Reducing client-handling musculoskeletal disorders


Providence Healthcare is a leading Toronto health care facility that offers rehabilitation, palliative care, outpatient clinics and services, caregiver support and long-term care. Providence is the perfect example of an organization taking steps to make their workplace safer for employees while enhancing quality care for its patients, residents and clients. Most remarkable, perhaps, is that it has embarked on a committed journey to radically change the way it looks at health and safety with a project budget of $0.

Suzanne MacDougal, Manager, Occupational Health and Wellness Department and Lila You, Staff Physiotherapy, Rehabilitation & Education noticed that the majority of employee injuries, perhaps as much as 95 per cent, were related to client handling, in particular, patient lifts, transfers and repositioning. As well, due to the nature of the work and a more mature workforce with health care challenges of its own, the organization was facing high injury rates. Determined to take control of a less than optimal situation, MacDougal and You turned to the Public Services Health & Safety Association (PSHSA) for guidance.

Patti Boucher, Vice President of Prevention Services at PSHSA, is not new to the challenges facing Providence. “Musculoskeletal Disorders (MSDs) account of almost 50 per cent of lost time injuries in the health care and community care sector,” she says. “The rates of MSD related to client handling have started to decrease slightly over the last three years, but at 21 per cent of the total injuries in healthcare, preventing these types of injuries must remain a focus in our sector.”

MacDougal and You were informed of a joint PSHSA and Canadian Back Institute program by their PSHSA consultant. Inspired by a one-day Train the Trainer course based on the PSHSA Handle with Care Program, You returned invigourated and began planning a brand new e-learning education program for staff. Since Providence operates around the clock, it made sense to conduct online training so all staff would have access to consistent training to suit their schedules. After ten months of planning, using nothing but in-house resources and input from a safe client handling committee of a variety of healthcare professionals, You was able to develop all of the content.

Parceled into four modules, each module tackles the subject matter in a logical sequence:
Module 1: Background and Legislation of safe client handling
Module 2: Client Assessment –a key component of safe client handling
Module 3: Scenarios – video clips showing the correct way to perform client handling actions
Module 4: Mechanical Lifts – safe principles and “code green”

Each module takes about 30 minutes to complete and is mandatory for any staff handling clients as well as staff who may be exposed to patients, residents and clients requiring assistance (e.g. social workers).  “We want to provide a best practices approach and assure the safety of all our staff and go above and beyond the minimum requirements,” says MacDougal.

Getting buy-in

To date, only the first module has been released and it’s too early to tell what the success might be. “We know e-learning isn’t perfect. Some staff members aren’t comfortable working on a computer so we developed supplemental face-to-face training and demonstrations to help them through it,” says You. Henrietta Van hulle, Director and Healthcare Lead at PSHSA agrees. “While e-learning is a great tool for transferring knowledge, some safety training also requires a hands-on component that allows employees to practice and demonstrate technique.”

“Senior management commitment is the first step in implementing any successful program,” says Van hulle.  MacDougal adds, “By talking about the program all the time, we’ve made it part of our culture here. We also make sure it’s a part of our mini training session as well as our orientation for new staff. We have presented it at leadership forums to generate awareness amongst the managers, as well as a sense of responsibility. This has led to senior management support within the organization. ”

Within a short time frame, but with a lot of effort and commitment, Providence Healthcare continues to improve its culture of safety through innovation. As the other three modules roll out over the next year, Providence will be examining the effect it has on staff actions and how this program affects the number of client handling injuries.

The PSHSA Handle with Care program provides all the pieces required for a comprehensive client handling program. This includes client assessment tools, sample procedures for client handling and decision trees to assist staff in deciding if a particular transfer is appropriate or if a mechanical lift is required. PSHSA also offers supporting materials such as free fact sheets related to client handling and musculoskeletal disorder prevention and “CARE” posters designed to remind care givers to assess the client before each lift, transfer or reposition. More information on this and all PSHSA products, training and services can be found at