Hospital managers cringe every time a court of law or a governing body makes a well-intentioned decision that alters the way the business of healthcare is conducted. Whether by judicial reckoning, regulatory decree or legislative tally, some changes can produce damaging side effects.
Two recent examples involve providers in California, the epicenter of healthcare trends and tribulations. One undermines management authority over staff operations, and the other could interfere with peer review procedures designed to improve the quality of patient care. Both deserve further attention, especially the California Assembly's vote to regulate staff nursing ratios in the state's hospitals (June 7, p. 4).
The cause was spearheaded by the mighty California Nurses Association, with its deep pockets, fervent members and well-oiled lobbying machine. The bill would mandate one nurse for every two patients in critical-care and burn units, as well as in labor and delivery departments. While these seem like appropriate guidelines, hospital administrators need flexibility to manage staffing properly. The government is obligated to monitor patient care and ensure safety. It has no business setting staff ratios that fulfill a labor group's wish list.
Let's hope the California Senate and Gov. Gray Davis, a Democrat who was elected with strong support from the CNA, vigorously reject this lame proposal.
The second case centers on the U.S. Supreme Court's decision to let stand a ruling that pierces the confidentiality of peer review proceedings (June 14, p. 3).
The high court's indifference could hamper the peer review process, which requires a free flow of information among physicians interested in reviewing and improving their performances.
To avoid a backlash, hospital managers should brief their medical staffs on this unusual malpractice case, which involved Redbud Community Hospital in Clearlake, Calif. At the same time, healthcare lobbyists must persuade Congress to pass legislation protecting the confidentiality of peer review records.