Ceiling Lifts: the BC Experience

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Tuesday, November 16, 2004

Operator: Good afternoon, ladies and gentlemen. Welcome to the Overhead Lift BC Experience Conference Call. I would now like to turn the meeting over to Ms. Jo-Anne Hurd. Please go ahead, Ms. Hurd.

Jo-Anne Hurd: Good morning. My name is Jo-Anne Hurd. I am the Northeast Consultant with the Ontario Safety Association for Community and Healthcare of Ontario. On behalf of the Health Care Health and Safety Association, I'd like to thank and welcome all the participants for attending today. Today our presentation is Overhead Lifts and the BC Experience. Following the presentation of our speakers, we invite you stay on the line for a question and answer period. Please note that the question and answer period is on a limited time, so if time runs out and your question is not addressed, please stay on the line and the operator will take your information.

Before introducing our speakers, I'll take a few minutes and reminders for the audience. First, please try to eliminate all background noise or discussion during your call, as this will affect audio quality. Come to the microphone if you're in a large room so that everyone will be able to hear you. Turn off all your pagers and cell phones. And finally, if your building has a PA system, turn it down or turn it off if possible. I would like to point out at this time that this teleconference is related to British Columbia's proactive activity and health care sector.

OK, our speakers today are Patti Boucher, Aaron Miller and Michael Paine. Patti Boucher is the Niagara Regional Field Consultant with the Ontario Safety Association for Community and Healthcare. Patti has over 27 years of nursing experience, 18 of which have been in the field of occupational health and safety. She is also a certified, a Occupational and Health Nurse, a Canadian Registered Safety Professional, and Certified Disability Management Professional. Patti is currently working on a Masters program in health care management. Patti will present a brief update of OSACH's current involvement with regards to overhead lifts.

Aaron Miller is an ergonomics project coordinator within the ergonomics program at Occupational Health and Safety Agency for Health Care in British Columbia. He has a kinesiology degree from Simon Fraser University, with a specialization in ergonomics, and is an associate ergonomist through the Canadian College for Certification of Professional Ergonomists. Aaron's responsibilities include project management on numerous OHSAH partnership initiatives with stakeholders across the province. His primary areas of focus have been program and project evaluation surrounding the No Manual Lift policy in British Columbia, and health care facility design. Aaron's presentation will examine the prevalence of musculoskeletal disorders in health care, and the range of factors that led to the introduction of ceiling lifts in the BC health care sector. OHSAH evaluated the effectiveness and cost benefit of ceiling lift installations at three sites across the province, the results of which will be presented.

Our last speaker, Michael Paine, is the Manager of Industry Services, Health Care and Government at the Workers Compensation Board of BC. His role is to support industry associations in the delivery of occupational health and safety services, and to lead provincial initiatives. Prior to joining the WCB in 2000, Michael held managerial roles in human resources and occupational health and safety in health care and manufacturing sectors.

Patti Boucher: Hello, my name is Patti Boucher, and I'm just going to give you a brief overview of the initiatives in Ontario to date. And Ontario Safety Association for Community and Healthcare has been working hard at communicating what's been going on in British Columbia and Quebec in trying to spearhead initiatives here in Ontario towards reducing our lost time injuries rates in the health care sector.

In the Ontario health care sector there is an urgent need to reduce the incidence, severity and costs associated with workplace injuries. As you well are aware, musculoskeletal disorders are the most frequently reported types of injury, accounting for approximately 54% of all lost time injuries in the health care sector in 2003. Forty percent of these lost time injuries are actually directly attributed to client handling activities. And to date there have been very few musculoskeletal disorder prevention initiatives that have emerged and been sustained in Ontario's health care sector. Other provinces, such as British Columbia and Quebec, actually lead the way in the reduction of client handling related musculoskeletal disorders.

Ontario Health Care workplaces must move forward in adopting musculoskeletal disorder prevention initiatives. And the Ontario Safety Association for Community and Healthcare has recognized that the prevention of musculoskeletal disorders due to client handling requires adequate mechanical lift equipment coupled with a comprehensive program approach. This is highlighted in a new resource document that is now available through Ontario Safety Association for Community and Healthcare, entitled, 'A Planning Guide for the Selection and Implementation of Client Mechanical Lifts.' This is available free of charge, so that you can download it from our web site. This document is intended to guide organizations in their selection and installation of client mechanical lifts. And it also provides information to assist in the development of an action plan and implementation strategy to establish a safe client handling program for staff and for your clients and residents.

Organizations can invest all the money into equipment; however, unless they adopt a comprehensive program that supports that equipment, a reduction in client handling injuries will not be achieved. In addition, Ontario Safety Association for Community and Healthcare strongly encourages organizations to use the 'OSACH Handle with Care' resource document to guide them in the development and implementation of a program. This document is also available free of charge through our web site. Thanks, Jo-Anne.

Jo-Anne Hurd: Alright. Thanks, Patti. And now we'll leave it to Aaron.

Aaron Miller: OK. Good afternoon. My name is Aaron Miller, and I am an ergonomics project coordinator with the Occupational Health and Safety Agency for Health Care in BC. Today I wold like to discuss how using a joint union-management approach, as well as strong evidence-based approach, to effectively implement ceiling lift solutions in the BC health care industry has improved workplace health and safety. For the next 20 minutes I will be providing an overview of OHSAH and our mission, and outlining the statistics in health care, both Canada-wide and specific to BC; an overview of the problems of manual patient handling; BC's approach to patient handling; and finally, OHSAH's ceiling lift research, our past as well as current research in ceiling lifts, and how we can make patient handling a lot easier.

During the 1998 collective bargaining, in response to skyrocketing injury rates and increasing costs, the union and Ministry of Health agreed to turn the focus of their efforts onto the occupational health and safety of the workers. I bipartite agency, which holds both union and management representation on its board of directors, was created to remove workplace safety issues from the bargaining table. OHSAH was created to reduce workplace injuries and illnesses in health care workers, and to return injured workers back to the job quickly and safety. It was seen as a synthesis between research and decision making, the goal being the collaborative identification of evidence-based best practices.

OHSAH's mission is to work with all members of the health care industry to develop guidelines and programs designed to promote better health and safety practices, and safe early return to work; to promote pilot programs and facilitate the sharing of these best practices; and to develop new measures to assess the effectiveness of programs and innovations in this area.

