BU Health Policy Institute receives grant to study complex patient care, staffing, and cost issues

Researchers seek ways to manage demand and reduce cost as they maintain quality care

(Boston) Boston University's Program for Management of Variability in Health Care Delivery has received a $290,000 grant from the Robert Wood Johnson Foundation to study nurse staffing and patient care issues in the context of controlling and managing costs while delivering quality health care. Eugene Litvak, Ph.D., professor of Health Care and Operations Management and director of the program, known as the Management of Variability Program (MVP), is principal investigator for the project.

The year-long project will examine the potential for improving care in hospital medical/surgical units by studying the impact of changes to scheduling of elective surgeries to smooth the flow and reduce variation. It will explore variability in hospital patient census, its relationship to service demand variability and its impact on nurse-to-patient staffing ratios, and the amount of care nurses provide at the bedside. This could result in improved patient flow into surgical units and a better environment for nurses caring for patients.

"Taking care of sick people is a very demanding job even when patient demand is stable," Litvak says. "We should not create an additional burden on nurses by subjecting them to artificial swings in the number of patients they are taking care of. Determining a scientific and feasible way of reducing such artificial stresses would also have a significant impact on quality of care, timely access to care, and patient throughput."

The study will be carried out at four participating hospitals, including Vanderbilt University Medical Center and will run through April, 2007.

"The project is particularly important because we will concentrate on better understanding the factors that affect the demand for nurses and whether and how hospitals can better manage the workloads of nurses," said Peter Buerhaus, Ph.D., senior associate dean of research, Vanderbilt University School of Nursing, and co-principal investigator of the project.

"Understanding work variability is critical to forming effective solutions for safe and high quality nursing care," said Marilyn Dubree, chief nursing officer for Vanderbilt University Medical Center.

Other hospitals planning to participate in the project include: Cincinnati Children's Hospital Medical Center, Caritas Norwood Hospital, and Beverly Hospital, the latter two are in Massachusetts. The MVP is currently working with each of these three hospitals in separate initiatives aimed at improving hospital operations.

The new project involves the collection and analysis of data on admissions, patient census, nurse staffing, and patient care in a medical/surgical unit in each of the four hospitals. Although variability in census and nurse-to-patient ratios also affects other types of inpatient units, medical/surgical units are often the largest units in the hospital and thus impact the most patients. The data analysis is expected to shed light on three key issues:

  • The extent to which variations in hospital patient census produce variations in the number of patients cared for by individual nurses;
  • Whether variations in the number of patients cared for by each nurse affect the amount of time nurses spend providing direct care to patients; and
  • Whether and to what extent variations in patient census are attributed to scheduled/elective admissions compared to unscheduled/emergency admissions.

A growing number of studies report that inadequate nurse staffing is associated with an increased risk of adverse patient outcomes, including mortality. Efforts to improve nurse staffing in hospitals by hiring more nurses have been and continue to be constrained by a limited supply of nurses and the substantial costs associated with recruiting new nurses. Forecasts of a future and much larger shortage developing in the next decade suggest that hospitals will continue to face significant constraints in maintaining an adequate supply of nurses. Therefore, in order to attract and retain high-quality staff and enable them to do their best, it is important to examine strategies to improve the hospital work environment.


The Management of Variability Program is recognized as a leader in the effort to demonstrate, promote, and advance the benefits of applying the principles and practices of operations management and variability methodology to the health care delivery system. Through its research and policy analysis, MVP has made substantial contributions in understanding the root cause of hospital Emergency Department overcrowding and in linking the cost and quality of health care to how that care is delivered. This project is expected to add to that record of contribution. MVP is part of Boston University's Health Policy Institute, which is directed by Dr. Richard Egdahl. More information about the program is available at: http://www.bu.edu/mvp/.

Vanderbilt University School of Nursing is committed to academic excellence and innovation in nursing education; clinical research, patient care, and advance practice delivery systems for nurses and the entire healthcare workforce. More information about the school is available online at: http://www.mc.vanderbilt.edu/nursing/.

Boston University is an internationally recognized institution of higher education and research. With more than 31,000 students, it is the fourth largest independent university in the United States. The university is comprised of 17 schools and colleges along with a number of multi-disciplinary centers and institutes, which are central to its research and teaching mission.

Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
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