Helping Nurses

Over the weekend I had some interesting conversations with local nurses about the quality of care, and nursing care in particular, at local health behemoth UPMC Health Systems.

This morning, I read that new PA legislation took effect last week that bans mandatory overtime for nurses. That sounds like a win for both nurses and patients.

For all of the region's current pride about "eds and meds" driving the new Pittsburgh economy, and for all of the related celebration of regional "innovation" (on the one hand), and for all of the bleating about the sheer scale and wealth of UPMC (on the other hand), I don't read much about UPMC and innovation, especially in health care administration.

That's not a surprise. If UPMC is a monopolist, then as a monopolist it has little reason to innovate.

But that failure to innovate -- the fact that the Pennsylvania Legislature (no model of innovation itself!) intervened to force a change in practices -- is a disappointment.

Maybe I've missed an important story. Is that right? I've dealt with UPMC as a provider and insurance carrier for many years. The care has been fine, but the administration has been mediocre. I had a lot of contact with Kaiser Permanent in Northern California before I moved to Pittsburgh, and I was (and am) impressed with how that organization was run. Here and there, most recently in The New Yorker, I read stories that hold Kaiser up as something of a model of an efficient health care enterprise that delivers high quality care. Am I right that UPMC is a laggard on the first part of that equation, at least?

I'd rather be shown to be wrong.

Comments

5 Responses to "Helping Nurses"

EdHeath said... 7/07/2009 8:13 AM

I recently had an emergency room visit and overnight stay In Shadyside for something that appeared like a heart attack and turned out to be vertigo (I posted on it on my blog). I hope that my experience was atypical, though I fear it was not. The staff was kind, but clearly overworked. I was hooked up to a machine monitoring my heart, but if I had had a stroke or some other kind of incident, it would have been up to me to attract the attention of the nurses. Otherwise no one might have noticed for an hour or more.

Paul O'Neill had an interesting column in the NYTimes yesterday. I don't believe his observation that Obama/the Democrat's health care proposals do nothing to address medical mistakes is quite accurate, but O'Neill is quite right that addressing medical mistakes is an important and currently overlooked tool for saving money. O’Neill pointedly mentions doctors who have lead the way to cut the rate of infections at hospitals in Utah, Seattle and at UPenn. The fact that he did not mention a Pittsburgh hospital is doubly embarrassing since O’Neill does live in Pittsburgh.

The fact that the US spends more per capita on health care (and probably absolutely more almost every other country), has dismal health statistics and still has tens of millions uninsured indicates in stark terms the need for healthcare reform. Fixing medical mistakes should be a cost cutting part of that reform. But it is something we should do no matter what the outcome of the rest of the healthcare debate. Hospitals would reduce the average length of stays if they didn’t need to fix mistakes that were made because their employees are overworked.

Jonathan Potts said... 7/07/2009 9:37 AM

In March, my mother had to be rushed to UPMC St. Margaret when she had bleeding in her esophagus related to a liver condition. She sees a specialist at UPMC Presbyterian, but she was taken to St. Margaret because it was the closest to the retirement community where she lives.

She spent an entire night in the emergency room, where she nearly died, because no beds were available in the ICU. However, what is most notable is that it was exceedingly difficult for anyone at St. Margaret to get her medical records. I found that odd because my PCP, part of the UPMC physicians network, can easily call up my records in her office, including procedures that occurred before I was her patient. In fact, my sister had to get the number of my mother's specialist from the address book at my mom's apartment. The folks at St. Margaret had a tough time looking it up.

One person who worked there said that since St. Margaret became part of the UPMC system, a lot of physicians have gone to work there, transforming what was once a sleepy suburban hospital into a very busy -- and from what I could see, overcrowded -- medical center.

Just some thoughts that speak to what you are getting at.

Anonymous said... 7/07/2009 11:20 AM

I think the same could be said for Passavant Hospital in McCandless. I once non-profit community hospital is now part of the "non-profit" UPMC Health System.

joe said... 7/07/2009 1:37 PM

On cue, here's a new AP article on innovations in electronic medical record use at the new Children's.

Crystal Eastman said... 7/21/2009 4:31 PM

the organized healthcare workers of SEIU Healthcare PA are largely responsible for the mandatory over-time legislation.

another example of how workers being organized benefits the whole community.

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Pittsblog 2.0 is written by Mike Madison, a law professor at the University of Pittsburgh. Send email to michael.j.madison[at]gmail.com. Mike also blogs at Madisonian.net, on law and technology. Chris Briem of Null Space drops by from time to time.

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