Crisis of Medical Staff Shortage
The healthcare staff shortage has been a perpetual problem in Taiwan, and has been taking toll on the island’s healthcare quality. One of two main reasons behind this shortage is unappealing work environment and the profit-oriented hospital managements. The work of healthcare staff often contents long working hours, lots of pressure, under-paid salaries, and potential health-related hazards. On the other hand, the profit-oriented hospital managements have marginalized medical personnel’s rights and safeties for greater profit returns.
Taiwan Healthcare Reform Foundation believes sufficient workforce is essential to maintain the quality of care. But a disturbing trend we have observed over the years is that medical facilities begin to cut positions in order to reduce cost. As the result, growing number of cares are being handled by inadequate number of healthcare staff.
Minimum requirement for Staff-patient ratio Revision
In order to dress the crisis of healthcare staff shortage, the Department of Health (DOH) was planning to revise the Health Act at 2005. And part of this revision will revamp the minimum staff requirement for each healthcare specialty. The current staff requirement standard has not received much change ever since its enactment at 1987, and most of its regulation has become unsuited to meet the demands of today’s medical environment.
Since the issue of staff requirement concerns both hospital management and medical personnel, the government has set up numerous negotiations between hospital representatives and medical unions to discuss the new minimum staff requirement. The negotiation began as early as 2003. However, the composition of the negotiation committee was usually biased in favor of the hospital representatives, and ignored the voices of medical personnel who work directly with patients. The discussion process was completely sealed from the outside supervision, and often one union representative would need to face 4 to 5 hospital counterparts. The Department of Health announced the draft of the new standard disregard the obvious flaws in the negotiation setup. Consequentially, most of medical fields?minimum staff requirement is lowered substantially in the new draft revision.
From our own observation and data provides by other patient NGOs and unions, the healthcare staff shortage is hurting both patient' safety healthcare quality. For instances, average pharmacists in Taiwan has around 270~500 prescription orders filled per day, which means they will need to process one drug every 17 seconds. During this short period of time the pharmacist is required to complete standard procedure on safety check including identifying the drug, revising the prescription, and analyzing patient’s health status and possible adverse reaction. Staff shortage would only drastically increase chance of error in the already intense procedure. According to the pharmacist union, medical centers around Taiwan are currently suffering 20% shortage on the pharmacist staff. The shortage would likely be further extended if the new draft came to effect.
Nurses of all medical fields are also plagued by the staff shortage. However, the upcoming staff requirement revision has made little effort to address this issue. The patient bed per nurse ratio, which is used in Taiwan to measure nurse’s workload, is doubled in the draft as the result of unfair negotiations process. The authority seems planning to give hospital more liberty on staff management, and makes the new staff requirement more result-oriented. But due to the lack of regular surveillance on the hospital performances, we concern that the result-oriented staff requirement would only become ineffective. The nurse shortage is currently not only degrading the care quality in major hospitals, but more seriously hurting the cares in the smaller facilities such as rehab center or hospice care.
Other medical subspecialties that are reported being effect by staff shortage includes homecare, radiologists, Anesthetists, mental care, rehabilitation care, and many others.
Sufficient workforce is essential to the quality of healthcare. It would be difficult to maintain healthcare standard or to ensure patient safety in an environment that suffered from serious staff shortage. The revision of the Health Act and the minimum staff requirement standard is thus a crucial opportunity for us to address this issue.
Taiwan Healthcare Reform Foundation has launched various campaigns to warn about the healthcare staff shortage crisis since 2002. We focus our advocacies on two main areas: a reasonable staff-patient ratio that suites for the current healthcare standard, and a balance, open, well-supervised negotiation process for the new requirement. We believe a reasonable staff-patient should provide a safe healthcare environment for both patients and healthcare staff.
Jointed Press Conferences
At August 7, 2005, THRF, together with 9 other NGOs and unions launched a joint press conference to raise the government’s awareness on the healthcare staff shortage, and the unfair negotiation process for the new staff requirement.
More than 500 health personnel and civil workers rallied in front of the Department of Health to protest the upcoming reduction on the minimum staff requirement standard. Together, the representatives from each organization delivered their petitions to the Legislative Yuan.
During the joint press conference, we made the following suggestions regarded to the revision of minimum staff requirement:
1. The Department of Health needs to establish new minimum staff requirement based on authentic, up to date, and publicly disclosed data. We also hope DoH could take reference from the health standard of other developed nations.
2. The new staff requirement must make sure the required staff level would be able to meet demands of the standard of procedures (SOP) from each medical field.
3. Patient and healthcare personnel’s benefits should be the core value of the new standard requirement.
The negotiation for the minimum staff requirement is still under process, the Taiwan Health Reform Foundation continues to be closely involved.