Processes, barriers, and outcomes described by ergonomics consultants in preventing work-related musculoskeletal disorders

Hidden risk factors and the mediating role of sleep in work-related musculoskeletal discomforts

OBJECTIVE

Musculoskeletal discomforts (MSDs) are prevalent occupational health issues that are associated with a wide range of risk factors. This study aimed to investigate some of the occupational hidden risk factors and the mediating role of sleep in work-related musculoskeletal discomforts.

METHODS

In a cross-sectional study, the role of job stress and shift work as two hidden risk factors and sleep problems as the mediator in work-related musculoskeletal discomforts was investigated in 302 healthcare workers using the path analysis models. For this aim, healthcare workers' Occupational Stress and musculoskeletal discomforts were evaluated using the Health and Safety Executive questionnaire and Cornell questionnaire, respectively. Moreover, the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) were used to examine the sleep characteristics of participants. Shift work and job stress as predictor variables and sleep characteristics as mediating variables were analyzed.

RESULTS

The results showed that the path coefficients of job stress on indexes of quality sleep and insomnia severity were significant. Also, the path coefficient of shift work on quality sleep index was significant. In return, the path coefficients of shift work on the insomnia severity index were not significant. Additionally, there was a mutually significant association between indexes of quality sleep and the severity of insomnia and musculoskeletal discomforts. The direct effect coefficient of job stress on MSDs was significant, whereas the direct effect coefficient of shift work on MSDs was insignificant. This means that shift work alone does not significantly impact these disorders.

CONCLUSION

It would seem that shift work and job stress as two occupational hidden risk factors can mediate sleep indexes and indirectly play a critical role in the incidence of musculoskeletal discomforts. Moreover, sleep disorders and musculoskeletal discomforts are mutually related and have a bidirectional relationship.

Does occupational health surveillance lead to risk reduction for workers exposed to hand-intensive work?

This mixed method study aimed to describe what risk-reducing actions were proposed by ergonomists after the execution of a guided process for occupational health surveillance for workers exposed to hand-intensive work in ten companies. Another aim was to describe the exposed workers' proposals for risk-reducing actions, including their perceptions of potential changes in the self-assessed exposure levels and work-related pain. Several actions, targeting organizational, technical, and/or individual measures were proposed. Proposals from the ergonomists more often targeted the personal measures, whereas the workers' proposals targeted technology or organizational changes. Six companies implemented at least one of the action proposals. These action proposals were not related to evaluation metrics, nor were they evaluated. This study indicates that both ergonomists and companies need guidance on how to improve to work in a participatory process for the implementation and evaluation of risk-reducing actions, e.g., by how to better include workers' experiences.

Psychosocial hazards play a key role in differentiating MSD risk levels of workers in high-risk occupations

OBJECTIVES

Workplace management practices targeting risk of musculoskeletal disorders (MSDs) fail to reflect evidence that risk is affected by psychosocial as well as physical hazards. To promote improved practices in occupations where MSD risk is highest, better information is needed on how psychosocial hazards, combined with physical hazards, affect risk of workers in these occupations.

METHODS

Survey ratings of physical and psychosocial hazards by 2329 Australian workers in occupations with high MSD risk were subjected to Principal Components Analysis. Latent Profile Analysis of hazard factor scores identified different combinations of hazards to which latent subgroups of workers were typically exposed. Survey ratings of frequency and severity of musculoskeletal discomfort or pain (MSP) generated a pre-validated MSP score and its relationship with subgroup membership was analysed. Demographic variables associated with group membership were investigated using regression modelling and descriptive statistics.

RESULTS

Analyses identified three physical and seven psychosocial hazard factors and three participant subgroups with differing hazard profiles. Profile group differences were greater for psychosocial than physical hazards, and MSP scores out of 60 ranged from 6.7 for the low hazard profile (29% of participants) to 17.5 for the high hazard profile (21%). Differences between occupations in hazard profiles were not large.

CONCLUSIONS

Both physical and psychosocial hazards affect MSD risk of workers in high-risk occupations. In workplaces such as this large Australian sample where risk management has focused on physical hazards, actions targeting psychosocial hazards may now be the most effective way to reduce risk further.

