Unit VIII Case Study

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Original article Scand J Work Environ Health 2015;41(2):111-123

doi:10.5271/sjweh.3467

How compatible are participatory ergonomics programs with occupational health and safety management systems? by Yazdani A, Neumann P, Imbeau D, Bigelow P, Pagell M, Theberge N, Hilbrecht M, Wells R

Prevention of musculoskeletal disorders (MSD) often involves a participatory rrgonomics (PE) program. The paper compares the PE approach with occupational health and safety management system (OHSMS). The PE literature did not speak to many elements of OHSMS. It is expected that paying attention to management system frameworks could make prevention of MSD activities more effective and sustainable.

Affiliation: Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada. [email protected]

Refers to the following text of the Journal: 2005;31(3):0

Key terms: ergonomics; management system; MSD; MSD prevention; musculoskeletal disorder; occupational health and safety; occupational health and safety management system; OHSAS 18001; OHSMS; OSH management system; participatory ergonomics; participatory ergonomics program; quality; risk assessment

This article in PubMed: www.ncbi.nlm.nih.gov/pubmed/25380301

Scand J Work Environ Health 2015, vol 41, no 2 111

Original article Scand J Work Environ Health. 2015;41(2):111–123. doi:10.5271/sjweh.3467

How compatible are participatory ergonomics programs with occupational health and safety management systems? by Amin Yazdani, MSc,1, 2 W Patrick Neumann, PhD,3 Daniel Imbeau, PhD,4 Philip Bigelow, PhD,2, 5 Mark Pagell, PhD,6 Nancy Theberge, PhD,1, 2 Margo Hilbrecht, PhD,7 Richard Wells, PhD 1, 2

Yazdani A, Neumann WP, Imbeau D, Bigelow P, Pagell M, Theberge N, Hilbrecht M, Wells R. How compatible are participatory ergonomics programs with occupational health and safety management systems? Scand J Work Environ Health. 2015;41(2):111–123. doi:10.5271/sjweh.3467

Objectives Musculoskeletal disorders (MSD) are a major cause of pain, disability, and costs. Prevention of MSD at work is frequently described in terms of implementing an ergonomics program, often a participatory ergonom- ics (PE) program. Most other workplace injury prevention activities take place under the umbrella of a formal or informal occupational health and safety management system (OHSMS). This study assesses the similarities and differences between OHSMS and PE as such knowledge could help improve MSD prevention activities. Methods Using the internationally recognized Occupational Health and Safety Assessment Series (OHSAS 18001), 21 OHSMS elements were extracted. In order to define PE operationally, we identified the 20 most frequently cited papers on PE and extracted content relevant to each of the OHSAS 18001 elements. Results The PE literature provided a substantial amount of detail on five elements: (i) hazard identification, risk assessment and determining controls; (ii) resources, roles, responsibility, accountability, and authority; (iii) competence, training and awareness; (iv) participation and consultation; and (v) performance measurement and monitoring. However, of the 21 OHSAS elements, the PE literature was silent on 8 and provided few details on 8 others. Conclusions The PE literature did not speak to many elements described in OHSMS and even when it did, the language used was often different. This may negatively affect the effectiveness and sustainability of PE initiatives within organizations. It is expected that paying attention to the approaches and language used in management system frameworks could make prevention of MSD activities more effective and sustainable.

Key terms MSD; MSD prevention; musculoskeletal disorder; OHSAS 18001; OHSMS; quality; risk assessment.

1 Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. 2 Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD), Waterloo, Ontario, Canada. 3 Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Ontario, Canada. 4 Département de Mathématiques et de Génie Industriel, École Polytechnique de Montréal, Montréal, QC, Canada. 5 School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada. 6 Smurfit Graduate School of Business, University College Dublin, Dublin, Ireland. 7 Canadian Index of Wellbeing, Faculty of Applied Health Sciences, University of Waterloo, Ontario, Canada.

Correspondence to: Amin Yazdani, Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada. [E-mail: [email protected]]

Employers have a duty to anticipate, assess, and control a wide range of hazards in order to protect the health and safety of their workers. Many organizations have a busi- ness framework that they use to structure their prevention activities. If formalized, it could be considered an occupa- tional health and safety management system (OHSMS). Musculoskeletal disorders (MSD) are a major cause of pain, disability, and costs to workers, employers, and soci- ety. It might be expected that MSD prevention activities

would draw on methods and approaches like the OHSMS. A forthcoming scoping review (Yazdani et al. Preven- tion of musculoskeletal disorders within management systems: A scoping review of practices, approaches, and techniques. Submitted to J Appl Ergonomics), however, found there was little information on how MSD preven- tion activities might be implemented within an OHSMS. Instead, MSD prevention was often described in terms of implementing a stand-alone ergonomics program, often

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a participatory ergonomics (PE) program. We wondered what challenges and barriers might exist when integrating MSD prevention into an OHSMS.

There is evidence of the effectiveness of both approaches. Robson and colleagues (1) conducted a systematic review of the effectiveness of mandatory and voluntary OHSMS interventions. They found that OHSMS interventions, in general, were effective in managing health and safety related issues. With respect to the effectiveness of PE programs, the systematic review of Rivilis and colleagues (2) concluded there was partial-to-moderate evidence that PE interventions have a positive impact on musculoskeletal symptoms, reducing injuries and workers’ compensation claims, and a reduction in lost days from work or sickness absence.

