Work Right Blog

A Pop Singer, Workplace Safety & Unintended Consequences

unintended-consequence

“I didn’t mean for that to happen….”

This is a statement that we have all uttered at one point or another in our lifetimes. For some of us less fortunate people, we have been forced to say this phrase numerous times throughout our lifetime.

Our life is full of purposeful decisions that will correlate with reactions in the world around us. Hopefully, most of the decisions that we make will result in the desired outcome, however, occasionally the outcome we hoped for is not achieved. Moreover, sometimes the outcome we hope for does occur but the system that we operate in is impacted in an unforeseen manner, something that we weren’t expecting as the result of our initial action. This is the definition of unintended consequences, a term that was coined in a 1936 paper written by Robert Merton. In Merton’s thesis he declared that all decisions will create a ripple effect in the system that we live in, sometimes these ripple effects are positive, sometimes they are negative and sometimes they are irrelevant, but at the end of the day all decisions that we make will have a ripple effect.

To give you an example of unintended consequences in popular culture, let’s talk about Barbara Streisand. As a celebrity Barbara Streisand values her privacy. In 2003, prior to the popular rise of social media, a photo was taken from a helicopter of Barbara Streisand’s residnece. The website Pictopia.com published this picture of Ms. Streisand’s home. In an effort to protect her privacy, Ms. Streisand followed the appropriate measures to minimize exposure of her residence to the general population by filing suit against Pictopia.com. While her desired outcome was to limit the number of people with access to the image of her residence, her actions had an entirely different result. Prior to filing suit, the image of Barbara Streisand’s home had been viewed on Pictopia’s website 6 times, and 2 of those were by Streisand’s attorneys. Consequentially, following the media attention surrounding her lawsuit filed against Pictopia.com 420,000 people downloaded the image of her house over the next year. While her desired outcome was to limit exposure of her residence to the general population, her actions actually had the opposite effect. This example is such a strong illustration of negative unintended consequences that sociologists have actually termed this “The Streisand Effect”.

Unintended Consequences in Workplace Safety
As professionals in workplace safety we should be proud of how far workplace safety has come In the last 25 years. The incidence of catastrophic incidents has been reduced exponentially from where they used to be. Overall, workplace safety in the United States is significantly improved. Programs such as Behavior Based Safety, Lean Safety, The Strive for Zero, etc. have been key elements in this improving system. Building off of Robert Merton’s definition & the illustration of “The Streisand Effect” I have been challenging groups of safety professionals to take a minute and think of the unintended consequences in workplace safety. If we are to learn anything from the teaching of Robert Merton, than we should recognize that these dramatic changes in the workplace safety “system” will have correlating unintended consequences. Some of these unintended consequences are having positive impacts. For example, effective integration of ergonomics programs into the Lean analysis of an organization will often correlate in improved efficiency of the productivity of the operation. An unintended consequence that resulted in a positive result.

With that in mind, I believe that for us to continue to improve workplace safety, we need to humbly recognize that some of our actions have had secondary impacts that may not be positive, possibly even negative. For us to apply methods of continuous improvement in our safety programs, we need to address these unintended consequences and implement solutions to rectify the challenges that have been identified. I believe one of these unintended consequences is a huge opportunity for us to impact workplace safety, specifically with respect to musculoskeletal disorders (MSD’s).

For most organizations, MSD injuries account for the highest frequency & most expensive occupational injury claims that they have. These are the sprain or strain type of injuries. Specifically, they are the rotator cuff tendonitis, lumbar strain, degenerative disc disorder type of conditions. If you are reading this, I am sure you can think of 2 or 3 of your most recent claims and it is highly likely that one of them will fall into this category. These are the type of injuries that we all deal with on a regular basis. They are not life-threatening injuries, but they one of the leading causes of disability in the workplace. To identify and learn about risk factors in the workplace, most organizations have implemented programs that focus on zero injuries & immediate reporting procedures. These are great initiatives and I recognize their value in the workplace, however I feel very strongly that they have had an unintended consequence correlating with MSD injuries.