Reliability and Validity of Six Selected Observational Methods for Risk Assessment of Hand Intensive and Repetitive Work

Risk assessments of hand-intensive and repetitive work are commonly done using observational methods, and it is important that the methods are reliable and valid. However, comparisons of the reliability and validity of methods are hampered by differences in studies, e.g., regarding the background and competence of the observers, the complexity of the observed work tasks and the statistical methodology. The purpose of the present study was to evaluate six risk assessment methods, concerning inter- and intra-observer reliability and concurrent validity, using the same methodological design and statistical parameters in the analyses. Twelve experienced ergonomists were recruited to perform risk assessments of ten video-recorded work tasks twice, and consensus assessments for the concurrent validity were carried out by three experts. All methods' total-risk linearly weighted kappa values for inter-observer reliability (when all tasks were set to the same duration) were lower than 0.5 (0.15-0.45). Moreover, the concurrent validity values were in the same range with regards to total-risk linearly weighted kappa (0.31-0.54). Although these levels are often considered as being fair to substantial, they denote agreements lower than 50% when the expected agreement by chance has been compensated for. Hence, the risk of misclassification is substantial. The intra-observer reliability was only somewhat higher (0.16-0.58). Regarding the methods ART (Assessment of repetitive tasks of the upper limbs) and HARM (Hand Arm Risk Assessment Method), it is worth noting that the work task duration has a high impact in the risk level calculation, which needs to be taken into account in studies of reliability. This study indicates that when experienced ergonomists use systematic methods, the reliability is low. As seen in other studies, especially assessments of hand/wrist postures were difficult to rate. In light of these results, complementing observational risk assessments with technical methods should be considered, especially when evaluating the effects of ergonomic interventions.

Ergonomists' experiences of executing occupational health surveillance for workers exposed to hand-intensive work: a qualitative exploration

Background

In order to reduce work-related upper limb disorders, the Swedish Work Environment Authority introduced an occupational health surveillance targeting hand-intensive work. A process model, aimed at supporting the employers as well as the occupational health service provider (i.e., ergonomist) in the work process with the occupational health surveillance, was developed. The objective of this qualitative study was to explore ergonomists’ experiences of the execution of occupational health surveillance for hand-intensive work when following the novel process model as well as factors influencing the execution.

Methods

Semi-structured individual interviews were conducted with ten ergonomists on one occasion regarding their experience of following the work process. Qualitative content analysis with an inductive approach was used for analyzing the data.

Results

The ergonomists’ experiences were summarized in one theme “A joint roadmap supporting a participatory process” and two categories “Clear structure provided by the components” and “The process influenced by collaboration and context”. The ergonomists valued being guided by the systematics of the model, which provided structure and clarity in their work. Factors affecting the execution were related to communication deficiencies and uncertainties regarding expectations between different roles and functions (e.g., ergonomists and contact person, lack of information to workers). Additional factors, for instance, companies’ routines and the ergonomist’s intra-organizational support, such as access to IT-resources, could also affect the process.

Conclusions

The findings reveal that this process model facilitates the ergonomists’ work and cooperation with a client company. However, the process model needs to be developed and accompanied by a guideline with information related to the process, including e.g., description of a start-up meeting and of the roles/functions of the involved parties.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08601-2.

The problem with "ergonomics injuries": What can ergonomists do?

Effects of psychosocial hazards on risk of musculoskeletal disorders (MSDs) are often very substantial, but workplace risk management practices focus largely on biomechanical hazards, as do the risk assessment methods used by ergonomists. Translation of research evidence into more effective workplace practices demands a more holistic risk management framework that encompasses both types of hazard. In this context, we evaluate the validity of different MSD risk assessment methods for different purposes, focusing particularly on requirements for routine workplace risk management. These include choice of fit-for-purpose assessment methods, prioritisation of hazards that are most affecting risk, and control actions as high as possible in the risk control hierarchy. Ergonomists could facilitate more effective workplace risk management by promoting: awareness of the need for change; improvements to guidance from OHS regulators; research on MSD-related workplace management issues; and professional development programs on this topic for ergonomists and other OHS practitioners.

Exploring ergonomists' experiences after participation in a theoretical and practical research project on observational risk assessment tools

Objective. The aim of this qualitative study was to explore how ergonomists experienced an e-learning concept as a tool for knowledge translation; furthermore, to explore what, if any, impact the knowledge translation had regarding the ergonomists' work with risk assessments. Methods. Twelve Swedish ergonomists employed in the occupational health service (OHS) participated in a research project, which included an e-learning program in risk assessment training. Focus group interviews and individual interviews were used for data collection. Results. The ergonomists appreciated the e-learning concept, e.g., its flexibility enabled them to decide when and where to practice. The concept was considered feasible within the context of the OHS. The ergonomists experienced an increased knowledge of different observation-based risk assessment tools, which expanded their professional toolboxes. Additionally, they began to reflect more regarding the reliability of risk assessment tools and how to enhance quality in risk assessment assignments. Conclusion. This study showed that e-learning may comprise an efficient knowledge translation for improved risk assessments in the OHS. The program contributed to changes in ergonomists' risk assessment procedures, e.g., in the selection of tools, increasing the number of observers, employing a participatory approach and more often actively involving stakeholders during the risk assessment process.

