There is now considerable evidence that musculoskeletal disorders (MSD) are caused by multiple, interacting factors across the work system. In practice, however, most investigations focus on the injured person and the immediate context. As a result, the response to MSDs is often focused on training, or retraining, individuals. This presentation will describe the development of an investigation toolkit designed to help shift the focus during investigations from the injured worker to the broader work system. The presentation will present an overview of the toolkit, and the feedback from OHS practitioners at three hospitals in Victoria using the toolkit. A case study application of the toolkit will be presented to demonstrate how the toolkit can help to develop a better understanding of the system-wide factors that contribute to MSDs. The strategies that were identified to improve the risk control measures following the investigation will also be discussed.

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Investigating the
work system, not
the injured person:
pilot of a systems
thinking toolkit for
investigating MSDs
Dr Natassia Goode

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MSDs are a systems problem
• Load
• Force
• Duration
• Repetition
• Posture
• Environmental factors
• Equipment design
• Job demands
• Job control
• Task diversity
• Pace
• Co-worker support
• Supervisory methods
• Work scheduling
• Breaks
• Organisational change

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PHIRES =
Patient Handling Injuries Review of Systems
Asystems thinkingtoolkitfor reviewingand revising risk control measures
followingthe report of a staff injuryrelating to patient handling

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Purpose of PHIRES toolkit
Improve compliance with Reg. 28(1)(c)
Optimise the risk controls
Optimise the allocation of resources in Victorian hospitals
Improve collaboration across all levels of the system
Prevent further patient handling injuries

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Co-design of PHIRES
• Literature review on the factors influencing patient handling
injuries and MSDs
• Design workshops with healthcare/patient handling SMEs,
WorkSafe and systems thinking researchers
• Pilot with 1 health service
• Pilot with 3 health services
Systems thinking| Feb 2019

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Rasmussen’s
Accimap

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PHIRES Classification scheme
Systems thinking| Feb 2019

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PHIRES
Process
Step 1: Define the focus for the review
Step 2: Identify relevant stakeholders
Step 3: Event timeline
Step 5: Identify factors influencing safety
Step 6: Analyse the dataNO
YES
NO
YES
Step 7: Brainstorm potential strategies
Process
Step 4: Identify current risk controls
Step 8: Action plan for implementation

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Implementation framework

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Aims of Pilot
Evaluate the usability of PHIRES Toolkit, process and the
associated implementation framework:
• Completion of reviews using PHIRES
• Application of systems thinking to review risk controls
• Application of systems thinking to revise risk controls
• Feedback from participants

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Participants
Four OHS Officers from three health services (2
metropolitan-based, 1 regional).
Participants had between 1 – 15 years’ experience in
their role.
Systems thinking| Feb 2019

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Completion of PHIRES (3 month period)
1. 6 reviews
2. 4 reviews
3. 5 reviews

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Systems thinking to review risk controls
Level Health
Service 1
Health
Service 2
Health
Service 3
TOTAL
Government, Regulators &
External Influencers
6 (7%) 9 (12%) 4 (5%) 21
Governance & Administration 10 (11%) 23 (29%) 11 (14%) 44
Operations Management 23 (25%) 10 (13%) 21 (27%) 54
Front-Line Staff 44 (48%) 26 (33%) 27 (35%) 97
Equipment & Surroundings 8 (9%) 10 (14%) 15 (19%) 33

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Back strain injury from pushing patient in wheelchair

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Systems thinking to revise risk controls
• Training is likely to be ineffective in preventing future patient
handling injuries.
• Effective strategies for reducing patient handling injuries involve
improving the flow of information up and down levels of the
system (Consultation).
• The implementation of risk controls can be improved by mitigating
against pressures (e.g. time pressure) through work design and
planning.

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Systems thinking to revise risk controls
HEALTH
SERVICE 1
HEALTH
SERVICE 2
HEALTH
SERVICE 3
# of reports with actions 6 reviews 4 reviews 5 reviews
Mean # of actions per report 4 actions 4 actions 2 actions
# of reports with actions
involving training
2 out of 6
reviews
2 out of 4
reviews
1 out of 5
reviews
SYSTEM-LEVEL PRINCIPLES
# of reports with actions to
improve consultation
5 out of 6
reviews
3 out of 4
reviews
3 out of 5
reviews
# of reports with actions to
mitigate against pressure
5 out of 6
reviews
4 out of 4
reviews
5 out of 5
reviews

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Systems thinking in action…
“Explore resource strategies with the Disability Working Party to
ensure that patients with special needs &/or disabilities have
appropriate levels of care” (Health Service 1)
“Interdisciplinary scenarios/drills between birth centre and theatre”
(Health Service 2)
“Conduct audit of facility to identify numbers of rubberised hoist
hangers.” (Health Service 3)
Systems thinking| Feb 2019

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Feedback from participants
• Comprehensive and helped guide a more thorough investigation
• Helped to identify factors at higher-levels of the system
• Prompted more extensive conversations with the stakeholders
The resulting Accimaps:
Facilitated the process for identifying appropriate revision to the
risk controls;
Allowed participants to assess everything and provided an
opportunity to reflect on the system of factors influencing the
event; and
Provided an excellent discussion point with senior
management.

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What’s next?
• Implementation Evaluation Trial (May - Feb)
• 9 health services use the tool to collect data and provide
feedback on the barriers to implementation
• Aggregate all reviews and conduct a workshop to identify and
prioritise recommendations with stakeholders
Systems thinking| Feb 2019

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Questions
Associate Professor Sharon Newnam
Monash University Accident Research Centre
Phone: 03 9905 4370
Email: sharon.newnam@monash.edu
Dr Natassia Goode
WorkSafe Victoria
Centre for Human Factors & Sociotechnical Systems
Phone: 0468 576 679
Email: natassia_goode@worksafe.vic.gov.au