NOTE: This document is provided for historical purposes only.
Presentation by Eric Meittunen, Mayo Clinic
MR. FRAGALA: I'd like to now introduce our first speaker, because our main purpose of today's program is to present some cases where we've seen some successes. So we've tried to get a good mix for you. Our first speaker comes from the Mayo Clinic, a complex acute care system where, if we can put a program in place in such a facility, there are some things we can learn from that for some other types of facilities. Our speaker is Eric Meittunen who is an Environmental and Occupational Safety Coordinator with the Mayo Clinic Systems.
Eric is a relatively newcomer to health and safety, but he's already done some good work. He actually organized a session similar to this for the National Safety Congress in Orlando this year. He has studied occupational safety and health at the graduate level and holds a Masters degree in occupational safety and health. Eric has put in place a good program at his facility, and he'd like to share some of his ideas with you. I'd like to present to, Eric Meittunen.
MR. MEITTUNEN: It's a pleasure to be here. I think we should reflect upon what we learn this morning from the sessions and why this problem is really unique to the health care field. If you'll look at some of the speakers who presented this morning, we had people from Kodak, from Frito Lay and from Samsonite. One of the things that is unique to this problem is that I've never been punched or poked or prodded by any suitcase, Frito Lay bag or potato chips or anything. Not to say that all of our patients are this way, but we're working with a similar or a little different problem, and that's working with humans who actually have feelings and have comfort, too. That's the main result of the main approach of our situation here. We'd like to increase the patient comfort as much as possible.
For ourselves, we took a little different approach to it. Since we are working with patients, we took a quality approach to resolving the back injury problem.
We're utilizing the Gerand continuous improvement approach. This problem of back injuries to indicate the significance of the problem to the organization was nominated as one of Mayo's first continuous improvement projects three and half years ago. So we've been working on a solution to the problem every since. This is basically the Gerand process which we've been working on, and we are, after three and one-half years, just finishing up now. We're working on remedying the cause. We're just breaking into holding the gains down with some of our implementations.
We'll just briefly give you a little impact statement here. The impact: We're looking for projects which has a potential to increase employee and patient satisfaction. Really, the whole nomination process for continuous improvement wasn't just to reduce back injuries or to have an ergonomic focus. Basically, we're trying to focus on the care of the patient. Primarily, we're looking for projects which have a high urgency and patient contact, and patient care services definitely have this. And then we're looking for projects with different behavioral modification facts, too, which this involved.
Thus, this was nominated as one of the top projects for the Mayo Foundation. Our mission statement was quite vague and ambiguous at first, but we reduced it down to reducing the cost of injuries for nine patient care units. We did not define any specifics as far as back injuries at this time. We just wanted to reduce injuries and the impact on the patient care aspect. We had a diverse team from nursing, administration, preventive medicine, rehabilitation, transport and also safety.
Working through the process, we analyzed our symptoms, and we were looking at injuries by body part. Finger injuries were the number one injury for this group of employees. Back injuries was number two. We looked at the injury cost, wanting the most significant impact for the organization, we found back injuries were identified as the "vital few" or the "main cost" for the organization from a work comp standpoint.
We brainstormed theories with multiple surveys and different group brainstorming sessions, and we found over 110 correlated causes identified with back injuries for care givers. We broke them down into different categories with employee procedures, patient, equipment, and then the environment.
We tested our theories and found that basically our present injury incident form didn't have enough data. So we had to step back, redesign our form, and then we did a sampling of 50 injured staff to help us define the cause of injuries and the root causes. The root causes were identified as lack of staff availability, lack of staff education, and training with follow-ups on technique and equipment, poor use of body mechanics, previous back injuries, obese patients, cluttered patient rooms, lack of staff conditioning, uncoordinated scheduling of patient tests, procedures and also surgery.
This is more on a micro basis, meaning a transporter would show up to take a patient to a test and upon arrival we didn't have enough staff present in the room to assist with the transfer. Thus, the escort or the orderly or the transporter would try to accomplish this by themselves, setting themselves up for injury.
Lack of patient knowledge: And that's not from the patient's standpoint, that's from a care giver's standpoint. Can this person walk, stand or pivot themselves, or what assistance is going to be needed? And then other expectations during the transfer, too.
Our remedies for the problem were basically two-fold, an education process. We implemented a patient transfer team. The correlated remedy was out-sourcing physical therapy to the patient care units. Not providing and getting assistance or having assistance from an external care provider for physical therapy, but taking the physical therapist to the patient care units, specifically orthopedics. This seemed to reduce the frequency of patient transfers tremendously; and thus, if we're reducing the frequency, we're going to reduce the exposure for the care givers also.
Stepping back to the education process, we were educating three units and measuring our results. One with regular annual training, one with coach and reinforcement training, and the third, with an external consultant as a behavioral reinforcement type of training and who is there to give them reinforcement on a periodic basis. We also implemented the patient transfer team which was modeled after Bill Charney's work at San Francisco General. Bill actually came up and gave us a hand with project.
Our measures of success for the total program are the number and cost of injuries restricted in lost working days. We're getting into the qualitative information with a nurse satisfaction survey, patient satisfaction and then implementing our quality improvements process within the Department of Nursing with our education measures through staff observations. With the education measures and staff observations, we'll talk about that in the next slide.
Patient satisfaction survey: We surveyed 50 patients who were working with, or have been transferred by our transfer team. All of them had been giving favorable results to their team as far as comfort and professionalism is concerned. So coordination and communication does help.
