Seven evidence-based recommendations to improve the health and safety of hospital workers in 2017
By Cindy Moser
Incorporating practices and policies that help prevent injuries and disabilities among workers is essential to maintaining a healthy hospital workforce. However, knowing what practices and policies are actually going to make a difference is challenging. That’s where research from the Institute for Work & Health (IWH) can help.
As an independent, not-for-profit Canadian research organization, the Toronto-based IWH promotes the use of evidence among work-health professionals. It develops research-backed resources in two main areas: (1) workplace injury prevention and (2) recovery and return to work. Here is a quick look at recent research from the Institute—and the practical advice it gives rise to.
- Add peer coaching to patient lift programs to reduce injuries
Adding a peer-coaching component to a patient lift program can result in a large drop in injuries related to patient handling—at a small net cost to the system, an IWH study found.
This finding is based on an economic analysis of a peer-coaching program introduced in British Columbia across 15 long-term care facilities between 2006 and 2011. The facilities introduced peer coaching after finding the installation of ceiling lifts alone did not lead to their wide use. Although more than 90 per cent of the staff had been trained to use ceiling lifts, many went back to their old ways after a few months.
With the peer-coaching program, designated care aides received training both on using the lifts and on getting others interested in using the lifts. They were then given one day a week to work side by side with other care aides, encouraging them, listening to their complaints and reservations, and showing them ways to make their jobs easier and safer. The peer coaching program led to a 34 per cent reduction in injury rates during the program time period—and a 56 per cent drop after the program was over. This further reduction showed that the benefits of reduced injuries lasted even after the program ended, reflecting the new skills gained as a result of the coaching.
The total cost of the program was $894,000, and it delivered $748,000 in benefits. In other words, 84 cents was saved for every dollar spent on the program—representing a modest net cost to the system.
“The challenge is that all the costs are borne by the long-term care facilities, and the savings largely go to the insurer or workers’ compensation agency,” says Dr. Emile Tompa, labour economist and senior scientist at IWH who led the study. “As a result, the right incentives need to be set up for health-care organizations to support such a program.”
2. Coordinate management of operations and safety management to do better at both
Employers sometimes argue that focusing on occupational health and safety (OHS) compromises operational effectiveness. It’s the “trade-off” argument, which says organizations can choose to excel at operations or OHS, but not both.
However, a recent study of nearly 200 organizations in Ontario found no evidence of a trade-off. Instead, it found that organizations focusing on both operations and OHS through “joint management system” (JMS) practices achieve the same operational outcomes (i.e. better cost, quality, delivery and flexibility outcomes) as organizations that emphasize operations over safety. What’s more, they also achieve many of the same OHS outcomes (e.g. fewer lost-time claims) as organizations that emphasize safety over operations.
In essence, employers that adopt a JMS approach, which allows for the coordinated management of both operations and safety, do significantly better across the board compared to those that don’t. “The research provides empirical evidence supporting the integration of safety into operations, an idea that has been promoted by some OHS professionals based on their first-hand experience,” says Dr. Lynda Robson, one of two IWH scientists on the study research team.
3. Consider workplace-based resistance training to help prevent upper extremity MSDs
Strong evidence suggests that implementing workplace-based resistance training can help prevent and manage musculoskeletal disorders (MSDs) of the upper extremity, which includes the neck, shoulder, arm, elbow, wrist and hand. Resistance training refers to exercises that cause the muscles to contract against an external resistance (e.g. dumbbells, rubber exercise tubing, own body weight, etc.) with the expectation of increases in muscle strength, tone, mass and/or endurance.
This is the key finding of a systematic review recently conducted by IWH. The review team emphasizes that strong research evidence such as this is only part of evidence-based practice, which also incorporates the knowledge and experience of practitioners (e.g. occupational health and safety professionals) and end users (e.g. workers).
“We are not saying that workplaces should rush to implement resistance training,” says Emma Irvin, head of IWH’s systematic review program and one of the lead investigators of this project. “However, we are suggesting that OHS practitioners consider it in their arsenal of prevention practices when it comes to upper extremity MSDs.”
The review also found moderate evidence that stretching exercise programs (including yoga), workstation forearm supports and vibration feedback on computer mouse use have a positive effect on preventing and managing MSDs of the upper extremity.
