Patient Safety / Quality

The new normal

Many healthcare organizations are focusing on reducing costs to help them weather the coming months of shrinking budgets. Others are beginning to panic. For decades, hospitals have lived on a diet with a heavy dose of Medicare payments. The cuts that went into effect recently as a result of the Budget Control Act of 2011 (commonly known as the sequester) will reduce federal spending an estimated $1.2 trillion over the next 10 years. For 2013 alone, the Centers for Medicare & Medicaid Services estimates reductions of $11 billion to healthcare providers.

It seems most organizations didn’t plan for these reductions. Why not? Because no one thought they would actually happen. Critics say the fiscal situation caused by sequestration cuts is manufactured. The fact that the cuts are real has defied belief. Undeniably, today’s fiscal reality is the new normal.

The pain caused by this new austerity touches every sector of health care, and everyone is scrambling to protect his or her piece of the pie. We cry foul as low-margin portions of the industry anticipate closing their doors. At the same time, the very groups that have enjoyed high profits for years under favorable payment conditions are choosing to deny care rather than find ways to bear some of the burden with the public, who need their services. In April, The Washington Post reported cancer clinics across the country were bowing out of administering chemo­therapy to Medicare patients, blaming sequester cuts for a forecast of unsustainable payment reductions that would put them out of business. Reader reactions were visceral, attacking the President and politicians on both sides of the aisle. Hardly anyone believes he or she is paid enough—yet we know the current payment system is unsustainable.

For as long as most of us can remember, discussions on reducing healthcare costs have been as
common as cyclic nursing shortages. After the voluntary cost containment of the 1970s, the belt tightening of the 1980s due to the shift to prospective payment, then managed care, and finally today’s shift to payment for quality outcomes and penalties for adverse events, we shouldn’t be surprised we once again face an imperative to enact change vital to our survival.

The threat to survival makes us think of Maslow’s theory of motivation and the hierarchy of needs. We know human beings are motivated to satisfy basic physiologic needs before moving up the pyramid of higher-order needs—safety, social interaction, esteem, and ultimately self-actualization. In response to threats from today’s tough fiscal environment, we should decide how we will satisfy the needs to survive and thrive.

Solidarity and a commitment to act swiftly can provide the motivation and energy to move beyond survival and satisfy higher-level needs. In a recent dinner conversation, physician colleagues and I shared experiences of natural disasters, recalling extraordinary efforts by everyone pulling together to address threats to patient safety and care interruptions. We likened the everyday challenges of the hospital and healthcare world to a prolonged disaster. We all agreed that if we could bottle the camaraderie and optimism experienced during disasters, we could overcome obstacles facing healthcare organizations today. Instead of retreating to our respective corners of the boxing ring after coming together to face adversity, we could solidify collaborative working relationships unencumbered by status, title, or role to address the challenges of the new normal.


No one discipline has all the answers. Most feel loss of control and, at the same time, a responsibility to address the crisis at hand. Ironically, this month we celebrate National Nurses Week and National Hospital Week. We shouldn’t need special reminders to ground us in recognizing the value of our relationships. Instead, we should capitalize on the common ground that binds us as advocates for patients and protectors of the lives entrusted to us.

Challenges will continue to come at us at warp speed. We must confront reality and stand ready to act—together. Remember the famous line from The Three Musketeers: “All for one and one for all; united we stand, divided we fall.”

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN

Editor-in-Chief

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One thought on “The new normal”

  1. Maureen says:

    I really could relate to your article. I work as a nursing supervisor and as a nursing professor and it is a chotic healthcare system we are practicing in today and it has to change. We are always trying to cut costs and unfortuanately nursing is the biggest budget and we get cut first. Yet who is left at the bedside? Good article and great timing. It is time to band together and help change the way we practice healthcare.

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