November 2012
Presented by:
Clint Parram
Senior Director, Loss Control
Illinois Risk Management Services
Don Maynes
Consultant, Managing Partner
Equitable Health Care Alliances, LLC
Rob Humrickhouse
Director, Clinical Services
Metropolitan Chicago Healthcare Council
Session Objectives

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.
Florence Nightingale

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.
SAFETY’S ROLE IN BUSINESS FUNCTIONS
FINANCE /
ACCOUNTING
STRATEGY
OPERATIONS
SAFETY
and
HEALTH
MARKETING /
RISK
COMMUNICATION
MANAGEMENT /
ORGANIZATIONAL
BEHAVIOR
The Center for Business and Public Policy at Georgetown University
Profitability or Survivability

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.
Business Systems

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.
PLAN
Risk
Identification/
Analysis
ACT
DO
Strategic
Review and
Continuous
Improvement
Risk
Management
and Control
CHECK
Evaluation and
Corrective
Action
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
Incidents by Type
22%
32%
7%
8%
19%
13%
Sprains Strains
Exposures
Contusions
Punctures
Lacerations
Others
Patient Movement Incidents for IRMS
 Patient Movement MSDs made up (on average)
27%, 35%, 33% and 35% of all lifting incidents
over those 4 years
Patient Handling Incidents by Occupation
131
118
5
16
13
124
CNA
Nurse Assist.
LPN
RN
PCT
Other
Safe Patient Movement (SPM) Injury
Prevention Program in Nursing Homes

(Collins et al, 2004)
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)
Points of interest

Results
 SPM claims reduced by 57% from 129 to 56
 Direct injury costs dropped from $441,670 to
$277,061 yielding annualized saving of $54,870
 The 10 year net present value of the project at
the time of implementation was $594,605
 Accounting for capital maintenance, retraining,
and training backfill, the adjusted recovery time
on investment = 3 + years, but ROI for some
programs < 2 yrs.
Safe Patient Movement (SPM) Injury
Prevention Program in Acute Care

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
Rehabilitation Unit at
Acute Care Hospital

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
Patient Movement Incidents
$300,000
$272,328
$250,000
$200,000
$150,000
$86,807
$100,000
$63,741
$732
$50,000
$0
2005
2006
2007
2008
SYSTEMS
Performance Metrics
Leading
metrics
Attitudes
(set up conditions,
behavior)
- Perception
surveys
Program
Elements
- Training
- Accountability
- Communications
- Planning &
Evaluation
- Roles &
Procedures
- Incident
Investigations
Physical
conditions
-Inspections
-Audits
-Risk
assessments
-Prevention &
control
Behavior
(action)
-Observations
-Feedback
loops
ORC Worldwide M etrics Taskforce
Trailing
metrics
Incident
or Near
Miss
- OSHA
Recordables
- Lost
Workdays
- Restricted
Workdays
Current Challenges
Aging 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
Indicators of Worker Safety & Health
 Lagging




OSHA 200/300 logs
Workers comp claims
First aid cases
Use of temporary staff
 Leading





indicators
indicators
Injury risk indicators (ergonomic assessment)
Employee surveys: symptom surveys & satisfaction
Resident satisfaction
Safety audits
Physical Symptoms Survey Employee and Patient Surveys
 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
A Safe Work Environment is a
Safe Patient Environment

