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The US health care is a complex system of mechanisms and regulations that requires continuous improvement. This complexity leads to the fact that national healthcare has many shortcomings that need to be systematically and efficiently corrected.
One such problem is budget cuts in hospitals, which result in layoffs of support staff, cuts in nurses’ salaries, and an increase in their workload. This problem significantly affects the work of the team and the quality of care. Consequently, this paper will consider the problem of staff reduction due to lack of budget, its causes, and consequences, to propose options for solving it.
Causes and consequences of the problem
The reduction in the hospital’s budget is a consequence of inefficient allocation and management of funds, as well as poor quality of services, which leads to the loss of clients. Park et al. (2018) examine the different payment models for the four primary health care categories and finds that they all have advantages and disadvantages. Our hospital uses a fee-for-service system that encourages usage of more services but is retrospective (Park et al., 2018).
In other words, the hospital is not interested in saving money for their investment in improving hospital performance. Consequently, the lack of this opportunity deprives hospitals of one of the sources of budget increases and leads to the need to cut off support staff.
In turn, the reduction in staff leads to an increase in nurses’ workload at lower salaries. This fact affects the team’s job satisfaction and the quality of their service because of the low motivation to work and the reduction in the time of service for each patient. Consequently, patient satisfaction with the quality of service decreases, and the likelihood of re-readmission increases (Pérez-Francisco et al., 2020).
At the same time, according to Hospital Readmissions Reduction Program (HRRP), the financing of hospitals with a high level of readmission should also be reduced, since they do not demonstrate effective work. At the same time, Upadhyay et al. (2019) note that reducing readmission leads to revenue growth related to a decrease in re-treatment expenses. Thus, this situation leads to further budget cuts and a lack of funds for infrastructure changes and personnel.
The Solution to the Problem
The above analysis demonstrates that the hospital requires a change in the payment model, as well as the introduction of more efficient working methods for nurses. In the first case, the hospital can use the traditional capitation system combined with pay-for-performance presented in the article by Park et al. (2018).
Traditional capitation involves raising funds before providing services, which gives the hospital flexibility and the ability to allocate resources efficiently (Park et al., 2018). However, since this approach has a risk of low-quality service provision, the pay-for-performance system helps avoid this disadvantage (Park et al., 2018).
In other words, the hospital will receive prepayments (prospective payments) based on past months or years’ performance, and better quality will mean more budget. Thus, additional funds can be used to motivate or hire additional personnel, which will improve the quality of services, reduce the number of readmissions and make possible government funding.
However, since this process is time-consuming and can be challenging, the hospital also needs to invest in staff training and making them more efficient. The approach of distributing treatment and patient care duties among different specialists is often used by other organizations to solve problems of staff shortages. Norful et al. (2018) note that the collaborative management of patients by nurses, physicists, and other specialists increases the effectiveness and quality of treatment, reduces the individual workload and burnout of nurses.
Therefore, a gradual transition to this approach will lessen the nursing workload even with limited funds. Moreover, although this training is also a challenge, programs, such as one proposed by The National Center for Interprofessional Practice and Education, offer training to build interprofessional teams (Ricketts & Fraher, 2013). Therefore, it is the hospital’s job to provide such training for its staff, taking into account the work tasks and schedule.
Thus, the solution to the problem of the high workload of personnel has two ways that must be carried out collaboratively. Changing the payment system for services increases the budget due to the ability to control the distribution of funds and costs. At the same time, the transition to collaborative patient management will reduce the individual burden on the nurse and improve the quality of care. Thus, over time, these two changes will help increase the efficiency of staff and at the same time increase the budget and invest it in the development of the hospital.
Conclusion
Analysis of the issue of budget cuts in hospitals demonstrates that this problem leads to a chain of negative changes. Lack of funds means reduced support staff and nurses’ salaries, which negatively impact their job satisfaction, motivation, and ability to provide quality care. This fact, in turn, leads to the loss of funding opportunities through government programs and further budget cuts.
However, changing the system of payment for services to a prospective one will allow the hospital to control costs and direct funds to critical areas such as hiring and training personnel. At the same time, the simultaneous application of a pay-for-performance system will ensure high-quality service delivery.
In addition, training staff on how to manage patients collaboratively will allow for more efficient distribution of tasks and reduce the individual workload of each professional. Thus, over time, improving the quality of services and using an effective system for obtaining and distributing resources will solve the problem of a lack of budget.
References
Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. The Annals of Family Medicine, 16(3), 250–256. Web.
Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the quadruple aim. The Journal of the American Board of Family Medicine, 31(4), 588–604. Web.
Pérez-Francisco, D. H., Duarte-Clíments, G., del Rosario-Melián, J. M., Gómez-Salgado, J., Romero-Martín, M., & Sánchez-Gómez, M. B. (2020). Influence of workload on primary care nurses’ health and burnout, patients’ safety, and quality of care: Integrative review. Healthcare, 8(1), 1-14. Web.
Ricketts, T. C., & Fraher, E. P. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs, 32(11), 1874-1880. Web.
Upadhyay, S., Stephenson, A. L., & Smith, D. G. (2019). Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospitals. Inquiry : A Journal of Medical Care Organization, Provision and Financing, 56, 1-10. Web.
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