Small Efforts, Big Results: The power of leverage in dysphagia

Let’s be honest, the field of speech pathology is not for the faint of heart. In the complex world of dysphagia management, we have many questions, but not nearly as many answers due to a dearth of research and constantly evolving best practices. Like getting to the moon, it’s what makes our profession incredibly difficult, but also exciting and fulfilling all at the same time. 

There are a few things that have stood the test of time, though. We must leverage these resources and utilize them to our advantage, enabling us to improve the lives of the patients we serve most effectively and efficiently. Just as a lever can amplify force to move a heavy object, I’ve identified some leverage points we can strategically focus on to amplify the impact of the time, energy, and resources we spend on helping a patient reach their goals. Let’s take a look…

Identifying Your "Levers"

What does a lever have to do with dysphagia? A lever in dysphagia management is simply a resource that requires a relatively small amount of input but provides an asymmetrical level of output. Slept through that section in physics? No worries. Let’s talk about a few of these levers as they relate to SLPs.

Oral Care

Oral care might be the best example of a lever in dysphagia management. The bad news? It’s significantly underutilized. The good news? It’s significantly underutilized. Yup, you read that right. That wasn’t a typo. Many healthcare facilities lack effective oral care programs, which is, of course, detrimental to our patients. But the solution is simple, straightforward, and cheap… and effective. Really effective. A recent systematic review proves that it prevents “bacterial mouth infection, pneumonia, and aspiration pneumonia.”

Let’s see how these look in a leverage equation:

Input: A toothbrush and a spec of toothpaste (Less than $1 per brush) and a time commitment of 1-2 minutes. 

Output: Regular oral care has the potential to minimize the risk not only of oral infections, but also of a wide range of systemic diseases as well. And if that didn’t catch your attention, you should know that it can reduce the risk of and mortality of aspiration pneumonia as well. Simply put, brushing teeth saves lives.

Relationships

We don’t think of relationships as a resource (And that’s probably for the best: Please don’t formally ask your next date if they’d like to be your one and only resource until the end of time), but they are in the sense that the better relationships we have with our team members and with our patients, the more effective we become at achieving their goals. Much of this stems from trust. 

Input: Spending a few minutes helping colleagues each day and/or a few dollars treating them to lunch. Doing this day after day builds high-quality relationships based on trust and respect. Furthermore, spending a few minutes each session discussing the patient's life and goals enables us to tailor our plan of care effectively and establishes the trust necessary for the patient to follow through with our recommendations, which may be difficult and uncomfortable at times. 

Output: Exponential gains in productivity, efficiency, and safety from receiving help and support from your colleagues with no questions asked. Think about follow-through on your 9-step compensatory strategy, you need your patient to follow, or support for the new oral care initiative you’re implementing. It takes a village, but first you need to build that village hut by hut. Further, by establishing rapport and trust with your patients, the output becomes their carryover of your recommendations. You know, actually doing what you ask them to do. You can lead a patient to thickened water, but you definitely can’t make him drink it. 

Instrumental Swallow Testing

You KNOW you saw this one coming from a mile away. Instrumental assessments like the Modified Barium Swallow Study (MBSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) provide valuable insights into swallowing physiology and help guide treatment decisions. We now know that the bedside swallow evaluation has some serious limitations. While still integral to a comprehensive approach to dysphagia management, a more detailed assessment lies in swallowing imaging, which is becoming increasingly accessible and acts as a key leverage point to gather high-quality data, thereby improving the effectiveness of our care.

Input: A 10-15 minute instrumental swallowing evaluation. 

Output: An enormous amount of data about the swallow, including information regarding anatomy and physiology that leads to an accurate identification of problems, understanding why those problems occur, and developing effective approaches to resolve or minimize the impact of those problems. Think about this in terms of a silent aspiration that proceeded to plague a patient with recurring aspiration pneumonia for years, while another patient received an FEES and was able to incorporate a simple oral hold procedure with thin liquids to protect their airway, which led to a significantly reduced risk of aspiration and pneumonia.

Maximizing Your Impact

Hopefully, the gears are starting to turn as you think of all sorts of ways you can leverage better care for your patients. Here are some other ways you might consider leveraging high-yield activities:  

• Investing in high-quality continuing education to exponentially increase your knowledge base year after year.

• Collaborating with the best interdisciplinary team members to better understand problems outside of your scope.

• Promoting a proactive approach to dysphagia management for your patient before head and neck cancer to save them years of discomfort and distress.

• Focusing on a patient-centered approach that can save you endless hours implementing a plan of care they were never going to follow to begin with. 

These types of opportunities allow us to leverage just a tiny bit of input to receive an outsized output. The best part? They literally exist everywhere. We just have to look for them.

The Risks and Responsibilities of Leverage

Yup, leverage has risks just like everything else. While leverage can be a powerful tool, it's essential to use it wisely. Over-reliance on certain resources or neglecting others can lead to unintended consequences. For example, focusing solely on instrumental assessments without considering the patient's subjective experience can lead to misaligned treatment plans. The key is to use leverage judiciously, considering the broader context and potential impact of our decisions. This includes ethical considerations, patient safety, and the overall well-being of those we serve. 

Conclusion

By understanding the concept of leverage and applying it strategically in dysphagia management, we can amplify our impact, enhance patient outcomes, and maximize the use of available resources. Our inputs may be limited, but if we leverage them effectively, our outputs and the impact we have on a patient's quality of life and overall health become virtually unlimited.

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I would love to hear your thoughts on this topic! How do you leverage resources in your dysphagia practice? Share your experiences and insights in the comments below!