Mobility Minute: Nancy McGann talks systematic change through mobility measurement
Today we speak with Nancy McGann, PT, CSPHP
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.
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.
Listen to the full podcast here.
Note: Podcast transcript below is a condensed version of the conversation generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio before quoting in print.
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.
Sure - I would be happy to! When I graduated from college, I worked in a big teaching hospital first and ended up really being more attracted to outpatient rehab. 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. That led me to my next role working for a rehab hospital in their occupational rehab division and treating a majority of patients who had (on-the-job) back injuries.
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.
When safe patient handling technology was first introduced to me in the early 2000s, 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. 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.
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?
Not that I know of. 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.
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.
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?
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 that really helped me to voice why this is such a big deal for patient safety.
It was an 80-year-old cancer patient who 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?"
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.
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?
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 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 the root cause analysis and clinical pathway development.
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 the 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 by having a healthier response by being more mobile and upright and avoid ventilator-acquired pneumonia by getting people more mobile and getting their lungs more mobile. (The) COVID population is huge with that. So, 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.
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.
And being able to relay your experience as a PT and communicate with your senior leaders 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?
The key is measurement. You need to highlight that there's a problem and talk about the solution to the problem. 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.
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.
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?
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.
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.
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.
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?
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.
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. Measuring mobility and mobilizing safely with technology is the true answer from this angle.
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.
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.
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.
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.
Thanks!
ABOUT THE AUTHOR
DREW MARTIN
Drew works as marketing manager and takes care of digital and content marketing efforts for Recovery Force Health. He enjoys learning about and discussing newer medical technologies and adopting them into everyday marketing practices.