Medical professionals will recognize that most of the aforementioned MSD injuries will have multiple factors leading to the condition. For example, most rotator cuff injuries are not the result of one specific incident, but rather the cumulative impact of long term subacromial impingement – or in laymen’s terms friction between the rotator cuff muscle and the bones of the shoulder joint). It is very common for rotator cuff injuries to begin with an occasional pinch in the shoulder when you get in a compromising posture (think reaching under the barbeque to turn on the propane) but otherwise feel fine. As the cumulative impact of poor shoulder posture continue to rake havoc on your rotator cuff muscles, this occasional discomfort will progress to a constant discomfort every time you reach overhead, but otherwise is fine. As we continue our cumulative aggravating factors the overhead discomfort will then progress to constant discomfort in all planes of movement. If we don’t fix the issue at this point, then it is likely that tissue degeneration will occur leading to rotator cuff tendonitis or even partial thickness rotator cuff tears. As you can see, there was no specific incident that led to this injury, but rather the cumulative trauma of poor posture. It is still possible that there is an incident that will speed this process up, but the more cumulative trauma that has occurred to the tissue, the more easily it will be impacted by outside forces. This is where the unintended consequence lies. At what point does this employee report their shoulder issue to their employer. We all have various aches & pains, but we just write them off as just muscle soreness like we have had before. ”It will go away, just give it a day or two…” As the process progresses & we begin to realize that it is not going away like every other time, these employees often feel the conviction of making up a “cause” for their injury or face the potential penalty for late reporting.

You might be reading this and thinking, “That’s not us! Our folks aren’t sore and when they are, they report it immediately….” Recently I spoke at a large safety conference and in a lecture with approximately 300 various safety professionals & business leaders I had them all stand up and asked them this question, “how many of you in the last year have had back or shoulder pain?” Every single person in that lecture remained standing. I followed that up with “how many of you have had shoulder pain in the last year?” and approximately 70% of the room remained standing. Then for the coup de gras I asked them, “as safety directors, how many of you reported this discomfort to your workplace?” Amongst the smirks, and eye ducking in the room, the point was clear. None of them did. While these issues may not all be work related, there was a percentage of those issues that were impacted by their job duties. As the business leaders and safety champions, they are making the same internal decision that our blue collar workers make on a daily basis….”Is this just muscles soreness that will go away like every other time, or is it something bigger? Should I mention this to someone, or will it just go away with time?” This is the internal dialogue that our workers are making everyday in the workplace. I feel that this has been amplified by our focus on identifying a specific cause & effect for every workplace injury. To do this eliminates the life history, past medical history, hydration levels, etc. that all play a factor in MSD injuries.

So where do we go from here? I believe that this is an opportunity! I believe this is our chance to take the next step in workplace safety. I believe that we need to strive to build an environment that recognizes the impacts of cumulative trauma in the workplace (beyond just the type casted conditions such as carpal tunnel) & recognize that most MSD injuries have a component of life experience impacting them. We need to create cultures that promote people being open and honest about minor issues that likely are not work related, to try and influence the overall health of the worker & in the end reducing the risk for workplace injury down the road. Research tells us that the most accurate predictor of many MSD injuries is a past history of injury to that body part. As we build this proactive culture of workplace wellness, we will in fact be implementing a proactive approach to preventing the future workplace injuries.

In my opinion, this is the next step in workplace safety & merges a proactive approach to wellness with safety. It recognizes that we all have aches & pains, but rather than ducking our heads and hoping that they won’t turn into injuries, it encouraged a proactive approach that strives to prevent injury, rather than waiting for our people to break and paying to fix them. This is not a referendum on safety policies & practices. I think these programs are necessary and valuable. We should be seeking out root causes, but we also need to recognize that not all (possibly not even most) MSD injuries will have a direct incident alone that results in injury. We need to be engaging our people on a more personal level to help them achieve their optimal workplace wellness. This is just the next step & following this step, there will other unintended consequences that we will likely need to address then. It is just like the rock we throw into the lake, it will create ripples regardless of how small the rock we throw. My challenge to all safety professionals is to not think that we have figured it all out, but rather to be striving for continuous improvement within our safety programs. This is an opportunity for improvement that will positively affect our organizations, & also the health and safety of our workforce.

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The Value of Safety

We have all heard it & if I am being honest I have said it myself many times, “make safety a priority”. This language has been pervasive in industry over the last decade. Slogans such as “safety first” or “prioritize safety” are filtering throughout jobsites as we speak. While these priority-based safety initiatives are likely founded in sound motivation, I feel they are missing an opportunity for deeper penetration into the motivations of the individual.

The dictionary defines priority as “a thing that is regarded as more important than another”. A colleague of mine, Bill Wilsey frequently uses an analogy that really drives home the point I am trying to make. Bill will tell employees that he has many priorities. Over the course of his weekend his priorities include mowing the lawn, cleaning the garage and getting groceries. These are all priorities that he has set aside for the weekend “To-Do List”. But when his kids call him and ask him to come help them work on their car, all of his weekend priorities get pushed to the side. At the core of his being, his family is a value that he places before all other priorities. If his kids need something, he will drop everything to get it done.

This analogy illustrates perfectly the point I am trying to make. Safety needs to be personal. Safety is not a priority that is placed in line with the other “To-Do List” items for the day. Safety is a value that has very personal implications. The message needs to be that safety is a value, because you – the individual – are the one that safety affects. Safety is a value because you are willing to drop everything else on your priority list to accommodate safety. Safety makes a difference to you first and foremost!

