Patient Handling and Movement Programs (PHAMP): Building the Business Case

Patient Handling and Movement Programs (PHAMP):

Building the Business Case

Merl Miller, CIE; Certified Industrial Ergonomist

Ashton Tiffany, LLC

Prepared by :

Arizona Society for Healthcare Risk Management

Healthcare Has Changed…

Prepared by :

But… Not Enough

Why Do We Need a Business Case?

• Dissatisfaction with current state• Shared recognition of the need for,

and logic of, SPHM• Need for SPHM as a combination of

threats and opportunities

‘Urgency’ to build momentum for acceptance of SPHM

Prepared by :

Categories of Value

• Delivery• Quality• Efficiency• Health and Safety

• Outcomes• Injuries

Health and Safety

Quality

Efficiency

Costs

Prepared by :

Skin shear Comfort Safety

Length of stay Dignity Fatigue

Patient injury Satisfaction Empirical-basis

Fall risk Fear Best practices

Pressure ulcer Pain Morale

Quality of care Safety Satisfaction

Quality Care

Patient Satisfaction

Staff Satisfaction

Reduce Exposure to Hazards

• Injuries

Health & Safety

Injury rates Injury frequencyLost workdaysRestricted workdaysDirect cost of injuriesIndirect cost Total cost

Prepared by :

Personal Protective Equipment

Yet, we routinely accept exposure to musculoskeletal hazards.

Prepared by :

Incident Cost Iceberg

INJURY & ILLNESS DIRECT COSTS• Medical• Compensation costs

INDIRECT COSTS• Overtime• Quality• Patient injury• Hiring/Retraining• Short-term disability• Productivity/Efficiency

Underreporting

Prepared by :

Closer View of WRMSDs

REACTIVE APPROACHLagging Indicators

PROACTIVE APPROACHLeading Indicators

CRITICAL (Disability)SEVERE (Surgery)

SERIOUS (Incident)MAJOR (Pain)MINOR (Discomfort)UNRECOGNIZED (Tasks)

Ergonomic Risk Factors

Prepared by :

Replacement Staff vs. Core Staff

• What do we know about core staff?• Who is providing bedside care?• How does it impact quality?• Is this effective or efficient?

Prepared by :

Magnet® Recognition Program

Culture of Safety: EP30. Describe and demonstrate

“The structure(s) and process(es) used by the organization to improve workplace safety for nurses based on standards such as the ANA’s Safe Patient Handling and Movement”

Ref: ANCC (2008) The Magnet Model Components and Sources of Evidence. ANCC, Silver Spring, MD, p.19.

Prepared by :

Improve Patient Quality

• Outcomes

Quality

Patient experience Length of stay Never eventsNegative patient outcome: falls, skin and respiratory health

Prepared by :

Recruitment & Retention

Wages

QualityPermanent Disability

Aging Workforce

Staffing

Prepared by :

Falls

Skin

Pressure Ulcers

Respiratory Health

Length of Stay

PatientOutcome

PatientExperience

Prepared by :

Immobility

• Functional decline• Reasons for patient

immobility• Consequences of patient

immobility¨ respiratory (pneumonia)¨ CV (DVT, hypotension)¨ GI (constipation)¨ musculoskeletal¨ skin (pressure ulcers)¨ psychosocial

Prepared by :

Prepared by :

Understanding the Value

• Reduced patient falls and associated costs

• Reduced patient ulcers and treatment costs

• Increased patient satisfaction• Reduced costs from WC and lost/

restricted workdays• Improved worker satisfaction• Improved worker retention and reduced

turnover

Systems and Processes

• Delivery

Efficiency

Efficiency• number of staff to do task?• time spent waiting for assistance?

Non–value added tasksWasted motion and physical effortBarriers to efficiency

Prepared by :

What is Necessary for Change to Occur?

Model to follow—implementation process:• outlines the organizational strategy• provides an understandable approach• organizes tools and resources

Focus on process!

