A Rochester, NH hospital was among the first to implement a healthy workplace program based on the toolkit provided online by the Center for Promotion of Health in the New England Workforce, which is part of the University of Massachusetts Lowell and the University of Connecticut.
The toolkit provides seven steps, as follows:
Step 1: Identify problems and contributing factors. The healthy worksite toolkit recommends sites consider all possibilities and then focus on a single health and safety problem.
“We identified that patient handling injuries were a problem for one unit, so I took that information to our ergonomics team, which they call the design team,” says Janice Parker, MSN, APRN, FNP-B, employee health nurse practitioner/manager at Frisbie Memorial Hospital in Rochester, NH.
The ergonomics/design team looked at contributing factors, using the tool’s worksheet. Immediately, they could see that they didn’t feel like they had enough information, even with information from the injury reports.
The Frisbie Hospital team asked for more information, related to these questions:
Did employees get enough sleep?
Do they take their work breaks?
Do they work shifts back to back, or do they have time between shifts?
“We brainstormed and designed a survey, sent it to the unit, brought data back, collated data, and we got a lot of good information that we would not have known if we had not asked,” Parker explains.
From the survey and from having a member of their team who had first-hand knowledge of the unit, the team learned that the unit did not schedule breaks regularly for staff. Also, sometimes the unit would have a full shift of work when a large number of post-operation patients were sent there. There were no additional employees to handle the increased workload, Parker says.
“This was a very, very helpful process, and the people on the safety committee were very excited about it,” she adds.
Step 2: Develop intervention objectives and activities. Site facilitators should ask the team to focus on objectives that are realistic, measurable, and achievable, according to the toolkit.
“We brainstormed, looking at all data and came up with several possible solutions,” Parker says.
One of these was to reduce hazards associated with patient handling and moving. This was an equipment solution and related to storage and staff knowledge of how to handle equipment.
Another idea was to address workflow and staffing issues, including staff orientation. The unit would use a resource team or float team that was designed to be called anywhere in the hospital when needed.
“One thing we found was the employees who worked on the unit knew their workflow and equipment, while the resource team was slower to find things and understand what the workflow was,” Parker says.
This suggested that resource staff would benefit from equipment orientation training.
“We wanted to encourage healthy habits in employees,” Parker says. “We found many employees didn’t get adequate sleep, and we found that some of this had to do with inconsistent scheduling, which [affects] healthy sleep patterns.”
There were only two 12-hour shifts on the unit, so if someone assigned to one shift had to suddenly work a different shift, this would significantly impact their sleep-wake schedule.
Also, the team suggested using a block scheduling model instead of alternating days off, Parker says.
“We suggested they stop working more than 12 hours out of 24,” she says. “All of these factors added together can cause people to have disrupted sleep patterns.”
A stumbling block for employee health
Step 3: Set selection criteria. A worksite’s design team should prioritize interventions according to those that benefit a larger number of people, but also consider how one solution might be of benefit to different areas, the toolkit notes.
This step was a stumbling block for employee health, Parker notes.
“We had trouble,” she says. “We followed the form, but when it came time to use it we felt maybe we had not understood it.”
For step 3, the organization outlines the scope and impact, benefits and effectiveness, resources and cost, obstacles and barriers, of the wellness project. “You select criteria to later use to evaluate your intervention,” Parker says.
“Under the question about who the program would reach and benefit, we felt it would reach all staff and patients and benefit all of them,” she adds.
The team chose to define short-term as a year. They reasoned it would take at least a year to see any effect. This partly is because the injuries — even on the selected unit — were low. “We really have a good safety program, and we have a good handle on what’s going on,” Parker says.
Resources and costs also served as criteria. The team determined the cost of buying equipment, providing education and training and adding more staff to the unit.
“This encourages you to think outside the box, so we suggested providing fitness equipment for the staff to use when they are working 12 hour shifts and don’t have a lot of time to exercise,” Parker says. “Under obstacles and barriers, we found that money was a huge obstacle.”
Another barrier was determining how to educate off-shift staff.
Step 4: Apply selection criteria. Selection criteria may include key performance indicators set by the group. These are used to measure the effectiveness of activities and overall success of the intervention alternatives.
“We selected criteria for the activities and created three intervention alternatives,” Parker explains.
They got into nuts and bolts details about reducing hazards, including purchasing new patient lifts for one unit.
Adding more ceiling lifts
“One solution was to increase the number of ceiling lifts,” Parker says. “The portable lifts are wonderful, but having staff get them and get storage for them is a challenge.”
The portable lifts also needed to be stored in a way that would make it easier for staff to select and use the correct one.
“We also needed to improve equipment storage and organization,” Parker says.
Assessment of impact
Step 5: Rate interventions and select intervention alternatives. The toolkit recommends rating interventions according to a high (H) rating for those that meet or exceed what is stated in the selection criteria; a medium (M) rating for those that only partly accomplish the goals, and a low (L) rating for those activities that fail to accomplish or barely accomplish what’s stated in the selection criteria.
As a safety team thinks about the issues and rates the effort, the team should consider how much impact the activities will have and all of the anticipated benefits, Parker says.
“Rate the resources and rate the anticipated obstacles for each one,” she adds.
For instance, an activity involving hazards and equipment might already have processes and precautions in place. A solution involving workflow and staffing would require action on the part of management, she says.
“Promoting healthy habits is the easiest to implement, but the hardest to actually achieve end results,” Parker says. “Our ergonomics team wanted to go with the focus being on workflow and staffing.”
Step 6: Plan and implement interventions. The toolkit recommends that the site facilitator think in terms of changes to specific work units versus changes to the entire organization because a one-size fits all approach could be risky.
“The healthy workplace program online suggested different tools for tracking this step,” Parker says. “We developed a timeline and strategies, looking at who would implement the change, when, and how.”
Step 7: Monitor and evaluate interventions. The last step, which Frisbie Hospital had not yet reached at press time, involves measuring results and evaluating the program’s success, Parker says. “This program has helped us organize and plan approaches,” she says. “We’ve gotten much more input from all levels of the hospital: the front line, management, finance.”
This has helped the hospital create a wellness program that is more productive, while bringing all stakeholders into the conversation.