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Producing the evidence-base for complex assessment

Sheenagh OrchardRegistered member of National Back ExchangeRGN, RNT, CertEd, DN(London)

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2+Meeting complex need

Patients and Clients are presenting with a need for increasingly complex care management

Therapists and Risk Assessors decisions are being challenged particularly on the cost of complex managements

Imperative that meeting the individuals need is not compromised

How do we ensure the individuals need is central to the decision and demonstrate to clinicians and budget holders that our assessment is valid?

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3+Competent AssessorRequired by Law Management of

Health & Safety at Work Regulations 1999 (UK)

Every employer shall:

“appoint one or more competent persons…”

A person shall be regarded as competent where:

“they have sufficient training and experience or knowledge and other qualities to enable them properly to

undertake the measures …”06/06/2014

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4+Complex case assessment Requires a wider knowledge and

understanding of how to apply that knowledge effectively

Need to understand the law and its interpretation so as not to be swayed by ‘myth’ or ‘opinion’

Need to ensure managements are evidence-based demonstrating sound knowledge of: Best practice Biomechanics and normal movement Ergonomics and Equipment 06/06/2014

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5+Analysis and EvidenceMust be confident of our competencyMust be able to source and use evidence to

support our decisionsMust be able to produce our own evidence to

support our decisions e.g. use ergonomic assessment tools such as Borg, REBA.

Must be able to undertake analysis e.g. of equipment

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6+Positive Risk Taking This is nothing new – discussed in Health Care

in Later life 1996 Need to empower staff to think this way Hayes (1992) suggests ‘ the notion of risk as a

wager – assessing both losses and gains – would seem a more appropriate conception of risk’

Risk taking is a normal part of daily living at all stages of life

In order to experience maximum fulfilment in life and reach one’s potential it is necessary to take risks 06/06/2014

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7+Benefits For the individual include:

Increased emotional and physical independence Greater ability to make choices Increased confidence Regain and retain control over their lives within the

limits imposed by their physical and mental capacity For Social Care the benefit is mostly on cost

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Negative Outcomes Possibility of injury must not be ignored Each case must be considered individually and agreement

reached on the levels of risk, possible outcomes and possible injury

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8+Best Practice

How do you develop and evidence your own ‘Best Practice’?

The guides to the Handling of People are just that – Guides – Adaptation of standard practices is required if we are to meet some specific client need

How do you develop ‘variance practice’ and evidence it?

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9+An Example Use of REBA – postural analysis Borg – perceived exertion of carer Comfort Likert scale Activity Likert scale Benner – skill level of carer

E.g. to comply with MHOR 4(3) ..” the physical suitability of the employee to carry out the operations – their knowledge and skills …” Use of FIM to identify individuals

ability06/06/2014

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10+Assessment must take account of •Security & stability of individual•Body Mass Index ratio •Avoiding 2 tasks at once

The handling management can use 2 carersORErgonomically ‘design out’the issue to allow a single carer to safely undertake the management

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11+Equipment Require sufficient depth and breadth of knowledge to be

able to consider the ‘pros’ and ‘cons’ of every piece of equipment to be able to make sound choices for specific managements and individuals

Ability to analyse for ourselves not just accepting manufacturers claims

Make sound business case to demonstrate that cost of equipment can be off-set (e.g. reduced re-assessment, cost-effective use of carers

Does the equipment - • Utilise function and promote some independence• Reduce effort for the carer• Enable a single carer to complete a task

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12+Cost benefits of correct equipment

Time

Cost

Cost profile when using 2 carers to assist Service User

Cost profile when using 1 carer to assist Service User

Initial investment in equipment

Potential Benefit

The breakeven point will move dependant on whether new or second

user equipment is used

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13+Managements using a single carer This is one of the most topical complex case

management situations The framework just described can be used to

‘evidence’ the decision to use a single carer.Benefits to the individual - Improved dignity Less stressful and invasive, physically and socially. Improved flexibility in care routine. Empowering

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14+What ‘evidence’ supports the decisionBIOMECHANICAL – REBA Borg Considering Body Mass Index match

ERGONOMIC Training/Skill level/competence Risk Assessment Design

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15+The Framework Aiming to improve functional ability and

confidence The outcomes for the individual are key and a

balanced-decision making process must be used

Keep a ‘broad vision’ on equipment provision – providing even relatively high cost equipment has a cost benefit over provision of care

Involve all ‘interested parties’ but the individuals needs and opinions are central

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16+The Process Identify Broad Goals and the Desired Outcome Undertake an Activity Analysis – may use

ergonomic assessment tools such as FIM and identify what the ‘normal movement patterns’ are

Undertake a Task Analysis Identify the current difficulties for the individual in

achieving the task Set staged goals for the individual to progress

towards the Desired Outcome

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17+Task AnalysisTask analysis is the systematic analysis and recording of human work activity: Identify risk elements/factors/exposure Investigate usability and effectiveness of procedures Develop instructions/job aids Ensure the system will work and can be maintained Determine whether assistance required to meet

care/enablement needs

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18+Competent AssessorsDoes your knowledge/skill/experience

match the level of Risk Assessment you are undertaking?

Could you benefit from learning how to develop and apply evidence to support decisions?

Can you apply specific legislation to support your decisions?

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19+An Ergonomic systems approach to complex risk assessment in Health and Social Care

1 day Introduction workshop - Ethos5 day Advanced practitioner course

FacilitatorsJacqui Smith – Editor

Sheenagh Orchard – Contributing authorof

The Guide to the Handling of People 5th & 6th editionswww.angelbeck.co.uk or www.work-fit.co.uk

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20+References Michael V Hayes (1992) On the epistemology of risk: Language, logic and

social science Frances Heywood & Lynn Taylor (2007).  Better Outcomes, Lower costs.

 Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence.  Office for Disability Issues.

Jennifer Hurstfield, Urvashi Parashar and Kerry Schofield (2007).  The Costs and Benefits of Independent Living. Office for Disability Issues

HSE (1999) Management of Health & Safety at Work Regulations 1999, (2nd edition) Norwich: HMSO.

HSE (2004) Manual Handling Operations Regulations 1992 (as amended) (3rd edition) Norwich: HMSO

Smith, J (ed) (2005) The Guide to the Handling of People 5th ed 2005, BackCare Smith, J (ed) (2011) The Guide to the Handling of People 6th ed 2011, BackCare

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