HLTH 6840 Week 4 Policy Criteria Memo Example

Memorandum

To: Senate Health Committee staff, composite state legislature

From: Policy analyst

Date: Month Day, Year

Re: Five evaluation criteria for medical-surgical nurse staffing options, with operational definitions, measures and weights

Purpose

This memo sets out, for the committee's review and approval, the criteria by which it will compare options for addressing high patient loads on medical-surgical units, defined in the problem definition circulated last week. The criteria are settled now, before any option is evaluated, so that no option can be made to look attractive by choosing criteria to fit it. Policy analysis guides recommend separating criteria from options for exactly this reason (Bardach & Patashnik, 2020). Each criterion is defined operationally, with a measure and a reason it belongs on the list.

Criterion 1: Patient Outcomes

Definition: the expected effect of the option on risk-adjusted 30-day mortality, failure to rescue and length of stay for medical-surgical patients. Measure: estimated change in each outcome, drawn from published studies of comparable policies and applied to state data. Why it belongs: the problem is defined by harm to patients, and research links nurse workload to these outcomes (Aiken et al., 2002; McHugh et al., 2021).

Criterion 2: Workforce Effects

Definition: the expected effect on registered nurse burnout, job dissatisfaction and turnover on affected units. Measure: change in validated burnout and dissatisfaction scores from nurse surveys and in annual turnover rates reported by hospitals. Why it belongs: workload is linked to burnout (Aiken et al., 2002), and a policy that drove nurses out of the workforce would defeat its own purpose.

Criterion 3: Cost to Hospitals and the State

Definition: the net annual cost of implementing the option, separated into costs to hospitals (added nurse wages, recruitment, agency staffing, reporting) and to the state (enforcement and administration), net of avoided costs such as shorter stays and fewer readmissions. Measure: estimated annual costs and offsets over five years, with assumptions stated. Why it belongs: costs determine whether hospitals can comply and whether the committee can fund oversight, and evidence suggests some costs may be offset (McHugh et al., 2021).

Criterion 4: Feasibility and Administrability

Definition: the likelihood that hospitals could comply within the proposed timeline and that the state health department could monitor and enforce compliance with existing or authorized resources. Measure: a rating of high, medium or low based on workforce supply projections, the department's current inspection capacity and the experience of states with similar policies. Why it belongs: an option that cannot be administered will not deliver its promised effects.

Criterion 5: Equity Across Hospitals and Patients

Definition: whether the option narrows or widens differences in staffing and outcomes between hospitals, especially between rural or safety-net hospitals and others. Measure: projected change in the gap in average workloads between the quartile of hospitals with the highest workloads and the state average, and a rating of whether rural hospitals could comply without closing beds. Why it belongs: the problem definition notes that patients face different risks depending on which hospital they enter, and a policy that helped well-staffed urban hospitals while pushing rural ones to close beds would worsen that gap.

Criteria Considered and Left Out

Two criteria were considered and left out. Political acceptability matters to whether a bill passes, but it is a separate question from whether an option is good policy, and folding it into the comparison would let the expected strength of opponents decide the analysis. It will be addressed in the stakeholder map instead. Nurse satisfaction, as distinct from burnout and turnover, was folded into workforce effects, because satisfaction scores move with many things besides staffing, from pay to management style, while burnout and turnover are more directly tied to workload and to patient care.

How the Criteria Will Be Applied

The alternatives analysis will apply each criterion to each option using the same sources and the same time horizon of five years. Where evidence is thin, the analysis will say so and give a range rather than a single figure. Ratings will be shown in a matrix, but the matrix will not settle the comparison by itself; the analysis will explain in prose where an option's strength on one criterion outweighs its weakness on another. The criteria will not be revised after options are scored, so that the comparison cannot be tilted after the fact. Committee members who want a different criterion should raise it now, before any option is scored.

Weights

The criteria are weighted as follows: patient outcomes 35%, workforce effects 15%, cost 20%, feasibility 15% and equity 15%. Patient outcomes carry the most weight because the problem is defined by harm to patients. Cost carries the next most because it governs compliance. The weights are a judgment, not a finding, and the committee may change them; the analysis will show results under at least one alternative weighting, with cost weighted equally to patient outcomes, so members can see whether the recommendation depends on the weights.

References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

Bardach, E., & Patashnik, E. M. (2020). A practical guide for policy analysis: The eightfold path to more effective problem solving (6th ed.). CQ Press.

McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-1913. https://doi.org/10.1016/S0140-6736(21)00768-6