PARTICIPATORY ERGONOMICS PROGRAM IN CUSTODIANS HEALTH & SAFETY: WORKING TOWARD PREVENTION REDUCING DISCOMFORT AND RISK OF INJURY

Transcription

1 PARTICIPATORY ERGONOMICS PROGRAM IN CUSTODIANS HEALTH & SAFETY: WORKING TOWARD PREVENTION REDUCING DISCOMFORT AND RISK OF INJURY Debra Milek, MD, PhD, MPH Associate Professor General Internal Medicine UW Medicine at Harborview UW Medical Consultant Facilities Building Services, EHS Adjunct, DEOHS, UW School of Public Health COHE Medical Director at UW

2 2014 L&I Report to Washington State Rep. Reykdal & Sells

3 UW EXPERIENCE > Facilities Services ranked 3 rd for UW injury costs (behind patient caregivers at the two hospitals) > Within FS, custodian injury costs were the greatest. > The top injuries cause musculoskeletal pain in: shoulders back knees

4 UW FACILITIES SERVICES TOP POSITIONS FOR TIME LOSS Facilities Services: Top 3 Positions Time Loss Days Time Loss $ % of Total $ Custodian 5,520 $302,365 20% Pipe/Steamfitter 2,244 $242,532 16% Elevator Mechanic 1,532 $206,658 13% Total for all Facilities 17,638 $1,538,000

5 UW WC Data 2017: Stress on the Body = 60% of Injuries Resulting in Time Loss > Lifting, carrying > Pushing/Pulling/Reaching > Twisting, throwing > Repetitive motion > Continual noise

6 WMSD RISK FACTORS > Force > Repetition > Material Handling > Posture Awkward and Static

7 DISCOMFORT MAY BE AN EARLY INDICATION OF FUTURE INJURY 1. Suggestion that peak and cumulative discomfort could predict future musculoskeletal pain (Hamberg-vanReenen HH et al Ergonomics Vol 51 (5) 2008) 2. Baseline neck or shoulder discomfort predictive of future upper extremity tendonitis (Werner et al 2005 (15) J Occ Rehab)

8 INJURY CONTINUUM D. Darren McDonald, 2007 Regulatory Craft Conference Workers Compensation Board of Nova Scotia

9 IMPACT OF TRAINING ON DISCOMFORT (Liberty Mutual)

10 SHIP GRANT AWARDED BY LABOR AND INDUSTRIES A collaboration between EH&S and Facilities Services to reduce custodian discomfort

11 2015 SAFETY AND HEALTH INVESTMENT PROGRAM (SHIP) GRANT FROM LNI BEGAN WITH THESE BASIC POINTS: > Discomfort is a predictor of future injury > Custodians know their work better than anyone else > Prevention and/or reduction of injuries is possible > Shingo Leadership Principles: Respect everyone Lead with humility Constancy of purpose We then joined custodians with management and health and safety experts as Participatory Ergonomics

12 2015 SHIP GRANT ACTION STEPS IDENTIFIED 16 CUSTODIAL TASKS & DEVELOPED PICTORAL SURVEY IN ORDER TO: > Have custodians identify most uncomfortable tasks > Direct task selection > Assemble small groups of experts to create modifications to reduce discomfort > Implement changes and trained staff > Conduct post-modification survey > Determined pre- and post-risk assessments

13 SURVEY RESULTS > Participation: 60% of custodians took survey > Communication: 35% felt most relaxed listening to questions in their first language > Height: Most were 5 to 5 5 inches > Age-range peaks: years / (highest) > Job longevity: Average years

14 BODY AREAS MOST AFFECTED SAME AS UW WORKERS COMP DATA > Back > Shoulders > Knees

15 BACKPACK VACUUMING COMPLEXITIES OF ADDRESSING THE DISCOMFORT: > Extensive hands-on training > Individual fit > New harnesses > Policy changes > Reinforcement of training (more to learn)

16 VACUUM BACKPACK TRAINING RESULTS: Bolt Placement WOMEN MEN 18% of women preferred HI 57% of women preferred MID 19% of women preferred LOW Custodians under 5 Custodians 5 0 to % of men preferred HI 26% of men preferred MID 5% of men preferred LOW Custodians 5 6 to 5 10 Custodians (none preferred HI) 50% preferred MID 50% preferred LOW 20% preferred HI 61% preferred MID 14% preferred LOW 67% preferred HI 25% preferred MID 6% preferred LOW 73% preferred HI 20% preferred MID (none preferred LOW)

