Dear Colleagues,

Patients deserve our care...so let's work together to ensure that they can afford it. This is the challenge we face in the midst of a gathering storm in health care. 

Each year, hospital revenue typically increases 4 to 6 percent, with hospital costs increasing slightly less. In the coming fiscal year, which begins October 1, costs are projected to increase at a much higher rate than revenue for the first time ever. Revenue is increasing 0.6 percent, with costs projecting to increase 4.8 percent. This ratio of revenue to cost is not sustainable.  For us, that means it cannot be business as usual. 

As payers shift more of the financial risk to primary providers and patients, both are demanding greater value. Value equals quality of care over cost of care. At an organizational level, value means that we are providing patients with the right care in the right place at the right time. 

What can each of us as individuals do to create greater value? The narrative on page 3 by September Wallingford, BSN, RN, a clinical nurse on Tower 15CD, is a great example of what nurses can do to improve patient care and decrease unnecessary testing. I know that creative solutions lie within all of us if we can think beyond the paradigm "we have always done it this way." 

The reality is that this new economic environment will require us to fundamentally change the way we care for our patients.  You will all play a critical role in creating our path to the future. Here are a few examples of ways nurses can contribute: 

Actively participate with local leadership in efforts to decrease length of stay and question the efficacy of redundant tests and labs, as September did. 

Participate in your local practice councils and process improvement teams to continuously advance the quality, safety and experience of our patients. This is our passion and the right thing to do for our patients. Now, however, payers are putting more dollars at risk for our organization based on performance on quality metrics, such as patient satisfaction, falls, hospital acquired infections and pressure ulcers. 

Implement the discharge bundle, an evidenced-informed intervention to decrease 30-day readmission rates. The bundle includes warm hand-offs or telephone calls when patients are transferred to an outside facility, post-discharge telephone calls to patients at home, using the teach-back method when teaching our patients, especially regarding how to take their medications, and ensuring that patients leave with a follow-up appointment in hand.  These actions have been shown to reduce the likelihood that patients will be readmitted with the same diagnosis within 30 days of their last discharge. 

While we eagerly anticipate the roll out of eCare in May 2015, and the efficiencies the system will bring, we know that we are all responsible for coordinating care and improving efficiency wherever possible.  I am proud of the work that each of you does every day to position BWH to thrive in this challenging economic environment. I will commit to doing the same. 

Thank you, as always, for all you do in service to our patients, their families and each other. It is my pleasure to serve you. 

With warm regards, 

Jackie Somerville, PhD, RN

senior vice president of patient care services and chief nurse