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Ergonomic solutions to back injuries are often purely technological. Change a work station, use a lifting device, and the hazard goes away. But to tackle more complex issues of work practice, involvement of frontline workers may be the key to success, according to research at the Washington University School of Medicine in St. Louis. Researchers are still compiling follow-up data, but preliminary results show sustained reductions in injury rates with employee-based advisory teams.
"No one is really as aware of the working conditions as the people who are actually doing the work," explains Bradley Evanoff, MD, assistant professor of medicine.
Washington University developed Employee-Management Advisory Teams (E-MATs) to give employees a voice in identifying risks and possible solutions. For some employees, such as housekeepers and orderlies, it was the first time anyone had formally asked their opinion and given them a chance to change their work environment.
Just focusing on those other workers represented a new direction. Ergonomics in a hospital setting often begins and ends with patient handling. "We forget about a lot of other hospital jobs — housekeeping, dietary, maintenance, security. At least in our hospital system, those are all very high injury rate positions," says Evanoff. "You think about patient care, but you forget about the fact that people are pushing big laundry and cleaning carts around the hospital and have a fairly high rate of injury."
How you set up advisory teams may be critical to their success, says Evanoff. They operate through consensus-building and rely on strong management support as well as worker buy-in. "It’s important to have representatives of both the line workers and management," he explains. "It’s important for them to be excused from work tasks during the time they’re participating."
The teams at Barnes-Jewish Hospitals were composed of two to four workers, one or two supervisors, and up to three technical support staff members. They met at least once a month and had up to two hours of work time per week to complete tasks related to E-MATs.
Before they began, team members needed some instruction on team building as well as technical information on ergonomics. Evanoff and his colleagues developed an E-MAT manual, explaining the basics of the program. (See "What do employee advisory teams do?" in this issue.)
In the most effective groups, team members alternated roles taking minutes and leading discussion or investigation of an issue. "If one of the members had a problem they identified and knew the issue, they might take it on and be the lead person," says Paula Bohr, PhD, OTR/L, assistant professor at the Washington University School of Medicine and director of the university’s Occupational Health and Ergonomics Laboratory.
The E-MATs had no trouble identifying areas of concern. A team from the intensive care unit complained about the noise level from the patient monitors. When environmental health experts came in with monitoring equipment, they discovered noise levels above recommended levels — and high enough to cause hearing damage. The team was able to lower the volume on monitors while maintaining patient safety, says Bohr.
Housekeepers addressed problems with disposal, from overfilled containers to improper handling of materials. "People were not disposing properly of the containers that had chemicals, or they were putting broken glass in containers," says Bohr. E-MATs provided input to the hospital safety committee that ultimately resulted in the hospital deciding to purchase containers that could not be punctured by glass waste. The hospital also hired a service to empty sharps disposal containers, and clearly marked all disposal instructions.
"[E-MATs] gave the frontline workers a mechanism for input in changing the way their job was done," says Bohr. "They had somebody besides an administrator to go to [and] say, We’re having trouble with this’ or This isn’t working.’"
Evanoff and Bohr are still collecting follow-up data to determine the impact of E-MATs on injury rates. They note that some hazards will require the expertise of an ergonomist. But E-MATs have created a successful new avenue for problem solving, they say. "If people are involved in designing [a solution], they’re invested in it and they’re more likely to comply with it," says Evanoff.