As part of a larger project on MSD prevention within management systems, we (Yazdani et al. Prevention of musculoskeletal disorders within management systems: A scoping review of practices, approaches, and techniques. Submitted to J Appl Ergonomics) found little informa- tion on how MSD prevention might fit into an OHSMS. Given this absence of information, the goal of this paper is to assess the compatibility of elements described in well-cited PE program literature – representing common practice in PE – with the requirements of an OHSMS. Specifically, this paper addresses the question: What are the similarities and differences between an OHSMS framework and PE?

Occupational health and safety management system

An OHSMS is a formalized framework for organi- zations to manage the health and safety of workers (3). A variety of OHSMS frameworks and guidelines have been developed [eg, the Occupational Health and Safety Assessment Series (OHSAS 18001) (4), Brit- ish Standard (BS) 8800 (5), and International Labor Organization guidelines (6)]. OHSAS 18001 was devel- oped in response to demands from organizations to assess their management systems against a recognizable OHSMS standard (4). Some countries, like Canada, have developed management system standards for occupa- tional health and safety (OHS) that closely parallel the frameworks described above (8). In Europe, the “OSH Framework Directive” (7) was developed to introduce measures to encourage improvements in the safety and health of workers at work. The Directive contains basic obligations for employers and workers to ensure the health and safety of workers. The directive includes general principles of prevention such as evaluating risks, adapting the work to the individual, adapting to techni- cal progress, developing a coherent overall prevention policy, and prioritizing collective protective measures (7). This framework has been implemented in some European countries such as Sweden.

The main characteristics of proactive OHS manage- ment systems that distinguish them from traditional OHS programs are their ability to be integrated into an organization’s other systems, such as quality manage- ment, and the incorporation continuous improvement elements (1). Such management systems are generally based on the Plan-Do-Check-Act model (9) of continu- ous improvement.

Participatory ergonomics

PE is an approach frequently advocated for MSD pre- vention and has been described simply as “practical ergonomics” or a way to improve problem solving. A myriad of PE approaches have been reported in the literature under multiple taxonomies (10–18). The term “ergonomics program” or “participative ergonomics pro- gram” is often used synonymously with MSD preven- tion. Unless we are quoting from papers, we will use the specific term, MSD prevention. We note however that participation in ergonomics activities has been reported as an approach in the design process and health and safety activities, as well as in prevention in general. This paper is restricted to health and safety activities only.

Methods

In order to assess the compatability of PE programs with OHSMS, it is necessary to describe each approach explicitly. For this purpose, we selected OHSAS 18001 (4) as it represents an internationally recognized, well- practiced approach to the management of health and safety in organizations.

Explicit definition of PE programs

We are not aware of a universally accepted definition of PE. Programs or processes are frequently described whereby cross-functional teams, with representation from stakeholders (eg, workers, management, and engi- neers) are recruited, trained in ergonomics, perform observations and analyses, and then suggest solutions. However, details and components differ considerably in the literature. Rather than selecting just one of the many definitions, we chose to develop a composite definition based upon the most frequently cited PE papers in the literature. We looked into publications included in van Eerd et al’s recent systematic review which sought literature that addressed context, barriers, and facilita- tors to the implementation of PE interventions in the workplace (19). They systematically searched multiple electronic databases including MEDLINE, EMBASE, CINHAL, Business Source Premier, Risk Abstracts,

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CCINFOWeb, Ergonomics Abstracts Online, Scopus, ProQuest Digital Dissertations, Foreign Doctoral Dis- sertation, Index to Theses (Great Britain and Ireland), IDEAS and Canadian Institute for Scientific Information catalogue, Conference Papers Index, ISI Proceedings, PapersFirst, and ProceedingsFirst. They also searched relevant conference proceedings and reference lists. The authors included PE approaches that had attempted to improve workers’ health by changing work processes, work tools and equipment, and/or work and workplace organizations. Fifty-two documents (33 peer reviewed and 19 gray literature) met their review criteria (19). The authors used a large number of search terms in four broad areas including participation, ergonomics, inter- vention, and health outcome. The full list of search terms is available in Van Eerd et al (19). The selected papers were from multiple jurisdictions, but mainly Europe, Canada and the US.

We then used the Web of Science citation report tool to determine the total number of citations and average citations per year of each paper. This was performed in August 2012 and updated in October 2013. Papers with ≥10 citations since publication and an average citation rate of ≥1 citations per year were designated as “well- cited” and used as the basis for an inclusive definition of PE.

Framework for comparing OHSMS and PE

For OHSAS 18001 (4), a verbatim description of each element of an OHSMS was created from the document for short clauses. For longer clauses, the main ideas were summarized. These elements provided the headings by which the PE papers were analyzed. Two researchers read each well-cited paper on PE that met our inclusion criteria. Any text in each paper that was related to the elements of OHSAS 18001 was transcribed verbatim into an Excel spreadsheet. We used a content analysis approach to analyze the data extracted from the PE articles. Themes within each element were identified and papers contributing to that theme were noted. Topics related to the establishment and management of PE pro- grams that did not fit into the OHSAS 18001 elements were also noted.

Results

Of the 52 articles reviewed by Van Eerd et al (19), 20 articles met the criteria for selection as a well-cited article (table 1). A total of 21 elements were identified within OHSAS 18001 (table 2). The results are pre- sented according to these OHSMS elements.

