Implementing change in the NHS: Factors to consider
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Implementing change in the NHS: Factors to consider



Dr F C Trevelyan

Dr F C Trevelyan
Health and Rehabilitation Research Centre,
Auckland University of Technology
(P39, Wednesday, NZI 5 Room, 3.30-4)



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    Implementing change in the NHS: Factors to consider Implementing change in the NHS: Factors to consider Presentation Transcript

    • Implementing change in the NHSFactors to consider when implementing a ergonomics intervention aimed at reducing back pain among nurses Dr. Fiona Trevelyan¹ & Prof. Peter Buckle² ¹ Health and Rehabilitation Research Centre Auckland University of Technology, NZ ² Robens Centre for Health Ergonomics University of Surrey, UK
    • 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
    • Evaluation Intervention site Comparison siteBaseline measurement Baseline measurement INTERVENTION No intervention Re-assessment Re-assessment
    • Measurement strategy1. Reported back pain Self report questionnaire: low back and neck pain2. 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 Median duration (seconds) 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)
    • 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 transfersPatient transfers were characterised by  short duration  high percentage time in trunk flexion > 20 degreesLarge 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