The relationship between chronic pain, prehypertension, and hypertension. A population-based cross-sectional survey in Al-Kharj, Saudi Arabia

Background: Chronic pain and hypertension are highly prevalent in both developing and developed countries. Although they may appear to be two separate phenomena, several studies in developed countries have found them associated at the population level. Studies in developing countries are scarce and association between pain with prehypertension are rarely explored. The objective of this study was to explore the potential association between prehypertension, hypertension, and chronic pain in a Saudi population.Methods: A cross-sectional general population-based study was conducted on a random sample of employees and university students over a period of 6 months from January 2016 to June 2016 in Al Kharj, Saudi Arabia. A total of 1200 general population adults (aged 18 years and above) were invited to participate in the study.Results: With a response rate of 85.9%, 1031 individuals were included in the final analysis. Among the general population of Al-Kharj, statistically significant association was found between age and chronic pain [Odds ratio (OR) = 1.764 [95% C.I. = 1.391-1.927], P < 0.0001] and between hypertension and chronic pain [(OR) = 1.039 [95% C.I. = 1.018-1.060], P < 0.0001], respectively. The association between prehypertension and chronic pain was not statistically significant [(OR) = 1.211 [95% C.I. = 0.879-1.668, P = 0.243].Conclusion: Results of this survey suggests a statistically significant relationship between hypertension (but not prehypertension) and chronic pain. The temporality of the relationship between hypertension and chronic needs to be explored in future longitudinal studies.

Factors influencing ergonomists' use of observation-based risk-assessment tools

BACKGROUND:

Several observation-based risk-assessment tools have been developed in recent decades. Studies reporting their use often focus only on the user, the ergonomist. The influence of context and the attributes of the tools may also affect the use but are factors that are seldom considered.

OBJECTIVE:

The aim of the present study was to explore the process of risk-assessment assignments and to identify factors influencing the use of research-based observation-based risk-assessment tools among Swedish ergonomists, with a background as reg. physiotherapists, employed in Occupational Health Services (OHS).

METHODS:

A web-based questionnaire (n = 70) was combined with semi-structured interviews (n = 12).

RESULTS:

There was limited use of several observation-based risk-assessment tools. Furthermore, the results showed that ergonomics risk-assessment assignments are most commonly initiated reactively and that interventions were seldom evaluated. Factors that influence use are related both to the ergonomist and to the attributes of the tools as well as to contextual factors assigned to authorities, and internal organisations both within occupational health service companies and client companies.

CONCLUSION:

There was a lack of systematic approaches in ergonomics risks assessment and low use and knowledge of risk-assessment tools. This indicates that there is a need to support OHS companies in implementing systematic tools in their practice.

The APHIRM toolkit: an evidence-based system for workplace MSD risk management

Musculoskeletal disorders (MSDs) continue as one of the largest occupational health and safety problems worldwide. One reason for this situation is that current workplace risk management practices fail to meet some important evidence-based requirements for effective reduction of MSD risk. In particular: they largely fail to address risk arising from psychosocial hazards; do not allow sufficient participation by workers; and often fail to control risk at its sources.

To address these deficiencies, A Participative Hazard Identification and Risk Management (APHIRM) toolkit has been formulated in accordance with both a framework developed by the World Health Organisation and implementation science principles. It comprises a set of online tools that include automated data analysis and reporting modules, and procedures to guide users through the five stages of the conventional risk management cycle. Importantly, it assesses both hazard and risk levels for groups of people doing a particular job, focusing on the job overall rather than only on tasks deemed to be hazardous. Its intended users are workplace managers and consultants responsible for occupational health and safety, with active participation from workers also. Resultant risk control interventions are customized to address the main physical and psychosocial hazards identified for the target job, and repetitions of the risk management cycle enables ongoing evaluation of outcomes in terms of both hazard and risk levels.

Barriers to more effective prevention of work-related musculoskeletal and mental health disorders

Work-related psychosocial hazards have substantial effects on risks of both musculoskeletal and mental health disorders (MSDs, MHDs). Recent Australian research on workplace risk management practices in 19 work organisations found that risks from work-related psychosocial hazards were poorly managed. This study identified factors impeding better management of MSD and MHD risks within those organisations. METHOD: Interviews were conducted with staff from residential aged care and logistics/transport organisations in Australia. Transcripts were analysed using a worker-centred systems framework. RESULTS AND CONCLUSIONS: Many barriers to more effective risk management were identified. Most fundamentally, few people knew of the need to manage MSD risk arising from work-related psychosocial hazards, and OHS-related skills of key managers were often reported as inadequate, particularly concerning management of risk from psychosocial hazards. Also, funding and staffing levels were often reported as problematic, and OHS issues were seen as lower priority than accreditation and commercial requirements.