Scope

This element describes the scope of the OHSMS: enabling an organization to control its OHS risks and improve OHS performance. An OHSMS is intended to be applicable to any organization and address OHS issues. The PE programs described in well-cited articles were generally implemented at a department level within workplaces, but there was no information about the possibility of implementing a PE program within the entire workplace.

One article suggested that the scope of the “project” was identified after discussion of a number of trades and job tasks on the construction site (20). The purpose described was to address a specific issue, within a spe- cific workstation or department by a group of research- ers, and with the participation of different stakeholders within organizations. There are other examples of this type of strategy in the literature (10, 17, 21–25). Inter- estingly, only one paper implemented an “in-house continuous improvement” PE program in a public ser- vice agency (13). This could be considered as the sole attempt to enable an organization to control MSD risk factors within a continuous improvement framework.

OHSMS requirements (general)

None of the papers addressed this element. There were no recommendations regarding how organizations could maintain, and, more importantly, continuously improve their MSD prevention activities. There was no indication of requirements to be followed and the only indication of continuous improvement, as one of the main require- ments of OHSMS, was seen in the article noted in the previous section (13).

OHSMS requirements (OHS policy)

With respect to policy, only one paper reported that the the company’s health, safety and environment manager drafted the “Ergonomic Policy”, which was then revised by the joint labor-management committee (26).

Hazard identification, risk assessment, and determin- ing controls

This element was extensively described in most of the PE papers. Authors used one, or a combination of techniques. Table 3 summarizes the techniques and approaches reported in the well-cited papers to identify and control MSD risk factors.

Objectives and program(s)

Few of the papers partially addressed objectives, while apparently, in most of the PE papers, researchers deter-

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mined the objective before the start of the project (11). The objectives could be determined by having a group of stakeholders from different departments identify areas that require ergonomic improvement (17, 27), define a mission statement (17), followed by setting a timetable and appointing a person to oversee the follow-up. As reported in well-cited PE papers, proposed solutions should then be presented to the employer for final review and acceptance (27). In one paper, a “commitment con- tract” was used to indicate the objectives and time frame of the action plans (28). Similarly, another paper indi- cated that stakeholders should come to agreement on details about responsibilities and timelines, and then an ergonomist should contact the employer to arrange the implementation (29). One paper used a “product sheet” and an “ideas’ book”, followed by a meeting with man- agement and health and safety specialists to determine the objectives (30). Another paper suggested the company’s health, safety and environment manager draft the objec- tives which the joint labor-management committee would then revise (26). The reviewed articles implied that PE is a project- or intervention-based, relatively short-term process, and may not include continuous improvement.

Resources, roles, responsibility, accountability, authority

This element of OHSMS was partially addressed in many of the well-cited papers. The most common state- ment was that management commitment is required

for the program to be effective (31). With respect to resources, it was suggested that appropriate and ade- quate resources should be supplied to implement the PE program (11, 17) and that financial commitment should be sought from the organization’s chairman (32). It was also noted that an initial budget was given by manage- ment, followed by additional resources allocated by top management upon reviewing a progress report of improvement plans (21).

It was suggested that the president of the company (30) or a management representative appointed by top management (21) should lead the program or that an ergonomist should seek responsible parties for adjust- ment in the workplace (29). A commitment contract (28) or agreement (17, 27) was used to determine the roles and responsibilities of different stakeholders in the PE program, and involvement of individuals was voluntary (33). It was reported that working hours and personnel resources were made available after senior management became interested in the project (34). It was also reported that the company’s health, safety and environment manager drafted responsibilities which the joint labor-management committee then revised (26).

Competence, training and awareness

Training was regarded as a key element of PE approaches. One paper stated that training should focus on the development of effective skills for work-

Table 1. The total citations and average citations per year for the selected participatory ergonomics papers a.

Study Year Jurisdiction Industry b Total citation Average citations/year

Vink et al (10) 1995 Netherlands Public administration 40 2.11 Wilson (22) 1995 UK Manufacturing 26 1.37 Westlander (34) 1995 Sweden Wholesale trade, public administration 18 0.95 Bohr et al (11) 1997 USA Healthcare and social assistance 31 1.82 Halpern & Dawson (21) 1997 Western USA Manufacturing 30 1.76 Vink et al (23) 1997 Netherlands Construction 21 1.24 Laitinen et al (25) 1997 Finland Manufacturing 19 1.22 Haims & Carayon, (13) 1998 Wisconsin, USA Public administration 38 2.38 Rosecrance & Cook (24) 2000 USA Manufacturing, information & cultural industries 26 1.86 Loisel et al (27) 2001 Quebec, Canada Manufacturing, healthcare and social assistance,

other services (except public administration) 56 4.31

de Looze et al (35) 2001 Netherlands Manufacturing 25 1.92 de Jong & Vink, (30) 2002 Netherlands Construction 34 2.83 Anema et al (29) 2003 Netherlands Manufacturing, healthcare and social assistance,

accommodation and food services, other ser- vices (except public administration)

39 3.55

Hess et al (20) 2004 USA Not reported 24 2.40 Laing et al (17) 2005 Ontario, Canada Manufacturing 29 2.89 Lavoie-Tremblay (28) 2005 Quebec, Canada Construction, healthcare and social assistance 22 2.44 van der Molen (32) 2005 Netherlands Construction 19 2.11 Polanyi (26) 2005 Ontario, Canada Information and cultural industries 11 1.22 Rivilis et al (33) 2006 Ontario, Canada Other services (except public administration) 24 3.00 Burgess-Limerick et al (31) 2007 Australia Mining and oil and gas extraction 10 1.43

a The total number of citations and the average citations per year of each paper were obtained from the Web of Science citation report tool in August 2012, updated in October 2013.

b The industry type was extracted from a table presented by van Eerd et al (19).

