Ergonomics might sound like an expensive pain-in-the-neck to materials managers facing other challenges.

But without an ergonomics program, many say a pain in the neck, or in other parts of the body, is exactly what employees will experience, which will lead to mounting injuries and exorbitant, unplanned costs.

The old view of ergonomics as a fund-draining headache is being replaced by a consensus that such a program is a wise, cost-saving investment hospitals can't afford not to make.

Even as the debate continues about requirements, one thing is certain--ergonomics is playing a bigger role in more hospitals nationwide.

And that, says one fairly recent convert to the practice, is another reason for materials managers to make more ergonomic adjustments sooner than later.

"Even if ergonomics is not mandated in the industry, I think you're going to save yourselves and your facilities a tremendous amount of money if you equip the workplace the way it should be," says Dale Montgomery, vice president of support services, Hays (Kansas) Medical Center. "I think every workplace ought to require an ergonomics program. If you do it right, the payback is going to be there in the long run."

Investments in safety measures produce long-term savings, improve patient care and create a more stable work force. Data from hospitals across the country shows that ergonomics programs cut costs and reduce employee injuries.

In the short term, money for ergonomics even can be taken from tight budgets. An OSHA spokesperson says most ergonomics problems can be satisfactorily addressed by low-cost interventions using inhouse resources.

Bill Kempner, head of the ergonomics program, North Shore University Hospital, Manhasset, N.Y., was waiting for the emergency department to authorize new chairs. In the interim, he and a carpenter quickly and cheaply built a custom desk for an admissions clerk who didn't like to work sitting down. The result was a boost in the clerk's morale, which spurred the purchase of chairs for the entire department.

"A good ergonomically correct chair costs maybe $250," says Kempner, a safety services specialist. "How much does workers' comp cost? How much does two weeks, maybe a month out of work cost?

"It's a no brainer. What you're paying up front is ultimately savings from outlay you don't have to make."

While ergonomics may not be uppermost in the minds of most materials managers, their participation in programs is expected to grow.

Mike Foster, assistant materials management director, North Shore, says materials management's involvement, currently limited to buying decisions, attending safety committee meetings and learning more about ergonomics, is certain to expand.

"We're the first line of defense in terms of handling and lifting. I think you've got to make safety the priority without making it a cost issue," he says.

Adjusting ergonomics

Ergonomics, defined as the science of adapting the work environment to the worker, has been an issue for more than two decades and has grown in the past few years.

Last January, the Clinton administration developed the most sweeping set of workplace rules in a decade--1,688 pages of rules designed to prevent hundreds of thousands of crippling repetitive stress injuries. Employers were to be required to identify and minimize workers' risks for muscle and back injuries, perform work station reviews, and implement employee training and equipment modification or replacement.

An OSHA spokesperson says the national ergonomics standard would save $9.1 billion a year in medical expenses.

After the change in administrations, Congress rejected the new regulations and the White House struck them down in March. Objections cited from the private business sector stated that compliance could cost as much as $100 billion, compared to OSHA's $4 billion estimate.

President Bush called the regulations unduly burdensome and overly broad and promised to find another solution to ergonomic-related problems.

The new approach is expected to be announced by Labor Secretary Elaine Chao early this year.

Al Cook, chief resource officer, St. Francis Medical Center, Monroe, La., and AHRMM president, says that ergonomics issues are on the back burner at many hospitals. "We're pretty much focused right now on reducing costs wherever possible."

But experts advise not to forego an ergonomics program because of the tightened economy or the absence of government requirements.

They point to voluntary efforts at a minority of hospitals that have helped reduce ergonomics injuries by 17 percent since 1993, according to the American Health Care Association, resulting in major savings in workers' compensation and other expenses.

"It's not important whether there's a rule, it's a major cost issue," says Robert Goldberg, M.D., associate clinical professor of medicine, University of California-San Francisco (UCSF). Employees are getting hurt every day and the injury rate is comparable to that of the construction industry, he says.