Barriers to and facilitators for implementing an office ergonomics programme in a South African research organisation

The focus of this study was on the possibility of implementing an office ergonomics programme as part of a broader workplace health initiative at a South African research organisation. We explored the perspectives of actors in the workplace regarding organisational barriers and facilitators to implementing ergonomic interventions. This qualitative study presents the perspectives of three workplace actor groups: operational managers (n = 4); health and safety representatives (n = 9); and office employees (n = 4) who were involved in a previous ergonomic assessments that proposed several corrective and preventive actions. Eight factors emerged as either barriers or as simultaneous barriers and facilitators to the implementation of proposed ergonomic interventions. These are: organisational culture; information and specialist support; funding; support from operational managers; attitude towards changes; general organisational awareness; individual knowledge of ergonomics; and support from colleagues. This study is one of the first in South Africa to investigate the perspectives of workplace actors in an office setting with regard to factors that influence implementation of ergonomics initiatives to reduce work-related musculoskeletal disorders.

Barriers for implementation of successful change to prevent musculoskeletal disorders and how to systematically address them

This scoping review identified common barriers and facilitators encountered during the implementation of changes to prevent musculoskeletal disorders (MSD) and examined their relationship with those encountered in general Occupational Health and Safety (OHS) efforts. Thematic analysis of the literature identified 11 barriers: (i) Lack of time; (ii) Lack of resources; (iii) Lack of communication; (iv) Lack of management support, commitment, and participation; (v) Lack of knowledge and training; (vi) Resistance to change; (vii) Changing work environment; (viii) Scope of activities; (ix) Lack of trust, fear of job loss, or loss of authority; (x) Process deficiencies; and (xi) Difficulty of implementing controls. Three facilitators identified were: (i) Training, knowledge and ergonomists' support; (ii) Communication, participation and support; and (iii) An effective implementation process. The barriers and facilitators identified were similar to those in general OHS processes. The integration of MSD prevention into a general management system approach may overcome these barriers.

Workers' compensation insurer risk control systems: Opportunities for public health collaborations

INTRODUCTION

Workers' compensation (WC) insurers offer services and programs for prospective client selection and insured client risk control (RC) purposes. Toward these aims, insurers collect employer data that may include information on types of hazards present in the workplace, safety and health programs and controls in place to prevent injury/illness, and return-to-work programs to reduce injury/illness severity. Despite the potential impact of RC systems on workplace safety and health and the use of RC data in guiding prevention efforts, few research studies on the types of RC services provided to employers or the RC data collected have been published in the peer-reviewed literature.

METHODS

Researchers conducted voluntary interviews with nine private and state-fund WC insurers to collect qualitative information on RC data and systems.

RESULTS

Insurers provided information describing their RC data, tools, and practices. Unique practices as well as similarities including those related to RC services, policyholder goals, and databases were identified.

CONCLUSIONS

Insurers collect and store extensive RC data, which have utility for public health research for improving workplace safety and health.

PRACTICAL APPLICATIONS

Increased public health understanding of RC data and systems and an identification of key collaboration opportunities between insurers and researchers will facilitate increased use of RC data for public health purposes.

Inter- and intra- observer reliability of risk assessment of repetitive work without an explicit method

A common way to conduct practical risk assessments is to observe a job and report the observed long term risks for musculoskeletal disorders. The aim of this study was to evaluate the inter- and intra-observer reliability of ergonomists' risk assessments without the support of an explicit risk assessment method. Twenty-one experienced ergonomists assessed the risk level (low, moderate, high risk) of eight upper body regions, as well as the global risk of 10 video recorded work tasks. Intra-observer reliability was assessed by having nine of the ergonomists repeat the procedure at least three weeks after the first assessment. The ergonomists made their risk assessment based on his/her experience and knowledge. The statistical parameters of reliability included agreement in %, kappa, linearly weighted kappa, intraclass correlation and Kendall's coefficient of concordance. The average inter-observer agreement of the global risk was 53% and the corresponding weighted kappa (K_w) was 0.32, indicating fair reliability. The intra-observer agreement was 61% and 0.41 (K_w). This study indicates that risk assessments of the upper body, without the use of an explicit observational method, have non-acceptable reliability. It is therefore recommended to use systematic risk assessment methods to a higher degree.

'Power base' tactics for workplace change - an interview study with industrial engineers and ergonomists

The work activities of industrial engineers (IEs) and ergonomists drive workplace changes. The purpose of this study is to compare the work practices of the two professions and examine (1) how IEs and ergonomists gain influence over workplace changes and (2) whether there are prevailing types of intentional interaction behaviours called Power bases (PB) present in the interaction tactics they employ. The study identified key behavioural strategies used by the interviewees to successfully influence workplace changes; these were then mapped to their corresponding PB. Results showed that IEs and ergonomists were successfully influencing workplace changes using several tactics across the spectrum of PB, with the exception of Reward and Coercion. The study concludes with a list of recommended workplace change agent tactics, and proposes that a PB 'analytical lens' can serve to increase the budding ergonomists' critical and analytical skills when considering possible workplace change tactics. Practitioner Summary: This interview study examines how workplace ergonomics change agents, represented by the two professions: industrial engineers and ergonomists, perceive and exercise their capacity to influence workplace change. Key behavioural tactics that interviewees have found successful are reported, alongside effects on short- and long-term relations with other workplace-influencing stakeholders.

