How to build a case for ergonomic intervention
April 1, 2002
How to build a case for ergonomic intervention
Aging work force, cost data justify program
It was a compelling case for ergonomic intervention: Four nurses had suffered serious back injuries due to patient handling. Multiple surgeries could cost the hospital as much as $500,000 for each case, and the nurses might never return to full duty. Meanwhile, the risk of future serious injuries was growing with the aging of the hospital’s nursing staff. Some 53% of the hospital’s nurses are over 40.
JoAnn Shea, MSN, ARNP, director of employee health and wellness at Tampa (FL) General Hospital, carefully gathered the facts on past and projected costs to build an argument for new lift equipment and lift teams. Her efforts paid off. This year, the hospital is launching a new ergonomics program it hopes will dramatically reduce patient handling injuries and workers’ compensation costs.
Cost and injury data provide the key to gaining support for ergonomic improvements, Shea says. "You can’t just go to senior management and say, This is what I want.’ You have to tell how many injuries you’re having, what it’s costing them. We have very specific statistics. Back [injury] is our highest cost; patient handling is our highest injury. We showed that over five years, it’s not getting better. In fact, it’s getting worse."
Tampa General administrators agreed to spend $165,000 a year for a six-person lift team, which will cover shifts from 7 a.m. to 8:30 p.m., seven days a week. The hospital began installation of 190 ceiling tracks for portable lifts and purchased a variety of devices, including transfer sheets, floor lifts, chairs that convert into stretchers, and beds that fold into chairs. Each unit will also have a "superuser," a nurse who received special training to guide others in the use of the equipment.
"It’s a big program, but it’s well worth it," Shea says. "We didn’t know what else to do. How [else] can we prevent injuries in our staff?"
Creating a lift team was a critical part of Shea’s request to hospital management. She had contacted other hospitals and discovered that without the support of staff dedicated to safe lifting, time-pressured nurses would revert to their old, unsafe methods. "You can buy all the equipment in the world, but they get stuck in a room, and no one takes them out. If you don’t train the staff and have resources for them, you’re not going to have any impact," she says.
In a time of competing demands for shrinking revenues, a new expenditure of more than $300,000 in personnel and equipment may sound like an unlikely request. Shea took a methodical approach to justifying the need and the potential benefit of the Injury Prevention Program.
Shea’s best asset was Manon Labreche, RPT, CEAS, a physical therapist whom she had hired as an injury prevention coordinator.
"A lot of people call us and ask, How did you get that position?’" Shea says. "I presented five years in a row. I went to the safety committee. I went to senior management. Before I hired Manon, I created a back injury task force. I tried to use [in-house] resources, but no one had the time. I finally said it’s not working. If we don’t do anything, I’m going to keep coming back year after year, and our costs are going to keep going up."
Aside from helping the staff use the existing ergonomic equipment more effectively, Labreche began gathering information and statistics.
Shea spoke with and eventually hired lift team expert William Charney, a consultant based in Bellingham, WA.
"I went to every single department more than once and met with managers to get an understanding of what they do and what their high-risk activities were," Labreche says. "I conducted a comprehensive assessment of each department to look at what percentage of passive patients they have and what their injury rates were."
Labreche brought in dozens of pieces of equipment to use on a trial basis as she and Shea considered what type of ergonomic intervention would help reduce injuries. She immediately saw that equipment alone wasn’t going to be enough.
"I would show [the staff] the piece of equipment and inservice them as much as possible," Labreche says. "But when it actually came down to using the equipment, they didn’t take the time to go to the end of the hallway to get the floor lift. If it’s going to take them 10 minutes to move things out of the way, they’re not going to use it."
Ceiling lifts take up less room and could be more accessible, Labreche concluded. But even then, staff could benefit from lifting help.
Over the past few years, lift teams have incurred some criticism. How much injury risk will those lift team members encounter? What if the lift team isn’t available? Is the extra expense worth it?
Shea considered all those questions and interviewed colleagues at hospitals that had used lift teams. She concluded that the lift team members must use adequate equipment, and acknowledged that their assistance wouldn’t be available at every shift. She decided to focus resources on the times of day when most lifts occur.
The two-person teams work 10-hour shifts and receive pay comparable to a patient care tech. They will carry beepers and will have a response time goal of five to eight minutes. They will work throughout the hospital.
"It’s stated [in the hospital’s new ergonomics policy] that the staff will page the lift team for certain types of patients," Labreche says. "Eventually our whole goal is to become a no-lift hospital."
Waiting for a lift team and using new equipment when the team isn’t available will require a change in habit and mindset for the staff, she acknowledges. Labreche will be providing support and hopes the "superusers" and nurse managers will reinforce the program.
"Our hope is that we make it such a positive experience that the nurses won’t let them take the lift teams away in future budget crunches," Shea says. In fact, the ergonomics program may have other benefits in recruitment and retention of nurses. "Nurses say, I’m telling my friends to come over here if we have a lift team. Lifting patients just adds another burden to their workday," she adds.
While numerous studies show that ergonomic interventions reduce injuries, making the case at an individual hospital still requires time and planning. "When you start this project, you have to have the expectation that it’s going to take a year or two to get some good programs implemented," Shea advises.
She began by visiting the risk management and safety committees and talking to nurse managers and nursing directors. "We got all of them behind us. Then we went to senior management," she says. "You have to spend the time putting together a meaningful but short presentation. You never get more than 20 minutes."
Shea is looking forward to the day when she can present data on reductions in injuries and costs due to the program. "When you present it, you don’t have the hard dollar savings. You just have the studies that show what you can save [with equipment and lift teams]," she says. "It’s not until we take the savings from the bottom line that they’ll be believers."
Even with a compelling and clear case for ergonomics, Shea says her administrators took a leap of faith that their expenditures would produce a cost savings.
"I have to commend my administration for being so innovative and supportive," she says.
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