So before getting into the specific initiatives to reduce the injury rates due to patient handling in health care, I'd like to briefly discuss the statistics that show evidence of a need for these initiatives. When examining the provincial injury rate from '96 to 2002, the nature of health care work across the country is somewhat consistent, and it raises a question of what accounts for the discrepancies in injury rates province by province. While it is tempting to suggest that the rates are indicative solely of prevention initiatives, consideration must also be given to the provincial differences in tracking, supporting, claim adjudication criteria, as well as differences in policy.

As you can see from this graph, the national trend closely follows the trend of Ontario, which is not surprising, as you hold over one-third of the national workforce in health care.

Within British Columbia the provincial injury rate has decreased 27% since 1998. Annual days lost per 100 full-time equivalent workers have decreased 38% since 1999. This has saved over 100,000 days otherwise lost from work. The stabilization and ultimate decline of the BC injury rate appears to be the result of collaborative stakeholder efforts and the implementation of health and safety interventions, such as the establishment of OHSAH, our provincial No Lift policy, which I'll be talking about later, as well as ceiling lift installation.

From this graph, which I've not presented on… from 2003, the provincial injury rate was 3.6, and the projected injury rate is 3.3. Michael Paine will be talking about this later in his presentation.

When looking at health care in BC, the health care industry is the number one source of time lost claims in BC, accounting for 9.4% of days lost in 2003. This was higher than logging, manufacturing and transportation.

When examining the BC health care history, between '97 and 2001 the management and delivery of health care services in the province had been the responsibility of 52 separate health councils, each of them having their own CEO and board. In December 2001 the 52 health councils merged to form a new governance and management structure with five regional health authorities that govern, plan and coordinate services regionally, and one provincial health service authority that coordinates provincial programs and specialized services. This new structure made it easier to design, implement and evaluate occupational health and safety interventions.

Health care in BC is comprised of four major unions: the BC Nurses' Union, the Hospital Employees' Union, the Health Sciences Association, and the BC Government Employees' Union; and one employer, the Health Employers' Association of BC. By the end of 2003 there were 114,000 health care workers in the province, with the average age of 43 years. Nearly one-third of all registered nurses in Canada is aged 50 years or older.

Next I would like to discuss the need for safe patient handling. The lifetime prevalence rates of back pain of greater than 70% have been reported in health care workers. Higher incident rates of MSI have been observed in health care workers compared to other occupational groups; and many of the work-related factors that initiate the occurrence of MSI and other health injuries include the relationship between a physical work load and a high prevalence for low back pain. Back injuries have been a significant problem for those nurses providing direct patient care and nurses who frequently have direct physical contact with patients have been shown to have a higher incidence of back injuries than those who work with patients infrequently. The lifting and transferring of patients from one destination to another is believed to be the most frequent precipitating factor or causes of low back pain.

Bringing us back to British Columbia, if you look at the breakdown of the types of injuries reported by health care workers between 1994 and 1998, overexertion from patient handling is by far the greatest cause of injury, at 38%. This showed a need for safer patient handling throughout the province.

In recent years many researchers and health and safety practitioners have advocated replacing manual patient handling techniques and mechanical floor lifts with ceiling lifts. Ceiling lifts are ceiling-mounted lifting devices that consist of a ceiling-mounted track, an electric motor and patient sling. They can be configured in numerous arrangements to accommodate many beds within a single room, and possibly multiple rooms. There are generally two types of ceiling lift motors: portable and fixed. Portable motors are easily detached from ceiling lift tracks, whereas fixed motors are not. The advantages of ceiling lifts over conventional floor lifts are that they're easy to use and manœuvre, there's less space required to operate, there's no storage requirement, they're less obtrusive for patients, and probably most importantly, they're always available for use.

Next I would like to describe BC's approach to patient handling. Starting in 2001, BC took a hard line approach to preventing patient handling injuries, which consisted of a provincial No Unsafe Lifting Memorandum of Understanding, a funding framework consisting of $21 million over the last three years to support the safe patient handling program, the formation of an overhead ceiling lift committee, and the creation of ceiling lift program materials.

The first step in reducing patient handling injuries occurred in March 2001 with the signing of a Memorandum of Understanding between the health employers and the association of unions, which stated that the employer will make every reasonable effort to ensure the provision of sufficiently trained staff and appropriate equipment at all times and avoid the need to manually lift patients when unsafe to do so.

Once the Memorandum was signed, the next step was the formation of an overhead ceiling lift committee, which oversaw the development of program materials and the development of a ceiling lift funding framework. This committee had representation from the BC Ministry of Health, the Health Employers' Association of BC, OHSAH, the WCB of BC, management representatives from each of the health authorities, and finally, representation from each of the unions.

In May 2001 the Ministry of Health and WCB indicated their willingness to participate in the funding of a program to support lifting devices. The Ministry provided $15 million to support ceiling lifts and electric bed installations, and the WCB of BC provided an additional $6 million to support the implementation of elements of a No Manual Lift patient handling program. These funds from the WCB were provided as a targeted rebate from the acute care surplus.

Now that the Memorandum had been signed and the funding become available, there needed to be a program for the implementation of supportive ceiling lift initiatives. Part of this was the development of a patient ceiling lift program in 2001 involving OHSAH and the various health authorities. The core elements of this program involve resources on planning, resource allocation, implementation and reporting, and a management model consisting of design and budgeting, determining the configuration of the ceiling lift system, how to put ceiling lift policies in place, and how to research and report on the results. The budget algorithm was an important step for the facilities to determine the capital costs of ceiling lift installations. Ceiling lifts should only be implemented where a significant risk of MSI due to patient handling is present. Therefore many of the initial ceiling lift installations in BC occurred in the long-term and extended care sector. Currently many of the acute care beds throughout the province are beginning to have ceiling lifts installed over them.

It is important for facilities and health authorities to determine the configuration of ceiling lift systems. A participatory approach is paramount to create user buy in and ensure a user-centred approach. The involvement of many potential users in the process for determining the configuration of ceiling lift systems from the beginning reduces the likelihood of problems later on, and makes it easier to address any problems that do happen to come up. The effectiveness of these programs is due to the strong support of everyone involved. Therefore it is best to involve front-line care staff, supervisors, clinical resource specialists, engineers, ergonomists, and health and safety representatives, and representation from rehabilitation therapy. This group should work together to select the appropriate equipment as well as determine the configurations of the ceiling lifts within specific departments as well as facilities.

