Advancing Early Mobility Solutions for Immobility Challenges

In this episode of the Therapeutic Industries Podcast, I had the pleasure of chatting with Margaret Arnold, CEO of earlymobility.com and President of Inspire Outcomes. Margaret and I go way back, having met a decade ago at a conference in San Diego. Our conversation primarily revolved around the Early Mobility movement in healthcare, a mission Margaret is very passionate about! She reflected on her journey from a physical therapist to leading the early mobility crusade, highlighting the importance of mobilizing patients, particularly those in intensive care, who traditionally were left to rest, typically leading to long-term negative outcomes.

Margaret discussed how healthcare facilities are often fragmented, with patients suffering from immobility due to current practices. She stressed the need for safe patient handling, integrating mobility while ensuring the safety of both patients and caregivers. Margaret shared her experiences introducing new equipment and handling resistance, illustrating the importance of changing the culture in hospitals—a task that requires two to three years for a lasting impact. She emphasized that the marriage of safety devices, mobility, and caregiver safety can significantly improve outcomes.

We also touched on the financial challenges hospitals face, with emphasis on showing administrators the cost-effectiveness of early mobility programs. Margaret noted how investments in the right equipment—and ensuring it is used correctly and consistently—can prevent injuries and save costs in the long run. The podcast concluded with insights on boosting morale by listening to staff and investing in tools that help them perform their jobs more effectively and safely, fundamentally transforming healthcare delivery and patient outcomes.

 

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Transcript:

Laszlo Bayer: Well, hello everyone. I want to introduce to you today Margaret Arnold. She is the CEO of earlymobility.com and President of Inspire Outcomes. And Margaret and I have quite the history. We met 10 years ago at the combined sections meeting in San Diego and we’ve kept in touch ever since. And it’s been a great pleasure getting to know her and getting to watch her crusade, the early mobility movement actually in the United States. So without further ado, Margaret, welcome.

Margaret Arnold: Thank you so much, Laszlo. And yeah, it has been, gosh, it’s hard to believe it’s been 10 years. It seems like nothing, right? Since I know that meeting in San Diego. And yeah, I’m thrilled to be here today having seen the industry change and grow over the last, well, not just 10 years, but 20. I’ve been in this industry for 30 years now and there’s been a lot of changes.

Laszlo Bayer: No, you look like you’re 25. 

Margaret Arnold: I started when I was three, so you know.

Margaret Arnold:  It’s been a ride and it still is. We have so much more work to do and I’m so thrilled to have this opportunity to talk with you and your audience today because such an important topic. And at earlymobility.com, that is our goal. I’m guessing we’ll get into a little bit of that today, but that is our passion. And to me, Laszlo, it’s more than a job. This is mission work. This is helping those and being the voice for those who don’t have a voice for themselves. It’s not easy, but it’s important work that we do.

Laszlo Bayer: Yes, absolutely. Its interesting to me that prior to the whole discovery of how important early mobility is, especially for patients that are critically ill, critically injured that are in an ICU, you know we used to think, oh, let them just rest and heal. And we find out now that that’s not really the right approach, is it?

Margaret Arnold: That’s right. And I think the other thing that I’ve seen over the years, and this is how I grew in my role, I started off as a physical therapist in 1990. Well, I graduated in 93 and came over to the states in 95 and worked as an orthopedic outpatient physical therapist. And I was trained in ergonomics and back injury prevention across the spectrum you know office ergonomics, manufacturing industry, healthcare industry. And I was voluntold that I would be the chair of our ergonomics committee at my own hospital here in Michigan. And what I found was that so many of the people that I was treating as a physical therapist, because I worked in the occupational medicine PT clinic, so I would see all the injured workers and I would be treating their backs and their necks and their shoulders and the result of these injuries. And so that was why I get into the ergonomics piece.

