Tag: nurse staffing ratios

MHA CEO Report — Leading with Safety & Quality

MHA Rounds, Patient Safety and Quality

“Do the right thing. It will gratify some people and astonish the rest.”  – Mark Twain

Last month’s CEO Report focused on our grave concerns with legislative proposals to mandate nurse staffing ratios, and the negative impact they would have on patient access to care. And we spent the entire month of September laser-focused on telling our story to elected officials, the media, business and healthcare trade groups and many others who care about the Michigan healthcare ecosystem. This advocacy work will continue, without question.

But the hallmark of the MHA and our members is to not simply advocate against bad public policy, but rather, to voluntarily do the right thing when it comes to the best interests of the patients and communities we serve. And when it comes to the safety and quality of the care we provide in Michigan hospitals, we indeed have a very special story to tell.

This year marks the 20th anniversary of the inception of the MHA Keystone Center, which was originally created in 2003 as a first-of-its-kind collaboration among hospitals to identify and implement practices that improve healthcare safety and quality and reduce cost. Acting as our safety and quality organization today, the MHA Keystone Center voluntarily identifies safety and quality improvement opportunities and develops solutions among Michigan hospitals to improve experiences for both patients and healthcare workers alike. The extraordinary partnerships among MHA Keystone Center hospitals have saved many lives as well as healthcare dollars.

It needs to be stressed that there is no mandate requiring participation; all Michigan hospitals and thousands of their team members voluntarily participate in MHA programs to improve the safety and quality of healthcare because of their missions to care for the sick and vulnerable. Because of our long history of success, a growing number of hospitals in other states are now part of MHA-led safety and quality initiatives. In addition, the hospital-based collaborative efforts first pioneered by the MHA Keystone Center have now been replicated in 48 of the 50 U.S. states and various other countries.

These initiatives are driven by evidence-based best practices and strongly supported by data. One great example of how engaged hospitals have seen great improvements on safety and quality outcomes is through the MHA Keystone Center’s leadership of the Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network (HIIN). Michigan hospitals saved 3,350 lives and avoided 25,304 harm events within hospitalized patients over a three-and-a-half-year period from Sept. 2016 to March 2020.  In addition, our track record of outcome improvements includes the following:

  • Reduced the rate of CAUTI (catheter-associated urinary tract infection) events by 49% between 2012 – 2018.
  • Decreased CLABSI (central line associated blood stream infection) rates within ICUs by 35% between 2015 – 2018.
  • Reduced early elective deliveries by 68% between 2010 – 2018.
  • Reduced C. Diff rates by 15% from 2014 to 2017.
  • Reduced postoperative pulmonary embolisms and/or deep vein thrombosis by 22% from 2014 to 2016.
  • Reduced colorectal surgical site infections by 27% from 2014 to 2016.

This successful work led to the subsequent creation of the Superior Health Quality Alliance (Superior Health), which includes the MHA Keystone Center, along with our counterparts at the Illinois, Wisconsin and Minnesota hospital associations, and several other related organizations in the Midwest. Superior Health is funded by the federal government, which has clearly valued the ROI that is created by this work, both for Medicare and Medicaid patients for which they have a direct responsibility, as well as all patients.

On top of this work, the MHA Keystone Center has led hospitals on a high reliability journey for almost ten years now. Striving towards implementing and maintaining a high reliability culture means hospitals are focused on attaining zero preventable harm to patients, families and caregivers, making Michigan a safe place to receive care. Factors such as the pandemic, workforce shortages and increased rates of violence against healthcare workers all have emerged as challenges to this work. However, MHA Keystone Center member hospitals remain steadfast in their quest to reduce unintended harm in their facilities. One great example of how hospitals implement a high reliability culture is by stressing the importance of speaking up to prevent potential harm to patients or other staff members. Dozens of healthcare workers from hospitals throughout Michigan have been recognized by the MHA Keystone Center Speak-up! Award since it was launched in 2016.  It is heartening that hospitals across the state, both large and small, urban and rural, have embraced an organizational culture that promotes and even celebrates anyone within the organization who speaks up to prevent harm.

Our to-do list in this realm is long and is constantly evolving. Based on the current needs of our membership, we are now focusing on reducing health disparities as our state strives to achieve health equity; improving maternal health outcomes; establishing age-friendly health systems; implementing solutions to address the opioid epidemic; facilitating person- and family-centered care; improving workplace safety; and providing emotional well-being support to healthcare workers through a partnership with the Duke Center for Healthcare Safety and Quality that has so far assisted 5,000 healthcare workers from 144 organizations throughout Michigan.

