Long-term care home sees safety culture change after participatory ergonomics study

Involving front-line staff has helped residential home find lasting and low-cost solutions to injury hazards

The health-care sector accounts for the second highest number of lost-time injuries in Ontario and, within this sector, long-term care homes are among the workplaces with the highest injury rates.

At the Newmarket, Ont.-based Southlake Residential Care Village, a long-term care facility employing 300, the 2011 stats on time loss due to injuries were startling.

It was more than the equivalent of a full-time position, says executive director Anne Deelstra. That was why the facility wanted to take part in a 2013 study by the Institute for Work & Health (IWH) and Public Services Health and Safety Association (PSHSA), aimed at preventing musculoskeletal disorders (MSDs) and slips, trips and falls.

We jumped on board immediately, says Donald Squires, environmental manager and co-chair of Southlake’s joint health and safety committee (JHSC).

The program, called Employees Participating in Change (EPIC), used a participatory ergonomics approach to identify and control hazards. The central concept of participatory ergonomics is that the knowledge and experience of those directly affected—the front-line staff—can be valuable. Front-line workers can often provide more information than a trained expert (such as an ergonomist) can when it comes to the social and organizational factors that need to be addressed alongside the physical hazards.

As part of the 12-month program, Southlake and two other participating workplaces each formed a steering committee and a change team made up of front-line workers, supervisors and managers. In the first two months of the study, team members received training about the hazards and the participatory ergonomics method. During the remaining 10 months, the team met monthly to prioritize which hazards it needed to address. The idea was to work through as many of the prioritized hazards as it could.

All the while, a research team led by IWH Associate Scientist Dr. Dwayne Van Eerd evaluated the process of implementing these changes. Using focus groups and interviews, as well as injury and lost-time data, the researchers sought to understand what factors helped or hindered implementation of participatory ergonomics at the worksites. (A paper on this study is expected to be published in the months ahead.)

JHSC members helped get buy-in

At Southlake, a staff-wide survey was conducted to determine the top hazards and to invite ideas on how to control them. The dietary department and two nursing units were seeing higher rates of injuries, so they were chosen to take part in the study.

At first it was hard for me to get buy-in from the front-line staff, says Squires. These kinds of initiatives always take time. The pace of work at Southlake, as at other long-term care homes, doesn’t offer much room for new initiatives, he explains.

But when the change team, made up of JHSC worker members, started promoting the project, it sparked a huge interest from the staff, he says. Once they saw that it was a participatory approach, they wanted in.

A key concern for front-line staff was the motivation behind the initiative, says Squires. Once they realized that we were there not to discipline them for not following safe work practices, but to get their ideas about how they could do their jobs better and safer, then we got the buy-in, he says.

The change team didn’t ask front-line workers to come to the monthly meetings to offer input, says Squires. Instead, the change team took the message out to their co-workers. They went out to the floor and talked to them, peer to peer.

For the most part, the solutions were small and low cost. For example, the team learned that nursing staff were getting hurt when transporting residents in and out of the spa area for bathing or showering. To hold the door open as they pushed wheelchairs through the doorway, workers were putting their bodies in awkward postures.

The simple fix that front-line staff came up with for that practice? Doorstops (with approval from the fire department).

Another example: as part of their routine, housekeeping and dietary staff were emptying smaller garbage bins into large containers outside. Those large containers had high openings, so staff had to lift the small bins over their shoulders, resulting in injuries in the shoulder, arm and back. A low-cost fix for that was to ask the garbage company to use containers with lower openings, so staff didn’t have to lift the garbage over their shoulders, adds Squires.

The change team also came up with some new procedures that continue to this day. When conducting health and safety inspections, for example, staff now use a job observation form to check off the safe work practices that they see, especially for jobs that are more likely to cause injuries. Unsafe practices are caught early and corrected.

The participatory approach is still used today. Asking front-line staff for input on what the hazards are and how to reduce or eliminate them remains a standing item at the monthly JHSC meetings.

It has changed the entire safety culture, says Deelstra. We are not seeing the same injuries as before. And if we do see one or two every once in a while, they are not as severe. The organization has also seen a marked drop in lost-time hours, which now amount to just a few days a year, she adds.

Since the program, I’ve noticed that staff in all departments are reporting hazards more, says Squires. Not only that, they’re reporting them as they arise, instead of waiting to report them at the monthly JHSC meetings, at which point it can sometimes be too late, he adds.

And the people who report hazards—they now watch for them to be corrected. And that’s a huge shift in the safety culture.

Source: At Work, Issue 88, Spring 2017: Institute for Work & Health, Toronto

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