This article has been supplied by Brad Matthews of Winning Safety.  Winning Safety uses a process that goes beyond simply observing behaviour. It is designed to encourage “active listening” and promote safety leadership especially by managers in the workplace. Brad believes that with the proper framework, an organisation can use safety as a mechanism to meet production and profitability objectives and develop a culture of openness and trust.

Manual tasks contribute to injuries affecting all parts of the body, particularly the back, shoulder and wrist. These are commonly called musculoskeletal disorders and account for more than half of the following:

• cost of workers’ compensation claims
• number of days lost from work
• work absences over six months.

According to data collected by the Australian Safety and Compensation Council (ASCC), performing some manual tasks can cause musculoskeletal disorders (MSD’s) which can lead to death, injury or disease.

Between July 1997 and June 2003, injuries caused by manual tasks at work resulted in;

• 437,852 compensation claims in Australia, or 
• 41.6 % of all compensation claims during that period, 
• a direct cost not counting indirect impacts (including long-term impacts on the quality of life of the injured worker) of $11.965 billion.
• an estimated 11.6 million lost working days a year.

A staggering 38% of musculoskeletal disorders relate to back injury and an additional 27% of MSD’s relate to shoulder, hand, wrist and finger injury through carrying out manual tasks.

As an employer, you are responsible for preventing work related injuries or disorders (MSD’s) caused by manual tasks.

MSD’s are a priority risk to your business costs;

• they affect large numbers of people across most job roles
• they have the potential to ruin people’s lives 
• they impose heavy costs on your business and on society.

Key points to remember about MSDs :

• you can do things to prevent or minimise MSDs
• prevention measures are cost effective 
• you cannot prevent all MSDs, so early reporting of symptoms, proper treatment and suitable rehabilitation is essential. 

What are the Risk Factors?

Risk factors causing MSDs can be found in virtually every workplace from commerce to construction.

Areas that can create a risk:

• repetitive and heavy lifting
• bending and twisting
• repeating an action too frequently
• uncomfortable working position
• exerting too much force
• working too long without breaks
• adverse working environment (e.g. hot, cold)
• psychosocial factors (e.g. high job demands, time pressures and lack of control)
• not receiving and acting upon reports of symptoms quick enough

Remember that the greater the number of risk factors you are exposed to, the higher your risk of developing musculoskeletal disorders.

The longer your exposure, the higher your risk.

Managing the Risk

Risk management for manual tasks involves a 3 step process aimed at preventing work-related musculoskeletal disorders. Major stages in the risk management process include:

1. Risk identification: Identify the problem jobs/tasks which are likely to, or have caused injury.

2. Risk assessment: Investigate the problem jobs/tasks, determine the risk factors and evaluate them, assess their importance, and look for their causes.

3. Risk control: Decide on solutions, trial and implement them, and check later to see the changes are working.

Key Points:

• You can do things to prevent or minimise MSDs
• Prevention measures are cost effective
• Early Reporting is essential

Developing a Risk Management Strategy

Planning is critical to make sure controls for reducing risks in the workplace are implemented.

Successful programs aimed at reducing musculoskeletal disorders have five essential elements.

1. Safety Leadership.
2. Training.
3. Risk Management.
4. Rehabilitation.
5. Evaluation.
 
1. Safety Leadership
The most effective solution to reducing safety and health hazards is a combination of Management leadership and worker involvement.

In order to control and reduce work-related musculoskeletal disorders, the management of the organisation must be committed to the program both financially and personally. The commitment includes listening to and acting on feedback given by the workers.

Employees take their cue and motivation from the management’s actions and responses to their feedback. Without employee commitment the return on a program investment will not be fully realised.

2. Training
Training provides the basis for consistent awareness, identification, analysis, targeting and control of musculoskeletal disorders hazards.

3. Risk Management
Management and workers must be aware of risk factors and hazards of their jobs and in their work environment that lead to musculoskeletal disorders.

Careful evaluation of the workplace identifies risk factors and hazards; including the use of checklists and registers to help document all observations.

Once the risk factors, hazards and injuries are identified and recorded, the OHS personnel, in collaboration with management, contractors and workers, have the facts to assess the risks and develop solutions, e.g., improve site housekeeping through the alteration of material delivery schedule, use self-raising platforms or buddy system for lifting, etc.