We know each of these efforts impact the health and well-being of countless Michiganders today. Thankfully, we have diverse funding support for our work; in addition to the federal government’s role noted above, the MHA Keystone Center has been funded by the Michigan Health Endowment Fund, and from our own hospitals who pay an annual fee for the services provided by our MHA Keystone Center PSO, a federally-certified Patient Safety Organization which collects adverse event data. But special recognition needs to be given to Blue Cross Blue Shield of Michigan (BCBSM), and their CEO Dan Loepp. Their initial support was instrumental in getting the MHA Keystone Center off the ground all those years ago, and we are now operating under a third round of very significant financial support from BCBSM that has been critical to our success.

Finally, I would like to acknowledge the great leadership of Sam Watson, our senior vice president of field engagement, and Sarah Scranton, our vice president of safety & quality, as well as the entire MHA Keystone Center Board of Directors, and of course the incredibly talented and dedicated MHA Keystone Center staff. We are proud to work every day with so many hospital leaders and clinicians who are dedicated to doing the right thing for patients and healthcare workers. At the end of the day, this is mission-driven work that all Michiganders can be proud of.

As always, I welcome your thoughts.

MHA Hosts Successful Hospitals for Patient Access Advocacy Day

Member News, MHA In The News
Hospital and nurse leaders from across the state of Michigan during the Hospitals for Patient Access Advocacy Day.

The MHA hosted a successful Hospitals for Patient Access Advocacy Day Sept. 13, with more than 130 hospital and nursing leaders participating. Attendees completed 118 meetings with lawmakers, covering 80% of the Michigan Legislature. The relationships and conversations will prove extremely helpful in opposing legislation that would mandate one-size-fits-all nurse-to-patient staffing ratios for all hospitals in the state.

The MHA also hosted press conference and published a press release in conjunction with the advocacy day, releasing new data that illustrates strong public opposition to legislation proposing such a legislative mandate and hospital survey data on the severe impact of the legislation on access to care for Michiganders. The press event resulted in a number of news stories being published throughout the state from outlets including Becker’s Hospital Review, Detroit Free Press, Gongwer, MIRS, Michigan’s Big Show, WILX, WWMT, WJR 760 and WILS 1320.

An infographic that shares the new data and contextualizes the impact to healthcare access for Michiganders was also shared with lawmakers and media. Additional member communications tools are available upon request. Photos from the event can be found on the MHA Facebook page.

The MHA will continue to push back on this one-size-fits-all mandate and educate lawmakers on the harmful impact it could have on patient access to healthcare.

Members with any questions related to the legislation and advocacy efforts may contact Adam Carlson or Elizabeth Kutter at the MHA. Members with questions regarding media or requesting additional communications tools should contact John Karasinski at the MHA.

MHA CEO Report — Preserving Patient Access to Care

MHA Rounds

“For every complex problem, there is an answer that is clear, simple and wrong.”  – H.L. Mencken

Nurses are the heart and soul of our healthcare ecosystem. They were heroes long before the COVID-19 pandemic, they stepped up in extraordinary ways during the darkest days of that chapter in our history and they remain heroes today. Anyone who has spent time as a patient – or the family member of a patient – knows how impactful nurses can be, and how they truly become the face of our healthcare experience. In short, they deserve our admiration and support.

Our Michigan hospitals are proud to employ more than 62,000 nurses and the reality is that we are desperately trying to hire thousands more in every corner of the state. In terms of the supply of nurses, Michigan is confronting the same dynamics as the rest of the country. First, the significant number of baby boomers reaching senior status in recent years has translated to a growing exodus of nurses to normal retirement, while the unprecedented stress of the pandemic and its aftermath led many more to leave the field earlier than planned. As we engage with our leaders throughout the state, there is no question that the day-to-day work of our nurses has never been more challenging, and the rise in self-reported burnout rates is real and palpable.

On the first day of graduate school, one of my professors said something that I have subsequently heard many times throughout my career, and it is unequivocally true: “healthcare is not rocket science…. it’s much more complex than that.” This complexity is not limited to the incredible science behind our medical diagnoses and interventions, but extends to the organization and financing of that care as well. In practical terms, what this means is that absolutely nothing in healthcare happens in a vacuum – every potential lever to be pulled in the operational or public policy realm is impacted by a complex set of interwoven realities.

A case in point: recently-introduced state legislation (Senate Bills 334–336 and House Bills 4550–4552) would create mandatory minimum nurse-to-patient staffing ratios for Michigan hospitals. On the surface, such a mandate would seemingly ensure that we will have more nurses on the hospital floor, simultaneously alleviating their stress and creating better, safer care for patients. I would like to explain why this clear and simple proposal is flat out wrong.