The message that we strive to get across is that safety is personal. The injuries that we are aiming to prevent have very real consequences to individuals & to families. Safety is a value because we choose to make it a personal mission. We choose to make safety a value, not just a priority.

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The Texting Neck Epidemic –Solutions to Prevent Dealing with Complications of Smart Phone Pain

The utilization of cell phones, and more specifically smart phones, has reached unprecedented levels. Estimates as of 2012 concluded that more than 75% of the world population has cell phone subscriptions (1). To put that in perspective, the UN reported in 2013 that more people have cellphones than have toilets (2). In the United States, most of us do not know another adult that does not have a cell phone. Further, you are shocked if you see someone who is using a flip phone. The prevalence of smart phones is pervasive in the United States.

Smart phones have made our lives much more efficient, providing opportunities for us to take our email, entertainment, calendar, etc. with us wherever we go. Rarely are we ever more than a click away from accessing any information we want because of the mobile data plans. The benefits of the smart phones are substantial, unfortunately with these benefits come an increasing incidence of pain.

Fine motor skills required to handle the smart phone increase tension on the nerves increasing the frequency of disorders such as carpal tunnel syndrome and De Quervain’s tenosynovitis. Focusing on the screen of the smart phone leads to increased postural tension placed on the neck and shoulders as well. Fortunately, these episodes of pain are preventable with some minor postural cues and education.

The human head weighs approximately 13 pounds. Similar to the weight of a bowling ball. If the head is centered such that the ears line up immediately over the shoulders, than there is roughly 13 pounds of pressure on the spine. For every inch forward that the head leans (such as when using your smart phone) you increase the tension to the neck by 10 pounds. What this does to the body is place increased tension on the upper trap muscles of the shoulders and increases tension to the nerves of the arms. As we describe this posture, I am sure you are thinking about the posture you use to mess around on your phone. The chances are likely that you will notice that your head bends forward, as we described above, increasing tension on the neck and arms.

Instead of allowing your head to lean forward, the changes are simple to dramatically reduce the strain to the body. Looking straight ahead take a deep breath in. As you inhale, pull your shoulders back squeezing your shoulder blades gently. As you exhale, let your shoulders relax to a comfortable position. Lift the phone up towards your face at an angle that allows you to look at the phone without letting your head lean forward.

This is a small change that will drastically reduce the strain to the muscles of the neck and arms. Beyond that, it is a small postural change that will pay dividends immediately. I encourage you to think about the tension you are feeling when you use your smart phone next, and take the extra effort to correct your posture and reduce the strain the smart phone is putting on your body.

1. RFE/RL. “Report says 75% of World’s Population Have Mobile Phones”. http://www.rferl.org/content/report-says-75-percent-of-worlds-population-have-mobile-phones/24648234.html.
2. Wang, Yue. “More People Have Cell Phones Than Toilets, U.N. Study Shows”. http://newsfeed.time.com/2013/03/25/more-people-have-cell-phones-than-toilets-u-n-study-shows/

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Back Belts in the Workforce – What Does the Research Say?

Back Belts – What Does the Research Say?

How many of you have noticed the employees at the local hardware megastore walking around the store with a back brace as a part of their work uniform? How many of you have thought before, maybe I should wear a back brace to prevent myself from hurting my back when working in the yard? Questions such as these are common in work environment. The idea that a back that is supported with an external brace will be less likely to become injured than one without extra support. The principle makes sense, but what does the research say about this topic?

Low back injuries are the most common workplace injury. In 1998 there were nearly 300,000 lumbar injuries in the USA related to overexertion alone (1). Research studies have postulated that the prevalence of low back pain is between 60-90% of the population (2). In 2008 it was reported that there were 3.4 million emergency room visits related to low back pain alone, a figure that accounts for over 9,400 ER visits each day in the USA solely related to low back pain (3). By 2008, the annual cost of healthcare related to low back injuries in the United States had escalated from 28 billion in 1996 to $86 billion in 2008 (2,4). Needless to say, the emphasis to find ways to prevent low back injuries is warranted due to the escalating cost and frequency of injury. With that said, does the research support the utilization of back belts as a form of injury prevention?

There have been numerous studies done over the course of the last 15 years on the benefit, or lack thereof, of utilizing back belt as a form of injury prevention. Of these, I thought I would share the findings of a few. Wassell and Associates partnered with a large chain of merchandise stores. They broke the stores into 2 groups. Stores whose policy required all material handlers to wear back belts at all times and the contrary stores where utilization of back belts was voluntary. This was a large study, pulling data over 2 years. The experimental group that was wearing back supports at all times was made up of data from 89 retail stores, compared to the control group that was comprised of 71 stores. The results of the study illustrated that there was no correlation between wearing a back support and reduced risk for injury. There were roughly the same frequency and cost of injuries for both groups of participants in the study (1).

