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(ASQ: Milwaukee) -- More fragmented and uncoordinated health care may be on the horizon, thanks to a growing shortage of U.S. health care workers. That’s the message from a new poll of health care quality experts conducted by the American Society for Quality (ASQ), the world’s largest network of quality resources and experts.
Poll respondents indicate the biggest quality issues patients will face in light of a staffing shortage are:
• Spotty care
• Longer waits for primary-care physician appointments
• Medical errors
The online poll was conducted with 475 U.S. health-care quality professionals who are part of the ASQ quality community. According to the poll, 44 percent of respondents say health care quality will be most affected by shortages of primary care physicians; 27 percent say health care will be most affected shortages of nurses and nursing assistants. Shortages of laboratory professionals were also mentioned as an area of concern.
The U.S. Department of Health and Human Services predicts that health care staffing shortages will increase significantly after 2014—when approximately 32 million more people will be insured, as mandated by the health care reform law, and as baby boomers become Medicare-aged.
“This trend is real and could have a negative impact on a patient’s experience as heavier demands are placed on the system,” says Joe Fortuna, chair of ASQ’s health care division. “That’s why it is imperative that health care organizations focus on enhancing their ability to prevent errors, remove waste, and improve the clinical and operational quality of the services they provide.”
How can health care organizations prevent these shortage-related quality issues? Respondents ranked the following solutions in order of priority:
1. Create fast-track units. These units allow patients with less serious needs to be seen, assessed, and treated faster and released in a timely manner. This frees emergency room (ER) staff to focus on urgent cases and improves a patient’s access to emergency services overall.
2. Install and use health care IT systems.
3. Implement checklists in the ER and other hospital departments.
4. Establish more care teams of doctors, nurses, physician assistants, and disease educators.
5. Implement a scribe program to improve productivity. Hospital scribes trail doctors from bed to bed, taking detailed notes for a patient’s electronic medical record.
Fortuna believes that health care IT systems can be helpful in a number of ways to reduce errors, improve care coordination, and enhance access to needed medical information. “Innovations like fast-track units and scribe programs are also useful,” says Fortuna. “Process redesign coupled with culture change, however, can have a huge impact on cost and quality while at the same time ensuring the sustainability of the changes, once made.”
Poll respondents identified patient electronic medical records as the IT system that will provide the most value in reducing the effects of staff shortages. Respondents ranked other useful IT methods by priority:
1. Computerized order-entry system for medications
2. Clinical decision support system: A decision support system is a computer-based information system that supports an organization’s decision-making activities.
3. Telemedicine or remote monitoring systems
4. Automated dose dispensing
5. Disease registries: Registries are collections of secondary data related to patients with a specific diagnosis, condition, or procedure.
Respondents said that increased use of quality and process engineers should be the top priority for hospitals to reduce costs in light of shortages. Other methods identified by the ASQ poll include:
• Implement mandatory process improvement training for health care.
• Create financial incentives to deliver more efficient care.
• Redesign hospital care spaces to be more efficient.
• Changes in malpractice laws.
ASQ quality improvement experts work in a diverse range of health care organizations, from hospitals to public health departments. Quality improvement methods have proven increasingly successful in health care organizations. For example, lean emphasizes removal of wasteful processes and focuses on delivering more value to patients.