The stage of change approach for implementing ergonomics advice - Translating research into practice

The Stage of Change (SOC) approach has been proposed as a method to improve the implementation of ergonomics advice. However, despite evidence for its efficacy there is little evidence to suggest it has been adopted by ergonomics consultants. This paper investigates barriers and facilitators to the implementation, monitoring and effectiveness of ergonomics advice and the adoption of the SOC approach in a series of focus groups and a subsequent survey of members of the Human Factors Societies of Australia and New Zealand. A proposed SOC assessment tool developed for use by ergonomics practitioners is presented. Findings from this study suggest the limited application of a SOC based approach to work-related musculoskeletal injury prevention by ergonomics practitioners is due to the absence of a suitable tool in the ergonomists' repertoire, the need for training in this approach, and their limited access to relevant research findings. The final translation of the SOC assessment tool into professional ergonomics practice will require accessible demonstration of its real-world usability to practitioners and the training of ergonomics practitioners in its application.

Developing the Stage of Change Approach for the Reduction of Work-related Musculoskeletal Disorders

Musculoskeletal disorders remain the most prevalent form of occupational ill health, prompting examination of why attempts to manage the problem have been less successful than perhaps hoped. With a view to improving the efficacy of such interventions, this study examined the applicability of the stage of change approach to the workplace. Tools were developed to assess individual and organizational stage of change towards reducing the risks of musculoskeletal disorders. The tools were tested in a range of occupational sectors, and demonstrated high levels of validity and reliability. Implications for the application of the model in the workplace for improving intervention effectiveness are discussed.

Dissemination and use of a participatory ergonomics guide for workplaces

Musculoskeletal disorders (MSDs) result in lost-time injury claims and lost productivity worldwide, placing a substantial burden on workers and workplaces. Participatory ergonomics (PE) is a popular approach to reducing MSDs; however, there are challenges to implementing PE programmes. Using evidence to overcome challenges may be helpful but the impacts of doing so are unknown. We sought to disseminate an evidence-based PE tool and to describe its use. An easy-to-use, evidence-based PE Guide was disseminated to workplace parties, who were surveyed about using the tool. The greatest barrier to using the tool was a lack of time. Reported tool use included for training purposes, sharing and integrating the tool into existing programmes. New actions related to tool use included training, defining team responsibilities and suggesting programme implementation steps. Evidence-based tools could help ergonomists overcome some challenges involved in implementing injury reduction programmes such as PE. Practitioner Summary Practitioners experience challenges implementing programmes to reduce the burden of MSDs in workplaces. Implementing participatory interventions requires multiple workplace parties to be 'on-board'. Disseminating and using evidence-based guides may help to overcome these challenges. Using evidence-based tools may help ergonomics practitioners implement PE programmes.

When is job rotation perceived useful and easy to use to prevent work-related musculoskeletal complaints?

Job rotation is often recommended to optimize physical work demands and prevent work-related musculoskeletal complaints, but little is known about possible facilitators and barriers to its usefulness and ease of use. Following a qualitative research design, semi-structured interviews with employers (n = 12) and workers (n = 11) from the construction industry were conducted. Organizational climate, job autonomy, job characteristics and work processes were mentioned as either facilitators or barriers on an organizational level. Worker characteristics, work behavior and attitude were mentioned as either facilitators or barriers on an individual level. Following a structured approach to assess usefulness of job rotation to optimize physical work exposures and identifying barriers to usefulness and ease of use in relevant stakeholder groups is necessary in order to select or develop strategies to overcome these barriers, or to reject job rotation as a useful or easy to use intervention in the given context.

The implementation of ergonomics advice and the stage of change approach

This paper investigates the implementation of injury prevention advice tailored according to the Stage of Change (SOC) approach. The managers of 25 workgroups, drawn from medium to large companies across a wide range of occupational sectors were allocated to receive either standard ergonomics advice or ergonomics advice tailored according to the workgroup SOC. Twelve months after the advice was provided, semi-structured interviews were conducted with each manager. In a multivariate model, managers who had received tailored advice were found to have implemented significantly more of the recommended changes (IRR = 1.68, 95% CI 1.07-2.63) and more "additional" changes (IRR = 1.90, 95% CI 1.12-3.20). Qualitative analysis identified that the key barriers and facilitators to the implementation of changes were largely related to worker resistance to change and the attitudes of senior managers towards health and safety. The findings from this study suggest that the implementation of ergonomics recommendations may be improved by the tailoring of advice according to SOC principles.

