Safe Patient Handling part 2 with Rob Sylvester and Laurette Wright

From slips and falls and musculoskeletal injuries to quality of
care issues, safe patient handling and mobility poses challenges to
caregivers across the world.

According to OSHA, in 2017, nursing assistants had the second
highest number of recordable musculoskeletal disorders (MSDs)
cases with more than five times the average for all industries.
OSHA attributes these trends to repeated manual patient handling
activities.  Just having a program on the books is not
enough.


In this episode, Laurette Wright and Rob Sylvester, both Safe
Patient Handling and mobility experts here at MEMIC, join me to
explore a SPHM program’s components and what makes them succeed
or fail.


 


Peter Koch: Hello, listeners, and welcome to the
MEMIC's Safety Experts podcast, I'm your host, Peter Koch. Back
in June of 2020, we dropped the first of three episodes dedicated
to exploring the safe patient handling dilemma. And then episode
I spoke with Lauren Caulfield, director of the Atlantic Region
Loss Control for the group. And we unpacked the safe patient
handling problem focusing on costs for patients and providers, as
well as the history behind MEMIC Safe Patient Handling Program.
You can check it out at MEMIC.com/podcast#HealthCare in today's
episode. We're going to explore the dilemma from a slightly
different angle. Looking at it from the outside in or a
consultant's view, as the adage goes, sometimes it's hard to see
the forest through the trees. And when you're close to a problem,
it can be difficult to see its whole shape with the challenging
topic, like patient handling and mobility. You just can't look at
it from the middle. You have to see all the edges. So working
with someone who has a deep understanding of the benefits and
challenges of safe [00:01:00] patient handling can be invaluable
when setting up or evaluating your program. So that said, on the
line with me today to help us further define the patient handling
problem and look at what makes a program succeed or fail, are
Laurette Wright. And Rob Sylvester two safety management
consultants here at MEMIC and both experts in safe patient
handling. Laurette is a recognized practice leader within the
Safe Patient Handling and Mobility Community. She's presented
safe patient handling strategies internationally, across the
country and at the state and local levels. She's a contributing
author of the book The Illustrated Guide to Safe Patient Handling
and Movement, and has penned numerous articles published in trade
journals, including the International Journal of Safe Patient
Handling and Mobility. Laurette is a registered nurse and holds a
Bachelor of Science in nursing from the University of North
Carolina at Greensboro, as well as a Masters of Public Health
from the University of North Carolina at Chapel Hill. She has
credentialed as a certified occupational health nurse and
[00:02:00] certified safe patient handling professional Laurette
came to MEMIC in 2016 to be part of MEMIC's health care team in
our Atlantic region, focusing on safe patient handling. Laurette
, welcome to the podcast today.


Laurette Wright: Hi, good morning. Thank you for
having me.


Peter Koch: Right on. And then, Rob, Rob
Sylvester has a wide range of experience in the health and safety
field from military, manufacturing and emergency management to
health care teams and special needs populations. He works with
company leadership to provide tools necessary for workplace
safety success. Rob retired in 2017 after twenty five years of
active duty service in the Navy. His last assignment was Command
Master Chief of the Navy Operational Health Support Unit in
Portsmouth, Virginia. He is responsible for all enlisted matters
and provided guidance to the commanding officer for the nearly
600 sailors at 14 detachments in six states. Rob has an
associate's degree in occupational environmental [00:03:00]
health science and a bachelor's of science degree in health
sciences. He is a certified environmental health technician by
the National Environmental Health Association and a certified
safe patient handling associate. Rob came to MEMIC in 2013 and is
a leader with our health care team and our northeast region. Hey,
Rob, welcome to the podcast today.


Rob Sylvester: Good morning, Peter and Laura,
thanks so much for having me. Looking forward to today and
sharing some great keys to success and where we can help clients
make some improvements.


Peter Koch: Yeah, right on. So I'm really happy
to have you both on here. And like I started, we talked about
this particular problem with Lauren back in June. And then we
were looking at this in a three part podcast series, really
looking at it from the perspective of what's the problem? And
then now having you on looking at it from the perspective of a
consultant looking from the outside to the inside, like, what are
the edges of this problem look like? And how does that compare
with what maybe [00:04:00] the hospital leadership sees? And then
what are some success stories? So let's start with this. So, Rob,
let's start with you first. What was your experience with patient
handling prior to coming to MEMIC both personally and
professionally?


Rob Sylvester: Hey, Pete, thanks for the
opportunity. Prior to coming to MEMIC. As you said earlier, I had
a varied experiences out there, different industries, but really
with patient handling. It started with a special needs
population, cerebral palsy type population, where, you know,
prior to calling it and formalizing safe patient handling, you
know, we called it patient care. I had an amazing team of
therapists that I worked with, direct care staff. You know, I was
the risk management specialist there. And I'll tell you, I
learned so much from them and, you know, putting the client or
the resident first and realizing that it was making a safer
environment for not only the resident but the employee and vice
versa. So back then, [00:05:00] you know, it wasn't you know,
this is a safe place handling program. It was how we did day to
day care for the population. So that was kind of my opening to
it. And the challenges that came with it of the behaviors, the
acting out at the times when you're trying to transfer or assist
with mobility and things like that. And then after that, it was
actually interesting story, because years later I ended up
working for a very large acute care or actually a health care
network, which is actually when I met Laurette. Laurette was
working for another company and assisting as a consultant to help
us roll out a patient handling program. So I was responsible for
patient handling, leading a team that was responsible for patient
handling, for acute care, for ancillary services, for a long term
care facility. And it was an amazing process that truly
solidified. I'll call it my love or passion for helping clients
improve their programs, because, as you said, I've walked the
walk, the very difficult walk, the difficult walk of starting a
program [00:06:00] and trying to get people on board. And through
that process, as I said, that's where I actually met Laurette.
And we started working together back then. And now, almost seven
years later, I'm here at MEMIC and just loving life.


Peter Koch: Right on. That's a great story and
it really kind of shows how, you know, sometimes pardon the pun
you might stumble on a passion for a particular safety solution.
And in this particular case, you know, back in your history, you
had some significant experience with developing programs and are
bringing that expertise to us here at MEMIC, which is great. So
let's throw this to you. So the same question to you. So what was
your experience with patient handling before you came to MEMIC?
We talked about some of it in the intro there, but let's talk a
little bit more about that. So what's your experience with that,
both personally and then professionally?