17 SCRAPING FLOORS BEFORE AFTER

18 CLEANING TOILETS BEFORE AFTER

19 PICKING UP TRASH BEFORE AFTER

20 BUT... DID WE REDUCE DISCOMFORT?

21 HIGH DISCOMFORT: PRE & POST MODIFICATION

22 HIGH DISCOMFORT: PRE & POST MODIFICATION

23 Reduction in any discomfort and high discomfort in modified and unmodified tasks Baseline Follow-up t (d.f.) Any discomfort All tasks 96.2% 87.4% (102) Modified tasks 93.9% 74.7% (90) Unmodified tasks 94.7% 82.4% (101) High discomfort All tasks 52.6% 44.7% (102) Modified tasks 43.9% 25.3% (90) Unmodified tasks 45.5% 39.2% (101) p, singlesample t- test, onetailed.004 <.001 < <

24 Rapid Entire Body Assessment (REBA) SCORING (Ergonomics Plus) F

25 Rapid Entire Body Assessment (REBA) SCORING (Ergonomics Plus) > F

26 Rapid Entire Body Assessment (REBA) SCORING (Ergonomics Plus) TASK/SCORE PRE-MODIFICATION SCRAPER 10 (High Risk) POST-MODIFICATION 3 (Low Risk) TOILET 7 (Medium Risk) 1-2 (Low Risk) TRASH PICK 8-10 (High Risk) 3-4 (Low/Med) VACBAC* 4 (Medium) 3 (Low Risk) > *REBA doesn t fully account for static load

27 SUMMARY > Custodians participated together with managers, supervisors, & health and safety professionals to address ergonomic aspects of their work > Discomfort reports were consistent with WC injury data > Tasks where tools and training were received appeared to show greatest reductions in survey of discomfort > REBAS were reduced in tasks that were modified > Role for Participatory Ergonomics in Injury Prevention > The project enhanced the safety culture of the department

28 WHAT WE LEARNED TASKS ARE MORE COMPLEX THAN WHAT S APPARENT > Worker input, observations and participation are essential CHANGE IS A PROCESS; COMMUNICATION IS KEY > Planning and follow up are very important > Relationship building must take place WORKERS MUST DEMONSTRATE NEWLY-LEARNED INFORMATION > Almost no one learns by only watching NOTE > Be careful not to introduce new MSD problems

29 IMPORTANT REMINDERS > Supervisors need the same training > Reinforcement of new information is vital > Health and safety culture is essential for success > Worker and management engagement is crucial > Findings were not unique to UW custodial work > Most interventions were not costly.

30 POST-GRANT PROCESS CONTINUES WITHIN FACILITIES SERVICES > Conducts weekly participatory meetings > Helps ergonomics safety culture mature > Tool evaluation surveys to maximize custodian input > Completed additional tasks from the survey > Distribution and installation ongoing

31 POST-GRANT PROCESS CONTINUES WITHIN FACILITIES SERVICES > Addressed several task elements on the survey

32 AFTER THE GRANT: ADDITIONAL ACCOMPLISHMENTS ERGONOMIC MODIFICATIONS Toters for some areas Mini-Max Mini flashlights Stripes at stair bottoms Dumpster prop Magnets Surface wipers Keychains

33 THROWING TRASH INTO DUMPSTER BEFORE AFTER

34 TOILET CLEANING BEFORE: Using longhandle brush while holding door open with hip AFTER: Magnets installed to keep door open

35 TOILET CLEANING: RESULTS Door held open with magnetic post

36 WIPING SURFACES BEFORE AFTER

37 % POSITIVE RESPONSE SURFACE WIPER LIKE IT FEEL BETTER BACK ARMS USE IT SHOULDER KNEES CUSTODIAN OPINIONS

38 AFTER THE GRANT: ADDITIONAL ACCOMPLISHMENTS INCREASED COMMUNICATION Reporting problems: lighting & broken equipment ( diminish risks) Collaborating: Grounds Department (controlling leaves) Recycling (magnets for bins) UW students HIPRC Best practices, ideas and solutions Custodians generating ideas and solutions Slips, trips and falls training

