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Handling it well?

31 March 2014

Musculoskeletal Disorders (MSDs) remain one of the most frequent types of work-related injury and ill health conditions across all sectors of industry. Davy Snowdon the founder of manual handling training specialist Pristine Condition believes that this is because conventional methods of manual handling training often fail and suggests some steps organisations can take to succeed in this area.

A significant proportion of MSDs and back pain results from uncontrolled manual handling, yet, despite efforts to further reduce this through local legislation and better risk management initiatives, many organisations continue to experience accidents resulting in both traumatic and accumulatively-derived MSD injury.
Every effort must be made to reduce the risk from manual handling, for example by automation and mechanisation, but how common is it that it can be absolutely eliminated?
Somewhere down the line, someone will have to handle something – ie, some residual risk remains, even if it’s a relatively lower one. 
Whether that’s down to an over-reliance on having reams of written Safe Systems of Work which nobody then follows, the efficacy of any training given, or simply a mistaken belief that equipment such as weightlifting belts offer some form of protection to the wearer, the situation seems to be that, whatever organisations are doing, it isn’t working as well as it needs to.

As a former Guinness Book of Records World Record holder and Olympic Weightlifter who represented their country in the 1992 and 1996 Olympics, where I was selected as the Expert Strength, Conditioning and Power Coach, advising all 32 of Team GB’s Olympic sports teams I can provide an interesting perspective on this issue. I was also appointed National Coach to Great Britain’s Women’s Weightlifting team in 1992, taking them to the title of Champions of Europe.
In my experience in any programme where you are trying to persuade people to change their habits, success or failure will ride on three interdependent factors:
  • Individuals’ buy-in to why they need to change
  • The effectiveness of how change is monitored and 
  • Support for management in driving through and maintaining that change
The reality is that your initiatives will fail if any one of these three Universal Failure Modes is present.

When it comes to getting manual handling wrong though, the place to start is also the biggest single problem which conventional wisdom seems to overlook, and it’s this. 
The body doesn’t tell you every time you get it wrong, only when you’ve got it wrong too often. People go about their daily lives, often for years without any problems and then suddenly – bang – their back’s gone. 
Why is that? 
To begin understanding both the problem and the solution, let’s consider the most extreme manual handling tasks you’ll probably ever come across - Olympic Weightlifting. Professional weightlifters improve by continually increasing the weight and the tonnage they lift and, whilst muscle bulk, power, diet and physical build play their part, they are not the prime consideration. 

To the ordinary individual, the weights being lifted on a daily basis, without injury, are staggering. Currently a 75 kg man can lift 200 kgs above his head in a single lift and in one training session will lift in excess of 18,000 kgs - with 3 sessions per day being quite common. Similarly, females of the same body weight are lifting 170 kgs. 
Injury is a huge fear for any athlete and weightlifters are no exception. These athletes push themselves to the limit every day and injury is the one thing they must avoid if they want to compete. 
But even when they fail the lift, they don’t get injured. Why is that?
The answer lies in the fact that Olympic Weightlifting has evolved, with athletes striving for anatomical and mechanical perfection. The rare accidents that do occur are predominantly due to technical failures as opposed to the weights themselves. This anatomical perfection means that professional lifters minimise the pressure they are placing on their body, so they are not only less prone to both accumulative and traumatic injury, but they are also relatively less fatigued in the process.
What Olympic Weightlifting teaches us is that it’s not about weight; Technique is the key to avoiding injuries and reducing fatigue when manual handling. So, why not take those principles and apply them to industry? A great idea, but to succeed, you also need to address individuals’ belief systems and consider why people do what they currently do, before you can persuade them to change those habits.

Which brings us on to industry’s failings. Let’s consider some of the myths that are often promoted as "best practice”, for example: 
  • Bend the legs and keep the back straight 
  • Squat all the way down when lifting from the floor
  • Use a weightlifting belt to support the back
  • The ability to lift empty boxes correctly means you can lift anything and everything 
  • The maximum weight you can lift is 25/20 kg (men/women)
My own experience is that manual handling training is often far too generic and rarely represents the real world of the employee. It dreams up idealistic images of diagrammatic figures lifting empty cardboard boxes from perfectly flat floors onto perfectly level, waist-high tables. 

Worryingly, contemporary wisdom places far too great an emphasis on weight being the crucial risk factor. Anyone who’s studied weightlifting will tell you that it’s actually about technique and its consequential pressure that’s being placed on the body, that’s the problem. 
Literature, guidance, regulation and associated legal arguments have each played their part in perpetuating the problem. 
There number of tools employers can use for assessing risk appears endless, but where’s the detail on how to control residual risk practically, explaining to the employee precisely what technique to adopt for any given situation? There’s very little, if any. 
So what happens instead? Imagine your employee who’s just attended yet another manual handling refresher training course.
Back at the coal face and within 10 minutes of receiving classroom training, he’s presented with a handling task scenario that doesn’t quite fit into the sanitised version just seen.
And what happens? He may well try to do what’s been taught but if  - and when  - he finds the theory doesn’t match reality, he’ll very quickly revert to doing what he’s always done. Not only that though, in the process he’ll also emotionally disengage from everything he’s just been told because his belief now is "you can’t do it like that where I work”. And because no one counter-challenges him, the negative belief system prevails.