Laurette Wright: Wow. It's been an amazing
journey regarding safe patient handling for myself, one
particularly as a nurse. So back in the day, [00:07:00] I, you
know, managed and handled my patients manually. And I worked
third shift. And for those out there who work third shift in
nursing, you know, staffing levels aren't always the highest. So
when I would have particularly a deceased patient, I would often
have to try to manage and handle that person by myself and doing
the post-mortem care. And I can remember even today, the brute
force I had to use and how sometimes I felt really bad about the
handling of that person, even though they were deceased. I didn't
always feel like it was in the most dignified manner. But, you
know, going forward years later, starting to experience some back
difficulty and some back aches and also knowing then that it came
with the job, it was the implied philosophy that that's what us
as nurses [00:08:00] did. And so therefore, back in the day, I
didn't really see it as an incident at the time. I just felt like
that's how it was supposed to go.


Peter Koch: Part of the job.


Laurette Wright: Part of the job, and then
moving years forward. And around 2000 back up a little bit. I
evolved into occupational health and safety, focusing my efforts
in internally to considerations keeping people safe and healthy
said in 2000, I was contacted by a medical device manufacturer
who specialized in patient handling to help design a consultative
division or a unit to partner with their customers and helping
them implement safe patient handling practices, but to do it as a
process driven approach and not an event. And so that took me on
the journey of seeing hundreds of acute care, long term care
facilities. It took me on the journey of being [00:09:00] with
national task force groups, as well as speaking in different
countries. And the thing that's common across the nation is that
manual handling of patients is manual handling of patients that
nobody, there's no sweet spot or magic for how we do that unless
we have some tools to help us. On a personal note. Patient
handling was an integral part of elder parents who one was a
mother who was in a car accident and she had many fractures. She
was in her 70's and staff in the hospital who had patient
handling equipment, didn't use it, handled her manually in the
extreme pain coming from her, her voice on that. And my father,
again, was in a hospital that had patient handling equipment.
[00:10:00] Staff, again, didn't consistently use it. And he
became deconditioned and he went in, mobilized and he was
discharged, not having the ability to walk anymore because he had
become so deconditioned, so patient handling, safe, patient
handling equipment for me is I like to frame it as mobilization
tools and not really as equipment it's tools that can help safely
mobilize our patients and residents to their highest abilities to
the best that they can be. So I'm quite passionate on the front
lines for my colleagues, but as well as our family members and
friends who need that little bit of help.


Peter Koch: Yeah, that's an interesting story.
And you brought some interesting perspectives there and a couple
that I haven't thought of as when you talked about your dad going
in mobile, [00:11:00] and that had mobility and then coming out
without it, thinking about the tools that you have for patient
handling, being not just a tool to be able to help that person
move and help prevent an injury and better care for the person
that's being moved, but also helping them maintain mobility when
they can across the long run. And I think that might be missed by
different professionals within the industry. I know for a fact
personally, my daughter is just graduated from nursing school and
has been working as a nurse before. She sits for her boards and
we talk about patient handling all the time. And her perspective
or some of the information that she's been taught is more about
injury prevention and instead of being a mobility tool to help
maintain mobility and help with patient care overall. So that's
an interesting perspective that you bring. And I will try to
unpack some of that later on as we go. And [00:12:00] then, Rob,
one of the things that I was thinking about when you were talking
through it, too, is you've had some experience on the emergency
side of things, the pre-hospital side of things, too. And I think
even there you can talk about patient handling where there really
aren't a lot of tools that can be used to be able to move
somebody in an emergency situation from place to place. But there
are certainly things that can do that can not only help prevent
injury to the caregiver, but maintain good patient care and
reduce pain in motion when you are trying to move that person
from place to place.


Rob Sylvester: Great point, Pete. You know,
there are opportunities, you know, whether we're dealing with EMS
or, you know, the pre-hospital side of things or arrival at
emergency departments, you know, there are devices, whether it's
battery powered stretchers or gurneys, into things like, you
know, some call them non mechanical. I prefer to call them non
[00:13:00] powered, you know, non battery operated devices that
can get into vehicles for vehicle extraction or vehicle removal.
Somebody arrives at an emergency department again, you know,
somebody that's been in those situations, a lot of emergency
departments are resistant to that. You know, Laurette could talk
more about that later, but we get so many that are resistant to
the fact that, hey, we're an emergency department. This is an
emergency. Well, if you were to actually sit down and qualify to
quantify the number of patient interactions you have, how many,
when it comes to patient handling and mobility, are truly
emergent. So I try to remind our clients of that, you know, it
might be an opportunity. Are we saying there's a hundred percent
of the situations where they need to do that? No, let's face it,
there are times where it's an emergency situation, but there's so
many where they should and could be using a piece of equipment
because again, yes, it's about your safety as an employee, as a
caregiver, as you continuously tax your body. But at the same
time, it [00:14:00] is the safety of that person coming in. You
know, I've been in situations where people have been dropped,
whether it's because they felt they wanted to get out of bed or
out of a chair or because caregivers didn't use pieces of
equipment. And they went from, as Laurette said about her, her
father going from being mobile to, you know, going a decline of
their mobility status. So there are opportunities to be looked
at. And, you know, whether it's working with vendors, working
with your safety management consultants, you're partnering with
your broker and looking at those opportunities. So there are
opportunities in, quote unquote, emergent and pre-hospital
situations that can be discussed and really evaluated. Again, you
know, emergency departments deal with a lot of things that are
not emergent and there's opportunities for improvement there.


Peter Koch: So, again, really great points
there, Rob. And I hadn't, again, thought about that. There are
opportunities where if you change your thinking, you'll be able
to implement a safe patient handling process, whether [00:15:00]
it be a mechanical device or a non mechanical device or even a
process where if it is emergent, you actually have to be in there
and physically be with the patient. But what are some of the
things that can be done and then manage the thought process of is
it truly emergent? How many times do we actually have to fall
back to those emergency processes? And can we use the tools
provided for mobility and patient handling to not make it
emergent? I mean, if you step back and someone many times well, I
won't say many times, but I guess in my perspective, sometimes
patient handling will result in a fall because we didn't use the
right tools in the first place. And then that becomes emergent
and that puts not only the patient but the caregiver at risk. And
Laura, you talked about it being a process driven approach, not
an event. [00:16:00] Can you can you expand on that a little bit,
thinking about patient handling as a process driven approach, not
just as an event? And does that fit in with what we were just
talking about, about the opportunities to utilize tools?


