SHARP

Workplace Strategies & Interventions: lessons from ergonomics

Barbara Silverstein

Safety & Health Assessment & Research for Prevention

Washington State Department of Labor & Industries

Will it work?

Will it last?

SHARP

Planned Change

Technical features: Hardware/software How complex in terms of scope &

sophistication?

Implementation features: The more people affected, more required to change behavior, the greater the focus needs to be on implementation features

Power: How much “voice” do those required to change have?

SHARP

What can you learn?

Effectiveness of intervention Have you targeted the most important risk factors

or introduced new ones? Barriers to change Opportunities for change Organizational resources available How to do it next time (theory v. practice) Can only learn from measures you collect (or

don’t---the hard way)

SHARP

Considerations in implementing/evaluating interventions

Social & economic context during which data is collected. Implications for studies

Population changes during study periods Selection, strengths & limitations of

– Populations– Study design– Outcome measures– Exposure measures– Covariates– Models used in analyses– Implications of findings-generalizability

SHARP

Intervention study methods

Randomized controlled trial Participatory action research Pre-post: serve as own control Pre-post with internal comparison Pre-post with external comparison Role of case studies?

SHARP

Design Issues: Quasi-experimental Studies

Comparison groups provide estimate of incidence without intervention

Similarity in factors related to injury experience (restriction or matching), or control for confounding in analysis

Identify groups prior to intervention so can collect baseline

Contemporary vs. historical controls (full coverage interventions, e.g regulatory interventions)

SHARP

Practitioner Reported Case StudiesOften No before-after design No comparison group Inadequate statistical power Sample of convenience Inadequate description of methodology for

identification of exposure, effect, potential confounders, analysis

Vested interest in success

If same information is collected in multiple case studies…can begin to gain confidence in findings

SHARP

Evaluating success-health & work Discomfort, fatigue, symptoms, “presentism” Medical visits, absenteeism Long term disability, lost time, workers comp Workers compensation, turnover Productivity losses (overtime, overstaff, presenteeism)

Quality: scrap/repair Turnover, recruitment/training Lost investment opportunity

satisfaction

involvement

innovationUse short and long term measures

SHARP

Example: Aluminum Smelter

Opportunities to use ergonomics (joint ergonomics committee-design & review)

ProcessProcess: layout, equipment, info processing in new $40 million carbon plant

ProductionProduction: content, organization (self managed teams, crust breakers)

PersonnelPersonnel: methods & training

SHARP

Participatory Ergonomics (or any workplace change) Process

Commitment & Support

Worksite assessment

Integrate planning of change

Implement ergonomic solutions

Pilot test solutions

Monitor, evaluate, modify

Maintain Feedback to-from workers

TrainingTraining

Engineering and organizational change to teams resulted in significant decrease in exposures (2/3) and WMSDs (>1/2)

Comparison: crane operators: no change

SHARP

History at Aluminum Smelter

1991 New local union team, new plant management 1992 Joint Safety Plan (Start SHARP study, training, small changes, begin R&D on

larger changes)

1993 External factors:– Russian aluminum dumped on market, Drought in Northwest--> soaring energy costs

1994 Union elections, new skeptical leaders – difficult labor management relationship– New ergonomics committee

1995 Strike, hire 150 new workers,local union receivership1996 Reconstituted ergo committee ergo policy

SHARP follow up evaluationBegin design for new carbon plant

1998-99 Lockout (More $ selling energy than Al)Mill shut

SHARP

Improvements:•Use pre-defined keys to assign the grade marks to boards passing by•Marks logged into the computer for sorting at the mechanical sorter•This logged grade mark information is also used for analysis to monitor grader variation & improve training.

Sawmill Hazard Impact Partnership: 6 mills, SHARP, WISHA->reduce WMSDs in lumber handlers

Before After

Grader improvements reduced WMSD risk, improve quality

SHARP

Strategy: Industry Specific Solutions

Focus groups-labor/management/apprentice programs

Identify key players that make life difficult/easy – User/producer meetings

Field test solutions..what about it did and did not work.

Develop alternatives for what didn’t work Give trials enough time Agree on good practices

SHARP

WA StateWA State ZeroLift Initiative: ZeroLift Initiative: Industry, Industry, Labor, Government Labor, Government 258 “free standing” nursing homes

WA Health Care Assn: rebates, training, newsletters

UFCW,SEIU (10%)-supportive, not active

Dept of Labor & Industries Evaluate equipment-> FAQ publications WC premium discounts 6 counties for implementing

zero lift environment->jumpstart on equipment Education campaign on using job modification funds-

> No effect Evaluate effectiveness of efforts: surveys & site visits ZeroLift: policies, equipment, training, commitment/involvement, investigate/follow-up

SHARP

Results : WC analyses for lost time back injuries related to resident handling Resident/NAC ratio NAC turnover Management turnover Stable management 3 years Sit-stand devices Management commits/involve employees Premium discount

Risk

In all MLR analyses, being a small nursing home

4 annual surveys 85-95% participation

SHARP

Barriers to preventing back injuries in nursing Barriers to preventing back injuries in nursing homeshomes

• Management turnover •NAC turnover (70-400%) Experienced NACs moved on to hospitals or home health…better $ and working conditions•Larger % of PD nursing homes are “for-profit”-bankruptcy threats •Organization [change in resident characteristics, payment systems, ownership]

•Beliefs about risk, residents and time-Note: focus of effort was on management---no active engagement of NACs

SHARP

Making it Work Awareness of changing environmentManagement commitment (turnover likely?) Time, resourcesEmployee Involvement Time, training Identification, controls, evaluation Design & review (user/producer groups)Worksite analysis & controlsAppropriate technical resources for changes

SHARP

Recommendations

Leadership: credible, accountable Policy, process, performance measures Participatory process: fighting fires->design & review Embed process in existing structure Follow-through & feedback-no false promises Plan for the long haul Know when, where to get external help but

workplace should maintain internal control of the process

SHARP

Implementing Change- getting it right is a little like tai chi

Indu

stry

A matter of energy and balance