A guide to developing an ergonomics program
By Guy Fragala, PhD, PE, CSP
Director, Environmental Health and Safety
University of Massachusetts Medical Center
Worcester
The focus of ergonomics is to match the environment to the people who must live, work, and function within it. From an occupational perspective, this means matching jobs and job tasks to the capabilities and limitations of workers. From the perspective of the health care patient, it means creating a safe and comfortable patient care environment.
The Occupational Safety and Health Administration (OSHA) gave hospitals an added incentive to move forward swiftly with an ergonomics program. A grandfather clause in the standard states that organizations will be deemed to be in compliance with final standard requirements if their program meets the basic requirements of the standard and they can demonstrate that the program is effective.
There are many other compelling reasons to build an effective ergonomics management program. Health care organizations continue to have among the highest rates of occupational injuries. The majority of those injuries involve musculoskeletal disorders, many of which could have been prevented with an effective ergonomics management program. In addition, by effectively redesigning high-risk job activities, you can create a more satisfying work environment for health care workers.
Patients benefit, as well, when high-risk job tasks are redesigned. Through effective application of the concepts of ergonomics, patients may feel more comfortable and more secure as they are lifted and transferred within facilities.
Many organizations are buying into the concept that the time is right to develop an ergonomics effort, but they may not know how to begin the process. Depending upon the size of the facility and the staff resources available, the sophistication of a program can vary widely.
However, this structure should be applicable in almost every health care setting.
To get the process started, it is important to establish management commitment. Senior administration should understand the benefits of such a program and be committed to moving forward. An initiation team, which might be a committee or task force, will be necessary to get the process started. Someone on the initiation team will need to champion the process. That person should have the operational responsibility of managing the ergonomics program. Someone from senior administration should be involved early on in the process to demonstrate necessary management commitments. Once this initiation team is in place, the process can begin.
Step 1: Risk identification and assessment
In the risk identification and assessment phase, an organization should develop a system to determine what it perceives to be high-risk jobs and tasks. For example, some studies have indicated that bathing tasks, toileting tasks, and transfers from beds to chairs are high-stress tasks for patient handlers.
Through job observation, questionnaires to employees, or brainstorming sessions with patient handlers, individual sites should determine the high-risk activities within their organization. The ergonomics management team may design some specific data-gathering tools, such as a survey or checklist. Keep in mind the capabilities and limitations of the organization as you design these tools.
Step 2: Risk analysis
Once high-risk areas and jobs have been identified, conduct a risk analysis to correlate actual experience with what is perceived to be a high-risk situation. Are the perceived high-risk jobs actually resulting in losses associated with occupational injuries? In order to conduct an analysis, an organization will need a well-maintained database of occupational injuries and a review of OSHA Form 200 Injury Logs. If there is not a correlation between perceived high-risk situations and actual experience, find out why. It might be that some preventive activities are effective in minimizing problems in some areas, or characteristics of the work force have an impact on a unit’s experience.
Make sure you have selected the true high-risk or high-loss areas and you have some understanding of why problems are present and why there is potential for problems. By analyzing which areas present the highest risk, you can develop a priority list for tasks or jobs that need to be addressed in prevention programs. In addition, techniques such as job-safety analysis can help you define high-risk components of certain jobs and point to optimum methods for improvement.
Step 3: Formulation of recommendations
In the health care industry, high-risk situations or job tasks might include:
• reaching and lifting with loads far from the body;
• lifting heavy loads;
• twisting while lifting;
• unexpected changes in load demand during the lift;
• reaching low or high to begin a lift;
• moving a load a significant distance.
To reduce injuries, significant changes in job design must occur. Some examples of ergonomic recommendations might include matching height adjustable stretchers with beds, which will result in slide transfers rather than lifts. The use of sliding sheets or boards may further ease these sliding transfers. Wheelchairs and other chairs can be better designed to facilitate lifting tasks, which will reduce risk factors.
Probably the most effective ergonomic intervention related to patient handling is eliminating the lift whenever possible using effectively designed patient-handling equipment. Lifting equipment has been available for a number of years in the health care industry. However, it does not appear that such equipment has been used effectively to minimize risks associated with patient handling. Such specialized equipment must be properly designed and integrated into the overall system of patient care. That is why hospitals need an effective system of implementation.
Step 4: Implementation of recommendations
Implementing recommendations involves making changes to the workplace in a well-thought out process. For example, if engineering solutions such as patient-lifting aid equipment are to be introduced, you’ll need to provide programs for educational awareness and training. The implementation team must formulate a plan, and each player on the team must understand his or her role in the plan.
The objective of this ergonomics-based injury prevention program is to redesign high-risk job tasks in manual patient transfers. This message should be delivered throughout the organization in educational awareness sessions. Through hands-on training sessions, staff must be taught new techniques to be applied in transferring patients.
To achieve success, staff must know they are part of the program development. In this implementation phase, as a part of their training, patient-care handling staff should learn to assess risk factors in their jobs. They should be encouraged to minimize the risk factors with assistance from management and the implementation team. Workers need to understand the limits of lifting and prepare for the unexpected. Remember, the goal is to engineer solutions that will modify patient-lifting tasks to reduce risk factors. It is important that everyone understands and accepts his or her role in the overall ergonomic injury management program.
When back pain does occur, case management will continue to be an important part of the overall program. Through effective medical management, lost time can be reduced and workers can return to work without lengthy disability. Systems for early intervention to detect any early worker symptoms should be set up for injury prevention. When injuries do occur, mechanisms for close follow-up to monitor workers’ progress should be developed. The objective should be to return employees to the workplace as soon as possible after an injury does occur, including accommodations and modified duty.
Step 5: Measurement and evaluation
Finally, ergonomics management should include a system to measure the impact of the program after it has been operating for a period of time. By identifying successes and failures, you can consider appropriate adjustments. Monitoring and evaluation also helps to maintain interest and attention to the program.
Monitoring requires a system for data collection, as does risk assessment. Relevant information might include injury experience, lost work days resulting from occupational injuries, costs associated with occupational injuries, attitudes of staff, how effectively new equipment is utilized, and comparisons between units.
Develop a set of predetermined indicators so the data collection is consistent. An indicator is a measurable variable, such as the number of back injuries related to patient-handling tasks. Communicate your results in a way that can be easily understood by the appropriate staff. Monitoring enables you to make continuous improvement, with a cycle of modifications and evaluation.
[More information on how to develop an ergonomics program is available in Fragala’s book, Ergonomics: How to Contain On-the-Job Injuries in Health Care ($35 plus shipping and handling), available from the Joint Commission on Accreditation of Healthcare Organizations. Telephone: (630) 792-5800.]
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