The next step is for facilities to create policies and procedures for the use of ceiling lifts. This involves rules and procedures surrounding the lift, of when and how to use the lift, education and training consisting of how to use the lift, what staff have been trained, what staff and how frequently they have been trained and when the next training is to occur, and maintenance of equipment containing a maintenance log of how frequently the equipment has been maintained. In many facilities in BC this information is kept in a reference binder on the floor in a nursing station to be readily accessible for everyone.

Finally, and most importantly as part of our ceiling program, is the documentation reporting on the results. This documentation includes maintenance and availability reports for the lift, the amount of education and training provided, and how frequently the lifts are being used, as well as cost reports: costs listing the installation costs for the lift, costs for training and education per worker, as well as costs for maintenance and upkeep for the ceiling lifts. And finally, in terms of reporting, looking at injury and incidence reporting, looking at the impact the ceiling lifts have had on patient handling risks, and to see any changes in these risk factors and the need for more ceiling lifts to be put into a department and to refocus areas of need.

Now I'd like to discuss the research OHSAH has conducted on ceiling lifts throughout the province. In 1998 the WCB of BC funded the installation of 65 bed ceiling lifts at St. Joseph's General Hospital in Comox, BC. OHSAH was approached in the spring of '99 to conduct an evaluation of the ceiling project. In previous evaluations, information on the effectiveness of ceiling lifts was sparse. The purpose of the evaluation was to determine whether the ceiling lift system would lead to a decrease in MSI injuries among staff, and whether it produced economic benefits greater than the cost of the intervention.

This was the first evaluation of its kind in BC, and was also the catalyst to many of the events such as the Memorandum of Understanding and the funding framework that have happened with patient handling since. The original evaluation in 2000 was very favourable, showing a 58% reduction in MSI rates associated with patient handling, and a 69% reduction in claims costs. The follow-up evaluation was conducted in 2002, which included three years of pre-intervention data that had not been available during the initial evaluation, to offer a comprehensive, seven-year analysis from '95 to 2001. The results of this evaluation, as you can see from the slide, showed a 40% decrease in compensation costs, and an 82.9% reduction in lost hours for lift and transfer injuries. With the results from the study, it was determined that the estimated payback period for ceiling lift installation was from between 0.82 and 2.5 years. This follow-up evaluation has been accepted for publication in Applied Ergonomics.

Since the St. Joseph's study, OHSAH has funded and evaluated the effectiveness and cost benefit of ceiling lifts in a variety of settings, including a fixed ceiling lift study at an extended care unit in Saanich Peninsula Hospital in which 71% of staff preferred ceiling lifts for lifts and transfers, and 84.7% of staff found ceiling lifts to be safe and effective.

The second study was conducted in the 63-bed Fairhaven United Church home, in which facility construction included the installation of ceiling lift tracks over all of the beds, and ten portable ceiling lift motors to be shared throughout the facility. Seventy-five percent of direct care staff ranked ceiling lifts as their most preferred method for resident transfers, and 81% of staff found that they made lifting and transferring residents easier.

Our third study was an examination of portable ceiling lifts in an eight-bed nuclear medicine unit at Royal Columbia and Burnaby Hospital. Eighty-eight percent of staff reported that their jobs were easier to perform with the installation of the lifts, and there was reduced discomfort associated with ceiling lift use. Again, each of these studies showed extremely positive results for the installation of ceiling lifts.

Since the development of the Patient Handling Ceiling Lift Program in 2001, many things have changed in relation to safe patient handling research, and OHSAH's continuing to work with stakeholders to develop evidence-based initiatives to mould(?) best practices throughout the province. This includes our current patient handling consensus initiative, which is to develop harmonized, evolving best practices for safe patient handling in acute, residential and community care that would be supported by the health authorities and the universities and colleges that train health care workers, that is based on consensus from key professionals throughout the province, scientific evidence, as well as support from the WCB, OHSAH and the unions. This will lead to recommendations for consistent professional and academic training based on this guidance, and will lead to improved effectiveness, injury reduction, and patient outcomes. This has already been proven effective in the interior of British Columbia, where the Interior Health Authority and the Okanagan University College have been working together for the past five years to develop their curriculum.

Some of the other patient handling initiatives currently being conducted at OHSAH is a biomechanical study of repositioning tasks, and an authority-wide cost-benefit analysis.

OHSAH is currently examining the development of a method for quantifying biomechanical risk factors associated with repositioning. Such methods, which are used to evaluate the risk of injury to patient handling tasks, is not well-established, and there is little scientific literature available that compares biomechanical lifts between manual and mechanical methods of patient handling. As mentioned earlier, repositioning injuries have remained high, despite the installation of overhead ceiling lifts, because ceiling lifts have not been easily used for repositioning. This study will hopefully provide information to better streamline and understand the use of ceiling lifts for repositioning.

The second project we are currently conducting is an evaluation of the economic impacts, injury trends and quality of life for employees due to ceiling lift installations in the Interior Health Authority. This project's objective is to determine the cost-benefits ceiling lifts have had in 30 residential care facilities based on the direct care injury data from '98 to 2003, and ceiling lift installation costs from each facility.

So as a summary of what has been accomplished primarily as a result of the St. Joseph's study, it's evidence-based research on the effectiveness of ceiling lifts and reducing injuries to care givers throughout the province. OHSAH is collaborating along with the Ministry of Health Services, who has provided $15 million for lifting equipment which was available by a grant and request for the BC health care facilities; the signing of a Memorandum of Understanding; the WCB of BC providing $6 million for the purchase of ceiling lifts; and OHSAH disseminating program materials to eight health authorities on ceiling lift process. Currently we are updating our ceiling lift implementation guide from 2001, and it should be available in early 2005.

I would like to thank everyone in Ontario for having me today, and I turn you over to Jo Anne.

Jo-Anne Hurd: Thank you very much, Aaron.

Aaron Miller: Thank you.

Jo-Anne Hurd: Now I'd like to introduce Michael Paine. Michael?

Michael Paine: Thank you. My name is Michael Paine, and I'm the Manager for Industry and Labour Services, Health Care and Government at the Workers Compensation Board. The mission of the Workers Compensation Board in BC is workers and workplaces safe and secure from injuries and disease. What makes us unique in BC compared to some of the other jurisdictions is that we not only have responsibility for worker claims, but also we have a prevention mandate. We are also responsible for the WCB regulations and enforcement within the province.

