More Evidence Supporting Ergonomics as a Business Improvement Strategy

A well formulated and executed ergonomics program is once again shown to be a significant contributor to the organizational bottom line. The latest evidence comes from research conducted by University of Wisconsin based researchers Garg and Kapellusch who tracked key business metrics at seven health care facilities with ergonomics programs that included patient handling equipment. Safe patient handling has become an important topic in many health care facilities, and regulators in at least twelve US states, at the time of this writing, have taken note and enacted related regulations (e.g., see Safe Patient Handling Activists See Improving Attitudes in Healthcare Industry or Safe Patient Handling Law Signed by California Governor). 

In their scholarly article, the researchers share some recent industry statistics from the US BLS that show the burden of poor patient handling practices. For example, nursing aides:

  • had the third highest number of these injuries and illness among all occupations in 2007; 
  • experienced the highest musculoskeletal disorder (MSD) incidence rate of days-away-from-work (7 times the national average for all occupations in 2009; and

  • the majority of injuries and illnesses (56%) among nursing aides involved patients, and 86% of those injuries were linked to overexertion.

Though the exact causative relationship between patient handling and injuries remains debatable, according to a 1989 study, patient handling activities preceded injury in 89% of low-back injury reports filed by hospital nurses. Biomechanical, psychophysical and epidemiological studies have all linked manual patient handling activities to risk exposure and injury.

The authors note that historical approaches to this problem included education and training in body mechanics and lifting/transferring techniques, but "with a few exceptions, these approaches have not been effective in reducing MSDs in nursing personnel." Instead, they point to numerous studies that focused on the benefits of engineering controls, particularly patient handling devices, that solve the root causes of injuries, as the most effective approaches to reducing injuries. Their review of the literature revealed gaps in the research base, including:

  • most studies looked at only a single health care facility;
  • most only looked at mechanical assist devices, not including repositioning technology;
  • few looked at the impact of assist devices on patient safety and comfort;
  • few considered patient transfer times; and
  • few addressed the barriers to effective introduction and use of patient handling devices.

The authors provide additional background to this problem, as well as much more detail on methods, results and interpretation than can be summarized here, so interested readers are directed to the original research article, referenced below, for complete details.

Methods

In this study, Garg and Kapellusch cooperated with 7 patient care facilities (6 long-term care, 1 chronic care). The researchers assisted each facility to establish a participatory ergonomics program with a primary focus on "no manual lifting" procedures. Facility based teams consisted of management and volunteers from nursing, housekeeping, dietary, and maintenance departments. Each team invited vendors to demonstrate and leave equipment for further evaluation, and were later free to select and purchase equipment of their choice. Each team then:

  • developed training programs for equipment use;
  • determined appropriate equipment for each patient and transfer type;
  • monitored equipment use and compliance; 
  • addressed unforeseeable problems that arose following implementation; and 
  • met monthly to "discuss and resolve problems, address injuries, and monitor program effectiveness."

Taking special care to address known barriers to safe patient handling equipment implementation, the authors included these key aspects in the programs (italicized text is quoted directly from the original article):

  1. management commitment and participation;
  2. empowerment of nursing personnel in equipment selection and program implementation;
  3. evaluation of patients’ transferring needs by nursing personnel;
  4. laminated cards in each patient room specifying patient-handling devices to be used;
  5. adequate patient-handling equipment for each nursing unit for easy access;
  6. spare slings and parts in each facility to minimize equipment down time;
  7. hands-on training of all nursing personnel; monitoring use of patient-handling devices by key nursing personnel;
  8. feedback from key nursing personnel to those nursing personnel who needed help;
  9. team approach to address patients’ and family members’ concerns about patient-handling devices; and
  10. monthly meetings to discuss and resolve problems and concerns.
Interested readers are directed to the original research article, cited below, for detailed discussions on the methods directed towards the above topics, as well as pre-and-post-intervention data collection and analysis methods.
 
Results
 
The key findings from this study include:
  • patient-handling injuries decreased by 59.8%;
  • lost workdays decreased by 86.7%;
  • modified-duty days decreased by 78.8%;
  • workers’ compensation costs decreased by 90.6%;
  • perceived stresses to low back and shoulders among nursing staff were "fairly low;"
  • the "vast majority" of patients found the devices comfortable and safe; and
  • longer transfer times with the use of devices "was not an issue."
The researchers also reported significant return on investment (ROI) results for six of the facilities (data was not available for the seventh facility). The financial data was limited in scope to only include Workers Compensation related savings. Additional direct cost savings are also likely in terms of reduced absenteeism and turn-over, for example, not to mention financially intangible improvements such as improved patient experience:
  • mean cost of equipment: $53,571 (range = $45,000 to $62,000);
  • mean savings in workers’ compensation costs associated with patient-transferring injuries: $71,822 per year;
  • mean of payback periods: 15 months (range = 5 to 31 months).
Conclusions
 
Once again, an approach that involves engineering controls (patient handling equipment) that is introduced as part of a well formulated participatory ergonomics process proves to be a substantial improvement strategy for business. As always, when a comprehensive approach to ergonomics is applied in a systematic, continuous improvement fashion, it improves the organizational financial bottom-line; improves the customer experience; and improves the employee experience, at all levels of the organization.
 
In short, ergonomics is a win-win-win business strategy, primarily when it is recognized and implemented as a systematic continuous improvement process.
 
Reference
 
Garg, Arun, and Kapellusch, Jay M., Long-Term Efficacy of an Ergonomics Program That Includes Patient-Handling, Human Factors, published online 16 March 2012, DOI: 10.1177/0018720812438614.
 
At the time of this writing, the original research article was available online to subscribers to the Journal of Human Factors at: http://hfs.sagepub.com/content/early/2012/03/15/0018720812438614.abstract

This article originally appeared in The Ergonomics Report™ on 2012-03-20.