Laurette Wright: Absolutely. You know, the key
word is altering or change our thinking paradigm shift. Some of
that thinking, again, when we hear the word, especially if your a
health care provider like myself, if you hear the word emergent,
the first thing that pops into my head is there bleeding out or
is literally life or death. And I think we use that word outside
that context so much that when we do use it, we again just think
it's everything is life or death. And it isn't. So as a user and
user for patient handling, I was taught when I was in practice,
here's your lift and we need to use the lift. And [00:17:00] that
was all I really got. I you know, however, what I have found that
when we institute the use of patient handling in that manner,
we're missing opportunities of process approach to it. Because
when we talk about other things in health care, whether it's
using the code cart, giving out medicine, those kind of
protocols, we do that from a process. We don't just say you're
going to give this medicine out. And so we're missing an
opportunity if we look at this program or safe patient handling
as a one time thing and it's an event versus the process because
we have to embrace it, change our thinking behind it, and
therefore change the behavior. Behavior changes our processes.
You know, when I think about dieting or smoking, quit smoking,
dieting, all those things, that's a process. And so patient,
[00:18:00] safe patient handling in the context of that is
important to be looked at upon that manner right away. Because
other than that, it becomes a piece of hardware or metal that I
have to use. And the likelihood is I won't because I really
haven't changed my paradigm thinking.


Peter Koch: So expand a little bit more, and
either of you can jump into this one, so why don't people see
patient handling as a process? Why don't either nurses see it as
a process, caregivers see it as a process, or even hospital
administration see it as a process. Why do we start with here's a
tool. You have to use it and then we might teach you how to use
the tool, but we don't really give you a process to use it. Why
don't we start there?


Laurette Wright: It's just never been a part of
our culture. It's not been a part of nursing culture. You know,
if you look at books and images, which I [00:19:00] have from
back in the day of Florence Nightingale, they're showing nurses
wrapping people in sheets, what we call log rolling and then
carrying the sheet like three of us across horizontal to carry
the patient. It's just never been ingrained in our practice and
we don't know to do any different. And so there's opportunities
where the best approach to do that is to start in the nursing
schools and groom new nursing students to evolve into that. So
for me, my perspective is we just didn't know and no one really
looked at it this way until now. When we're seeing the injuries
and the number of dollars that employers are spending to comp
towards this now obviously it's hitting our bottom line and it's
becoming more visible.


Peter Koch: Do you think that there's a
connection between not seeing [00:20:00] it as a as a process and
nurses, caregivers seeing the tool as impersonal? And the care
that I'm trying to give this person needs to be personal. You
talked about dignity before Laurette, when you had to deal with
even a deceased patient and trying to treat them with human
dignity and maybe using a tool to help this person isn't seen as
personal. Is that a barrier? Is that a perspective that needs to
be changed?


Laurette Wright: Absolutely. One of the barriers
that I always have said to my colleagues is the only profession,
the only profession that thinks one hundred pounds is like is
nursing.


Peter Koch: That's true.


Laurette Wright: I have said many times to
colleagues, how many of you see the person carrying a big box to
your house with no tools? We don't see that. [00:21:00] And
because we think one hundred pounds is light, that drives our
behavior. And even today, with larger size patients and
residents, I've asked staff what they think is light. And now
most staff will reply to me like one eighty, one eighty-five. And
if that's what we see is light, then we're going to probably try
to counter it by ourselves. So again, there's a lot of myths out
there that has driven our behaviors and it's just a matter of,
again, reframing it. If we you know, if I said using equipment to
mobilize and I don't see it as a piece of hardware, but it's a
mobilization tool for my dad to keep him as active as possible.
The likelihood is dad may not have had deconditioning.


Peter Koch: Yeah, great point, Rob. How about
you? Do you want to you have anything to add to that?


Rob Sylvester: I do. Excellent points, Laurette.
[00:22:00] You know, when we look at things, a lot of people, you
know, especially in the world of safety, whether it's physical
plant safety, whether it's health care, safety, many don't look
at the overall approach and process like you were saying. And
like Laurette was talking about. A lot of time safety is
unfortunately, they attempt too often to drive safety through
compliance. You know, OSHA says thou shalt do this. To your point
earlier, Peter, you said, you know, we have these tools, you're
going to use them. And too often we see that especially in health
care. Hey, we have this new piece of equipment. Yes, we did
training on it. You know, let's face it, in my opinion, it's
really a I don't like calling it competencies, even though that's
the word that's used throughout the industry, because let's face
it, are you really competent? When you just saw a piece of
equipment 10 minutes ago for the first time, you're really, truly
not competent. So a lot of times your point, I see facilities
driving it via compliance. Our policy says so. We've spent the
money on the equipment. We did the training. So thou shalt use
this piece of equipment.  [00:23:00]So a lot of times I
think that's the big struggle is they try to drive things from a
compliance perspective versus reminding people. And to me it's a
continuous it's a daily whether it's a peer unit leader, whether
it's the nurse managers or others, it is a daily reminder at
huddles of why we truly need to use pieces of equipment. And it's
a journey. It takes a while to get to that point. We can't expect
overnight for people to make that change. You know, as Laurette
talks about, you know, going back to the days of Florence
Nightingale, you know, using your body to provide that care and
going through the process myself, working in legal and risk
management and health care and being that team leader for patient
handling that champion. You know, we would go around the facility
and we would talk to people in different units. You know, med
search may say, you know, I consider light one fifty, but then
I'd go to the ICU and sometimes some of those nurses were like,
yeah, we don't worry until they're about three hundred. We get
four patients in here and we use a sheet [00:24:00] and we log,
roll them. Well there's better not only devices, but there's
better ways, there are safer ways to do things. So the process
truly is to start at the beginning and look at your challenges.
Find, and I always like to say find a program where you were
successful in the past. You know, whether it's that
implementation program of, you know, a just right culture from a
human resources and people perspective or more of a clinical
approach, you had a new infection prevention process or a better
handwashing program. You know, that was a big push in the past
and of course, should be always continuously at the forefront of
what we do in preventing infections in health care. But I always
ask about that. You know, when they start seeing the hurdles and
the struggles, you may have as well name a program that you were
successful with, whether it's a new program or improving. And a
lot of times, you know, infection prevention or just a
handwashing audit will come up. Well, we were only at 50 percent
when we started. Now we're at ninety five percent. Well,
[00:25:00] how are you so successful in getting that? How can we
help you apply that to your safe patient handling program? So
that's usually a lot of times how, you know, we look at that, you
know, when it comes to patient handling. You know, we talked a
lot about, you know, my experience prior to MEMIC I can tell you
what really solidified that for me was my mom was an acute care
facility two years ago. And of course, me being a loss control
guy, I did a lot of research on the facility and found out that,
you know, they had a patient handling program or an award winning
program. And I can tell you, being bedside with my mother, the
patient handling equipment they used was a slide board. And my
mother was not a small woman, God rest her soul, but it was a
slide board. And I said, excuse me, you know, and the nurse
manager was there, excuse me, you know. Shouldn't you be using
patient handling equipment? Their answer was, we are there's six
of us, we're using a slide board. And I said in the alcove down,
there is a full body lift. Why don't you use that? And when the
nurse manager responds to me, this is quicker. Don't worry.
[00:26:00] We do this safely. We do it every day. And I'm like,
you know what? This is not acceptable. You know, this is not good
practice and this is my mom. So can we do something different?
And I will tell you, I failed because unfortunately, they never
used a piece of equipment other than a slide board. So, again,
was that safe for them? No. Was that safe for my mom? No. Luckily
there wasn't a situation she was not injured due to that poor
practice, but, you know, not ideal