4. Rehabilitation
Effective injury management relies on the cooperative efforts of all participants – employers, workers, insurers, doctors and other health practitioners.

The longer a worker is away from work the less likely they will return. Replacement of a skilled person is expensive or, at times, difficult to impossible.

It is a benefit to the individual and employer to bring the injured worker back to alternate or reassigned duties as soon as medically appropriate. This may mean re-skilling or providing additional training.

Your Risk management strategy should outline how this is going to be addressed.

5. Program Evaluation
Evaluating the effectiveness of a program is just as important as implementing the program.

• Is your program reducing musculoskeletal disorders, hazards and risks? 
• Does an initial upsurge in musculoskeletal disorders reporting mean your workplace became less safe because of the program?
• Does this upsurge mean that a hidden population of injured workers has received treatment and will be returned to a healthier level of productivity and lifestyle?
• Have you successfully identified and targeted your MSD hazards?

Program evaluation is vital to validating your required outcomes and obligations.

For more information regarding this article or Workplace Health & Safety advice or training, please contact Brad Matthews on 0423 902 477, via email at brad [at] winningsafety [dot] com or visit Winning Safety

Thank you Brad.

From the preceding articles we can see that the combination of physiological changes connected with stress and distress may well contribute to damage in muscles and other soft tissues of the musculoskeletal system of the body.

In the past soft tissue injuries have largely been attributed directly to task characteristics. This has led to direct management of risks associated with task by such controls as re-engineering, task rotation and so on. However we have not seen a significant reduction in the numbers or severity of soft tissue injuries from this approach.

Whilst the work at [Organisation] has remained relatively unchanged, except for product types and mix, a range of task related preventative actions to date have included:

• provision of scissor lift tables in Forge to reduce repetitive bending and reaching;
• modification of Knock-off conveyor speeds to vary work rates;
• education of employees in the use of safety devices (E-stops) and conveyor controls to manage critical mass of product flow (tangled castings) and oversize waste pieces (BBQ plates);
• task rotation to reduce exposure to repetitive tasks;

Certainly at [Organisation’s] plant, despite these preventative actions, we have experienced some severity of soft tissue injuries and the frequency, apart from the odd spike seems to be relatively static at an average of 1.75 per month. (see Table 1).

If we consider the broader implications of Human Stress factors and their potential involvement in the cause of soft tissue injuries, we might recognise the following work related stressors as potential contributors to this level of MSD experience (note the list is indicative but not exhaustive):

Managine Work Related Stress with a View to Reductions of MSDs

If we accept that stress factors may contribute to MSDs then we must take steps to manage the associated risks. Just as we re-engineer and administer actual task activities, we also need to identify and manage work related stress factors.

Given that each individual will perceive the current set of circumstances through their own set of life experiences and coping processes, it becomes a mammoth, if not impossible task to identify which employees may be at risk of stress related MSDs at any point in time.

Hence the best we can do is attempt to recognise and acknowledge the potential stress factors and then attempt to modulate the scope and scale of each one and the combination of them at any given point in time.

Associated with this, an education program in recognising and managing stress and a general health management program may be of some use in combating stress related MSDs.

References
Work-Related Musculoskeletal Disorders. Stage1. Literature Review. November 2006. Australian Government. ASCC

Selected Nursing Notes and Other Resources Lecture 3: Stress, anxiety and coping mechanisms. 1999 VUT School of Nursing HNB2212: Psychiatric Nursing.

Boletin Del CIS. 012 Stress, Psychosocial Factors. 1999. ILO

STRESS at Work. NIOSH Publication No 99-101

Repetitive Stress Injury: Diagnosis or Self-fulfilling Prophesy. Szabo RM & King KJ. September 2000. Journal of Bone and Joint Surgery

Upper Limb Disorders in the Workplace – Risk Factor Checklist HSE UK

Thank you so much to Les for this research. It has been fascinating and informative. The previous segment can be found at http://safetyconcepts.com.au/171/stress-and-msds/

Under normal conditions, where the individual is not overly stressed, some physical task activities, such as repetitive actions or sustained static loading may lead to minor lesions forming in muscle, tendon or ligament tissues. When the body is healthy these lesions heal fairly quickly and no long term damage is experienced.