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ing as a group (11). The duration of training in PE programs varied from a single training session (11, 25) to two sessions (27, 34), from 20 hours of train- ing (24) to a series of training sessions (17, 31, 33). The training was conducted through seminars (21, 25), workshops (31, 34), or during what was termed the “main meeting” (23). The training could then be followed by awareness education for other employees (21). Polanyi et al (26) reported that the comprehensive education and training program was conducted as part of a “Stop Repetitive Strain Injury (RSI)” program and was reviewed on a regular basis.

With respect to training content, authors indicated this

included: an overview of ergonomics terminology (11), MSD risk factors and task analysis processes (11, 26, 31), use of techniques and a PE program description (17), physical work demand and remedies to control it (32), the PE process (27, 29) theory and methods (29), mechanism of injury associated with manual tasks (31), technical ergonomics for analysis and design committees (21), the importance of hierarchy of controls and general strategies for eliminating and controlling manual tasks injury risk (11), and information about the PE project to increase awareness thereof (23). However, authors indicated neither how they measured the effectiveness of training provided nor how the training could be sustainable and effective.

Table 2. Descriptions of elements of occupational health and safety management system based on the Occupational Health and Safety Assessment Series (OHSAS 18001). [OHS=occupational health & safety; OHSMS=occupational health and safety management system.]

OHSAS clause number

OHSMS elements Description

1 Scope The scope is enabling an organization of any size and sector to control its OHS risks and improve OHS performance.

4.1 OHSMS requirements (general)

The organization shall establish, document, implement, maintain and continually improve the OHSMS.

4.2 OHSMS requirements (OHS policy)

The organization’s top management shall define and authorize the organization’s OHS policy and outline specific necessities for the organization’s policy.

4.3.1 Hazard identification, risk assessment and determining controls

The organization shall establish, implement, and maintain a procedure(s) for the ongoing hazard identifi- cation, risk assessment, and determining of necessary controls.

4.3.2 Legal and other requirements

The organization shall establish, implement and maintain an up to date procedure(s) for identifying the legal and other OHS requirements that are applicable to it.

4.3.3 Objectives and program(s) The organization shall establish, implement and maintain documented and measurable OHS objectives, at relevant functions and levels within the organizations.

4.4.1 Resources, roles, responsibility, accountability, and authority

Top management shall take ultimate responsibility for OHSMS and demonstrate its commitment by en- suring available resources, defining roles, allocating responsibilities and accountabilities, and delegating authorities.

4.4.2 Competence, training and awareness

The organization shall ensure that any person(s) under its control performing tasks that can impact OHS are competent on the basis of appropriate education, training, or experience.

4.4.3.1 Communication The organization shall establish, implement, and maintain a procedure(s) for communication with rel- evant parties with regards to its health and safety hazards and OHSMS.

4.4.3.2 Participation and consultation

Appropriate involvement of workers in risk assessment and determining of controls, accident investiga- tion, development, and review of OHS policies and objectives shall be established, implemented, and maintained by necessary procedure(s).

4.4.4 Documentation The OHSAS 18001 suggests a set of documentation including policy, objectives, description of the scope of the OHSMS, main elements of the OHSMS, and OHSMS records.

4.4.5 Control of documents OHSMS documents need to be controlled by establishing, implementing, and maintaining required procedure(s).

4.4.6 Operational control Then the organization shall implement and maintain operational controls for those activities, controls related to purchased goods and equipment, controls related to contractors, etc.

4.4.7 Emergency preparedness and response

A procedure(s) to address potential emergency situations and respond to such situations shall be estab- lished, implemented, and maintained.

4.5.1 Performance measurement and monitoring

OHS performance shall be monitored and measured and provide for quantitative and qualitative mea- sures, monitoring the organization’s OHS objectives, and effectiveness of controls, proactive measures of performance.

4.5.2 Evaluation of compliance Compliance with applicable legal and other subscribed requirements shall be periodically evaluated and the organization shall establish, implement, and maintain a procedure(s) for this matter.

4.5.3.1 Incident investigation The organization shall establish, implement, and maintain a procedure(s) to record, investigate, and ana- lyze incidents in order to determine OHS deficiencies and other causal factors.

4.5.3.2 Non-conformity, corrective action and preventive action

In order to deal with actual and potential non-conformity(ies) and for taking corrective action and pre- vention action, the organization shall establish, implement, and maintain a procedure(s).

4.5.4 Control of records In order to demonstrate conformity to its OHSMS and OHSAS 18001 requirements, records shall be es- tablished and maintained.

4.5.5 Internal audit The organization shall ensure internal audits of the OHSMS are conducted at planned intervals with re- spect to specific criteria.

4.6 Management review Top management shall review the organization’s OHSMS at planned intervals to ensure its continuing suitability, adequacy, and effectiveness.

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Table 3. Hazard identification, risk assessment and determining controls. [OSHA=Occupational Safety and Health Agency; RULA=Rapid Upper Limb Assessment; NIOSH: National Institute for Occupational Safety and Health.]

Study Year Hazard identification Prioritization of risks and control actions

Determining controls

Vink et al (10) 1995 Questionnaires, checklists, observation, WEBA-analysis for the most performed jobs and those with largest problems

Not reported Not reported

Wilson (22) 1995 Questionnaires, observation of work task, direct observation, production records, archive analysis on sickness, RULA, body- part discomfort technique, rating scales

Costs, technical feasibility Brainstorming meetings with workers and supervisors, Cost consideration through discussion of control actions with management

Westlander (34) 1995 Not reported Not reported Cost consideration prior to discussion of control actions with management, Categorizing proposed improvement into two groups: “expense-free” and “expense-incurring”.

Bohr et al (11) 1997 Basic level of technical information Not reported Not reported Halpern & Dawson (21) 1997 Video taping, OSHA 200 logs, compensa-

tion claims Not reported Control strategies were translated into

process improvement plans and proto- type workstation mock-ups

Vink et al (23) 1997 Checklists The degree of hazard (smallest versus largest)

Feedback provided by workers and experts, solution rating process

Laitinen et al (25) 1997 Checklists, observation Not reported Not reported Haims & Carayon (13) 1998 ergonomics coordinator survey Severity of the ergonomic

problems Not reported

Rosecrance & Cook (24) 2000 Questionnaires, observation, OSHA 200 logs, self-reported symptom survey, job factors surveys, several other qualitative and quantitative tools

Mechanism driven by number of injuries for prioritization

Ergonomic process and involvement of workers, Implementing “quick fixes” without a detailed analysis. For imple- menting more complex solutions, a more formal process is required that can guarantee appropriate resources for implementation

Loisel et al (27) 2001 Meeting with stakeholders, observation, video-taping, Interviewing workers and other stakeholders

Not reported Suggestions for improvement for hazardous tasks be made by an ergonomist

de Looze et al (35) 2001 Meeting with stakeholders, work condition survey in pre-intervention stage

Not reported Meetings with stakeholders

de Jong & Vink, (30) 2002 Questionnaires, Interviewing workers and other stakeholders, previous analysis and risk inventories

Questionnaire Solution sessions with the use of videotapes and slides, Contribution to productivity increase, Contribution to health problems, Consequence for company, Availability

Anema et al (29) 2003 Checklists, observation of work task, direct observation, Interviewing workers and other stakeholders

Frequency and severity of each problem, Feasibility and solving capability

Brainstorming meetings with workers and supervisors

Hess et al (20) 2004 Meeting with stakeholders, focus group, technical measures

Not reported Meetings with stakeholders, focus group

Laing et al (17) a 2005 NIOSH load-lifting equation, Snook & Ciriello manual material handling table, survey on psychosocial factors, basic physical demand analysis, pain, symptom survey

Not reported Not reported

Lavoie-Tremblay (28) 2005 Questionnaires, focus group, anonymous comments collected in a box

Team meetings Meetings with stakeholders

van der Molen (32) 2005 Meeting with stakeholders Not reported Meetings with stakeholders Polanyi (26) 2005 Not reported Not reported Not reported Rivilis et al (33) 2006 Not reported Not reported Not reported Burgess-Limerick et al (31) a

2007 Simplified version of Manual Tasks Risk Assessment Tool measure

Hierarchy of controls strategies Risk control evaluation

a Described a risk management cycle which is very similar with OHSAS 18001 approach including hazard identification, risk assessment; risk control and evaluation followed by hierarchy of controls strategies as an underlying principle.

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Participation and consultation

OHSAS 18001 (4) specifies one of the main elements of an OHSMS is the appropriate involvement of workers in risk assessment and determination of controls, accident investigation, and the development and review of OHS policies and objectives.

With respect to this element, most of the well-cited PE papers discussed their approach of seeking employ- ees’ involvement and participation in the ergonomics improvement activities with respect to MSD preven- tion. Laing et al (17) suggested that the involvement of employees is greatly helped by their participation in “ergonomic change teams”. Lavoie-Tremblay et al (28) suggested that a work team (consisting of differ- ent stakeholders) should be set to ensure commitment within the department and the institution. Loisel et al (27) indicated that in their approach, the injured worker, employer and union representative were deeply involved in the redesign process. They noted that being injured should not prevent workers from participating in the work groups (27). Van der Molen (32) reported that dif- ferent stakeholders from within an organization and an ergonomics consultant participated in their PE project.

As suggested by some authors, workers could select improvements if they received appropriate training and instruction (10) and the participation of trained workers could be achieved by contacting them (13). Different stakeholders within an organization could be actively involved in the PE program and have different roles in working groups such as management, worker, health and safety executive, and member of the steering or ad hoc groups that could be involved at different stages of the program (13, 22). As described by one of the papers, a group evaluated the improvement ideas suggested by employees and then positively evaluated ideas were added to an “idea’s book” (30).

Involvement of employees in one study was facilitated by providing information about the project, the outcomes and their likely effects, and then they were asked if they agreed with the changes (35). In another approach it was reported that all employees were involved by completing checklists, developing suggestions for implementation, testing improvements, and giving their preference (23). However, the authors suggested that the steering commit- tee should decide on the feasibility of proposed improve- ments, by considering costs and benefits before asking employees for their preference (23). In another study, ergonomic meetings were suggested where employ- ees could participate in the PE process (24). A further study involved employees by having them to complete questionnaires and then seeking their involvement in interventions (33). It was also noted that one organization encouraged employees’ participation by paying overtime for those attending meetings (31).

Documentation

The OHSAS 18001 framework provides a list of docu- mentation including policy, objectives, and a description of the scope, main elements, and records that should be available through an OHSMS. Only one paper addressed documentation, where the authors stated that methods of documentation should be provided (11).