The nurse satisfaction survey: We have results. Restricted and lost working days: We're obtaining those. The measurement period for the patient transfer team was started in September of 1996. So up until this point, our measures of success for the patient transfer team on those six patient care units that we're working with, we've had two injuries on the day shift. We are still observing some injuries on the night, evening, and weekend shifts. So our next process will be to improve the results that we're having on the nights and evening shifts, too.
Then we get into the educational measures. What we tried to accomplish here is to bring this within the Department of Nursing and measure our educational and training processes. We had various indicators such as spinal curves, and the next one is leader coordinated.
We had different specific criteria which we implemented within the Department of Nursing's Quality Assurance Program. They are the ones who are accomplishing the training, and the Nursing Department is also doing the measuring of the observations on a periodic basis within their Quality Assurance Program.
Unit One with no special intervention. Just a sampling of some of the criteria and the results. Basically, all of them have very favorable results. A little bit low on the pure reinforcement. To talk about the significance of the problem and how unique this is, we did hire an external consultant for Unit Two, but this person has basically moved on to a different project.
He has realized that this is a very unique problem, and his process really hasn't worked for health care. He was having some excellent results, but found it rather frustrating. I think that signifies the impact and the dilemmas which we do face. He has a very good reputation for reinforcement types of training in industry, but once you move into the health care field, it's totally different.
Another educational measure criteria. With these educational measures, we have fairly high results. I'll step back one minute. We have fairly high results. However, we are still experiencing moderately high injury rates among all the three units that we're working with. So we're going to measure this for another six months, and then we're going to perhaps combine the two transfer teams and the educational process.
We haven't yet started looking at equipment except for the equipment which is used with the patient transfer team: slider sheets, gate belts and some medi-lifters in areas. The reason is because we wanted the results to remain consistent with past practices.
Thus far, we have over 7,000 transfers without injury to this point. We have over 11,000 transfers that the transfer team has accomplished without injuries to the transfer team. A very positive qualitative information on the nurse satisfaction surveys, their time savers to family and staff. Working with the transfer team, we implemented a pre-work screen with our work rehab group.
We've also accomplished a behavioral interview, looking for people who are very self-confident and able to learn a technique and then promote it out there no matter what the pressures, no matter what the time factors are involved, the other pressures, the environmental pressures involved with patient transfers.
We've developed the orientation and training protocol for the team which is a five week training program, and we've educated nursing in transfer and how to work with them. We've also developed an intra-net --- organizational communication on the World Wide Web, or in this case, Intranet. We call it "Uplifting News."
Communication was the main factor involved for us and the main challenge with implementing a transfer team. These are the survey satisfaction surveys. We had 135 surveys received back from the Department of Nursing. I don't know if you can read that in the back. "Does the patient transfer team respond in a timely manner or fashion to the on-call pager request?" And we have good results: 40 percent "always" and 57 percent "most of the time".
"Does the transfer team accomplish most the cart-to-bed, chair-to-bed and patient fall transfers between the hours that they are working? And we have, 28 percent "always" and 58 percent "most of the time". So we have fairly high results here.
"Do you feel that the supervision of the team is adequate?" And this is an indication of my work, I guess, so we hope that this is appropriate. I didn't bribe them at all, but it's a 57 percent "always" and a 37 percent "most of the time".
"Does the team interact in a positive manner with patients and families?" Sixty-three percent "always" and thirty-four percent "most of the time".
This is one factor that we really wanted to improve from a qualitative standpoint. We have seven different groups transferring patients within the organization between radiology, test and procedures, surgery and general transport. So it's very challenging.
In the past, the patient would just arrive with that transporter, and the nursing staff or the patient care staff really wouldn't be aware that they were going to return to that unit. So we've increased the efficiency of the organization also. Now, we give a call to the unit secretary. This unit secretary calls the patient transfer team and also notifies the staff that the patient will arrive soon.
"Is the transfer team adopting its transfer activities based on the physical needs of the patients?" 64 percent "always", 34 percent "most of the time". Fairly high results here.
"Does the team interact in a positive manner with you and your colleagues?" Very important, especially in front of the patient. Sixty percent "always" and thirty-five percent "most of the time". We have one or two people who are pessimists, I think.
This is a key question here. "When the transfer team is not present, do you use the transfer techniques as encouraged by the team?" Only 20 percent "always", 58 percent "most of the time", and we have "about half the time" 15 percent, and then we have 2 and 5 percent there. This is an indication that they're not using their techniques which we're promoting. Thus, we are still having the injuries on the off-shifts, too. All the steps that are involved with a patient transfer is very challenging.
"Have you needed to delay a priority to transfer?" This would be a cart-to-bed transfer or perhaps post-surgery. Fairly timely, 54 percent "sometimes" and 32 percent "never". So we can increase the results here, improve the results.
"Have you ever experienced back pain correlated to transferring patients?" And we have a few who have. Let's see, 5 percent "always", 5 percent "most of the time" and 2 percent "about half the time".
Finally, "Is your job physically easier when you do use the transfer team?" We don't have the transfer team accomplishing the transfer by themselves, they're working with the escort and the nursing staff. Seventy-one percent "always" and twenty percent "most of the time".
In conclusion, we've had fairly good success to this point, and we're looking forward to our final data collection in the spring of this year. Then we can improve the scenario a little bit further and increase the results and try pulling the two together, basically, the education and the transfer team in addition to some newer equipment too this summer.
Thank you very much.
MR. FRAGALA: Thank you very much, Eric, for sharing your program results with us. As we proceed, I'd like you to think about the different aspects of an ergonomics program. Eric's program, again, was an acute care facility, and he really had some successes with administrative controls which are part of the solution process.
