The development and availability of standards for patient safety can serve several purposes. Standards establish minimum levels of performance, establish consistency or uniformity across disciplines and practice settings, and promote reproducible outcomes. Another purpose of standards is to set expectations for healthcare recipients and healthcare workers. Standards can be used in public regulatory processes, such as licensure for health professionals and healthcare organizations, such as hospitals or health plans. However, compliance with professional standards such as the ANA Safe Patient Handling and Mobility Interprofessional National Standards is entirely voluntary.

Although there are many kinds of standards in health care, few standards focus explicitly on issues of patient safety. Further, even fewer provisions are made to evaluate the comprehensive nature of a SPHM program. To evaluate the clinical and economic performance of a SPHM program, a process must be in place to collect complex data and provide a method of communicating the data in a straightforward manner. For example, under one safety-based program, trained healthcare workers used mechanical lifts and repositioning
devices rather than manual lifts and handling. In this particular case, researchers identified a 49% reduction in patient falls related to lift and transfer activities (Mattei, 2012). Proponents of this program also indicated that mechanical lift techniques free healthcare workers from the burden of lifting patients so they can devote their energies to direct patient care activities.

A robust process that generates reports on program indicators, both clinically and economically, helps the champions of the SPHM program meet goals and identify opportunities for improvement. However, it is essential that nursing not shoulder the actual work of the evaluation process. The goal of a successful SPHM team is to establish a process wherein data is provided by those in the organization who already have a mechanism in place for data collection; those data are analyzed at the point of extraction by stakeholders who are aware of their responsibilities to the SPHM team, which includes providing annotated information to the SPHM team for synthesis, evaluation, and publication.

New or emerging SPHM programs best serve their long-term objectives by recognizing opportunities for measurement early in the effort, which is the purpose of the tool titled, “Who can get me what I want?” which is the first step to a business case. (See the introduction.) This provides a reasonable baseline from which to measure and later manage. Mature programs, which have used worker’s compensation data as the sole means of gauging success, may find that use of more complex data is a meaningful way to demonstrate the value of sustaining SPHM investments over time. For instance, the Celano model (see the introduction) can be used over time to continue to support the business case for an evolving program. Ongoing improvement efforts, from quality, cost, and risk perspectives, are best managed by recognizing success and failures, and using recognized deficiencies as opportunities to further transform the SPHM program into a culture of safety.

What follows are selected ideas and insights on implementing the SPHM standard on establishing a comprehensive evaluation system. The direct and indirect impact and value of SPHM is just now coming into focus. For example, in 2008 a hospital in the northeastern United States created an early ICU rehab program with dedicated physical and occupational therapists, which added about $358,000 to the cost of care annually. However, by 2009, the length of stay in the MICU had decreased an average of 23%, down from 6.5 days to 5 days, while the time spent by those same patients as they transitioned
to less-intensive hospital units within the hospital fell 18% as compared with those not participating in the ICU rehab program. Using a financial model, the estimated net cost saving for the hospital was about $818,000 per year, even after factoring in the up-front costs. This program, framed within the context of a SPHM program, has the potential to capture a variety of positive outcomes associated with improved mobility status across units within the facility and may impact readmission outcomes and functional status in the post-acute care areas (American Physical Therapy Association [APTA], 2013).

The ideas and insights described herein are organized by the sets and subsets of the standards that are required by any facility: one specific to your organization as an employer, the other to your facility’s interprofessional healthcare worker. Collecting and managing evidence by way of a comprehensive evaluation system drives longevity and sustainability of the SPHM program over time, by demonstrating return on investment from the perspective of the healthcare recipient and worker.