Making healthcare a healthier place to work

The old adage, "physician heal thyself," could be amended in British Columbia to "health care worker heal thyself."

Finding a remedy for healthcare workers' high rate of injury and rising cost of claims are the tasks of a new program, the Occupational Health and Safety Agency for Healthcare (OHSAH) being developed with the guidance of the Health Evidence Application and Linkage Network (HEALNet).

"BC has an abysmal record in terms of healthcare worker rate of injury," says Gary Moser, president of the Healthcare Employers' Agency of British Columbia and a board member of OHSAH.

The statistics are discouraging.

Every 90 minutes, 24 hours a day a healthcare worker is injured on the job in BC. In 1995, injured healthcare workers lost 278,444 days of work -- the highest number of days lost of any industry class in BC. The healthcare industry is responsible for more days lost per claim and a higher injury rate than the provincial average for all BC industries combined, and the duration of time loss is increasing.

Geoff Walsh, Board Chair of OHSAH says frustration over the high rate of injury and rising cost of claims - amounting to $127 million in 1995 - led healthcare management and union representatives to conceive OHSAH in early 1998.

Incorporated on July 5, 1999, the Board of Directors of OHSAH consists of top representatives from both union and employer organizations.

For leadership and expertise, OHSAH recruited Dr. Annalee Yassi, the director of Occupational and Environmental Medicine at Winnipeg's Health Sciences Centre and a principal investigator within HEALNet.

"The mission of HEALNet is to develop guidelines and programs to enable decision makers to promote a healthier work place on the basis of scientific research," Dr. Yassi says.

HEALNet awarded Dr. Yassi $270,000 in July 1999 to help develop an evidence-based approach to preventing injury and disability among healthcare workers. "OHSAH and HEALNet are mutually beneficial," Dr. Yassi says. "OHSAH provides an opportunity to demonstrate our ability to apply scientific expertise to making the work place safer."

The work place injury rate for health care workers in BC is extremely high, especially for primary care givers, such as nurses, orderlies, and care aides. Primary care givers account for 60% of serious injuries in BC. The main source of injuries is muscle strain accidents from pushing, pulling, lifting and carrying, which account for 54% of claims.

According to Sharon Saunders, coordinator of health and safety for the BC nurses' union, the risk of injury to primary care givers is rising, in part, because patients are being sent home from hospitals earlier. So, primary care givers often have to work alone without any help in private residences that lack the proper equipment for lifting and transferring patients (eg. from bed to wheel chair or wheel chair to toilet).

Lifter for helping to lift patients

Moreover, this type of healthcare delivery is increasing annually as the Closer to Home healthcare model is expanded. Also, the risks of injury to primary care givers has risen along with increased work loads due to an aging provincial population.

The second major source of workplace injuries is physical assault. "Psychotic patients are mixed in with regular patients at hospitals, and many nurses have been kicked, grabbed or hit at work," Saunders says. Most physical assaults at work are a result of treating drunks and drug addicts with violent tendencies.

The objectives of OHSAH are to reduce workplace injuries and illnesses in healthcare workers and get injured workers back on the job quickly and safely. Using scientific evidence to inform decision making helps determine the best course of action. Research has dispelled old misconceptions about not permitting ill and injured workers to return to work, according to Dr. Yassi.

"Doctors formerly advised patients not to go back to their jobs until they were 100% healthy," Dr. Yassi explains. "But studies have shown that workers are better off returning to work as soon as possible, providing that employers can accommodate them." The first step HEALNet took in creating OHSAH was to conduct a needs assessment survey to study programs and policies currently in place in the healthcare industry in BC. Already hundreds of needs assessment surveys have been completed, coded, and entered into a database.

Healthcare worker using lifter to help patient get out of wheel chair.

The results will help determine the best practices from already successful programs in the field and serve as the foundation for the development of the program. Establishing a program for OHSAH involves developing a training curriculum; designing a return-to-work-program, creating guidelines to prevent musculoskeletal injuries such as patient lift and transfer injuries, and educating employers and workers about dangers. OHSAH will also provide $2.4 million in funding for stakeholder-driven initiatives, and expert assistance to workplace safety projects. OHSAH will drive down injury rates and decrease time loss from injury, according to Dr. Yassi.

Research at the Winnipeg Health Science Centre shows that applying scientific studies and centralized decision making to creating safer workplaces lowers costs. "Centralizing expertise saves money by sharing knowledge so there is less duplication since each agency does not have to draft new guidelines," Dr. Yassi explains. Also centralization reduces costs by creating economies of scale. Savings of 30-50% have been documented after successful workplace-based intervention programs are implemented.

Workplace-based early intervention programs for workers who incur back injuries at work have been shown to be effective in reducing time loss, but have also been effective in reducing other injuries in the workforce. Injury rate reductions of 25-30% have been documented in such programs.

Dr. Yassi hopes OHSAH will become a world class centre of excellence in the field of occupational healthcare, by fostering links with similar projects across Canada and around the globe.

For more information please visit the HEALNet Web site.

by Michael Rappaport