Implementing participatory ergonomics in the long-term care sector

Long-term care (LTC) homes are fast-paced, demanding environments where workers are at high risk of musculoskeletal disorders (MSDs). Efforts to address occupational health and safety (OHS) hazards in this sector are often challenged by high staff turnover and time constraints. Previous research has shown the potential of participatory OHS programs—i.e. programs in which frontline workers are involved in finding solutions—to be a good tactic for addressing MSD risks. However, study findings on the effectiveness of the participatory approach have been inconsistent, leading to questions about the implementation of such programs. In this study, a team set out to examine the implementation of a participatory OHS program in long-term care homes.  

The study was conducted at four LTC homes in Ontario over 12 months in 2017 and 2018. Two of the homes volunteered to carry out a participatory change initiative (the intervention). They were paired with two comparison homes that were similar in facility age, client make-up and municipal location. Over the same 12-month period, the comparison sites implemented an information program in which staff were given OHS brochures.  

In each of the two “intervention” homes, a steering committee and a change team were formed, each with about 10 members. The steering committee was made up of managers, supervisors and joint health and safety committee (JHSC) leaders; the change team was made up mainly of frontline staff working in a range of roles at the intervention site, as well as some JHSC members. The bulk of the change activity—identifying hazards, assessing risks and deciding on hazard control measures—was carried out by the change team.

At the outset of the change initiative, members of the steering committee and change team were given training on participatory OHS by an external facilitator. This facilitator also led the first meetings, then gradually moved into a mentoring role as the change team, supported by the steering committee, implemented new safety measures.

Study data were collected at three timepoints over the 12 months, from about 130 participants across the four homes. At each intervention home, study data was collected from members of the steering committee, the change team and about 10 additional frontline staff not involved in the committees. Paper surveys were filled out before the program started, at six months in, and again at the end of the program. Interviews and focus groups were conducted at the six-month and 12-month marks. The research team also conducted on-site observations to take note of workers’ postures before and after the implementation of the change program.

At the comparison sites, OHS information pamphlets were provided to managers, supervisors, JHSC members and staff. About 30 participants at each comparison site were recruited, in a roughly similar mix of roles and work status as the participants at the intervention homes. They were asked to complete the paper surveys at the same three timepoints and to let the research team observe their work; interviews or focus groups were not conducted with this group.

In interviews and focus groups, participants at the intervention homes described pushing, pulling and lifting hazards being of concern. The changes implemented to address these hazards cost little and, often, nothing. Changes included using new equipment, such as linen carts that were easier to pull, larger garbage bins that decreased spills, and medicine carts that were easier to see over when moving through hallways. Other changes included adding wheels to large dining tables to make them easier to move, changing laundry and storage room layouts to reduce the lifting or carrying of loads, and reorganizing shelves to reduce lifting above shoulder level.

Participants at the intervention homes also organized training sessions on proper lifting techniques, led by onsite physiotherapy staff. Training was supported by practice changes. Examples of these included stacking chairs to lower heights, providing recreation staff access to a reserve elevator (which lessened their need to rush and move more than one client at a time), and scheduling more volunteers to work when large numbers of clients needed to be moved.

Overall, the implementation process led to greater staff communication and collaboration about MSD hazards, as well as greater awareness and reporting of near misses.

Participants also identified barriers and facilitators to implementation. Barriers included challenges specific to LTC homes, such as staff shortages, high turnover, lack of time for program meetings, and unclear expectations about managers’ roles throughout the implementation process.

Facilitators included the involvement of frontline staff across different departments, support from upper management, the addition of the change program as a standing item in monthly OHS meetings, the MSD training provided as part of the program, and the availability of the external facilitator as a resource.

Based on survey results, no change was found over time in frontline workers’ general health, pain levels, control over work, self-efficacy (ability to manage MSD problems on an individual basis) or observed postures. More time is likely needed to show statistically significant changes in these outcomes. Statistically significant change was found in the self-efficacy scores of the managers at the intervention sites. Interview results revealed that participants were pleased with the program and felt they would continue with it. Indeed, key elements of the program’s staff participation component were incorporated into the health and safety processes at the intervention sites.

The study showed that participatory OHS change can be successfully implemented and sustained in busy LTC facilities, despite long-standing challenges in the sector such as staff shortages and turnover.   

A strength of the study was its use of a mix of methods to collect and analyze data about program implementation. A weakness of the study was its small sample size. The low number of participants was intended to decrease the burden on participating sites, but it meant program outcomes were difficult to detect using survey instruments. Another weakness was its short follow-up time, which limited the researchers’ ability to evaluate the program’s impact on worker health and pain symptoms.