Thomas Hoogeboom proposes a novel approach called "Ban Bed-centricity" to increase physical activity for hospital patients. The approach aims to change the hospital environment and culture away from keeping patients primarily in bed. Hoogeboom's team conducted research to understand physical inactivity levels in their hospital and factors contributing to it. They then implemented changes to the physical environment, equipment, staff mindsets, and monitoring to encourage patients to get out of bed and move more. Preliminary data suggests the approach may be cost-effective by reducing lengths of stay and preventing transfers to other facilities.

1. Ban Bed-centricity..
A novel approach to stimulate physical activity
in the hospital by crossing the borders of the
physical therapy profession
Thomas Hoogeboom, PT, PhD

3. Felten-Barentsz et al. Am J Respir Crit Care Med. 2015 Feb 15;191(4):476-7.
Felten-Barentsz et al. J Crit Care. 2018 Dec;48:321-327.

4. Is it necessary for this
person to be in bed?
If this person wanted to
get out of bed, where
would he sit?
If he wants to walk,
would he need to carry
pole with him?
What is he wearing?
Would you be active in
that?
If he actually got out of
bed, where would he
go?
If he is active, would be
not be properly
monitored?
In short, why would this
person be anywhere else
than in “his own” bed??
What is she doing?
Keeping him in bed?
Tv can only be viewed out
of the bed.

5. of the time people are in bed..
Brown et al, 2009
Hospitals are a bed centric world..

6. Ban bed-centricity
Perhaps we should try something
different than lying…

7. So… what did we do?

8. We just started changing the hospital…

9. “You cannot understand a system until you try to
change it” (Lewin)
Research Action
Better outcomes
for clients+ =
Uses information to
make decisions and
evaluate change
Improving the
siutation, process and
practice
High quality and
responsive services
Department of Health and Human Services (DHHS), 2012, p.7.
Janssen et al. Physical Therapy 93(7) · April 2013

10. Team Action

11. Team ResearchTeam Action

12. Team ResearchTeam Action
Q
A

13. “Are patients actually physically
inactive in our hospital?”
“If so, what factors cause this
inactivity?”
“How should we monitor physical
inactivity?”
“Can/Is Ban Bedcentricity (be)
(cost)effective?”
Qs:

14. “Is Ban Bedcentricity likely (cost)effective?”
Koenders et al, In preparation
Q:
Yes! 
For Ban Bedcentricity to be cost
neutral, the program has to prevent:
Just 1 (!) admission to a short stay
rehabilitation center, per YEAR!
A:

15. “How should we monitor physical (in)activity?”Q:
A:
Koenders et al. PLoS One. 2018 Oct 25;13(10):e0206304.

16. “How should we monitor physical (in)activity?”Q:
A:
Koenders et al. PLoS One. 2018 Oct 25;13(10):e0206304.
?

17. “Are patients physically inactive in our hospital?”
0.0
0.2
0.4
0.6
0.8
1.0
Day 1 Day 2 Day 3 Day 4
Proportiontimelying
Proportion lying,
individual patients
Q:
Yes! 
A:
Koenders et al, In preparation

18. “What factors contribute to inactivity?”Q:
IV poles, pain,
culture, habit,
environment,
heteronomy
A:
Koenders et al. Disabil Rehabil. 2018 Aug 9:1-8.

19. So again…
what did we do in our hospital?
Built
environment
Materials Mindset

20. Our motto’s:
“Make the right thing to do, the easy/fun thing to do.”
“Who cares who does it? As long as it gets done.”
“Research should never delay clinical innovation.”

21. We’ve changed the environment
https://www.radboudumc.nl/patientenzorg/uw-opname/tijdens-uw-opname/beter-uit-bed

22. We changed every staircase

23. We’ve changed the nature of our profession

24. We’ve changed the surgical clothing
https://ingawellbeing.com/nl/

25. We are changing the IV pole

26. We are changing the activity monitor

27. … and we did a lot of other things as well

28. So.. is Ban Bed-centricity cost-effective?
Cardiac
surgery
Cardiology Orthopedics
and trauma
Reduction in
length of stay
12% 14% 4%
# of prevented referrals to
place other than home
75 persons 81 persons 8 persons
Potkamp, Koenders et al. In preparation.
Likely!
Q:
A: Please note: we used a retrospective, pragmatic
stepped wedge study, so causality cannot be
inferred, however the data look promising:
Thank you for your attention!