By Rich Smith
An Ounce of Prevention Employers are realizing that paying attention to workplace ergonomics to prevent or reduce employee injury pays off in lower costs. Only about 40% of American companies have done something about ergonomics in the workplace, according to November 2000 OSHA statistics cited by Alison Heller-Ono, MS, PT, CIE, CMC, president and CEO of Worksite International in Monterey, Calif, and author of Your Guide to Developing an Ergonomics Process. Eventually, businesses yet to embrace ergonomics will do so as states begin adopting workplace standards or as those companies decide the costs of skyrocketing insurance premiums and court judgements are more than they can bear, says Joanette L. Alpert, PT, MS, CIE, CPE, of Woodward, Alpert and Associates Inc in Santa Ana, Calif. And that is almost certain to bring more growth in the already robust field of ergonomics, which is dominated by entrepreneurial-minded physical therapists and occupational therapists, adds Alpert's business partner, Candice Woodward, PT, CIE, CPE. More than New Equipment The aim of ergonomics, says Heller-Ono, is to maximize the "match between the user and the work environment." Alpert says employers often mistakenly think that means nothing more than brooming the office or assembly line of all the old, traditional-style tools and furniture in order to bring in comfort- and protection-engineered replacements. "A lot of them assume ergonomics is purely a function of equipment, but it's not. It's a matter of design problems and worker habits," she notes. Additionally, ergonomics plays a role in both injury prevention and postinjury rehab, experts say. "As to injury prevention, ergonomics helps by seeking to improve the relationship between the worker and the workplace by matching their abilities and limitations with the tasks they're required to perform," says Alpert. "Then, you have injury rehab. Here, we look at the cause of the worker's problem and offer advice to remedy it so that he or she will be in a better position to get well and avoid reinjury." For Heller-Ono, as much as 70% of her work in ergonomics is reactive; that is, she is called in to make ergonomic recommendations after an injury has occurred. "We see a lot of workers with problems related to upper extremity cumulative trauma," she says. "Mostly, it's related to poorly designed workstations-bad furniture, equipment set up in ways that put injury-resulting strain on the body, inability of workers to recognize awkward postures." Heller-Ono emphasizes that reactive ergonomics is not considered treatment. "We're not treating conditions," she says, "because ergonomics is not a service provided in a clinical setting. What we do is analyze, make recommendations, and provide education and training in the workplace, right at the workstation." The Appeal of Savings Ergonomics appeals to companies because it can save them potentially huge sums. "The biggest savings come in part from reductions in the severity of claims," says Alpert. "Ergonomics allows employers to catch problem-causing situations early before they develop into the need for expensive medical attention." The reduction in costs associated with the reduction in severity of claims appears to be felt most quickly by self-insured companies, experts say. "If a company isn't self-insured, reduced costs won't show up for 2 or 3 years," Alpert allows. "That's because their insurance company will want to see a couple of years' worth of evidence that things are improving before it will change the rates it is charging." Another source of financial benefit to companies is a reduction in the incidence of lost productivity from workplace injury. "An ergonomics program that qualifies as a success is going to keep people on the job, and keep them productive," Alpert says. "Doing so takes the strain off of coworkers because, when an employee is absent from the job, some or all of their tasks invariably are distributed to one or more colleagues. By increasing the burden on coworkers, they tend to tire faster. When they are tired, they are less productive. They also are more vulnerable to injury." A big reason more companies do not turn to ergonomic is they think the costs will outpace the savings. Not so, experts assure. "One company I worked with spent $160,000 over 5 years on ergonomics, but that averaged out to an annual cost per employee of a mere $71," says Heller-Ono. "As for return-on-investment, in the second year of the program, the company received a payback of $2.14 for every $1 spent on ergonomics. In the third year, the return was $13 for every $1 invested. In the fourth year, the return was $5.50 for every $1." Still, company executives when they first meet with an ergonomist often are skeptical. "They want to see some evidence that this stuff works," says Heller-Ono. "I've been tracking outcomes since 1994 and can show them very good results from companies across six different industries." Some executives cannot be persuaded that ergonomics is good for their companies. But that might not matter a few years down the road, since government is moving toward making ergonomics mandatory, just as it already is in California and Washington. "Standards are being developed in many other states, though nothing is yet finalized," says Alpert. "Nationally, it's only a question of time before a federal standard is adopted." Elements of Ergonomics A solid program of ergonomics contains many elements, including analysis, implementation of change, and training. Among the most critical, according to Alpert, is analysis. "The value of everything you recommend hinges on how thorough and reliable your analysis is," she says. Alpert's company offers four levels of analysis. "At the lowest level, we'll be