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 conditions

Results 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
 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 …
Ability to
compete
Access to
Global Markets
Enhanced
Reputation
Safety and
Health
Employee
morale
Cost and Risk
Reduction
Improved
quality
Improved
efficiency
Improved
productivity
Safe Patient Lifting & Moving Forum (SPL&M)
100%
90%
80%
70%
60%
50%
40%
33%
33%
30%
17%
20%
10%
0%
17%
0%
100 or less
0%
101 - 200
201 - 300
301 - 400
401 - 500
500+
17%
Yes
No
83%
100%
90%
80%
70%
60%
50%
50%
40%
33%
30%
20%
17%
10%
0%
Yes
No
On the Magnet® journey
17%
Yes
No
83%
SPL&M committee
83%
SPL&M unit champions
83%
SPL&M organizational coordinator
83%
SPL&M minimal lift policy
83%
SPL&M lift team
33%
SPL&M patient advisory policy
0%
Other
0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
90%
83%
80%
67%
70%
67%
60%
50%
40%
33%
30%
20%
10%
0%
Formal ongoing
training classes
Ongoing active
coaching in the
patient care
environment
Annual refresher
training
Other
100%
90%
83%
80%
70%
67%
60%
50%
40%
30%
17%
20%
10%
0%
0%
Initial competency Annual competency No Other Assessment
assessment
assessment
Other
Standing and raising aids
Manual lateral slides (i.e., draw sheet, Maxi-Slide™)
Hydraulic gurneys
Height-adjustable exam tables
Gait belts
Air-assisted lateral slides (i.e., HoverMatt®)
Passive floor lifts
Hydraulic floor lifts
Equipment transport devices
Beds
Wheelchair transport devices
Patient transfer aid
Motorized stretchers
Ergonomic shower chairs
Ceiling lifts
Bed transport devices
Mechanical lateral slides
Other
One-way slide chair cushions
83%
83%
67%
67%
67%
67%
50%
50%
50%
50%
33%
33%
33%
33%
33%
33%
17%
0%
0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
67%
50% 50%
33% 33% 33%
17% 17% 17% 17%
0%
0%
0%
Year
Total #
hours
worked by
all
employees
Total #
recordable
SPL&M
injuries &
illnesses
2009
5,990,752
2009
Dart
incidence
rate
Annual workers
compensation
payments
related to
SPL&M injuries
& illnesses
Cost of
Worker’s
Comp
3
0.934774
$61,984
0.010347
10
1.048779
$20,770
0.004357
0
$931,020
0.183207
7
1.396373
$49,000
0.028509
22
3
0.876715
$319,993
0.056109
11
11
0.91645
$386,514
0.080505
0
$483,585
0.0978
5
0.774286
$133,000
0.085817
37
4
1.37762
$260,732
0.043804
16
4
0.849496
$139,162
0.029554
0
$192,824
0.038035
0.624916
$6,400
0.003999
SPL&M
Rate
Recordable
Total # nonrecordable
SPL&M injuries &
illnesses for your
organization
SPL&M Rate
NonRecordable
Total # SPL&M
incidents
resulted in days
away from work
Total # SPL&M
incidents resulted
in job transfer or
work restriction
28
0.934774
12
0.400617
25
4,767,448
28
1.174633
3
0.125853
15
2009
5,081,780
36
1.416826
4
0.157425
2009
1,718,739
8
0.930915
6
0.698186
5
2010
5,703,107
24
0.841646
23
0.806578
2010
4,801,137
26
1.083077
4
0.166627
2010
4,944,638
28
1.13254
6
0.242687
2010
1,549,815
5
0.645238
8
1.032381
1
2011
5,952,293
40
1.34402
35
1.176017
2011
4,708,676
44
1.868891
24
1.019395
2011
5,069,660
26
1.02571
6
0.236702
2011
1,600,216
4
0.499933
0
0
2
3

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
MCHC DATABASE
Manufacturer(s) of lift equipment utilization:
ArjoHuntleigh
EZ Way
Guldmann
Hill-Rom
Hover Tech
Hoyer
Joerns
Liko
McAuley Medical
Medcare
Stryker
THE
Consultant Utilization:
Type of consultant:
Internal
Equipment manufacturer representative
Outside consulting company specializing in SPL&M programs
# of Hospitals
% of Total
YOUR SYSTEM
# of Hospitals
% of Total
YOUR ORGANIZATION
# of Hospitals
% of Total
2013 Plans

Proposed Quarterly Meetings
 January, April, August, and November

Proposed 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, MPH
Rob Humrickhouse
Don Maynes
Senior Director
Illinois Risk Management Service
Illinois Hospital Association
(630) 276-5646
cparram@ihastaff.org
Director
Clinical Services
Metropolitan Chicago Healthcare Council
(312) 906-6061
rhumrick@mchc.com
Consultant, Managing Partner
Equitable Health Care Alliances, LLC
(515) 262-5187
(515) 554-9115 (c)
donmaynes@msn.com