Hospital staff often default to keeping patients in bed, especially those perceived as wanderers. Changing this culture requires more than directives; it needs a shift in mindset and training."
To ensure person-centred optimal mobility care becomes an integral part of all hospital settings, a multi-faceted approach focusing on culture change, strong leadership, and systematic implementation is required. Hospitals should aim to build a mobility focused culture built on a strength-based approach, emphasising the principle that a focus on mobility, motivation, cognitive stimulation and maintaining independence is not just the responsibility of dedicated staff such as occupational therapists and physiotherapists, but all staff.
C1. Embed the principles of optimal handed care in all hospital settings through culture change and leadership commitment
This can be achieved by:
- Securing executive leadership buy-in: Build a compelling case to hospital executives (CEO, CFO, CMO, COO) highlighting the benefits of a mobility-focused optimal handed care culture: reduced length of stay, lower readmission rates, reduced patient harms, reduction in deconditioning and related bed days lost, improved patient satisfaction, and potential cost savings.
- Form a multidisciplinary mobility and optimal handed care steering committee: Appoint a diverse team representing nursing, medicine (geriatricians, surgeons), moving and handling professionals, physiotherapy, occupational therapy, pharmacy, quality improvement, social care providers and patient advocacy to champion the initiative. The committee should develop a vision and mission statement for a function and mobility focus culture in the hospital, set goals, oversee implementation, and monitor progress. For example, the committee could include a nurse manager from each ward, a physical therapist specialising in geriatrics, a hospital administrator responsible for resource allocation, and a person who has experienced mobility challenges during hospitalisation.
- Develop standardised mobility protocols: Create clear, evidence-based protocols for assessing and addressing mobility limitations across all wards. These protocols should include:
standardised comprehensive assessment tool, as outlined in High Impact Change Area A.
guidelines for safer person handling techniques, including optimal handed care principles relevant to each area.
criteria for documenting mobility status and progress in the EPR.
- For example, a protocol could specify that everyone admitted to the hospital receive a mobility assessment within 24 hours of admission, if medically appropriate. It could also outline specific interventions for people with different levels of mobility, such as bed exercises, transfers, and walking with assistance. Interventions that stimulate cognition and keep people’s’ minds active are equally important for generating positivity, hope, aspiration and reducing loss of confidence. For example, making time to talk to people, getting to know them, encouraging them and facilitating interactions with other people around them.
- Develop a communication strategy: Create a comprehensive communication plan to disseminate information about the mobility and motivation focused culture to all staff, people, and families. Utilise multiple channels: newsletters, intranet postings, staff meetings, posters, public information brochures, and digital displays. Emphasise the "why" (benefits), "what" (new processes), and "how" (training opportunities).
C2. Ensure appropriate systems, processes and support are in place to facilitate the implementation of person-centred optimal handed care across the hospital
The rehab offer is very lower limb, but upper limb is key. Arm strength is vital to getting out of a chair and without it we create a culture of dependency."
Leadership at the ward level is crucial. Managers need to monitor patient progress and ensure all staff are aligned with rehabilitation goals."
This can be achieved by:
- Early mobilisation culture: Following assessment within 24-48 hours, if medically appropriate, embed a mobilisation culture in every ward through training all staff to support mobility, ensuring rehabilitation continues even when therapists are unavailable.
- Whole team approach and ward leadership: Foster a team-based approach where every staff member is responsible for rehabilitation. Leadership at ward level is critical to the success of embedding mobility and optimal handed care. Provide comprehensive training and empower the ward nurse manager to trial, adjust and adapt processes as required. For example, a ‘Mobility Buddy’ initiative can include a senior nurse educating other staff around mobility and optimal handed care techniques. An ‘eat, dress, move’ initiative can improve people’s mindset to be more active and take ownership of their care.
- Optimising the hospital environment: Make physical changes to the hospital environment to support mobility and engagement in functional activities, such as: encourage people to dress in their own clothes every morning, clear hallways and patient rooms of clutter, ensure availability of walking sticks, wheelchairs, and other aids, install grab bars in bathrooms, toilets and hallways, create designated areas for exercise and walking and a space where people can make their own drinks or snacks. Where possible, use visual cues (posters, signs) to encourage activity and self-care. For example, ‘Move as much as you can’ poster can state, “Moving helps you heal faster and feel better! Aim to get out of bed and walk at least [number] times a day. Ask your nurse or physiotherapist for guidance”. Ensure visual cues are in clear and simple language (avoid medical jargon), accessible, culturally sensitive and up to date.
- Integrating technology: Explore and implement technology solutions to enhance mobility care, such as, wearable activity trackers to monitor people’s activity levels, virtual therapy to provide engaging and motivating exercises, telehealth to provide remote monitoring and support. Where appropriate, consider use of AI-based virtual exercise programmes, especially for people with dementia, to promote engagement and social interaction.
- Equipping wards with necessary resources: Ensure that each ward has the equipment and resources needed to support independent care, including: A variety of assistive devices, adjustable beds and chairs, safe and accessible spaces for mobility exercises.
- For example: Allocate funds to purchase enough mobility aids for each ward. Install grab bars in public bathrooms and hallways. Create a designated "mobility zone" in each ward where people can practice exercises under supervision.
Studies have shown that progressive mobilisation interventions and multicomponent interventions appear to be effective for improving physical activity participation and reducing functional decline in medical inpatients. (Adsett, Julie A, and Alison M Mudge.)
C3. Ensure systems are in place to monitor and evaluate performance with regular quality improvement cycles.
This can be achieved by:
- Tracking key performance indicators: Identify and track key metrics to monitor the effectiveness of the mobility focus, such as, percentage of people assessed for mobility upon admission to a ward, average length of hospital stay, readmission rates, falls rate, people’s satisfaction score relating to mobility care and engagement during their stay, percentage of people reaching their mobility goal during their stay in the hospital.
- Conducting regular audits: The mobility and moving and handling committee can conduct periodic audits to assess compliance with mobility protocols, care plans and identify areas for improvement.
- Implementing a feedback mechanism: Establish a system for collecting feedback from people, families, and staff about the mobility and moving and handling risk assessment, compliance by staff and people and outcomes. Use surveys, suggestion boxes and focus group to gather feedback and analyse feedback to identify areas for improvement, such as, public information, staff training, communication.
- Embedding quality improvement cycles: Implement and embed quality improvement cycles (e.g., Plan-Do-Study-Act). Use data from KPIs, audits and feedback to continuously improve the mobility and motivation focused culture across the hospital.
C4. Ensure sustainability of culture shift through embedding mobility, motivation and optimal handed care as business as usual.
This can be achieved by:
- Identifying mobility champions: Identify mobility and optimal handed care champions in each ward and recognise their contribution and commitment through sharing success stories and providing opportunities for professional development.
- Maintain leadership commitment: Regularly update executives on the progress and outcomes of a mobility and motivation focus, involve them in celebrating successes, and seek their guidance on addressing challenges.