October 2023 ASPHP Newsletter

Start Small, Dream Big: 

The Power of Quality Improvement in Safe Patient Handling and Mobility

Jay Hamilton-Roque

Our Grim Financial Reality

Justifying new resource allocations or technology investments is harder now than ever. From fiscal year (FY) 2020-2022 hospitals saw a 17.5% increase in expense growth, while only seeing a 7.5% growth in Medicare reimbursement¹. This has led to over half of U.S. hospitals operating at a financial loss in 2022 ¹. With this grim financial reality, asking for more resources (regardless of its impact on patient/ caregiver care) can make any facility change agent feel as though there will never be “room in the budget” for what they know could make a dramatic impact to a facilities’ clinical/ financial outcomes. 

Free Samples

We’ve all been to our local supermarket on a mission. We have our list in hand, we know where all our items are per aisle, and we have a busy schedule so this grocery run needs to be completed ASAP. Yet, as we stalk the halls, an unexpected variable throws a wrench in our meticulous mission, the free sample counter. Maybe it’s a flavor that we’ve never tried before, maybe it’s an old favorite with a new twist, or maybe we just forgot to eat before going to the store and now we’re hungry, but the allure of the free sample table is always the same “low stakes investment, high reward opportunity”. Whether our rendezvous with the free sample counter ends in a purchase or a polite removal of the free morsel into a well-placed napkin/ trash can, we can still walk away without “buyer’s remorse”, and that’s exactly what healthcare needs right now, to be able to invest in new preventative solutions, but negate that pesky buyer’s remorse. Fortunately for us, we have a “free sample” counter of our own, Quality Improvement Projects (QIP). 

What is a Quality Improvement Project?

Quality Improvement Projects are formal initiatives that measure variables that affect patient/ caregiver harm, introduce new solutions, and measure the outcomes. While it can be argued that quality improvement is baked into the DNA of healthcare, it wasn’t until Dr. Avedis Donabedian published “Evaluating the Quality of Medical Care” that Quality Improvement gained significant traction in the American healthcare system². Since this seminal research was launched, there have been numerous regulations (Patient Protection and Accountable Care Act ³), federal organizations (Agency for Healthcare Research and Quality⁴, National Committee for Quality Assurance⁵ ), and independent organizations ( Institute for Healthcare Improvement⁶) that all aim to assist and reinforce this formal method of introducing and evaluating new interventions. 

What is the scope of a

Safe Patient Handling & Mobility Quality Improvement Project?

These projects generally require a significant amount of data collection, intervention training, and management, and, thus, are limited to a small sample size of an organization’s overall patient population. These small sample sizes generally make new investments more palatable (think of the free samples table) for financial leaders, while allowing facility change agents to validate the outcomes of their new solution. For Safe Patient Handling & Mobility, these initiatives are generally held in Intensive/ Critical Care units as these areas traditionally have the greatest need for Safe Mobility interventions. 

What is normally assessed during a

Safe Patient Handling & Mobility Quality Improvement Project? 

These projects generally look at both qualitative and quantitative data. For SPHM QIP’s qualitative side, researchers may research staff’s education and engagement with SPHM before and after a new intervention. For quantitative reviews, researchers generally review before and after staff member injury rates, or patient quality metrics relating to early mobility like pressure injuries, ventilator-associated pneumonia incidents, or delirium occurrences.

What tools are used during Safe Patient Handling & Mobility Quality Improvement Projects?

While no two QIPs are exactly alike, some consistent QIP tools would benefit any SPHM QIP. 

• Flowchart: A flowchart — also known as a “process map” — is a visual representation of the sequence of steps in a process. Understanding the process as it currently operates is an important step in developing ideas about how to improve it. This makes flowcharts especially useful in the early phases of improvement work. ⁷
• Cause and Effect Diagram: A cause and effect diagram is an organizational tool that helps teams explore and display the many causes contributing to a certain effect or outcome. It graphically displays the relationship of the causes to the effect and each other, helping teams identify areas for improvement. ⁷ 
• Failure Modes and Effects Analysis (FMEA): Failure Modes and Effects Analysis (FMEA) is a tool for conducting a systematic, proactive analysis of a process in which harm may occur. In an FMEA, a team representing all areas of the process under review convenes to predict and record where, how, and to what extent the system might fail. Then, team members with appropriate expertise work together to devise improvements to prevent those failures — especially failures that are likely to occur or would cause severe harm to patients or staff. ⁷
• Run Chart: Run charts help improvement teams formulate aims by depicting how well (or poorly) a process is performing, understand the value of a particular change, and begin to distinguish between common and special causes of variation.⁷

Rinse & Repeat

Once you’ve determined your study aim, how you’ll be measuring it, and have identified your intervention, the fun begins. Most QIPs follow the Plan, Do, Study, Act (PDSA) model. This model allows your team to think through an ideal approach, see what actually occurs, and review if another PDSA round is warranted. While not all initiatives will result in positive outcomes, all well-run QIPs will teach the researcher about the independent and dependent variables that lead to success/failure, and ultimately improve the next round of quality initiatives. 

Putting it all together

While there is overwhelming agreement that Safe Patient Handling and Mobility is a beneficial practice for patients and caregivers alike, motivating a facility to invest in the resources needed to enact these changes can be extremely daunting in today’s fiscal healthcare landscape. Yet by utilizing QIPs, facility change agents can ask for a small investment, prove the validity of SPHM, and leave our financial stewards without any buyer’s remorse. 

Citations

American Hospital Association. (2023). The Financial stability of America’s hospitals and health systems is at risk as the costs of caring continue to rise. Available from https://www.aha.org/system/files/media/file/2023/04/Cost-of-Caring-2023-The-Financial-Stability-of-Americas-Hospitals-and-Health-Systems-Is-at-Risk.pdf

Donabedian, A. (1966). Evaluating the quality of medical care. The Milbank Memorial Fund Quarterly, 44(3), 166-206.

Congress, US, The Patient Protection and Affordable Care Act, Washington DC; 2010

Marjoua, Y., & Bozic, K. J. (2012). Brief history of quality movement in US healthcare. Current reviews in musculoskeletal medicine, 5, 265-273.

Sennett, C. (1998). An introduction to the National Committee for Quality Assurance. Pediatric Annals, 27(4), 210-214.

Institute for Healthcare Improvement. (n.d.). Vision, Mission, Values. Retrieved from https://www.ihi.org/education/Pages/certified-professional-in-patient-safety.aspx

Institute for Healthcare Improvement. (n.d.). QI Essentials Toolkit. Retrieved from https://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx