Better living through disclosure

April 15, 2005 -- Today the Kansas City Star published a brief but persuasive editorial by Mary Nash supporting draft Missouri legislation to require disclosure of the ratio of patients to nurses and other direct care workers in the state's hospitals. Ms. Nash is the president of Nurses United for Improved Care.

Ms. Nash's piece, "Staffing for safer hospitals," argues that the staffing disclosure is a critical piece of consumer protection. She compares it to the nutritional information that must now be listed on some food items. Nash notes that the pending bill would "require hospitals to publicly disclose, in each unit, on a daily basis, the ratio of patients to nurses and other health-care workers who provide direct patient care." Nash writes that understaffing is now a "near crisis" at "virtually every" Kansas City area hospital, even though research confirms that having more nurses saves patients' lives. Nash believes that the "best scenario" would be legislation requiring specific staffing levels. But even without that, she suggests that, armed with the staffing ratio information, health care consumers would be able to choose the hospitals that provide the best nursing care, and thereby create a powerful incentive for area hospitals to provide better staffing.

Disclosure of staffing levels is a potentially promising vehicle to improve staffing at hospitals, and it is also an element of more comprehensive draft legislation now pending in the U.S. Congress. Of course, not all disclosure is the same. According to Ms. Nash, the proposed Missouri bill would require that the ratios be posted on each unit, where consumers of that unit's services are more likely to see and understand them. This is also the approach of at least one bill recently introduced in Congress. Another recent bill now pending in Congress requires that all ratios for an entire hospital be posted in one location, a method that would seem less likely to present the information so that it would be easily found and understood by consumers. Disclosure may be enhanced even further by requiring hospitals to report their data to a government agency, which can then make it available to the public, such as on a web site. This kind of reporting has been a key element of government regulation in other areas, such as campaign finance. Some of the draft federal nurse staffing legislation provides for such reporting.

In general, disclosure may serve several important functions, even where political or other factors limit the extent to which the government regulates the underlying conduct being disclosed. As Ms. Nash notes, disclosure may simply embarrass hospitals into behaving in a particular way. It may also create significant financial incentives, to the extent consumers become aware of the importance of the data and choose their health care accordingly. Where the regulated community's underlying conduct is also subject to restrictions, such as mandatory staffing ratios or limits on overtime, disclosure can also be a critical way to help the government enforce such restrictions, as it may provide a constant window on what a given actor is doing.

The Center commends Ms. Nash for her editorial and the Star for publishing it. See the article "Staffing for safer hospitals" by Mary Nash in the April 15, 2005 edition of the Kansas City Star. You can reach Ms. Nash through the snail mail address on the Nurses United web site.