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 [email protected]. 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.