Hospital support staff layoffs risk patient safety

Modern Healthcare – Wednesday, May 21, 2025
By Alex Kacik

Health systems are cutting support staff as they brace for potential federal funding cuts, a move that could limit hospital capacity and care quality.

Providers have laid off thousands of workers over the last several months — predominantly nonclinical employees — as Congress looks to decrease federal spending through potential cuts to National Institutes of Health grants and Medicaid. The layoffs and hiring freezes have largely spared physicians, nurses and other clinicians but cutting nutrition, janitorial, sterile processing and other roles that keep hospitals running could crimp operations and reduce revenue over the long term, experts said.

“Many healthcare leaders have an intense preoccupation with finding cost savings,” said Stephanie Mercado, CEO of the National Association of Healthcare Quality. “But there is a real risk of downstream impacts on quality and safety when you start pulling threads like environmental service workers and food and nutrition staff out of the mix.”

Salaries and benefits typically make up about half a hospital’s operating expenses so it is the first place executives look to for savings. Contract workers, many of whom fill hospital support jobs, may be the first to go, said Bianca Frogner, a health economist and family medicine professor at the University of Washington.

“I imagine that’s where hospitals are looking to cut before letting go of employed workers,” she said. “But if facilities aren’t cleaned and maintained or food isn’t being delivered in a timely manner, those issues could all contribute to the well-being of a patient and how smoothly facilities run.”

Health systems are typically reluctant to cut physicians and nurses because of the time spent training clinicians and persistent shortages in many specialty roles. Hospitals can’t treat staff without specialists, and stretching a limited clinical staff over a growing number of patients could lead to care mishaps.

“For years, health system leaders have had a strategy to never cut at the bedside,” said Jill Ryan, executive director of quality at UNC Health Blue Ridge in Morganton, North Carolina. “But we have to stop thinking of bedside caregivers as just nurses, physicians and respiratory therapists. An environmental services worker in a lot of ways has as much of an impact on patient outcomes as their clinician teammates.”

Eliminating support staff also could jeopardize patient care and access, experts said. If there are fewer sterile processing and laundry service workers, providers run the risk of increased hospital-acquired infections. A smaller custodial team could force emergency department patients to wait longer for inpatient beds.

Environmental service workers and facility managers were integral to Providence’s response to the recent measles outbreak, said Dr. Lara Johnson, chief medical officer of Lubbock, Texas-based Covenant Health, which is part of Renton, Washington-based Providence.

Covenant providers, administrators and support staff would huddle at least once a day in early February to map out care for patients with measles.

Since the virus is airborne, custodial staff would have to wait two hours to clean a room after a patient was discharged. Environmental service managers would help coordinate patient care with those timelines in mind, while facilities managers rerouted patient pathways and set up negative pressure rooms to limit exposure to measles, Johnson said.

“Everything would come to a screeching halt without them,” she said.

Staffing and infection control have been persistent issues for many health systems, said Rebecca Crapanzano-Sigafoos, executive director of the Center for Research, Practice and Innovation at the Association for Professionals in Infection Control and Epidemiology. Maintaining adequate staff and quality outcomes could be more difficult if Congress follows through with plans to curb Medicaid spending, she said.

“We’re always fighting an uphill battle when it comes to staffing and infection prevention, and now it could get worse,” Crapanzano-Sigafoos said. “Sterile processing staff and environmental service workers have a huge role in infection prevention.”

Hospitals may choose to reduce support staff to mitigate financial headwinds over the short term. But long-term access and care quality consequences stemming from those cuts could erode their margins, said Mark Pascaris, senior director at credit rating agency Fitch Ratings.

As a result, providers will try to avoid any headcount reductions by reworking vendor contracts, such as by outsourcing support staff employees or bringing outsourced workers in-house, he said.

“Health systems have to find every dollar possible, be it top-line revenue growth or managing their expense base in a world where they are managing all these headwinds and it’s difficult to maintain adequate margin,” Pascaris said. “No stone will be left unturned.”

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