My presentation today will cover six specific areas: a WCB prevention overview; I'll elaborate somewhat on some additional health care statistics beyond what Aaron has provided; I'll speak specifically to WCB's approach to patient handling from a WCB perspective, so that I'm not overlapping with what Aaron has already presented; I will discuss from our perspective some of the successes and challenges that we've experienced over the past three or four years; I'll discuss what's next; and finally, a reference page in terms of resources that you may wish to access.

Firstly, in terms of the WCB's prevention overview, we have a Regional Services Department and area within the Workers Compensation Board. Within Regional Services we have an inspectorate of 164 prevention officers located around the province of BC. Their primary responsibilities are regulatory compliance and injury prevention activities. Their contacts are at the site level, with both workers and employers, and they take a three-pronged approach to educate, consult and enforce.

The department that I'm in is Industry and Labour Services, that was established five years ago, and it was based primarily on the Ontario model of having industry health and safety associations established. Currently within BC we have seven health and safety associations established for high-risk industries. OHSAH would be one of those health and safety associations Our role within Industry and Labour Services is to increase occupational health and safety capacity within a particular high-risk industry, and to initiate provincial injury prevention programs. The No Lift program that I'm going to discuss is one of such programs. Our key contacts are occupational health and safety associations, employers' associations, and unions at the provincial level. Our approach within Industry and Labour Services is from a non-regulatory perspective.

So why is the health care sector of interest to the Workers Compensation Board? As Aaron has already discussed, health care is an extremely big sector within the context of the province. It represents 10% of all of the WCB claims that we receive, $418 million in fully-reserved claims costs over a five-year period, and over that same period almost two million days lost and 38,000 accepted time lost claims to the board. On average within the province of BC, 700 health care workers are away each day on a Workers Compensation Board claim.

So how is the health care industry doing overall in terms of its injury rates? The light-coloured bars are the health care injury rates year over year expressed as 100 person-years of employment. The darker bars reflect the overall all-industry injury rate average for the province of BC.

Over time the health care industry has remained above the overall BC injury rate average, which is particularly challenging in one sense, when you consider we have such high-risk industries such as construction and forestry within the province. But the good news is the health care injury rate is declining and, as Aaron's mentioned, it's down about 27%.

The other thing I will mention is the health care injury rate is declining faster than the all-injury rate within the province. So we're seeing the health care sector improve at a faster rate than the overall injury rate for all industries.

To some extent, because health care represents such a large part of the overall injury rate, health care will be chasing a lowering injury rate as it influences the drop of the provincial rate. Projected out to 2004, we are expecting that the injury rate for health care for 2004 will come in at 3.3, down from 3.6 in 2003, and we expect the injury rate for the province to remain at around 3.1.

So in turning to the next slide, so where is the problem? I've identified here the four… what we would call high-risk areas within the health care sector. These four high-risk areas within health care and social services represent 85% of the claims that we accept at the Workers Compensation Board. Acute care and long-term care represent 70% of all of the health care claims that we accept. This is a function of two things. Firstly, most of the workforce within the health care sector is employed within acute and long-term care, but it also reflects the risk of the work activities themselves(?). What we have noticed over the past three years is where we have targeted resources and activity, we have seen a drop in the injury rate. We have not seen a drop in our injury rate in the community health sector or the residential services area. So the areas that haven't received any attention, we're not seeing any improvements thus far.

Patient handling injuries: Within the health care sector within BC, 34% of all accepted time lost claims arise from patient handling. They represent 41% of total accepted claims costs at the WCB, with an average cost per claim of over $8000.

I'm going to speak specifically now to the WCB's approach to patient handling, and approach it from a bit of a chronological method.

In 1998 the WCB introduced new WCB ergonomic MSI requirements. These regulations specifically called for engineering, administrative and other work practice controls to reduce the risk of musculoskeletal injuries to workers. In the same year, in 1998, Aaron mentioned that we started the Comox pilot at St. Joseph's Hospital to look at the efficacy of the installation of overhead patient lifts.

Following that initial pilot project, we made arrangements to lead a delegation from BC to visit both Quebec and Ontario to hear from those jurisdictions as to their experiences with overhead lifts in health care facilities. Representatives from the Ministry of Health, OHSAH, and the Workers Compensation Board visited several hospital sites to meet with staff, review injury stats, and observe the installation of overhead lifts and their effectiveness at reducing the risks to health care workers.

Also in 2000, we worked to build internal partnerships at OHSAH, WCB and the Ministry of Health for a coordinated approach to reducing the risk of injuries arising from patient handling.

And turning to 2001, the Memorandum of Understanding that Aaron referenced in regards to No Unsafe Patient Handling, within that document there was a reference to making arrangements to provide a framework of funding from the Workers Compensation Board. While we recognized that we couldn't fund all of the installations within health care, we felt that if we could provide some funding to ensure that key program elements were present, there was an opportunity for us to assist the industry and leverage them into safer patient handling practices.

Also in 2001, the Workers Compensation Board Chair at the time lobbied the provincial government to earmark $15 million to patient handling, specifically the purchase of overhead lifts and/or electric beds. Of that initial commitment of 15 million, $12 million was directed to overhead patient lifts.

In 2001 at the Workers Compensation Board we made arrangements for Kate Tuohy-Main, an international expert from Australia in patient handling, to hold a one-day conference at the Workers Compensation Board. It was a conference to explore safer patient handling practices -- lifting, transferring, and repositioning, with the specific goal of bringing together clinical clinicians, OTs, PTs and clinical specialists with occupational health and safety staff to bridge the gap between patient assessment and risk assessment.

Also in 2002, the Workers Compensation Board made a significant commitment to the health care industry. We increased our officer time to the health care sector to 14% of officer activity. That represented 22 full-time equivalents dedicated to the health care sector. Within the Workers Compensation Board we established an internal committee called the Health Care Advisory Group, where we brought together a dozen officers who were specifically assigned to the health care sector, and made arrangements that this committee would meet three times a year specifically to address the health care sector, provide them with education and training to coordinate prevention activities. So that we had a common understanding of the issues, challenges and opportunities that existed within health care.

Specifically, three ergonomic projects were developed for the health care sector in 2001, and these I'll allude to later on, but they are available on our web site. We developed the OSACH Handle with Care document specifically designed for the health care sector that set out how does the WCB ergonomic MSI requirements apply to patient handling. This is a reference document that many health care employers, unions and OHSAH have used to assist them in then developing educational material.