Performance measurement and monitoring

Most of the papers addressed this element. Authors used a variety of techniques to measure the effectiveness of changes (table 4).

Incident investigation

The OHSAS 18001 (4) framework requires that the organization shall establish, implement and maintain a procedure(s) to record, investigate, and analyze incidents in order to determine OHS deficiencies and other causal factors. Only two authors mentioned a mechanism for incident investigation. One reported that methods for calculating job and department level injury incidence and severity rates were introduced (17). In addition, a pain/symptom survey was introduced. The other col- lected occupational histories and past histories of MSD of injured workers, descriptions of job tasks, workers’ workplace medical files, and description of any past work accidents (27).

Non-conformity, corrective action, and preventive action

According to OHSAS 18001 (4), in order to deal with actual and potential non-conformity(ies) and to take corrective action and prevention action, the organization shall establish, implement, and maintain a procedure(s).

Haims and Carayon (13) stated that in order to edu- cate workers on solution implementation, the ergonomist should provide information and instruction to workers about the new approach. The supervisors were also informed of the ways that they could encourage and guide the worker in new work situations. Using a simi- lar approach, Vink et al (23) reported that instructional videos were developed, including working methods with reduced physical workload, and employees were informed about new situations. Halpern and Dawson (21) describe a coordinated effort to translate the inter- vention and abatement strategies into production design changes: while the maintenance department was imple- menting changes, the engineering department was incor- porating them into its new products and new manufac- turing sites (21). Both Laing et al (17) and Rosecrance and Cook (24) had the ergonomic committee test the solutions prior to full-scale implementation. Westlander

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et al (34) stated that the intervention had been scheduled after pre-intervention analysis. The short-term interven- tion was implemented for current problems, followed by long-term intervention for future problems.

Management review

According to OHSAS 18001 (4), an organization’s top management shall review the OHSMS at planned inter- vals to ensure its continuing suitability, adequacy, and effectiveness.

Only two of the papers mentioned a mechanism for management review. One noted that information directed to middle management and feedback about using ergonomic measures directed towards employees could strengthen the commitment, communication,

and support for incorporating the new policy to use ergonomic measures within the company (32). Another reported that “Breakthrough Thinking” methodology was used to establish purpose, goals, program structure, and plans for the future, one year after the initiation of an Ergonomic Coordinator program (13).

Elements not reported

Eight elements of OHSMS based on the OHSAS 18001 framework (4) went unmentioned in the well-cited PE papers: (i) legal and other requirements; (ii) commu- nication; (iii) control of documents; (iv) operational control; (v) emergency preparedness and response; (vi) evaluation of compliance; (vii) control of records; and (vii) internal audit.

A summary of the presence of elements of OHSAS 18001 (4) in the PE articles is shown in table 5. We did not find concepts within the PE papers that were not addressed in OHSAS 18001’s elements (4).

Discussion

The PE papers described approaches for improving work- place ergonomics, but they were actually aimed at prevent- ing MSD, except for Laitinen et al (25), which was an ergonomic development program that was implemented in conjunction with a housekeeping program. In addition, as Loisel et al (27) described in their study, the PE program was implemented in a rehabilitation rather than preven- tion context. However, the authors argued that the imple- mentation of PE resulted in increasing the awareness of back-pain risk factors in the workplace, which can poten- tially impact primary prevention. The PE program was implemented at organizational level, involving multiple stakeholders within an organization, to modify the work demands and improve work tasks of workers with back injuries, and hence is worthy of inclusion in this analysis. In their study, before subject recruitment, employer and union representatives of several workplaces received PE training and then workers with back pain were recruited and an ergonomist met them first at the clinic. These are examples of the diverse use of the PE approach.

Of the 21 elements of the OHSAS 18001 framework, although silent on eight, the PE literature did however provide a substantial amount of detail on five of the elements: (i) hazard identification, risk assessment and determining controls; (ii) resources, roles, responsibility, accountability, and authority; (iii) competence, training and awareness; (iv) participation and consultation; and (v) performance measurement and monitoring. However, the authors used many different approaches to address these elements. The findings of this study suggest that,

Table 4. Performance measurement and monitoring.

Study Year Tools

Vink et al (10) 1995 Questionnaires, observational techniques, pro- cess evaluation techniques

Wilson (22) 1995 Not reported Westlander (34)

1995 Questionnaires, interviewing steering commit- tee members and other stakeholders, document (minutes and directives) analysis

Bohr et al (11) 1997 Survey, team effectiveness indicator, number of identified problems, number of solutions that were implemented successfully

Halpern & Dawson (21)

1997 Not reported

Vink et al (23) 1997 Questionnaires Laitinen et al (25)

1997 Weekly feedback observation by team

Haims & Carayon (13)

1998 Research diary

Rosecrance & Cook (24)

2000 Questionnaires, employees feedback, produc- tivity, committee productivity and participants’ feedback, errors and accident rates, employee morale and job satisfaction, quality, illness and injury rates, absenteeism

Loisel et al (27)

2001 Survey

de Looze et al (35)

2001 Questionnaires, productivity, interviewing employees

de Jong & Vink, (30)

2002 Questionnaires, interviewing steering committee members and other stakeholders

Anema et al (29)

2003 Not reported

Hess et al (20) 2004 Employees feedback, lumbar motion monitor Laing et al (17)

2005 Worker perception via “one minute survey”, biomechanical modeling, electromyography, accelerometry, expert opinion of the research group, questionnaires

Lavoie- Tremblay (28)

2005 Questionnaires

van der Molen (32)

2005 Specific measurement indicator

Polanyi (26) 2005 Not reported Rivilis et al (33)

2006 Questionnaires

Burgess- Limerick et al (31)

2007 Not reported

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irrespective of the strength of PE, it does not match busi- ness processes and practices. Analysis of the content of well-cited PE articles suggests that the implementation of PE programs has not been reported or written about in a fashion that facilitates easy integration into an orga- nization’s management system because of the structure and language differences. PE appears to be regarded as a stand-alone program to solve a specific problem or sets of problems.