Margaret Arnold: And a huge portion of the people that were getting hurt were our own nurses, our own therapist in our own hospital. So that led me in 2005, 2006 down the Safe Patient Handling Road, and we actually started a safe patient handling program at my hospital in Michigan in 2006. We were very successful in reducing the injuries, but what I found as I was spending a lot more time on the acute care side of the house is I was finding that a lot of our patients were staying in bed. So fast forward a couple of years to 2009, 2010, a lot of the early work from Intermountain Health from the Institute of Health Improvement, so IHI the work coming out of Johns Hopkins with Dale Needham on early mobility. It kind of all was about that time. And back then I remember very clearly doing a presentation at the Safe Patient Handling Conference with Andy Rich from Arjo. He’s one of the OTs and Educators. And I remember we had a handshake on our first slide saying, safe patient handling meet early mobility.

Margaret Arnold:  One of the things as a physical therapist that really concerned me, and I think in the early days it was hard for physical therapists to get on board with safe patient handling because a lot of it seemed very passive. A lot of the tools in the devices just getting a passive lift went against the grain of the physical therapist and occupational therapy where our goal is to get that patient moving again, to avoid muscle weakness, to help them recover as quickly as possible. And so in the course of that conflict, if you will, or that tension that man, are we making patients too passive with a safe patient handling? And really digging into that question, not just fluffing over it, but really getting our teeth into that question started a whole new track for me in terms of the reason safe patient handling equipment is important is because we’ve got to move people.

Laszlo Bayer: Right, right.

Margaret Arnold: But we don’t allow them to move by themselves and when we become their muscle or we use a lift to be their muscle, we’re actually causing deconditioning.Right in the ICU, you mentioned that that is a tragic, there’s no word that is strong enough to describe what we are doing to our patients by over sedating them and keeping them immobile.

Margaret Arnold:  It is the long-term cognitive and physical and psychological and financial impacts that we are many times causing by our treatment, not just the condition that brought them to the ICU. We’re beginning to understand the urgency with which we have to address some of these problems. And again, not just the ICU, but even in our med-surg units, we have about 20% globally of our patients that come into the hospital, able to walk, being discharged, not able to get out of a chair.

Laszlo Bayer:  Wow

Margaret Arnold: Having to go to skilled nursing because they can’t do the things for themselves. And that’s our immobility. It’s not the pneumonia, the GI pain, the thing that brought them to see us. That’s us not getting them up.

Laszlo Bayer: Right, right

Margaret Arnold: But equally on the flip side, a lot of the early, early mobility work was done without any equipment. And I actually was invited to go to a hospital in another country where I was doing some consulting and I was invited as a guest to observe their state-of-the-art early mobility program. And the patient actually fell in the hallway as they were mobilizing the patient. So clearly that wasn’t a great outcome either.

Laszlo Bayer:  No, it wasn’t.

Margaret Arnold:  And so really the challenge for us, and I’m so pleased that we’re able to have this conversation today, is to keep our patients mobile, to keep them at their highest level of mobility if they were able to walk before they came in. If they have not come to us with a condition that in and of itself impairs their ability to walk, they should leave the hospital walking. Right

Laszlo Bayer: Right, exactly, exactly. I totally agree.

Margaret Arnold: But staff shouldn’t get hurt in the process. And we shouldn’t be risking the patient’s safety with a fall in the process either. So the marriage of the safe patient handling devices plus the mobility plus the caregiver safety is where we really need to be going. And honestly, that’s one of the reasons why I love what you’ve done with your company and with your product because from the very first time I saw you back in San Diego at combined sections in 2014, my radar is always my antenna are always looking for the new devices that can accomplish all of those things at the same time. There’s lots that can do one or the other, but I really like to look at those products that can accomplish all of them. And so that was why I made a beeline for your booth that time and why I’ve made it a priority to stay in touch with you. And I know that you’ve been to our conferences because it’s pretty exciting. What I’ve seen.

Laszlo Bayer:  It really is. You know you mentioned that, well, one of the things that we encountered early on was a new product resistance. Right? Whenever you bring a new product into the marketplace, you have people just questioning it. Is it gonna work? How am I benefit from it? And we found that it’s a culture that you have to address and it takes some time to do that. Now, I would imagine that early mobility safe, patient handling that concept has to be introduced to this culture. Talk about that a little bit. How long does that take? What are the challenges that you face when you go into a facility and you go, guys, you’re doing it all wrong, here’s the way it should be done.

