Part 3 - "Operation Safety" - Preventing OccupationalInjuries through Regional Intervention

Executive Summary

Background and aims

Changes to the Victorian public fund workers’ compensation system in 1992 paved the way for initiatives in the area of return to work and pilot studies in the area of prevention.

The present study was conducted in order to reduce the incidence of severe occupational trauma associated with manual handling, in particular among those occupations where this represented a high priority for prevention. The analytical focus was set by the medical priorities of the workers’ compensation data, and the approach represents a test of how workplace intervention and a regional media campaign can be combined and integrated in order to attain a regional reduction in injury incidence.

The aim was to provide as many regional establishments as possible within the targeted industries with knowledge of, and access to, equipment, logistics and applications to reduce the risk of occupational trauma associated with manual handling.

The aim was also to provide for a later State-wide roll-out of initial intervention solutions, which had been developed in the regional project.

Priorities

On the basis of 25 month claims for workers’ compensation in the state of Victoria, occupational titles, activities associated with injury, and equipment involved in injury were identified and described in terms of medical consequences and severity. The analysis of the claims material was further focused on the greater Ballarat region, a semi-rural district northwest of Melbourne with around 125,000 inhabitants and a varied industrial structure.

The analysis identified priority target areas characterised by having above average severe injuries, and above average contribution to the pool of all claims. In the Ballarat region target areas associated with high proportions of "harm" (severity x frequency) were identified as manual handling operations among transport workers and nursing staff.

The intervention area for the project "Operation Safety" was delineated on the basis of the available media maps for coverage of local radio, newsprint and television, and contained 1,560 establishments in the areas of transport, manufacturing, retail, hospitality and nursing, in all employing 1,360 transport workers, and some 2,416 nursing staff.

Results

Site visits - transport

From the visits to some 50 industrial sites involved in different types of transport activities it became clear that the main issues relating to manual handling, and to the associated slips and falls from vehicles during manual handling, were:

• current truck design makes very little provision for aiding loading and unloading in distribution, which is typically manual with no mechanical aids,

• there is often a lack of adequate provisions at dispatch and receiving points in companies to aid loading/unloading vehicles,

• containerised loads need to be typically loaded (filled) and unloaded (emptied) as individual items manually,

• personnel access provisions to truck cab and load area are typically very poorly designed, inherently unsafe and generate slips and falls from the vehicle.

A major workshop was held on developing ideas for a new model truck design incorporating advanced features for load handling and operator access. This work is continuing and the new truck design is presented in Appendix 1.

Site visits - nursing

Contributing to the manual handling problem at some 10 nursing facilities was the inadequate design in terms of small room sizes (toilets, bath rooms, etc) forcing nursing staff to carry out patient handling in awkward postures or with restricted assistance hence increasing exposure to injury risk. The conclusions in relation to patient handling in nursing are several and represent the somewhat contradictory picture of a problem strongly associated with reduced staff levels and the economics of care:

• nurses should adopt a "non-lifting policy" achieved through the compulsory use of mechanical lifting and patient transfer devices,
• special training directed at improving the professional skills in relation to patient transfers (eg. manutension) should be applied for all nursing staff,
• the development of in-house programs directed at improving mobilisation of patients, combined with health/fitness programs among staff, should focus on manual handling techniques.
• the development of designated staff for non-medical patient handling would imply that specific professional skills in the physical handling of patients could be developed and overexertion risks decreased.

The HR department at a Melbourne private hospital was commissioned by Operation Safety to produce a report describing the introduction of Patient Service Associates - PSA’s - into the employment structure of the hospital. The restructuring and development of the non-medical caring tasks is a question of vital importance for the health system, especially in long-term care, and is crucial to the issue of occupational risks and back injury.

Survey data

Two independent regional telephone surveys of 1,000 households each, undertaken in December 1995 and December 1996, provide comparative measurements of the underlying occupational injury incidence in the region. Comparing 1996 with 1995;

• occupationally related ill health dropped significantly,
• sprains and strains dropped significantly,
• more people reported lost time injuries in 1996, but the number of "repeaters" had dropped significantly; the overall result was a considerable reduction in the total number of lost time episodes in the region,
• sprains and strains dropped significantly for health workers.

A survey of participating workplaces indicated that half of the companies had initiated activities in relation to manual handling problems after the visit from "Operation Safety"

Claims data

While the injury incidence and severity associated with all claims have increased in the rest of Victoria, there has been a substantial drop in Ballarat. Comparing 93/94 with 95/96 we record a 16% increase in claims and severity in the rest of Victoria while there is an 18% drop in claims and severity for Ballarat. The difference between Ballarat and the rest of Victoria is statistically significant (Chi-square=33.9; P<0.0001).

The transport workers have recorded a 4% drop in claims in Victoria and a 16% drop in the Ballarat region, even if the absolute regional numbers are small. The nursing staff have increased claims in Victoria by 6%, but record a 22% drop in Ballarat.

The total payments associated with severe claims have increased by 45% in Victoria and by 28% in Ballarat. If the difference is attributed to Operation Safety, the regional intervention represents an annual save of around $400,000.-. Conversely, it is projected that a state-wide intervention along the lines of Operation Safety represents an annual potential containment of payments of claims estimated at around $11.5 million for Victoria.

It is advised that the consistency of any impact on injury incidence must be measured in the claims material over a longer period, i.e. after 24 or 36 months.

Concluding remarks

The analytical conclusions from the assessments of occupational risks associated with manual handling tasks among transport workers and nursing staff in Ballarat are quite clear. Further long-term occupational injury prevention activities can benefit from these experiences.

There is a great need for local risk analysis and constructive and applied injury prevention at the workplace level, such as demonstrated in this regional project, to become accepted management practices.

Perhaps the most important conclusion from the present project has to do with the dynamics between the themes of applied prevention and the media messages. Television, radio and newsprint messages were built around the problems uncovered by the regional intervention; manual handling problems were acknowledged and addressed locally with the help of constructive problem-solving, and the solutions were often provided by the creative resources of the region.