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Reducing use of seclusion and restraint and improving safety pays off big for provider

July 5, 2012
by Nick Zubko, Associate Editor
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Grafton Integrated Health Network sustains a "major cultural shift" by reducing the use of seclusion and restraint methodologies with its large population of physically aggressive adults and children. The change reaps a huge windfall in quality, safety,
Click To View Figures 1-4 related to the story

The next step was to create a transitional return-to-work program for workers who had been injured on the job. Under GIHN’s previous program, employees who left work due to injury stayed on leave until they could come back to work at 100% capacity in the role to which they were assigned.

But, depending on their job, a sprained ankle or wrist could mean they were out for weeks. As part of the new policy, GIHN instituted a transitional return-to-work program, which covers different levels of injury and associated jobs. Injuries are now evaluated on a case-by-case basis and employees who are unable to perform their normal jobs at 100% are temporarily placed in other jobs, enabling them to continue to be productive.

So while an employee may not immediately return to a position in the group home, for example, he or she might work in the office until they are fully recovered. “It truly does get people healthier quicker, and back into their normal routine a whole lot faster than sitting at home,” Sanders notes.

In terms of savings, when GIHN was doing restraints as “business as usual,” Gaynor says the organization’s high risk index was reflected in its insurance rates. Based on what was quoted as $2.5 million in 2004/2005, the number soon fell to $1.6 million (Figure 1). Now it’s below $1 million and “still sinking.”

Looking at the results

When GIHN began the initiative, Gaynor’s mandate was two-fold: “We needed to get out of the restraint business and we needed to do it in a way that prevented staff from being injured any further. While the first year was “a little iffy,” he says a “tipping point” soon occurred.

“Successes start to happen, they go viral, and people want to be on that side of the equation,” explains Gaynor, who credits the program’s success with its focus on “the art of asking better questions. If you approach it that way, it will be embraced as a value-added learning opportunity across the board.”

The results have been what he calls a “massive reduction” in the number of staff who are involved in client-induced injuries. When other organizations learn of the initiative’s results, he says that they have a number of common questions.

“For example, people often ask about the duration of restraint and seclusions (when they do happen), and whether seclusions are being substituted for restraints—thus taking a benefit by using what some would see as a more coercive technique. In fact, the duration of the average restraint has also significantly decreased. “When we do use them,” Gaynor explained, “they are much shorter.”

Other significant improvements between FY 2005 and FY 2011 include:

  • Client induced injuries dropped 65 percent. (Figure 2)
  • Staff injuries from restraints dropped 93 percent. (Figure 3)
  • Lost time expenses fell by over $410,000. (Figure 4)

And while those numbers tell part of the story, GIHN has also conducted numerous independent staff satisfaction surveys to ascertain how employees feel about the changes that have taken place.

“Those ratios have increased pretty proportionately with a lot of these trends,” notes Gaynor. “Morale has gone up, and all that has significantly resulted in a decrease in sustainable staff turnover margin.”

 

 

Note: Grafton Integrated Health Network was one of three provider organizations recognized with 2012 Negley Associates Annual Awards. These annual awards, sponsored by Negley Associates (Roseland, NJ), recognize excellence in risk management in the field of behavioral health. 

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