At issue | March 7 Herald-Leader article, "UK alters view of top nursing honor; Officials downplay loss of once-heralded Magnet status"
I was much dismayed by the University of Kentucky's response to University of Kentucky Chandler Hospital and Kentucky Children's Hospital loss of Magnet status, a honor from the American Nurses Credentialing Center's Magnet Recognition Program.
The university's response downplayed the designation and questioned its importance since it is given from a professional society. Similar remarks could be made about other major accrediting organizations whose funding comes from the institutions they accredit.
Approximately seven percent of the hospitals in the United States have obtained Magnet status. Only five percent of the hospitals in Kentucky are Magnet hospitals.
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There is no doubt that nursing care is the key to good patient care. Approximately 50 percent of a facility's operating budget is in staffing; in some facilities the percentage is even greater. The rest of the budget is relatively fixed through contracts and purchasing alliances. Thus, an easy but dangerous way to cut costs is to cut staff.
California has approached this problem though mandatory minimum nurse-to-patient ratios. The detractors of this approach state that nursing levels should be determined based upon a patient severity of illness.
However, when quality or outcome measurements are proposed to check the level of care, it is then argued that the data cannot be accurately adjusted for the severity of illness. You cannot have it both ways.
Many patient complications — from infection rates to bed ulcers — are nursing-sensitive measures. In other words, to score well you have to provide good nursing care. Transparency and public reporting of these measures is fast becoming national policy as a means of promoting health care quality.
Twenty-seven states now mandate transparency and these initiatives are supported by the Centers for Disease Control and other major health care organizations. Standardization of state reporting systems is made possible by using the CDC's National Patient Safety Network.
During a recent Kentucky House Health and Welfare Committee hearing, it was stated that the value of public reporting was not so much in comparing different hospitals but that "you manage what you measure and publicly report."
One can only wonder if the legislature in 2008 had passed Sen. Vernon McGaha's bill on mandatory public reporting of hospital-acquired infections, whether UK would have lost its Magnet status.
Voluntary reporting of hospital quality and protocols is performed by the Leapfrog Survey Group (www.leapfroggroup.org.)
Leapfrog was formed after the 1999 Institute of Medicine report which found 98,000 Americans die each year from preventable medical errors. Its initial funding came from the Business Roundtable.
Only six Kentucky hospitals have completed this survey; another two declined to respond. UK, unfortunately, does not participate. Frankfort Regional Medical Center, which is a Magnet facility, not only responded but scores high on many parameters, including on managing serious errors. Leapfrog's policy includes waiving all patient charges directly related to a serious reportable adverse event, as defined by the National Quality Forum.
Unfortunately, the federal initiatives on non-payment of health care acquired conditions have fallen short due to the complexities of billing and have resulted in relatively few actual dollars being recouped.
Certainly a university striving to be in the Top 20 should have a hospital that is taking the Leapfrog Survey and should have as official policy waiving charges related to adverse events.
They should also maintain Magnet status and be a leader in health care transparency by helping implement a statewide policy to benefit all Kentuckians.
The status of health care policy in Kentucky is on life support. The University of Kentucky will, I hope, learn it takes more than bricks and mortar to be a Top 20 institution in the United States.