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Occupational health professionals recognize that ergonomics programs can help them reduce injuries and slash workers’ compensation costs, as well as improve productivity. But simply implementing such a program does not guarantee impressive results. It takes careful planning and preparation, experts say.
"People have written whole chapters in books — and whole books on setting up ergonomics programs," notes Ira Janowitz, PT, CPE, MS (certified professional ergonomist), senior ergonomics consultant with the University of California San Francisco/Berkeley Ergonomics Program. "But there a few keys to success that stand out."
First, he says, employers should approach an ergonomics program the way they would set up any good program in the workplace. "The first thing you do is conduct a needs assessment," he advises. "You have to know where the problems are, and the extent of the problems. If you were setting up a program to look for toxins in the workplace, or the level of alcohol consumption, you would first try to find out where the problems were and how severe they were."
Next, he says, you should set up an early warning system. "Waiting until an employee files a workers’ comp claim is like waiting for a call from the cops," he says. "You don’t want to look for lagging indicators, but leading indicators — like people telling you, This job’s really fatiguing,’ or When I do that task my back aches.’ Get on it then; don’t wait until it becomes a crisis."
Next, train your key people about ergonomic risk factors, so they will know what to look for and will be able to start a problem-solving process, advises Janowitz. And finally, have a feedback loop. "Evaluation is a key feature," he asserts.
Your key staff must be aware there are certain risk factors that make it more likely a job will be associated with musculoskeletal disorders and other problems, say observers. "You must first identify what a risk factor is," asserts Dennis Downing, president of Future Industrial Technologies (FIT) in Santa Barbara, CA. "It can be anything that potentially puts physical stress on the body repetitively or excessively. The way we look at it, through ergonomic prevention you can eliminate a lot of risky behavior by adapting the worker’s physical environment."
Janowitz cites six key ergonomic risk factors:
• High repetition: Frequent duplication of the same motion or motions during the performance of any given job task.
• High force: This often is linked to high repetition, notes Janowitz. A worker may have high repetitions on a keyboard, but if the force used is light, the risk would not be as great.
• Awkward postures: This is linked with the first two factors. "You can’t exert the same torque if your elbow is above shoulder height, or way down below your knees," Janowitz explains.
• Static postures: This involves holding the same position for a long period of time. "The human body is meant to move and change positions frequently during the day," notes Janowitz. "Our ancestors didn’t stand or sit still; they moved around a lot. So, even if you use the proper’ posture, if you’re sitting all the time it will cause problems. Then, if you combine static posture with awkward posture, we really have a problem."
• Vibration: This could involve whole-body vibration, like the kind you experience when sitting in a motor vehicle or heavy earth-moving equipment (which can accelerate disk degeneration), or hand-arm vibration, such as that caused by using tools that vibrate a lot — especially compressed air tools. "If you use a vibrating tool and use high force to grip it, you have two risk factors," notes Janowitz. "If you’re working in concrete, you may have to hold an awkward posture. Then, if the tool is not powerful enough, and you have to hold it for an extended period of time, you have four risk factors. That’s what we really have to be concerned about — the simultaneous combination of risk factors."
• Contact stress (pressure points): This occurs when a tool does not fit comfortably in the hand, or when a worker uses a keyboard and rests his wrists on the edge of the table.
Potential ergonomic problems can readily be seen in health care-related job activities, notes Janowitz. "If you are taking blood pressure readings or starting an IV and bending over to do that, and you have to hold that position for an extended period of time, there could be risk involved," he notes. "Anyone in the health care field knows there are some patients in whom it is very hard to find a vein, and you have to stay in that bent-over posture for a long period of time."
Height-adjustable beds are another example of potential risk, he notes. "You may get the bed up to a more comfortable height for the patient, but not necessarily for you. However, you can raise the bed to a better height for you while keeping the patient in the same position. Or, maybe you could do your job more easily if you had better lighting on the situation. The key is to look for ways to do things better from an ergonomic frame of reference."
Employers should be aware that the impact of these risk factors extends far beyond medical problems, says Janowitz. "For example, if a worker has numbness and tingling in his hands, his precision will be affected and you will likely see a high number of errors," he explains.
To most effectively address these problems requires thought beyond the ergonomics basics, says Downing. "It’s not enough to conform the work environment to the body; you must teach your workers how to use that environment," he explains. This falls under the heading of "bionomics," which Downing describes as a subset of ergonomics. "Ergo means work," he explains. "Nomics means manage. So, ergonomics is more commonly known as adapting the physical environment to reduce physical stress. Bionomics addresses how to use the body."