Another study done in the Netherlands, compared airline baggage handlers complaint of pain, injury rates and days away from work between laborers wearing back supports and those that did not wear any support. This study found that the two groups had almost identical injury rates and further, had no difference in days away from work (2).

A third study published in the Journal of Occupational Medicine corroborated the results of the aforementioned studies. They did not find any statistically significant reduction in injury rates for laborers at Tinker Air Force Base. This study did identify an interesting point that would be relevant for further investigation. The study by Mitchell and associates found that while there was no reduction of injuries in the group that was wearing back belts, what they did find statistically significant was that the cost of injuries for the group that wore the back supports was statistically more expensive on average than the control group that did not wear back supports. So not only did the back belts not help reduce injury, but they also increased the cost of injury for the laborers that wore the back supports (5).

In an effort to illustrate both sides of the debate. The “Home Depot Study” published in the Journal of Occupational Environmental Health in 1996 did demonstrate some support for the utilization of back supports. This study was a statistical analysis over the course of 6 years. The study found that there was a 34% reduction in low back injury rates following the integration of back supports to the workforce. However, there were many other changes made at the same time. Some of these changes included the integration of lift/assist methods (fork lifts and pallets) and the study was not randomized, so the findings were not controlled. With that said, there was a reduction in back injuries following the integration of back belts (6).

While there is some conflicting studies, the majority of research that is randomized, controlled studies that aim to eliminate bias demonstrate that there is minimal injury prevention benefit by utilizing a lumbar support in the work environment. The best form of injury prevention for low back pain is proper engineering and continual feedback on proper ergonomics. Providing braces for the workforce just isn’t supported when you look to the research.

Works Cited:
1. Wassell, JT, Gardner, LI, et.al.. “A Prospective Study of Back Belts for Prevention of Back Pain and Injury” Journal of American Medical Association. December 2000-Vol. 284, No. 21. Pages: 2727-2732.
2. Van Poppel, M.N.M., Koes, B.W., et.al. “Lumbar Supports and Education for the Prevention of Low Back Pain in Industry” Journal of American Medical Association” June 1998-Vol.279, No. 22. Pages: 1789-1794.
3. “Treatment of Low Back Pain – Exploring the Costs”. Results Physiotherapy. http://resultsphysiotherapy.com/treatment-of-low-back-pain/.
4. Boyles, S. “$86 Billion Spent on Back, Neck Pain”. http://www.webmd.com/back-pain/news/20080212/86-billion-spent-on-back-neck-pain
5. Mitchell, L.V., Lawler, F.H., et.al. “Effectiveness and Cost-Effectiveness of Employer-Issued Back Belts in Areas of High Risk for Back Injury”. Journal of Occupational Medicine. January 1994.
6. Kraus, J.F. et al. “Reduction of Acute Low Back Injuries by Use of Back Supports” International Journal of Occupational Environmental Health. 1996-Vol 2. Pages: 264-273.

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Why Does The System Wait For People To Break?

We have all heard the phrase “follow the money, for that is where the true intentions lie”. Often this phrase holds true. When you follow the money in the Workers Compensation system, none of the money begins changing hands until the worker is broken. There is no financial incentive for the occupational physician to prevent an injury. They get paid for treating injuries on a fee for service basis. If they prevent an injury, than they are effectively cutting the legs out from their revenue source. Further, there is extensive money paid to TPA’s to limit the cost of injuries after the worker has been broken. This is where the money currently goes. With that said, there is plenty of rhetoric proclaimed regarding prevention, and lots of corporate policy centered on injury prevention, however when you “follow the money” it is not going that direction.

I want to make it clear that this is not a slam on the occupational medicine field or TPA’s. They serve a critical role in taking care of the people that are broken & whose injuries cannot be prevented. The system will always need them! Further, that is not to say that companies are not trying to provide a safe work environment. I have had the opportunity to observe many corporations that value the safety of their employees and truly do care for their well-being. This is to say, that if we “follow the money” the system does not kick in until the person is broken. The point is to illustrate that the system is flawed as it has been created reactively. What if we thought of the system differently and invested some of the finances in preventing the large majority of injuries that could be prevented? How much more effective could that be for the person, the employer and the overall effectiveness of our workplace EHS programs?

