Historically, many have believed that the purchase of SPHM technology was synonymous with a SPHM program. Time has proven that this is not the case. Audrey Nelson and co-authors (2008) outline the following steps to success: administrative support, policies, procedures, technology, and training. Education and training are key elements to success.

Education is described as knowledge transfer and is essential to sustaining success over time. For example, in years past healthcare workers were told that heavy lifting led to issues of wear-and-tear injuries. Consider William, a healthcare worker who has lifted weights in his garage for 12 years. Although he was told that activities such as the dead lift or deep squats were damaging over time if too many repetitions were performed with excess weight, he was excited about body building, and lifted the maximum amount of weight possible for as many repetitions as his body allowed. Initially, William experienced
occasional neck and shoulder pain; today, he explains that he now experiences neck, shoulder, knee, and back pain more than 75% of the time. This discomfort interferes with his sleep and ability to enjoy the activities of everyday life. Anecdotally, healthcare workers, like William, knew that damage from wearandtear injuries over time was likely because after certain lifting tasks, the healthcare worker felt fatigue, discomfort, or pain. However, even more problematic is that some healthcare workers, like William, would perform what is now recognized as unsafe handling practices for years with little discomfort, until the damage was done—at which point the consequences became lifelong and severe. However, unlike William, James, a physical therapy assistant at a larger urban acute care hospital, explains that injuries can occur irrespective of one’s strength or appearance of strength. James, who is tall and muscular, explains that he is always the first person asked to help move a larger or heavier healthcare recipient, because he has the look of a very strong individual. He explains to other healthcare workers that technology is the first line of defense against injury when performing such tasks, and goes on to explain that if he hurt himself at work he would be unable to participate in the activities he enjoys outside of the work setting. James is a safe, healthy ambassador and champion for the SPHM program and serves as an unofficial trainer as well. The issue, historically, is that healthcare workers did not have evidence that fully described the manner in which cumulative and acute injuries develop.

Researchers now have science to help healthcare workers better understand the dangers inherent in manual handling activities. William Marras at Ohio State University explains that 75% of the time that the healthcare worker lifts more than 35 pounds, a microfracture occurs at the vertebral endplate (Marras, 2008). This microfracture is designed to heal completely, but will produce a small amount of scar tissue. Further, Tom Waters (1999) explains that the 35-pound limit is a maximum, especially when the task is performed under less favorable circumstances, such as: lifting with extended arms, lifting when near the floor, lifting when sitting or kneeling, lifting with one’s trunk twisted or with the load off to the side of one’s body, lifting with one hand, lifting in a restricted space, and lifting during a shift lasting longer than eight hours. The human body is not designed to lift more than 35 pounds repeatedly throughout the day, the year, or a lifetime, as occurs in the life of today’s healthcare worker. This science creates the foundation for education.

Training is described as skill acquisition, and differs from education in that it has a performance component. Some consider education as answering the “why” question, whereas training answers the “how” question. Skill acquisition
can occur in a classroom, at the bedside, or in a simulation center or learning lab. Proponents of the simulated experience argue that “Michael Jordan didn’t become a great free throw shooter by watching a video of someone else shoot free throws.” For this reason, the simulated experience is gaining popularity in SPHM efforts. For example, the Swedish Hospital System in Washington State has had a SPHM Learning Lab, with simulated opportunities, in place for at least five years. The lab is designed to allow healthcare workers to practice with technology in a safe environment. The Banner Health System currently has four learning labs throughout the Banner system. The largest (in Mesa, Arizona) is a converted hospital; this simulation center offers endless opportunities for skill acquisition.

The SPHM Simulation Center at the Immersion and Simulation Based Learning Center at Stanford University in Palo Alto, California, is managed in conjunction with Stanford Hospital and Clinics. This simulation center provides monitored classrooms and a “hands-on” experience. Dr. Gaba, Director of the simulation center, explains that simulation training is a technique, not a technology (Gaba, 2007). Simulation training is designed to replace or amplify real experiences. Interest in simulation training for health care emerged from the successful use of simulation training in nonmedical industries. Examples are commercial and private aviation, the military, and other industries that are hazardous and complex. In the SPHM simulation center, learners experience compatibility between technology, car extractions, and discipline-specific sling selection, which are some (but not all) of the skills also taught at the SPHM simulation center at Stanford. The value of this model is that education and training can occur concurrently. Further, an environment dedicated to simulated techniques allows mistakes to be made in a controlled setting, where issues can be mitigated prior to contact with the healthcare recipient and family members.

Regardless of the structure selected for education and training, it best serves the employer and the healthcare worker to partner in establishing an effective and meaningful system of education and training to maintain SPHM competence.