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The Disease Care Industry

March 17, 2009 -- On February 15, 2009, the Seattle Post-Intelligencer ran an op-ed by nurse Kathleen Bartholomew that used recent layoffs at a local hospital as a vehicle to urge the public to rethink the way the United States provides health care. The op-ed is "We all hurt when hospitals shrink themselves into budgetary compliance." It says that the layoffs of "200 personnel" and the elimination of the chief nurse position at Swedish Medical Center will greatly undermine the infrastructure on which already-stretched direct care nurses and physicians depend. Bartholomew argues that essential support for health practice is crumbling in hospitals because the U.S. regards health care as a business rather than a right, and because the nation misallocates precious health care resources. Results include "long-term higher costs along with health care workers and leaders losing heart," with nurses bearing much of the burden. Sadly, one month after Bartholomew's op-ed appeared, the Seattle Post-Intelligencer itself shrank into budgetary compliance, and the paper delivered its last print edition today. We thank Bartholomew and the Post-Intelligencer for this powerful op-ed, which also shows that nurses are strong, expert patient advocates.

Contrary to news reports that these layoffs "will not affect doctors and nurses," Bartholomew argues, they are symptomatic of a crumbling health care infrastructure that puts patients in danger. Of course health professionals will struggle if there are far fewer other workers to support their care. This is an excellent point, and one that is clearly not obvious to those outside the system. In fact, though Bartholomew does not say so specifically, nurses are often asked to do the work of support staff when those positions are cut, and when nurses are busy doing non-nursing work, patients can suffer and even die. And the fact that the layoffs obviously have a terrible effect on the health workers who were laid off should not be overlooked.

Bartholomew explains that hospitals today feel they must shrink in order to survive in the harsh financial climate they face, even though they have already been operating in a "lean" way for years. She attributes the situation to increased regulation creating more work, the fact that reimbursement does not actually cover the costs hospitals must meet, and the current economic crisis. Fundamentally, she argues, the situation can be traced to the fact that the U.S. regards health care as a business rather than a "universal human right," and consistent with this view, health care providers are reimbursed for services rather than the overall health of their communities. So even though "[s]icker patients who are living longer require more acute care," "[n]ursing units staff to budget rather than the acuity of the patient." And when times are tough, hospitals lay off staff, which is their biggest operating cost:

In this particular case, nursing took a big hit as the most senior position of chief nurse was totally eliminated, signaling that the role is dispensable. Now, without representation at the executive level, there will be no advocate for nursing -- especially when it comes to the ever-shrinking budget. That must have been a difficult decision considering that the pillars of the hospital's foundation are built on providing safe, quality nursing care.

Bartholomew also points to two other dysfunctional elements of the U.S. approach to health care: our death-fearing culture "uses 80 percent of all health care dollars to support the first and last six months of life," and we devote the vast portion of these dollars to the "same five chronic illnesses (that we can control, but won't)." In this environment, Bartholomew says, overburdened nurses, physicians, and managers have already reached their "maximum capacity."

Bartholomew concludes that this "Disease Care Industry" is "crumbling," and so it must, to make way for a better model before health professionals succumb to the crisis. She urges all to support "health care reform (not just insurance reform), support nursing leadership and stop pretending that the impact of such layoffs will be minimal on already stretched-thin health care teams."

We thank Bartholomew for this high-profile call to action.

See Guest Columnist: We all hurt when hospitals shrink themselves into budgetary compliance from the February 15, 2009 edition of the Seattle Post-Intelligencer by Kathleen Bartholomew.

See Kathleen Bartholomew's website.


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