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Prepared Statement WHMP

For immediate release: September 19, 2011Contact: Christina Trinchero, CDH Marketing Communications, (413) 582-2421

Safe Staffing Inquiry: CDH Supports MHA Position

NORTHAMPTON In preparation for the Legislatures Joint Committee on Public Health on

Tuesday, Sept. 20, the Massachusetts Hospital Association (MHA) summarizes the reasons

nursing rations will not work. Cooley Dickinson Hospital agrees with their summary, which

appears below:

HEALTHCARE REFORM:It's About High-Quality Patient Care forAll, Not Job Security for SomeNO TWO PATIENTS, NO TWO HOSPITALS, NO TWO NURSES ARE ALIKE.

Effective patient care must be based on the individual needs of each patient, which canchange hour-by-hour.

Because staffing needs can change along with changes in the patient's condition, nurse leadersand RNs need the flexibility to use all members of the caregiving team to meet patients' needs.

A nurse's education level, experience, as well as the technological resources of thehospital itself, all influence how a patient is cared for.

Because hospitals or hospital units aren't identical to another, their staffing should also not be

identical.

Government-mandated one-size-fits-all ratios or fixed-formulas, which are arbitrary, fixed,universal numbers, run counter to the flexible, coordinated care demanded by patient needs.

THERE HAS NEVER BEEN A SCIENTIFIC STUDY NEVER THAT DEFINES THEIDEAL NUMBER OF NURSES PER PATIENT.

While studies have shown that having more nurses is generally good for patient safety (weagree!), no study has determined the correct number of nurses yet the MNA bill would do

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just that: set a static minimum ratio for departments, units and types of nursing care that allhospitals must follow.

Hospitals must be empowered to create care systems that are tailored to each individualhospital. This flexibility allows each hospital to meet the ever-changing patient care needs withinput from direct care registered nurses.

Since California enacted its mandated ratio law in 1999, many states have looked at the

mandated approach to patient care and recognized its liabilities. After more than 12 years, nota single state has followed the lead of California.

Massachusetts hospitals were the first in the nation to voluntarily post nursing quality datathrough our patientcarelink.org website, and we believe in hospital-specific transparencyregarding healthcare quality. MHA hospitals are committed to transparency about the care theyprovide and should be held accountable for that care. This is a far more rational and effectiveway to improve patient care than ratios and fixed-formulas.

CAREGIVERS NEED THE FLEXIBILITY TO USE THE ENTIRE CAREGIVING TEAM IN

DELIVERING HIGH-QUALITY, SAFE CARE.

Flexible staffing practices determined by staff nurses, nurse leaders and hospital colleaguesworking together based on the individual patient's condition helps provide the best possiblecare.

Massachusetts exceeds the national average on numerous, scientifically based, nationallyapproved measures of patient safety and quality. This accomplishment has resulted from a singularfocus on patient care and innovation in the use of resources to improve that care.

In the five years since the Massachusetts hospital community went live withwww.patientcarelink.org the first in the nation effort providing public transparency of nurse

staffing the amount of time devoted to direct patient care by both caregiving teams and

RNs alone has steadily increased.

This means that in the harshest of economic times, when the number of patients seeking carehas increased, (that is, increased inpatient days on Medical/Surgical floors) patients arereceiving more hours-per-day of care from RNs and other caregivers.

The hospital community is proud that Massachusetts has a highly skilled nursing workforce.

Massachusetts RNs are also among the most highly compensated RNs in the country second only to California. Nurses are an essential component of

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hospital care, but they are not the only, essential piece to quality patient care. It takes a team tocare for patients!

THE REJECTED 1990's CONCEPT OF MANDATED STAFFING RATIOS DOESN'T FITWITH THE TRANSITION TO AN INTEGRATED, ACCOUNTABLE, CARE DELIVERYMODEL.

Sweeping federal and state healthcare reform efforts are already underway, tying payments tothe delivery of high-quality care. Already there is far greater transparency and accountabilityregarding how care is delivered and its cost. And, transparency and accountability will only increase

over time.

Overlaying outdated, dysfunctional government-mandated ratios on top of the newintegrated care model is inefficient and impractical. It will be a barrier to successful,meaningful systemic reform.

In order to receive reimbursements under the new system, hospitals will have to provide qualitycare in an efficient manner. That means that the full caregiving team will need to beeffectively deployed for each patient supported with the proper resources. Mandating a ratio

for some members of the team will only interfere with the efficient functioning of the team.

At a time when there is a broadly supported effort to become efficient in order to make healthcare affordable, government mandating ratios or fixed-formulas for staffing will onlyfrustrate efforts to improve care and efficiency.

If this misguided approach to care was implemented in the manner the union desires, it would

add at least $200 million annually to healthcare premiums in the Commonwealth. Otherestimates indicate the impact could be significantly higher. Adding artificial costs to thehealthcare delivery system is not in the best interests of patients, employers, state and localgovernments, or caregivers.

Reforming the health care system and providing quality care more efficiently is about

each patient being secure in the knowledge that they will receive affordable, quality care it is not about employment security.

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