The second ergonomic initiative that we undertook was to post resource materials on our WCB web site, resource materials such as installation considerations, various types of lift tracking equipment, information about slings, facility planning considerations, structural, electrical, and overhead ceiling lift structures.

The other resource that we developed was a transfer assist kit for WCB offices. With the increased commitment to the health care sector, one of our challenges was what type of activities could you then have our WCB prevention officers perform in health care. It became apparent to us that many smaller long-term care facilities were under-resourced, and many of them did not know of current lifts and transfer assist devices that in fact were on the market. We made arrangements for 30 clinical resource practitioners, OTs and PTs, experts in patient handling, to attend the WCB and evaluate about 50 pieces of lift and transfer equipment devices.

At the end of the day they had selected ten devices that they would put in a kit, and then we went out and purchased ten hockey bags, loaded them with the lift and transfer kits, and gave them to our WCB officers, who then went out and visited long-term care facilities around the province. WCB officers are not experts in patient handling, and the purpose of the kit was merely to create awareness within long-term care facilities, leave the kits and provide the long-term care facilities an opportunity to trial this equipment. The materials that are contained in the kits are also posted on the WCB web site.

In 2002, in working with the health care industry, we committed as the Workers Compensation Board $6 million to the No Lift program. Our interest in doing so was to leverage the industry, to encourage the industry, to apply comprehensive occupational health and safety program elements to their program. The second thing that we issued was a Work Safe Bulletin about the importance of properly installing, inspecting and load testing overhead lifts. 2002 also saw several vendor forums held throughout the province.

In 2004 the WCB, in conjunction with the Interior Health Authority and the Okanagan University College, provided pilot funding, $15,000, for the installation of overhead lifts in the student nursing lab as part of their nursing education program. The interest in doing so from the Workers Compensation Board was to influence the component in their curriculum related to occupational health and safety and patient handling.

In turning back to the $6 million, funds for the No Lift program, this money went directly to the six provincial health authorities. We as the Workers Compensation Board developed contracts with each of those six health authorities, and required them to target those funds to high-risk areas.

Contained in those contracts, as a condition of the funding, were the following program elements: one, that each of the participating health authorities must conduct the appropriate risk assessments; two, that they needed to establish joint steering committees to ensure the workers were engaged in the selection and evaluation of overhead lifts; two, that appropriate No Lift policies and procedures be developed; that worker education and training was a significant part of the program; that there were funds for equipment procurement for lift and transfer equipment; that the equipment and program would be maintained appropriately; and that OHSAH would provide program evaluation on the intervention.

So what's been the impact of the No Lift program? Currently within the province of BC, 20% of the high-risk beds that were identified have been covered with overhead lifts. Over $20 million has been invested to date, and we as the Workers Compensation Board are tracking a 30% decrease in patient handling injuries from 2001 to the end of 2003, and that trend is still continuing for 2004.

So what have we learned? Some of the successes that I'd like to identify are the importance of partnerships between Ministry of Health, health care employers, the unions, Ministry of Labour and OHSAH. A commitment of resources: one of our experiences in this is that you really do need project leadership, and within each of the health authorities they did assign a project lead to ensure that the funded initiatives moved ahead, and they assigned someone in that leadership role. That there was a targeted approach to high-risk occupations and high-risk activities. That much of this was done through… initially through pilot projects and starting small, and then developing a program to target the high-risk areas within the health authorities. That staff involvement was critical in terms of where do you put the lifts, how many slings do you need to purchase, how does the use of overhead tracks interfere with curtains, privacy issues, and having the staff engaged for buy-in and ultimate use of this equipment was paramount. Engaging all of the program elements to ensure the flow efficacy of the program was critical from the Workers Compensation Board perspective.

Some of the challenges that we experienced in going ahead with this program was when the program initially started, the health authorities had just reorganized as the six health authorities, down from 52 health regions. There was considerable reorganization taking place about which facilities would remain open, which facilities would close, what type of patient care services would be provided in the facilities, how do we prioritize challenges around data collection, given various data systems in terms of WCB statistics, where and what to purchase, structural issues within facilities, both with the cost of going ahead with the program and was it worthwhile, given the structural upgrades that may be required within a facility.

Spending the funds, absorbing change: One of the things that has happened with the program is that spending the funds has taken longer than the health authorities had originally anticipated. Early challenges were the availability of qualified installers from the overhead lift manufacturers and suppliers. Initially they did not have an adequate number of qualified installers, and that also affected the ability of the program to move ahead. We had at one of our facilities an overhead patient lift failure, so right in the first year of going ahead with the program, one of the overhead tracks was not structurally secured appropriately and in fact was pulled down from the ceiling in its first use. And that led to the WCB bulletin that I referred to earlier about the proper installation, inspection and load testing of overhead patient lifts prior to use.

Since these programs tend to be longer programs over two or three years, they do tend to overlap on cyclical events within the health care industry. One of them was collective bargaining, and the challenges faced around continuing with committee meetings when you're in the midst of collective bargaining is one of the realities the industry had to deal with.

So what's next in patient handling within the province here, from the WCB perspective? We want to continue with the No Lift program in health care, to identify the next tier of beds that we need to install overhead lifts in. We will be working with OHSAH and the industry to develop best practices across the industry for patient handling. We will continue with education and training, particularly in expanding the education and training curricula of health care… nursing students and nurse aides. That we will be expanding the program into some of the smaller facilities, not-for-profit and private long-term care organizations. And that we will be looking at the home and community sector as well.

Finally, some resources that you may wish to access is our WCB web site. You can access it through worksafebc.com, or go through directly into the Ontario Safety Association for Community and Healthcare Centre where all of this resource material is available on line. And you can also contact us in the Industry and Labour Services Department. Thank you.

Jo-Anne Hurd: Great. Thank you, Michael.

OK, this concludes the formal part of the presentations today. At this time we will open it up to questions from the community at large.

Operator: Thank you, Ms. Hurd. We will now take questions from the telephone lines. If you have any questions, please press on star one on your telephone keypad. If you are using a speaker phone, please lift the handset and then press star one. If at any time you wish to cancel your question, please press the pound sign. Please press star one at this time if you have a question. There will be a brief pause while the participants register for questions. Thank you for your patience.

The first question is from Lucie Blench from Queensway Carleton Hospital. Please go ahead.

Lucie Blench: Yes. Would you have any statistics with regards to the compliance of using the ceiling lifts compared to the floor lifts with staff?

