2020 Volume 2 Issue 1 Article ID: 2020-GPS01
At present, along with the increasing number of care facilities due to super aging, work-related accidents (low back pain resulting from accidents, in particular) requiring at least 4 days away from work have increased in the health care industry, especially in social welfare facilities, which is a problem. The Guidelines on the Prevention of Lumbago in the Workplace by the Japanese Ministry of Health, Labour and Welfare that was revised in 2013 focused on care work as an important issue of discussion1). For patient handling operations, no manual lifting is proposed as a rule on the basis of the No Lifting Policy.
The results of Fact-Finding Survey on Occupational Safety and Health were published by the Japanese Ministry of Health, Labour and Welfare in 2015. These described the survey results on measures taken to prevent lower back pain associated with care receiver-lifting operations. According to the results, only 20% to 29% of sites subject to the survey took the following preventive actions, among others: “we have a standard operating procedure and/or manual,” “we have care workers use a sliding sheet/board,” and “we try to reduce care workers’ workload through the use of care-assisting machines/equipment, such as lifts.” To date, only a few research studies on operations in care work have been conducted. One of the challenges in workplace improvement in care work settings is to perform work analysis and visualize workload, which will provide reference information for operating procedures.
For the purpose of this case study, patient handling operations, which require the lifting of a care receiver, were regarded as a single operation process. The workload analysis method that has been used in the field of Industrial Engineering for workplace improvement of manufacturing plants, etc. was employed to extract element work components in the manual patient lifting operation, and analyze an operating procedure and method for the manual patient lifting operation. In addition, from the viewpoint of visualizing workload (i.e., quantitatively understanding workload), the Ovako Working Posture Analysing System (OWAS Method), which has been frequently and widely used in the field of occupational health, was employed to code working postures and assess the amount of workload placed on the musculoskeletal system and the urgency of immediate improvement, both per element work component2,3). The OWAS methodology defines that working postures included in “Action Category (AC) 4” place a substantial workload onto the musculoskeletal system, and that these require immediate remedial actions for improvement. The element work components for which the percentage of AC4 was high included not only the main action of “lifting a care receiver” in the manual patient lifting operation but also peripheral actions before and after the lifting. In light of this finding, the “Action Check List for Improvement of Manual Patient Lifting Operation” was developed for the purpose of determining the priority of actions to be improved among those before, during, and after the manual patient lifting operation. This Action Check List was then utilized in the improvement activities.
Step 1: Work-site observation patrol
Step 2: Work analysis of the manual patient lifting operation using the work sampling method
Step 3: Classification of the operation process of the manual patient lifting operation
Step 4: Workload assessment by the OWAS method for working postures
Step 5: Development and utilization of an Action Check List (ACL) for work improvement (Fig. 1)
“ACL for Manual Patient Lifting Operations” was developed on the basis of work analysis and workload assessment for working postures.
Step 6: Meeting held to discuss work improvement in which all staff participated (Photo 1)
Meetings in which survey results were reported and methods of how to improve work were discussed, so that all staff were engaged in workplace improvement.
Step 7: Implementation of improvement activities
On the basis of the results of work analysis, workload assessment for working postures, and ACL, meetings in which all staff participated were held to discuss how this work should be improved.
1. Improvement of poor working postures: After the three improvements listed below were established, the categories of working postures were changed.
(1) Installation of a holder on which a bed fence is hung (Photo 2): AC4→AC1
Improvement activities done together with staff.
(2) Installation of a shoe rack for the user’s shoes: AC4→AC2
(3) Installation of casters on a chest of drawers (to expand a work place): AC3, 4→AC2, 3, 4
2. Increased efficiency of work: Regarding the action of removing and placing a bed fence (Photo 2), the installation of the bed fence holder reduced the number of element work components and shortened the work time by about two seconds, which increased work efficiency. In addition, the installation of the shoe rack eliminated the time required to “look for the user’s shoes” and the associated poor working postures.
3. Investigation of an efficient and safe operating procedure: The use of ACL created the opportunity for staff to recognized differences among them in operating procedures; consequently, the staff were able to share safe and efficient operating procedures.
Work analysis requires a substantial amount of time and effort because all operations of the worker subject to work analysis need to be recorded without omission. It is necessary to quantitatively identify “to what extent” an “operation” in which risk factors for work-related musculoskeletal disorders such as poor working postures occur. Work analysis results can be utilized as effective criteria, according to which we can determine the priority of “the action to be improved.” In this case study, due to difficulties in funding the costs required for improvement and structural limitations of the facility, equipment such as a lifting device which directly reduce workload in the care receiver-lifting operation was not introduced. However, based on the work analysis results and opinions of the staff, the scope of improvement was limited to the actions before, during, and after the lifting of a care receiver, and improvements were made. In the future, it will be desirable to enrich teaching materials, etc. so that even individuals other than specialists can utilize the work analysis method and workload assessment, leading to the establishment of an environment in which improvement activities will be conducted in a more systematic manner.
The authors declare no conflicts of interest.
The committee for continuing education of Japan Society for Occupational Health has responsibility for the synthesis and dissemination of educational opportunities in occupational health, including selection of Good Practice Samples (GPS). This good practice sample was awarded and released in Japanese as the best good practice by the committee (https://gps.sanei.or.jp/). With the permission of the committee for continuing education of Japan Society for Occupational Health and the editorial boards for Environmental and Occupational Health Practice, the GPS was translated into English for publication.
