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November 2012
Presented by: Clint ParramSenior Director, Loss ControlIllinois Risk Management Services
Don MaynesConsultant, Managing PartnerEquitable Health Care Alliances, LLC
Rob HumrickhouseDirector, Clinical ServicesMetropolitan Chicago Healthcare Council
By the completion of the session you should be able to:
Describe why safety patient handling and movement initiatives are valued business functions.
Explain the methods needed to develop an efficient business plan for safe patient handling and movement.
List the components to successfully monitor your safe patient handling and movement program.
Session Objectives
Nursing is an art: and it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit?
It is one of the Fine Arts: I had almost said the finest of Fine Arts.
Florence Nightingale
SAFETY’S ROLE IN BUSINESS FUNCTIONS
FI NANCE / ACCOUNTI NG
OPERATI ONS
SAFETY and
HEALTH
STRATEGY
MANAGEMENT / ORGANI ZATI ONAL
BEHAVI OR
MARKETI NG / RI SK
COMMUNI CATI ON
The Center for Business and Public Policy at Georgetown University
One of the overriding principles of business is not about maximizing profit but avoiding loss
Organizations can survive without making a profit (nearly 50 % of all healthcare organizations are not profitable (per the Metropolitan Chicago HealthCare Council, 2011)
An organization will soon cease to operate if they consistently sustain losses.
Profitability or Survivability
Safety (patient, staff or environmental) is just one of many business systems, like clinical care, quality, accounting, support services or payroll.
Safety management systems (those improvement processes leading to a reduction of accidents and other mishaps) must be managed similar to other business systems which must be designed, implemented and evaluated to provide effectiveness and value.
Business Systems
Risk Identification and Analysis
Define the problem and outline the goals Too many injuries/costs associated with resident handling Need to implement ergonomics based SRH program
Determine solutions SRH policy Appropriate equipment
Collect data to demonstrate a change Injury rates & costs, indirect costs, etc Anticipated costs and benefits of solutions
Cost justification analysis Return on investment Program effectiveness
MSDs (strains, sprains) accounted for 32 % of all workplace injuries from 2008 to 2011
32%
13%19%
8%
7%
22%Incidents by Type
Sprains StrainsExposuresContusionsPuncturesLacerationsOthers
Patient Movement MSDs made up (on average) 27%, 35%, 33% and 35% of all lifting incidents over those 4 years
Patient Movement Incidents for IRMS
131
516
124
13
118Patient Handling Incidents by Occupation
CNANurse Assist.LPNRNPCTOther
Investment $143,556 in equipment and $27,600 in training
($498 and $77 per employee respectively)
Trained 288 employees 1 ¼ hours each on equipment use
Safe Patient Movement (SPM) Injury Prevention Program in Nursing Homes
(Collins et al, 2004)
Safe Patient Movement (SPM) Injury Prevention Program in Nursing Homes
(Collins et al, 2004)Points of interestResults
SPM claims reduced by 57% from 129 to 56Direct injury costs dropped from $441,670 to
$277,061 yielding annualized saving of $54,870The 10 year net present value of the project at
the time of implementation was $594,605Accounting for capital maintenance, retraining,
and training backfill, the adjusted recovery time on investment = 3 + years, but ROI for some programs < 2 yrs.
250 bed acute care medical center implemented SPM program in 2004
Achieved a 70% ($322,000 to $80,000) reduction in cost from the previous year
Safe Patient Movement (SPM) Injury Prevention Program in
Acute Care
Equipment cost over 6 years (most past 3) $138,600
Cost of claims paid prior to January 2005 $189,540 or cost/quarter $19,000
Claims costs since January 2005 $2,038 or cost $203/quarter
Savings for reduction in claims the past 10 quarters $189,300
Rehabilitation Unit at Acute Care Hospital
SYSTEMSPerformance Metrics
Attitudes (set up conditions,
behavior)Program Elements
Physical conditions
Behavior (action)
- Perception surveys
- Training- Accountability- Communications- Planning & Evaluation
- Roles & Procedures
- Incident Investigations
-Inspections-Audits-Risk assessments
-Prevention & control
-Observations-Feedback loops
I ncident or Near
Miss
- OSHA Recordables
- Lost Workdays
- Restricted Workdays
Leading metrics
Trailing metrics
ORC Worldwide Metrics Taskforce
Current ChallengesAging Hospital Facilities
Parts of many hospitals date back to 1917, 1927, 1951, 1958, etc.
Many have few private rooms
Rooms designed inadequately for new technologies and patient services
Old buildings expensive to maintain; difficult to keep comfortable
Growth has created problematic parking and access issues
ER’s are small, overcrowded, and result in long wait times
Lagging indicators OSHA 200/300 logs Workers comp claims First aid cases Use of temporary staff
Leading indicators Injury risk indicators (ergonomic assessment) Employee surveys: symptom surveys & satisfaction Resident satisfaction Safety audits Physical Symptoms Survey Employee and Patient Surveys
Indicators of Worker Safety & Health
Created SmartMoves Program for safe patient handling
Hospitals started adopting program in 2009
Savings at St. Mary’s Hospital in Amsterdam, New York (earliest pilot program) equal over $4.2 million
SmartMoves has become a cornerstone program offered by Ascension Health
Patient safety and employee safety are both attributes of health care systems
Errors in practitioner-patient interactions and employee injuries, are enabled by “latent” errors - upstream defects in the design of systems, methods, organizations, management, training, and equipment
Emanuel, Berwick, et al. Advances in Patient Safety: New Directions and Alternative Approaches. Volume 1, AHRQ Pub 08-0034(1). July 2008. http://www.ahrq.gov/qual/advances2
A Safe Work Environment is a Safe Patient Environment
Health care worker safety is inextricably linked to patient safety
Patients affect employees’ health Employees’ affect patients’ health Patients and employees occupy a common environment
with common hazards Patients and HCWs are both part of the same health
care system. The environment of care and the environment of work are the same.
