All MA hospitals agree to make staff plans public

Move is part of effort to put Patients First’

In a move billed as a nationwide first, all hospitals in Massachusetts now will be voluntarily posting their staffing plans through a new web site — — as well as through notices in hospitals. This will give consumers the number and type of caregivers assigned 24/7 throughout every hospital in the state. A consumer brochure also will be distributed at the hospitals. Entitled "It Takes a Team," the brochure will explain the many professionals involved in patient care.

The effort is part of "Patients First," a broad quality and safety initiative launched by the Massachusetts Hospital Association (MHA) and Massachusetts Association of Nurse Executives one year ago. They expect to issue quality reports for each hospital later this year and begin reporting "nursing-sensitive" care measures to the public in 2007.

A bill pending before the Massachusetts legislature and supported by MHA would codify elements of the Patients First initiative and provide resources needed to increase the number of nurses in the state, which faces a growing shortage of nurses and other health care personnel.

Why has this not been done before? "I often joke about it, saying these things are being done not because they are easy but because they are hard," says Karen Nelson, RN, executive vice president of the MHA. "It is hard; it’s a brave thing for a hospital to do. It takes courage to state your promise in advance — this is how we will staff, and we will tell you at the end of the year if this plan has been met."

If there is a variance from the plan, she continues, "We will tell you why we made the changes. This is very transparent, and it is taking somewhat of a risk. The most critical issues are somewhat hard to foresee, yet every single hospital in Massachusetts has agreed to do it — and is doing it."

Working behind the scenes

Getting the process going took quite a bit of work behind the scenes, says Nelson. "The Massachusetts Association of Nurse Executives got together with a data analysis company and worked in a pilot group across the state to make sure we had a tool that would work for everyone," she explains. "Hospitals all staff differently and have different types of staff."

Was it difficult it to get all Massachusetts hospitals to sign up? "Hospitals in our state have a long-standing commitment to quality, and this is part of that commitment," says Nelson. "There was continued snowballing as the word got out, and it became the right thing to do."

The significance of this effort is two-fold, she continues. "First, in terms of patients, you are saying, Rest assured, when you come to the hospital we have a plan to take care of you; we will tell you in advance who will be caring for you, and we want you to know that it takes a team to take care of you.’"

It also assures the patient that their plan will be individualized — that it may even be different from what their neighbor receives. "It lets them know how care is delivered, who the providers are, what kind of care they deliver, and that the care team needs to be customized to the patient," Nelson explains.

The second impact area, and part of the larger agenda of "Patients First," is the workforce itself. "There’s a clear concern about the shortage of nurses," notes Nelson. "They are mainly in their mid-40s, and there will soon be rapid retirement. Yet, as the population ages, it will have more and more health care needs, so at the current rate the supply [of nurses] will not keep up with the demand." The public posting of the staffing plans, she continues, "Speaks to workforce issues because it lets nurses know there isn’t a mystery behind staffing. It also communicates the message that the hospital is not routinely using overtime as a staffing strategy. The hospitals are saying in advance that they are pledging not to have mandatory overtime."

Quality tie-ins seen

Nelson says that this specific initiative, as well as the overall "Patients First" program, have several ties to quality improvement. "First, the public posting of staffing speaks to quality to a limited degree, in terms of transparency," she asserts.

Beyond that, however, all of the hospitals in Massachusetts have agreed to a much larger quality and safety agenda. "This includes the fact that all hospitals will be in [the IHI’s] 100,000 Lives’ campaign," Nelson shares. "And, they have agreed to public reporting of quality measures."

The posting of the staffing plans, Nelson shares, "is just the beginning step in the quality picture." For example, she says, ongoing efforts will include collecting nursing-sensitive quality measures using National Quality Forum (NQF) standards.

"We are doing a pilot program on six of these: Patient falls, falls with injury, ventilator associated pneumonia, bloodstream infections from central lines, a nursing workforce index (a series of questions nurses will be asked about their work environment), and pressure ulcer prevalence," Nelson shares. "These are already tested, validated measures, through NQF."

The pilot program is just getting underway, she reports. "Initially, we will figure out how to best collect the data. Then, we will start two or three pilots statewide and continue to publicize results," she says.

For more information, contact:

Karen Nelson, RN, Executive Vice President, Massachusetts Hospital Association, 5 New England Executive Park, Burlington, MA 01803. Phone: (781) 272-8000, x. 136. E-mail: