Drew
00:00:02 - 00:00:56
Welcome to this episode of the mobility minute podcast. I'm your host, Drew Martin. Today we speak with Nancy McGann. Nancy is a physical therapist and ergonomist whose work in both inpatient and outpatient environments has molded her understanding of the value mobility and safe patient handling can have on quality of care. In her current role as system manager of clinical associate safety at SCL Health in Colorado, McGann has worked closely with hospital leadership to establish the framework for system-wide mobility initiatives. It was great to be able to speak with Nancy, and I think her perspective as a physical therapist who now works in the Quality Department is very unique and as she gets into a little bit isn't very common in hospitals across the country.

Drew
00:00:56 - 00:01:10
So with that, we'll get into our conversation. I appreciate Nancy and her time to be able to talk with us here on the mobility minute podcast, enjoy.

Drew
00:01:17 - 00:01:32
Hi Nancy, thanks for joining us today. As we do with most of our guests, I'd like for you to start by giving a little bit about your background and how this combination of physical therapy and quality led you to the role that you're currently in.

Nancy
00:01:32 - 00:02:20
Sure I would be happy to. So when I graduated from college, I worked in kind of your big teaching hospital first and ended up really being more attracted to the outpatient rehab. And so I spent my last year when I was at Brigham and Women's in Boston in the outpatient clinic. And I rounded at that time with their industrial accident board and treated a lot of people that were injured on the job. And it led me to my next role which was working really for a rehab hospital in their occupational rehab division and treating the vast majority of my patients who had back injuries. That was my specialty in manual therapy. And they were injured on the job. And then we also rehabilitated them to go back to their heavy manual jobs, most of them.

Nancy
00:02:20 - 00:02:59
I worked at Braintree rehab for about eight years and ended up moving up into a management position. I managed all the occupational rehab programs in our outpatient clinics that were all around the metro Boston area. And at that time I also had the opportunity to work on-site at Raytheon and Foot Joy and some other corporations. We had pt clinics that we embedded there, and we'd go out and do the ergonomics because what we noticed is we would treat people, they would get better. We even put it maybe in our work conditioning or hardening programs and then they come back and they came back because they were introduced to the same poor ergonomic design as before.

Nancy
00:02:59 - 00:03:40
And so that is really when I started studying ergonomics, which is about two years after I graduated from college in the early nineties. That led me on that path and really, um the ergonomic tools and equipment that I had for those industrial environments were far superior to what I could offer my colleagues where I worked. And again, Braintree rehab had an outpatient part, a very large one, but they also had an inpatient hospital, rehab, hospital traumatic brain injury, stroke rehab, and spinal cord injury. And so I also spend a lot of time treating my colleagues and I did not have good solutions for them at that time. I'd raise the bed, use the gate belt, you know, use the right technology that was really all we can offer them and they were getting injured and reinjured where the people I was treating an industry, we could correct their ergonomics, there were good solutions. And so when safe patient handling technology was first introduced to me in the early two-thousands, it was like the collision of both my worlds because I could help my colleagues and give them the right tools so that they could do their job and not get hurt.

Nancy
00:04:09 - 00:04:34
Early on, I also started thinking about the quality of patient care and the reason why I was because of my background in ergonomics. So what I anticipated with safe patient handling early on was if this is a really good ergonomic modification, it's also going to improve quality. But I had no idea at that time, just how much it would improve quality.

Drew
00:04:34 - 00:04:46
Thank you for explaining all of that. Seems like your worlds really did collide to end up where you're currently at. Is it common to see someone with a physical therapy background end up in quality?

Nancy
00:04:46 - 00:05:18
Not that I know of. I don't know any. I am connected in the safe patient handling world pretty vastly on a national level, and I don't know anyone else who works in quality and safety as I do whether they're a PT or a nurse with this kind of background in ergonomics and safe patient handling. My journey was sort of a unique one because I've worked in my health care system for a little over 14 years and really associate and patient safety should be together.

Nancy
00:05:18 - 00:05:53
We call it one safety at SCL Health because safety is safety. So if you have a safety culture and if you're doing the interventions to prevent injury to our patients, you're also preventing injuries to our associates and the like. I embrace this. I think it's actually a great place for people with my background. But certainly, I do feel like a fly on the wall as a physical therapist because the vast majority are pharmacy, physicians, and nurses and really rehab had little to do in my experience with this in the past.

Drew
00:05:53 - 00:06:02
You talk a little bit about that PT background, but how did that continue to shape how you see safety and quality in your system specifically?

Nancy
00:06:02 - 00:06:39
Early on, I was very concerned that we were only looking at associate safety as a measure of success for safe patient handling specifically because that's where I was most involved at that time. And an event happened that one of our hospitals and one of our wound care nurses reported in our event reporting software. That really helped me to voice why this is such a big deal for patient safety. So this particular nurse went in because she had a consult for a coccyx wound that she needed to debris. And it was an 80-year-old cancer patient.

Nancy
00:06:39 - 00:07:00
She was in for IV chemotherapy and she was there with her daughter who was her caretaker at home. When she had to look at the wound, she used the repositioning sling that was under the patient and ceiling lift to move the patient up and to turn her. And then when she was leaving the room after her treatment lunch was coming in and her daughter said, "hey could you help me boost my mom up in bed for lunch?"

Nancy
00:07:00 - 00:07:37
And this particular nurse was like, "Well I'll get your mom boosted up in bed for lunch, but I don't need your help, we can use the lift for this." And they used the lift, she didn't have the daughter's help. And her daughter actually got a little teary and was like, "oh this is so much better. I've been helping boost my mom up with the other caregivers, and every time we do that her skin peels off and it really hurts her." So that one event really allowed me in our organization to show the huge impact of what's protecting our associates from being injured, is also majorly improving the quality of care we deliver.

Drew
00:07:38 - 00:07:50
And that seems to be at the core of what your role in your organization is. How does your perspective as a physical therapist contribute to the overall goals of the safety and quality department?

Nancy
00:07:50 - 00:08:40
We don't tend to have senior leaders on a system level that our physical and occupational therapists. We have our chief nursing officer (CNO), a chief medical officer (CMO), our chief operating officer (COO). So I'm often the only PT in the room.  A lot of these conversations, not because I'm a PT, because of my role as a clinical associate safety manager. So it does open my eyes to the lack of focus at times on that knowledge base that comes from being in rehabilitation and being a part of root cause analysis and clinical pathway development. Getting involved Institute for health care improvement and some of their process improvement strategies. You know, these are all things that would greatly benefit the rehab world, and likewise, that rehab input and the way we look at things as physical and occupational therapists greatly help the quality world.

Nancy
00:08:40 - 00:09:21
So - I would love to see more people with my background in a Quality and Safety role. There's just so much that needs to be understood about physiology of mobility and that not only is it the obvious stuff like we don't want people's muscles to get wasted while they're in the hospital. We will directly impact blood pressure having a healthier response by being more mobile and upright and avoid ventilator-acquired pneumonias by getting people more mobile and getting their lungs more mobile. (The) COVID population is huge with that. So, with that and hearing about that and understanding these quality measures has allowed me to address that in a different way because of my PT background.

Nancy
00:09:22 - 00:10:05
And one thing we did last year in 2020 was we had mobility's medicine tip sheets and we picked a different physiologic body system every month and addressed what low mobility does to those systems and related it to the BMAT which is our mobility assessment tool at SCL Health. How to exercise safely using equipment to overcome that low mobility, and I can tell you that our physicians and our nurses really opened their eyes and it got them very excited about this whole process and helped to get that buy-in that we needed. Missing an opportunity to mobilize is like missing a blood pressure medication. It's not gonna hurt someone immediately, but it will lead them down the road to morbidity and mortality.

Nancy
00:10:05 - 00:10:31
We need to get away from thinking that safe patient handling is a passive way of moving someone from Point A to Point B. And it's no it does do that for sure and it needs to do that, but it also facilitates mobility, walking with a sling and a lift, for example. And again, the key is to get that education across that, you know, intrinsically as a PT and OT that you may not know as a physician or nurse,

Drew
00:10:31 - 00:10:49
And being able to relay your experience as a PT and communicate with that senior leadership who may not have that sort of perspective on things. So how do you communicate with those who don't have your background about the far-reaching impacts that immobility can have?

Nancy
00:10:49 - 00:11:34
So the key is measurement. So you need to highlight that there's a problem. Then you need to talk about the solution to the problem and then you need to ask senior leaders what you need from them for support. They are bombarded with information and are very busy people with a lot coming at them. So, simple reporting, numbers (absolutely need numbers), and then getting The Ask. Don't just come to me with a problem coming to me with a Problem a Solution and Ask. I find those three things are the most effective way to work with these people that have the ability to remove barriers like you've never seen but also are very busy have a lot of people asking them stuff. 

Nancy
00:11:34 - 00:12:10
You need to get into that consciousness at a very high level, and that even goes for the frontline leaders as well, but you really do need to garner that support. In our organization, we have these grants, and a couple of years ago I had been talking with a lot of our frontline leaders about mobility grants and so about four or five people applied for those grants. And that's actually when the system office came to me and said pull together a system-wide grant for this because they needed to see there was frontline leadership willing to invest in this and then we go to the senior leaders and show that support. So you really do need both ends.

Drew
00:12:10 - 00:12:22
In terms of some of the measures that you guys have that you can directly tie to increased mobility such as length of stay or readmissions. Can you talk a little bit about how those are all interconnected?

Nancy
00:12:22 - 00:13:05
Yeah. And before I dive into that, I do want to reflect on the need for balancing measures because what we've done historically from our regulatory bodies is focus on patient falls and patient falls with injury. And in so doing that, we ended up voiding moving our patients. So we weren't moving them because we didn't want them to fall. So if they stayed in bed or they stayed in their chair, they're not going to fall, but they're going to decline and they're gonna have physiologic changes that then actually increase the risk of falling. So it really was a vicious cycle. At SCL Health, we have balancing measures so that we won't incentivize things in an improper way.

Nancy
00:13:05 - 00:14:03
So we want to see fewer falls. We want to see less patient handling injuries, preventing boosting a patient, and we want to see increased mobility. What we're doing this year is we're looking at increasing ambulation of our 65 and older population because they're the most vulnerable to the effects of immobility.  In the future, we're actually going to be doing dashboards and development on pre-ambulation. So measuring that is complex and I'll focus mostly on just measuring what we're doing this year. You need to work with your clinical informatics team and you need to work with all your stakeholders because we often need to change our documentation and educate people on that. Then we need to work with our abstracters and our analytics teams that can build a dashboard that they extract accurately from a health record because if you don't have it from the health record, it's very labor-intensive and it's not going to happen.

Nancy
00:14:03 - 00:14:31
So that is what we have been doing. And so we do have a very simple ambulation dashboard that our leaders can even extract patient-level information so they can see who is walking three times a day for a sustained period of time, who's not, if not why not? And they also get those reports on a monthly basis. Our nurse executive committee gets a dashboard and they see our pilot units right now and starting next month, every unit in our hospital system.

Nancy
00:14:32 - 00:15:06
And how much they're ambulating that 65 and older population. So it's simple to use it and it's very hard to get to that simple state of communication. So the easier that you can get data and the more it's visual to people, the more you're going to create that opportunity for change. If it's not measured, it's very difficult to get the change to happen. And again, if you want senior leaders to invest in your work, they need to see it's going to change and they need to see there is a good measure or they're not going to invest in it, and understandably so.