Prepared by :

Barriers to Efficiency

Equipment access:LocationDistanceCompliance

Inventory and par levels:Insufficient resourcesBudgetAccountability

Logistics and cleaning:ShrinkageScheduleTurnaround time

Prepared by :

What are the Program Elements?

• Leadership commitment• Employee involvement and participation• Program management and coordination• Worksite analysis• Risk identification, analysis, and control• Education and training• Medical management• Continuous monitoring and improvement

Prepared by :

Employee Engagement

Develop a facility SPHM team• facility process leader(s)• administrative sponsor• SPHM specialist or coordinator• SPHM team members• SPHM coaches• ergonomics and injury prevention

specialist

Prepared by :

Why Do You Need a SPHM Specialist?

• Strong and committed leadership• Visible, active, and public commitment/

support• Willingness to take initiative and challenge

the status quo• High level of attention to/focus on SPHM• Change leadership as full-time activity

Prepared by :

Financial Performance

• Quality• Health and Safety• Efficiency

Costs

Net operating marginRetentionLabor costs (float, pool, and travelers)Workers’ compensation premiums: based on frequency and severity

Prepared by :

Loss Data Used to Build a Shared Need

• Forces any resistance or apathy to be addressed head-on

• Indicates why SPHM is critical• Builds momentum to get SPHM program

communicated and launched

Prepared by :

Gaining Commitment

• Identify direct and indirect cost of WRMSDs

• Calculate overtime, premium labor and agency staff

• Relate to operations and profit margin• Link with patient safety and satisfaction• Consider the dollars of reimbursement

needed to offset workers’ compensation claims?

Prepared by :

• Productivity

• Efficiency

• Performance

• Injury risk

• Probability of injury

• Injury consequence

Prepared by :

Return on Investment

Operating Margin Impact

• Patient handling injuries (3-year average)• Incurred costs $ 76,477• 966 LWD/RWD 231,840 (@ $30/hr)• Direct cost $308,317• Operating margin 4%

Annual Direct Cost

$7.7 million additional annual revenue needed to offset cost of claims

Prepared by :

Hiring

Training

Legal Investigation

Teamwork

Schedules

Indirect Costs

3–10 X Direct Costs

Operating Margin Impact

• Direct cost $308,317• Multiplier 4 X• Indirect costs $1,233,268• Total cost $1,541,585

Annual Direct Cost + Indirect Costs

Total Cost $1,541,585

Prepared by :

Operating Margin Impact

• How much revenue to offset expenses?• What is the operating margin of facility?• What is the financial impact?

Losses Versus Profits

Additional Annual Revenue $38.5 Million

How many additional surgical cases must be performed to cover these dollars?

Prepared by :

Which Option Makes Sense?Threats Opportunities

Short term

Restricted time awayLost time awayPool, float, and premium laborDecreased quality of carePatient injury (fall, skin, or ulcer)Litigation potentialCosts

Cost savings with decreased WCPatient quality/function improvedReturn to work—full duty

Long term

Aging workforceEmployee turnoverDecreased recruitmentExit professionLoss of “wisdom-workers”Federal legislationCosts

Improved staff moraleImproved staff satisfactionImproved staff recruitmentImproved staff retentionImproved patient satisfactionImproved quality of careFacility recognition

Prepared by :

External Organizations with Recognition

• The Joint Commission Accreditation• ANCC Magnet Recognition Program®• American Nurses Association• American Industrial Hygiene

Association• Association of periOperative Registered

Nurses• National Association of Orthopaedic

Nurses• American Association for Safe Patient

Handling and Movement

Prepared by :

Regulations

• Safe patient handling—federal bill introduced¨ States with legislation passed or introduced¨ TX, IL, MN, MD, NJ, RI, WA, NY, HI, MA,

MI, MO, VT• Federal OSHA—general duty clause:

“every employer must provide a safe working environment for their employees”

Prepared by :

Prepared by :

If you have questions or would like a copy of this presentation, please contact:

Merl Miller, CIEAshton Tiffany, LLC333 E. Osborn Road, Suite 300Phoenix, Arizona [email protected]://www.ashtontiffany.com