Aaron Miller: In terms of compliance, I think of one of the biggest things is that having staff adopting the ceiling lift. It's like any new piece of equipment, that staff need to have the proper introductions as well as proper training and education on how to use the lifts. Once staff realize that the ceiling lifts are safe and effective, it's night and day in terms of preference for the ceiling lifts. They actually love them in comparison to the floor lifts.

Lucie Blench: To the floor lifts, OK.

Aaron Miller: Yes.

Lucie Blench: Thank you.

Aaron Miller: You're welcome.

Operator: Thank you. The next question is from Lina DiCarlo from Credit Valley Hospital. Please go ahead.

Lina DiCarlo: Thank you. Can you tell me what period of time did it take you to develop the underpinnings of this program, understanding that it's an ongoing progress, but how long did it actually take you to develop some additions to the policies and procedures, develop a training and education component and roll it out?

Aaron Miller: That's been quite the … I think I'll use the word "iterative" … approach to our dealing with programs throughout the province. It's been ongoing since… essentially it resulted from the Comox study in 2000, that we took over a year to develop the ceiling lift implementation guide, where that came out in 2001. It took a while for the No Lift policy, the Memorandum of Understanding in March 2001. And even now, we're finally getting some facilities in the outlying regions of the province starting to follow the Memorandum. And so it's a very long process. I think we're currently revamping our ceiling lift implementation guide because we feel that changes are needed, that as health care evolves and changes, so are (inaudible) these types of programs.

Lina DiCarlo: Thank you. May I ask a second question?

Aaron Miller: Sure.

Lina DiCarlo: There seems to be a lot of controversy over this No Lift versus safe lift. Can you comment on that? Recognizing that it's literally impossible to not lift. It may be a play on words, but certainly there are some compliance implications. Can you speak to that?

Aaron Miller: I'll try my best. In terms of the Memorandum, they stated it as No Unsafe Lifting, in that if it is unsafe to lift a person, either for staff or the patient's sake, mechanical equipment should be used. We know that a straight no lift police may not be feasible. But throughout BC we have been promoting the No Unsafe Lifting.

Patti Boucher: If I can just add to that - it's Patti Boucher - we certainly recognize that no health care facility can totally eliminating lifting. Even lifting a limb is lifting. So what we're actually encouraging organizations to do, if they want to use the term 'zero lift,' they need to qualify that. But we do encourage the word 'minimal lift.' And I think these terms are used synonymously, and our message to our client organizations is to ensure that you have defined what you mean by that. Because you can't enforce something that is perceived differently by different staff members.

Aaron Miller: Exactly. Like, whatever policy your facility or region adopts, it needs to be universally accepted as well as understood…

Lina DiCarlo: Understood.

Aaron Miller: …by everybody equally.

Lina DiCarlo: Right.

Michael Paine: I think that's a very good point. Barbara Silverstein in Washington state speaks to a zero lift policy there. My preference over time, I think, is to simply move to safer patient handling.

Lina DiCarlo: Right. Thank you.

Operator: Thank you. The next question is from Julie Duller from Ontario March of Dimes. Please go ahead.

Julie Duller: Can you hear me?

Aaron Miller: Yeah.

Michael Paine: Yes.

Julie Duller: Is there a maximum capacity on most of the lifts? What weight would that be?

Aaron Miller: We know with some of the lifts it's usually about a 400 pound maximum. But however, I think through the United States they're beginning to develop a bariatric type lift for bariatric patients, to accommodate much higher weights from that.

Julie Duller: Mm-hmm. Would the structure of the building that it's in, you know, have any effect on it?

Aaron Miller: Oh, definitely. If your ceiling can't support the weight, the ceiling lift won't be able to hold it up at all. So…

Julie Duller: It would have to be up to code, then.

Aaron Miller: Exactly. And what we found, a lot of problems, a lot of our older buildings throughout the province, is that they need to have major facility reconstruction to be able to hold up patients within the ceiling lifts.

Patti Boucher: And if I can just add the Ontario experience, Ann Duffy, our ergonomist, and I have worked very closely with vendors. And their experience is that there may be some installation challenges in some buildings, but basically what they are advocating is that the structure of a building, no matter if it's 80 years old or it's a new build, they feel that there's appropriate structural support that can be applied so that ceiling lifts can be installed. And certainly we have heard that from our organizations that are in the process or who have implemented ceiling lifts.

And also, just to qualify the issue around maximum weight limits on equipment, a floor lift traditionally on average is around 300 to 350 pounds. And with a ceiling lift, we did a cross-match cross of all of our vendors, it's around 400. But I caution you with that. I think you have to be careful to ensure that you're communicating with your vendors and looking at the specifications with respect to your equipment.

Also in Ontario we do have, and there is quite a selection of bariatric equipment available, both in the floor model and in the ceiling lift model.

Julie Duller: OK. Thank you.

Aaron Miller: Also we have found that within some facilities in BC you can purchase portable ceiling lift gantries, which is almost like a portable metal frame that can be placed around a bed, that the ceiling lift can be attached to.

Patti Boucher: Right. And we certainly are advocating that for organizations that have asbestos in their interstitial spaces, where asbestos abatement would be far too costly to really install the ceiling lifts in the ceilings. So that's certainly a great idea.

Operator: Thank you. The next question is from Beth Simons Chambers from Province Continuing Care Centre. Please go ahead.

Beth Simons Chambers: Hello. Can you hear me?

Patti Boucher: Yes.

Aaron Miller: (Inaudible)

Beth Simons Chambers: Hi. We're a complex continuing care rehab hospital in Kingston, Ontario. And we've already started to implement ceiling lifts in our facility. The one question I had for Aaron from his presentation was can you just explain what the acute care surplus funds were?

Aaron Miller: I think Mike might be better to explain that, because the funds did come through the WCB of BC.

Michael Paine: Yes. The acute care rate group surplus is just… reflects the funds, the premiums that we collected from the health care employers in the province of BC. And that rate group can either operate in a surplus or deficit based upon the dollars that we pay out in claims.

Beth Simons Chambers: OK.

Michael Paine: The rate group just happened to be in a surplus through what we'd collected in premiums and through investment income at the board. And the health authorities saw that as an opportunity to direct funds specifically to the patient handling initiatives.

Patti Boucher: And Mike, if I can add to that, just for the Ontario listeners, the WCB system in BC is very different to the WSIB. We're on the NEER experience rating system. So individual organizations actually can be in a rebate or surcharge situation which, if they're in a rebate, they get the money at that specific organization. And I'm led to believe that in BC, BC reserves those funds. Is that correct?

