A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?

Source: Ann Hendrich, Marilyn P Chow, Boguslaw A Skierczynski, Zhenqiang Lu, Permanente Journal, Vol. 12 no. 3, Summer 2008

From the abstract:
Nurses are the primary hospital caregivers. Increasing the efficiency and effectiveness of nursing care is essential to hospital function and the delivery of safe patient care.

We undertook a time and motion study to document how nurses spend their time. The goal was to identify drivers of inefficiency in nursing work processes and nursing unit design. Nurses from 36 medical-surgical units were invited to participate in research protocols designed to assess how nurses spend their time, nurse location and movement, and nurse physiologic response.

A total of 767 nurses participated. More than three-quarters of all reported time was devoted to nursing practice. Three subcategories accounted for most of nursing practice time: documentation (35.3%; 147.5 minutes), medication administration (17.2%; 72 minutes), and care coordination (20.6%; 86 minutes). Patient care activities accounted for 19.3% (81 minutes) of nursing practice time, and only 7.2% (31 minutes) of nursing practice time was considered to be used for patient assessment and reading of vital signs.

The time and motion study identified three main targets for improving the efficiency of nursing care: documentation, medication administration, and care coordination. Changes in technology, work processes, and unit organization and design may allow for substantial improvements in the use of nurses’ time and the safe delivery of care.

The Decline of Career Employment

Source: Alicia H. Munnell and Steven A. Sass, Center for Retirement Research, Issue Brief #8-14, September 2008

From the introduction:
With a contracting retirement income system and increased life expectancy, working longer has emerged as perhaps the most effective lever for improving retirement income security. More work at older ages should be entirely feasible for the bulk of the population, given that today’s workers are healthier and work is less onerous than in the past. Indeed, some indication that people might be willing to work longer comes from the fact that the century-long downward trend in the labor force participation of older men has clearly ceased, with participation rising slightly since the mid-1990s. But the changes to date fall far short of what is required to offset declining Social Security benefits and modest 401(k) balances – an increase in the average retirement age from the current 63 to an estimated 67.

The brief’s key findings are:
• Today only 46 percent of older male workers are still with their age-50 employer, down from 70 percent in the early 1980s.
• This drop in career employment means that more older workers face the challenge of finding a new job.
• These new jobs generally pay less and offer fewer benefits, but also are less stressful and more satisfying.
• Eventually job changing could encourage longer worklives by better matching employer and worker needs, but in the short term it is an impediment.

Bailout Plan Must Help The Middle Class And Grow The Economy

Source: Lawrence Mishel, Ross Eisenbrey, and John Irons, Economic Policy Institute, EPI Policy Memorandum #129, September 29, 2008

Congress is currently haggling over an agreement to bail out the financial markets. While a final agreement is still up in the air, we must not forget than inaction is not an option. Without action to shore up the banking system, financial markets may very well freeze up, stalling the overall economy. And without action to spur job creation and support working people, the labor market will freeze and fundamental economic weaknesses will continue.

Thinking Outside The Hospice: States Look To Expand Palliative Care Services

Source: Matthew Gever, State Health Notes, Volume 29, Issue 524, September 29, 2008

Historically, palliative care has been seen as the provision of comfort for the terminally ill and those closest to death. In the last decade, however, palliative care has evolved and is now an approach that tries to improve the quality of life of patients and their families facing the problems associated with life-threatening illnesses. Along with helping patients and their families cope, palliative care may also offer some cost savings for states.

Health Plans Lack Tools to Compete in Retail Marketplace

Source: Brian Keane, Paul Holdren, Susan Novak, Deloitte LLP, September 2008

From the summary:
In the face of relentless health care cost increases, health plans’ historical employer-sponsored (group) market is showing signs of stagnation or decline. Emerging in its place is a new retail market of informed, empowered individual buyers – a 60-million-plus member segment that is conservatively expected to grow at 4 percent annually.

A new report from Deloitte LLP, Profitable Growth in the Emerging Retail Marketplace: Implementing a Target Approach to Health Plan Sales & Marketing, asserts that health plans should respond to and penetrate this growing market. However, the standard sales and marketing “toolkit” – which focuses on wholesale selling to employers – lacks tools to help health plans compete in a retail world.

Changing Lanes: Addressing America’s Congestion Problems Through Road User Pricing

Source: William Eggers, Deloitte LLP, September 2008

Traffic is overwhelming a growing number of America’s cities. From Los Angeles to Chicago to Miami, Americans spend hours each week caught in bumper-to-bumper traffic. Urban residents and commuters are confronted with the challenges that jammed roadways cause on a daily basis. The Urban Mobility Report estimated that in the United States in 2007, congestion caused 4.2 billion hours of travel delay and 2.9 billion gallons of wasted fuel, for a total cost of $78.2 billion.

At the same time, governments facing increasing demands and reduced budgets may consider creating a market in which people are charged for their use of a given roadway to help raise additional funds for transportation projects. The National Conference of State Legislatures estimates that about 18 percent of the more than 912,000 miles of America’s roads and highways are in poor or mediocre condition, and about 27 percent of the nearly 594,000 U.S. bridges are structurally deficient or functionally obsolete.

How can America’s cities and states reduce congestion, raise necessary funds for infrastructure improvements and reduce the environmental impact of congested roads? A new study from Deloitte highlights the benefits of road user pricing to reduce gridlock and raise significant revenues in the process.
See also:
– Press Release: Deloitte Study Recommends a Better Approach to Dealing with Congested Roadways in the United States
– Research: Closing America’s Infrastructure Gap: The Role of Public-Private Partnerships
– Podcast: Bridging the Gap: How Private Investment Can Reduce the Infrastructure Deficit
– Resources: Serving the Public Sector: Transportation
– Resources: Private Investment in Public Infrastructure
– Overview: U.S. State Government

Reinventing Transparent Government

Source: Patrick Radden, The Century Foundation, September 10, 2008

From the summary:
In “Reinventing Transparent Government,” a new policy brief for The Century Foundation, Patrick Radden Keefe, fellow and expert on national security and civil liberties issues, calls for rolling back the secrecy of the Bush years and restoring transparency and accountability to American government. In the brief, Keefe explores the broad range of areas in which the United States government has adopted a policy of reflexive secrecy in recent years, and examines the extent to which that posture represents a departure from the American tradition of accountable, transparent government. Keefe makes five concrete proposals for specific changes a new administration could make to usher in a new era of sound, open, responsible government, and invokes James Madison’s admonition that “A popular government, without popular information, or the means of acquiring it, is but a Prologue to a Farce, or a Tragedy, or perhaps both.”

Elections: States, Territories, and the District Are Taking a Range of Important Steps to Manage Their Varied Voting System Environments

Source: Government Accountability Office, GAO-08-874, September 25, 2008

Our Nation’s overall election system depends on all levels of government and the interplay of people, processes, and technology, which includes the voting systems that are used during an election. GAO has previously reported on issues and challenges associated with ensuring that voting systems are secure and reliable.

One-in-Five and Growing Fast: A Profile of Hispanic Public School Students

Source: Rick Fry and Felisa Gonzales, Pew Hispanic Center, August 26, 2008

From the summary:
The number of Hispanic students in the nation’s public schools nearly doubled from 1990 to 2006, accounting for 60% of the total growth in public school enrollments over that period. There are now approximately 10 million Hispanic students in the nation’s public kindergartens and its elementary and high schools; they make up about one-in-five public school students in the United States. In 1990, just one-in-eight public school students were Hispanic.