The document discusses the development of a tool to measure the success of patient handling interventions across the EU, addressing the inadequacies of previous reviews that did not adequately identify reductions in musculoskeletal disorders. It outlines the project's methodology, literature analysis, focus group outcomes, and trial results, emphasizing the importance of various outcome measures and the establishment of a standardized evaluation tool. The findings suggest that the tool improves the ability to compare interventions and provides insights for better resource allocation and benchmarking in healthcare settings.

1. A tool to measure the success of
patient handling inter ventions
Mike Fray and Sue Hignett
Healthcare Ergonomics and Patient Safety Research Unit
Loughborough Design School
Loughborough University
UK
Sponsors: Arjo-Huntleigh ab, EPPHE.

2. Patient Handling Interventions
 Many reviews have failed to identify MSD
reduction from patient handling interventions
(Van Poppel 2005, Bos et al 2006, Amick et al 2006, Haslam et al 2006, Dawson et al, 2007, Martimo et al
2008)
 More inclusive reviews identify that other
outcomes could be used to show success (Hignett
et al 2003, Fray and Hignett 2006)
 How can different interventions be compared
when different measures are used?

3. Overview of Presentation
 5 year part-time PhD programme
 Aim - Develop a tool to measure the success of
patient handling interventions applicable across
the EU
 Overview of the project methods
 Results
 Development and evaluation of the tool

4. Methodology
Literature Analysis Focus Groups
Intervention types Outcomes
Outcomes Outcome measures
Outcome measurement tools
Academic Quality Preferred Outcome
Intervention Ranked List
Scoring
System
Intervention Evaluation Tool
Evaluation Trials

5. Literature Analysis
 Search strategies from existing publication
(Hignett et al 2003)
 Intervention type, study design
 Specific outcome recorded
 Level of outcome measure (Robson et al 2007)
 Measurement device used for outcome
 Academic quality score (Downs and Black 1998)
 Practitioner rating (Hignett et al 2003)
 Ranking of outcome from EU study
 323 studies 2 reviewers

6. Literature Analysis - Level of Outcome (Robson 2007)
Intervention
Outcomes that measure quantities
and qualities of the intervention
Outcomes that represent a reduction
in exposure to known risk factors
Outcomes that measure real effects in
the target population in a real situation

7. Literature Analysis
 Search strategies from existing publication
(Hignett et al 2003)
 Intervention type, study design
 Specific outcome recorded
 Level of outcome measure (Robson et al 2007)
 Measurement device used for outcome
 Academic quality score (Downs and Black 1998)
 Practitioner rating (Hignett et al 2003)
 Ranking of outcome from EU study
 323 studies 2 reviewers

8. Focus Group Study
 ‘Nominal Group Technique’ Higgins 1994
 Range of outcomes at onset of scenario
 Secondary list of outcomes recorded at end of
scenario discussion
 Ranked outcomes at end of scenario
discussion
 Thematic and content analysis from
transcriptions (NVivo)

9. Focus groups
 Four EU focus groups (n=34)
 UK
 Finland
 Italy
 Portugal
 Two expert panels (n=10)
 Holland, USA, Australia, Belgium, Finland,
Portugal, Italy, Germany
 Cross comparison

10. Qualitative Analysis
Outcomes identified in focus
groups (210)
Identified themes Included in priority
(42) lists (38)
12 highest ranked
outcomes included in
Intervention Evaluation
Tool

11. Focus Group Results: Transformations of data
 Grouping of themes gave clear definitions
 Remove intervention definitions (Robson 2007)
 Combined categories
 Separated categories
 Categories with < 5 votes excluded

12. Most Important Outcomes (Ranks)
Theme Italy Port Fin UK TOTAL
Accidents 8 3 11 5.5 6
Absence, Staff health 3 8 2 3.5 4
Financial 11.5 11.5 7 10 12
Risk Management, Safety culture 2 1 1 2 1
MSD Measures 1 5 8 1 2
Exposure Measures 11.5 9 5 12 10
Compliance, competence 4 2 4 5.5 3
Psychological well-being 10 6.5 9 3.5 7
Patient injuries 8 11.5 11 9 11
Patient perception 8 10 11 8 9
Patient condition 6 6.5 6 11 8
Quality of care 5 4 3 7 5

13. Analysis
Difference versus Association
 Kendall’s Concordance (W)
 Using tied ranks correction
 Chi Square comparison
 W= 0.623
 Chi square = 27.7
 Sig 0.005

14. Included outcomes
Outcome Conversion
factor
Safety Culture 12
MSD measures 11
Competence Compliance 10
Absence or staff health 9
Quality of care 8
Accident numbers 7
Psychological well being 6
Patient condition 5
Patient perception 4
MSD exposure measures 3
Patient injuries 2
Financial 1

15. Measuring each outcome
 Inclusion Criteria
 Tool used in patient handling study
 Level of the QR >50% (308 Included)
 Selection Criteria
 High QR scores
 Evidence of peer reviewed validation studies
 Used in a peer reviewed intervention trial
 Most frequently used measurement devices
 Complexity of the data collection in health