called in to confirm that everything is OK in terms of the ergonomics of one or more areas or departments," she says. "These assessments are often brief and involve the use of sampling. An employer who calls us in for this level of assessment may not have seen any injuries and is interested in making sure none occur. "The next level up is early intervention. Here, the employer is aware that there are some minor problems among workers because there have been complaints of discomfort and tolerable pain, but not yet any injury claims. We'll come in and conduct a more comprehensive evaluation that may include a review of the medical histories of the workers who we determine are at risk. "The level beyond that is postinjury. This is where someone has filed a claim because of a disability involving a medically documented problem. This requires the most thorough, careful evaluation as well as documentation, because the injury claims have the potential for ending up in a court of law." The fourth level of analysis involves site evaluations, usually conducted as a prelude to a redesign of a position or a department. Changing Behaviors After analysis comes implementation of change in the ergonomics of the workplace. "Ergonomic solutions tend to be customized for each workplace, since no two workplaces are exactly alike," says Heller-Ono. "In coming up with a recommendation, we take into account what the employer wants to achieve. The plan of action includes recommendations for equipment and how to structure work flow." No matter how well conceived the plan, implementing change can pose daunting challenges because employees are often reluctant to abandon familiar-and psychologically comfortable-work habits. "People have difficulty changing their habits," says Woodward. "You can show them a better approach, but altering their behavior requires lots of practice and education-education that is personalized and applicable to their individual situation. You can't just tell them to stop doing a task a certain way. You have to give them options of doing things differently in a way that makes sense to them. Once you have their buy-in, it takes reinforcement and reminders to get results. For long-term success, you have to establish an infrastructure and internal resources within the company, because as an ergonomist you can't always be there to cajole people." No Medical Codes Referrals for ergonomic services come from physicians and workers' compensation insurance companies, but requests can also arise directly from employers. "Employers don't necessarily know who to call for help," says Heller-Ono. "Many times, they look in the Yellow Pages. Alternatively, they'll ask an associate for a referral, which is where most of our ergonomic clients come from." Clients and insurance companies appreciate that Alpert, Woodward, and Heller-Ono are PTs. "We have the medical background needed to understand the mechanisms of injury and how to prevent it," says Alpert. Woodward notes that knowledge of ergonomics among PTs is growing. "In part, that's evidence of the fact that PT students are beginning to receive some instruction in ergonomics at school," she says. Ergonomic services provided by PTs and OTs are usually delivered on a consultative basis, say authorities. It is most cost-effective that way. "Although many facility-based PTs and OTs today have basic ergonomics knowledge, often they're unable to provide the service because it's too expensive to send them outside their facilities-and, for ergonomics work, venture outside they must," says Alpert. Ergonomics consultants who are not hospital- or facility-based have little or no difficulty getting paid for their services. "We don't use medical codes when billing for our services," Alpert reveals. "I'm paid as a consultant, whether I'm working for the employer or for the insurance company. I'm not functioning in the role of a medical provider. I put together a proposal for my services, I tell the client what it is going to cost, and they are free to accept it or not. If they accept it, my fee is never cut because it is not subject to review." A caveat: the lure for clinicians to enter the field of ergonomic consulting is potent, but Alpert warns that it is tough to make a go of it without a strong set of entrepreneurial, business-administrative skills. "It's hard to be a small company," she confides. "The nature of consulting means that work may come in cycles, and the size of projects varies from client to client. This is common in a specialty niche practice." Alpert and Woodward started their firm in 1994, after each having spent the previous 4 years operating solo consulting companies. Heller-Ono launched her company in 1993 and today is teamed with two other ergonomics consultants. Her company consists of two divisions: one is service-oriented, and the other focuses on training. She is currently marshaling a network of ergonomic service providers that she hopes will span the continent. "The mission of the network is to fundamentally change the way health care is delivered to the workplace over the next decade by creating a national affiliation of PTs and OTs to effectively and competently perform ergonomic services within their individual communities," she says. "We're rolling out with it early next year." Heller-Ono says the network concept is viable because there is an growing need for more ergonomic consultants to be out in the field nowadays than ever before. "The growth of ergonomics is a reflection of the increasing awareness among employers, physicians, insurance companies, and even employees that ergonomics is good business practice and everyone stands to gain by having an effective program in place." Rich Smith is a contributing writer for Rehab Management.
