"Some of these things people might call 'soft costs,' like nurse turnover," says Douglas. "But to me, money is money."
Soft costs have hard financial implications. Value-based purchasing has already put real money behind patient satisfaction. To make the link to staffing research and why it matters, we have to stop looking at staffing numbers in isolation. Until we look at the whole picture, which includes everything associated with staffing, we're not going to understand financial performance.
"Staffing costs sit in one part of the budget, so we think of the results there," says Douglas. "Then the cost of errors sits in another part of the budget. If I could say one thing to healthcare executives it is to make staffing a top strategic priority in your organization. If you look at top priorities—LOS, safety, quality—all of these things have direct links to staffing."
An organization that has cut back on staffing may not notice that it is overusing overtime and not notice that there's a relationship between the overtime and the number of infections on a unit.
Peter I. Buerhaus, PhD, RN, FAAN, chair of the National Health Care Workforce Commission, a 15-member panel composed of distinguished leaders from academia and the healthcare industry created under The Patient Protection and Affordable Care Act, published research in 2008 looking at unreimbursed errors in healthcare, such as catheter-associated urinary tract infections and central line infections.
"I decided to get out my calculator and add them up. When I looked at it in one year the total came to $21 billion in unreimbursable events," says Douglas.