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Factors Associated With Staff Injuries in Intermediate Care Facilities in British Columbia, Canada

Yassi, Annalee; Cohen, Marcy; Cvitkovich, Yuri; Park, Il Hyoek; Ratner, Pamela A.; Ostry, Aleck S.; Village, Judy; Polla, Nancy

Features

Background: Large variations in staff injury rates across intermediate care facilities suggest that injuries may be driven by facility-specific work environment factors.

Objectives: To identify work organization, psychosocial, and biomechanical factors associated with staff injuries in intermediate care facilities, to pinpoint management practices that may contribute to lower staff injuries, and to generate a provisional conceptual framework of work organization characteristics.

Methods: Four representative intermediate care facilities with high staff injury rates and four facilities with comparable low staff injury rates were selected from Workers’ Compensation Board (WCB) databases. Methods included on-site injury data collection and review of associated WCB data, ergonomic study of workloads, a telephone survey of resident care staff, manager-staff interviews, and focus groups. Pearson product-moment correlation coefficients identified associations between variables. Analysis of variance and t tests were used to determine differences between low and high staff injury rate facilities. Content analysis guided the qualitative analysis.

Results: There were no significant differences between low and high staff injury rate facilities in terms of workers’ characteristics, residents’ characteristics, and per capita public funding. The ergonomic study supported the survey data in demonstrating a relation among low staffing levels, greater muscle loading, and greater risk of injury. As compared with facilities that had high staff injury rates, facilities with low staff injury rates had significantly more favorable staffing levels and supportive work environments. Perceived quality of care was strongly correlated with burnout, health, and satisfaction.

Conclusions: Safer work environments are promoted by favorable staffing levels, convenient access to mechanical lifts, workers’ perceptions of employer fairness, and management practices that support the caregiving role.

Annalee Yassi, MD, MSc, FRCPC, Founding Executive Director, Occupational Health and Safety Agency for Healthcare; Director of the Institute of Health Promotion Research, University of British Columbia, Vancouver, British Columbia.

Marcy Cohen, MA (Education), Director of Research, Hospital Employees’ Union, Vancouver, British Columbia.

Yuri Cvitkovich, MA (Gero), Researcher, Institute of Health Promotion Research, University of British Columbia, Vancouver, British Columbia.

Il Hyoek Park, PhD, Post Doctoral Fellow, Institute of Health Promotion Research, University of British Columbia, Vancouver, British Columbia.

Pam Ratner, RN, PhD, Associate Professor, Nursing and Health Behavior Research Unit, School of Nursing, University of British Columbia, Vancouver, British Columbia.

Aleck Ostry, PhD, Assistant Professor, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia.

Judy Village, MSc, School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia.

Nancy Pollak, MA (candidate), Researcher, Hospital Employees’ Union, Vancouver, British Columbia.

Accepted for publication December 15, 2003.

This project, initiated by the Hospital Employees’ Union, was funded by the Workers Compensation Board (WCB) of British Columbia and the Canadian Institute of Health Research through the Community Alliance for Health Research Program and through career awards to Drs. Yassi, Ostry, and Ratner. The authors are grateful for the support provided by staff from the Occupational Health and Safety Agency for Healthcare and the University of British Columbia Institute of Health Promotion Research. They also acknowledge with thanks the advice received from their stakeholder committee, which included representatives from WCB Prevention (Stephen Symon), the BC Nurses’ Union (Lorley Pachkowski), the Health Benefit Trust (Jan Mitchell), the Health Employers’ Association of BC (Linda Rose), the BC Ministry of Health (Stephanie Sainas), the Hospital Employees’ Union Executive (Mary Nicholls and Joanne Foote).

Corresponding author: Annalee Yassi, MD, MSc, FRCPC, Institute of Health Promotion Research, University of British Columbia, 2206 East Mall Vancouver BC V6T 1Z3 (e-mail: AnnaleeY@aol.com).

© 2004 Lippincott Williams & Wilkins, Inc.