How to Make the Safe Patient Handling Financial Case€¦ · – $700K (see next slide) •...

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How to Make the Safe Patient Handling

Financial Case

Ed Hall, MS, CSP, CSPHPSenior Director,

Risk Management Loss Control & Education

Copyright 2012 by Stanford Hospital and Clinics. All Rights Reserved.

Ed Hall is the Senior Director for Risk Management at Stanford University Medical Center. Ed has more than 18 years of diverse loss control and safety management experience, with an emphasis in managing worker safety risks in healthcare and industrial sectors. He has spent more that 10 years in the Safe Patient Handling arena and participated in developing the business case for over 30 hospitals.Ed is recognized for his leadership in implementing innovative loss control risk management programs resulting in dramatic and immediate savings. In 2010 Ed was recognized as Innovator of the Year by Risk and Insurance as well as receiving the Responsible Leader Award.Ed’s expertise focuses on utilizing quantifiable data to identify risk reduction objectives and opportunities which result in significant returns on investment.Ed received a BS in Fire and Safety Engineering, an MS in Loss Prevention and Safety from Eastern Kentucky University and is a Certified Safety Professional as well as a Certified Safe Patient Handling Professional.


Edward Hall MS, CSP, CSPHP

Senior Director, Risk Management Controls and Education

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How to Make the Safe Patient Handling Financial Case Using Data that Matters

• Alternatives for Safe Patient Handling Programs

• Data Diagnostic Process

• Total Program Costs

• Simple Internal Rate of Return

• Advanced Financial Model


Alternatives Defined

• Risk Financing (Insure the Exposure) – Legal Requirement So Leverage the Investment

• Risk Assumption (Cost of Doing Business)• Risk Avoidance (Contract out the Exposure)• Loss Control (Aggressively Manage Claims)• Partial Loss Prevention (Implement Partial Intervention

Strategies)• Full Loss Prevention

Alternatives When Considering Risk Intervention Options

Copyright 2012 by Stanford Hospital and Clinics. All Rights Reserved. 4

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Data Presented with Clear Picture of Necessity• This graph represents the inpatient acuity and corresponding patient care strategy

31%

33%

18%

18%

Independent: Minimal Assist: Extensive Assist: Total Lift:


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SHC Aggregate Claims Costs - Patient Handling Injuries - 2001 - 2008

$-

$250

,000

$500

,000

$750

,000

$1,00

0,000

$1,25

0,000

PH -Transfer to and From – Car to Chair

PH -Transfer to and From – Chair to Stretcher

PH -Transfer to and From – Chair to Exam Table

PH - Repositioning - Wheelchair

PH - Repositioning - Chair or Dependency Chair

PH – Transporting - Wheelchair

PH -Transfer to and From – Chair to Toilet

PH -Transfer to and From – Chair to Chair

PH -Transfer to and From – Bed to Stretcher, Trolley

PH- Transfer to and From – Bed to Chair

PH – Other Manipulation - Falling Patient

PH - Repositioning - Side to Side / Bed / Stretcher

PH – Other Manipulation - Lifting Patient off of floor

PH – Transporting - Stretcher / Bed

PH - Repositioning - Up in Bed / Stretcher

Patient Handling -Other


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Repositioning & TransferPatient Handling Equipment Options CY2003 - 2007YTD