I had the pleasure of meeting recently with the director of corporate risk for AIG. In our conversation he gave a stat that confirmed what I have known for some time. He mentioned that musculoskeletal injuries account for 40-70% of all workplace injuries. Beyond that, he said the cost of the musculoskeletal injuries account for 50-80% of the cost of workers comp claims. So what does this have to do with anything? From a clinical standpoint, we understand that musculoskeletal injuries most typically have early warning signs of discomfort that can be identified prior to the development of an injury. Rarely is the rotator cuff disorder, the lumbar disc injury or the carpal tunnel develop due to one specific event. There are usually warning signs that can be identified and prevented if the financial incentive were placed on prevention, rather than the current model that waits for the individual to break.

Early in my career I worked in outpatient orthopedic physical therapy. The most common Work Comp patients that I would see were rotator cuff disorder or lumbar dysfunction. In the huge majority of these patients, the fix would have been quick, easy and minor had they addressed the early signs of discomfort. Unfortunately, I was typically seeing these patients 8-12 weeks following the beginning of their symptoms. By this time the symptoms were chronic and required a treatment program that would take 4+ weeks of rehab multiple times per week. I would do my best to treat, educate and address the chronic symptoms and get them back to work as quickly as possible. This illustration highlights the problem we face. How much more effective would it be for the worker to address those issues on Day 0, instead of waiting for Day 56? How much more cost effective would it have been for the company to prevent those outpatient PT visits, prevent the loss time and have a productive employee at work doing their job?

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A mentor of mine is a retired corporate finance director, and he used a great phrase last week when we were having coffee. He mentioned that “People are the largest investment on the asset side of the balance sheet”. I say this because we know it makes sense to maintain and invest in our machinery/vehicles/production lines/etc to prevent them from breaking. It is more affordable to prevent a breakdown than it is to fix the broken machine. But with our largest financial asset, we don’t utilize that same philosophy. We need to be investing in early identification, prevention and maintenance of our people in the same fashion that we do with our equipment. We need to change the system so that when we “follow the money” that some of the resources are being utilized to prevent injuries, rather than waiting for our people to break. The trend in industry is starting to go this direction, we just need the system to change to continue to support it. We will always need to fix the people that are broken, and the pieces are in place to continue doing that with great Occ Med clinics and effective TPA relationships, but for the majority of those claims that would benefit from preventive measures, the system needs to change. The motivation needs to be on prevention!

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Sitting versus Standing – Like Being Between a Rock and a Hard Place

As a Physical Therapist people are drawn to ask questions related to posture, health or wellness topics. Further, as a PT who specializes in industrial safety and ergonomics, the questions often relate to desk ergonomics. Without question, the in vogue topic has been adjustable sit-stand desks. Many of you, I am sure have seen co-workers with desks that go up and down, and wondered to yourself, “is that really necessary, or is it just a giant waste of money?” The goal of this post is to sort through some of the evidence that is out there and give the reader an educated position on the topic of sit-stand posture at work.

Health Risks of Sitting:
With an increasing percentage of the US workforce operating with relatively sedentary jobs, it is important to identify some of the health risks associated with prolonged sitting. Research identifies that prolonged sitting can have serious consequences in multiple body systems. A study out of the Mayo Clinic demonstrated that prolonged sitting has been shown to increase blood glucose levels, decreased respiration efficiency due to poor muscle efficiency of the diaphragm, slowed metabolism and reduced number of lipid/triglyceride fighting enzymes in the blood stream. These changes in physiology can result in increased obesity rates, increased likelihood of developing type 2 diabetes and decreased life expectancy. The American Cancer Study published a report that analyzed 123,000 Americans over a 14 year period. Their study illustrated that people who sat greater than 6 hours per day demonstrated a death rate 20% higher than those who were more active. These are startling statistics that illustrate the health risks associated with prolonged sitting.

The Health Risks of Standing:
While prolonged sitting demonstrates serious potential health risks, there are also health risks associated with prolonged standing. Literature illustrates an increased risk for venous insufficiency, increased likelihood of lower extremity musculoskeletal dysfunction and increased likelihood of low back pain disorders. Prolonged sitting has shown an increased tendency for varicose veins, knee pain and lumbar degeneration. The health risks associated with standing are more specifically associated with standing on hard surfaces and increase with static standing postures. The research is less specific on the cause of these risk factors, but does show an increase in frequency when people stand for extended periods of time.

The Best of Both Worlds
Fortunately there are alternatives to the complications depicted with prolonged sitting and standing posture. Research demonstrates that as little as walking 5 minutes per hour will reduce the changes in arterial walls with prolonged sitting. Further, research out of the University of Chester highlighted that standing 10 minutes per hour resulted in decreased blood glucose levels, increased metabolism and improved heart rate. Both of these studies did not demonstrate any ill-effects from the short duration standing positions.

