Throughout several countries, perhaps most, healthcare costs are rising, and staff shortage is evident. In the UK, there is doubt as to how many healthcare workers will leave the country when the country leaves the European Union. One in every eight are of non-British nationality. 

That is 144,000 people out of the 1.2 million NHS staff in total. Quite a substantial number, wouldn’t you agree? The UK will find itself in dire straits if the vast majority of non-British healthcare workers leave and the influx of new staff decreases. 

But even if you don’t work in the UK, you may still be concerned, as there is a serious shortage of healthcare workers in many countries. Many low-income countries suffer from what is known as a “brain drain”. Physicians, nurses and pharmacists are part of what easily could be described as an exodus of such professionals. Skilled labourers are always at risk of leaving their respective countries with the hope of gaining a higher income and hopefully a better quality of life for themselves. I can’t really blame anyone for wanting to improve the life for themselves and their families. It is quite the natural thing to do if you have the means to. It does however impose a serious problem for the countries affected by such emigration. They will still have the same number of people that require healthcare, and many countries also see demographics and epidemiology of the population being served increasing the need for people requiring care. In short, the need for care increases while the people trained to deliver it are fewer, at the same time as costs increase because of more expensive devices and drugs.  

Now, add to that the centralization of healthcare institutions to urban areas. In countries like e.g., Nigeria, only some 50% of the population resides in urban areas whereas the rest apparently have poor or no access to qualified healthcare. Still some 70% of the healthcare budget is spent in the urban areas. This in the most populous country in Africa with a population of some 190+ million inhabitants. It is also the worlds’ 20thlargest economy. Still, it cannot support the healthcare need adequately. 

This is a problem not easily solved. It is in itself a clearly understood problem, but its solution is multifaceted and not easily defined. To do nothing though, is not sustainable. It needs to be fixed. And, it needs to be fixed by the governments. 

I am not a politician, so I will be very short on suggestions else I risk missing consequences I cannot foresee or completely understand. However, from a layman’s perspective it seems bad business to invest in someone’s education only to see them take advantage of that investments elsewhere where I don’t get to reap any benefit from it. Where I to invest personally in someone’s education, I would have some demands attached to the investment. Likely, I would set it up as a loan. I could ask that the student, once graduated, remains in his/her profession within the country for 10 (?) years. If the student decides to leave prior to that time, the investment would be repaid over the next 10 years. If the student fulfils the required stay in profession, the loan would be 100% depreciated.  

You could stage it so that if the student who is by then a doctor, nurse, OT, etc, would decide to leave after e.g., eight years, the loan would be depreciated by e.g. 50%. All in all, you make an investment, you want to see some gains from it, right? 

Now, this may or may not be a viable part fix but how do we deal with the situation right now? How do we approach current staff shortages? How do we get more people receiving adequate healthcare with existing staff? One thing just could be to enable nurses and occupational therapists with the tools and training required to do cut down on the number of individuals needed to perform certain tasks, without negatively affecting either patient or staff safety.  

Recently, I came across a concept, which was new to me at least, in the UK. One of those chance meetings where you just happen to pick up on something that triggers your imagination and connects a few dots. Nurse Deborah Harrison, founder of A1 Risk Solutions, was happy to present the concept of Single-Handed Care to me. The general idea is that many patient handling activities can be performed by a single carer, rather than two. This, of course, implies having not only needed equipment for vertical and lateral transfers but certainly also the proper training in best practise methodology. Deborah invited me to join her in repositioning a patient. She instructed me as what to do, how to place my hands, my posture and when to lift. I had my eyes and attention on her without flickering. Then, she told me she would do it herself. She had to get a little help from the “patient”, so she asked him to hold a strap, to try to move his leg just a little bit, asked if he felt comfortable, and using the proper sliding tools, she repositioned him. It then dawned on me.  

When she and I did the lifting/sliding, we spoke to each other, we looked at each other, and – the patient was goods to be moved. When she did it without me, she and the patient spoke. They helped each other. The patient was involved in his own care and received a very dignified care. One carer actually delivered equally safe but so much more patient centred care. So, what about me then...? Well, were I a trained nurse, I could tend to another patient instead, couldn’t I? Suddenly two patients would be treated instead of one without adding more carers!  

Patient handling requires plenty of time from caregivers and is an important task for several reasons. Depending on the patient’s level of mobility, you need to assure the risk for pressure ulcers is minimized thus repositioning is frequently required. When manually lifting a patient, there is an imminent risk of back injuries and thus you need to ensure the proper tools and trainings are in place and fully implemented. Patients need their hygiene tended to and thus lifting and moving patients to and from bathroom or shower occurs regularly. Or it could just be to get a patient transferred between bed and wheelchair. Many hours are spent on patient handling. What if you could cut down on even some 30% of that time? What if you could do it without impacting either safety or quality of life? Perhaps even increase patient and staff satisfaction? I’d give it a go for sure! 

How do I propose you get there then? Well, I think what you want to do is to make sure you have a good business case at first. Boring start, I know, but it helps as you move along to ensure you get the tools and training funded. 

Make an assumption, if you can, as to how many hours you’d save, treating the same number of patients as today, by using one carer instead of two, where possible. Get the cost savings. Make an estimation as to what equipment needs you have (sliding sheets, ceiling lifts, mobile lifts, raising aids, and so forth) and approximate the cost of ownership per annum. See if it makes sense. Or, get a patient handling company to do it for you in which case the cost side of things will be more accurate, and they may be able to come up with some attractive financing solutions too (CapEx, leasing, pay-per-use, TCO program, other) that suits your needs. If they don’t – find another one. You’re the client and they are there to serve you. 

Now, you may be looking to treat more people rather than achieve cost savings. Then, you’d take the hours saved and see how many new patients you could treat without adding more caregivers to your staff. This, in turn, can also achieve consequential cost saving opportunities as bed blocking is likely to go down (higher patient throughput, less cancellation of procedures), more people may be treated at home rather than in a facility (more carers available), less staff turnover (because of less back injuries, higher staff and patient satisfaction). Win-win really. 

Next, get a nurse or occupational therapist, trained in single handed care, to manage the training program. Once you have it done in one place, you may want to cascade it throughout your organization with the help of internal trainers. Train the Trainers. Then, you assume full ownership of the program and lessen the need for external consultants. I am not aware of where to find such trained professionals locally but suggest you reach out to e.g., Nurse Harrison whom, I am sure, will point you in the right direction.  

For you, it is time to consider if Single Handed Care is a viable choice for you and your place of work. I think it would be. I think you’d like it and benefit from it.