Follow the numbers for ergo success

Hospital tallies risk, cost, return

Ergonomics involves an equation: Too much force on the body equals pain and injury.

So when Jessie King, RN, COHN-S, director of staff health services at Exeter (NH) Hospital, wanted to reduce musculoskeletal injuries, she took a step-by-step approach that relied on the numbers.

With the help of an ergonomist and the support of her administration, she analyzed about 200 jobs over a two-year period. For example, the ergonomist determined how many pounds of force it takes to reposition a 150-pound patient, or how much force it takes to move a 150-pound patient from the bed to a stretcher. The analyses were job- and unit-specific.

"When I first got hired, one of the things I discovered was that we were hiring people who were physically not capable of doing the job," she says.

The job function tests became a part of pre-placement exams. "We came up with testing stations that replicated the essential functions of the job and were able to measure the ability of the person to do those," she says.

But analyzing the force involved in job tasks was just one part of the equation. King also took a close look at the hospital's musculoskeletal disorder-related injuries. Patient transfers, such as from bed to chair, and repositioning were causing most of the injuries. The 100-bed hospital did not have friction-reducing devices and had inadequate lift equipment, says King.

"The bottom line is that you cannot do these tasks safely without an assistive lifting device. You're at risk no matter what you do," she says.

King again took a methodical approach. She wanted to identify the risks, assess the equipment, and measure the improvement. She gave employees a questionnaire to find out what they considered to be their most risky activities.

Getting staff involved from the beginning, with the risk assessment, is key to a successful ergonomics program, says Guy Fragala, PhD, PE, CSP, director of compliance programs for Environmental Health and Engineering in Newton, MA, who consulted with Exeter Hospital using the HELP program.

Fragala sets up interactive sessions with frontline staff to give them an opportunity to identify their greatest concerns. He also walks through the high-risk units with staff to find out what they consider to be the highest priorities. He compares their top five list with activities identified as causing the most costly injuries in workers' compensation claims.

"We're redesigning high-risk activities. We need the team to buy in to the improvements," he explains.

At Exeter, King discovered issues that contributed to the risk, such as twisting while lifting, unexpected changes in load during a lift, and reaching high or low. Some changes could be made by moving furniture or adjusting equipment. But the hospital still needed lift equipment.

King focused on the medical-surgical unit and intensive care. She issued invitations to RNs, LPNs, and LNAs on every shift to come to a vendor fair. In return for filling out an evaluation form on equipment, they received raffle tickets for prizes.

Fragala helps hospitals estimate their savings from reducing injuries — their return on investment. "We consider a conservative reduction of 50% of patient handling injuries. We think that's conservative," he says.

King took an even more conservative approach. "We want to decrease the rate of injuries by 20%, and we want to decrease the costs by 10%," she says. The hospital is still purchasing equipment and implementing the program, so outcome figures are not yet available.

But she anticipates benefits that go beyond dollars. "We want to increase the morale of our staff," she says.

Injuries have a ripple effect on the work force. "People were disgruntled because of lost wages when they had an injury. It created a lot of stress and low morale," she says. "Peers became angry and frustrated because they felt forced to work shorthanded. Managers were scrambling to find the manpower needed to care for patients.

"When an employee is injured at work, everybody loses. That was the bottom line."

Meanwhile, King continues to analyze injuries. She has discovered some perplexing patterns.

"You would suspect it was the older employee who's getting injured, but it really isn't," she says. "In our analysis of our information, the average person who is getting injured is someone between 21 and 35. Our highest rate is between 21 to 25, second highest rate 26 to 35."

Young people who have worked for the hospital for less than five years are the most likely to sustain an injury, she says.

"We're going to be following this a little closer and come up with a theory as to why this is happening. We're not sure," she says.

She also shares information with employees and middle managers. The managers need to understand the costliness of injuries — even if the cost doesn't come directly out of their departmental budgets, says King.

"We invited them to be part of this whole process," she says. "It took a little convincing, but they did come on board in full force."