July 1 marked the reporting deadline for the Minnesota Hospital Association to report actual nurse staffing for all facilities in the state. MHA already reported the staffing plans for each hospital on April 1, 2014. The numbers are there, but the truth is less than transparent.
The Minnesota hospitals reported nurse staffing, but they also combined it with the care hours of other types of staff, which could include everything from nutritionists, case workers, and even clergy. The time licensed nurses and non-nurses spend directly with patients is broken down into “Worked Hours per Patient Day” otherwise known as HPPD in hospital budgeting terms. That number can be higher or lower than the actual planned number, but the average consumer has no guidance on what number assures him or her the quality care they deserve.
Instead the numbers are a jumble of mystifying data that will confuse patients and their families rather than help them make educated decisions on where to receive the best care. This is not the transparency that hospitals agreed to provide patients and their families who need to make a decision on where to find good healthcare.
Take a look at the following snapshots from the hospital reporting website. They show a large, metro hospital Med/Surg unit and a small hospital in greater Minnesota. Given these numbers, which hospital would deliver better patient care? The consumer is still helpless in a sea of meaningless data.
Here’s the link to look up your own hospital and compare it to others nearby: http://www.mnhospitalquality.org/NSFacility.aspx
While accessing this data, ask the following questions:
- How are hospitals defining “direct patient care?” Is it nursing care or do other employees, such as pharmacists, dietitians, and nurse managers who seldom see patients count their hours here as well?
- As a consumer, should I be looking for a hospital with a low HPPD number, which means they’re not as busy, or a high HPPD number that means they employ lots of nurses and have lots of patients?
- Who exactly is counted as other assistive personnel?
- How do nursing assistants differ from nursing aides in the care they deliver?
- Are all hospitals and units within hospitals reporting their staffing data? Is my hospital missing?
- Do these figures rely on averages, such as average patient counts? If so, how is the number of patients in the hospital counted each day? How much higher than the average does it go at my hospital and when? Should I avoid a hospital at certain times of the year?
- Isn’t there a simpler way to report how many nurses are on duty at a given time? How is this data helpful to me as a patient?
Interestingly, when hospitals budget their staffing they don’t use figures and models like this. They use simple grids that show patient count (also called census) on one side and staff needed on another side. If patients had a minimum standard of care in Minnesota, they could choose any hospital knowing that regardless of the number of patients or the severity of illness by other patients they’d still receive the quality care they deserve.