Peter Koch: Really solidifying experience with
your mom there. I can only imagine that was incredibly, knowing
you, I can imagine that was incredibly frustrating for you to see
that happen and trying to fix it and getting that answer. But I
guess let me ask you both that question. How do people get there?
I mean, you could see it from the outside. And, you know, Rob,
you said you did your research and Laurette, you've seen, I'm
sure you've seen similar things happen either as a consultant or
[00:27:00] as in your professional life prior to becoming a
consultant. How do caregivers get to that point where quicker is
better and they see that manual movement being better than using
the tool that's down the hall or the tool that they've been asked
to use? How do they  get there? What's the barrier to them
moving beyond that?


Laurette Wright: I think it goes to
organizations who work from a culture of optionality, to those
who work from a culture of accountability. And I often have
people say, well, you know, we can't get Sally to use that lift
and we can't get Jon to use you know sheets and I often have a
strong belief that there's other things in that system [00:28:00]
that they're having challenges with because it becomes a culture
of optionality. When it becomes a culture of accountability, you
really don't have to remind people because it's the expectation,
you know, when people say, well, what is culture of optionality
mean for me? It's when I don't do something you asked me to do
and nothing happens.


Peter Koch: Right?


Laurette Wright: Right. Nothing happens because
I don't really have to because you're not going to really do
anything about it versus looking at changing my clinical practice
as it being a critical, essential task. And there aren't any
options to that. Like, I don't get an option to miss a drug. So
when we raise the bar and look at expectations [00:29:00] from
that level, I think that really helps those weed out those who
are very successful versus those who have some challenges.


Peter Koch: Right on. So almost it's not about
the tools as much as it is about the leadership and the culture
within that organization that would really help drive a more
successful program or move people beyond the desire for speed or
the habit of convenience to actually using the tool as part of
the process.


Laurette Wright: Correct.


Peter Koch: Right on. So if we're lacking some
education. Right. We talked about that before. Here's a tool. You
need to use it, but we really haven't entered it into a process.
We might have cultural challenges to utilizing those tools
because it's a culture of optionality. I think I'm going to steal
that from you. Right. I like that. I don't think I've used that
before. I heard that before. So I like [00:30:00] that culture of
optionality instead of a culture of accountability. And so we
have some cultural issues, some leadership issues. We have some
educational issues. We know that these are problems. So if those
have been identified or any of those have been identified, I
think probably if folks are honest that a part of each of those
three pieces. So culture, leadership and education, some of those
will be part of each organization's challenge to move forward
with a patient handling program. If those three things are the
challenges, then where do you start to build a successful patient
handling program? And Rob, I'm going to throw that to you first.


Rob Sylvester: Well, that, you know, if we could
solve that, that's one of those world problems.


Laurette Wright: Right +


Rob Sylvester: I think where I see And I think
maybe I'm just getting ahead of myself when we talk about, you
know, where programs start to, I hate to use the word fail, but
let's face [00:31:00] it they fail.


