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Nine cost-cutting pointers for belt-tightened times


June 1, 2009

On the surface, it would appear that trimming hospital budgets would have a negative effect on safety.

However, it doesn’t have to be that way. Briefings on Hospital Safety has drawn on the experience of its editorial advisors, soliciting their best practices for dealing with shrinking budgets. Many of the following steps can be measured to gauge success:

1. Customize your pitch for new projects by focusing on your leaders’ pet concerns. “In the minds of most decision-makers, safety and emergency management issues do not generate revenue,” says Paul Penn, MS, CHEM, CHSP, owner of EnMagine/HAZMAT for Healthcare in Diamond Springs, CA. “One of the keys is to articulate to the decision-makers that safety saves them money … It’s sad, but in these times, [safety managers] have to justify the return on investment.”

You know where the safety problems are in your hospitals, and you know the hot buttons a particular administrator might have—so push them to help raise awareness of the EC.

For example, if your chief financial officer watches for excessive workers’ compensation claims, get him or her on board with a new program (e.g., reducing employee injuries in the ED) that will reduce those claims and save money, Penn says.

2. Run an incident command center exercise to improve utilization. Zach Goldfarb, EMT-P, CHSP, CEM, president of Incident Management Solutions, Inc., in East Meadow, NY, says that one of his clients recently put its disaster training to use in a more mundane manner: The hospital wanted to track bed use throughout the hospital because the ED had been reaching capacity too often.

The most efficient way to do that was to activate the incident command center. The instant feedback and communication that resulted helped lead to a financially beneficial utilization tune-up and yielded the opportunity for disaster practice.

3. Prioritize your projects based on cost-benefit ratios. In other words, determine how much money lower injury and error rates will save, says Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant at Di Giacomo-Geffers and Associates in Trabuco Canyon, CA.

Organization pays off, says Di Giacomo-Geffers, who is a former Joint Commission (formerly JCAHO) surveyor. Identify problems, drill down to get to the root causes, and prioritize the more serious concerns. In these tough financial times, a serious problem could be defined as whatever costs hospitals the most money.

For example, if the patient fall rate in a particular area is high, investigate who’s falling and why. Lowering that rate might be as simple as installing a grab rail, says Di Giacomo-Geffers, and that would be a good return on investment for senior leaders closely watching the bottom line.

“By thinking quantitatively, some projects make more sense today than before the economic downturn,” says Barry D. Watkins, MBA, MHA, CHSP, senior EC specialist at Carolinas HealthCare System in Charlotte, NC. “For example, our department is resurrecting a project evaluation to possibly purchase an automation software system. The project was postponed prior to the economic downturn due to cost. However, senior leadership [recently] approached us asking why the particular process was performed manually.”

4. Tap into useful return-to-work activities. If an employee recovering from an injury can work but isn’t ready to go back to his or her old job, see whether you can draft that worker to help the safety department with the large volume of paperwork and rounds that otherwise take up a safety officer’s time, Penn says.

5. Use online training and virtual drills when feasible. Some tech-savvy responders are using federal grants to build virtual hospitals on Web sites such as Second Life (see the April Briefings on Hospital Safety for more details).

Earl Williams, HSP, safety specialist for BroMenn Healthcare in Bloomington, IL, is working on such a project for his staff. Williams is also using more online training courses for safety matters (e.g., properly handling hazardous materials) than he has in the past. Online modules are more cost-effective compared to hiring an instructor or sending employees to off-site seminars.

“That’s what I’m depending on at this point,” Williams says, adding that combination telephone conference and Webcasts offer much value. “In the past, most of them were very focused. We’re looking for more bang for the buck, so [educators] are now covering two or three subjects in one shot in order to get the most for our dollars,” he says.

6. Look critically at the costs of face-to-face meetings. You might find that phone and video conferencing are more affordable ways to meet. Watkins admits that multifacility organizations such as his probably spend a lot of money reimbursing employees for travel.

“While much of our travel is essential to ensure we maintain adequate presence and surveillance of our coverage areas, we are able to minimize travel by phone conferencing meetings,” Watkins says. “We also use video conferencing for our larger systemwide meetings.”

Give yourself some final icing by documenting your travel expense savings when reporting to your boss about the meetings. (See “Ideas to better organize yourself and your coworkers” below for more administrative efficiency ideas.)

7. Focus on nurse safety as a cost-saving measure. Some hospitals have a difficult time keeping nurses on staff, leading to more money spent on recruiting and training new nurses, Penn says.

Reducing nurse injury rates not only saves costs when nurses leave due to injury, but also cuts funds spent on workers’ compensation and floater nurses when the regular employees are out of work.

Developing patient lift teams or purchasing patient lifting equipment are two prominent options for decreasing nurse injuries. Such safety investments will help your facility keep the nurses it has longer and aid recruitment efforts when word spreads that your hospital cares about nurse safety.

8. Standardize EC training across facilities. If you’re in charge of safety for multiple sites, it may pay off to homogenize your staff education across the board, Watkins says. Originally, Carolinas HealthCare System looked to its EC standardization (ECS) initiative to increase the quality of the EC by making sure that everyone’s training was at the same level at each facility. But it can also be viewed as a cost-cutting measure.

“The phrase ‘work smarter, not harder’ applies more today than ever,” Watkins says.

Thanks to the ECS effort, safety managers spend less time on common items such as formatting committee meeting agendas, minutes, attendance records, subcommittee report templates, management plans, and annual review templates.

“It is a win-win proposition—enhanced EC programs and efficient use of personnel,” Watkins says.

9. Install motion sensor switches for occasionally used rooms. Although BroMenn Healthcare has already put many energy-saving measures in place, it identified one more penny-pincher: motion sensors in infrequently used rooms.

When someone forgets to turn off the lights, the motion sensor switch will dim the lights after a certain period of time, Williams says.

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