EZ Way Lunch & Learn Webinar Series Presented by Equitable Safety Group Making Cents The Business Case for Safe Patient Handling November 13, 2008 Welcome to the EZ Way Lunch and Learn Series. Today we are showing Making Cents: The Business Case for Safe Patient Handling as produced by Equitable Safety Group specifically for this series. 1
Your Lunch & Learn Presenter Don Maynes Director of Operations for Equitable Safety Group (ESG), has spent 27 years in the insurance industry focusing on loss prevention, risk management, reinsurance, capital investment, and claims. It is my pleasure to introduce you to Don Maynes, Director of Operations for Equitable Safety Group and one of the managing partners in the company. Don has spent most of his career working toward program development with the insurance industry, and has a background in several forms of claims, risk management and capital investment. 2
Safe Patient Handling Defined Safe patient handling programs consist of the equipment, educational components, and the support that is needed to assure results. One of its core principals is budget neutrality. For starters, safe patient handling programming, as we define it here, is not a thing. Each unique program consists of measurable objectives, educational components, staff support mechanisms, and the equipment required to accommodate enhanced methodology. One of the core principals of any safe patient handling program is measuring the nature of its budget neutrality, and we ll talk a bit more about that in a few minutes. This presentation, however, is meant to be more of a general overview of the elements involved in safe patient and resident handling, and is the first in a series that will take each of the many components, and focus on them individually and in detail. Our next presentation will be on loss analytics, and is expected to be done in the near future. Be watching for more announcments. 3
Basic Requirements Safe patient handling typically consists of: Specifically designed equipment that is needed to safely move or transfer a patient The knowledge of how to safely and effectively use the equipment that is present As is the case with any type of programmed format, there are basic requirements of operating safe patient handling programs; and prior to making any investment into any safe patient handling program you should create the business case directed at its ultimate outcome or desired result. As you will see, that consists of measuring known risks, and identifying means of mitigation through specifically designed equipment, that will assist in making the overall environment safer for your staff and patients alike. As I mentioned on the first slide, all programs consist of both hardware (the equipment) and software (the education, support and measurement functions) that are designed to assure that the human and physical aspects become and remain integrated. 4
The Initial Objectives Discuss the elements of exposure in patient handling/transfer Identify methods to successfully mitigate the risk of patient handling injuries Verbalize an understanding of the cost/benefit analysis of various interventions State the key elements to communicate to management in promoting your plan Building the business case can start with a simple discussion amongst members of your staff who have familiarity with the risks associated with patient lifting and transfer techniques. In these conversations, you can readily identify where hazards exist, and how injuries typically occur. Identification of methods needed to successfully mitigate those risks, however, often times (and particularly for start up programs) involve the expertise acquired from outside resources. The reason that is usually done is because there are so many different types of risks, and therefore, so many different types of equipment, that the knowledge level of what s available in the marketplace is multi-faceted, and sometimes difficult to accumulate. Once the first two objectives have been accomplished, it is time to compile your overall business approach, with supporting analyses. When we are completing this portion for our clientele, the reports that we produce typically run over 500 pages in length (with all the detail). That said, the business plan needs to be brought down to a manageable level, and usually down to a communications page or two for senior management to understand the nature of what the next steps will require. Finally, it is important to secure the full VISIBLE support of your management team. 5
Adopting Safe Patient Handling Programs Programming is conducted in four phases An investigative and discovery phase The planning and audit phase The implementation phase Ongoing operations Adopting a safe patient handling program actually starts during the definitive phase of building the business case. We say that there are four phases, however, you could break down each of these into additional sub-phases and say that there are many more. The first of the four phases is an investigatory or discovery phase. It s during that phase that you will do such things as review your workers compensation loss runs to better define what the historic costs have been, conduct site and task analyses to determine what risks are resident and driving those costs, put together the original business approach and secure management s approval of the pre-program design. The next phase involves refinement of the strategic implementation plan, and an audit of the previous risks and exposures analysis. With revisions now made to your living document business plan, you re finally ready to commence full implementation and to achieve ongoing operations. 6
Our Focus Today Developing the financial justification For the balance of the time we have together today, we are going to focus on just the financial justification. Future Lunch and Learns will bore down into other aspects of safe patient handling like program support, educational techniques, etc. 7
ESG Performance Specifications We start with a Loss Run review We then project losses For the next three years We factor in The program cost Minimum Reduction Reduced Losses This represents the minimum Claims cost reduction At Equitable Safety Group, we have successfully used the performance specifications as we will show them here, and have taught them at various seminars over the past fifteen years. These techniques are based on insurance company experience rating methods, and have proven reliable time and time again. We ll look at that in more detail in a moment, but this is the general financial argument that needs to be made to effectively enable management to achieve prudent decisions regarding the various investments needed to accomplish full programming. To start the analysis, review workers compensation loss run information for the previous three complete calendar years. From that we can determine what the most likely case will be in the future through simple trending techniques. We have always based our approaches on conservative forecasting, so next we factor in what the program costs will be (as determined in the investigative phase). That, then, forces us to determine exactly what the minimum reduction in claims costs HAS to be in order to maintain budget neutrality. 8