Peter Koch: Stumble,


Rob Sylvester: They stumble that's a great one.
The culture of optionality, you know, that that truly goes to so
many aspects of an organization, you know, similar to that coming
from health care. When we used to do annual mandatory training, I
used to ask my senior leadership team, which was the CEO, CFO,
COO, et cetera, VP of H.R. I would say what does mandatory mean??
And they would look at me like, well, that means you must do it.
And I go, well, why do we have 10 percent of the people are
passed the deadline and they're still not completing things. So
to me, it goes back to yes, we always talk about that senior
leadership support. We always talk about that mid-level
management support and things like that. But really, it can be
quite difficult because when let's face it, one of the number one
struggles we have out there with any health care facility is
staffing levels. So when you have the staffing levels, they may
not have the time to [00:32:00] allow the patient handling peer
unit leaders to be on the floor doing mentorship, doing audits,
doing just in time training. So to me, that's a big part. We say,
yes, mid level, we have senior and mid-level management support.
Truly, my follow up question is, what does that really mean to
you as an organization? And have you gone back and looked at the
process and seen. Is this, you know have you identified your
hurdles or your struggles, because I can tell you, you know, the
vast majority of time, you know Laurette I'm sure you face the
same thing. We go to a safety or safe patient handling committee.
And who do we see sitting around the table? It's generally
management. And part of that process that we've talked about is
getting that front line engagement. So when we say we have the
engagement, we have the management support, what does that truly
mean? Are they making time for those peer unit leaders? You know,
does mid-level management. Understand? [00:33:00] This is when I
see a lot that, hey, we've had no injuries. So we're going to
forego this month's meeting. But do we really know of why there
were no injuries? I would love to celebrate with them and say
we've come all this way and looked at our process. We've improved
our process, our program, our policy. We have leadership support.
We have better staffing. And that's why we don't have any
injuries or claims this month from a patient handling
perspective. But is that truly the case? You know, just because
you don't have injuries, I tell people it doesn't mean that you
have a great program in place. It may mean that, I hate to say
it, but you were lucky that month. It may mean people weren't
reporting. It could mean a whole slew of things, which is where
when Laurette talks about we need to look at the process, it
doesn't just include that training. It doesn't just include that
assessment of the patient. It doesn't include that just that
assessment of the equipment. And are we using it the right time?
It's a whole program aspect of [00:34:00] looking at their
injuries. It's looking at their claims, again, being depending on
how things are reported. They could be two different things, you
know, looking at everything from the OSHA log to the H.R.
tracking to getting onto the units and performing an assessment
and talking to people and asking that question. Have you been
injured when handling a patient? Yes, I have. Did you report
that? No, I didn't. Well, there goes that culture of optionality
again. Well, why didn't you report it now? It's you know, it's
the third time I've been injured this month. It's just we have
this difficult patient. If I'm not here, they don't have a
caregiver. And you know what? Let's face it. I'm in aide I'm a
PCT I'm a nurse. I'm a HHA whatever. So it's part of my job. I'm
sorry, but in my opinion, it shouldn't be part of your job. Does
it happen? Yes, it does. Does it happen more often than other
industries? Yes, it does, but it doesn't need to. So we really
need to look at that from I hate to [00:35:00] use the word
holistic, but an overall approach looking at the process and
truly use tools that are out there, whether it's OSHA, whether
it's MEMIC, whether it's A and A there's so many different tools
out there to evaluate programs, you know, and then look at the
intersecting data points of falls. You know, a lot of times when
we're looking at patient handling, we ask about falls, you know,
and correlate that data. We look at behaviors at something
Laurette and I are working on now is type two behaviors, you
know, clients to caregivers. So patients lashing out and injuring
your caregivers. And that's something in the next few months
we'll be pushing out products programs. And I'm sure there will
be another podcast on that. But when we look at that, that's all
part of your program. That's all part of your assessment. And
looking at making improvement, it's not that narrow approach of
OK equipment. What comes with equipment. We must do training. We
must do a competency evaluation and then get it to the floor and
use it. There are so many other aspects to look at. So hopefully
that answered [00:36:00] your question Pete.


Peter Koch: There's a lot of great information
in there talking about understanding your current process,
identifying those problem areas, using different assessments,
checking out behaviors, looking at lagging indicators, all good
ways to get a start, to understand what may need to change. And
you hit on a really good part, which is, you know, if you are
successful or at least you think you're successful because the
number that you're looking at, the injury number, that lagging
indicator shows that you didn't have any that I think a very
relevant question is, well, were you lucky or can you prove that
these were the things that truly caused you to not have injuries?
And that's a really hard question for any company to answer. But
I think it's even more difficult for health care because of the
reliance on the human factor all the time. It's not like
manufacturing where you can say, well, we didn't have injuries.
We [00:37:00] can look at all the equipment that got used in
order to put that in place. You still have the human factor, but
you don't have the patient interaction with the caregiver. That
makes it even more challenging. So you talked a little bit about
peer groups, peer mentor-ship, peer unit leaders, Laurette, can
you describe some of what those are? And if you were going to if
you're going to have. Goes on in your facility, what they are,
what they do and why do they help?


Laurette Wright: Those people or those
individuals are our cheerleaders. You know, I call them our
silent partners. They're the ones that can be given some
authority and formal authority and encouraged to support the
practices in real time. So when someone can't find a sling or
someone can't find a battery for a lift, [00:38:00] those are my
cheerleaders that help support me in real time on the day to day
to find those gaps and help me get what I need. So those
programs, again, have been quite successful, but it also has a
lot to do with engagement and giving voice. So if I'm a peer
leader and I truly have a voice to let you know, it's challenging
us on our units and then you support those, those programs have
been very, very, very successful. And it's a model that happens
in lots of organizations. Right. Just, you know, we at health
care got used to doing it, whether it's from fall committees or
pressure ulcer prevention committees. We often have those what we
call unit champions, unit peer leaders to help us with the day to
day.


Peter Koch: Those identified [00:39:00] people
as a peer unit leader or a mentor leader. Those aren't foreign to
the health care groups or health care industry. They've been used
in other areas. So, again, I think, Rob, you said this. Look at
where you've been successful in the past and then try to draw
from that program. What made that program successful? And can you
use that as a model to help implement your patient healing
program? And then so what made those peer group leaders in some
of those other groups be successful and then try to model it
after that? That's I hadn't realized that before that those
existed prior to the patient handling movement.


Rob Sylvester: Definitely. And sometimes we'll
have, you know, high performing organizations, organizations
getting to great as we hear. You know, they'll have preceptors
mentors. They'll call them senior aides maybe. And some are able
to pay them extra, which I always love to see. There's an
incentive there. Some do [00:40:00] not. But again, it's a
selection process and it's another program that MEMIC currently
putting together. And we'll publish before the end of the year of
a peer review unit, training, you know, peer unit leader
training. You know, how do we select the right person? You know,
sometimes we say, well, you know, Tammy's always got something to
say. Well, maybe with a little coaching, Tammy would be that
cheerleader that is out there doing what we need them to do. So,
again, it all depends on the organization. Every organization
cultures different, every I mean, within, let's face it,
different departments, different units have different cultures.
And the organizations, they're the subject matter experts. A lot
of times the MEMIC safety management consultant, I consider the
catalyst will come in there with ideas. What works in another
facility. And our let's face it, we all know is safety management
consultants. Our clients will generally say, hey, you know what?
Slow your roll, because that's not going to work here. OK, well,
what does work here? Let's talk more about that. So a lot of
times they have it in place. It just may [00:41:00] need to be
tweaked. So they're already set up for success. They just may not
see that. So that's where we try to come in and help them with
that process.


