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Although significant improvements can be seen, occupational back pain remains to be a problem for nurses working in health care. In Dutch health care ergonomic changes are stimulated by means of national Guidelines for Practice in health care. All sorts of additional implementation strategies have been undertaken to ensure permanent change. In short: the approach is successful but a lot of lessons were learned and still are being learned. We will present a brief overview of the developments and the effects of the national approach in The Netherlands over the past 15 years.  The main successes, failures, missed opportunities and unexpected winners  will be presented in an interactive way.  An outline will be presented of  the roles and responsibilities taken up by employers, unions, managers, insurance companies and the government. Also we will discuss the relation of our guidelines with the ISO TR 2012 on the Handling of Patients.

Peer leaders or ErgoCoaches

To facilitate the implementation of the guidelines on the work floor itself, peer leaders or ErgoCoaches, were appointed. These nurses or nursing aids have received additional training and have, in addition to their normal nursing work (90-100% of their working hours), a special responsibility to stimulate safe work practices among their colleagues.

Currently over 16.000 are registered and their development has been studied over a period of 12 years  by means of regular surveys and by two more in depth studies. The overall results of these three studies are presented in interaction with the audience, by means of statements and a simplified e-learning style. This intends to facilitate the audience to pick up the relevant issues for their own situation.

In short the results show gradual changes towards a more efficient and potentially more effective model of peer leadership. In addition to that a slow but steady shift can be seen from ErgoCoaches acting mainly as ‘change agents’ with a short term focus towards a role as long term ‘guardians’ to sustain and stabilize safe working routines.

So far there does not appear to be an independent, stand-alone effect of ErgoCoaches, but as part of  a comprehensive program there is evidence that they reinforce and consolidate the positive effects of ergonomic programs mainly by motivating nurses and promoting the use of protocols in patient care plans. Nonetheless the yearly surveys among ErgoCoaches also point to a lack of training, expertise and time for ErgoCoaches to perform the activities that are expected of them.

Behavioural change

As the study into the effects of the ergonomic approach and the effects of Ergocoaches pointed to the extreme importance of motivation and behavioural change a separate implementation line was developed: the Voilà-Method. To support Ergocoaches they have been offered training in this Voilà-Method. In short:  it stimulates behavioural change among careworkers, creates a positive social norm, promotes commitment and stimulates careworkers to take responsibility for solutions, find new solutions and enable permanent change. Evaluations of this method are positive both for short term and long term change. One of the advantages is that it demands very little nursing time. It makes use of three simple but effective cornerstones: the ‘huddle’, the ‘actionbloc’ and monitoring. A brief outline will be presented and a separate workshop with a more in depth presentation is also offered.

Managerial challenge: the businesscase

The long term and short term managerial challenge is, no doubt, to find an optimum model of ErgoCoaches with a balance between the costs of having and maintaining a group of ErgoCoaches and their contribution to an effective ergonomic policy. A interactive businesscase (Excel module) with this purpose was developed to assist managers in making these choices as the optimum may differ between health care sectors and facilities and the implementation stage they are in. The businesscase is used to simulate the implications of the choices managers make.