$43,336

$44,200

$109,338

$192,885

$194,138

$228,254

$344,457

$382,838

$597,598

$609,577

$783,607

$1,016,856

$1,182,418

$1,185,626

$1,525,207

$1,582,798

$3,874,424

$- $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000



PH - Transfer To & From - Chair to Exam Table

PH - Transporting - Wheelchair

PH - Transfer To & From - Car to Chair

PH - Repositioning - Bathing

PH - O Man-Pt Hdling Task Req Sustd Hold of a limb

PH - Transfer To & From - Chair to Toilet

PH - Transfer To & From - Chair to Chair

PH - Other Manipulation - Lifting Pt off of Floor

PH - Transfer To & From - Chair to Stretcher

PH - Transporting - Stretcher / Bed

PH - Transfer To & From - Bed to Chair

PH - Other Manipulation - Falling Patient

PH - Repositioning - Side to Side/ Bed / Stretcher

PH - Transfer To & from - Bed to Stretcher,Trolley


Cau

se o

f In

jury

Total Gross Incurred Costs

7%

9%

9%

11%

11%

28%


TransferPatient Handling Equipment Options

CY2003 - 2007YTD

$43,336

$44,200

$109,338

$192,885

$194,138

$228,254

$344,457

$382,838

$597,598

$609,577

$783,607

$1,016,856

$1,182,418

$1,185,626

$1,525,207

$1,582,798

$3,874,424

$- $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000


















Cau

se o

f In

jury


7%

9%

9%

11%

11%

28%


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Repositioning ‐ BathingPatient Handling Equipment Options

CY2003 - 2007YTD

$43,336

$44,200

$109,338

$192,885

$194,138

$228,254

$344,457

$382,838

$597,598

$609,577

$783,607

$1,016,856

$1,182,418

$1,185,626

$1,525,207

$1,582,798

$3,874,424

$- $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000


















Cau

se o

f In

jury


7%

9%

9%

11%

11%

28%


SHC Patient Handling InjuriesDays Restricted Duty & Days Absent

2002 - 2007

0

500

1000

1500

2000

2500

3000

2002 2003 2004 2005 2006 2007

Restricted

Lost


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Data Drives Cost Acceptance

• Clinical training and consultation

– Two years estimated at $150K total

• Labor Training

– $700K (see next slide)

• Equipment Cost

– $800K

• Ongoing program expenses

– Patient specific slings estimated at $25,000 per year

– Reoccurring staff and coach training estimated at $6,000 to $8,000 per year (2 coach days, 4 staff training days)


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USE YOUR TOOLS IN HOUSE


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Now a More Advanced Approach

Value Protection

Val

ue

Cre

atio

n Quantified Risks and Uncertainties

Value & Risk Maps Quantified Value Model

Key Value Drivers

Value at Risk Contingency Strategy Components of Value

Enhanced ISO 31000 Process

Decision A

Decision B

Scenario X Scenario Y



Application to Develop the Business Case for Safe Patient Handling Programs

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For Stanford’s Safe Patient Handling Program, we began by structuring all the factors and their relationships.

Value of theSafe Patient

Handling program

Invest in a SafePatient Handling

program

Requiredequipments

Cost of program

Mix of injured staff(RN vs. support)

Mix of ulcerstages acquired

Change in patientsatisfaction score

(Press Ganey)

Benefits fromemployee

satisfaction

Mix of patientinjuries (serious

vs. minor)

Time replacementfactor

Retentioncost savings

Change inemployee

satisfactionscore (Gallup)

Reduced claimsfrom patient falls

Reduction inpatient falls

Average costof an injury

Average cost ofa ulcer treatment

Reduction inemployee injuries

Savings on workerscomp. claims

Savings on lost &restricted days

Average cost ofreplacement staff

Direct financialbenefits

Savings in ulcertreatments

Benefits frompatient satisfaction

Profit fromadditional

patient referrals

Pressure ulcerreduction rate

Reductionin turnover

Average cost torecruit & train

Mix of patienthandling staff

(RN vs. support)

Equivalentcampaign

budget savings

Increases inpatient referral

Equivalent HRbudget savings

On-going costs

Initial costs

Patient mobility

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The tornado chart shows the key drivers for total value.

