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.

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