Peter Koch: Nice. Yeah, it's always good to have
that outside eye. We started the podcast talking about, you know,
can't see the forest through the trees when you're really close
to the problem. You might not even see it as a problem until
someone helps you understand that it truly is a problem. So
utilizing that consultant to help guide you and where to start or
how to continue is a really key parts of reaching out for some of
those external resources and then identifying the internal
resources that can be the cheerleader. You did touch on this,
Rob, that you training for that particular individual. It's not
always, it's not always prudent to expect that someone that you
rely on often to be able to take something that could be foreign
to them and then become that cheerleader without some support or
training. And [00:42:00] it's great to hear that MEMICs got some
programs out for that peer unit leader training. But before that
comes out, what are some key points that you might use or that
you might train that person on in order to get them to be
effective as a peer unit leader without a formal training
program? What are some things that you need to help them with?


Rob Sylvester: Great question. I think a lot of
it comes down to starting with just like any process is having
the discussion with people that want to be a part of that
solution. And a lot of times they may not know because they don't
understand the program, so, you know, you start with
expectations, what is the end state? I like you know, it's always
military planning. We start with the end and work our way
backwards. And to me, it's a great concept, you know, to say, OK,
well, here is where we need to go and let people be a part of the
Creating Solutions identifier. It should start with identifying
challenges and then creating those solutions, you know, getting
volunteers [00:43:00] to talk about, you know, what their
concerns are, you know, and it doesn't have to be the formal
group setting of a committee process. It can be, you know,
whether it's a lunch and learn and say, hey, we're going to start
rolling out a new program and we want input, you know, whether
it's starting with survey monkey or another survey process and
seeing where who wants to be involved. But again, you have to
start off with clear expectations of where this thing's going to
go. And again, that's going to morph over time. You know, they
talk about crucial conversations and teaching people, because I
can tell you one of the hardest things, it's a soft skill. And
helping people through those challenges is a great opportunity
for, again, current preceptor training program, mentor program.
You know, Human Resources has some great experience with that and
getting those volunteers to understand and, you know, as Laurette
said that informal authority, because let's face it, there's a
lot of times you may be assigned as a project lead and you're
leading your peers. Everybody on this call and [00:44:00] many of
our listeners have done that in the past, you know? Well, that's
my peer. Well, when you have that senior level management support
saying, well, Peter's in charge of this program, you may not have
that title as a manager, but he's in charge of this program. So
getting them to that point and identifying getting people to
understand your peer unit leader is that leader. They may be on
the floor doing Just-In-Time training. They may be doing your
competencies with the support of that unit nurse manager, but
really getting those people that training, which can start in an
informal way and doing I love role play, which I know Laurette
does, too. And we're talking about, you know, here's a scenario,
you know, Laurette and Rob are equals well Now Laurette's in
charge of where she's been identified as that peer unit leader.
You know, how does Laurette go about not just saying? Because I
said so. Because our policy says so. Because as I said earlier,
you know, safety too often is driven by compliance or attempted
to be driven by compliance. And I'm sorry, [00:45:00] but that
doesn't work. So getting people to understand how to convince
people of this is why we do it. You know, it's about quality,
patient care. It's about safety of ourselves, safety of our
residents, patients, clients, family members, caregivers, et
cetera. So, again, it's, you know, getting those people to not
only identify, but then helping them through those crucial
conversations. And I think without a formal program being pushed
out yet by MEMIC, I think the opportunity is there for human
resources or other identified staff to help with those
conversations. And truly, I think starting with role play, you
know, people understanding how to approach their peers because,
again, peer unit leader is a lot harder, in my opinion, than
being identified as a manager because informal versus formal
authority, Laurette anything on that.


Laurette Wright: No, I agree, particularly if we
go back to cultures again. Right. So there is a hierarchy of
[00:46:00] control in health care and it's been challenging for a
CNA or PCA to feel they could be empowered to direct and
encourage a different way of thinking or practice to an RA. Let
alone someone who may have a master's degree and or a Ph.D., so
in addition to everything else we're trying to navigate around,
we're having to also navigate around the cultural issues of
hierarchy and how we encourage to break down some of those
barriers so that people are just seen as people and with no
specific title, but with all of us having the same goal in mind,
which is the safe practices of movement and mobility of our
[00:47:00] patients and residents.


Peter Koch: Right on a lot of great stuff.
They're talking crucial conversations, culture, again, coming up
to be those successful touch points for any organization to have
a successful safe patient handling program. So, Laurette, if you
were going to advise a health care organization to evaluate their
current program, what are some things that you would ask them to
look at first? So they're going to look at a safe patient
handling program. They might have one or they might just they
might not have a formal program. But every health care
organization has patient handling in their process because that's
just what we do. So where would you ask them to? What were some
things that you would ask them to evaluate if they've never
evaluated the success or effectiveness of their program before?


Laurette Wright: You know, Peter, there are a
lot of tools because, again, this has come to the forefront of
health care and is not as foreign [00:48:00] as it could have
been or would have been 20 years ago. There's just a lot of
survey tools that's already in existence that teams can take into
play and go through their system and answer the yes or no's and
then identify where those gaps are and prioritize it from there.
You know, again, when I take a look at things and I say it's
systemic or process approach above all else, I need to identify
the needs. Right. And do a needs assessment. And the very first
step in doing something like that would be to  evaluate what
do I have currently? Because I think, Rob brought a great point
in the play, which I know I'm very passionate about, is aligning
anything that I do with patient handling, with existing systems,
existing processes, so [00:49:00] that we are not duplicating
services because we understand how precious time is, particularly
in the health care environment. So take a look, you know,
evaluate, develop a scorecard, make consultants, help a lot with
that and then go from there. Once I have the outcomes from that,
then decide the pieces that we're going to tackle one time, one
bit at a time. It's a big elephant in the room and we often want
to jump in with both feet and just gobble it all at once. But
really it's pulling back and taking a little bits at a time is
again one of those key factors in ensuring some successful
outcomes.


Peter Koch: So it's not going to be an
instantaneous result. You might want it to be. But to embark on
the journey to implement a successful safe handling patient
handling [00:50:00] program might take years in order to have it
implemented well and then be able to self maintain as you go
forward with changes in administration, changes in staffing to
make sure it can outlast those changes.


