QUALITY: On-the-Job Training Lowers Turnover Rate of Nurses

After decades of letting newly-licensed nurses sink-or-swim on the job, some hospitals are finally tossing their new nurses a life preserver. The goal is both better quality care—-and fewer newly-minted nurses who quit.

 According to the Los Angeles Times, a recent national study found that one in five newly licensed nurses quit within their first year of work. This is not what we need given our nursing shortage. Peter Buerhaus, of the Vanderbilt University Medical Center, told the LA paper that we could have a shortage of 500,000 nurses by 2025, due to increasing rates of retirement and the demands of the aging baby-boom generation. This shortage too comes at a time when nurses may actually have a larger role to play in a reformed health where we place more emphasis on primary care, care coordination, and management of chronic diseases.

COST: Hospitals and the Economic Crash

There's a strain of conventional wisdom that the health sector is recession-proof but it's not so clear that it's true when a recession is this broad and deep. Many people who are losing their jobs also are losing their insurance, and there's ample data to remind us that the uninsured and the underinsured skimp on care, which in turn affects hospitals and other providers. Even the insured are watching their health care pennies. PBS's NewsHour, in the first of a three-part series this week, profiled a husband and wife paying $800 a month for a family health insurance policy but their out-of-pocket expenses were still so high (and his mortgage-industry income nicked because of the real estate crash) that they had to choose between treating her gall bladder problems or his lung infection.

The American Hospital Association, in a bid to secure hospitals a share of the upcoming stimulus package, started running ads noting that community hospitals directly employ more than 5 million people, and hospitals support a tenth of all US private sector jobs. In 2007 45 percent of all new private sector jobs were in health care. But income is down as patients delay getting care and the demand for uncompensated care rises. Many hospitals are feeling the pinch.

COST: The Slump's Impact on the Health Care Sector

Health care is usually deemed more or less recession proof. Maybe not this time, according to a recent Chicago Tribune article that analyzed several Moody’s Investor Service reports on sectors including hospitals, medical devices and insurance companies. Bottom line: Moody's revised the health care industry’s 12- to 18-month outlook from "stable" to "negative."

HEALTH REFORM: The Health Agenda of a Hockey Mom

We just posted an item about how health played at the conventions. Now for those of you who want to learn something about Gov. Sarah Palin's health reform history, here's some recommended reading.

The Washington Post and the Wall Street Journal both look at her record on health care in Alaska, and find it's fairly slim. Her focus was naturally in keeping with her free market philosophy. She pushed for more transparent information for consumers, and waged an unsuccessful fight to end the state's certificate of need rules, even after an expert panel she appointed recommended that the CoN law remain on the books.

CULTURE BEAT: "HOSPITAL" Takes Us Inside Culturally Complex Brooklyn Hospital

Picture an urban hospital where 67 languages are spoken, the Chinese food is glatt kosher, and the most exotic ethnic species is a blond Nebraskan surfer named Davey doing his medical residency in the E.R. Welcome to Maimonides Medical Center, in Borough Park, Brooklyn.

In HOSPITAL: Man Woman Birth Death Infinity Plus Red Tape Bad Behavior Money God and Diversity on Steroids author Julie Salamon gives rare insight into one year in the life of a large, complex, urban hospital (Read Jackie Judd's interview with Salamon about her new book here). In 2003, Maimonides admitted 38,667 patients, 127,319 were seen in its outpatient clinics, and 81,190 passed through the Emergency Department. More than 6,000 babies were born; more than 1,000 people died.

INNOVATORS: Wisconsin Hospitals Trim Waste and Improve Care

"There are two things we need to do in medicine," a hospital administrator told Guy Boulton of the Milwaukee Journal Sentinel recently. "We need to learn to see waste. And we need to see risk."

The paper wrote a thoughtful two-part series (here and here) recently documenting how ThedaCare, a four-hospital chain in Wisconsin, has used those two guiding principals not just to save money but to improve patient care. They've re-examined everything from washing sheets to heart surgery. They've saved money—and improved outcomes for patients. They've shortened waits for appointments for CT scans. And they've eliminated hundreds of forms.

One example: an uncomplicated heart bypass surgery, including the doctors' fees, cost $30,400 at a ThedaCare hospital. At some other southeastern Wisconsin hospitals, insurers pay more than double that.

A lot of the improvements can be seen in the general medicine unit at ThedaCare's Appleton Medical Center, where they've introduced a model called "Collaborative Care." The unit serves patients with infections, pneumonia, heart failure, and similar problems. The improvements have cut the amount of time patients typically stay in the hospital by 20 percent.

QUALITY: What If All Patients Could Go to a "Benchmark Hospital"? Part II

Yesterday I posted on this year's "100 Top Hospitals: National Benchmarks for Success" list, released this week by Thomson Healthcare. I promised I would post today about how to get from here to there.

I bet you lost sleep with anticipation!

Again, I want to quote Steven Pearlstein's column last year on this issue, specifically the story of how Winchester Medical Center in Virginia responded to its "somewhat disappointing" report a few years ago:

Winchester Medical Center set a goal of making the Top 100 list by 2008. It hired a consultant, altered its executive compensation to put a bigger emphasis on quality and organized teams in every department to implement small changes in procedures that translate into big improvements in its quality score.

After nurses took extra time to take fuller medical histories, and body hair was clipped rather than shaved before surgery, and the timing was changed on when antibiotics were administered, for example, surgical infection rates fell by 75 percent.