4 Assess worker vulnerability to injury to help tailor prevention programs
A new evidence-based tool from IWH measures the extent to which workers may be vulnerable to increased risk of work-related injury and illness. Called the OHS Vulnerability Measure, the tool can be used to identify and address OHS program weaknesses in order to prevent injury and illness.
The 27-item questionnaire asks respondents about their exposure to workplace hazards and the presence of three types of protection: (1) workplace policies and procedures; (2) worker awareness of OHS hazards, rights and responsibilities; and (3) worker empowerment to participate in injury prevention. The tool considers workers to be vulnerable to injury and illness when they’re exposed to hazards at work and inadequate protection in at least one of the three areas.
“The underlying idea of the tool is that workers are vulnerable only if they’re exposed to hazards, but vulnerability is more than just being exposed to hazards alone,” says Dr. Peter Smith, an IWH senior scientist and the lead researcher on the team that developed the measure. “Hazards are an intrinsic part of the work in many industries and occupations. It’s when workers are exposed to hazards and also lack one of these other types of protection that they become vulnerable.”
To download the measure, go to: www.iwh.on.ca/ohs-vulnerability-measure
5 Prepare for challenges in returning employees with psychological injuries
People who file workers’ compensation claims for psychological injuries are less likely to be offered modified work and less likely to go back to work than those who file claims for musculoskeletal disorders (MSDs). This is according to an Australian-based research project that included two IWH senior scientists on its team. The study found psychological claimants:
- are less sure about returning to their previous jobs;
- are less likely to be contacted by their workplace’s return-to-work (RTW) coordinator;
- are less likely to be offered and to accept modified duties;
- face more negative reactions in response to the injury from supervisors and co-workers; and
- experience more stressful interactions with health-care providers, RTW coordinators and claims agents.
According to Dr. Smith, one of the IWH senior scientists involved in the study, the results suggest workplaces don’t really know what to do when someone has a mental health injury. This needs to be addressed, he adds, given the growing consensus that work conditions can play a role in the development and exacerbation of mental health issues. “Regardless of the system under which chronic and acute psychological injuries are compensated, we need to start thinking about whether we need different return-to-work strategies for psychological injuries,” says Smith.
6 Consider screening for depressive symptoms in first six months post work injury
Depressive symptoms are common in the first year after people have been injured at work, and the first six months appear to be particularly important to an injured worker’s future mental health, an IWH study finds.
According to the study, about half of injured workers feel many symptoms of depression at some point during the year after their injury. For most injured workers, depressive symptoms do improve over the course of the year. However, the course of depressive symptoms in the first six months seems to be an important indicator of how well injured workers will likely feel by the year’s end. In other words, levels of depressive symptoms appear to stabilize at six months.
“Our findings suggest that the first six months after a workplace injury are particularly important to an injured worker’s future mental health,” says IWH research associate Nancy Carnide, the author of the study. “This six-month period may be a window of opportunity to screen for symptoms of depression, and to provide the necessary support to those who need it, in order to prevent mental health problems in the future.”
7 Turn to existing benefits and accommodation programs to support workers with arthritis
A recent IWH study about workplace supports for people with arthritis suggests that many affected workers don’t feel they need frequent help. However, when they do need help, the study also finds that the benefits and accommodations needed—ranging from extended health benefits to flexible working hours—are often already being offered by employers. Workers who are able to access these supports often report better outcomes at work, which can mean less job disruption, greater ability to concentrate on tasks and fewer changes to work hours.
“Our study suggests that providing benefits and accommodations to workers improves work participation,” says Dr. Monique Gignac, an IWH senior scientist and lead author of the study. “It also suggests that providing such support is unlikely to drain company resources.”
There are things employers can do to help, and they’re not things that employers have to design from scratch, says Gignac. A lot of these things are policies or practices that companies are doing for other employees, especially as people age and start to have health problems. “What we’re finding is they can make a difference for people with arthritis as well,” she adds.
STAY TUNED FOR MORE PRACTICAL FINDINGS
The Institute for Work & Health has a number of projects on the go that will likely yield research findings of practical benefit to hospital workplaces. For example, IWH researchers are studying the implementation of workplace violence legislation in Ontario’s acute health-care sector, the incidence of work-related aggression and violence in Canada, and the role of health-care providers in the workers’ compensation system and return-to-work process, among others. To ensure you learn of these findings as soon as they become available, you can sign up for the Institute’s monthly e-alert, IWH News: www.iwh.on.ca/e-alerts
Cindy Moser is a Communications Manager at The Institute for Work & Health.