Patient safety and quality improvement
efforts have grown impressively
in recent years. Despite these
gains, though, questions remain about the
value of improving quality from both societal
and hospital perspectives. From the societal
perspective, the question is whether gains
from improving quality reduce costs to patients,
hospitals, and payers or, if they increase
costs, whether the value of the quality
improvement to patients justifies spending
more on care. From the hospital perspective,
the question is whether cost savings or revenue
gains from improving quality offset the
costs of quality initiatives—that is, whether
there is a business case for quality. Sheila
Leatherman and colleagues, in language relevant
to both perspectives, recently wrote,
“There is a compelling need to understand
better the economic implications for all
stakeholders of implementing quality improvement.”1
The growing body of evidence linking hospital
workforces to patient outcomes suggests
that one way to improve quality is to increase
nurse staffing.2 Because nurses are a large portion
of hospital labor costs, the cost of increasing
staffing would not be insignificant. The
additional costs of having more nurses, however,
should be offset to some extent by the
monetary and nonmonetary benefits of
reducing adverse outcomes.