Every single day in every single Michigan hospital, nursing leaders determine appropriate staffing levels in the emergency department, the labor and delivery unit, and in every other corner of the facility. These decisions take into account a complex set of variables, including the volume and acuity level of patients in house at that time, the training level and experience of not only the nurses, but all other members of the care delivery team, the various technologies that may or may not be available for deployment, and a wealth of in-house data and metrics that are updated multiple times per day. Seasoned nurse leaders have developed a good sense of the unique dynamics in a given community and in a given hospital, and they use their long experience to ensure the safest possible staffing models accordingly.

Here is the bottom line: even if there was a robust, immediately available supply of nurses to meet the proposed minimum staffing ratio mandate (there is objectively not), and even if there was an unlimited supply of available funding to pay for this new staffing (there is objectively not), there is simply no way on earth that it makes sense to replace the expert judgment of nurse leaders at the local level with a one-size-fits-all, inflexible model developed by politicians in Lansing. 

There is a good reason why the Michigan Organization of Nurse Leaders (MONL) is adamantly opposed to this legislation, and good reason why many nurse leaders I have spoken with in recent months have said they are personally offended by the premise behind it. Such a mandate would create an untenable situation for hospitals when a patient shows up and the facility is already at the mandated ratio: willingly ignore the law and risk penalties, fines and reputational damage, or follow the law and essentially tell the prospective patient “There is no room at the inn” and send them down the road. Of course, the hospital down the road will be in precisely the same boat. Without question, more hospitals will go on diversion, more hospitals will temporarily or permanently take beds offline, and more hospitals will make the difficult decision to eliminate entire service lines. In other words, the real losers here are patients and communities, who will lose access to care. This will be a reality in every corner of the state, and particularly alarming as we consider winters in rural Michigan and the distance between providers. Access reductions will become very serious, very quickly.

In public policy and politics, it is often instructive to examine other states that have already implemented a policy that is under consideration. To that end, California was the first state to adopt legislatively mandated nurse staffing ratios, some two decades ago. According to data from the Bureau of Labor Statistics, Michigan has a greater number of nurses per capita today than California. Despite having staffing ratios, California continues to have a shortage of 40,000 RNs, demonstrating they are suffering from the same problem as all other states in the country and the presence of legislatively mandated staffing ratios has done virtually nothing to improve the size of the workforce. Meanwhile, Michigan outperforms California in hospital quality, as Michigan has both a higher percentage of 4- and 5-star hospitals than California (49% to 35.3%) and a lower percentage of 1- and 2-star hospitals (18.4% to 38.7%), according to CMS Care Compare Hospital Overall Star Ratings.

Legislation similar to what is now being proposed here in Michigan was recently defeated in Minnesota, after the leadership of every single hospital in the state raised grave concerns about the severe negative consequences of its passage. The Mayo Clinic – world-renowned for its quality of care – publicly threatened to withdraw billions of dollars in planned investment in the state should the bill be adopted. The fact that an organization of their reputation and credibility felt so strongly about the negative ramifications of this concept should be a major red flag for policymakers in all states.

The mission of the MHA is to advance the health of individuals and communities. When we see public policy proposals that jeopardize our ability to achieve this mission, no matter how well-intended, we will do everything in our power to stand strong, to stand united and tell our story to our elected officials. Healthcare is complex, and Michiganders deserve better than ham-handed mandates coming from Lansing.

As always, I welcome your thoughts.

Headline Roundup: Hospital Staffing Shortages

MHA In The News, Top Issues - Healthcare, Issues in Healthcare
Laura Appel speaks with WXYZ Detroit on cancer drug shortages.
Laura Appel speaks with WXYZ Detroit on cancer drug shortages.
Laura Appel speaks with WXYZ Detroit on cancer drug shortages.

The MHA received media coverage the week of June 19 regarding mandated nurse staffing ratios, legislation to address violence against healthcare workers and chemotherapy drug shortages.

MHA representatives appearing in published stories include CEO Brian Peters, Executive Vice President Laura Appel and Senior Vice President Adam Carlson.

Below is a collection of headline from around the state.

Sunday, June 25

Thursday, June 22

Wednesday, June 21

Tuesday, June 20

Members with any questions regarding media requests should contact John Karasinski at the MHA.

Urge State Lawmakers to Oppose Harmful Hospital Nurse Staffing Legislation

Member News
capitol building

capitol buildingHarmful legislation was introduced in the Michigan Legislature May 11 that proposes mandated nursing staffing ratios, which would exacerbate existing shortages and restrict important access to healthcare services for Michigan patients.

