Date of Award

Spring 5-2020

Degree Name

Doctor of Public Health (DrPH)



Second Advisor


Third Advisor



Introduction: This study examined the effectiveness of Safe Patient Handling (SPH) legislations in difference states across the country. In January 2006, the state of Texas legislated the Safe Patient Handling and Movement Practices Act which required all hospitals and nursing homes to implement safe patient handling and movement program. To date, 10 other states have enacted law or regulations to control work-related musculoskeletal disorders (MSDs) among healthcare workers (HW). Despite the effectiveness of these policies in the individual states, MSDs remain prevalent among HW nationwide. Hence, the call for national legislation. Methods: Using the state-level incidence rate data from the Bureau of Labor and Statistics (BLS), piecewise regression and difference-in-difference (DiD) estimates were used to compare the incidence rates before the implementation of the safe patient handling policy with those after policy implementation. This comparison was followed by a systematic analysis of the legislative mandates in states with SPH laws. An eight-step framework (as adapted from Bardach’s Eightfold Path to More Effective Problem Solving,) was employed in this policy analysis.

Results: The piecewise regression analysis indicated positive effects of SPH in the form of increase in downward trends of total MSDs in New York, New Jersey, and Missouri following implementation. The results of DiD estimates indicate significant corellation between the implementation of SPH legislation and reduction in the incidence rates of MSDs in Texas, Maryland, Minessota, and Missouri. Conclusion: Variation in the results of both analyses could be attributed to variations in the policies – in terms of elements, implementation, and enforcement. Setting a nation-wide minimum standard for safe patient handling will help minimize the incidence rates of MSDs among HW. Therefore, a prototype was developed for national legislation, considering the strengths and limitations of reviewed state policies.