It is worth noting that even when the PE literature addressed the management system elements, the vocabu- lary that was employed in the PE literature often dif- fered from that used in a management system frame- work. For instance, one of the main elements of OHSAS 18001 describes how organizations should determine measurable objectives and targets (4). Also, the input and output requirements and data should be outlined pre- cisely. However, few of the authors mention this ele-

Table 5a. Presence of Occupational Health and Safety Assessment Series (OHSAS 18001) elements in participatory ergonomics articles. [OHS=Occupational health & safety; OHSMS=occupational health & safety management system.]

Authors Year Scope OHSMS General

OHS Policy

Hazard identifica- tion, risk assess-

ment & determining controls

Legal and other requirements

Objectives and Programme(s)

Resources, roles, responsibility,

accountability and authority

Vink et al (10) 1995 X X Wilson (22) 1995 X X Westlander (34) 1995 X X Bohr et al (11) 1997 X X X Halpern & Dawson (21) 1997 X X X Vink et al (23) 1997 X X Laitinen et al (25) 1997 X X Haims & Carayon (13) 1998 X X X Rosecrance & Cook (24) 2000 X X Loisel et al (27) 2001 X X X de Looze et al (35) 2001 X de Jong & Vink, (30) 2002 X X X Anema et al (29) 2003 X X X Hess et al (20) 2004 X X Laing et al (17) 2005 X X X X Lavoie-Tremblay (28) 2005 X X X van der Molen (32) 2005 X X Polanyi (26) 2005 X X X Rivilis et al (33) 2006 X Burgess-Limerick et al (31) 2007 X X

Table 5b. Presence of Occupational Health and Safety Assessment Series (OHSAS 18001) elements in participatory ergonomics articles. [OHS=Occupational health & safety; OHSMS=occupational health & safety management system.]

Authors Year Competence, training and awareness

Communication Participation and consultation

Documentation Control of documents

Operational control

Emergency response

Vink et al (10) 1995 X Wilson (22) 1995 X Westlander (34) 1995 X Bohr et al (11) 1997 X X Halpern & Dawson (21) 1997 X Vink et al (23) 1997 X X Laitinen et al (25) 1997 X Haims & Carayon (13) 1998 X Rosecrance & Cook (24) 2000 X X Loisel et al (27) 2001 X X de Looze et al (35) 2001 X de Jong & Vink, (30) 2002 X Anema et al (29) 2003 X Hess et al (20) 2004 Laing et al (17) 2005 X X Lavoie-Tremblay (28) 2005 X van der Molen (32) 2005 X X Polanyi (26) 2005 X Rivilis et al (33) 2006 X X Burgess-Limerick et al (31) 2007 X X

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ment and the description was limited to using terms such as “commitment contract” (28) or “stakeholder agree- ment” on an existing problem (29). The process and lan- guage introduced in OHSAS 18001 suggests a more sys- tematic approach that enables continuous improvement. In addition, OHSMS elements can be easily integrated into other management system practices and approaches, such as environment or quality. PE approaches described appear to lack these capabilities, or it could be said that the authors did not describe how prevention activities using PE methodology could be integrated into an orga- nization’s broader management system.

The approaches used by Laing et al (17), which were based upon the Participatory Ergonomics Implementa- tion Blueprint developed by Wells et al (36), and the program reported by Loisel et al (27), were examples of approaches that were most similar to the OHSAS 18001 framework (4). Haims and Carayon (13) were the only authors to describe a continuous improvement approach (for the PE process), which is one of the main features of any management system. Zink (37) made a distinc- tion between “selective” and “continuous improvement” participation: using participatory practices for specific organizational projects, such as implementing new technology, refers to selective participation. For con- tinuous improvement, the authors suggested the use of participatory practices in an attempt to achieve continu- ous improvement within an organization (13, 37). It is worth noting that Kaizen and Six-sigma also encourage a participatory approach and are well-practiced and popular approaches used by organizations across differ- ent sectors to solve specific problems.

With respect to sustainability, it was reported that the research team provided expertise, time, and effort as resources to the project, and they created “an ergonomics library” (13). It was suggested that outside experts should leave the organization with an internal program in place that would be capable of addressing future problems (13). Haims and Carayon (13) stated that in order to ensure suitability, the Ergonomic Coordinator program be evalu- ated and continuous improvement was planned in their PE program. In addition, Liang et al (17) reported that following the withdrawal of the research team, a plant- or union-based ergonomics champion might enhance Ergonomic Change Teams sustainability. However, Bohr et al (11) and Burgess-Limerick et al (31) reported some signs of sustainability in their implanted PE program. As the PE literature seems to have been written by research- ers for researchers, there was only a moderate amount of detail about how to implement and structure a PE program within a target organization.

