The Future of Public Hospitals: Cuts in HHC

The Patient Protection and Affordable Care Act—the health care reform law that Congress passed this year—will extend health coverage to almost 35 million people who may have relied on public hospitals and clinics for their care when they were uninsured or underinsured. But what will happen to them once the uninsured are covered and have a wider range of choices for care?

HHC President Alan Aviles

This question is complicated by cutbacks in federal, state, and local funding for safety net hospitals and clinics. One month ago, Alan Aviles, president of New York City’s Health and Hospital Corporation (HHC) testified before a New York City Council executive budget hearing on the corporation’s plans to reduce spending by $600 million from a system that has a $1.2 billion deficit. Cuts extend across all areas, including corporate-level nursing, physicians, maintenance services, and others. More cuts may be forthcoming as the state and city tighten their belts.

What are the implications of these cuts? Here are just two.

First, we still have millions of uninsured and underinsured and, while the new health care reform law will reduce these numbers, it won’t cover everyone. If safety net facilities close as their patients become insured and go to private facilities, where will undocumented immigrants get health care? This is a humanitarian concern but it’s also a public health issue since communicable diseases care nothing of citizenship. And a change in the political climate in the future could roll back gains in insurance coverage—then where will people go for health care? Imagine Bellevue Hospital closing. Will other hospitals be able to expand their capacity? Aviles says that no patient will be turned away and HHC will close no hospitals. But that’s today’s message, not tomorrow’s.

Second, over 2,400 positions will be eliminated through layoffs or attrition. During a time when jobs are scarce, those who have been laid off will join the ranks of the unemployed with few immediate prospects.  I was concerned that all of the corporate level nursing staff was cut, including chief nurse officer Marie Ankner. Today, best practice in health care systems is to have a chief nurse officer at the corporate level to ensure integration of nursing services across facilities, provide a vision for promoting excellence in nursing care, and to seize opportunities for cross-facility initiatives. HHC Director of Media Relations Pamela McDonnell told me that a chief nursing executive is being hired for the corporate office.

It sounds like Aviles has little choice. Certainly, these are difficult financial times. But it will take close monitoring to ensure that essential services to protect the public and provide the fundamental elements of health care are preserved in what is probably the nation’s largest public health care system.

Diana J. Mason, PhD, RN, FAAN

The Patient Protection and Affordable Care Act—the

What’s Joy Got to Do With Work?

Abba*

Founders of Ben and Jerry's Ice Cream

Can you imagine a group of busy health care professionals coming together for a week to discuss joy in and at work and its relationship to the quality of that work?  

For the past five or six years, I’ve attended an annual conference that the participants call “Summer Camp.”  Its real title is “Building Knowledge for the Leadership of Improvement of Health Care” and was started 17 years ago by Paul Batalden, a professor and pediatrician at The Dartmouth Institute for Health Policy and Clinical Practice. Each year, the group of about 70 health care administrators, physicians, and nurses (about one-third each and most of whom hold academic appointments) explores a different theme related to the quality and safety of health care. It’s a fairly consistent group and it has become a supportive and generative community. The group uses various modes of teaching and learning: theory ‘bursts’, individual and group exercises and discussion, poetry, film, food, physical activity, and simply rich conversation.

This year, it felt a bit frivolous to tackle joy in work when so many people feel overwhelmed with long work hours, multiple demands and roles, and connectivity that never ends—except in the learning sessions at camp where blackberries and pagers are off limits. But joy should not be confused with frivolity. The literature attests to the connection between joy at work and creativity and excellence  in an organization. Wouldn’t we all want to work for organizations that care as much about the engagement and joy of its employees as they do about the bottom line? Joy in work by employees may be essential to that bottom line. TCAB, or Transforming Care At the Bedside, is an initiative that includes team vitaility as an aim and has been able to reduce the turnover of nurses.

By the last day, I saw new ways to actualize what I’ve long believed—that we’re each responsible for creating and maintaining a supportive, joyous work environment and that joy at work can lead to better work.

How long will this feeling of certainty and commitment last? We’ll see, but I’m already working on the ways I can up the joy quotient in my work and at my work. Ben and Jerry’s Ice Cream has even formalized the importance of joy in the mission and organization—this company has a different CEO, a chief euphoria officer. Go Ben and Jerry’s!

Diana J. Mason, PhD, RN, FAAN

Co-director, CHMP; Rudin Professor of Nursing

“So I say Thank you for the music,