Trimming Wastage out of the Healthcare Budget

Transcription

1 Trimming Wastage out of the Healthcare Budget Rest Home Managers, gearing up for the predicted downturn in the economy, may feel obliged to take a scalpel to rosters, as the best way to cut costs. This can be false economy. More exceptions [falls, medication errors, challenging behaviours] cost what was saved, and more. Let s consider three cost cutting measures by targeting wastage common in Healthcare: 1. Be a good employer. ACC s Work Safety Management Program [WSMP] gives money back to employers who show how well they care for employees [and everyone else]. This may be a sideways shift for Health Providers primarily focused upon resident / client care. But for safe workplaces, failing to apply is the same as throwing money away. Every $10,000 in ACC levies [on employee wages] is eligible for $1500 $2000 discount! Dollars are also saved as costly incidents are reduced. Happy staff stay on, cutting training need / cost. Theoretically, good employers should be richer employers as well. Rapid response to exceptions Robust induction & training program Good employer One FREE audit [ACC pick up the tab] only looks at Health & Safety Management and lasts two years. Levies are discounted for the next two years for workplaces taking all practical steps to keep employees [and anyone else] safe. This is how it works: Show genuine intent to save ACC money [prevent injury] and ACC will refund up to 20 percent of employee s ACC levies. Larger facilities are more likely to have taken advantage of the scheme as payoff is proportional to wages paid. Smaller providers overlook the refund for two reasons. Most are audited so often that they simply don t want to face yet another audit. The second reason is a commonly held perception that the audit will be a lengthy and grinding experience. Not necessarily. ACC give away a simple Self Assessment Workbook that structures and helps preparation. Health providers should find they are 90 percent compliant to the tool, by default, through HDSS audits anyway. It is nice to hear ACC auditors give you their recommendation, after a short audit, on the day no waiting around. Bonus: Happy workplace reduces staff turn over [huge saving to recruiting, inducting & training]

2 Bonus: Less time loss injury [employer pays first week off]. Bonus: Less injured clients [less injury care and lower attrition rate] 2. Make the Training Program pay for itself Certification & Healthcert Audit for DHB s has Health Providers carrying responsibility for comprehensive employee training: Safe medicine management [administration, prn medicine guidelines, diabetes & insulin PLUS controlled drugs] Fire Warden training, First Aid PLUS Emergency situations Personal cares skills and using essential equipment Comfort & terminal cares Managing challenging behaviours Restraints Preventing Abuse & neglect Moving & handling safely Infection control Continence care Pain management Treaty of Waitangi & cultural safety Effective communication Code of Rights & Informed Consent Complaints management and the list goes on.... Paying good trainers AND paying staff for their time costs money. Inducting staff who fail to stay is an unrecoverable loss. However, failing to induct can end up even more costly when care is compromised. Martin Taylor s 2004 HCPNZ Membership Survey revealed that 18 per cent of care givers had less than one years experience. Many job applicants have little or no training. They are applying for care giving with minimal formal education and [often] English as a second language. Yet these same applicants can be kind and diligent workers fiscally bonded to their jobs out of a real need to make ends meet. More often that not, they are lovely young women [mostly] capable of kind and compassionate care.