Janowitz has a slightly different take. "The key point is whether the job is proper, not whether you are moving badly," he notes. "Ergonomics asks whether the job is designed to allow people to use good work practices. For example, patient handling is very high risk; it involves high force and awkward posture."
Downing insists that’s still not enough to ensure risk-free job activity. Through its BACKSAFE and SITTINGSAFE programs, FIT addresses both ergonomics and bionomics in helping companies reduce musculoskeletal disorders through onsite, job-specific training. "You have to teach basic body management techniques — stretching, biomechanics, and proper posture," says Downing. "Even with an $800 chair or an assembly line built in an ergonomically perfect way, if the individual was never taught how to sit properly, or how to use a keyboard properly, how to lift his children or his patients, or how to use his patient-handling equipment, you’ll still have problems."
The combination of ergonomics and bionomics proved extremely powerful at Hillcrest Healthcare Systems, a 15-facility organization in Tulsa and eastern Oklahoma. "About a year ago, we started BACKSAFE at two of our major hospitals with 70% of our employees — about 6,200 people," notes Cheryl King, director of workers’ compensation. "We had way too many injuries to deal with."
King comes from a background of prevention. "Hospitals, ironically, do not think about prevention — they’re used to treating people," she declares. "I explained that if we wanted to make income off our own folks we couldn’t think that way. About 78% of our injury claims over the previous five years had been back strains and sprains."
So, with FIT trainers, around-the-clock training was conducted on all three shifts during a period of 60 days. "We also brought in lifting equipment, so nurses would no longer have to lift 300-pound patients, and we taught them how to use the equipment properly," notes King.
Claims started dropping tremendously "right off the top," she says, crediting a lot of those initial savings to safety awareness — a "major culture change" in the hospitals. "We also experienced a lot fewer severe claims, all of which netted us $1 million in claims savings in one year," she observes.
King is convinced it was the combination of better equipment and proper usage that led to such significant savings. "If you get a nurse leaning over the gurney with that low back under pressure, she’s still in that vulnerable position no matter what equipment she’s using," she notes. "I wish more hospitals would think more about prevention, since we can’t find enough nurses no matter where we look."
Janowitz, whose group includes two occupational med physicians, also sees positive results from hospital ergonomics programs. "We set up a lifting team at a large medical center," he recalls. "There were two strong staff members assigned to handle the more difficult patient transfers. Two other health care systems chose patient transfer devices to help reduce the strain on staff."
Is it necessary to bring in outside professionals to accomplish your ergonomic goals? "Cert-ainly, there are ergonomic changes you can make without calling in a professional ergonomist," says Janowitz. "But if you want to set up a comprehensive program, it’s a good idea to call one in to help train you and your staff to know what to look for and to get good examples of successful changes. There are excellent programs all around the country, and we can learn from those." (An ergonomics program does not necessarily have to be comprehensive to make a difference. See "A little prevention goes a long way," in this issue.)
If you are seeking outside help, how do you find the right vendor? "You choose an ergonomist like you would choose a good doctor — a combination of qualifications and word of mouth," says Janowitz. "There is also a Board of Certification in Professional Ergonomics, which is based in Washington state. They have a list of ergonomists by state and by region."
"The Internet is a good place to look," adds Downing. "I would warn that ergonomic equipment or furniture isn’t necessarily in and of itself a solution. Look at what will give you the best bang for the buck; you can get a return of three to five times your investment." He also recommends that occupational health professionals interested in learning more about ergonomics read Liberty Mutual’s "Executive Survey of Workplace Safety" on their web site: www.libertymutual.com.
[For more information, contact:
• Ira Janowitz, PT, CPE MS, University of California San Francisco/Berkeley Ergonomics Program. Telephone: (925) 256-0628. Web: www.me.berkeley.edu/ergo.
• Cheryl King, Hillcrest Healthcare Systems, 111 W. 7th St., Tulsa, OK 74119. Telephone: (918) 579-5153.
• National Institute for Occupational Safety and Health (OSHA). Telephone: (800) 356-4674. Web: www.cdc.gov/niosh.
• Center for Ergonomics, University of Michigan, 1205 Beal Ave., Ann Arbor, MI 48109-2117. Telephone: (734) 763-2243. E-mail: email@example.com.]
Charney W. Reducing back injury in nursing, Journal of Healthcare Safety, Compliance & Infection Control. Vol. 4, No. 3, March 2000.