A Sound Approach to Safe Lifting
Interdisciplinary management systems can reduce lifting injuries in health care settings.
It has long been recognized that back injuries account
for a disproportionate share of worker’s
compensation dollars paid in permanent disability,
in questionable worker’s compensation
claims, and in litigated cases. OSHA has not developed
specific standards, in large part because individual susceptibility
factors (age, physical health, pre-existing
conditions, etc.) makes a one-size-fits-all standard impossible.
Societal factors—the aging workforce, the
problems with American obesity, Americans who are
out of shape, stress, and similar factors that are often
seen as being outside the organization’s span of control—
aggravate the problem of lifting injuries.
Still, the problem of preventing lifting injuries remains
in industry as a whole, and particularly in the
health care industry, which relies heavily on lifting and
bending in order to serve patients as they need to be
served. Unlike in manufacturing, patients cannot be put
on a well-designed and ergonomically correct conveyor
belt. Fortunately, through the use of an interdisciplinary
management system, one that looks at all variables and
ensures the quality of the variables affecting lifting injuries,
these injuries can be controlled, with claims greatly
reduced and often eliminated.
In the past, hospitals and nursing homes have used
the traditional safety measures of engineering and education
with some success in controlling back injuries and
related lifting injuries attributable to the handling of patients.
Unfortunately, these effective countermeasures,
which will be discussed later, can be expected to produce
only so much in terms of results. Simply put, if there are
10 variables affecting the quality of the back safety program
and only two of those variables, engineering and
education, are addressed, less-than-ideal results should
be expected. All variables affecting the back safety program
must be identified and quality-assured for quality
results. For example, prior to implementing the old safety
favorites of engineering and education, management
variables should be evaluated.
The Impact of Production Requirements
The first management prerequisite to review is production
requirements. Fortunately, outside factors,
such as the Joint Commission, medical liability, and the
shortage of nurses, limit production (quantity) and
force a certain level of quality. The quantity versus
quality balance is a concern in all industries and a regular
balancing act of management. In health care, often
a certain level of quality of care is required by outside
forces. Unfortunately, in some areas of health care—
such as in nursing homes in lightly regulated areas,
home health care, or paraprofessionals in certain health
care settings—the quality and type of work required
will result in an injury.
A paraprofessional home health care aide would be
a good example in that he/she would be required to do
certain types of lifts that puts him or her at risk for injury.
This passage is specifically vague so the appropriate
managers in the very diverse areas of health care can get input from the workforce and ask themselves
if the very nature of the work, either
in the quantity or type required (quality),
will result in lifting injuries. In the same way
that driving one mile per hour over the
speed limit will not increase the risk of an
auto accident but driving 30 mph over will
send the frequency of losses disproportionately
higher, the speed some workers are
being asked to work will result in lifting injuries—
end of story. In the same way, driving
the speed limit in good conditions
might be acceptable from a risk standpoint
but driving the speed limit on ice will put
you into a ditch.
Are the tasks the worker is being asked to
do an invitation to injury? It is a managerial
balancing act between production, which results
in profit, and safety. However, don’t ask
your health care workers to drive 80 mph on
ice and then be surprised when lifting injuries
occur. This is a delicate balancing act
that no OSHA standard, lifting table, or lift
aid will help with.
Another prerequisite to traditional countermeasures
has to do with the workforce. To
put it bluntly, Americans are too overweight
and out of shape, and, as a workforce, are
rapidly aging. This is another area that can
have a devastating effect on lifting injuries
and one that too many managers surrender
to fate. For solutions, one must leave the traditional
safety field and go to the discipline
of employee health and human resources.
Employers and insurers have been “encouraging”
good health by building gym memberships
and raising health insurance rates
on smokers. Now, this is spreading to raising
health insurance rates on those who are
overweight, those with high cholesterol, and
those with high blood pressure (Associated
Press, 2007). Can building in innovative employee
health ideas such as these help improve
the health of your workforce and thus
lower your frequency of lifting injuries? Can
smaller businesses work with their insurers—
insurers who are desperate to keep
claims low—to pool resources and take advantage
of their insurers’ programs to promote
good workplace health?
This article originally appeared in the July 2008 issue of Occupational Health & Safety.