Article By: Mark Williams, AWARE-NS Safety Collaborator

The Problem

In 2012 The Worker’s Compensation Board (WCB) presented to the DHA’s/IWK a problem. In essence the problem can be described something like this:
80% of time loss claims, in Healthcare, reported to the WCB are strains and sprains (AKA musculoskeletal injuries [MSIs], repetitive strain injuries [RSIs], cumulative trauma injuries [CMIs] and soft tissue injuries [STIs]). Of those about half are associated with patient handling activities.
The cost to the system is multiple millions of dollars and the human costs are incalculable (how do you quantify an injured employee being unable to lift their child when they are home?)
A partnership was formed with AWARE-NS, the DHAs/IWK, and the WCB to commit resources to solving this problem. A group of senior executives and injury prevention experts were pulled together to create a plan to address the problem of strains and sprains in healthcare. Since that time, more partners have stepped up to the challenge including the Department of Health and Wellness, Health Human Resources Sector Council and Department of Labour and Advanced Education.

The Solution

All partners involved agreed continuing with the status quo would not solve the identified problem and the underlying factors contributing to the injury rates would take a significant change in current practices. A working group was formed and, despite a few changes in membership, focus has been maintained on the mandate. This focus comes largely from the passion and expertise of the working group members, but also from early work facilitated by co-sponsors of the initiative, Sheila Rankin (AVH) and Steve Ashton (IWK), in which guiding principles for the strategy were created. The guiding principles agreed upon were collaboration, integration, evidence based, sustainability, concurrent activities, and people centred/cost effective/resource wise.

A Strategy In Motion

With the nature of the changes required in the sector, organizations, and individuals to solve the problem of strains and sprains it was always clear that engagement of the folks most impacted is critical. This focus on engagement weaves the other 6 guiding principles together and is considered in every action taken by the working group.
The healthcare sector is large and complex, a highly regulated environment with a mixture of organizations that interconnect to varying degrees. To define the problem of strains and sprains into manageable pieces the working group has divided up the problem. The intention continues to be to progress through the pieces systematically, passing along lessons learned, at each step.

What will Soteria – Strains, the first Soteria project in the strategy, look like?

The Soteria working group has identified 2 major deliverables to provide to the partner organizations.

  1. A Program Guide– this will include elements shown to be effective in published literature as well as elements identified as helpful or required based on what was heard during engagement sessions with the individuals who manage and do the work of assisting patients to move. This will also include supporting materials and direction to resources such as training material.
  2. An Implementation/Sustainability Guide – This will include information on successfully implementing the program and sustaining it.

The Program Guide could be considered the meat of the program or the ideal state. The implementation guide is a map of how to get to that ideal state. Currently the focus is on the DHA’s/IWK and lessons learned will be shared with long term and home care.
Visit the Soteria website to learn more about this exciting project!

About The Author

Mark Williams, Physiotherapist, is currently the Project Leader for Soteria Strains, a provincial injury prevention strategy for Nova Scotia healthcare. Mark was seconded from Capital Health’s Injury Prevention team in March of 2013 to his current role. Prior to his two and a half years as Capital Health’s Injury Prevention Consultant Mark spent nearly a decade working in various private practice Physiotherapy settings including Team Leader for CBI Physiotherapy and Clinic Administrator (Manager) for HealthSouth, at the time the largest health care provider in the United States. He has always enjoyed integrating injury prevention consulting work with his busy practice and often speaks of his gratitude for the recent opportunities to focus on this important work fully. Mark has consulted with various organizations including the Halifax Shipyards, Department of Natural Resources and the Nova Scotia Truckers Safety Association.


Soteria LogoNova Scotia’s District Health Authorities and the IWK, Workers Compensation Board of Nova Scotia, and AWARE-NS, the Nova Scotia Health and Community Services Safety Association have partnered on this shared agenda for change. This work has the potential to improve safety within the health system and we believe it will significantly improve the health and well-being of health care workers. This partnership helps all to work in collaboration to support the goal of lowering workplace injuries in health care, helping to ensure more people return home safely at the end of each workday. A safe environment for our workers helps ensure a safe environment for patients, clients, residents, and their families – it benefits us all.
In Greek mythology, Soteria was the Goddess of safety and preservation from harm. Soteria strategies will be focused on improving our culture in healthcare—promoting a culture of safety and well-being for all.
Soteria Strains is focused on musculoskeletal injury prevention (strains and sprains). In 2011, almost 80 percent of all time loss claims reported to the Workers’ Compensation Board of Nova Scotia (WCB) by health care workers were musculoskeletal injuries (Strains) and more than 50% of these Strains were the linked to some type of manual lift or transfer task (WCB NS, April 2011).

NEW Documentation

The Soteria Strains Working Group has released two new research reports that were prepared by the Nova Scotia health Research Foundation on their behalf.
Musculoskeletal Injury Tracking and Prevention – Jurisdictional Review: Key Informant Interview Analysis
Musculoskeletal Injury Tracking and Prevention – Jurisdictional Review: Literature Review

Perception Survey

Pink CrossOne goal of Soteria Strains is to define a baseline for the cultural environment and possible opportunities and barriers to the success and sustainability of the project. A Perception Survey has been created with this goal in mind. The purpose of the Soteria perception survey is to assist in identifying barriers and drivers for safe lift, transfer and repositioning activities.
A thorough review of current evidence based practice identified eleven key elements to successful safe patient lifting, transferring and repositioning programs. This evidence guided the selection of categories and specific items for the perception survey. For example, evidence based practice clearly supports the use of lift equipment, therefore there are items to identify beliefs, attitudes, and reported behaviours towards various aspects of equipment use. The Survey is designed to be administered in 15-20 minutes in either an online or paper format.
Healthcare Professionals – Take Survey


Green CrossOur Soteria Strains Provincial Working Group did an amazing amount of research to bolster the front end of this strategy. This work is presented in two informative white papers below.
These are great resources and enough for most to consider themselves armed and ready to rollout a province wide health work place injury prevention program. But, not Soteria Strains. The Soteria strategy values the voice of the health care workers and patients most impacted by such a program. With research in hand, we are now asking the people that matter about their needs and what they think will make a successful patient handling (any activity that is involved with moving or assisting patients such as lifts, transfers, turns and repositions) program.
Evidence Based Practices
Business Case Rationale
Learn More