Laurette Wright: Yes, because it has to outlast
staff turnover, changes in director level positions. It just has
to be ingrained. And that takes time. And, you know, it's about
having patience, patience for everybody involved. It's an all
encompassing program. It touches many touch points and in the
health care community. So, yeah, but the very, very, very first
thing is to say, here's what I currently do. Let's take an
assessment, take a temperature check and then see where we have
some gaps and then how do [00:51:00] I want to prioritize that.


Peter Koch: Right on. Right on. So is there a
resource? You said there's a lot of tools out there and I know
MEMIC has some specific ones, but are there national resources
that our listeners could reach out to and like online and find an
assessment? Or find something that would help guide them in
evaluation.


Laurette Wright: OSHA has actually rallied
around this effort for the last couple of years and have some
really nice self-administered tools online on their site under
patient handling and health care and the American Nurses
Association. This is also become one of their huge platforms as
an organization. There's a lot of tools out there. Those would be
a couple of places I would try. I don't want to give, like, too
many because [00:52:00] I don't want, again, it be so
overwhelming for people. But I would say those are the two
places. Just a keynote on OSHA, there are no federal OSHA
standards on patient handling. Some states have some standards
and they vary in complexity. But OSHA does not have anything.
However, they do look at that exposure and if they were to have
some concerns, may consider a citation under the general duty
clause. And in a nutshell, that's, you know, employers are
required to provide a healthful working place for employees. So
while I mentioned OSHA and they have some tools out there, again,
as of today, there is no particular standard under OSHA for
patient handling.


Peter Koch: But it is such a recognized hazard
because it's prevalent across all health care industry, though,
the patient handling [00:53:00] or injuries that are caused by
handling a patient, because since it is a recognized hazard,
you're very true. It might fall under that general duty clause
where it becomes a problem if OSHA looks at it in that
perspective.


Laurette Wright: Absolutely.


Peter Koch: Right on.


Laurette Wright: Rob may have some other things.
Rob, anything comes to mind for you one or two resources.


Rob Sylvester: No, I think you know, I think
it's a good time to tell them, you know, getting us involved,
like Laurette said, and making sure we're able to help and
provide some of the simple tools, because I'm a big one on
keeping it simple.


Peter Koch: Yeah, right on it. And if you are a
MEMIC, insured MEMIC has a safe patient handling program. And we
have specialists like yourselves that can come in and assist with
the initial assessment and an entire program to put it in place
to help get your process off the ground and then become
successful with it.


Rob Sylvester: Yes, definitely. And 
[00:54:00]we don't really tend to look you know, we look at the
program, let's put it that way. We look at the program. We like
to look at processes and help guide them on that versus, you
know, a vendor may come in and a lot of times we'll do it with
assistance from a vendor or they'll have them say they'll have a
vendor looking specifically at the equipment and things like
that. Whereas we like to look at that whole program approach and
then bring in the all day the six hour safe patient handling and
mobility workshop. And again, as Laurette said earlier, you know,
it's about the mobility. And I don't want to lose focus on the
mobility because I can't tell you the number of times where, you
know, we don't celebrate the aha moments of the increased
mobility of our patients or residents. We truly need to
concentrate on the fact that we are early. We are mobilizing
patients earlier than they have in the past, maybe earlier than
other organizations. And truly, those [00:55:00] moments are what
need to be celebrated, you know, whether it's length of stay or
other aspects of it, meeting milestones early from a physical
therapy aspect. But again, when we're looking at this, it's not
just about safety. This is quality of care. This is skin sharing
issues. This is, you know, skin integrity. This is wound care. So
when we started looking at these things, truly, this has such a
positive effect. They say patient mobility program has a positive
effect on so many different aspects. Falls, skin integrity,
safety of the resident or patient safety of the individual.
Improved quality care. How about their mental health aspect that
they're not just laying in bed all the time? There are so many
different aspects of a safe patient handling a mobility program
that come to mind. And I want to make sure we don't lose sight of
that, because I can tell you when it came to why did I become
passionate about this, about patient handling? Truly, when those
caregivers get that aha moment [00:56:00] of this is why I should
be using it. You know, this is why I shouldn't be making excuses
or reasons to say, well, this takes longer. Well, actually, there
are studies that show it doesn't take longer when you have a team
approach to patient handling, when you have the knowledge,
skills, education and equipment up front and staged properly, it
really doesn't take longer when you know somebody care plan and
what it involves, what type of equipment is needed, how many
people that takes and getting it to the bedside and utilizing it,
it doesn't take longer. And again, you know, when you say, well,
this takes longer. Well, when you counter with and if you are
injured or you injure that patient, doesn't that take longer?
Doesn't that negate what we're supposed to be doing as a health
care organization? So I definitely don't want to lose sight of
that mobility aspect.


Peter Koch: Now, that's a huge point there. And,
you know, we've we floated that through the conversation, this
conversation. And I know Laura and I talked about it, and it just
brings [00:57:00] to mind that, you know, especially when you
look at it from the perspective of if the processes in place and
the tools are there and you've staged things up front, there is a
much greater possibility that the patient will have success. And
I think about it from this perspective, like my mom had had her
knee replaced earlier, she had both knees replaced. And the
second one has just been about a year now. And I remember them,
because I was there when she was out of surgery and in recovery,
getting up and moving for the first time. And the first knee
replacement that she had did not go very well for whatever
reason. The second knee replacement. There was a lot of
trepidation and the smile on her face when they got her up and
had her weight bear the first time. And it was different because
they used some tools. They just didn't, you know, yank her up out
of the chair and help her physically walk across the room. They
[00:58:00] use some tools to get her to stand up, to get her to
start to weight bear. So they took in mind, they bore in mind her
concerns and they use some tools to allow her to be successful.
So she I think about that. And I think, wow, that was an aha
moment for me right now, thinking that there is more than just
using the lift or using the belt or using whatever other tool you
have. There's the success of the patient to keep in mind, too,
not just the safety aspect and the compliance aspect of it.
Really neat. I want to ask you both this question. This kind of
will bring you back to your early days. So what do you know now
that you wish you had known when you started out? What do you
know now about patient handling that you wish you had known when
you first started out in the process?