Michael Paine: No. No.

Patti Boucher: OK.

Michael Paine: No, we have an experience rated system as well, where you can be either assessed a hundred percent more than your premiums or 50% less than a base rate premium, based upon your individual employer performance.

Patti Boucher: OK. So do the individual organizations get rebated?

Michael Paine: They get rebated through reduced premiums the following year.

Patti Boucher: But they don't get rebated in lump sum like they do in Ontario?

Michael Paine: Correct.

Patti Boucher: OK. So that is a significant difference. So you have used those funds then to fund BC health care organizations.

Michael Paine: Correct.

Patti Boucher: OK.

Beth Simons Chambers: Can I ask one more question, if you don't mind?

Michael Paine: Yes.

Beth Simons Chambers: How did you folks deal with privacy curtains? We've had a big issue with that. Our hospital was really built in stages from the 1800s to the 1970s. So we had like the pull-around the bed, ceiling-mounted privacy curtains. Has anybody come up with any good ideas to work with the ceiling lifts in the rooms?

Aaron Miller: What we have found in a few of our acute care facilities is that there would be an X-like (inaudible) placed actually above the wires for the curtains to allow the ceiling lift tracks to move, I guess, above the curtain, so there wasn't any interference with the opening and closing of the curtains. I hope that makes sense.

Beth Simons Chambers: It does, but I don't think probably the type of ceiling lift and the configuration for us is the same as what it is for you guys. With our ceiling lifts, the ports run from the floor up the wall, and then the whole transfer bar traverses the whole room so that we can use the same motor, the same ceiling lift for the number of patients that we have in the room.

Aaron Miller: Ah, that makes sense. Like, the system I was describing is when there's just generally one ceiling lift motor per bed.

Beth Simons Chambers: OK. This is one ceiling lift motor per room.

Patti Boucher: Is that a four-bed room?

Beth Simons Chambers: It could be a four, a three, a two, or a one.

Patti Boucher: OK. Did you consult with your vendor on that one?

Beth Simons Chambers: It's made by Liko.

Patti Boucher: OK.

Beth Simons Chambers: The ceiling lift. And we've used the Liko products for years as mobile lifts.

Patti Boucher: Right.

Beth Simons Chambers: And… who's… [some off-microphone consultation]

Peridot is the company that we deal with.

Patti Boucher: Right. That's the Peridot group, and that actually is the manufacturer of the Liko. But I would actually consult with them to help you problem solve around that.

Beth Simons Chambers: We have, and they have a lovely privacy curtain system for the tune of something like $2500 a section…

Patti Boucher: Ouch.

Beth Simons Chambers: …that we really can't afford at this time. So that's what I was asking, if there were other people in the group that had come across some other ideas.

And the last question I have is how do you work around getting your staff to use the lift to move the patient up in bed, not just to transfer them out of it? Are there any tips for us for that?

Aaron Miller: We found that is one of the biggest troubles with ceiling lifts, is that with repositioning, in one of our research studies, staff find the ceiling lifts are… they prefer them, they find them more safe and effective…

Patti Boucher: …reduce their repositioning injuries tremendously. And it was just the type of sling that they used that actually was more conducive to the repositioning of the client.

Beth Simons Chambers: Well, that's interesting.

Patti Boucher: Mm-hmm. Now, if you're wanting that contact information following the conference call, I'd be happy to direct you to Stephanie at Vancouver General Hospital.

Beth Simons Chambers: Yeah, that'd be great. Thank you.

Patti Boucher: OK.

Beth Simons Chambers: The last question we had from our group here: Has there been communication from the WSIB group in BC with the WSIB group in Ontario?

Michael Paine: I have spoken to some of the representatives at the WSIB in Ontario, yes.

Beth Simons Chambers: And does it seem to be of interest to WSIB to pursue the same type of program here?

Michael Paine: Well, they were interested in the approach that we've taken, and we've provided them all of our materials. I can't really speak beyond that. I'm not sure what they're doing with it at this point.

Patti Boucher: If I can just add to that, that actually we have, you know, specifically went to Prevention Services at WSIB in Ontario, and have given them the presentation on what British Columbia is doing in their initiatives. And certainly at the Health Care Intersector Group, the HCIG group that we have operating, Ontario Safety Association for Community and Healthcare communicating with Ministry of Labour and WSIB, they're very keen and interested in these initiatives and fully support these initiatives.

I stress the difference in the WCB structure in BC as compared to WSIB, with the allocation of funds. However, there is work going on behind the scenes to support such initiatives.

Beth Simons Chambers: OK. Thank you very much.

Michael Paine: Thank you.

Operator: Thank you. The next question is from Lucie Blench from Queensway Carleton Hospital. Please go ahead.

Lucie Blench: Yes. Firstly I'd like to share something about the curtains. Possibly if you contact St. Vincent's Hospital here in Ottawa, Sheena O'Donoghue is the physiotherapist working with the ceiling lift project, and I know they've resolved the curtain issues quite satisfactorily and quite economically. So you may try that.

Patti Boucher: That's wonderful. Thank you for sharing that.

Lucie Blench: OK. And now, my question was with regards to the tracks. I've been reading about them, I've drawn patterns on paper, I've actually made mock attempts in the rooms with tape and all this stuff. But what is your experience, because it does get confusing between the diagonal, J, just a one bar that traverses the room, compared to sort of an H system. What have you found in a room of two or four beds that really works the best?

Aaron Miller: That's a really good question, I think. What we found is almost every facility does their own risk assessment in terms of what are the needs for their patients or residents. For example, in St. Paul's Hospital in downtown Vancouver, in their emergency department they use an H-type configuration due to the different needs of patients coming in and a very variable patient population…

Lucie Blench: OK.

Aaron Miller: …whereas the Fairhaven United Church Home project which I talked about today, they used a J formation and different types of tracks for helping patients getting out of bed, getting into bed, as well as ceiling lift tracks all the way into each of the separate patient washrooms.

Patti Boucher: Now, Aaron, does the H give you greater flexibility as far as room coverage?

Aaron Miller: It does give you greater flexibility because you do work on essentially a giant rectangle or box.

Patti Boucher: Right.

Aaron Miller: And so it's very flexible in terms of what side of the bed you want to go, if you want to move up the bed, down the bed.