However, where an individual perceives a threat or a series of threats to be ongoing the chemical and physiological changes can reach the point of becoming unhealthy. This condition is termed ‘distress’.

There are some situations where this condition of being over-stressed or distressed may lead to other physiological damage due to the combination of stress related internal changes and the nature of work tasks being performed.

• Arterio/vascular change
  For example, where the blood vessels have been constricted to some muscles and those muscles are involved in work tasks requiring repetitive activity or sustained static loading, damage may be done to muscle structures due to the lack of nutrients and oxygen being provided and/or the build up of toxic waste matters not being cleared away in the muscle cells.
• Reticular formation change
  Heart rate, blood pressure and respiration changes affect the amount of oxygen supply and waste removal to various parts of the body. Fatigue begins to affect the body when these changes continue for prolonged periods.
• Immune system change
  Chemicals released to combat infection may begin to attack cells involved in minor lesions causing inflammation and pain.

You’ll find the previous segment of Les’ research in article The Effects of Stress on the Employee.

Every individual employee is being exposed to various combinations of these human stress factors at any one time. For many people the actual combination may be in a constant state of flux and even that continuously changing exposure may affect the levels of stress they experience.

As the individual perceives their world at any given time, they may feel threatened by any one or more of these stress factors and that sense of feeling threatened causes their body to become ‘stressed’ and respond as described in the previous section of this report: The Human Response to Stress.

For most people the stress response may be short lived and they will recover relatively quickly from the chemical and physiological changes their body underwent. However for some people, the stress response may be either prolonged and/or often repeated leading to a physiological and/or psychological injury or illness.

The previous section of this article is titled Human Stress Factors.

Human Stress Factors

There are a significant number of factors that may impact on an individual’s perception of threats. These are termed stress factors. Again, each individual will experience, and respond to, these stress factors in different ways. Stress factors include:

• Task Related Stress Factors (directly connected to work performance)Physical Task Demands: include various physical characteristic requirements such as strength, flexibility, agility, height, etc. Specific details may include weights to be moved or lifted, heights and distances that weights need to be moved through, repetitive actions required, awkward or static postures that need to be maintained, types of hand grips, contact with mechanical conditions such as vibration and temperature, and so on.

  Perceptual, Cognitive and Psychomotor Task Demands: include factors such as concentration for close inspection, precise fine motor movements, speed and accuracy, task cycle time, work rate, etc.

  Overall Job Demands: include factors such as duration of working hours, quantity of work to be performed within given timeframes, access to rest or toilet breaks, task rotations, shift patterns, etc.

  Physical Environment Hazards: include factors such as constrained or confined spaces, noise, whole body vibration, working at heights, temperatures, lighting, floor surfaces, etc.

• Work Related Stress Factors (connected to the workplace environment)Psychosocial Environment: related to the level of:
  - Control over work tasks; eg: the difference between work rates controlled by conveyor lines compared to a tradesman having some autonomy over work rate.
  - Social support; relates to the degree of ‘membership’ in work teams and social groupings in the workplace.
  - Instrumental support; relates to the degree and nature of supervision, access to break times and toilet breaks.

  Employee Characteristics: relates to the individual states of stress, fatigue, and/or overall wellbeing of an individual whilst in the work environment.

• Social Stress Factors (connected with general life experiences and conditions)Relationships: states of marital, parental, sibling relationships

  Bereavement: loss of loved ones and associated perceptions of death and ‘afterlife’.

  Finances: related to the degree of financial stability and security

  Illness & Disease: related to both short and long term health issues, recovery rates and management processes. Includes ongoing medical conditions such as diabetes, arthritis, asthma, etc.

  Leisure and Lifestyle: related to social relationships and leisure activities. Includes factors such as use or abuse of alcohol and other drugs.

  Aging and Physical Changes: related to how individuals deal with the physical and emotional changes associated with the aging process. These include such factors as reducing flexibility/agility and mobility, hearing loss, changes in visual acuity, etc.

Stay tuned for the next part of Les’ research.