A way to bend the cost curve up

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Minimum staffing provisions in public sector union contracts – largely in police and fire departments – are a major reasons those services are so expensive.

They lead to massive, unnecessary overtime costs and are easily abused – it is simple for a worker to call in sick so a friend can pick up some extra OT.

It also turns the proper relationship of manager and worker on its head – employees, not management, dictate how many people are required to do a task. The union, naturally, wants as many people as possible on a task, a vehicle, a shift. It undermines efficiency and productivity, by design.

Gov. Deval Patrick and state legislators, who huff and puff about “bending the cost curve” of health care down, ought to keep that in mind. If they cave to pressure from the Massachusetts Nurses Association to impose mandatory minimum staffing, they will bend the cost curve in the wrong direction.

Lynn Nicholas, president and CEO of the Massachusetts Hospital Association, makes the right arguments in a Boston Globe op-ed today:

The union wants fixed and inflexible staffing ratios for nurses. But clearly there is no “one size fits all’’ method for achieving high quality, safe patient care, nor should there be. Especially during this time of dramatic, fundamental change in health care, it’s time to think — and act — outside of the box, while keeping patient safety at the forefront.

Shackling hospitals with cookie-cutter methods for delivering care stifles innovation. It ignores the needs of individual patients. And it doesn’t acknowledge our nurses’ individual levels of expertise and experience. Nurses need to be treated fairly; likewise, nurse managers need the flexibility to use all of the resources at their disposal.

Legislators may dismiss Nicholas as a special interest. She is, of course. But so is the union. Legislators also love to portray themselves as standing up for working people. That’s fine too, but they should keep in mind that it is working people who pay for health care costs spiraling well beyond the rate of inflation every year.

Beyond that, they should not be injecting themselves into micromanaging the labor/management relationship. Their track record of managing market forces is abysmal.

There is no need for a study on what minimum staffing would do. The evidence is there, in police and fire departments across the state, that it usurps the proper role of management and, no surprise, drives up costs.

Would the governor and legislators allow their own employees to usurp management rights? Not likely. They should not force it on hospital managers either.