Requirements for more effective prevention of work-related musculoskeletal disorders

BACKGROUND

Exposures to occupational hazards substantially increase workers' risk of developing musculoskeletal disorders (MSDs) and can exacerbate pre-existing disorders. The effects on MSD risk of the physical requirements of work performance are well recognised, but there is now ample evidence that work-related psychosocial hazards can also have substantial effects; further, some hazards may be additive or interactive. This evidence is not reflected in current workplace risk management practices.

DISCUSSION

Barriers to more effective workplace management of MSD risk include: the widespread belief that risk arises largely or entirely from physical hazard exposures; regulatory and guidance documents targeting MSDs, most of which reflect this belief; risk assessment tools that focus narrowly on subsets of mainly physical hazards and yet generate outputs in the form of MSD risk indicators; and the conventional occupational health and safety (OHS) risk management paradigm, which is ill-suited to manage MSD risk. It is argued that improved workplace management of MSD risk requires a systems-based management framework and more holistic risk assessment and control procedures that address risk from all types of hazard together rather than in isolation from each other, and that support participation by workers themselves. New MSD risk management tools are needed to meet these requirements. Further, successful implementation of such changes is likely to require some restructuring of workplace responsibilities for MSD risk management. Line managers and supervisors often play key roles in generating hazards, both physical and psychosocial, so there is a need for their more active participation, along with OHS personnel and workers themselves, in routine risk assessment and control procedures. MSDs are one of our largest OHS problems, but workplace risk management procedures do not reflect current evidence concerning their work-related causes. Inadequate attention is given to assessing and controlling risk from psychosocial hazards, and the conventional risk management paradigm focuses too narrowly on risk from individual hazards rather than promoting the more holistic approach needed to manage the combined effects of all relevant hazards. Achievement of such changes requires new MSD risk management tools and better integration of the roles of OHS personnel with those of line managers.

Acceptability and feasibility of potential intervention strategies for influencing sedentary time at work: focus group interviews in executives and employees

BACKGROUND

Occupational sitting can be the largest contributor to overall daily sitting time in white-collar workers. With adverse health effects in adults, intervention strategies to influence sedentary time on a working day are needed. Therefore, the present aim was to examine employees' and executives' reflections on occupational sitting and to examine the potential acceptability and feasibility of intervention strategies to reduce and interrupt sedentary time on a working day.

METHODS

Seven focus groups (four among employees, n = 34; three among executives, n = 21) were conducted in a convenience sample of three different companies in Flanders (Belgium), using a semi-structured questioning route in five themes [personal sitting patterns; intervention strategies during working hours, (lunch) breaks, commuting; and intervention approach]. The audiotaped interviews were verbatim transcribed, followed by a qualitative inductive content analysis in NVivo 10.

RESULTS

The majority of participants recognized they spend their working day mostly sitting and associated this mainly with musculoskeletal health problems. Participants suggested a variety of possible strategies, primarily for working hours (standing during phone calls/meetings, PC reminders, increasing bathroom use by drinking more water, active sitting furniture, standing desks, rearranging the office) and (lunch) breaks (physical activity, movement breaks, standing tables). However, several barriers were reported, including productivity concerns, impracticality, awkwardness of standing, and the habitual nature of sitting. Facilitating factors were raising awareness, providing alternatives for simply standing, making some strategies obligatory and workers taking some personal responsibility.

CONCLUSIONS

There are some strategies targeting sedentary time on a working day that are perceived to be realistic and useful. However several barriers emerged, which future trials and practical initiatives should take into account.

Ergonomics action research II: a framework for integrating HF into work system design

This paper presents a conceptual framework that can support efforts to integrate human factors (HF) into the work system design process, where improved and cost-effective application of HF is possible. The framework advocates strategies of broad stakeholder participation, linking of performance and health goals, and process focussed change tools that can help practitioners engage in improvements to embed HF into a firm's work system design process. Recommended tools include business process mapping of the design process, implementing design criteria, using cognitive mapping to connect to managers' strategic goals, tactical use of training and adopting virtual HF (VHF) tools to support the integration effort. Consistent with organisational change research, the framework provides guidance but does not suggest a strict set of steps. This allows more adaptability for the practitioner who must navigate within a particular organisational context to secure support for embedding HF into the design process for improved operator wellbeing and system performance.

PRACTITIONER SUMMARY

There has been little scientific literature about how a practitioner might integrate HF into a company's work system design process. This paper proposes a framework for this effort by presenting a coherent conceptual framework, process tools, design tools and procedural advice that can be adapted for a target organisation.

