7 Things That Will Change How You Deliver Healthcare in 2010

By Marcia Faller, RN, MSN, executive vice president and chief clinical officer, AMN Healthcare

Jan. 20, 2010 - Every January signals a new beginning. This particular January, as we begin a new decade, healthcare providers are about to experience some major changes, and the coming year will be shaped by a number of outside forces. But will these forces overwhelm you, or will you be ready with new staffing plans that can weather the storm?

Here are seven key issues to watch in 2010, along with some suggestions for dealing with each proactively:

1. Legislative Healthcare Reform  

Until this past Tuesday, the healthcare reform legislation appeared imminent, but with a Republican taking over Ted Kennedy's Senate seat in Massachussetts, things could change or at least be delayed. If and when the bill does pass, two major questions remain: what will reform look like at the facility level and what can we do to prepare? After Congress and the president have done their part, the real work for healthcare providers will begin.

With an estimated 30 million more Americans about to gain access to healthcare insurance, inpatient census is expected to climb dramatically across the country. Many healthcare facilities will need to expand their clinical rosters this year, but may not get budgetary approval for a sufficient number of permanent positions. The added flexibility of using temporary physicians, nurses, allied health workers and pharmacy personnel can help hospitals and other providers keep up with demand and continue to deliver quality patient care during these uncertain times.

2. Economic Changes  

Recent economic indicators hint that this painful recession could be on its way out in the coming year. As more people go back to work and family finances begin to stabilize, Peter Buerhaus and other workforce experts expect that the nurses and other healthcare workers who put off retirement, went back to work or increased their weekly hours will return to their previous levels of work. The reduction in hours and the onset of more retirements will lead to more staffing shortages. These shortages--coupled with the increased patient load brought by reform--will require facilities to put a greater focus on recruitment and retention efforts and to consider all of their staffing options.

Even if the recovery is months away, facilities should begin to map out their permanent recruitment and temporary staffing needs now in order to secure the best clinical talent.

3. The Focus on Safety and Quality  

A decade ago the Institute of Medicine (IOM) report, To Err is Human, put a spotlight on the safety of our country's healthcare system by pointing out the high number of patients who die each year in hospitals from medical errors. This launched a patient safety movement that continues to shape healthcare delivery. Safety became even more of a financial issue in October 2008, when the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing the costs to treat select preventable hospital-acquired conditions.

The IOM report (and other studies since) found that mistakes were more prevalent in working environments that were understaffed, and instead of blaming individual healthcare workers, shifted the focus to system flaws that lead to errors. Read the IOM report.

4. Health Information Technology  

Health information technology (HIT) promises more efficiency for providers and greater portability for patients. But until now, the cost and difficulty in converting to electronic medical records--all while protecting patient privacy--has kept some from entering the fully-electronic realm. New financial incentives under the American Recovery and Reinvestment Act promise to make 2010 the year that more physicians and providers take the plunge.

Some steps to consider: In order to ensure a smooth transition, providers may want to bring in temporary nurses who specialize in computer conversion projects, and start planning now for permanent positions in HIT support.

5. Patient Satisfaction and a Growing Consumerism Mentality  

It is no longer a world of "Doctor knows best." Today's patients are better informed, more demanding and searching for answers to their own ailments online. They are more likely to check out other patients' reviews of your facility and staff and compare outcome data and patient satisfaction scores through sites like Consumer Reports Health and the CMS Hospital Compare site. Improving patient satisfaction and dealing with healthcare's increased transparency is key to bolstering your facility's reputation and future success.

A 2009 report in Health Affairs, "Nurses: A Key to Patient Satisfaction," showed that nurse staffing is an important factor in helping patients feel cared for and improving their overall satisfaction with a facility. More than ever, your annual staffing plans should include a sufficient number of nurses and other healthcare professionals to take care of each patient appropriately.

6. New Efforts in Efficiency  

According to PricewaterhouseCoopers' Health Research Institute, the primary emphasis for healthcare organizations this year will be on reducing costs and creating greater value in the health system. But where should the money be spent? A new article in the New England Journal of Medicine, takes up this subject in "Comparative Effectiveness and Health Care Spending," and points out the difficulty of balancing "the widest good" with the individual patient. A number of new ideas and existing initiatives, like Lean Thinking and Six Sigma, may see additional growth this year in an attempt to improve efficiencies and produce systematic innovation.

When it comes to staffing plans, managers need to evaluate how they can use their funds for human capital most efficiently in the coming year.

Some steps to consider: hiring more nurse practitioners to handle some of the physician overload, consolidating supplemental staffing needs with vendor management, and bringing in temporary clinicians to cover absences, census fluctuations or major projects without committing to long-term overhead costs.

7. Expectations for Emergency Preparedness  

What will you do if a health crisis hits your community, affecting the availability of your workforce and increasing your patient load? Based on the recent H1N1 pandemic and medical relief efforts in the wake of earthquakes and other tragedies, healthcare providers should have a renewed sense of the need to be prepared. In addition to formal emergency plans and committees, managers in charge of clinical staff need to develop their own contingency plans.

Some steps to consider: During 2010, build a partnership with your staffing company to plan for the changes you expect, and to know what to do when the unexpected happens.

(For more information on preparing for a public health crisis, see this related article in Healthcare Briefings.)