Why ergonomics should belong to employees
'Participatory' ergo creates instant buy-in
The problem is a common one: Patient handling leads to back strain and pain and even to serious injury. The solution is less obvious: Empower health care workers to analyze the tasks and come up with their own corrective plan.
"Participatory ergonomics" is emerging as a more effective way to control the greatest hazard in hospitals. Employees often nurses or nursing aides redesign tasks and identify equipment needs to reduce patient handling injuries. With their involvement, they become stakeholders, making it more likely they will follow the new protocols they develop and use the new devices, says Robert Henning, PhD, CHFP, associate professor at the University of Connecticut in Storrs.
"It's not just a suggestion box, asking employees for a one time input," says Henning, who has evaluated participatory ergonomics programs. "Small design teams meet on a regular basis to identify problems, develop possible solutions using ergonomics, test the solutions and refine them a continuous improvement process."
It is notoriously difficult to change workers' behavior even when the changes are occurring for their benefit. The participatory approach is one way to break down some of the barriers to change, says Barbara Silverstein, RN, PhD, MPH, MSN, CPE, research director of the Safety & Health Assessment and Research for Prevention (SHARP) program at the Washington State Department of Labor & Industries.
In fact, the employees are not only likely to have insight into workable solutions, they can shed light on the hazards, she says. "If you don't have the end-user, the people who are most affected, often you come up with very superficial solutions without understanding why those hazards are there in the first place," she says.
Creating an employee-led program is time-consuming and logistically challenging but it is worth the effort, says Silverstein.
The task force should be small and focused, allowing employees to target the needs of a specific unit, she says. But it also needs management representation, she says." You have to have some people with the authority to make the decision about change," she says.
Employees will first need education about ergonomics and the development of musculoskeletal disorders including the impact of cumulative trauma. "You can't expect people to fully participate without having some basic grounding in what the issues or principles are," says Silverstein. "Training is critical to effective participation."
Of course, you also have to arrange for meetings on a regular basis a logistical challenge for frontline workers who find it difficult to leave their posts. When Renee Fekieta, PhD, data analyst specialist with the Department of Quality Improvement Support Services at Yale-New Haven Hospital, organized a participatory ergonomics program at a 204-bed hospital in Connecticut, she realized that scheduling regular meetings would be difficult.
Small teams in each department met weekly for three months to discuss the needs and risk analysis. Often, that involved a nurse, an aide, and an assistant nurse manager with a program facilitator. They would provide feedback to a larger, multidisciplinary patient handling task force and ultimately help create forms and algorithms and select equipment.
For example, the frontline workers thought through the laundering of slip sheets and slings. They talked about the space and layout on the floor and proposed where equipment could be stored. They drafted their own meeting schedules and agendas.
"There should be some real control there [in the meetings]. It's not just a feel-good thing," says Henning, who oversaw the participatory ergonomics project. "Successful ergonomics programs include ergonomics training and some team-building."
If it's difficult for employees to take time off for meetings, an innovative approach might work, suggests Silverstein. With "walk-around" meetings, some committee members visit frontline workers on their units to share ideas and get feedback, she says.
"They can get information from their coworkers and they can meet informally with other peer champions," she says. "[You can] figure out how to make it possible without restricting it to a particular meeting time and place every month."
Within a year, Fekieta was able to measure success for the participatory ergonomics program: a 25% reduction in the lost-time injury rate for a workers' compensation savings of $74,000. In a survey, staff reported that they felt employee involvement had increased, as had management support of their involvement. They also perceived that their risk of injury from patient lifting had decreased, she says.
Fekieta conducted observations and staff interviews and found that employees were more likely to use the equipment.
Participatory ergonomics requires support from every constituency: senior management, nurse managers, and workers. "From the start, it's important to have the commitment from senior administration and senior management," says Fekieta. "They made sure this safe patient handling program was visible. It was marketed a program that was for health care workers. Usually what they see are programs that are for patient safety. This was truly for employees."
A strong facilitator and constant communication also boosted the program, she says. Minutes of the safe patient handling meetings were posted in each unit, and reference information was available in binders.
Most importantly, employees received feedback so they knew how their input made a difference. "That really is critical to the success of the program," says Fekieta.
The problem is a common one: Patient handling leads to back strain and pain and even to serious injury. The solution is less obvious: Empower health care workers to analyze the tasks and come up with their own corrective plan.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content