Doing 'organizational work': expanding the conception of professional practice in ergonomics

Literature on ergonomic practice contains many discussions of how ergonomists should work but far less attention has been paid to how they do work and the factors that influence their practice. In an effort to improve our understanding of ergonomic practice as it occurs and how it is conditioned by broader contexts, we conducted an interview study with 21 ergonomists in Canada. We were particularly interested to understand the different kinds of activities study participants engaged in during the course of their work, the challenges they faced and the strategies they employed for facing these challenges. Findings indicate that in the course of their professional practice ergonomists engage in a variety of types of activities. This includes consulting on risk factors as well as a proactive role of fostering the application of ergonomics in organizations. The process of advocating for ergonomics brought study participants into a variety of interactions and collaborations with workplace parties in a type of activity we have called "organizational work". In the course of doing organizational work, ergonomists utilize different strategies, including "political manoeuvring", tailoring data collection and report presentations to clients' concerns and 'goal hooking' in order to make the case for implementing ergonomics in workplaces. The article concludes with a list of "tips" for practicing ergonomists that are suggested by the analysis.

Ergonomics contributions to company strategies

Managers usually associate ergonomics with occupational health and safety and related legislation, not with business performance. In many companies, these decision makers seem not to be positively motivated to apply ergonomics for reasons of improving health and safety. In order to strengthen the position of ergonomics and ergonomists in the business and management world, we discuss company strategies and business goals to which ergonomics could contribute. Conceptual models are presented and examples are given to illustrate: (1) the present situation in which ergonomics is not part of regular planning and control cycles in organizations to ensure business performance; and (2) the desired situation in which ergonomics is an integrated part of strategy formulation and implementation. In order to realize the desired situation, considerable changes must take place within the ergonomics research, education and practice community by moving from a health ergonomics paradigm to a business ergonomics paradigm, without losing the health and safety goals.

Integrating ergonomics into production system development--the Volvo Powertrain case

Understanding the barriers and assists to integrating ergonomics into production system design remains a research issue. An action research case study at Volvo Powertrain/Sweden was conducted. Researchers worked collaboratively with the firm in efforts to improve the company's ability to handle ergonomics in their daily work of improving and developing production systems. Researchers observed and reflected collectively on the change process using field notes and recordings to support their observations. Observed integration barriers included both individual level issues like life events, and organisational aspects such as communication barriers between groups or assignment of tasks to people not involved in decision-making. Observed assists included the 'political reflective navigation' (c.f. Broberg, O., Hermund, I., 2004. The OHS consultant as a 'political reflective navigator' in technological change processes. International Journal of Industrial Ergonomics 33 (4), 315-326) by the project owner to find new ways to overcome barriers and anchor ergonomics into the organisation. While special 'ergonomics' groups did not survive long, progress was observed in including ergonomics in regular design groups. A cross-functional workshop that fostered discussion across organisational boundaries helped shift focus from retrofitting systems to future production systems and improve engagement of engineering teams. Progress was marked by both success and setbacks and full integration appears to require more than 2 years time. It is concluded that support by senior managers should include succession planning for personnel that are key to the change effort.

The Cochran-Weiss-Shanteau performance index as an indicator of upper limb risk assessment expertise

Ergonomists and many other professionals apply ergonomics principles to musculoskeletal health problems. This study examines whether there are differences when it comes to judgement expertise concerning upper limb disorders (ULDs) between ergonomists and those with less ergonomics training. The Cochran-Weiss-Shanteau (CWS) performance index combines judgement consistency with discrimination into one CWS index. Fifty-eight professionals working in the musculoskeletal health area, from four different professions, judged the likelihood of staff complaining of ULDs in a number of written work scenarios containing ULD risk factors. A student group (n = 148) taking an introductory ergonomics module was used as a reference. The ergonomists scored higher on the CWS index than all of the other groups, performing significantly better than all but the occupational health advisors. Performance improved with increased training level but not with experience. This study suggests that ergonomists are quantifiably different from other ergonomics advisors in their judgement performance in this context. Given the global cost of musculoskeletal disorders, assessing the expertise of those giving ergonomics advice for the management of musculoskeletal health is of great significance. This study presents a method for assessing judgement performance in ULD risk assessment, an important part of musculoskeletal health management.

