SUPPORTING STATEMENT

The Committee has a responsibility to “review matters concerning or relating to the quality of medical care delivered to patients, efforts to advance the quality of health care provided and patient safety.”1 Adequate staffing levels are critical to patient safety and high-quality care. Studies show that as the number of patients assigned to a nurse increases, so too do morbidity, mortality and patient safety events such as falls and post-operative infections.2

Inadequate staffing levels can be caused by health care worker burnout, which according to a recent report by the U.S. Surgeon General, contributes to high turnover and staffing shortages, as well as “harmful consequences for patient care and safety.”3 At the same time, inadequate staffing levels and the stress associated with working under those conditions, causes turnover, creating a vicious cycle. The Surgeon General’s report recommends that health care organizations “updat[e] policies for staffing standards that ensure patient safety and health worker well-being.”4
The COVID-19 pandemic’s exacerbation of health care worker burnout and the resulting impacts on turnover and patient care have been widely chronicled in media reports.5 Policymakers are responding: in January 2022, the Biden Administration awarded $103 million in American Rescue Plan funds “to improve the retention of health care workers and help respond to the nation’s critical staffing needs by reducing burnout.”6 Bipartisan federal legislation providing additional funds for physician mental health care was introduced in the House in 2022;7 legislation imposing staffing standards, or mandating a process to set such standards that incorporates health care workers’ input, has been passed in New York8 and Colorado,9 and introduced in Washington10 and Pennsylvania since the start of the pandemic.11

HCA’s staffing levels are reportedly 30% below the industry average in recent years. Eighty-nine percent of respondents to a January 2022 survey of over 1,500 health care workers at HCA hospitals agreed with the statement, “I feel short staffing at my hospital is compromising patient care.”12 An HCA nurse recently published an opinion piece in Newsweek describing patient care and safety consequences of inadequate staffing.13

Despite staffing levels’ importance, the Committee’s charter does not specifically identify them as a factor the Committee should review in connection with its oversight of patient safety and quality of care. We believe that robust board oversight of this area is crucial for effective risk management and protection of long-term shareholder value.