Tensions are rising at the University of Wisconsin School of Medicine and Public Health. Nurses are pushing the UW Hospitals and Clinics Authority Board to recognize their newly established union, even though recent legislation effectively bars the health care system from reaching any collective bargaining agreement with its employees.
UW nurses want more room at the negotiating table after a round of sweeping budget cuts that are pushing nurses and healthcare workers to the limit. With fewer nurses on the floor, providers are being forced to split their time between dozens of patients, leading to negative health outcomes, increased burnout and stress, unsafe working conditions, and poor employee retention.
Hospital administrators claim the budget cuts are needed in order to keep the facility financially afloat. They are using complex algorithms and big data to improve efficiency while reducing nurse-patient staffing ratios as much as possible.
Learn more about this contentious disagreement and how Wisconsin nurses are standing up for themselves and their patients.
Cutting Costs by Any Means Necessary
Healthcare facilities across the country are looking to reduce costs. A recent survey from the Navigant and Healthcare Financial Management Association shows that nearly half of chief financial officers and other executives considered cutting labor costs as their top financial strategy for 2019.
These cuts often come at the expense of healthcare providers and ultimately, patients. Curbing costs often means reducing staff. As a result, nurses are forced to spend less time with their patients. They must care for them on a purely physical level, instead of focusing on compassion and empathy. Statistics have shown that reduced nurse-patient staffing ratios can lead to increased burnout and stress, while reducing workplace safety and diminishing quality of patient care.
Relying on Big Data
Several Wisconsin hospitals have resorted to extreme measures to reduce healthcare costs. In a statement to employees, Dr. Alan Kaplan, CEO of UW Health, related the problem to an “unprecedented shift in our industry” where the growth of expenses is outpacing revenue.
As Kate Walton, an emergency department nurse at UW Health, said in an interview, “It was very strange because we’ve always been a fairly financially sound institution. It was very much sold to us — if we didn’t make these cuts, we’re in a lot of danger.”
As costs continued to climb, UW Health eventually turned to Prism Healthcare Partners, a Chicago-based consulting group, for assistance. Together, they set an ambitious goal: Save $80 million over 18 months. Prism specializes in creating algorithms that use big data to suggest sweeping organizational changes; specifically, improving efficiency and reducing costs. Prism helped UW Health set up an algorithm that would essentially reduce staffing ratios as much as possible without putting patients in harm’s way.
Over the next couple years, the health system employed 284 fewer nurses than it did a year earlier. The algorithm also suggested reducing onboarding costs for new hires, eliminating management positions, reducing overtime, and leaving open positions empty. The facility also opted for poor quality medical supplies in hopes of reducing costs. For example, plastic urine collection bottles now feature sharp edges that can cut male patients.
UW Health nurses have started to feel the pressure. Different departments are now pleading with each other in order to share or borrow certain nurses when patient volumes are high. One text message read, “Roses are red, violets are blue, we need a sixth RN and I think it’s you.”
The algorithm regularly predicts how many nurses are needed on the floor based on previous data and current patient volumes. It also calculates productivity. It will only request additional nurses once certain productivity thresholds are met. Mariah Clark, an emergency department nurse, said sometimes her department gets a few extra nurses than the model deems necessary, but they are often sent home early. These nurses are then forced to use their vacation time or go unpaid if their hours are cut.
In the end, the algorithm worked. UW Health exceeded its initial savings target, saving $105 million since 2017. Reduced labor costs accounted for $42 million of these savings.
For facility nurses, it’s a pyrrhic victory, at best.
How Wisconsin Nurses Are Fighting Back
UW Health nurses are being pushed to the breaking point as they struggle to adjust to these new protocols. Walton recalls having to stay late after a 12-hour shift when she saw a new nurse having to care for a terminally ill patient. “I knew that she didn’t feel comfortable and there wasn’t really anybody else that could stay and help.” In another instance, a patient in labor called out for pain medication for nearly an hour before a nurse came on the scene.
Nurses are pushing for unionization in order to address these issues. However, Wisconsin sharply reduced the power of unions back in 2011. UW Health nurses argue that the hospital board can choose to recognize their newly formed union, regardless of the law.
The “Lean” Model
UW Health is using what the industry calls the “lean” model. Since the model went into effect, the proportion of nurses who “intend to stay” at the hospital fell from 89% to 83% from 2016 to 2019.
Many nurses have adopted the phrase, “Lean is mean.” Relying on algorithms can overlook the human factor of healthcare. Nurses and providers are often reduced to simple statistics. Overall, providing care is starting to look more like manufacturing and less like a human-to-human interaction. Nurses are being asked to complete routine tasks as quickly as possible, but this can lead to costly mistakes – and that’s just the beginning.
Many healthcare organizations are currently battling and preparing for the coronavirus. Reduced nurse-patient staffing ratios can leave facilities unprepared for certain public health emergencies. Facilities may be suddenly overwhelmed with patients in the event of an outbreak with few nurses on staff to cover this surge in demand. The “lean” model does little to account for the unexpected in healthcare. Some facilities may rethink this approach as the coronavirus continues to spread.
Nurses around the country are organizing in opposition to the “lean” model. Stay tuned as these trends continue across the country.