39 MORE COMMUNICATION: SLIPS, TRIPS & FALLS PRESENTATION > Developed and presented by custodians

40 CURRENT ACTIVITIES > Sustain the changes we made Train the trainer Review of recommended work practices on the job Updating best practices Record keeping > Custodians are now aware and active in injury prevention continue to grow SAFETY CULTURE! Continue to encourage custodian evaluation of problems and development of solutions. Still Participatory Continue weekly meetings to discuss progress and new issues

41 FOCUS ON ISSUES IMPACTING SAFETY > Follow up of area post-grant information sessions In addition to study results, we asked: > WHAT WOULD YOU LIKE TO SEE FROM MANAGERS AND SUPERVISORS TO PROMOTE HEALTH AND SAFETY? > WHAT WOULD YOU LIKE TO SEE FROM EACH OTHER TO PROMOTE HEALTH AND SAFETY? Identified other areas important to safety CONCURRENT FILLING OF VACANT POSITIONS

42 FIND MUTUALLY BENEFICIAL GOALS > Trash vs recyclable survey Institutional benefit ($) > Liquid elimination/reduction in trash Student engagement (environment) Institutional benefit ($)

43 REDUCING UW INSTITUTIONAL DISABILITY: PRIORITIES TOWARD REDUCING UW DISABILITY INSTITUTIONAL PRIORITIES > Focusing on safety is most important > Engaging in return-to-work efforts

44 Greater Involvement in Building and Surroundings Design

45 BEYOND THE HORIZON BEYOND THE HORIZON > Continue Participatory Ergonomics & Safety Program > Expand program toward other injury prevention ideas---stretch > Develop modified duty program for custodians > Review workers comp and absence data for program impact After an anticipated increase in injury reporting due to awareness & better reporting, we now anticipate a decrease in injuries and time loss AND fewer days away from work > Continue to influence manufactures regarding ergonomic tool design > Participate in building design and materials as impacts custodians & other workers

46 THANKS TO THE SHIP GRANT PROJECT TEAM and THE CURRENT SAFETY AND ERGO TEAM: Gene Woodard (Facilities) Tracey Mosier (Facilities) Mike Nguyen (Facilities) Scott Spencer (Facilities) Sattia Sear (Facilities) THE FACILITIES CUSTODIANS, MANAGERS & SUPERVISORS Karen Crow (EHS) Rebecca Tesfamarian (Facilities, WFSE) Steve Davis & Terry Graham (Performance Ergonomics) Sheryl Schwartz & Suzanne Mason (EHS); former EHS, Ed Havey Vivian Lyons (HIPRC), Allyson O Connor (HIPRC, DEOHS), Karen Segar (HIPRC) Amazing Contributors: Mark Hash and Dean Seaman Chris Pennington and Barbara Brown (UW Facilities Health & Safety) Chris and Jacalyn from ProTeam Aaron, Mark D.,,Christine, Zerome, John, Crystal, Rosanda and UW Mechanical Engineering Students

47 COMMENTS OR QUESTIONS?

48 STAFF BACKGROUND > Highly engaged staff > 239 full-time custodians / 48,536 sq. feet each > English is often second or third language > 14% absentee rate > Day cleaning

49 INJURIES Any job that produces injuries is a good candidate for redesign. > Bending The deeper the bending motion, the greater the physical stress on the low back. Frequent bending regardless of weight is not recommended. > Twisting This motion puts uneven forces on the back thereby presenting additional physical stress. The greater the twist, the more physically stressful the task. > Reaching The distance that a load is held away from the body greatly affects the forces on the back, shoulders, and arms. The farther the reach, the more physically stressful the task.

50 INJURIES Any job that produces injuries is a good candidate for redesign. > One-Handed Lifts By nature, these tasks place uneven loads on the back and present a greater physical stress than two-handed lifts. > Hand-Holds The inability to get a good grip on the load presents a greater physical stress. > Catching or Throwing Items Any tasks involving catching or throwing items are physically stressful and, therefore, are good candidates for redesign.

51 TOOL EVALUATION SURVEYS Tool: e.g. Long-Handled Surface Wiper Survey Area: Date: Name (optional provide if you want us to follow up with you): Do you like using the new tool? Y or N What area(s) of body felt better using this tool? Did any area(s) feel worse using this tool? Y or N if yes, where Is this same, better or worse than previous tool for cleaning the surfaces that you need to clean? Why? How many days did you use this tool/method? Would you use this tool if it was provided? Y or N How do you store and transport this tool? Do you have any ideas to improve it? Additional comments: