AFTER THE ERGONOMICS RULE WHAT NEXT?

The problems of employee safety didn't go away and still require action--perhaps even in Washington

With congressional rejection of the proposed Ergonomics Rule in March, after 10 years in the making, the saga of ergonomics standards in the workplace continues, with the future unclear. The Department of Labor (DOL) was scheduled to hold a series of public hearings last month, but as of press time it was uncertain how productive or influential these hearings would be.

The general consensus is that ergonomics policy makes sense and provides value, but there has been much controversy in trying to formulate an acceptable standard to be administered by the DOL's Occupational Safety and Health Administration (OSHA). It is important to understand that the intent of the Ergonomics Rule--to prevent musculoskeletal disorders in the occupational environment--is generally accepted as necessary. Many believe the proposed standard failed because of its requirements related to medical management and methods for determining whether injuries were job-related. Under the medical management requirements, employers would have been required to compensate workers on disability at rates higher than provided by state workers' compensation laws. The process to determine whether an injury was job-related was also highly complex.

Musculoskeletal disorders--particularly back injuries sustained within the healthcare industry--are a major problem that must be addressed, as apparently acknowledged by Secretary of Labor Elaine Chao, who has promised to pursue a comprehensive approach to ergonomics, including possibly a new rule-making process. In a letter to key senators before their vote on the rejected standard, she stated that this new approach will provide employers with achievable measures that protect employees before injuries occur. Members of both the House and Senate have also weighed in with their concerns--for example, introducing legislation in both houses requiring the DOL to promulgate a new standard within two years.

This legislation provides specific direction for any future rule--requiring it, for example, to spell out in clear terms when an employer would be required to address ergonomic hazards, and to avoid conflicts with state workers' compensation programs.

In addition to OSHA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will be applying more pressure on the healthcare industry to address occupational injuries. This action grew out of a partnership the Joint Commission established with OSHA in 1996. The initial partnership, planned for three years, was expanded in 1998 and then, in 2000, extended for another three years. The 2001 JCAHO standards manual includes, in its chapter on Environment of Care, EC 1.1.1, the requirement that "the organization plans for worker safety." JCAHO surveyors will be asking organizations about their most significant occupational injury problems and what actions they've taken to address them.

In view of all this, healthcare organizations should consider injury-prevention activities and ergonomics management programs as good candidates for performance improvement initiatives. Ergonomics management programs offer an excellent opportunity for initiatives such as these involving multidisciplinary groups working together to solve problems and create improvements.

This is worth serious attention because, even without the Ergonomics Rule, there is no getting away from the data. According to the Bureau of Labor Statistics, in 1998 there were 1,730,500 lost-time occupational injuries reported in the United States. Forty-four percent of these were strains and sprains, with the majority involving the back, and 10.5% of the total number of occupational back injuries suffered in this country, when considering all industries, were caused by moving and assisting patients in healthcare settings. In reviewing work-related musculoskeletal disorders involving time away from work, the occupations leading the list are nursing aides, orderlies and attendants. Registered nurses are number six on the list. Sixty-six percent of all injuries suffered by nursing aides and orderlies and 59% of all injuries suffered by registered nurses were strains and sprains. Within nursing and personal care facilities, the injury incidence rates arising from overexertion and, specifically, from overexer tion caused by lifting, are four times higher than the national average for all industries.

The cost of occupational injuries remains a significant burden to the healthcare industry--in fact, greater than many realize. Often only the direct costs associated with these occupational injuries are considered when investigating cost impact--e.g., the cost for medical care and the compensation paid to injured workers. In addition to these direct costs, however, are such indirect costs as those for replacement of the injured worker, additional training, additional supervisory time, at least temporary loss of productivity and decreased staff morale. It has been estimated that these indirect costs can exceed four times the amount of direct costs. Although the impact of direct costs can be softened by the purchase of insurance, indirect costs must be absorbed by the organization's operating revenues. Therefore, the reduction of occupational injuries and associated costs offers the long-term care industry a significant opportunity for financial survival and growth.

What, in the meantime, can the long-term care industry expect from Washington? In speculating upon the form a new ergonomics rule might take, it could be that drafters will find it to be more acceptable and appropriate to use a performance-based approach rather than a prescriptive standard. With a performance-based approach, each organization would be given flexibility in implementing a new program and would be evaluated based on a demonstration that the program is working and is effective. Certainly this approach would seem to make more sense than prescribing the maximal weights to be lifted and number of repetitions allowed.

It is also worth noting that OSHA has, in the past, incorporated a grandfather clause in its standard. This would allow organizations to continue with pre-existing ergonomic management programs that are proven effective and contain elements that OSHA considers to be key to an effective ergonomic management program. These key elements include:

* A process to identify and assess high-risk activities and departments

* A method to analyze these activities to determine where change is required

* A process to formulate recommendations and redesign high-risk jobs and activities to eliminate or minimize hazards

* A method to implement the process, which would provide educational awareness, employee buy-in and training of employees in new work methods

* A method to measure the effectiveness of the program and encouragement of a process for ongoing improvement

In adopting this approach, an organization should be able to improve its safety profile and do well, no matter what the deliberations in Washington might bring.

Guy Fragala, PhD, PE, CSP, is director of the Department of Environmental Health and Safety, the University of Massachusells Medical School, Worcester, Massachusetts.