Implementing change in the NHS: Factors to consider
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Transcript of Implementing change in the NHS: Factors to consider
Implementing change in the NHS Factors to consider when implementing a ergonomics intervention
aimed at reducing back pain among nurses
¹ Health and Rehabilitation Research CentreAuckland University of Technology, NZ
² Robens Centre for Health ErgonomicsUniversity of Surrey, UK
Dr. Fiona Trevelyan¹ & Prof. Peter Buckle²
Extent of the problem
Bureau of Labour Statistics (2002)
1st = Truck drivers
2nd = Nursing aides, orderlies and attendants
3rd = Labourers
6th = Registered nurses
7th = Construction workers
Low back pain has been identified as a major reason why nurses leave their profession (Nelson et al, 2003)
Smedley et al (1995) found a 1-year prevalence of 45% with 10% having an absence from work for a cumulative period of greater than 4 weeks
Aim of our study
To implement and evaluate an ergonomics intervention in an health care setting
Smedley J., Trevelyan F., Inskip H., Buckle P., Cooper C., and Coggon D., (2003) Impact of an ergonomics intervention on back pain among nurses. Scand J Work Environ Health. 29 (2), 117 – 123.
Intervention process
3 main stages Definition Implementation Evaluation
Content of intervention
Policy and risk assessment Work organisation
Senior managers Change agents Manual handling link nurses
Equipment Training
Patient handling equipment
Intervention site
Baseline measurement
INTERVENTION
Re-assessment
Comparison site
Baseline measurement
No intervention
Re-assessment
Evaluation
Measurement strategy
1. Reported back pain
Self report questionnaire: low back and neck pain
2. Exposure to risk factors associated with back pain
a) Task analysis
Identify proportion of nursing shift accounted for by nursing tasks
b) Exposure to physical risk factors
Describe each nursing task with respect to time spent exposed to awkward posture (trunk flexion>20 degrees) and load
Data collection: PEO
Observed pre/post intervention at both sites:
• 16 nurses each for a full shift• Medical and orthopaedic
wards• Staff nurses and health care
assistants• Early and late shifts
Time spent on ‘intervention’ tasks
Proportion of shift Min. – Max.
Administration 14% 3 - 26% Attend patient 12% 5 - 16% Clean/tidy 7% 1 - 14% Wash/dress 6% 0 - 15% Make bed 3% 0 - 7% Patient transfers 3% -
TOTAL 45%
Examples of task identification
attend patient administration
Time spent on ‘non-intervention’ tasks
Proportion of shift Min. – max. Communication 23% 10 - 25% Fetch/carry 7% 3 - 9% Other general 11% 6 - 31% Other misc. 1% 0 - 12% Rest break 8% 2 - 11%
TOTAL 50%
Time spent on ‘other’ tasks
Proportion of shift Min. – max.
Assist to eat 0% 0 - 5% Drugs 1% 0 - 9% IV/injection 0% 0 - 5% Mealtime 1% 0 - 5% Move object 3% 1 - 6% Other basic 0% 0 - 4% Other technical 1% 0 - 3% TPR 0% 0 - 2% Wound 0% 0 - 0.3%
TOTAL 6%
Duration of ‘intervention’ tasks
Comparison Intervention
Pre (post) Pre (post)
Administration 52 (55) 58 (36)
Attend patient 38 (45) 47 (46)
Clean/tidy 68 (60) 74 (78)
Make bed 157 (260) 161 (209)
Wash/dress 415 (342) 534 (298)
Median duration (seconds)
Results: task analysis
administration’ and ‘clean/tidy’ tasks were associated with the least amount of trunk flexion > 20 degrees
‘wash/dress’ task was associated with the greatest amount of trunk flexion > 20 degrees
‘make bed’ task changed by the greatest amount at both sites
Results: patient transfers
Patient transfers were characterised by short duration high percentage time in trunk flexion > 20 degrees
Large variability due in part to:- level of patient dependency handling technique and equipment used work environment
Conclusions: exposure data
Changes in exposure were less than expected
Variability in nursing tasks made true estimates of change in exposure very difficult to interpret
Changes at comparison site were not anticipated
Conclusions
Methods must be sensitive to anticipated change Tasks where interventions are targeted may form a small
part of a shift Organisational factors can influence the intensity and
uptake of an intervention The impact of an ergonomic intervention may vary in
different parts of an organisation
Factors that influenced the intervention
Intervention took place in a ‘real life’ setting Large scale of intervention (24 wards and 1600
nurses) Problems with staff attendance to manual handling
training Work load of Health & Safety Advisers Profile of health and safety in the hospital
Recommendations If planning a similar intervention
Recommend a top-down/bottom-up approach Adopt a participatory approach Agree a strategy that ‘fits’ the organisation and is supported by key
stakeholders Target high risk work areas – depending on size of organisation Target high risk ‘intervention’ tasks Ensure change agent that leads the intervention is respected within
the organisation Empower local experts e.g. manual handling link nurses Create a sustainable structure that will survive staff turnover