So to avoid Universal Failure Mode #1, you need to deliver practical training, using lifting principles that every individual will buy into because they genuinely believe it reduces their chances of being injured, it’s easy to follow and they can apply it to any and every handling scenario.
Deliver this in a fun and engaging way and I guarantee you’ll get more buy-in to the programme than you ever thought possible. A good start would be to ban PowerPoint from any training session where you seriously need people to stay awake.

But that still leaves us with Universal Failure Mode #2.
Why didn’t his incorrect technique get challenged?
I’m willing to bet a £million that if I walked through your factory, warehouse or yard without wearing the company’s designated PPE, for example a Hi Viz vest, people would be tripping up over themselves to tell me, in the strongest possible terms, that I’m doing wrong.
So why don’t they do that when someone’s using incorrect handling technique?
The answer’s pretty simple really. If you challenge someone, you’ll likely get 1 of 2 answers; the first will be unprintable here, but the second would be something like – "If it’s wrong, you show me how to do it right”.
And there’s the rub; most front line supervisors and their managers won’t know what "right” looks like because they’ve also been subject to the same myths as everyone else, so even though they know it’s wrong, they aren’t prepared to challenge bad behaviour.
Result? Bad practice prevails because the system isn’t geared to break the cycle of incorrect behaviour.
So not only do you need to train the workforce, you also need to train front line managers how to spot and correct any incorrect technique.
But that’s where many people, too often having an unhealthy passion for spreadsheets and pivot tables, go wrong by introducing a complex auditing system, which might be fantastic at producing reams of charts and statistics, but tells you very little about what’s really happening at the sharp end.
The trick actually is to keep things simple – so simple in fact that it’s as easy as spotting a PPE violation.
Your Lifting Principles not only need to be simple, they also need to be binary. By that I mean that it’s either right or it’s wrong. There are no grey areas. It’s green or it’s red. It’s correct or it’s incorrect.
Keeping it simple makes it far easier to carry out workplace task observations, trying to spot not just incorrect technique but correct technique too. 
The trick though is giving the supervisor the skills to deal with either scenario constructively.
Look at it from the supervisor’s perspective. You observe someone lifting correctly. You approach them and congratulate them for following their training. It’s a win win.

If they’re not doing it correctly, you still approach them, constructively explain in the right manner what they’ve done wrong, show them how to do it right and get the
individual to repeat it back to you, validating their understanding and capability. Win win again.

The really clever bit though is to have a very simple method for recording your findings, so you know which tasks have been monitored, the ratio of correct vs incorrect technique and any actions taken so you can track any emerging trends generally.
But does recording both correct and incorrect technique matter?
Of course it does, because it’s the changing relationship between the two which informs you whether your programme is actually working or not.
And while you’re at it, take a healthily sceptical view on any trend that suggests we never see anyone doing anything wrong here, ever. 100% compliance.
Sense-check that with your own observations and ask yourself if these two findings match up? My experience is that, invariably, they don’t. So now you’re realising the checkers aren’t doing their checks properly too -  another guaranteed route to programme failure.

The final piece of the jigsaw is keeping the momentum going and also dealing with the scenarios that you hadn’t planned for. There will always be new ways of doing things, new plant and new processes, new equipment and new tools, so your handling techniques need to keep up with that change.
So what are you going to do when you encounter something that’s outside of the norm? To avoid Universal Failure Mode #3:
  • Always plan ahead and think about how you’ll address the "known unknowns” – ie, the things that aren’t an issue today but there’s every chance something like that might happen. 
  • Think also about how you’ll stay abreast of latest technological best practice affecting your industry, accident trends and their avoidance, the civil scene and what’s happening with personal injury claims trends.
  • Think about how to keep the programme’s momentum going and look for ways that you can re-deliver similar messages differently, so people don’t get bored and switch off.
  • Programming in refresher training is a given, but think more creatively about how that’s going to be done without it becoming just another "elf n safety” course.
  • Don’t just focus on the emotional negatives of failure either, like accident statistics. Celebrate the positives, like the results which good auditing will undoubtedly deliver when done properly, especially when it’s reinforcing good behaviours.
  • Share that positivity with the employees – let’s face it, we all like to be associated with something that’s successful! 
  • But when it does go wrong and someone does get injured, make sure you include reference to their anatomical technique in the Investigation. Be prepared to challenge inconsistencies and only ever record facts – not presumptions or opinions.
To conclude, despite a backdrop of improving safety performance resulting in fewer workplace injuries, the ratio of MSD injuries, particularly back pain, remains far too high. The cycle of failure can be broken, but organisations need to devise management systems which:
  • Get the right information to employees once and for all, through task-specific training that is both technically fit for purpose and, through its delivery style, guarantees employee buy-in
  • Changes habits through simple but effective monitoring that cement buy-in at every level and
  • Keep the momentum going long-term by continually reinventing the programme and dealing with the new technical challenges that inevitably arise.

In my experience, organisations which consistently satisfy all three requirements see significant reductions in their manual handling risk profile, in their manual handling accidents, in the cost of those accidents and in their associated personal injury claims costs.