Participatory teams solve ergonomics problems
March 1, 1998 6 minutes read
Participatory teams solve ergonomics problems
New approach effective for some departments
Using an ergonomic approach borrowed from the meat-packing industry, researchers at a large Midwestern hospital report some success in reducing musculoskeletal injury rates and lost workdays among health care workers.1
As musculoskeletal disorders persist in plaguing hospital employees, ergonomics experts continue to explore possible solutions. Under a two-year grant from the National Institute for Occupational Safety and Health (NIOSH), researchers from the Washington University School of Medicine and BarnesCare Corporate Health Services in St. Louis are the first to implement employee-management advisory teams (E-MATs) in a hospital setting. Participatory ergonomics teams had been used successfully in the meat-packing industry to identify musculoskeletal hazards and develop solutions that reduced or eliminated them.2
The approach also is similar to the "quality circles" concept used by some automobile manufacturers, says lead researcher Paula C. Bohr, PhD, OTR/C, FAOTA, director of occupational health and the ergonomics laboratory at the medical school. The main idea is to empower the work force to recognize problems and explore solutions.
"It’s more effective to get worker buy-in because then you are more likely to see follow-through in implementing solutions," Bohr notes.
Vern Putz Anderson, PhD, CPE, NIOSH’s senior advisor on ergonomics activity, says E-MATs’ continuous quality improvement (CQI) approach has contributed to their success in other industries, and can do the same in health care.
"Any success [in solving ergonomic problems] will be part of the organizational culture, and management must address this as it would any aspect of quality," he says. "The idea of the CQI concept is that anything you are really serious about, you have to build in from the beginning. It’s an ongoing process, not something that can be solved by one visit from an expert coming in to fix one problem."
Anderson says any successful employee health and safety program has four main elements: management commitment, employee involvement, a process for evaluating work sites and jobs for hazards, and a prevention and follow-up component. (For more details on NIOSH’s E-MAT recommendations, see box on p. 35.)
Still an ongoing project at Barnes Jewish Hospital, a large metropolitan medical center in St. Louis, the E-MAT approach has so far proved most successful in one of three participatory teams formed. Three teams were established among HCWs: orderlies, intensive care unit (ICU) nurses, and laboratory workers. After one year, the most effective team was that of the orderlies from the dispatch department, which employs approximately 100 workers. Team effectiveness was assessed by observations of team interactions, by team members’ perceptions of their effectiveness, and by the teams’ success in identifying problems and implementing solutions.
The orderly team was most successful by those measures, Bohr says, with results so far showing a 28% reduction in musculoskeletal injury rates and a 90% reduction in lost work days.
Groups were selected because of the diverse potential hazards that could be addressed and because of the employees’ different educational backgrounds and work activities. Orderlies were targeted due to potential back, knee, and shoulder injuries associated with lifting, moving, and transporting patients. ICU nurses were chosen due to the multiple stressors they encounter, including long work shifts, psychological stress, heavy lifting, prolonged standing, and awkward postures. Clinical lab workers reported problems with upper-extremity fatigue and strain.
ICUnurses had trouble implementing E-MATs
Prior to launching the project, upper-level administration committed to support participation of E-MAT members during their normal working hours. However, Bohr notes that the necessary team meetings presented a problem for the ICU nurses, which accounted for that group’s lack of success.
"This approach really didn’t work in the ICU. They could not have dedicated times for the members to meet due to patient responsibilities. They were constantly interrupted to tend to patient matters, which were much more critical, so they weren’t able to have even short periods of time away from their jobs to address [ergo nom ics] problems," she explains.
The lab workers’ team was established several months after the other two, and its interventions have not been evaluated yet.
"This is one feasible solution, but we have found it doesn’t apply in all cases in a hospital because of patient demands," says Bohr. "It’s not the only approach to ergonomic problems, but it is one that has been effective with the group of orderlies. We have every reason to believe we are going to see similar results with the laboratory team."
Critical factor: Management support
The success of E-MATs depends on a number of critical factors:
• management support and advocacy for allocating time for teams to meet during work shifts, for acquiring funds for equipment purchases, and for facilitating interactions with other departments as necessary to solve identified problems;
• dedicated meeting times, usually about two hours a week at first, then one or two hours every other week as the team becomes more efficient;
• beginning with problems that are easily solved or that have clear-cut solutions so team members’ morale is boosted by achievement;
• team training that emphasizes the team process and communication, instead of too much technical information (which can be provided by advisors in meetings).
"Being able to work together as a team is key to success," says Bohr. She speculates that E-MATs tend to be especially successful when composed of workers who traditionally have not been asked for input into their jobs.
"Nurses are always being surveyed and asked their opinions; they have mechanisms for providing input, but employees such as orderlies usually don’t. Allowing the opportunity to have input into the factors that are affecting their job motivates the team members and makes the team more cohesive. It fosters a sense of pride," she says.
E-MATs can be established in any size facility, unionized or not, she adds. Ideal team size is about four or five members who represent both managers and workers, as well as different job categories within a department. Some groups may need to be slightly larger, but Bohr says a group with more than seven members will face "group mechanics problems."
Initial training requires approximately eight hours and includes exercises for team-building and group work, provision of basic technical information, and opportunities to apply knowledge and reinforce group skills.
All team members receive resource manuals providing basic information about project logistics, suggestions for team process, technical information, forms and methods of documentation, and lists of facility resources.
A survey was developed to enable team members to evaluate their own effectiveness quarterly. Project advisors observed team interactions. Team effectiveness also was measured by the number of problems each team identified and the number of solutions implemented successfully.
In the successful orderlies’ E-MAT, a major problem identified was the lack of standard procedures for lifting and moving patients. The solution was development of a procedural manual that was distributed to all dispatch employees and nursing supervisors in patient care areas. Bohr notes that team members had identified the problem and outlined procedures after the E-MAT had been meeting for about five months. The time from problem identification to solution development depends on the nature of the problem and the amount of research needed.
Bohr and colleagues are expanding the E-MAT program to several other hospitals within the Washington University system, and plan to establish teams in other departments such as housekeeping and dietary services. A cost-benefit analysis will be done later this year.
While noting the concept’s limited effectiveness in departments that require immediate patient care responsibilities, as well as the inability of some hospital systems to respond to solutions that might require equipment purchases or altered work environments, the researchers maintain that E-MATs appear useful as part of a multifaceted approach to the problem of musculoskeletal injuries in health care systems.
References
1. Bohr PC, Evanoff BA, Wolf LD. Implementing participatory ergonomics teams among health care workers. Am J Ind Med 1997; 32:190-196.
2. Moore JS, Garg A. Use of participatory ergonomics teams to address musculoskeletal hazards in the red meat packing industry. Am J Ind Med 1996; 29:402-408.
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