latrobe.edu.au CRICOS Provider 00115M Barriers to improved risk management of Musculoskeletal Disorders: What is the role of the regulator? Dr. Jodi Oakman La Trobe University

2 Research Team Adjunct Professor Wendy Macdonald Professor Tim Bartram Dr. Tessa Keegel Natasha Kinsman

3La Trobe University Project Aims To identify: (1) workplace stakeholder beliefs and attitudes about factors affecting the incidence of MSDs and of MHDs; (2) workplace stakeholder perceptions of new evidence- based risk management procedures and associated resources, and factors likely to hinder or facilitate their implementation.

4La Trobe University Barriers to improved risk management of Musculoskeletal Disorders:

5La Trobe University Extent of the problem  Over half of OHS claims are musculoskeletal ̶Many clinical diagnoses, poor reliability across different clinicians ̶Many arise from cumulative trauma (RSI, etc) but claims data is an unreliable indicator of this  MHD claims are second most common ̶Many fewer than MSDs, but very expensive ̶The most severe work-related MHD – suicide – is probably greatly under-reported  ‘Stress’ can be important in development of both MSDs and MHD – so makes sense to consider them together

6La Trobe University Many MSDs develop gradually... large opportunity for prevention

7La Trobe University Cumulative tissue damage Physical hazards Psychosocial hazards Internal Biomechanical Load Physiological Stress Response Muscle Tension Hormones etc. Pain sensitisation Work-related hazards Internal processes MSD CAUSAL MECHANISMS

8La Trobe University Workplace Hazards affecting MSDs (a) Manual handling hazards... task specific (b) Psychosocial hazards... 2 sub-groups: ̶Organisational – work organisation, job design ̶Social context- support, communications, relationships with managers

9La Trobe University Psychosocial hazards Subgroups OrganisationalSocial Context Working hoursCommunications with management High workloadsBeing valued Poor job designHealth/Safety Culture Low levels of controlRelationship with colleagues Pace of workRelationships with supervisors Conflicting work demands

10La Trobe University Physical hazards Workplace Psychosocial hazards Workplace Psychosocial hazards Low job satisfaction Low job satisfaction MSD RISK

11La Trobe University What is needed to reduce MSD risk in workplaces?  Research supports the need for interventions to be... ̶multi-pronged... tackling several different factors together ̶participative... not something imposed by managers or technical experts alone NB: there is strong evidence that training in ‘safe lifting/movement’ techniques is NOT effective in reducing risk

12La Trobe University Project Outline  La Trobe University funded by ISCRR to conduct this research  Residential Aged Care sector and Logistics/Transport sectors targeted because of high claims rates  19 organisations participated - 10 Logistics/transport - 9 Residential Aged Care  67 Individual interviews with Managers, OHS staff and H&S Reps ₋41 with Logistics/transport people ₋26 with Residential Aged Care people  Policy & procedure documents collected from 14 of the 19 organisations  Interview data analysed and themes developed following analysis  Policy & procedures were analysed for coverage of manual handling and psychosocial hazards and more general risk management strategies

13La Trobe University Policies and Procedures Review

14La Trobe University How well did these docs cover requirements for effective management of MSD risk?  All provided information of “Manual Handling” risk management... but no one sent us docs about management of MSD risk  In other words … management of “manual handling” hazards or “hazardous manual tasks” is usually seen as the same as MSD risk management.