Margaret Arnold: So first of all, they’re doing it all wrong. Might not be the best strategy.

Laszlo Bayer: Probably not.

Margaret Arnold: But no, you bring up such a good point, Laszlo, because there is a lot of resistance and there are some external factors that drive that in the industry. Some staffing is an issue for healthcare right now. It was an issue before covid and covid exacerbated many of the things that we were already beginning to see. But the problem now is we’ve blamed so much on COVID that there’s a lack of recognition sometimes that these were problems even before Covid, the baby boomers. We know and you and I are going to be there, right? This is the care we’re talking about that we people now and moving forward are going to receive. There aren’t as many staff coming into nursing schools, PT schools, OT schools, physician. This shortage is not necessarily going away anytime soon.

Margaret Arnold: So we have to figure out how to work smarter with what we have going on. One of the challenges we see is healthcare is so fragmented Laszlo, It is the costs that occur not just to the patient but also to the healthcare facility are often in many, many different buckets. So let’s take a patient fall, a healthcare executive who’s making decisions about equipment they’re buying or consulting, which is what we do with early mobility to help them implement the program and help them get the outcomes. That initial outset of capital funding is very, very hard sometimes for them to see all the places that that will touch that are so many competing priorities for that capital funding. Right? And what I’ve found in my experience is very often the financial Officer, the CMO, the CEO, they don’t see all the buckets. So for a fall, that patient may need another x-ray. If we think they’ve broken a hip or fractured a wrist that x-ray is costing the hospital money, but that comes out of a diagnostic imaging bucket. They may need a new scan, a CT or MRI. If we think they’ve hit their head for a neuro scan that comes out of a different budget. If they need sutures because they’ve lacerated their skin, that’s a different budget. If they’re using more pain meds now because they’re in more pain or they’re more fearful, or now we’re dealing with some anxiety that they have that comes out of a pharmaceutical budget line item, it now takes two nurses to get that patient up to the bathroom because they’re fearful or they’re hurting or whatever that comes out of your staffing and it doesn’t show up in your staffing budget. It shows up in the fact that two carers are now tied up caring for this one patient and somebody else doesn’t get their meds on time.

Laszlo Bayer: Yup

Margaret Arnold:  Or somebody else falls off the toilet because that care aid is no longer available to help them. It shows up on that patient staying for six more days. A HRQ shows that the average patient fall injurious and non injurious, the average length of stay increase is six to 12 days. So now we’re not discharging them in the window that we expected for the DRG amount of money that we got to care for that patient. So all of these things, they live in different buckets and until we pull all that together and show the administrators, look, all these initiatives you’re trying to do in all these places, here’s one that will address multiple initiatives, but it’s helping them see that and there’s a lot of work in pulling all that together for them. I think the other thing that we’ve seen is healthcare has been oversold on so many product services. Everybody comes in saying, my widget, my gadget, my program is going to save you money. And it’s good, you know if all these things actually saved all this money, as they all said they would, hospitals would be doing fantastic.

Laszlo Bayer: Right

Margaret Arnold: We be in that crunch. Right? So there’s a resistance because people have been oversold. And one of the things I challenge sales reps, manufacturers, reps, anybody who’s going into a hospital is make sure that you’re honest about what your product will do and what it won’t do and what it will take for your product to get those results in the facility.

Laszlo Bayer: Exactly.

Margaret Arnold: I just recently, were doing some work with a company to try and get people over the leaving patients in bed, right? I think I maybe shared this with you before I went to the gym and I laid down on the treadmill. I told my husband, take a video of me, and he is like, what are you doing? You’re completely nuts. Why are you lying on the treadmill? I said, oh, I’m just resting here until my muscles get strong enough to walk, right? So we get a few people around us going, you guys are nuts. What are you doing? But sometimes in the hospital, that’s the thought is that patient needs to stay in bed until their muscles get strong enough. And as you know, we have to use our muscles.

Laszlo Bayer: Right

Margaret Arnold: So being honest about what it will take to use the equipment and on the treadmill, how often are treadmills sitting in a closet as a clothes horse, right? You’re not gonna lose weight or it reach your exercise goals or whatever the reason you bought that treadmill. You use it as intended when intended you know for the right dosage and all those things. You use it as intended when intended you know for the right dosage and all those things. So it’s a combination of things. And I always say to our partners, so the equipment manufacturers and also we are a service, right? We do the same thing. We want to be certain that what we say we’re going to help them do, we do, and then we follow it up and we show them the outcomes they got. Or we take the work to show them the reasons they didn’t get the outcomes if they didn’t send staff to training.  We can’t expect the staff to know how to use a piece of equipment if they didn’t send them to training and mandate the competencies. It is really multifactorial and it’s helping our customers and our hospitals and health systems put all the dots together and understand all pieces that have to work together, and then they will get the outcomes. It does work.

Laszlo Bayer: I remember the first time I was in a skilled nursing facility early on and I was watching the therapist lift this patient out of the wheelchair and have them walk down the hallway 50 feet, and it reminded me of a car who starter went out, but we didn’t get the starter fixed. We just pushed the car and rolled it down. That’s not solving any problem is it? So I went to them and I said, shouldn’t you be building the leg strength in this patient to go from sit to stand before you focus so much on the ability to walk? Because it’s much harder to go from sit to stand than it is to walk. And they looked at me like I was crazy. And later on I figured out why they wanted to get this patient to walk 50 feet because of their own charting. This is what the patient’s able to do. And that struck me because the last thing I ever want to lose as I get older is the ability to go from sit to stand. Because if I can’t go from sit to stand, my mobility now is greatly reduced.

Margaret Arnold: That’s right.

Laszlo Bayer: You’ve got to be able to take care of your own hygiene in and out of bed, in and out of a car for doctor’s appointments. So it’s really, really important to maintain that strength. I don’t know why that’s not on the top priority for a lot of these patients in that early mobility.

Margaret Arnold: Tell you exactly why. Well, I’m going to give you my opinion.

Laszlo Bayer: Okay

Margaret Arnold: Yes, you’re right. We have to be able to sit stand to be able to walk. Walking is still important because it uses different muscles and there’s a certain reflex, underlying reflex neurophysiologically that when we walk, there’s something about the rhythm of walking that has almost got a neurological reset to it that the brain is like, oh, this is, I recognize this rhythm. I recognize what I’m supposed to be doing here. So it’s always important to try that. Now, if we’re dragging somebody down the hallway, we’re not exactly getting that rhythm of movement, right? but you are right. If we can’t do sit to stand on our own, we never get to the walking.

Laszlo Bayer:  Right? You don’t get it.

Margaret Arnold: It doesn’t matter how well we can walk. So the sit to stand piece is very, very, very difficult. And I’ve gone through, this is one of my hobby horses, I guess. I’ve gone through rehab facilities and I’ve done training and consulting in rehab facilities all across the country and internationally a little bit as well. And I look at a rehab facility and I see patients sitting in their wheelchairs doing arm curls and you know doing this, and they’re lifting their legs up, but they’re not doing a lot of sit to stands. And I will ask the patient, I ask the therapist or the nurse and say, why can’t this person go home? Well, they can’t stand up and they can’t go to the bathroom. And I’m like, oh, that’s because they’ve got weak arms, right, doing all that. Right. And of course it’s a provocative question and I understand that, but my point is, in order to be able to stand up, you have to work the muscles to make us stand.

Laszlo Bayer: Exactly

Margaret Arnold: Glutes in our quads. And you have to practice standing to get better at standing. And so the reason it’s not done is because it’s very difficult with a dependent patient to do, right? It is a lot of lifting. If you don’t have the right equipment for therapists. It’s exhausting. And I’ve done this and I still do it. I just was at a conference teaching at a workshop out in California last month. And to make the point, I’ll quite often get somebody from the audience say, okay, come and sit and you be the patient and I’ll be the therapist and I use all the best body mechanics and I bend my knees and I keep my back straight. He heave ho. And I grab the patient and they’re standing up and then I say, okay, I’m locking their knees. And I’m like, how many of these can I do.

Laszlo Bayer: Exactly.

Margaret Arnold: And where do I go now? I’m kind of here. I’m stuck. If I let his knees bend at all, he’s going down and I might be going down with him or her. And so it always gets a chuckle because people see it and I’m sweating and I’m breathing hard, right?. But it makes the point because the other thing we really need to consider is neurological recovery, what we call neuroplasticity. When we’ve had, if it’s just basic strengthening, let’s say there’s no neurological, no braining problem, just weak legs. Even when we go to the gym, if I just do a one rep or a two rep curl, I’m not doing a whole lot to build much endurance of any muscle, right?. I have to do at least 10 to 15 repetitions. You look in any sports physiology, and you’ll see you need to do at least 10 to 15 repetitions if you’re dealing with a neurological problem. You have to do hundreds of repetitions.

Laszlo Bayer: Yeah

Margaret Arnold: To develop that, what we call neuroplasticity, that new neural plan. So if I’m lifting a person with my own muscles, I’m not getting there. And so that’s why so often you will see people doing activities other than two or three sit to stands because it’s physically exhausting for the therapy.

Laszlo Bayer: Yup, yup. Early on, one of the things that we did to introduce our equipment was we put it into facilities and we said, okay, we’re gonna to let you use this piece of equipment for two weeks, two a month, and you evaluate it. And it was basically a trial basis. Here you go, not going to cost you anything, just try it out. And so we start off with 20 tables that we put out there and said, okay, well, when we went back after a month or so, said, okay, we’re ready to pick it up. 18 out of the 20 said, no, you’re not gonna pick it up because it was such a valuable tool. And we realized then that there are two pieces to this puzzle. One is the patient and one is the clinician safety for both of them is the goal.

Margaret Arnold: Absolutely.

Laszlo Bayer: So that the therapist feels safe in doing whatever exercise, whatever motion, whatever treatment they want to do. They need to feel safe, that they’re safe and that the patient is safe.

Margaret Arnold: That’s right.

Laszlo Bayer: And if the patient feels safe, then their anxiety is reduced

Margaret Arnold: And they’ll do more.

Laszlo Bayer: Oh, yes. And they feel more confident. That’s right. Do this. I’m not going to fall. And it’s all about baby steps and then building that confidence in them. And so we need to build this confidence with the financial part of the industry, and we need to be able to tell them, look, you’re investing in something that is gonna  pay back tenfold without a doubt.

Margaret Arnold:  And we just have to show them. So once we’ve implemented it and they’re using it, we have to find ways to get the staff to measure the difference it’s made and to be able to go back so often. And one of the things that this is called is sometimes managing up is management often happens top down, right? The communication flows down.

Margaret Arnold: The power of saying thank you to the administrator who loosened up the purse strings, who said yes to that purchase order, who said yes to that equipment proposal? Go back. Once you’ve used the equipment and you’ve shown the outcomes and you say, okay, we’ve got 20 patients here that would have been with us on average this long. You don’t have to do a big clinical study if you’re so inclined. That’s one of the things that we love to do is come alongside facilities and help them put together projects, case studies before and after design projects to show the difference that these interventions make. And to go back to that administrator and say, this is what we saved because we did this. That was you saying yes to this project that allowed us to do what we do to keep our patients and our caregivers safe. So often that piece is missed. And it’s the little things. It’s the little things that can make all the difference in the world.

Laszlo Bayer: Reduction in injury, staff injuries, not having a lost days or days off because you’ve injured yourself. I mean, those are very big issues in the industry. As you know, it’s statistics say that it’s in the top three most dangerous professions in the country is healthcare.

