Managing in economic austerity

Speaking a while ago, newly-elected British Prime Minister David Cameron suggested that ‘the rainy day we didn’t save for has now arrived’. Many countries are reeling from the credit crunch and its financial effects. Some must now deal with the results of their own waste, debt and profligacy, while others are concerned about whether they can afford to bail them out – or afford not to. In this issue of the Journal of Nursing Management, we are publishing a selection of commentaries from around the world, which explore the local economic situation, and then consider the implications for the health system and for the nurse managers working within it. Where necessary, our writers have suggested ways forward for nurse managers. We also publish a series of papers that return to a theme, patient safety, last explored in depth in our March 2009 issue. These topics are, in turn, followed by a set of papers that examine nurse satisfaction, ways of estimating nursing workload and absenteeism, attitudes toward information technology and leadership for change, with each one of direct relevance to finance and patient safety, as well as being significant in their own right. The current financial situation in health care can be analysed in many ways, but we feel it is very useful to marshal the discussion in terms of four concepts: ‘Solvency’, ‘Safety’, ‘Sustainability’ and ‘Solidarity’ (Newbold 2008a, 2010); each one an entry portal into a web of interacting issues. Although better analyses probably exist, these concepts may at least help Journal readers start to explore the issues. The ‘solvency’ of an organization is its ability to live within its means. In order to survive, it must at least break even on the cost of its operations and pay its debts. To do this it must also have accurate and complete information on its running costs and be able to claim payment for goods and services in timely and efficient ways. Providers unable to do this may struggle. Another threat to provider solvency is cost inflation, where the price of delivering services rises as a result of rising input costs. Bodenheimer (2005a,b,c), Bodenheimer perceived threats to their registration; complaints by patients as a result of reporting the incident; difficulty managing the consequences of an adverse event; and a lack of confidence. However, limitations to human factors suggest error in health care is inevitable and if harm is to be minimized staff must report adverse events. In turn, as Moumtzoglou suggests, this requires a change in the system and culture from one of blaming individuals for failures of the system, to one in which staff aim to prevent error or minimize its harmful effects and learn from this to enhance future care delivery. Health Care Assistants play a major role in the delivery of nursing care, with a high proportion of their working day spent in direct patient contact. So they may be important in the monitoring, early recognition and reporting of markers of clinical deterioration in patients. The study by James and colleagues (2010, pp. 548–555) shows that these workers are fully able to participate, as part of the team, use an early warning system and engage in appropriate escalation behaviour if there is a problem. This is consistent with current thinking on teamwork for safety, as is the suggested usage of scenario-based learning by these authors. The paper by Riley and colleagues (2010, pp. 556–563) reports on a model for developing high-reliability teams in health care, which has four components, technical and non-technical skills, process design and a culture of safety. Experiential learning plays an important role in this, using in situ simulation, along with coaching for teamwork, standardized communication processes (inward and outward) and a ‘just culture’ which better balances an individual’s accountability for their own actions with that of the leader who the This is a very of published in an earlier issue which has potential for improving patient safety, increasing the solvency of and reducing the cost and consequences of clinical on the of nurses with their working is a in this and as patient and are to it. In this and (2010, pp. on the theme with study of nurse in and This was one of the first to in order to improve the working for with a on and was that nurse improve on in the with the of a nurse being more in 2008 being than in In the study by and colleagues (2010, pp. factors were to play a slight role in the of nurse Using a being and of the this and 2010, the important role of in a working for nurses that can improve their and hospitals were one in and one in was that nurses greater of and than their but the latter greater and the suggest that factors are also in the and and 2010, pp. to a financial theme, and colleagues (2010, pp. some very important topics which affect nurses working conditions, and patient safety. this paper the of nursing services in the arrangements of many health systems. In the for instance, these have been with costs. These are defined by and as for and other This was also in the earlier paper by Wong (2010, pp. and colleague's study (2010, suggests that the may not be the best of nursing with the potential for patients to to be from the some nursing information systems may not fully the cost of The findings of and study us for an will also to meet the true of nurses This is also by Bortoluzzi and Palese in this issue Also, in nursing with costs may make revenue and it to the impact of nursing by not it as its own cost nursing information systems may also the true level of nursing resources will be very difficult to safe care these and there is also a and present to solvency. and (2010, pp. suggest of absenteeism by nurses may to its As these the and may increase the workload and for other with a possible adverse impact on quality of care. absenteeism on the Not only it is to staff and may be with local and may lack the of events 2010) which is in improving patient safety. if the of absenteeism is then knowledge of a true running cost is also not which may solvency and the capacity of a to its true is an that any spending on nursing care be estimated and Providers unable to do this may money given the technical and impact of it is now time to make all nursing services (Newbold As in earlier if the on services is not fully for and this may in adversely affect a ability to generate quality nursing and may have an adverse impact on staff and increase the latter is not further of is with a adverse impact on outcome. technology plays a crucial role in the future financial of health providers and also in patient safety. In the paper by (2010, pp. suggests that to Health away from paper can reduce administrative costs. also suggests that of information technology in healthcare a it by health staff. was that nurses do a this However, system running and may adversely affect this. We live in difficult and austerity may that change, and the of health care innovation is necessary, for the running of clinical and even the of thing is as and suggests in this issue nursing staff will be to their leaders to the of change and how it is in their But of In this issue we have seen that the effects of the financial have out of the financial sector and into the general economy and the countries with serious financial problems Italy, Spain and to be on a similar public sector pay freezes or cuts, of and public sector public sector and taxation and The health sector in these and other countries may see its share of these cuts and so it is that appropriate reforms As Bodenheimer and Fernandez suggest the to are that are cost they also at least the same level of quality and then it is to be an efficient Many nursing are capable of this and we would also nurse in this better health care delivery systems are needed in order to the issues of safe care, with access and this issue shows the potential of new to do this. knowledge of the costs is needed along with financial management of nursing resources, fully nursing services (Newbold and systems to enhance revenue capture for nursing (Newbold leaders and managers are well to have a very on this and the ability of the health sector to the financial will on their ability and