Nancy
00:15:06 - 00:15:20
And the other thing that we do as an organization really, um is to rapidly be able and ready to change when something is not working. And so there's a lot of work with process improvement so that we do that effectively.

Drew
00:15:20 - 00:15:47
I want to talk about a phrase that you had mentioned previously in our conversation. You mentioned that 'safe employees lead to safe patients and safe patients lead to safe employees.' Can you break down what that means to you and how you've tried to incorporate it in terms of your mobility protocols and programs?

Nancy
00:15:47 - 00:16:35
I'll link that back to your other question, which is about hospital-acquired conditions. In the health care quality world, we have what's called an integrated quality scorecard, and it covers a huge majority of patient safety measures that both impact the quality of care we deliver, how other outside organizations report our safety record, and how we get reimbursed by CMS and by other governing bodies. So really, when you're looking at that marriage of patient and associate safety, you're looking at our employees not getting injured, but you're also looking at that because they're having less false skin tissue damage, CAUTI, and COCCI, which are urinary tract infections and blood infections.

Nancy
00:16:35 - 00:17:17
Because they're having less pneumonia, we will then see a decrease in our length of stay and a decrease in our 30-day readmissions. And those are huge quality indicators. Again, that is so important organization because it shows we're treating our patients and we're not harming our patients, and it helps us to be more financially sound so that we can go on and give the tools to our patients, to our employees are caregivers to take care of our patients. So if you have a culture of safety, it's going to be safer for your employees and your patients. That cancer patient I mentioned is a great example of that. Right? That same tool that prevents injury to our nursing staff also

Nancy
00:17:18 - 00:18:08
allows a better patient satisfire, a lower risk of infections from a cancer patient's skin peeling off when we're boosting them in bed. So really you can't separate the two because if you have an intervention, in this case, an ergonomic intervention lift, if it's a good intervention, it's going to improve quality, which is patient safety and this instance in health care and it's going to prove the safety of your caregiver. Another major indicator in the quality world is nursing-to-patient ratios. Clearly, the lower the ratio the safer our patients are so if we can keep our nurses using their critical thinking and not their physical humping ability, we're gonna go a long way in patient safety. So again, measuring mobility and mobilizing safely with technology is the true answer from this angle.

Drew
00:18:08 - 00:18:23
Thank you for hitting on that. Utilizing technology as opposed to brute physical force can be really helpful for caregivers who have a lot on their plate. So thank you for acknowledging that. And I appreciate how you've painted this picture for us.

Nancy
00:18:23 - 00:18:40
Thank you. And you know, I want to add one more thing and it's kind of cliche. But, one of the things that we always have to remember when we're in health care and we don't take that the oath that a physician does as a physical therapist, but it's certainly still our goal is it's always that first do no harm.

Nancy
00:18:40 - 00:19:23
And really that's another reason we fit in the quality world because we do harm our patients when we don't mobilize them or we don't do the right skin protection technique or whatever that happens to be. And so in the case again of mobility, we are going to harm our patients if we don't use safe patient handling technology to mobilize them sooner and safer. And we're never going to get the support for that unless we can clearly measure mobility. And so that's the message I really want to leave with is that we are harming our patients in the whole world really right now, by keeping them in bed, keeping them in a chair. And so I do hope for a better future because I'm getting older, and I'm going to be one of those patients soon.

Drew
00:19:23 - 00:19:50
Well, it's been wonderful speaking with you today on the Mobility Minute podcast nancy. Some of my key takeaways revolved around the statement you made earlier about missing an opportunity to mobilize and equating that to missing a blood pressure medication. You also talked about the importance of mobility measurement and taking that data to visualize it to your senior leadership. So again, I thank you for your time today and I appreciate you being with us on the Mobility Minute Podcast.

Nancy
00:19:53 - 00:19:54
Thanks!

Drew
00:20:03 - 00:20:09
The Mobility Minute podcasts brought to you by Recovery Force Health.