Establishing Your Injury Prevention Program.And, in that sense, each and every healthcare environment, whether long term or acute care, is totally unique. Therefore, this quest becomes the establishment of a program that will be tailor made, and will only work for your particular operation 9
We will help you: Contact ESG Analyze the nature of the prospect Develop approaches for ongoing dialogues regarding the complete approach (where appropriate) Help you to determine methods of calculations for the eminent sale (e.g. Return On Investment {ROI} of a single lift, tracking a single room, etc.) When we at Equitable Safety Group are not conducting or developing educational sessions like these, we are actively in healthcare facilities across the United States helping them (first) with the investigative phases, then with implementation, and finally with monitoring program operations. Initially we help each organization analyze the nature of the risk, recommend strategic implementation options, and help to present and cement the calculation of the return on investment for senior management approval. That, in turn 10
Leading to the Business Case Define what the cost has been over a three year time frame Define what the cost will be over the next three years if you don t initiate a zero lift program Define how much you can spend on an intervention program where the cost of the program is offset by a reduction in claims Leads to the completion of the business case where we define what the various costs have been over the past three years, trend out what they will be in the next three (if you continue your current practices), and then create a comparative to what the future would be like if you implemented your safe patient handling program. 11
The Starting Point The creation of a comprehensive Financial Impacts Report (the complete business case) Includes Loss Analytics Plans to mitigate risks and exposures Resulting expected returns on investment Complete and ongoing program support to assure program results To start that process, we create a comprehensive Financial Impacts Report that consists of a loss analysis of what types of expenses you re currently paying (workers compensation costs, professional liability costs, related agency nursing fee expenses, etc.). Once we determine what the costs have been, we then conduct unit-by-unit site visits to analyze the nature of the risks that can and do hurt people. Next, we develop the plan to eliminate, or at least mitigate those hazards. Finally, we measure the expected future savings against the investment required to achieve a return on investment that s based on complete and ongoing program support to assure those results. 12
Loss Analytics The Basis of the Financial Report Is found within workers compensation listings or what are called Loss Runs That information is available from the insurer, your self insured trust, or third party administrator This information provides a financial snapshot of what has historically been the case at a given location Loss analytics starts with a review of workers compensation loss run information, and then expands into other areas. By using this technique, you will be able to readily see the type, nature and impact of your program in years ahead. We recently calculated the three-year impact for one of our smaller hospital clients, and learned that they had saved a grand total of $3.7 million over their previous costs. Rarely, we have seen facilities where workers compensation costs are little. In those cases we can generally find various components of safe patient handling already in place. Regardless of the dollar values reflected, we can always determine the nature of the risks that ARE there, and help to refine the focus of safety that needs to be present. 13
Historic Experience From the Loss Runs Experience Rating is used by all experienced insurance underwriters and actuaries to determine what future trends will be We can determine the changes in values of claims as the develop over time We can identify the systemic risk that is in any given location The technical phrase that applies to the method we use is Experience Rating ; That s because we are simply reviewing your various experiences. We also take into account the fact that claims DEVELOP over a period of time and build that into the future projections. Finally, we look for the bull s eye or driving force behind all losses through identification of what s known as the systemic nature of the risk. For some, this may seem to be a lot of technical talk to get to a really simple point..right now you re spending money.in the future, demands are mounting for you to spend less and do more may sound too familiar. By identifying the nature of the risk and where it s located, you can control it or at least modify it to acceptable levels. While you may not be able to totally eliminate the risk, through your efforts you can reduce its impact, significantly reduce the costs associated with it, and create a much better environment for your staff and patients to enjoy. As a rather significant aside, that revised environment leads to greater patient satisfactions scores, and that (in turn) leads to enhanced revenues for your hospital. That will be the topic of a future Lunch and Learn program. 14
Information Needed The Data Required from the Loss Run Claim Date Incurred dollars (paid and reserves) The Unit/Department where the claim occurred What caused the claim? How did it happen? (Examples) Lifting Patient Repositioning Patient in Bed Tripped on Wheelchair Automobile Accident So let s return to our main focus today, and look at the information that you need to gather in advance of creating your safe patient handling business plan. All of the data is accumulated into a listing of workers compensation claims called a Loss Run. There are certain fields of data contained in the loss run that are more important in building the business case. We show those in the four main categories shown above: The claim date; The total incurred value of the claim; The location where the claim occurred; and What caused this particular claim. Note that the claimant s name is not important for this analysis. 15
Loss Run When you request the information from either your insurer, third party administrator or the members of your staff who oversee your self insured program, you will receive a listing that looks quite similar to this. For this example, names of claimants were provided, however, and again, that information is not needed to complete an analysis; and for the privacy sake of individuals involved, we prefer not to gather that specific information. As it is presented here, this information is merely a listing of claims that have occurred within a designated timeframe, so we must combine the claims together to come up with various analyses that will empower you to make specific arguments for safe patient handling programming. 16
