With union contract bargaining set to begin next month, nurses and other Zuckerberg San Francisco General Hospital workers this week alleged that understaffing and high workloads are placing patients at risk.
According to the workers, the hospital’s shift to a more “lean” and efficient workflow in recent years has led to chronic understaffing.
More than a dozen registered nurses attended a Health Commission Joint Conference Committee meeting held at the hospital Tuesday to denounce a lack of transparency over patient data and hospital policies, as well as inadequate staffing levels across departments that they claim often leave staff overworked, patients unsupervised and the hospital potentially in violation of state law.
In the period from October 21, 2018 to January 20,2019, the hospital’s day shifts had “16 violations in which they did not provide adequate break coverage,” alleged Norlissa Cooper, a registered nurse in the hospital’s Medical -Surgical unit, who is also the president of SEIU Local 1021’s Registered Nurses Chapter.
Over the last three months, Cooper has tracked compliance with Title 22, a state law that sets the nurse-to-patient ratio. On night shift, Cooper claims that the hospital was out of compliance in regard to adequate break coverage “70 percent of the time.”
Understaffing has long been an issue, said Cooper, who on Tuesday gave hospital administrators an ultimatum — bring staffing levels into compliance with Title 22 in the next 30 days or “I will be reporting my tracking sheet to the full Health Commission and to the state,” she said.
“At the end of the day nurses get disciplined for not following hospital protocols and procedures but the hospital gets to willingly violate the law? It’s unacceptable,” said Cooper.
It is unclear if the hospital has been cited for staffing violations. A spokesperson for the San Francisco Department of Public Health, which the hospital is a part of, deferred comment to ZSFGH’s spokesperson, who did not respond to inquiries about the allegations by press time.
Ahead of the move into a new, $1 billion facility at its Potrero Avenue campus, the hospital implemented a new management system, Lean, and electronic record platform, Epic. Workers blamed this change for many of the staffing issues.
Holding up signs that read “Epic + Lean = Racism & Union Busting,” a group of pharmacists and food service workers who rallied in front of the hospital Wednesday alleged that the hospital’s implementation of the “Epic” and “Lean” initiatives have kept staffing at minimum, while pushing workers to do more.
Epic is the single database platform contracted under the San Francisco Health Department’s push to unify electronic health records, and went live in August. The City has authorized a $377 million budget over the next 10 years to accomplish the contracting, staffing, training, infrastructure and equipment required for the new system’s implementation.
Lean is an “improvement methodology and management system based on the Toyota Management System,” according to a 2014 memo on Lean management at the hospital to the Health Commission’s Joint Conference Committee. It is described as an organization’s “cultural commitment to applying the scientific method to designing, performing and continuously improving” the work of teams of people.
“It’s based on the Toyota plan where they would design the workflow to be more efficient but at the same time have people do more with less. Less staff, more work,” said Pharmacy Technician John Wadsworth.
Some who complained have said they face retaliation.
Earlier this month, longtime ZSFGH registered nurse Sasha Cuttler reported the hospital to the California Labor Commissioner’s Office and the U.S. Occupational Safety and Health Administration over allegations of retaliation.
Cuttler alleged that he has been removed from oversight positions on various regulatory boards and denied promotions after advocating for patient protections, data transparency and for stripping Zuckerberg’s name from the hospital.
The hospital has previously denied Cuttler’s allegations of retaliation, and said that it would cooperate with all investigations into the matter.
Cuttler said that he has been concerned about the hospital’s adaption of the Lean quality improvement scheme because “research has not been able to find that Lean improves patient safety or the efficiency of care, patient satisfaction or nurses’ satisfaction.”
“The fact that this is not evidence-based is concerning as well because it’s a lot of money going to that and then they say they don’t have enough money to provide sufficient nurses and nurses’ aids,” said Cuttler. “Their hope is that [Lean] will ultimately lead to being more efficient and make patients happier, but we are not an assembly line… and speed is not the most important virtue when it comes to safety.”
Nurses who testified at Tuesday’s meeting agreed.
“We are filling up our [resuscitation] rooms a lot more than we should be,” said Will Carpenter, a registered nurse with the hospital’s Emergency Department. “We used to have a few trauma rooms open in the old department, now we are trying to shuffle people around to get them into a trauma bed. We are constantly filling up every space we have and we just don’t have the nurses to care for all of these patients.”
ZSFGH spokesperson Brent Andrew told the San Francisco Examiner on Thursday that Lean is a way to “facilitate better patient-focus, constant improvement in our processes, and greater employee engagement in idea-generation and decision-making,” not “a job-reduction strategy.” He added about Epic that all staff required to use the system will be trained and supported, and that the hospital has communicated that “no one will lose their job because of this effort.”