It could be argued that research publication did not allow detail of implementation as needed by practitio- ners. This could potentially make PE difficult to imple- ment successfully by practitioners and organizations.

The literature showed that the scope of the PE pro- grams described was usually limited to a departmental or similar level. As such, PE could be considered similar to other improvement processes such as Six-Sigma. The Six-Sigma approach, though, emphasizes “mea- surement” whereas in the PE literature, a qualitative approach is frequently employed. In addition, Six-Sigma can be used widely within an organization to address multiple issues, in contrast to PE, which has a much nar-

Table 5c. Presence of Occupational Health and Safety Assessment Series (OHSAS 18001) elements in participatory ergonomics articles. [OHS=Occupational health & safety; OHSMS=occupational health & safety management system.]

Authors Year Performance measurement

and monitoring

Evaluation of compliance

Incident investigation

Non-conformity, corrective action and

preventive action

Control of records

Internal audit

Management review

Vink et al (10) 1995 X Wilson (22) 1995 Westlander (34) 1995 X X Bohr et al (11) 1997 X Halpern & Dawson (21) 1997 X Vink et al (23) 1997 X X Laitinen et al (25) 1997 X Haims & Carayon (13) 1998 X X X Rosecrance & Cook (24) 2000 X X Loisel et al (27) 2001 X X de Looze et al (35) 2001 X de Jong & Vink, (30) 2002 Anema et al (29) 2003 Hess et al (20) 2004 X Laing et al (17) 2005 X X X Lavoie-Tremblay (28) 2005 X van der Molen (32) 2005 X X Polanyi (26) 2005 Rivilis et al (33) 2006 X Burgess-Limerick et al (31) 2007

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rower application, often only for MSD prevention. More generally, the PE literature seldom referred to methods or systems used in other areas of a company (eg, qual- ity), organizational change, process improvement (eg, Six-Sigma or Kaizen) or other engineering approaches. Introducing ideas from related well-regarded busi- ness and engineering processes has the potential to strengthen MSD prevention. Similarly, introducing MSD prevention into business and engineering processes and methodologies also has the potential to improve MSD prevention, especially hazard identification and control. For example, it has been shown that it is feasible to inte- grate PE approaches into by Kaizen events as conducted in the lean manufacturing tradition (38).

PE articles did not typically comment on the sustain- ability of their approach and its continuous improvement capability. As might be expected, researchers or an outside party conducted the majority of studies found in the well-cited PE literature, and these were usually of short-to-moderate duration. It could be speculated that making future improvements would require the return of the researchers to the organization. Conse- quently, the sustainability of these programs is usually unknown. Management system frameworks, such as OHSAS 18001 by virtue of its continuous improve- ment nature and compatibility with business processes, tend to lead to sustainable prevention activities (39). Therefore, in order to achieve a sustainable and effective approach to prevention of MSD using a PE approach, more integration into management system frameworks using a continuous improvement method may be useful. PE can be used in a process-oriented organization but its integration into other processes within an organization has not been reported, and it therefore seems unlikely to achieve sustainable prevention. Hence, it may remain a parallel process that will require resources to keep it alive on an ongoing basis. This may make PE too costly for an organization that is trying to streamline its processes, which may mean that PE is seen as an outlier that could be eliminated.

Burgess-Limerick et al (31) noted that the greatest progress towards becoming self-sufficient was seen in a company where the PE program was adopted within the company’s “site standard”, and program sustainability was therefore less likely to be affected by personnel changes. The natural fit of OHSMS with the normal way of doing business makes this an excellent opportunity to bring health and safety and MSD prevention to the table. This could occur by harmonizing concepts and terminologies for MSD hazard assessment with those commonly used in OHSMS or similar management system approaches.

Recently, there have been a few attempts by research- ers to develop new PE frameworks such as development of Stay@Work by Driessen et al (40). The authors

suggested that despite the positive feedback about the PE program and training using their framework, the implementation of the prioritized ergonomics changes (measures) was lower than expected.

The findings of this study are restricted by relying only on the peer-reviewed and grey literature iden- tified by Van Eerd et al (19). PE approaches devel- oped by individual companies and consultancies may have different characteristics. However, we chose to use 20 papers from multiple countries that were well- cited (table 1). The study sought only English language papers but the selected papers represent many different countries including the USA, Canada, Australia, and multiple European countries. Our definition of OHSMS was based on a single framework, OHSAS 18001 (4); nevertheless, other frameworks such as BS 8800 (5), International Labour Organization guidelines (6) or CSA-Z1000 are very similar (6–8).

A number of the PE programs have been imple- mented within research studies. Constraints that might have been introduced by this method include shortened timelines for obtaining pre-post measures, a lack of consideration of the sustainability beyond the study duration or the provision of substantial outside consult- ing, and facilitation resources by the research team. This may have affected the form of PE program from that which might be seen in organizations outside of a research study.

Concluding remarks

Both PE and OHSMS frameworks have evidence of suc- cess in addressing workplace hazards. Importantly, we did not find any conflict between these approaches. This suggests that MSD prevention activities and approaches such as PE could be beneficially integrated into existing management structures. This approach would supply PE’s absent elements. We therefore believe that paying attention to and adopting management approaches as well as the language used in management system frame- works could make MSD prevention activities using PE more effective and sustainable.

Acknowledgement

This project was funded by a Workplace Safety and Insurance Board (Ontario) research grant.

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Received for publication: 28 July 2014