Nurses' Expectations, Experiences and Attitudes towards the Intervention of a ‘No Lifting Policy’

The aim of the study was to evaluate expectations and attitudes towards a No Lifting Policy programme, the "No Lift system", among nurses at hospitals where an introduction of the intervention was planned (PreNLS hospitals), and to make a comparison with nurses' experiences and attitudes at one hospital where the intervention had already been implemented (NLS hospital). A cross-sectional study of nurses at two PreNLS hospitals and one NLS hospital was performed. Most nurses at both the PreNLS hospitals and the NLS hospital were positive or very positive to the intervention. The expected and experienced obstacles differed between nurses at the PreNLS hospitals and the NLS hospital; however, there was more agreement concerning benefits. The most frequently expected obstacles at the PreNLS hospitals were organisational issues and obstacles related to the facilities, while most obstacles identified at the NLS hospital concerned specific transfers or were patient-related. A decrease in the number of injuries was the most often considered benefit among most nurses. Nurses at the NLS hospital rated their physical exertion as lower in seven out of nine specific patient transfers compared with nurses at the PreNLS hospitals. They also reported increased well-being at work and an improved ability to manage their daily work. The comprehensive approach and participatory design, including all levels of staff and extensive support from the nurses' own union and management, is probably one important explanation for the positive attitudes and successful introduction of the intervention.

A stage of change approach to reducing occupational ill health

OBJECTIVE

Interventions targeted by stage of change have been shown to improve the efficacy of public health promotion initiatives in areas such as smoking cessation, alcohol reduction, and mammography screening. Targeted interventions are designed to tackle the key attitudes, beliefs, and intentions that underpin an individual's health-related behavior. Work-related ill health is an increasingly serious issue, the most common cause of which in both the UK and the US is musculoskeletal disorders. This study examined whether the stage approach could be applied to workplace interventions aimed at improving occupational health.

METHOD

A total of 24 multi-component occupational interventions aimed at reducing musculoskeletal disorders were monitored over a period of 4-6 months. In half of these cases, approaches were targeted according to workers' stage of change.

RESULTS

Targeted interventions were found to be significantly more effective in promoting risk awareness and desired behavior change among workers. Significant reductions were also found in self-reported musculoskeletal discomfort among workers having received targeted interventions. No significant differences were found in self-reported musculoskeletal discomfort among workers following standard interventions.

CONCLUSION

Stage-matched approaches may offer scope for substantially improving the efficacy of occupational health and safety interventions by increasing the uptake, implementation, and maintenance of risk-reducing measures.

Ergonomic decision-making: a conceptual framework for experienced practitioners from backgrounds in industrial engineering and physical therapy

Ergonomists play an important role in preventing and controlling work-related injuries and illnesses, yet little is known about the decision-making processes that lead to their recommendations. This study (1) generated a data-grounded conceptual framework, based on schema theory, for ergonomic decision-making by experienced practitioners in the USA and (2) assessed the adequacy of that framework for describing the decision-making of ergonomics practitioners from backgrounds in industrial engineering (IE) and physical therapy (PT). A combination of qualitative and quantitative analyses, within and across 54 decision-making situations derived from in-depth interviews with 21 practitioners, indicated that a single framework adequately describes the decision-making of experienced practitioners from these backgrounds. Results indicate that demands of the practitioner environment and practitioner factors such as personality more strongly influence the decision-making of experienced ergonomics practitioners than does practitioner background in IE or PT.

Is the use of ergonomic measures associated with behavioural change phases?

The aim of this study was to test the hypothesis that the absolute number of completed behavioural change phases (ABP) and the sequentially ordered number of completed behavioural change phases (SBP) are positively associated with the use of ergonomic measures by two groups of stakeholders in bricklaying companies (employers/planners, foremen/bricklayers). The measures, consisting of trestles, bricklaying scaffolds, mast-climbing work platforms and cranes, reduce the physical work demands made upon bricklayers and bricklayers' assistants. Structured interviews were conducted with stakeholders of 27 companies. Ordinal regression of behavioural change phases on the use of ergonomic measures showed a significant increase in both ABP and SBP in relation to increased use of three of the four ergonomic measures (i.e. trestles, bricklaying scaffolds, mast-climbing work platforms) by employers/planners and increased use of one ergonomic measure (i.e. trestles) by foremen/bricklayers. In conclusion, the positive and significant associations between the completed behavioural change phases (ABP and SBP) and use of ergonomic measures differ for the stakeholder groups and between the ergonomic measures. The data suggest that there is a higher chance of increasing the use of ergonomic measures by means of a higher ABP than a higher SBP. It is recommended for activities to be carried out-primarily by employers/planners-to facilitate as many behavioural change phases as possible in order to stimulate actual use of ergonomic measures at worksites.

Macroergonomics: analysis and design of work systems

Attending to the larger system components such as organizational design and management is not novel for ergonomists. In Europe, there has been a strong tradition to investigate ergonomic problems within a holistic, systems context. "Macroergonomics" builds upon this tradition by providing specific methods and tools that yield large-scale results. It is believed that meaningful and large-scale results are needed in today's competitive and turbulent work environments. Macroergonomics is defined, its history is uncovered and focus is given to a key methodology, macroergonomic analysis and design. Case studies are used to validate the method and illustrate that performance results in the 60-90% range can be expected.