Employee and Patient Safety: Prerequisites for Quality Medical Care, AOHP 2011
National Conference 30 September, 2011, presented by Andrew I. S. Vaughn, M.D., M.P.H
A Safe Work Environment is a Safe Patient Environment
Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditionsResults The study found a negative association between two SAQ domains, Safety and Teamwork, with the odds of both decubitus ulcers and nurse injury. RNHPPD showed a negative association with patient falls and decubitus ulcers. Unit turnover was positively associated with nurse injury and PE/DVT, but negatively associated with falls and decubitus ulcers.
Conclusions Safety climate was associated with both patient and nurse injuries, suggesting that patient and nurse safety may actually be linked outcomes. The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries. Jennifer A. Taylor, Francesca Dominici, Jacqueline Agnew, Daniel Gerwin, Luara Morlock, Marlene R. Miller, BMJ Quality & Safety, October, 19, 2011
A Safe Work Environment is a Safe Patient Environment
The purpose of the Safe Patient Lifting and Moving (SPL&M) Forum is to convene representatives from facilities that have implemented a SPL&M program as well as facilities that would like to explore development and implementation of such a program.
The forum is designed to share innovative practices, discuss challenges and explore solutions as it relates to SPL&M program implementation.
Currently there are 57 forum members from 31 organizations representing nursing, rehabilitation, employee health, quality, patient safety and workers’ compensation
August, 2012 sent a pilot survey to organizations asking them participate in potential database launch.
There were a total of 6 participants from organizations ranging from 101 -500 licensed beds
EXCELLENCE IN SAFETY & HEALTH Adds Business Value and Competitive Advantage …
Safety and Health
Ability to compete
Access to Global Markets
Cost and Risk Reduction
Enhanced Reputation
Employee morale
Improved quality
Improved efficiency
Improved productivity
Safe Patient Lifting & Moving Forum (SPL&M)
Year
Total # hours
worked by all
employees
Total # recordable
SPL&M injuries & illnesses
SPL&M Rate
Recordable
Total # non-recordable
SPL&M injuries & illnesses for your
organization
SPL&M Rate Non-
Recordable
Total # SPL&M incidents
resulted in days away from work
Total # SPL&M incidents resulted in job transfer or work restriction
Dart incidence
rate
Annual workers compensation
payments related to
SPL&M injuries & illnesses
Cost of Worker’s
Comp
2009 5,990,752 28 0.934774 12 0.400617 25 3 0.934774 $61,984 0.010347
2009 4,767,448 28 1.174633 3 0.125853 15 10 1.048779 $20,770 0.004357
2009 5,081,780 36 1.416826 4 0.157425 0 $931,020 0.183207
2009 1,718,739 8 0.930915 6 0.698186 5 7 1.396373 $49,000 0.028509
2010 5,703,107 24 0.841646 23 0.806578 22 3 0.876715 $319,993 0.056109
2010 4,801,137 26 1.083077 4 0.166627 11 11 0.91645 $386,514 0.080505
2010 4,944,638 28 1.13254 6 0.242687 0 $483,585 0.0978
2010 1,549,815 5 0.645238 8 1.032381 1 5 0.774286 $133,000 0.085817
2011 5,952,293 40 1.34402 35 1.176017 37 4 1.37762 $260,732 0.043804
2011 4,708,676 44 1.868891 24 1.019395 16 4 0.849496 $139,162 0.029554
2011 5,069,660 26 1.02571 6 0.236702 0 $192,824 0.038035
2011 1,600,216 4 0.499933 0 0 2 3 0.624916 $6,400 0.003999
Database• Benchmark organizational data in comparison to other organizations
similar in size. • Predictive modeling for SPL&M programs in the future.
Survey and database full deployment• Hospitals, LTC, National
Safe Patient Lifting & Moving Database
Manufacturer(s) of lift equipment utilization:MCHC DATABASE YOUR SYSTEM YOUR ORGANIZATION
# of Hospitals % of Total # of Hospitals % of Total # of Hospitals % of Total
ArjoHuntleighEZ WayGuldmannHill-RomHover TechHoyerJoernsLikoMcAuley MedicalMedcareStrykerTHE
Consultant Utilization:Type of consultant:InternalEquipment manufacturer representativeOutside consulting company specializing in SPL&M programs
2013 PlansProposed Quarterly Meetings
January, April, August, and NovemberProposed Subcommittees
Bariatric Preparedness Topics include identifying facility-wide bariatric needs, bariatric sensitivity and
bariatric equipment checklist. Program Sustainability
The committee will explore best practices related to training, implementation, equipment needs and sustainment.
SPL&M Expo March/April 2013
Explore new technologies and evidence- based practices Hands on demonstrations Educational sessions
Clint Parram, MPHSenior DirectorIllinois Risk Management ServiceIllinois Hospital Association(630) [email protected]
Rob HumrickhouseDirectorClinical Services Metropolitan Chicago Healthcare Council (312) [email protected]
Don MaynesConsultant, Managing PartnerEquitable Health Care Alliances, LLC(515) 262-5187(515) 554-9115 (c) [email protected]