The impact of national guidelines covering moving and handling of people on injury rates and related costs.

Objective National guidelines for moving and handling of people (MHP) were introduced in New Zealand in 2012 to reduce MHP-related injuries in the healthcare sector. This study assessed the effectiveness of this on MHP-related injury claims. Methods MHP-related injury claims were identified from the national injury claims database, which included 118 755 accepted claims for 2005-2016 across 14 industries. Interrupted time-series analysis was used to assess temporal changes in MHP-related claims rates, costs, and causes for the period before (2005-2012) and following (2013-2016) the introduction of the national guidelines. Results Prior to the introduction of the guidelines, MHP-related claims were estimated to be 39 209 (33.0% of all accepted injury claims), with claims rates and associated costs for the 14 industries decreasing by 0.4 [95% confidence interval (CI) -0.5‒ -0.2, P<0.001] and NZ$ 230 per claim (95% CI -324‒ -136, P=0.001) respectively. In the year following the introduction of the guidelines, there were no overall changes in claim rates or costs. However, significant increases in claim rates [ranging from 1.27-1.99 (P=0.004-0.010)] and claim costs [ranging from NZ$ 724-987 per claim (P=0.032-0.045)] were found 2-4 years later. More than 65% of all MHP-related claims were caused by lifting/carrying/strain, and there was a significant increase in claim numbers due to this cause, ranging from 431.7-594.0 (P=0.001-0.008) in the four years following the introduction of the guidelines. Conclusions The introduction of national MHP-guidelines in 2012 in New Zealand did not reduce MHP-related injury rates and costs. On the contrary, there were statistically significant increases 2-4 years after introduction of the guidelines.

How was a national moving and handling people guideline intended to work? The underlying programme theory.

In healthcare, moving and handling people (MHP) often cause musculoskeletal disorders. To prevent musculoskeletal disorders due to MHP, many national evidence-based guidelines have been developed. However, little is known about how these guidelines were intended to work, i.e. their 'programme theory', how implementation by intended users is influenced by contextual factors and mechanisms to produce outcomes. This paper identifies the programme theory of a national MHP guideline (MHPG) using thematic analysis of the MHPG document, three organisational planning documents, and interviews with MHPG developers. The analysis identified the intended users of the MHPG as health and safety managers and MHP coordinators. The programme theory comprised contextual factors, potentially hindering (e.g. budget constraints) or facilitating (e.g. changing demographics) implementation, being influenced by mechanisms mainly based on ethical (quality of care, evidence-based practices), and economic reasoning (reducing cost of MHP, return on investment) to reduce injuries caused by MHP - the intended outcome.