The Analysis Summarizing claims by group By location in which the claim occurred By nature of the causation Total cost of claims over the last three years in each department Total cost of claims related to patient lift and transfers in each department The first thing that we do is summarize the claims by grouping them together in such a way that we can determine what happens the most frequently in any given area. And, since we re building the business case for safe patient handling we need to pay special attention to the details associated with any claim involving a patient or resident lift or transfer. 17
Grouping Claims A Patient/Resident lifting claims B Patient/Resident repositioning claims C Cumulative trauma claims D Slip and fall claims E Not otherwise classified When we summarize the information, we do so into one of the above categories. For clarification purposes: Category A is any type of vertical lifting activity where the patient or resident was the subject of the lift; Category B is any activity involving laterally moving the patient or resident (such as repositioning or transferring from a bed to a gurney); Category C is used for all forms of cumulative trauma (such as carpal tunnel and other forms of injury that develop over a longer period of time); Slips, trips, and falls from any surface to any surface; and Claims of all other types and origins. 18
Goals When you use those categories, and then sum each up, you now have a detailed analysis of what your claims costs have been over the preceding three year time period, and have established the baseline for determining what they will be in the future if you continue your current operations exactly as they are today. Put another way, and as frequently quoted during this most recent political season, Einstein said To continue doing things the same way, and expect different results, is the definition of insanity.or words to that effect. 19
Future Trend Using the past to teach us the future Historic Developed Average Values Without intervention The underwritten approach Assumes all requirements are in place Conservative Value Underwritten values v. actual experience So, we now look at the way that things have been and we know where they re going to go if we do nothing but continue the current practices. Using the underwriting approach, however, allows us to make certain quantifiable assumptions and to determine how different things would be IF ALL requirements are put into practice. 20
Future Trend When it comes to creating a report, in this example, we show things both ways: What will most likely happen without a safe patient handling program in the upper box; and Our conservative estimates as to the savings that will occur if a safe patient handling program is effectively operated. 21
When Savings Become Investments Finally, we show a single Investment Summary that reflects what claims have been, what savings will be, what the depreciated equipment costs offset those savings, how much capital investment will be required to adequately fund the program, and finally what the internal rate of return and return on investment values are when measured against those savings. 22
The Bottom Line Provide a systematic approach using standardized methods that reveal the facts And the facts Speak for Themselves The bottom line here is that, in building the business case for safe patient handling, you need to provide a systematic approach using standardized methods that will reveal the facts. And the facts Well, they speak for themselves. 23
Determining Clinical Requirements in Each Department Analyze Injury History Define patients dependency level Define patient movement tasks Define physical characteristics of the department As we ve shown, determining the methods and equipment needed, starts with the analysis we just covered. From there, we launch our way into a tour of the facility and interviews in each department to determine such things as patient s dependency level, the tasks that are done, as well as the frequency and difficulty of those tasks. Doing such things as repositioning patients or residents in bed, done every two hours, twelve times per day, times 100 people who require that assistance, leads to doing that highly difficult task over 400,000 times per year. Is it any wonder then, that without any assistance from equipment specifically designed for that purpose, that injuries occur? We also look into the physical aspects of each corridor, patient room, restroom, and storage facility. Doing a bit more digging, you look at such things as transportation patterns, and even laundry practices. All of this is taken into account when you compile your original business plan. 24
Design Flexibility The analysis enables the facility to develop several strategies Examples of interim solutions: Conversion of transport teams to lift teams Combination of lift teams and equipment Prioritization of high risk departments Addressing all lateral transfers Transition plan over three to four years Definition of both short and long range planning Collecting that data not only enables a valuable comparison from the investment perspective (because that leads to the equipment needed, programming, policies, procedures, etc.) but it also helps to define the various interim solutions that can lead to the ultimate total solution. 25
Goals The Next Steps The creation of your own unique comprehensive Financial Impacts Report Conducting a Risks and Exposures analysis to determine appropriate interventions Development of strategies based on the financial condition and culture of your facility Summarize your findings in a single comprehensive business plan Define the exact nature of YOUR Safe Patient Handling Program Formally adopt YOUR Safe Patient Handling Program This slide represents a checklist of to do items needed by anyone entering into safe patient handling as an established practice. Today, we have focused more on the first step, while making mention of the others at various points in the presentation. It is our intent to continue the EZ Way Lunch and Learn Series into the foreseeable future, and to cover each of these other items in more detail. 26
Supporting the business of healthcare workplace safety, the people who make it work, the equipment manufacturers who serve that need, and the patients who experience the result. At Equitable Safety Group, we support the business of healthcare workplace safety, the people who make it work, the equipment manufacturers who serve that need and the patients who experience the result. It has been our honor to conduct the first of the EZ Way Lunch and Learn Series, and we look forward to supporting this program more in the future. 27
Contacts to learn more how ESG and EZ Way can help you implement your program Don Maynes (ESG) Mary Landhuis (EZ Way) donmaynes@msn.com (515) 262-5187 mlandhuis@ezlifts.com (800) 627-8940 Thank you for attending today. 28