15La Trobe University How psychosocial hazards are seen, and managed  Documents from around half of the orgs included policies and procedures where source of the risk is seen to be individual workers – e.g. policies and procedures re drugs/alcohol policies, discrimination, harassment, bullying, EAPs  It seems that “psychosocial hazards” are mainly seen as: ̶people’s personal problems (e.g. problems at home that cause them to come to work stressed or tired) ̶workplace bullying or harassment ̶so … mainly seen as an individual responsibility, or arising from behaviour of particular ‘problem’ individuals

16La Trobe University How psychosocial hazards are seen, and managed … CONTINUED Psychosocial hazards affecting MSD risk – mainly arise from work organisation, job design and the psychosocial work environment (as outlined earlier) Documents reviewed little mention of these hazards  Need for consultation was mentioned by most orgs (2 had separate docs on this) … not surprising because there is a legal requirement to ‘consult’ Apart from consultation:  4 of the 14 orgs had brief mention of some such hazards (3 of 8 Log/Trans; 1 of 6 Aged Care), but none had anything on how to assess and control risk from them (except reference to a procedure for dealing with fatigue from work-related driving except one which referenced fatigue).

17La Trobe University Interviews

18La Trobe University Strategies reported for managing manual handling hazards Examples - quotes Training & education programs (mostly about manual handling) The no lift training is an annual competency and so is the general manual handling training... have to do it annually. Lifting machines (Aged Care) we've got our lifting machines, we've got our hoists in the ceilings in every room, we have got lifting equipment, we've got a no lift policy Personal Protective Equipment (Logistics/Transport) your correct PPE which is your high ankle lace up boots to prevent ankle roll and knee injuries. And then at night we’re issued head lamps and torches and stuff Hazard reporting & risk assessment your risk assessment going through the individual, sort of narrowing it down, to the particular task. Doing a risk assessment, really pulling that task apart and identifying the hazards, identifying the risks. More so the manual handling because we obviously identified that it’s manual handling

19La Trobe University Strategies reported for managing other types of hazard Examples - quotes Employee assistance program/ in-house counselling We've got an EAP service so staff are aware of the service and there's posters and cards in the staffroom area that they can access EAP confidentially whenever they like. Workflow management Workflow management. So we review the allocation of staffing quite frequently, just to work out the acute needs of the resident, based on how many staff are allocated in that area. Working hours As a business, we’ve taken a positive approach to try and get our drivers home for their rest break, their long rest break, their 24-hour breaks. We make a concerted effort to try get them home every weekend. Job redesign For instance the heavy tyres used to come laced in a container which means people have to actually touch them. Well they don’t come like that anymore. They come so that a machine can get them out.

20La Trobe University Types of reported barriers to reducing risk

21La Trobe University Key Barriers to improved risk management of MSDs MSDs and MHDs managed separately Lack of guidance material to support those who manage psychosocial hazards, in particular relation to MSDs Challenges in identifying and then developing controls for psychosocial hazards

22La Trobe University What is the role of the regulator? Integration of material relating to the identification and control of psychosocial hazards into resources for MSD risk management Review and development of a modified hierarchy of risk control that more appropriately deals with MSDs Support a different approach to risk management that takes into account a more holistic assessment and control approach and takes into account relationships between hazards

23La Trobe University MSDs Risk Management Toolkit Taking into account this evidence we have a developed a risk management toolkit for MSDs  The toolkit...  aims to help workplace stakeholders (non-experts) to manage MSD risk more effectively  includes procedures to assess and control risk from both manual handling and psychosocial hazards... so should reduce risk of MHDs also

24La Trobe University The toolkit is for use by non-experts in routine workplace management of... Physical hazards of manual handling Job-related psychosocial hazards MUSCULOSKELETAL DISORDERS & INJURIES STRESS-RELATED MENTAL HEALTH DISORDERS

25La Trobe University Conclusions Significant gaps exist between research evidence and current workplace beliefs and practices. Workplace policies and procedures do not currently reflect the important role of psychosocial factors in the development of MSDs. A role for the regulator exists in developing contemporary, evidence-based resources to modify the existing workplace culture and promote more effective MSD risk management practices.

Thank you latrobe.edu.au CRICOS Provider 00115M This research is supported by funding of a Development Grant from WorkSafe Victoria and the Transport Accident Commission (TAC), through the Institute for Safety, Compensation and Recovery Research (ISCRR).”