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Mandated nurse staffing ratios are the wrong approach to patient safety

Around the clock, highly-trained teams of healthcare professionals converge on patients who desperately need their care. Nearly 24,000 patients seek care in New York State’s emergency rooms each day, with 6,000 patients sick enough to require inpatient admission. Those new admissions, combined with the tens of thousands of patients already occupying inpatient beds, illustrate the constant imperative to keep patient safety top of mind.

Proponents of mandated nurse-to-patient staffing ratios would have state policymakers believe these ratios are the best way to keep patients safe. Not only is this wrong, but this outdated, myopic proposal would take New York backward on the progress underway with other broadly-supported, evidence-based approaches to improve patient safety.

High-quality, patient-centered care is the number one priority of New York’s hospitals, which have been working for years to improve patient safety, with positive results. For instance, the New York State Partnership for Patients (NYSPFP), created in 2011, has helped more than 175 participating hospitals make significant gains toward the nationwide goals of reducing hospital-acquired complications and preventable readmissions. As a result of this long-term, broad-based effort, doctors, nurses, and other caregivers better understand the evidence-based steps needed to deliver the highest quality care and improve patient outcomes.

The healthcare community has also embraced the importance of a safety culture that values critical thinking and recognizes the essential link between proper training and a supportive culture to ensure proper execution.

The effort to create this culture exists in other high-risk industries that must reliably achieve safe outcomes, such as aviation. For example, the calm, precise approach of Captain Tammie Jo Shults on Southwest Airlines Flight 1380 last week didn’t happen by accident. Years of training and a culture that supported her decisive actions enabled Captain Shults and her team to effectively respond and protect their passengers.

In healthcare, the effort to enhance this safety culture has manifested in hospitals’ pursuit of high reliability. Many New York hospitals are already on their journey toward high reliability, voluntarily driving that progress, because that approach has been proven to work.

As described by the Agency for Healthcare Research and Quality (AHRQ), high reliability organizations “work to create an environment in which potential problems are anticipated, detected early, and virtually always respond early enough to prevent catastrophic consequences.” The culture of high reliability empowers caregivers through the principle of deference to expertise to those on the front lines of care.

We need to support work cultures that recognize the important contributions of all caregivers, not just some. Responding to the conditions of the moment requires a certain type of expert nimbleness, so that teams with the appropriate mix of expertise are always available to deliver patient care. This agility must extend to all - not just the physicians and nurses, but the case managers, respiratory therapists, and others who directly and indirectly impact patient care. The inflexible, one-size-fits-all approach of mandated staffing ratios fails to consider recent advances in how care is organized and delivered and fails to consider improved care models on the horizon.