Laurette Wright: I wish I had been taught. That
is an integral part of my practice [00:59:00] and techniques as a
nurse.


Peter Koch: And not just an extra.


Laurette Wright: And not just there's some
hardware in the corner and they quote unquote, no one ever could
really tell me who they were, but they said we have to use it.
And again, not being told that it's just good quality patient
care and that if I manually lift or move or transfer someone that
negates the type of care that I want to give. That's one of my
biggest things I wish I had known then now that what I know
today.


Peter Koch: Those are great points there. And it
really would have maybe changed some of those decisions early on.
It might not have put you, you know, at physical risk for
potentially early on. Yeah. Hey, Rob, how about you? Same
question. What do you [01:00:00] know now that you wish you had
known when you started out?


Rob Sylvester: Well, definitely the advantages
of such a program, because we just talked about it's not just
about money, but at the same time, I'll talk about return on
investment or that cost avoidance, both direct and indirect, what
a program has or contributes to. And as I stated earlier, you
know, it's not just about the money, but let's face it, if we had
an extra hundred thousand dollars, we weren't spending on
injuries, what could we use it for? You know, in an ideal world,
in my opinion, we would be giving it to those frontline workers
when a lot of times frontline workers like, well, no, we
wouldn't. OK, fine. Would you be able to fix that flooring issue?
You do that? Would you be able to? I've seen renovations to break
rooms would be able to buy more equipment to support the staff,
would be able to do things. And then again, it goes back to, you
know, skin integrity, wound care and things like that. There's
such an amazing opportunity for we always use [01:01:00] that
return on investment phrase ROI But really it's cost avoidance,
you know, cost avoidance. But when I say cost, not just money,
but what does that cost? What is the improvement in mobility
level? To me, those are all cost avoidances. When you're
improving one, it's not just about that money. So to me, I think
knowing what I know now and knowing that it's not just like
Laurette says, that it's a piece of equipment in the corner, we
must use it because it's in their care plan. But truly, why? So
if I had seen the advantages of using that, I think that's what I
wish I knew back then. Maybe I could have helped more people.


Peter Koch: Well certainly both of you are
certainly helping people now with that, with the whole process of
championing safe patient handling and mobility programs across
all of our insureds and even those that you get to speak with
outside of our insured group, when you talk at conferences and
other group forums, we're getting right towards the end of the
podcast here. So last question. Is there anything [01:02:00] that
I should have asked you? But I didn't anything that you want to
point out and let our listeners know about that we really didn't
touch on during the podcast today?


Laurette Wright: For me, Peter, I think we hit
hard on the process approach. In addition, I'd like just to
remind all our listeners that it's a program that can't be done
in a silo. So while it's nurse driven and I use that word to
include my aides and in anyone that clinically has to touch a
patient, whether it's emergency technicians, whomever, to get
them to move or reposition, we can't do that alone. So this
program has a lot of tentacles to it, like maintenance and
laundry and education and people [01:03:00] who oversee
compliance and pressure ulcers and fall communities. So, yeah,
that would be the one thing I'd leave people with. In addition to
everything we've talked about, this is a program that can't be
done in isolation.


Peter Koch: That's a great point. Really, really
good point. And it shouldn't be lost with our listeners that if
you're starting this, if you're evaluating your program, maybe
you've had a program for a while. Maybe one of those things to
look at is who are you involving across your company in order to
make this successful? Because there might be some departments
that you need to pull in. Maybe it is maintenance, maybe it is
laundry, maybe it is somebody else in order to help support the
safe patient handling and mobility process. Awesome points,
Laurette. Rob, how about you? Anything that we should that I
should ask, but I didn't.


Rob Sylvester: Well, Peter, that's a hard one to
follow up with. Laurette's always a hard one to follow up. You
know, I think the one and most important thing [01:04:00] is the
reminder of the one question I ask. And it was really reinforced
when my mother was in the hospital. I always ask that question of
how would you want your own loved one assisted or mobilized? And
the question or the answer? The only answer is the safest way.
That's how. So that's about it.


Peter Koch: Yeah, that's a great question. And
it really I think that's the essential question. Like, if I'm a
nurse or I'm an EMT or I'm a caregiver at home, like, that's the
question. How would I want my loved one to be moved? How would I
want them to be mobilized? How would I want them to be treated?
And does my program reflect that? Does the program reflect that
we're going to be treating people not just with the cost the end
cost in mind, but the end cost avoidance of all of the pieces
that you've talked about and not just the monetary cost, but all
of the parts that we've [01:05:00] talked about before. Really
good points. Absolutely. So that really wraps up this week's
Safety Experts podcast. I really want to thank you both for being
here today and sharing your experience and expertise with us and
our listeners here. So thanks very much for coming on now.


Laurette Wright: Thank you, Peter, for inviting
us on. It's great. It's always fun to share with others those
things for a most passionate about.


Rob Sylvester: Thank you so much again. Laurette
Thank you for everything. Your wisdom, your guidance over the
years and definitely for your time today. And Peter, thank you
for the awesome podcast. You Make Life Easy.


Peter Koch: Right on. Thank you very much again.
So thanks again for joining us. And to all of our listeners out
there today on the MEMIC Safety Experts podcast, we've been
speaking about the unique challenges that a safe patient handling
program might have and looking at it from the perspective of a
consultant from the outside looking in. And we've been speaking
with Laurette Wright and Rob Sylvester's safety [01:06:00]
management consultants with the MEMIC group. You have any
questions for Laurette or Rob or. We'd like to hear more about
our particular topic on our podcast. Email me at
podcast@MEMIC.com. Also, check out our show notes at
MEMIC.com/podcast, where you can find a bunch of additional
resources and links to the first podcast as well. And you can see
the entire podcast archive when you're there. And while you're
there, sign up for our Safety Net blog so you never miss any of
our articles or safety news updates if you haven't done so
already I’d appreciate if you took a few minutes to review us on
Stitcher, iTunes or whatever podcast service that you found us
on. And if you've already done that, thanks, because it really
helps us spread the word, please consider sharing the show with a
business associate friend or family member who you think will get
something out of it. And as always, thank you for the continued
support. Until next time. This is Peter Koch reminding you that
listening to the MEMIC Safety Experts podcast is good, but using
what you learned here is [01:07:00] even better.