Occupational Injury and Illness Disparities Research in the Healthcare Work Environment: Opportunities and Obstacles Craig Slatin, Sc.D. Jamie Tessler, M.P.H. Michael O’Sullivan, Dr.P.H. Laura Punnett, Sc.D. The PHASE in Healthcare Project Univ. of Massachusetts Lowell This project is supported by a grant from the National Institute of Occupational Safety and Health Grant #R01-OH , “Health Disparities Among Healthcare Workers.”

2 “PHASE” Project Promoting Healthy and Safe Employment in Healthcare. Key Question: To what extent is the socio-economic gradient in health explained by factors in the work environment?

3 The Setting: Community Hospitals and Nursing Homes  Healthcare: a major sector of the U.S. economy 2003 expenditures = $1.5 trillion 2003 expenditures = $1.5 trillion  Diverse workforce  Multiple occupations  High rates of acute injuries, MSDs and other occupational illnesses

4 The Nature of Health Disparities Research  Multidisciplinary Qualitative Methods Qualitative Methods Quantitative Methods Quantitative Methods  Multiple Domains Macro level: Industry and Facility Occupational Exposures Health Endpoints Social and Economic Outcomes

5 Unique Aspects of the Healthcare Industry  Hospitals are among the most complex organizations  Contain both “clinical” and “hotel” functions  Conflicting accountability structures  Industry recently restructured by neoliberal economic policies

6 Challenges to Research  Emphasis on patient safety versus employee health and safety  Unclear definition: “Who is a healthcare worker?”  Working conditions: overtime,  turnover, downsizing, etc.  Heavy demands on workforce outside of the facility (83% ♀, second job, work/family balance)  41% part-time workers (esp. nurses)

7 Challenges (cont’d.)  Few unionized facilities in study region  Negotiations with employers and access to employees  Limited size and scope of H&S infrastructure  Distrust of academic research  Limited diversity and affirmative action programs

8 Research Impact on Healthcare Facility Research Impact on Healthcare Facility  Community hospitals not accustomed to demands of research  Interruption of patient care routines  Managers already wearing multiple hats

9 Sustaining Facility Participation  Management concerns re: discovery of safety hazards discovery of safety hazards employee discontent employee discontent Regional unionization drives Regional unionization drives Negative publicity Negative publicity  Disparity: local facility versus parent corporation  Presence of healthcare unions on PHASE advisory board  Impact of economic restructuring RESULT: 3 HC org’s lost by 3 rd year.

10 Quality of Available Data  Uneven use of computerized databases across facilities  Race/ethnicity/native language data absent or inaccurate  EEOC data could not be used to classify SES  Data on Staffing difficult to obtain; decentralized procedures by dept.

11 Injury/Illness Data  OSHA logs lacked Department info  Workers’ Comp data lacked job title  Heavy underreporting suspected in HC industry  PHASE qualitative results show: Injuries considered part of job, not reportedInjuries considered part of job, not reported Compensation too cumbersome, workers don’t botherCompensation too cumbersome, workers don’t bother Return to Work programs are problematicReturn to Work programs are problematic Workers can’t afford ($) not to workWorkers can’t afford ($) not to work

12 Barrier #1: Facility Selection  Strategy – Select facilities based on prior connections and loyalties and utilize those relationships effectively.  Results – Mixed. Top level management: effective Staff level: loyalties (e.g. alumni) not activated /utilized

13 Barrier #2: Employee Recruitment  Strategy – One-on-one conversations with employees  Results – Good; reached workers via job fairs, dept. meetings, exposure assessment team activities

14 Barrier #3 Management Buy-In  Strategy – Identify what managers value most: Prestige Prestige Routine Routine Productivity Productivity See if research can support them  Results – Mixed:  PHASE may not have listened enough  Proposal already defined  Moving fast to compensate for IRB delays

15 Summary  Conflicting needs Employees Employees Managers Managers Patients/residents Patients/residents Researchers Researchers  Healthcare org’s are trying to deliver quality patient care and keep the organization economically viable  Researchers want to study health disparities Summary: More obstacles than opportunities