The MHA voiced their public opposition to the bill package immediately following its introduction in a media statement, in conjunction with the Michigan Organization for Nursing Leadership (MONL). Since that time, the MHA has shared its position with all members of the Michigan Legislature and have been in frequent communication with legislative leadership to express the implications of this legislation and how it fails to solve the root cause of nurse staffing shortages.

The MHA is specifically advocating to oppose Senate Bills 334 – 336 and House Bills (HBs) 4550 – 4552, while asking for practical solutions for nursing shortages, which include:

  • Michigan joining the national Nurse Licensure Compact to allow out-of-state nurses to move to and practice in Michigan immediately.
  • Increasing eligibility for Michigan Reconnect by lowering the age requirement to 18 and older.
  • Expanding Michigan Reconnect availability to include 4-year institutions.
  • Increasing penalties for violence committed against healthcare workers.

An action alert is available in the MHA Legislative Action Center of the MHA website to complement the advocacy work of the MHA and member hospitals and health systems. This alert provides a drafted message to be sent to specific lawmakers once demographic information is provided. Members are encouraged to use and share this tool with appropriate stakeholders to help lawmakers understand the magnitude of this issue for hospitals.

The MHA is already conducting social and traditional media efforts, as well as advocacy work, on this critical issue. These efforts will continue through the next several weeks and potentially through the rest of the year.

In other legislative news, bills to make improvements to Michigan’s Medicaid expansion law were advanced from the House Health Policy Committee. HBs 4495 and 4496 were introduced by Rep. Will Snyder (D-Muskegon) and Rep. Graham Filler (R-Clinton County) and are supported by the MHA. The bills are intended to lower out of pocket costs and improve the experience for Healthy Michigan Plan beneficiaries by streamlining and removing sections that have proven to be arbitrarily penalizing, difficult to administer or otherwise ineffective at improving health outcomes. The bills now head to the House Floor for further consideration.

Members with questions about state legislation may contact Adam Carlson at the MHA.

Harmful Nurse Staffing Legislation Introduced in Michigan Legislature

Member News
capitol building

capitol buildingHarmful nurse staffing legislation was introduced May 11 in the Michigan Legislature that would mandate nurse staffing ratios, require public disclosure of the ratios and restrict mandatory overtime for nurses. The bill package is pushed by the Michigan Nurses Association (MNA) and was announced during a press conference with some of the bill sponsors.

A joint media statement was published by the MHA and the Michigan Organization for Nursing Leadership (MONL) immediately following the press conference to express each organization’s opposition to the legislation. The statement referenced the potential to severely harm hospitals and access to important services for patients if the bills become law. A statement was included in multiple media stories throughout the state.

The series of bills are even more harmful than prior versions. Changes for this session include:

  • Increasing the timeline for implementation from three years to two years for rural hospitals and one year for all other hospitals.
  • Removing a committee approach to establish staffing models, within statutory minimum staffing ratios. The new bills do not call for or allow for the establishment of a committee.
  • Increasing ratios from prior versions. The maximum allowance is now 1:4 in behavioral health, acute rehab, med/surg and post-partum.
  • Specifying ratios to only registered nurses (RNs). Prior versions referenced licensed practical nurses (LPNs) in the definition section, but these bills do not define LPNs and only specifically reference RNs only.

The bills introduced include:

  • Senate Bill (SB) 334 introduced by Sen. Sylvia Santana (D-Detroit).
  • SB 335 introduced by Sen. Stephanie Chang (D-Detroit).
  • SB 336 introduced by Sen. Jeremy Moss (D-Southfield).
  • House Bill (HB) 4550 introduced by Rep. Stephanie Young (D-Detroit).
  • HB 4551 introduced by Rep. Betsy Coffia (D-Traverse City).
  • HB 4552 introduced by Rep. Carrie Rheingans (D-Ann Arbor).

Several other bills saw action during the week. Members of the House Health Policy Committee voted to report legislation requiring drug manufacturers to report certain data and price changes to the state of Michigan. Introduced by Rep. Samantha Steckloff (D-Farmington Hills), HB 4409 would also be known as the Drug Manufacturer Data Reporting Act. The MHA sees this as an important step in providing transparency into the fastest growing expense for Michigan hospitals. For example, drug costs rose nationally by 36.9% between 2019 and 2021. This bill now heads to the House floor for further consideration.

On the Senate floor, a vote was held on Sen. Santana’s bill intended to increase access to vaccines and certain laboratory tests. SB 219 would allow pharmacists to order and administer immunizations and certain diagnostic tests for their patients without physician supervision. A new substitute was adopted on the floor, incorporating feedback from the MHA’s Pharmacy Management Committee. The new language removes unnecessary continuing medical education requirements for vaccinations, matching current standards. The MHA is supportive of SB 219, which the Senate passed by a vote of 36-1.

