On Tuesday Los Angeles County starts hiring more than 700 nurses to replace contract workers and decrease overtime hours, part of a larger effort to improve quality of care and thus keep patients in the county health system.
County health officials say the move was spurred by changes brought on by the Affordable Care Act, which expanded Medicaid (Medi-Cal in California) and gave many the chance to buy subsidized private insurance.
Historically a provider of last resort for the uninsured, county facilities now face the prospect of losing those who are newly insured to other providers.
"We need to be able to compete in health reform, we need to be able to attract patients and retain patients over time so that we can be financially sustainable," said Christina Ghaly, deputy director of strategic planning for the L.A. County Department of Health Services. "To do that we need to make sure we are providing the best quality of care and the best patient experience."
The County Board of Supervisors approved the plan to hire 737 nurses and support staff last month. County health officials say hiring full-time staff will not only reduce costs, it will raise the quality of care at its four hospitals and 19 stand-alone clinics.
County medical centers have gained a reputation over the years for long wait times and poor service. Ghaly said until now there wasn't much incentive to do better, because the patients had nowhere else to go.
"Because of that there was a feeling of ambivalence on the part sometimes of...staff about the services we were providing and didn’t necessarily feel that we had to go above and beyond to keep our patients and to be a place where patients wanted to go," Ghaly said.
Nurse supervisor Chad Hazard welcomes the county's initiative. He oversees 21 full-time nurses and two part-time staff in the procedural unit at Olive View-UCLA County Medical Center in Sylmar. Hazard says he occasionally uses contract workers, but mainly his staff works extra hours or flex time to cover shifts, because they are specially trained to assist in procedures from colonoscopies to inserting heart stents.
Hazard says he will be getting four additional registered nurses, his part-time nurses will be able to go full-time and he will get three more clerks.
"Right now we are not able to do as many procedures as we would like, or our patients are waiting a little longer," Hazard said. The county's plan "will allow us to do more and work a little longer," he added.
This round of hires is part of a four-year effort; all told, the county envisions hiring about 1,200 nurses and staff. Other parts of the initiative include improving wait times, increasing access and improving services.
The challenge of retaining newly insured patients is not unique to L.A. County, said Geoffrey Joyce, director of health policy at USC's Schaeffer Center for Health Policy & Economics. County and public health facilities across the country that serve the uninsured are facing the same issues, he said.
"These pressures are more acute because they haven’t played by these rules in the past. But everyone is feeling the pressure," Joyce said.