A recent survey by the American Nurses Association states the risk of a disabling back injury is cited as the number two concern behind stress and being overworked.

"I hear from [hospital] managers that they don't want to have younger employees coming in who they have to train," says senior ergonomics consultant Ira Janowitz, UCSF. "If the job's not too much of a backbreaker, it's easier to get John or Jane Doe back on the job after an injury."

Handling the load

So what can materials managers do?

"You don't just buy a truckload of patient-lifting equipment," says Goldberg, who works with hospitals on ergonomics. "There's a lot of training and implementation that needs to be taken care of."

Look for internal expertise or ask the human resources or safety manager to hire a consultant to help start a program, he says. Ensuring top management is committed to the program and increasing budgeting for equipment purchases also is key.

Next, review the workplace and, by adjusting or replacing equipment, hazards in the area with the highest incidence of problems can be reduced. At the same time, workers must be educated about risks.

Depending on hospital size, a good program takes three months to six months to implement, Goldberg says.

Equipment purchases are integral to any program, including ergonomic furniture and mechanical lifts. A portable standard lifting device costs about $3,000, while not inexpensive, is still less than the price of back surgery, he says.

Hays Medical started its program in the summer of 2000 to reduce carpal tunnel injuries, eye strain and lost work days, and also because of the impending regulatory clampdown.

Montgomery says the 160-bed hospital invested an initial $20,000 to $30,000, with $10,000 to $15,000 now budgeted annually for new office furniture, patient lifting equipment or maintenance.

"You can get a small office full of ergonomically sound furniture--desk, chair, computer work station--in the neighborhood of $1,000 or $1,100. You don't have to spend a lot of money doing this," he says.

It is important that those working on an ergonomics project have good communications with the materials management department so the proper equipment is ordered, says Tammy Reeves, ergonomics coordinator, Hays Medical.

Managers met with their occupational therapists and directors to outline program goals and target problem areas, Montgomery says. The materials management department helped develop specifications for equipment and chose two or three lines of chairs.

The program then was left mostly to the occupational therapists and safety committee, he says.

"It took six months before we fully understood what ergonomics meant," he added. "But once you recognize it, you buy ergonomically smart equipment and it becomes a part of your operational life."

In full swing

Shands HealthCare, a Florida-based system of eight not-for-profit hospitals, negotiated with a supplier to have stricter ergonomics standards applied to beds, because its previous standards wouldn't have met OSHA requirements.

Even though the ergonomics regulation wasn't passed, the hospital system didn't stop improving its six-year-old program. Randy Haas, materials manager, recently revised the furniture standards manual with the help of an ergonomist and consults frequently with the ergonomics department regarding purchases.

"We make sure we include our ergonomics staff in a lot of our decisions, because they have the expertise," says Haas. "We include them in decisions regarding such push-pull things as beds or carts and also for furniture purchases and office design. It's another piece of key data when making a decision."

California-based Kaiser Permanente, which operates 29 medical centers in nine states, has focused its ergonomics program on housekeeping and patient handling.

Last year, these departments accounted for 30 percent of the organization's worker compensation cases. With mandatory purchasing requirements for ergonomics accessories and other measures, Kaiser is spending $100,000 per center on equipment to reduce back injuries.

St. Mary's Hospital, Huntington, W. Va., completed a $3.5 million ergonomics investment last year that included the purchase of 289 beds and new mechanical lifting and transfer devices.

Kristina Senior, director of rehabilitation services, says it's the precursor to implementing a formal program. For now, ergonomics is within the purview of its safety committee.

"We're waiting to see our successes and go from there," she says. "No matter what happens with OSHA, with an aging work force and the high cost of injuries, it's the right time to have a program."

For cost-free starters, visit the following sites: www.me.berkeley.edu/ergo and www.mhia.org. To order a back injury prevention guide, visit www.dir.ca.gov.

Dave Carpenter is a freelance writer based in Chicago.

This article first appeared in the January 2002 issue of Materials Management in Health Care

• See:

Reasons why ergonomics programs are considered at hospitals