Massachusetts Hospitals Quality and Safety Agenda
Patients First Fact Sheet

Brochure

• Massachusetts hospitals are among the best in the world. Doctors, nurses and other caregivers share a common mission – delivering safe, high-quality care to patients.
   
  
• Here in Massachusetts, we are leading the nation in developing new standards of transparency and accountability.
   
  
• In January 2005, Massachusetts hospitals, in partnership with the Massachusetts Organization of Nurse Executives, launched Patients First – a bold, comprehensive initiative to further the longstanding commitment to quality and safety second to none.
   
  
• MHA and the Massachusetts Coalition for the Prevention of Medical Errors tackled two complex problems in patient safety – reconciling medications and communicating critical test results – which became the model for JCAHO’s 2005 National Patient Safety Goals.
   
  
• All of the 68 acute care hospitals in Massachusetts have signed onto the Institute for Healthcare Improvement (IHI) “Campaign to Save 100,000 Lives,” which includes adopting six interventions to improve patient care and prevent avoidable deaths.
   
  
• Through Patients First, Massachusetts hospitals are embracing innovative, new strategies to reduce medical errors, craft and publicly report staffing plans that meet patient needs, and alleviate shortages of nurses and other caregivers.
   
  
• Because Massachusetts hospitals believe the public has a right to know who is caring for them when they are hospitalized, a key component of Patients First is the public posting of nurse staffing plans.
   
  
• Massachusetts hospitals are the first in the nation to voluntarily post such plans both in hospitals as well as on the website www.patientsfirstma.org.
   
  
• While the staffing plans are compiled in the same format, each hospital and each unit within a hospital is different. In addition, each patient has individual needs and hospitals continually customize the care they provide to support each patient’s needs. Therefore, staffing plans will look different from hospital to hospital and unit to unit.
   
  
• The care an individual receives in a hospital is provided by a team of people – and comprised of more than nurses alone.
   
  
• Massachusetts hospitals will continue their commitment to public accountability and next year make public “nursing sensitive-care measures.”

Here are some questions and answers to help explain staffing plans and interpret their information.

What types of hospitals are there?

There are four major categories of hospitals at which you may receive care.

• Acute care community hospitals provide medical and nursing care for medical and surgical conditions.
• Tertiary hospitals provide medical and nursing care for medical and surgical conditions and also provide specialized consultative care by specialists, usually on referral from a medical provider, such as your primary care doctor.
• Teaching hospitals provide training for interns and residents who are studying to advance their skills as doctors. In general, all tertiary hospitals are teaching hospitals. Some acute care community hospitals may also have training programs for interns and residents.
• Specialty hospitals include long-term acute hospitals, rehabilitation or behavioral health hospitals that provide diagnostic and treatment services to patients with specified medical conditions or, in the case of behavioral health hospitals, diagnostic and treatment services for patients who have mental health-related illnesses. The staffing plans you will see are divided into three groups: Acute Community Hospitals (58), Tertiary (10) and Specialty (13).

What types of hospital “units” are there?

Hospitals have different types of units that are usually categorized based on the care that a patient will need. For example, a medical surgical unit may have a mix of patients with different kinds of problems, such as respiratory, cardiac, or cancer problems. Patients needing more specialized intensive care may spend part of their hospital stay in an intensive care unit, such as a cardiac care unit (CCU) or surgical intensive care unit (SICU). Some hospitals also have “step-down” units or telemetry units, for those patients who require more monitoring but do not need to be in an ICU.

What is a staffing plan?

Every hospital develops a staffing plan to make sure that patients in their hospital receive appropriate care. Many different factors go into development of a staffing plan. Some of these include the experience and education of the registered nurse, the availability of other caregivers, the needs of the patients on the unit, and the severity of the patients’ illnesses.

Have hospitals always compiled staffing plans?

Yes, hospitals have always compiled staffing plans. Under Patients First these plans are being developed in a uniform way so the public can see the different factors that go into the development of a plan.

How are staffing plans determined? Staffing plans are determined based on patients’ needs. The Nurse Manager together with other staff develop the plan based on the anticipated needs of the patients who will be assigned to the unit. The plans need to be flexible to account for changes that occur. Patients’ needs change over the course of a day and staffing is adjusted to account for those changes. Every patient needs the right care, not the same care.

Are staffing plans only for nurses?

Staffing plans involve the team of professionals who may be involved in the care of a particular patient and are based on the patient’s individual clinical needs. Nursing plays an important role in the care of every patient but nurses are just one part of a larger team of caregivers who work together to make sure that patients receive the highest quality of care.

Can any conclusion be drawn if the staffing on one unit is higher or lower than another?

Direct comparisons like that can not be made between or across units. Staffing is based on the needs of a particular patient unit and can differ from unit to unit within the same hospital. For example, staffing in an intensive care unit is higher than staffing in a general medical surgical unit because of the critical needs of patients that are in intensive care units. They require more hours of nursing care and close monitoring for changes in condition. Staffing across similar units can also vary based on the experience and education of the registered nurses and the availability of other clinical caregivers, such as therapists. When looking at a staffing plan, it is important to look at the indirect resources who also provide care, and to look at other attributes of the unit, such as technicians or specialists who may provide care and services.

Why do staffing numbers differ from hospital to hospital and unit to unit?

Staffing numbers vary because patient care needs differ and can change minute to minute, hour to hour. Staffing has to be closely watched and adjusted from time to time based on the changes in the needs of the patients. The plan is based on averages. There are times when more staff will be needed and times less staff will be needed.

Activity on a patient care unit changes constantly and, therefore, patient needs change constantly. For example, admissions, transfers and discharges occur on a regular basis, changing the make-up of a unit, and patients may become sicker during a day and need more than expected nursing care.

Nurse staffing is frequently evaluated and readjusted to make sure patients are properly cared for. The staffing plans, therefore, are not meant to compare one hospital to another or one unit to another, but are a planned baseline from which patient care needs are adjusted.

What are Worked Hours Per Patient Day (WHPPD)?

Worked hours per patient day are the number of hours of direct care a patient can expect to receive from an RN, along with LPNs and nursing assistants in a twenty-four hour period. Worked hours per patient day is a measure that is nationally recognized and part of the National Quality Forum’s Nurse Sensitive Measure Set. This measure set was established by experts in the field of Quality Measurement and Nursing Care.

What do these numbers mean for patients?

This number will tell patients how many hours of nursing care they are receiving. It is not meant to be compared across units or across hospitals. It is one more piece of information for consumers to have in understanding how care is provided to them when they are in the hospital.

Why does it seem there are fewer staff on the evening and night shifts?

On some units, there are fewer admissions, transfers and discharges on the later shifts. Also, during the evening and night, patients may receive fewer treatments, testing and transporting, and may have fewer needs for assistance with daily activities, such as bathing or eating. Some units have the same number of RN staff on all shifts, however, such as Intensive Care Units (ICUs) where the care needs vary less.

Where should I be able to find the staffing plans for hospitals?

Staffing plans for hospitals are now available on the Patients First website at www.patientsfirstma.org or by asking individual hospitals for a copy.