Empowering competence

In these austere times, it is imperative to re-evaluate how mandatory training is delivered. There needs to be reductions in the number of hours front line staff are away from the workplace and often managers turn to e-learning as a solution. However, for practical skills requiring physical practice, such as manual handling, this will not suffice. 

Staff need to demonstrate that they have attained the manual handling principles of safe practice including: recognition or risk, posture, safe systems of work/techniques for handling patients and objects, and making use of available local equipment. Managers need to ensure staff are committed to maintaining and improving health and safety culture within the workplace, and competent to practice.

Health care workers are considered a high risk group for musculoskeletal injury. Managers often see training as a health and safety risk control strategy, but current classroom-based training does not guarantee that skills are transferred from the classroom to the workplace; a change to scenario-based training sessions has been found to be more effective in reducing awkward postures. 

Health care organisations need to individualise training and nursing competencies to provide relevant content. At the same time, it is impractical to have lots of techniques for different manual handling situations; therefore, the principles of good practice should be taught so that staff can develop safe ways of working.

The key to reducing refresher training frequency and duration, and identifying competency gaps in individuals and then close the gaps, is in assessing practical competencies for the role for which they are employed. Trainers could provide, as agreed with managers, competency assurance assessments for clinical and non-clinical staff. This provides the evidence that staff and patients are using and/or receiving safe handling in the workplace and identifies those staff who should come back for further training with assessment.

Currently in the UK, the manual handling training which is provided varies between health organisations in terms of how and where it is delivered, duration per session, the techniques used and the frequency with which updates are required. Organisations such as the National Back Exchange imply that updates are required yearly; however NHS Employers need to follow the legal requirements for providing training and updates to ensure staff are competent, as set out in:

• The Management of Health and Safety at Work regulations 1999,
• The Health and Social Care Act 2008 (Regulated Activities) Regulations (2009), and
• The Manual Handling Operation Regulations 1992. 

There are no instructions for how often the training should be repeated or how it should be delivered so it is therefore up to individual organisations to produce their own training needs matrixes. 

The Nursing and Midwifery Council (2008) and the Chartered Society of Physiotherapy (2008) offer no clarification on frequency for training updates for manual handling training. The National Health Service Litigation Authority requires that there is a competent and capable workforce, and there is opportunity here for healthcare organisations to reduce the time delegates spend in training without compromising safety and legal requirements. 

In 2010 I proposed a Competency Assurance Assessment scheme (CAA) as an alternative method to classroom- based training within my trust, which would check that all staff were competent in manual handling. The scheme was agreed, piloted and then implemented, along with other changes to the manual handling training programmes with estimated cost savings of over £30,000 a year and workforce savings of 1,800 hours in staff time. 

The training updates prior to CAA consisted of techniques being demonstrated and delegates repeating them, which shows that delegates can copy and are aware of the safe systems of work. However, we had no evidence that the techniques and principles of safer handling were transferred to the workplace, or that employees remained competent. The current recording on electronic staff records shows attendance for training and this does not currently include an indication that the employee has achieved competent levels for their job role.

Within my trust there is no link-nurse scheme for manual handling. This scheme did exist in the past and is in operation within some NHS organisations, but sending link workers for training and then expecting them to train staff in all the core wards techniques in the workplace can be time consuming - along with keeping the documentation records. 

Most health care organisations employ small numbers of manual handling advisors. I have managed to provide a competency assurance framework alongside some more traditional training now, with scenarios to cover the 5,000 employees (approximately) who are in the organisation.

My manual handling training system did require all employees to come for practical sessions with the training department. This was repeated every two years for clinical employees and every three years for non-clinical employees. The proposed manual handling competency assurance system includes changes to scenario-based competency tests, which alternate with the practical training sessions to update. This means clinical staff will return for a test at two years and then training at four years if competent. Non-clinical staff will return for test at three years and training in six years. 

It is important that the competency framework will highlight areas of weakness. Delegates who fail in one competency task on testing can often be trained up after the group CAA, with the trainer. The trainer needs to have experience and a flexible approach towards delegates, as rarely will every delegate be fully competent on assessment. The trainer may need to correct posture and then see that posture is maintained throughout the assessment. 

Often the trainer will need to assess the safety of the delegate and if it is really necessary for the delegate to return for full theory and practical training. However, the trainer may need to recommend to the delegate’s manager a return for the refresher update training with scenarios. During the past year date this has only been recommended for three delegates. 

Observable behaviour of posture, communication and staff selecting appropriate equipment or manual techniques indicates that the manual handling policy and training is proving to be effective.

During the past year, staff manual handling injuries have remained low. A follow up study (which included theory and practical demonstration) on nursing staff delegates who have attended CAA, and those who attended an update session reveals similar retention of knowledge and skills with regards to moving and handling.  

The benefits of introducing CAA:

• Clarity to staff and the trust organisation, aims and objectives for staff competencies and training requirements.
• Identifies competency gaps, needing to be addressed.
• Demonstrates that staff transfers skills from the classroom to the workplace.
• Training the non-competent leads to savings in time and costs.
• Evidence of, the use of correct posture and techniques for moving and handling assures the trust managers that they have a competent skilled workforce.

Including competence assurance frameworks for training provides evidence that Healthcare organisations have a competent workforce. It helps identify who needs the training and how often employees require training or competency testing, which therefore decreases the time staff spend away from the workplace. The inclusion of CAA ensures the trust is meeting requirements to comply with legislation and recognised standards. 

Competency Assurance Assessments could be used for other mandatory training updates where e-learning is inappropriate and represent an alternative way of training which gives value for money in a changing health care environment.

Sharon Ebel is lead manual handing advisor at Royal Berkshire Foundation Trust.