Lucie Blench: Yeah. And right now I'm sort of favouring the H because I think that that might be a problem that we're seeing with the repositioning, if the track isn't just quite right, because everybody's morphology is different, then they can't quite move the patient up or down the bed, whereas the H would allow them both to transfer, lift and repositioning probably with more ease.

Patti Boucher: And you're correct in your assumption, because that's how Vancouver General Hospital in their installation of 380 or 400 ceiling lifts, they went with the H for the greater flexibility and the ability to reposition.

Lucie Blench: OK. Good. OK. Thank you very much.

Aaron Miller: Thank you.

Operator: Thank you. Once again, please do not hesitate to press star one for any questions or comments. The next question is from Stewart McNeil from Hamilton Health Sciences. Please go ahead.

Stewart McNeil: Yes, I have two quick questions. Thank you. I'm just wondering, the savings of 30% in 2001 and 2003, what is that dollar amount? Do you have that?

Michael Paine: Not immediately handy, no. Let me see if I can sort of roughly figure that out for you, if we can take a next question and I'll come back to it.

Aaron Miller: Actually, I can take that down to a facility level. When discussion of St. Joseph's General Hospital study, the ceiling lifts cost roughly $340,000. And when we compared that savings in injuries three years after installation, we roughly estimated a payback period of between less than a year to two and a half years. And so it provided a very good cost benefit in terms of patient handling injuries.

Stewart McNeil: OK, so it depends on your injury rate, then, for the payback. So if you've got a high injury rate, then you're going to have faster payback; if you have a low injury rate, you're going to have a longer payback.

Aaron Miller: Potentially, depending on the benefits of putting the lifts in and the changes in patient handling injuries.

Stewart McNeil: OK. Thank you. I just had one more quick question. Are there any ceiling lifts installed on the outside of the ERs for removal from cars?

Michael Paine: Not that I'm aware of at the WCB. Not that we're aware of, no.

Aaron Miller: No, we've mainly just seen them over top of the beds within the ERs.

Stewart McNeil: OK. Thank you.

Operator: Thank you. The next question is from Lucie Blench from Queensway Carleton Hospital. Please go ahead.

Lucie Blench: Obviously you've done a lot of research with regards to the suppliers of lifts. Would you be able to list, let's say, the top three or the top four in your research?

Michael Paine: Kind of a tough one. I think the biggest thing is I really don't want to endorse any companies.

Lucie Blench: … it's just that, you know, we're receiving so much information…

Michael Paine: Oh, definitely.

Lucie Blench: …and in our city, we're just beginning to use the ceiling lifts. So obviously, you know, you don't want to be caught with just better marketing or better brochures, because everybody promises you the world right now. Even if it was the top five, at least I would be able to discount some of the others.

Patti Boucher: Well, we can't endorse any individual manufacturers of lifting equipment. However, I really encourage you to download our document. And the other distinguishing factor is there are some organizations that are respecting the new CSA standard. And we urge you to do your homework and read up on that, and ask these manufacturers specific questions with regards to, you know, how they're testing their equipment, testing the weight, the CSA standard, and you'll be able to come up with a top five fairly easily.

Lucie Blench: OK.

Michael Paine: And it's also very beneficial to talk to other facilities in your region to see who they've used for their ceiling lift installation and what are their thoughts.

Lucie Blench: OK. Thank you.

Operator: Thank you. The next question is from Erna Bujna from Ontario Nurses' Association. Please go ahead.

Patti Boucher: Hi, Erna.

Erna Bujna: Hi. Can you hear me OK?

Patti Boucher: We can.

Michael Paine: Yes.

Erna Bujna: OK, great. Actually, I just have a statement. It's not a question. But I just wanted to say that the Ontario Safety Association for Community and Healthcare's planning guide is an excellent resource. The other thing that I haven't heard, and maybe I missed it somehow, but… you're speaking quickly to get everything in in the whole hour that we have, but… is the Ministry of Health in the last budget announced that there's an additional $60 million that's going to be dedicated to purchase 12,000 bed lifts for hospital and long-term care facilities to improve working conditions of the health care workers. And it's a huge opportunity for the employers, for unions, if there is a union in the facility, to come together now and start planning for that. Because the Ministry of Labour expects that the two sides come together. And as you said, in BC, you know, the two sides did come together and have really made some progress. BC's so far ahead of Ontario when it comes to this. But I think we're headed in the right direction. And I don't know if all the health care employers are aware of that money that's going to be released. So it's just a statement.

Patti Boucher: Thanks very much, Erna. That's a good reminder to organizations to establish their relationship with vendors in preparation for this funding announcement. We have no idea when that funding announcement is going to be made, so it's… the more you can get done in the meantime in establishing relationships… We know the turn-around time will probably be very tight as far as having to get this money spent on the equipment, so as much as you can do in advance, the better. And we urge you to download our document to help you in that process, and consult with your local Ontario Safety Association for Community and Healthcare consultant.

Erna Bujna: So we've actually shared that document with all of our health and safety reps, so…

Patti Boucher: Wonderful, Erna. Thank you.

Operator: Thank you. The next question is from Stewart McNeil from Hamilton Health Sciences. Please go ahead.

Stewart McNeil: I'd just like to ask, in Vancouver, are there any injuries associated with the ceiling lift program in Vancouver now? Are is there something new happening with the ceiling lifts, other than the one that failed and collapsed, but are you starting to see another different type of injury to staff with the ceiling lift?

Aaron Miller: Actually, that's a really good question. In terms of our cost-benefit analysis that was conducted in Interior Health Authority, we have only seen two injuries in 30 facilities over a six-year period associated with the ceiling lifts. They were both shoulder injuries. And it's quite surprising, the dramatic decrease in injuries.

Stewart McNeil: OK. Thank you.

Aaron Miller: You're welcome.

Operator: Thank you. There are no further questions registered at this time. I would now like to turn the meeting back over to you, Ms. Hurd.

Jo-Anne Hurd: Thank you. OK, then. I'd like to thank our speakers for taking the time out of their busy schedules today to speak to us. I'm sure we all can agree on how valuable it is to get current and up-to-date information from the field. Thank you once again, Aaron, Michael and Patti.

Patti Boucher: Thank you.

Michael Paine: Thank you.

Aaron Miller: Thank you.

Jo-Anne Hurd: OK. This concludes our presentation today. But before we end, I'd like to remind you that our planning guide for client mechanical lifts is available free from our web site. Please check our web site at www.osach.ca for more details, or contact your regional consultant for further information.

Once again, I thank you all, and I wish you all a safe day.