16. IET – Outcome Measures QR>50% (308)
Preferred outcome No. measures
included
Safety Culture 5
MSD measures 45
Competence Compliance 21
Absence or staff health 19
Quality of care 1
Accident numbers 2
Psychological well being 8
Patient condition 1
Patient perception 26
MSD exposure measures 170
Patient injuries 0
Financial 10

17. Preferred outcome Method for collection Source paper
Safety Culture PHOQS Documentation review Hignett 2005, 2007
MSD measures Nordic Questionnaire (or derivative) Knibbe 1996
Lagerstrom 1997
Competence Compliance Observational checklist. DINO Johnsson 2002, 2005
Absence or staff health OSHA Logs. Standardised data per population Charney 1997,
Nelson 2006
Quality of care Meeting the clinical needs of the patient, patient evaluation. Nelson 2008
Accident numbers Standardised incident numbers and non-reporting ratio Menckel 1997
Psychological well being Job satisfaction Evanoff 1999
Psychosocial stressors
Patient condition Meeting the clinical needs of the patient, staff evaluation. Arjo Care Therm. 2007
Nelson 2008
Patient perception Comfort, security, fear patient evaluation Kjellberg 2004
MSD exposure measures Patient handling demand Knibbe 1999, Cohen 2004,
Arjo Resident Gallery 2005
Patient injuries Detrimental effects of poor case management New tool
Financial Calculation of costs v. investment Chokar 2005, Nelson
2006, Collins 2004

18. IET to TROPHI Development
IET (Vi)
Peer review 2 UK hospitals
UK Peer review panel (Vii)
IET (Viii)
4 section data collection
Translation and peer review
4 EU sites
4 EU trials
EPPHE peer review panel
TROPHI

19. TROPHI
T ool for
R isks
O utstanding in
P atient
H andling
I nterventions

20. Field Trials: Aims
 Identify good and bad performers
 Assess applicability to other EU countries
 Final review panel (EPPHE) to gain expert
consensus on method and content

21. EU Trial Results (Positive Negative defaults)
UK1 UK2 Po1 Po2 Fi1 Fi2 It1 It2
Safety Culture 55.6 46.7 13.8 23.3 30.7 39.8 15.6 25.2
MSD measures 40.0 50.0 55.0 51.5 22.6 21.6 38.5 100
Competence Compliance 29.2 47.9 3.5 11.5 59.6 29.3 56.9 29.6
Absence or staff health 0.0 10.7 95.9 64.6 71.2 0.0 100 99.5
Quality of care 75.0 80.0 100 69.0 64.2 86.7 88.8 79.5
Accident numbers 0.0 97.3 89.5 69.8 82.5 72.0 89.8 88.5
Psychological well being 76.2 82.4 77.7 70.7 75.0 70.3 71.7 81.2
Patient condition 64.5 79.9 45.0 65.9 64.2 62.5 69.1 84.4
Patient perception 68.7 100 100 66.7 100 52.1 93.3 90.0
MSD exposure measures 64.0 70.8 52.1 55.2 79.4 75.8 71.6 97.1
Patient injuries 0.0 0.0 91.8 66.8 100 100 100 100
Financial 100 100 100 100 100 100 100 100
IET SCORE 38.5 53.0 53.2 46.0 53.5 42.3 58.4 65.6

22. Evaluation
 Range effects
 Scores collected 11/12 sections
 Data collection 3 hours per ward area
 Differences identified and measured
 Only small differences were noted in
subjective data collected (DiNO 80%)
 Improvements for data collection methods

23. EPPHE Review
 MSD and absence score could be age and
experience factored
 Validity issues regarding single point data
 Reliability for different users and different
systems
 MS workload exposure score

24. Recent implementation
 UK, 2010. Mental health unit, Defined
minimal requirement of PH demand
 Portugal 2011, 8 wards areas acute hospital,
(Cotrim et al 2012)
 UK 2011, 6 wards acute hospital. Audit
review study. Repeatability of measures over
3 month period

25. Why is Safety Culture No 1
Organisational
behaviour
measures
(Safety Culture)

26. Why is Safety Culture No 1
Organisational Measures of safe
behaviour or quality
measures behaviour
(1) (Competence,
compliance,
Quality of care,
Accidents)

27. Why is Safety Culture No 1
Organisational Measures of safe Measures of
behaviour or quality effects on
measures behaviour individuals
(1) (3,5,6) (MSD exposure
and prevalence,
Absence, Well
being, Patient
condition and
perception)

28. Why is Safety Culture No 1
Organisational Measures of safe Measures of Financial
behaviour or quality effects on outcomes
measures behaviour individuals (12)
(1) (3,5,6) (2,4,7,8,9,10,11)
Strength of outcome by interaction
The flow cannot be reversed

29. Summary
 IET has been successful in measures from 4
EU countries
 3 hour data collection
 Range of scores across 12 sections
 Potential uses:
 Pre-post intervention
 Intra or inter site comparison
 Benchmarking
 12 sections and total score allow more
directed use of resources than with single
measurement tools.

30. Future work
 Previously the outcome measure selected
restricted the ability to compare different
interventions but TROPHI increases this
process
 A large scale data collection is required to
further validate the TROPHI methods
 Use section scores to direct future
interventions
 Set standards for each section and total as a
worldwide benchmarking tool

31. Thank you for listening