Paul Harrison Interview – Measuring the Cost Efficiency of Turning Beds
Whether it’s a hoist or a turning bed, the first thing that people look at is the price. The moving handling specialists are the best ones to look at cost efficiency because although there is an investment in the money, a good risk assessor will actually turn round and say but, this is the benefit of investing in equipment.
The problem we’ve got is that many people understand the risk assessment, but its finding a means of doing the pump priming investment; where do I get the money to get the first piece of the equipment in? It is one thing to upgrade from an existing one so those areas that have got a turning bed are now looking for the next one after the existing bed has come to the end of its life.
But where people have never used them and are convinced that they need one, they are then stuck with the issue of how do I actually persuade my manager, my trust, my finance director to actually do it. It’s not like I’ve gone to him and said I want to replace one because it’s now broken and it’s at the end of its life and we’ve established the need for it where they’ve got a very good clinical case that they can present.
It is where somebody is trying to say, Oh I went to such an such a hospital and they’ve got this piece of equipment and I want to use it. Or, we’ve looked at this piece of equipment, we’ve asked around and we think that we have particular problems where we should be turning these people more frequently, there are benefits to having the equipment.
Somebody has to sit down and add up not just the staffing but the benefits of the turning bed itself, so do we actually have a reduction in the use of antibiotics, do we actually have a reduction in the bank staff, the additional hours we have to pay for and do we actually have anything in terms of staff wear and tear.
There may not be injuries as such, that would normally get flagged up on data files or audit but there are a lot of staff who go, “Oh” at the end of the shift, “I really felt in the bones, I really felt in the muscles”, because that’s the true cost efficiency of it. We need to look at physiological outcomes holistically, as well as the moving in manual handling and most of all it is to ask the patient because, the satisfaction of the patient is also something that can be mentioned as is the satisfaction of the staff.
A lot of people have gone from manual turning methods, where the manual turning method is really good for the staff and the patient has to be told to grin bare it. However, for the first time both patients and staff can do a turn and actually say that felt nothing like what I did before. This is because in those areas, these beds are coming in to people who have never used them before and suddenly they realize what they have been missing all these years.
For both them and their managers, the true issue is how do they persuade somebody to part with the sums of money that are needed. I would say to them that you sit down and you total up what you expect to save and then take that true cost to your finance director. What is typical is that they look at the price and they say we don’t have that amount of money.
You cannot just go to somebody and say I want one of these. They will be sitting there with a limited pot of money, and they will be saying ‘why should I fund your bid against some of these others’. You have to go in and say, because this is saving on some other things. It may be that there is not one person that goes or one discipline, but in fact the nurse goes with the doctor, the pharmacist and with the moving and handling trainer and they all say collectively that there is a benefit to all of our services. They actually stop talking about beds like these becoming department property and actually talking more about them being in trusts.
Many trusts are waking up to the fact that specialist equipment where they spend a lot of money should not be left waiting with a cover on it. They want people to present a plan that guarantees you will get maximum utilization out of this investment and what they really mean is can this bed be in use 365 days a year, except when it is down for maintenance or when you can show that there isn’t a patient in this hospital who would benefit from it.
You should go in and say ‘these are the people who will benefit, this is how many of these people we have and this is what the benefits are compared to what we are doing now’. ‘This is how we manage them now, this is what the cost is when we look at them now and these are the complications we think we can avoid’. It is an awful lot of work to put these business cases together.
If people really want these pieces of equipment, they go to the finance manager and its only on the base of saying well that was a really good pitch you did, I’m really sorry but the only reason we didn’t fund your bid is that the others actually have a greater priority for the benefit. In other words, the cost benefit of the ones that we funded was actually greater than yours, but you actually told us everything we need to know and that as and when we get down to yours, you can have it.
This satisfies you to say, I have done everything I can to get it and that’s also down one funding stream and they may also point out there are other funding streams like charities. This means that not everybody gets the money through the NHS, some money you get through charities, some people can raise money by sponsorship and that’s where they have to understand that it’s not just buying a piece of equipment, you’ve also got enough money left over for the maintenance, servicing contracts and any kind of supplementary disposables, you need as well.