November 2012 Presented by: Clint Parram Senior Director, Loss Control Illinois Risk Management Services Don Maynes Consultant, Managing Partner Equitable.

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]