The Committee is responsible for “review[ing] matters concerning or relating to the quality of medical care delivered to patients,
efforts to advance the quality of healthcare provided and patient safety.”1 Adequate staffing levels are critical to patient safety and highquality care. Studies show nurse-to-patient ratios significantly impact infections, morbidity, mortality, errors, and patient safety events, such
as falls.2
The number of staff per patient also impacts patient satisfaction ratings.3 This is evident at HCA’s Mission Hospital in Asheville, North
Carolina, where staffing levels were reduced from 6 full time equivalents per bed prior to HCA’s purchase in 2019, to 3.7 post-sale.4 Over
the same period, Mission’s patient satisfaction ratings dropped two points.5
Inadequate staffing levels can be caused by healthcare worker burnout, which contributes to high turnover and “harmful
consequences for patient care and safety.”6 The Surgeon General recommends healthcare organizations, “updat[e] policies for staffing
standards that ensure patient safety and health worker well-being.”7
COVID-19 exacerbated healthcare worker burnout, and the resulting impacts on turnover and patient care have been widely
reported.8 National and state policymakers responded. In January 2022, the Biden Administration awarded $103 million “to improve the
retention of healthcare workers and help respond to the nation’s critical staffing needs by reducing burnout.”9 Bipartisan federal legislation providing funds for healthcare
providers’ mental health was adopted in 2022,10 and 2024 legislation to reauthorize that law passed out of committee.11 Legislation
imposing staffing standards or mandating a process to set standards passed in several states, and was introduced recently at the federal
level12 and in Maine13 and Illinois.14
HCA’s staffing levels are reportedly 30% below industry averages in recent years.15 Eighty-nine percent of respondents to a January
2022 survey of over 1500 healthcare workers at HCA hospitals agreed with the statement, “I feel short staffing at my hospital is
compromising patient care.”16 Nursing shortages at Mission Hospital coincided with an Immediate Jeopardy citation based on nine cases,
including four deaths, and an Emergency Medical Treatment and Labor Act violation in February 2024.17
Despite staff 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. Robust board oversight of this area is crucial for effective risk
management and protection of long-term shareholder value. For these reasons, I urge you to vote FOR this proposal.