3 Essentials for a Robust Induction & Ongoing Training Program Train & Retain Nurture a solid core of experienced care givers. Promote willing diligent workers into leadership roles and supply beautiful certificates [Health & Safety Representative, Senior Care Giver] Be flexible and understanding of individual needs and inabilities Those that fail in one area may succeed in another Be Organised Decide what essential testing / training is required for each position. This is an index to your Induction & Ongoing Trainign Program. Have all the paperwork ready in a pack for each new arrival Have a person in charge of inducting new employees [signing off essential trainings] Check Competence Recognise known robust trainings from elsewhere, but don t rely on them Recognise the specialised needs of your client group and find interesting training in that area Use assessments of knowledge to test understanding. Don't be too keen to hire [try a paid two week training trial]. Exclude the incompetent from tasks until they have upskilled sufficiently. Cost Cutting Measures: Seek good resources for essential training. For example, new employees cannot wait until the next time a trainer arrives to learn about medicine management if they are giving out medications. Such training needs to be in house, graphical and simple. It needs to target set areas like giving out prn medication, insulin or controlled drugs, according to the situations staff are likely to face. It s no good relying on an annual visit from a free trainer, once a year. Trainers should endorse and elaborate on a sound in house program. It also makes sense to use sufficiently robust free trainers like Douglas Pharmaceuticals who train onsite, DHB funded training, Diagnostic Medlab and Healthcare Help Douglas Medico Systems train and assess Medicine Management Programs [to help prevent those costly errors] for those using Medico Packs for medications. The new Healthcare Help Training Program only provides essential training needed to gain certification. It is designed to be

4 used in house with an RN or Manager using paper based resources. Modules are also online accessible to any computer. The online training modules are FREE to all and no registration is needed. It s beautifully presented with lots of pictures and comes with advice, colourful posters or work instructions, resources for trainers and assessments of knowledge, to test competency. Saving: Induct and train well to reduce costly mistakes made by employees. 3. Respond quickly to exceptions [Quick & Easy Stats] In real terms, fast response times to exceptions will yield greatest savings. So many health providers have accident and incident reporting forms. The forms get filled in and later on the forms are filed. The task is complete. But people are still getting hurt! Most common example: There are several incident forms where a resident has fallen over. Could the incident have been prevented the form asks? A care giver has ticked yes and writes that they told the resident to ring the bell for help. This is written on each form. Great idea, except that the person is: too forgetful, too independent, too frail or too demented to obey. They rush to get to the toilet, trip on their sloppy slippers, miss the walking frame parked on the other side of the room, to fall over yet again but this time they break their hip. This is costly in healthcare dollars and costly in human anguish. The first fall was a near hit. Each subsequent fall was a further warning. If we have RN / managers alert to putting in place more supports, that actually lower risk [like regular toileting regimes at set times, supervised journeys, sensor mats, exercise programs & suitable footwear], then real costs will go down. Healthcare Help finds most medication errors investigated describe further training as the corrective action, and lack of training directly proportional to the magnitude of the error, especially where insulin is involved. When the same incidents are happening over and over again money is bled on staff time documenting mishaps, costly dressings and nurse hours. Unhappy staff will move on, inflating the training budget. What is needed is same day support for care staff. Look to prevent problems. Rather than blaming [disciplining] staff for doing something wrong, look instead at changing things so that no one can make that same error ever again. Healthcare Help provides a FREE online database to track exceptions that really is quick and easy to use [Benchmarking Stats]. It is well categorised so Rest Homes, Hospitals, Home Care Services, etc are compared separately. Individual Rest Homes enter beds occupied and the number of exceptions per month [e.g. the number of falls, skin tears, infections or medication

5 incidents]. This generates a graph with results compared to the average of everyone else individual results cannot be seen by others. Data is at a rate rather than numerical so that small and large providers are compared fairly. See example, below. Essentially, this is free trend analysis that benchmarks in a printable graphical form. Graphs can be copied and pasted into other documents. Where threshold values are exceeded [e.g. too many urine infections or falls] links show resources to help improve. The program is three years old now and has earned highest grades at audits for those using it Saving: Fully attained or Higher grades [CI s] = longer certification periods = fewer audits = savings. Good employers, gearing up for profitability, strive to show employees what they may face at work. By training them well for the job, and responding with support, as soon as things go wrong, a culture of support and trust is created, so employees are less likely to leave, seeking more satisfaction elsewhere. By counting up what has gone wrong [trend analysis] we can predict and prevent further incidents. There are more cogs on the wheel to a finely honed profitable business, but these three target wastage common in Healthcare.