On the House floor, votes were taken on a package of bills that would allow Michigan citizens to designate themselves as an organ donor on state tax forms. Introduced by Rep. Felicia Brabec (D-Pittsfield Twp), Rep. Cynthia Neeley (D-Flint) and Rep. Natalie Price (D-Berkley), HBs 4362 through 4364 would provide for the question to be asked on tax forms starting in the 2023 tax year. The MHA is supportive of the legislation, which is being led by Gift of Life Michigan to reverse the decline in individuals signing up for the donor registry. Gift of Life Michigan testified in committee that states across the country are dealing with this decline, as the pandemic and online services have led to fewer trips to Secretary of State offices. The bills passed with bipartisan support and now move to the Senate.

Members with questions about state legislative action may contact Adam Carlson at the MHA.

Headline Roundup: Nurse Staffing Legislation & Staffing Shortages

Member News, Issues in Healthcare, MHA In The News, Top Issues - Healthcare
Brian Peters

The MHA received media coverage the week of May 8 regarding nurse staffing legislation, healthcare worker shortages, the ending of the COVID-19 public health emergency and more. A joint media statement was published May 11 by the MHA and the Michigan Organization for Nursing Leadership (MONL) immediately following a press conference announcing legislation that would mandate nursing staffing ratios. The statement referenced the potential for the proposed bills to severely harm hospitals and access to important services for patients, if the bills become law.

MHA representatives appearing in published stories include CEO Brian Peters, Executive Vice President Laura Appel and Senior Vice President Sam Watson. MONL President Kim Meeker, RN, BSN, MBA, also appears in a collection of stories on the nurse staffing legislation. Below is a collection of headlines from around the state.

Friday, May 12

Thursday, May 11

Wednesday, May 10

Tuesday, May 9

Members with any questions regarding media requests should contact John Karasinski at the MHA.

MHA & MONL Issues Joint Statement on Harmful Nursing Legislation Introduced in the Michigan Legislature

Member News, Top Issues - Healthcare, News Releases
Kim Meeker, RN, BSN, MBA, president of the Michigan Organization of Nurse Leaders.

The following joint statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association, and Kim Meeker, RN, BSN, MBA, president of the Michigan Organization for Nursing Leadership (MONL).

Kim Meeker, RN, BSN, MBA, president of the Michigan Organization of Nurse Leaders.
Kim Meeker, RN, BSN, MBA, president of the Michigan Organization of Nurse Leaders.

A package of bills announced today in the Michigan Legislature has the potential to severely harm hospitals and access to important services for patients, if ultimately passed. Proponents of the legislation falsely claim this will address nursing shortages in Michigan, but those claims couldn’t be further from the truth. Michigan hospitals are trying to fill 8,500 job openings for nurses. Instituting a one-size-fits-all mandate requiring hospitals hire more nurses who do not currently exist will limit the services hospitals can offer to their communities, prolong the time it takes for a patient to receive care and hinder the ability of hospitals to respond to a crisis in fear of violating Michigan law.

Tangible, proven steps are needed to attract more nurses to Michigan. Those include passing legislation that allows Michigan to join the Nurse Licensure Compact, expanding Michigan Reconnect eligibility and increasing penalties for those who commit acts of violence against healthcare workers.

Brian Peters
MHA CEO Brian Peters.

Michigan hospitals and health systems have been hard at work addressing nursing shortages over recent years. Those efforts include:

  • Obtaining a total of $300 million in state funding that has benefitted at least 69,000 healthcare workers for the purposes of the recruitment, retention and training through Public Act 9 of 2022 and Public Act 5 of 2023.
  • Securing additional nurse training opportunities including expanded state policy allowing four-year BSN programs at community colleges.
  • Expanding Michigan Reconnect to allow funds to support Michiganders moving from a licensed practice nurse (LPN) to a registered nurse, or from a patient care technician certificate to a LPN.
  • Modernizing the scope of practice for certified registered nurse anesthetists which allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources under Public Act 53 of 2021.
  • Providing emotional well-being support to healthcare workers through a partnership with the Duke Center for Healthcare Safety and Quality that has so far assisted 5,000 healthcare workers from 144 organizations throughout Michigan.

Nursing careers not only provide stable, well compensated jobs with a set of transferrable skills that rarely become obsolete, but in a rewarding environment that truly make a difference in the lives of the patients they serve. The MHA and our member hospitals and health systems, together with MONL, remain committed to focusing on effective solutions that support Michigan nurses and ensure safe patient care.