A Few Bits of Advice
The research illustrates that alternating positions is the most ideal practice. Trying to stand for periods of 5-10 minutes per hour will reduce the negative risk factors associated with prolonged sitting, but not increase the complications when standing. When you are standing, it is beneficial to use an anti-fatigue mat to reduce the compressive forces that are placed on the knees and lower back. Further, make sure that you are using an adjustable desk that will allow for neutral typing height as well as neutral monitor height. Desks that do not adjust independently will often put the arms in an awkward posture when typing in a standing position. Overall, the key point is that position change is important for multiple factors including blood flow, metabolism, heart rate and joint health. So, all the buzz about a sit-stand desk might make a lot of sense in the long run.

Sources:
http://www.nytimes.com/2011/04/17/magazine/mag-17sitting-t.html?_r=2&
http://www.juststand.org/Portals/3/literature/UofChesterStudyResults.pdf
http://www.sciencedaily.com/releases/2014/09/140908083748.htm
http://www.ncbi.nlm.nih.gov/pubmed/12454452

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Actions Speak Louder Than Words, Especially With Safety Culture

“A way of thinking, behaving, or working that exists in a place or organization” is one of the definitions that Webster’s Dictionary lists for culture. A critical component to this definition is the first segment, “A way of thinking, behaving or working”. This definition illustrates that culture is made up of both beliefs and actions. When considering this definition with regards to Safety Culture, it is important to understand that every company has a safety culture! Every group of people that work together have a series of beliefs associated with their work environment, including workplace safety. These beliefs can be both positive and negative, but they are the illustration of the safety culture for the work environment.

My job often takes me into corporate environments to analyze and discuss safety programs. The term safety culture is often flippantly thrown around in these conversations by executives, as if it is something that can be implemented when desired. Consistently in these conversations, I will mention that every company has a safety culture already in place, including their company. Often times, the culture that is in place is not the desired safety culture, but is an accurate representation of the beliefs of the employees.

If companies have not specifically tried to create a culture, than how are these beliefs developed. Roger Conners and Tom Smith wrote a book specifically on this titled “Journey to the Emerald City”. I encourage you to read it if you are focusing on your corporate safety culture. The key points of the book are that culture is created by 4 components: Experiences, Beliefs, Actions & Results. Conners and Smith bring to light a specific plan for changing culture in corporate environments. The critical component to changing a culture is to develop experiences that will change beliefs. Once the beliefs are changed, than the employees actions will represent the desired cultural beliefs, creating the desired cultural results. At the core of this philosophy is understanding that actions speak louder than words.

If a company recognizes that they want to create a proactive safety environment that listens to the employee’s feedback, encourages employee participation, and aims to generate the safest work environment possible by eliminating hazards prior to incurring an injury than they must create experiences for the employees that illustrate the company’s beliefs and the desired culture. Employees are not going to change their current beliefs that have been developed by years of experiences in the work environment just because the Management Team has a big presentation on safety culture and tells them the direction the culture is going. Culture is a way of thinking, behaving or working that is the result of experiences that employees have had. In order to change a culture, corporations need to foster experiences that will create beliefs that align with the desired culture. In order to create the above safety culture, the company must create experiences that make the employees understand that they care about what the employees say about workplace safety. Further, they need to create opportunities for employees to share their opinions. Lastly the environment has to positively encourage this feedback without the fear of retaliation. If this company simply stated that they wanted a proactive culture and encouraged employee feedback, but concurrently created policy that was threatening or an extreme hassle to report potential hazards, than the employees beliefs would be that the company says they want to know about potential hazards, but that is just corporate lip service. Remember, the specific experiences will generate the beliefs of the employee. Create interactions that will foster the desired safety culture and promote the desired cultural beliefs.

In summary remember that every company has a safety culture already in place. This culture has been created by the experiences and beliefs that the employees have already experienced. If you are going to try and change a culture, focus on creating experiences that will establish employee beliefs that fit the desired safety culture. Remember that actions speak louder than words!

Cited References:
Connors, R., Smith, T. “Journey to the Emerald City – Achieve a Competitive Edge by Creating a Culture of Accountability” Prentice Hall Press. 1999.

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Slips, Trips & Falls Related to Aging – A Physiological Understanding

The aging workforce is an increasing topic of discussion over the course of the last 10 years and will continue until 2030 when the last of the “Baby Boomers” will reach the age of 66. It is well documented that the population as a whole is increasing steadily with an unprecedented 20% of the population predicted to be over the age of 65 by the year 2030[1]. This transition in population demographics will surely have an impact on occupational demographics as well. The AARP reports that 79% of “Baby Boomers” polled report that they plan on working past the age of 65 years of age due to financial instability[2].