Margaret Arnold:  And two additional things to that, a study by Dr. Erman and some colleagues that published last year, it found that less than a third of people even report their injuries, so around a third. So even with being in the top three, that’s with only a third of people reporting. Right?

Margaret Arnold: So post coved, we’ve also seen a further reduction in the number of people that report their injuries. And a lot of the reasons for that are employee health docs are really hard to get into. And the tendency for employee health to sign somebody off of work, and then it’s six weeks before you can go back in and see them. What a lot of employees are finding, or what they’ve shared with us across multiple facilities is I can’t afford to be off work as long as my doc’s going to sign me off. And if I go to the work comp doc, there’s an element of mistrust. They don’t believe what I’m saying. I have to see their providers. I don’t like their providers. I’d rather go to my own doc on my own time, choose my own provider. I’ll stay at work. A lot of people are just not even going down the work comp route. Now, if they’re hurt, they’re changing jobs, they’re not showing up, they’re taking more pain meds. So they might be showing up, but not able to really be productive at work.

Laszlo Bayer: Right

Margaret Arnold: Showing up in different ways. And one of the things we’ve done started doing with early mobility.com and we go in and do a gap analysis in a facility is we do look at the OSHA logs. We look at all that. We look at the mobility, but we do what we call what’s called a symptom survey. And this was published gosh, many, many years ago as a tool in the ergonomic world to really understand the true musculoskeletal health of the workforce. It’s a leading indicator. It’s much more sensitive than the OSHA recordables is voluntary to fill out. But we find that everybody fills it out because they want us to know how bad they’re hurting at work. So it has a picture of a body on it front and back, and it just asks them to shade any parts that hurt that they think are related to their work to give us a number 1 to 10, how bad is the pain? And how long into their shift does the pain come on? Does it come on within the first two hours within? Is it towards the end of the shift? And then how long does it take to go away?

Laszlo Bayer: Right

Margaret Arnold:  And that really gives us a good feel of the incidents and severity of the musculoskeletal health of the workforce, regardless of the end industry you’re in. We routinely find, since we’ve started doing this and we’re thinking about publishing some of our data routinely average daily pain before we start these programs of the nurses and the therapist is about a 7 out of 10.

Laszlo Bayer: Wow

Margaret Arnold: About 75% usually say they have some pain throughout their shift, about 40% of that. The percentage that say they have it say that it is moderate to severe. And about 20% of them say it never goes away. They take pain meds when they go home and it never goes away. So the problem is even the Bureau of Labor Statistics, I know we’ve all seen the iceberg, but it’s real. It is real. And again, like we did before, it’s not showing up in your time off. Sometimes it’s showing up employees being there addicted to medicine, to painkillers. It’s showing up in employees not getting a patient out of bed because their back hurts.

Laszlo Bayer: Exactly. exactly. And a lot of these injuries are cumulative. I mean, they don’t happen right away. It’s a repetitive movement over years. I mean, it can happen immediately, but that’s not really the case. It’s a cumulative buildup of the same repetitive movements time after time after time. And once you get that initial injury and you continue to work, it’s going to be much harder to recover from that injury.

Margaret Arnold: That’s right. Absolutely.

Laszlo Bayer: Margaret, I run a big hospital and I would like to get your services and come in and assess what we’re doing and how we can save money. How would I get in touch with you?

Margaret Arnold:  Great. Please do. Please do [email protected]. It’s pretty easy.

Laszlo Bayer: Okay.

Margaret Arnold: [email protected]. And you can go to the website early mobility.com and you can see what we do there. And we would love to talk with anyone who just has questions. There’s various different levels of support that we can provide, whether it’s one-time training, whether it’s getting nurses and therapists to talk to one another, whether it’s recommending equipment like we talked about before, we touched on your device, the assisted sit to stand that can give variable assistance. And I love that device. We can help do equipment fairs. We can help be informed consumers of equipment so that you know what you need. We can help you understand who your patients are.

