital has meet standards. However, an examination of its structure and operations indicates that there are some issues that have to be addressed if the hospital is to improve the quality of care.
Evaluation of Metrics
In his article, Joseph Krause (2017) highlights the importance of benchmarks. One of the issues that the article addresses is that by comparing their performance against benchmarks, healthcare providers are able to determine the areas where they fall short. On its dashboard, the Mercy Medical Center provides information that can be used to assess its performance. The information concerns such issues as the demographic profile of the patient population, the facilities that the provider relies on for its operations, and readmission rates, among others. For the most part, the metrics in the dashboard suggest that Mercy Medical Center is complying with applicable laws and regulations. However, further scrutiny reveals that the readmission rates and nurse working hours are among the metrics that point to the provider’s failure to fully comply with the law. The dashboard indicates that in the Medical Surgery unit, the average RN FTE stands at 14 hours. There is also a problem with the hospital’s high readmission rates. For such conditions as heart failure, the admission rate is 40%. This is higher than the national average of 37%.
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There are various federal, state and local laws that apply to the areas identified above where Mercy Medical Center falls short. The Patient Protection and Affordable Care Act is one of these laws. Essentially, this law mandates that hospitals should take all necessary steps to safeguard patient health and keep the costs of medical care low (Martin, 2015). The high readmission rates and the long working hours suggest that Mercy Medical Center flouts the provisions of the Patient Protection and Affordable Care Act. In particular, the long working hours poses a serious threat to patient health since nurses who are overworked have a higher chance of committing errors (Olds & Clarke, 2010). It is unfortunate that such states as Michigan have failed to follow the example of the federal government and institute standards regarding working hours and readmission rates. Currently, Michigan has not established a law that limits the number of hours that nurses can work (“Legislation & Advocacy”, n.d). Given the lack of state laws, Mercy Medical Center should be guided by best standards and practices when seeking to improve its performance.
Challenges
Mercy Medical Center prides itself as an institution that is committed to excellence. This raises the question of why the provider is underperforming in the areas mentioned above. There are various challenges that could be responsible for the underperformance. Inadequate human resources are among these challenges. On its dashboard, the provider indicates that it employs 433 physicians. While this number seems large, it may be insufficient to meet the needs of the community. Research shows that understaffing is to blame for long working hours and high readmission rates (McHugh, Berez & Small, 2013). This research finding underscores the possibility that inadequate human resources could be to blame for Mercy Medical Center’s underperformance. It is also possible that limited financial resources could behind the facility’s underperformance. When they are cash-strapped, providers are unable to hire enough practitioners or invest in measures that improve patient outcomes (He et al., 2016). This could be the case at Mercy Medical Center.
Benchmark Underperformance
As noted earlier, working hours and readmission rates are the key areas where Mercy Medical Center underperforms. It has been determined that the provider’s performance falls short after a comparison with established standards. Since there are no federal laws mandated maximum working hours and Michigan has not developed such laws, one is forced to turn to such states as California which has enacted a law that sets the maximum working hours. This law stipulates that nurses shall not be compelled to work overtime (Rogers et al., 2004). Essentially, the California law places the limit on working hours at 12. At 14 for its practitioners in the Medical Surgery department, Mercy Medical Center’s work schedules violate the law in California. What makes the hospital’s readmission rates unacceptably high is the fact that it is above the national average.
The long working hours and the high readmission rates pose a grave risk to the patients that Mercy Medical Center serves. When they work for long hours, nurses are usually exhausted and are more likely to commit errors. Patients bear the brunt of the long working hours. It is also the patients who suffer as a result of the hospital’s high readmission rates. These rates indicate that after discharge, a patient should understand that there is a high chance of being readmitted. The readmission is accompanied with higher medical costs and the risk of developing complications or even death. Given the dangers of its underperformance, Mercy Medical Center should strive to improve its performance. The hospital’s staff are also affected. For example, by being required to work long hours, the nurses suffer fatigue and burnout. Moreover, they could face legal action for negligence when they commit errors as a result of the exhaustion. It is possible that the high readmission rates and the long work hours have a detrimental effect on the morale of the hospital’s staff. Since they affect the staff, patients and the community, both the long working hours and the high readmission rates provide the hospital with the opportunity to improve. However, fixing the problem of the long working hours offers the greatest opportunity for improvement.
Solution
In order to restore trust, Mercy Medical Center should address the areas where it underperforms. To solve the problem of the long working hours, the hospital should change its work schedules by hiring more practitioners. Research shows that by lowering the number of hours that nurses are required to work, hospitals achieve enhanced work-life balance, higher satisfaction rates and improved patient outcomes (Gyllesten, Andersson & Muller, 2017). As part of its efforts to reduce the readmission rates, Mercy Medical Center should adopt a raft of measures. Patient education, follow-ups, patient-centered care, home visits, and patient self-care are among the approaches that have proven effective in reducing readmission rates (Leppin et al., 2014). It is advised that Mercy Medical Center should incorporate these strategies into its operations. These strategies should be directed at the patient population and their implementation should be spearheaded by the hospital leadership in conjunction with employees and other stakeholders. As it adopts these strategies, Mercy Medical Center will be successful in lowering the readmission rates, keeping the cost of care low and enhancing patient satisfaction.
In conclusion, Mercy Medical Center highlights the importance of quality improvement. The information on its dashboard shows that the hospital is committed to quality healthcare. However, the high readmission rates and the long working hours point to the fact that there are areas that require improvement. Left unaddressed, these issues could adversely affect patient health. To address the issues, the hospital should revise its work schedules and invest in the approaches that have been shown to lower readmission rates.
References
Gyllesten, K., Andersson, G., & Muller, H. (2017). Experiences of reduced work hours for nurses and assistant nurses at a surgical department: a qualitative study. BMC Nursing. DOI: 10.1186/s12912-017-0210-x
He, J., Staggs, V. S., Bergquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality. BMC Nursing. DOI: https://doi.org/10.1186/s12912-016-0181-3
Krause, J. (2017). Four questions to ask about healthcare benchmarking. Managed Healthcare Executive. Retrieved October 6, 2018 from http://www.managedhealthcareexecutive.com/benchmarks/four-questions-ask-about-healthcare-benchmarking
Legislation & advocacy. (n.d). MI Nurses Association. Retrieved October 6, 2018 from https://www.minurses.org/legislation-advocacy/
Leppin, A. L., Gionfriddo, M. R., Kessler, M. et al. (2014). Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174 (7), 1095-1107.
Martin, E. J. (2015). Healthcare policy legislation and administration: patient protection and affordable care act of 2010. Journal of Health and Human Services Administration, 37 (4), 407-11.
McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals with higher nursing staffing had lower odds of readmissions penalties than hospitals with lower staffing. Health Affairs (Millwood), 32 (10), 1740-7.
Olds, D. M., & Clarke, S. P. (2010). The effect of work hours on adverse events and errors in health care. Journal of Safety Research, 41 (2), 153-162.
Rogers, A. E., Hwang, W., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. HealthAffairs, 23 (3). DOI: https://doi.org/10.1377/hlthaff.23.4.202