As the workforce ages, research reports increases in the severity of occupational injuries as well as the cost of occupational injuries[3][4]. Further the types of injuries transitions as the workforce ages. Shuford illustrates the data created by the Workers Compensation Research Institute, pointing out that rotator cuff injuries are the 26th most common claim for 15-24 age bracket, but are most common claim in frequency for 65+ age bracket. Similarly, the top three most frequent claims for the 65+ age bracket include rotator cuff pathology, carpal tunnel syndrome and meniscus tears. All three of these injuries are not in the top three claims for occupational injuries until the 55-64 age bracket. Previous to the age of 55 the research reports that lumbar dysfunction is the most frequent claim[5].

One specific area that changes dramatically is the frequency of “falls on same level”, often referred to as “slips, trips and falls” in the aging workforce. The Swedish Occupational Injury Information System demonstrated a significantly higher rate among construction workers falling on the same level in workers over the age of 45[6]. This is an important area for concern because falls result in high force impact and can increase the frequency of head trauma, knee pathology and upper extremity dysfunction when trying to catch oneself. Injuries related to falls can be very costly and there is preventative measures that can help reduce the increasing risks of falls in the aging workforce.

In an effort to understand why “falls on the same level” increase in the aging workforce, it is imperative to understand some of the physiological changes that occur naturally with aging. As one ages, the speed of neuron transmission decreases. In basic terms, this means that the body sends messages more slowly. This decreases reaction time, increases instability and also can change the way our body reacts internally to changes in blood pressure. Our blood pressure is constantly regulating itself as we change positions. When bending down, standing up, or changing body positions our body automatically adjusts the blood pressure in our head to maintain a steady awareness. As we age and the nerves slow down, the regulation of our blood pressure also decreases. Because of this, an older worker who has been bent over working stands up quickly, it is not uncommon for them to have a short period of dizziness or instability increasing the likelihood for falls. This phenomenon is called orthostatic hypotension and is very common in the aging workforce. Understanding this will allow for companies to implement strategies to assist the aging worker in preventing episodes of orthostatic hypotension. As much as possible trying to keep the aging worker in positions that do not require them to be kneeling or working below waist level is one possible solution. Another valuable lesson is to educate the aging workforce on orthostatic hypotension and tactics to prevent the causes of such. Prior to changing positions, if the aging worker pumps their ankles 10 times, it will help circulate blood from the lower extremities and decrease the effects of postural changes. Also, encourage workers to take their time when changing positions and to make sure that they have 3 points of contact when they are rising from a bent over, or kneeling posture.

Simple changes targeting task planning, personal understanding and simple exercises can assist in reducing the effects of orthostatic hypotension. This will help reduce the frequency of “falls on the same level” and promote increased awareness to balance in the aging workforce. While orthostatic hypotension is not the only age related change that effects balance, it is a common occurrence that is important to think about.

 

[1] Lockwood, Nancy. “The Aging Workforce – The Reality of the Impact of Older Workers and Eldercare in the Workplace”. 2003 SHRM Research Quarterly. 2003. 1-11

[2] Reeves, Scott. “An Aging Workforce’s Effect on U.S. Employers”. Forbes Online. http://www.forbes.com/2005/09/28/career-babyboomer-work-cx_sr_0929bizbasics.html 9/29/2005.

[3] 2008. “Older Workers” Bureau of Labor Statistics. http://www.bls.gov/spotlight/2008/older_workers/

[4] Welbourne, T. 2010. “Strategies for Dealing with the Challenges and Opportunities of America’s Aging Workforce”. American Management Association. http://www.amanet.org/training/articles/Strategies-for-Dealing-with-the-Challenges-and-Opportunities-of-Americas-Aging-Workforce.aspx.

[5] Shuford, H. et. al. (2005). “Thinking About an Aging Workforce – Potential Impact on Workers Compensation”. NCCI Research Brief.

[6] Schwatka, N. et. al. (2011). “An Aging Workforce and Injury in the Construction Industry”. Epidemiological Review Published by Oxford University Press for Johns Hopkins Bloomberg School of Public Health.Vol 34, 156-167.

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Zero Injury Focus Isn’t The Problem – The Implementation Culture Can Be

I have often thought about the topic of Zero Injuries or the ideology “All Injuries are Preventable”. As a Physical Therapist and owner of a business that focuses on workplace safety I have often felt convicted by this ideology. As a medical professional it is impossible to not think about the personal health factors and genetics that play a role in most workplace sprain/strain type injuries. For example, a diabetic is far more likely to develop shoulder tendonitis than a non-diabetic employee who is doing the exact same job in the same environment. Would this injury be preventable by workplace measures or controls? From an outside perspective you would like to think that it would. Implementing controls to limit aggravating postures, increase job rotations, and providing educational resources to manage systemic disorders such as diabetes for the workforce. However, this is often not the case and many of these injuries occur regularly as personal health knowledge is not readily available. Further, with the workforce aging, aches and pains are common. To have controls that eliminate ALL risk of discomfort/injury in a 66 year old pipe fitter seems as though it is irrational thought. A 66 year old pipe fitter likely hurts daily. To utter these thoughts in some corporate settings, and many safety environments, would come across as heresy. Further, to start this conversation would give the impression that you are willing to accept “some” injuries. At what point is the value of “some” determined.