Net Present Value ($ '000)

$3,500 $4,000 $4,500 $5,000 $5,500 $6,000 $6,500 $7,000Base Value

Expected value = $5,184

Reduction in Turnover 0% 20% 2%

Increase in Patient Press Ganey Score (% pt)

0% 3% 2%

Workers Comp Growth (baseline)

-17% 19% 0%

Increase in Staff Gallup Score (% pt)

0% 2% 1%

Percentage of Ulcers in Stage 1 or 2

80% 70% 75%

Lost & Restricted Days Growth (baseline)

-17% 36% 0%

Reduction in Workers Comp 60% 82% 60%

Ulcer Reduction Rate 30% 40% 30%

Percentage of Patient Referral

1% 20% 1%

Patient Volume Growth -1% 5% 0%

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The cumulative probability distribution shows the total uncertainty in value.

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The waterfall chart shows the breakdown among cost and value components.

NPV ($ '000)

‐$3,000 ‐$2,000 ‐$1,000 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000

‐$1,536 Initial Investment

$1,789Workers Comp Savings

$500Lost & Restricted Days Savings

$245Patient Falls Savings

$1,761Ulcer Treatment Savings

$782Retention Costs Savings

$374Gallup Score Improvement

$1,307Press Ganey Score Improvement

$106Patient Referral

‐$144 On‐going Costs

$5,184Mean NPV

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The approach provides a more robust and comprehensive way of understanding and

increasing value.

• It makes use of all available data, but also captures hard‐to‐quantify factors.

• It identifies the most important value drivers and risk factors.

• Done well, it provides a reliable guide to actual realized costs and benefits.

• It provides a defensible, transparent, “investment grade” basis for making difficult decisions under uncertainty and among competing priorities.

• It provides a means of creating new alternatives to increase value and reduce costs.

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Stanford Hospital Renewal Project

Safe Patient Handling Options for New Construction

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23Copyright 2012 by Stanford Hospital and

Clinics. All Rights Reserved.


Alternatives Defined

• Risk Financing (Insure the Exposure) – Legal Requirement ‐ So Leverage the Investment

• Risk Assumption (Cost of Doing Business)• Risk Avoidance (Contract out the Exposure)• Loss Control (Aggressively Manage Claims)• Partial Loss Prevention (Implement Partial Intervention

Strategies)• Full Loss Prevention

Alternatives When Considering Risk Intervention Options

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Net Present Value ($ '000)

$3,500 $4,000 $4,500 $5,000 $5,500 $6,000 $6,500 $7,000Base Value

Expected value = $5,184

Reduction in Turnover 0% 20% 2%

Increase in Patient Press Ganey Score (% pt)

0% 3% 2%

‐17% 19% 0%

Increase in Staff Gallup Score (% pt)

0% 2% 1%

Percentage of Ulcers in Stage 1 or 2

80% 70% 75%

Lost & Restricted Days Growth (baseline)

‐17% 36% 0%

Reduction in Workers Comp 60% 82% 60%

Ulcer Reduction Rate 30% 40% 30%

Percentage of Patient Referral

1% 20% 1%

Patient Volume Growth ‐1% 5% 0%

The Tornado Chart Results are Coming In…..

Workers Comp. Baseline

33%


Core Competencies of Staff was a Second Wave Initiative

Required Skills

Financial Acumen‐Demonstrated through budgeting, cost justification and/or vendor negotiation

Team Leadership‐Demonstrated through assembling and leading a cross functional team

Policy and Procedure Deployment‐Demonstrated through the development, modification and implementation of

SPH P&P

Training Deployment‐Demonstrated by development and delivery of training

Clinical Knowledge & Experience‐Demonstrated through clinical job duties

Risk Analysis & Control‐Demonstrated through formal analyses and linking control measures to risk results

Program Promotion‐Demonstrated by promoting the benefits and/or results of the SPH program internally and

externally

Program Audit‐Demonstrated by a formal review and reporting of program performance

Unit Specific Customization‐Demonstrated by adapting procedures to unit specific and patient specific needs.


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Thank you!Visit

http://src.stanfordhospital.orgfor more information


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How to Make the Safe Patient Handling Financial Case€¦ · – $700K (see next slide) •...

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