1. SHARP Workplace Strategies & Interventions: lessons from ergonomics Barbara Silverstein Safety & Health Assessment & Research for Prevention Washington State Department of Labor & Industries Will it work? Will it last?

2. SHARP Planned Change Technical features: Hardware/software How complex in terms of scope & sophistication? Implementation features: The more people affected, more required to change behavior, the greater the focus needs to be on implementation features Power: How much “voice” do those required to change have?

3. SHARP What can you learn? Effectiveness of intervention Have you targeted the most important risk factors or introduced new ones? Barriers to change Opportunities for change Organizational resources available How to do it next time (theory v. practice) Can only learn from measures you collect (or don’t- --the hard way)

4. SHARP Considerations in implementing/evaluating interventions Social & economic context during which data is collected. Implications for studies Population changes during study periods Selection, strengths & limitations of –Populations –Study design –Outcome measures –Exposure measures –Covariates –Models used in analyses –Implications of findings-generalizability

5. SHARP Intervention study methods Randomized controlled trial Participatory action research Pre-post: serve as own control Pre-post with internal comparison Pre-post with external comparison Role of case studies?

6. SHARP Design Issues: Quasi-experimental Studies Comparison groups provide estimate of incidence without intervention Similarity in factors related to injury experience (restriction or matching), or control for confounding in analysis Identify groups prior to intervention so can collect baseline Contemporary vs. historical controls (full coverage interventions, e.g regulatory interventions)

7. SHARP Practitioner Reported Case Studies Often No before-after design No comparison group Inadequate statistical power Sample of convenience Inadequate description of methodology for identification of exposure, effect, potential confounders, analysis Vested interest in success If same information is collected in multiple case studies…can begin to gain confidence in findings

8. SHARP Evaluating success-health & work Discomfort, fatigue, symptoms, “presentism” Medical visits, absenteeism Long term disability, lost time, workers comp Workers compensation, turnover Productivity losses (overtime, overstaff, presenteeism) Quality: scrap/repair Turnover, recruitment/training Lost investment opportunity satisfaction involvement innovation Use short and long term measures

9. SHARP Example: Aluminum Smelter Opportunities to use ergonomics (joint ergonomics committee-design & review) Process Process: layout, equipment, info processing in new $40 million carbon plant Production Production: content, organization (self managed teams, crust breakers) Personnel Personnel: methods & training

10. SHARP Participatory Ergonomics (or any workplace change) Process Commitment & Support Worksite assessment Integrate planning of change Implement ergonomic solutions Pilot test solutions Monitor, evaluate, modify Maintain Feedback to-from workers Training Engineering and organizational change to teams resulted in significant decrease in exposures (2/3) and WMSDs (>1/2) Comparison: crane operators: no change

11. SHARP History at Aluminum Smelter 1991 New local union team, new plant management 1992 Joint Safety Plan (Start SHARP study, training, small changes, begin R&D on larger changes) 1993 External factors: –Russian aluminum dumped on market, Drought in Northwest--> soaring energy costs 1994 Union elections, new skeptical leaders –difficult labor management relationship –New ergonomics committee 1995 Strike, hire 150 new workers,local union receivership 1996 Reconstituted ergo committee ergo policy SHARP follow up evaluation Begin design for new carbon plant 1998-99 Lockout (More $ selling energy than Al)  Mill shut

12. SHARP Improvements: Use pre-defined keys to assign the grade marks to boards passing by Marks logged into the computer for sorting at the mechanical sorter This logged grade mark information is also used for analysis to monitor grader variation & improve training. Sawmill Hazard Impact Partnership: 6 mills, SHARP, WISHA->reduce WMSDs in lumber handlers BeforeAfter Grader improvements reduced WMSD risk, improve quality

13. SHARP Strategy: Industry Specific Solutions Focus groups-labor/management/apprentice programs Identify key players that make life difficult/easy –User/producer meetings Field test solutions.. what about it did and did not work. Develop alternatives for what didn’t work Give trials enough time Agree on good practices

14. SHARP WA State ZeroLift Initiative: Industry, Labor, Government WA State ZeroLift Initiative: Industry, Labor, Government 258 “free standing” nursing homes WA Health Care Assn: rebates, training, newsletters UFCW,SEIU (10%)-supportive, not active Dept of Labor & Industries Evaluate equipment-> FAQ publications WC premium discounts 6 counties for implementing zero lift environment->jumpstart on equipment Education campaign on using job modification funds- > No effect Evaluate effectiveness of efforts: surveys & site visits ZeroLift: policies, equipment, training, commitment/involvement, investigate/follow-up

15. SHARP Results : WC analyses for lost time back injuries related to resident handling  Resident/NAC ratio  NAC turnover  Management turnover  Stable management 3 years  Sit-stand devices  Management commits/involve employees  Premium discount Risk In all MLR analyses, being a small nursing home 4 annual surveys 85-95% participation

16. SHARP Barriers to preventing back injuries in nursing homes Management turnover NAC turnover (70-400%) Experienced NACs moved on to hospitals or home health…better $ and working conditions Larger % of PD nursing homes are “for-profit”- bankruptcy threats Organization [change in resident characteristics, payment systems, ownership] Beliefs about risk, residents and time-Note: focus of effort was on management---no active engagement of NACs

17. SHARP Making it Work Awareness of changing environment Management commitment (turnover likely?) Time, resources Employee Involvement Time, training Identification, controls, evaluation Design & review (user/producer groups) Worksite analysis & controls Appropriate technical resources for changes

18. SHARP Recommendations  Leadership: credible, accountable  Policy, process, performance measures  Participatory process: fighting fires->design & review  Embed process in existing structure  Follow-through & feedback-no false promises  Plan for the long haul  Know when, where to get external help but workplace should maintain internal control of the process

19. SHARP Implementing Change- getting it right is a little like tai chi Industry A matter of energy and balance