Margaret Arnold: Which units have unique physical challenges where one piece of equipment might be really good in this unit, but it’s probably a waste of money over here because what you do with your patients is a little bit different from one unit to the other. So we would love to just help you understand, see where your opportunities are. And even if it’s just starting with a gap analysis to say, okay, come in and take a look and tell us where we’re spending money that we shouldn’t be spending and give us some ideas on what we can do to save it all the way up to a three year program, which from culture change research, we know that it takes two to three years to really change a culture. And you and I have talked about that, that sometimes the person getting the device or the program or the equipment, they understand it, they get it, they train everybody on it. It goes really, really well. And healthcare, we’re awful at doing this. We do it over and over and over and over again, and then that person leaves.

Laszlo Bayer: Right

Margaret Arnold: Or go to another job or gets five more duties added to their job, and now their focus is not here. It is got to be over here. And before you know it, that piece of equipment, that program is kind of in a back closet somewhere, like the treadmill gathering clothes. And you’re like, oh, what That investment that you spent, you were getting. Right? That’s why we believe changing culture to where this is the new way we do things at this hospital and everyone that comes into our hospital to work with us. This is how you’re trained. Anybody who ultimately, after all the training, anyone who doesn’t want to get on board with keeping themselves safe, the patient safe, and really promoting that culture, because we understand what immobility does over time, it becomes, if this is not what you can do as part of your work, we need you to consider whether this is the best place for you to work. Ultimately, that’s what we’re looking at with a change of culture. And that takes two to three years to get there.

Laszlo Bayer: Yeah. Yeah. It sure does. But I think you know you got to start somewhere, right?

Margaret Arnold: That’s right. Start with evaluating where you’re at. Start with the gap analysis. If you’ve got the wherewithal in-house do it, great. If not, we would love to help with that.

Laszlo Bayer: That’s great. I read this a number of years ago that it is far less costly to prevent an injury than to deal with it after the injury has occurred. And I hope that our administrators, your CFOs, CEOs, take the time. It’s their responsibility. They have to take the time to understand what happens on the front lines. It’s like a military situation. The general has really got to know what’s happening in the front, right?

 

Margaret Arnold: That’s right. And two of the things that I say, and I know we’re getting up against the time, I know that we’ve both got hard stops, but two things that I always say to all from administrators, CEO, all the way down to the frontline staff, you’ll spend the money one way or the other. You can spend it treating the harms of not keeping your staff safe or keeping your patients safe, or keeping them mobile and functional. You’ll spend it treating the pressure injuries, the falls, the extra length of stay, the employee injury, the reserves that you’re spending, because in case there’s a lawsuit, you’ll spend it there or spend it preventing. You’re going to spend the money anyway. You’re going to spend the time anyway. If you don’t take the time to prevent the injuries, prevent the patient falls, prevent the deconditioning. You’re going to spend the time. If you’re a nurse, an administrator, a unit manager, you’re going to be doing paperwork on a post fall huddle. You’re going to be justifying why this patient got a skin wound. You’re going to be talking to a family about why this person can’t go home.

Margaret Arnold:  You’re going to spend the time. I urge you, be the smartest leader in the room.

Laszlo Bayer: Right

Margaret Arnold: The injury in the first place. Understand just what you said, you’ll save money, save time and your care excellence will be so much better.

Laszlo Bayer: It certainly will. And one quick point is that I’ve seen the morale of these clinicians change when the administrator listens to them, spends the money, puts a piece of equipment or something in there that’s going to help them do their jobs better and safer. All of a sudden the morale is so much better.

Margaret Arnold: Because they feel listened to and they feel cared for. Right? That’s what staff want, want to feel like they’re valued. So you couldn’t have said it better.

Laszlo Bayer:  Well, Margaret, it’s always a pleasure to see you. It’s always a pleasure to talk to you. We’ll see you again very soon.

Margaret Arnold: Perfect. Okay. Thank you so much.

Laszlo Bayer: Best of luck and anything I can do for you, you let me know.

Margaret Arnold: Sounds great. Thanks so much Laszlo . Take care. Bye.