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?
At the risk of sounding sarcastic, this
would require management to think outside
the box and to take the initiative, but isn’t this
management’s job? This author, as have many
who are reading this article right now, has
dealt with companies, especially small companies,
that have been put out of business by
high worker’s compensation rates. The cost / benefit
analysis of this proposal must be
weighed by each company based upon organizational
circumstances in order to determine
the feasibility. However, when both traditional
management methods of trying to
increase productivity without determining
whether the environment to increase productivity
is possible and of engineering and
education fail to produce the desired results,
other methods, such as those described
above, must be explored.
Workforce Issues
After these two non-traditional measures of
reviewing production requirements and intervening
in employee health issues have
been implemented, then traditional safety measures can be explored. One of the most
common is engineering, or the use of lifting
devices, to aid the worker in picking up or
moving the patient so the task is not done
manually. This article will not go into the devices
available. These devices and the importance
of their proper use are well known
in the health industry and, as traditional
safety, have been written of extensively. It is
safe to say that, after a JHA (Job Hazard
Analysis) has been performed, someone
somewhere has built a device to deal with
such a problem.
Again, do not forget to review outside
variables that will affect the success of the
lifting devices. Are production requirements
so heavy that the staff will not take
the time to use the devices because the time
would reduce production? Are the devices
on the other side of the building where
workers will not take the time to go and get
them? Are the devices kept locked up or in
a maintenance closet inaccessible to the
workers? If the devices are there, they
should make a difference. Remove barriers
prior to their introduction and find out
what you missed by talking with the workers
after the devices are in place.
Apart from the engineering aspect of preventing
lifting injuries, education of the
workforce is another staple of traditional
safety. Too often, back injury training is limited
to “Keep your back straight, now lift with
your knees,” and not much more. If a lifting
injury education program is not producing
the desired results or failing altogether, it is
probably because of “what” is being taught or
“how” it is being taught.
The “what” of what is being taught can
be reviewed through a review of the losses,
information readily available through
OSHA records and insurance company loss
runs. Does the training being provided
match up with the types of losses the firm is
experiencing? Is training provided on the
lifting devices?
“How” the training is occurring is another
subject far beyond the scope of this article.
A big part of training involves knowing how
to train. Malcolm Knowles, whom some consider
the father of adult education, wrote
hundreds of articles and books (American
Society for Training and Development, 1998).
Knowles coined the term “andragogy.” Andragogy,
as opposed to pedagogy, is how adults
learn versus how children learn. Knowles emphasized
key points of how adults learn that
are often violated. For example, unlike children,
adults want to know why they are learning
something. Adults want to know how
what is being learned can be put to immediate
use in their busy lives, as opposed to children,
who learn to prepare for when they
“grow up.” Adults expect to have input on
their learning, as opposed to being spoon-fed
like children. Adults learn best when they can
relate what they are learning through their life
experiences. Finally, they expect to be able to
use their expertise in their learning (Knowles,
1950; Adams, 2000).
Unfortunately, training too often involves
lecturing adults in a classroom setting like
children on a subject that can be rather boring,
or having the group watch a training
video. Anyone who has trained knows these
methods are not very effective and produce
more yawns than learning. The bottom line is
that poor training produces poor results,
while good training—absent another intervening
factor, such as having too high production
requirements—produces good results.
Identifying and ensuring the quality of
all inputs is vital to assuring the quality of the
back injury program.
Finally, the issue of employee discipline
must be considered. If lifting devices are
provided and are not being used, the question
is why, because lifting devices are very
expensive items and management has a vested
interest in the investment. Workers have
a vested interest in not getting hurt on the
job. Why are lifting devices not being used?
This is a question of employee discipline, but
it must not be addressed in an adversarial
fashion. If an employee is ignoring safety
rules and being unsafe, the issue is discipline.
However, if employees are not using the lifting
devices because they are not trained in
how to use them, or because there is one device
per too many employees, or because
production requirements are so high that
they do not have time, then it is management’s
problem, not the employees’.
Looking at All Variables
In addition to the listed variables, certainly
readers will think of other variables in their
systems that will affect the quality of the back
safety program. It is this type of active and innovative
system that can produce excellent results,
not heavy reliance on a canned “Stopping
Lifting Injuries” checklist.
An excellent example of this is OSF
Saint Francis Medical Center. According to
Smith (2007):
“OSF Saint Francis Medical Center in
Peoria, Ill., has substantially reduced lift injuries
while boosting staff satisfaction with
the creation of a new lift team department
that provides patient transfer and mobility
assistance. Details of the program are available
in a white paper titled ‘Illinois Hospital
Reduces Lift Injuries, Staff Satisfaction Soars
with Lift Team Department and Liko Lifts.’”
Nurses are highly skilled, well paid, and
in short supply. The field is predominately
female and, like the rest of the workforce, is
aging. Why not bring in a “lift team” complete
with individuals well trained in safe
lifting, with the proper equipment, and who
might be more physically able to lift than the
nurse? This lets the highly trained medical
professional do his or her job of patient care
and lets the more manual task of lifting be
delegated to others. This is an excellent example
of an organization thinking outside
the box and achieving noteworthy results.
In conclusion, the ideas presented in this
article are not conclusive. It is this author’s
genuine hope that others will take these ideas
and build upon them with new ideas. Simply
relying on the old safety standbys of influencing
just the engineering and the training
aspect of lifting understandably produces
mediocre results because it ignores the other
variables, such as production requirements,
staffing, and discipline that make traditional
patient lifting techniques impotent.
Management must look at the lifting task
from a number of different vantage points,
looking at all variables, if we ever hope to
prevent patient lifting injuries in health care
environments.
This article originally appeared in the July 2008 issue of Occupational Health & Safety.