Phil LaDuke recently wrote a great article on this topic titled “Debunking the myth of the inevitability of injuries”. If you haven’t read it, I encourage you to do such. The link is below in the references. My interpretation of his article was that goals of zero injuries are a great thing. A safety culture should strive to be the very best that they can be. While achieving zero is unlikely, the focus on zero maintains an environment that does not accept the status quo but is constantly seeking for answers to prevent potential hazards. As soon as a company assumes “some” injuries are normal, complacency sets in and the risk for serious injury or fatality increases. These are inexcusable risks to be allowed in any workplace setting. I agree whole heartedly with his viewpoint on the issue. All companies should constantly be searching for zero injuries and looking for opportunities to improve.

The strive for zero is a great goal for companies to have and can promote a fantastic safety culture when implemented effectively, however my real challenge with the issue is the way that zero injuries are implemented. I have had the opportunity of being around companies that have successfully integrated the “strive for zero” and others who have not integrated it well. The damage that can be done to a safety culture when the program is not properly administered can be challenging to repair. The negative connotations associated with a “strive for zero” is when the administration focuses on the blame associated with an injury. If every injury is truly preventable, than conversely these institutions believe that every injury has someone to blame for the fault. This becomes a toxic culture that promotes intimidation and under-reporting. Further, it creates a barrier between safety professionals and the day to day activities of the workforce because the people are afraid of repercussions of being honest.

In order for a “strive for zero” to be successful, the culture from the bottom to the top needs to be invested in searching for solutions. These programs need to align themselves with solving problems and preventing hazards, rather than finding individual fault. I am not advocating for no personal responsibility, but rather am encouraging the focus to stay on creating an environment that welcomes discussion on workplace safety without the fear of being punished. “Striving for Zero” is a goal for excellence for a company, but it needs to be tied to a culture that fully adopts protecting each other.

References:
LaDuke, Phil. “Debunking the Myth of The Inevidibility of Injuries”. http://www.safetyrisk.net/debunking-the-myth-of-the-inevitability-of-injuries/

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“The Aging Worker” A Trendy Phrase or A Cause for Concern?

“The aging workforce” has been a trendy phrase over the course of the last 10 years in workplace safety circles. However, often this phrase is just that, a conversation starter. Many people have discussed the aging workforce, but rarely is this conversation pushed towards action. Many of the aging worker lectures/articles that I have been witness to focus on the changing sensory components of the body with the aging worker. By this I am referring to the changing visual awareness to colors, decreased auditory reference of pitches, etc. These are important issues to cover and are avenues that should be analyzed when looking into the ergonomics of a work environment. However, hearing dysfunction and slips/trips/falls are not the most common type of injury in the workforce. Musculoskeletal disorders continues to be the most prevalent workplace injury but are rarely covered in aging workforce conversations.

When analyzing the workplace census data, the number of workers over the age of 65 is increasing on an annual basis. In 1995 44% of 65 year olds were working a full time job. As of 2007 this number had increased to 56% and continues to rise. As the baby boomers enter the tail end of their careers the size of the workforce over the age of 55 is expected to increase by 36% (http://www.bls.gov/spotlight/2008/older_workers/ ). These numbers illustrate the reality that people are working later in life out of financial necessity.

Understanding that “the aging worker” is a reality, it is important to understand the risk associated with this phenomenon. All of us have heard our Parents or Grandparents complain about their sore back or arthritic knees. Traditionally these age-related pains were noticed on the golf course or around the house while enjoying retirement. As the work environment has changed, these pains are now being recognized at work and causally being claimed as work injuries. Compounded with increasing personal health deductible costs, corporations are going to see a continued increase in occupational injuries in the aging worker.

With that said, it is my belief that the emphasis of education and resources targeting the aging worker should look at overall wellness, weight loss initiatives and core strengthening exercise routines to improve core stability and reduce the risk associated with age related degeneration. While sensory-based programs are important, they don’t represent the larger area of need in the aging worker. The focus should be on preventative wellness to reduce the risks associated with aging to the musculoskeletal system.

Sources:
http://www.bls.gov/spotlight/2008/older_workers/

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