As workers' compensation costs continue to rise, employers desire to return employees with injuries back to work in a timelier manner and address the ergonomic risk factors related to the injury. Integrating ergonomics in the return to work process is essential to decrease the risk of injuries and enables employees with injuries to return to work without the fear of being reinjured. Ergonomics has the ability to enhance early injury and illness identification, supplement appropriate medical intervention, promote injury prevention, and decrease future injury recurrences. As employers focus on addressing ergonomic hazards, gains are made in public relations with employees, workers' compensation costs are reduced, and employees return to productive work more quickly.
Employers often struggle with the question, "why does the same employee continue to be reinjured?" Rarely does only medical intervention completely resolve and prevent the recurrence of similar injuries after an employee returns to work. Not only does this affect an employee's ability to work, but it also affects a company's financial bottom line. In the United States, workers' compensation medical costs rose 12% from 2001 to 2002 and are expected to continue rising.1 With the increasing cost of workers' compensation premiums, companies face a daunting task to decrease total injuries and their overall risk. It becomes necessary to use a multifaceted approach with addressing ergonomics at the core. The purpose of this article is to describe the implementation of ergonomic components to enhance the success of a return to work program.
The goal of a return to work program is to return employees to meaningful, productive employment following an injury or illness. The employee is involved in the process until released to full duty by a qualified health care provider. Williams and Westmorland state that a comprehensive return to work program can "contribute to a safe environment, thereby reducing total disability costs, reducing total health care costs, decreasing lost work days, increasing employee productivity and job satisfaction, and reducing employee turnover." The primary goal of a return to work program is to quickly and safely return an employee to work.2
It is in the best interest of the employer and the worker to return to work following a work-related injury or illness.3 According to research cosponsored by Intracorp and CIGNA Group Insurance, shorter disability duration was experienced by employees who returned to work within 90 days, in relation to those who did not (12.5 days versus 328 days).4 Many companies administer a return to work process that enables employees to return to work based on their physician's work restrictions. The benefits for the worker include little or no loss in earning power, the ability to work while allowing the affected body part to heal, and continuing to feel as part of the team. Benefits extended to the employer include retaining a trained employee, decreasing injury-related compensation, and demonstrating an outward concern for a worker's health and well-being.
Employers can make great strides in public relations with employees by incorporating ergonomics into the overall return to work process. As an employee observes a company focused on injury prevention and attempting to fit the job to the worker, a feeling that the employee's health is valued emerges. Three primary objectives exist in the return to work process: (a) early injury and illness identification, (b) timely and appropriate medical intervention, and (c) promotion of the prevention and recurrence of future injuries and illnesses.3 Ergonomics has the ability to increase the effectiveness of each of these objectives.2,5
Employees have the responsibility to notify front-line supervisors at the first onset of acute pain or pervasive recurrent pain. By identifying pain early, an appropriate investigation can be conducted to determine a probable root cause. With proper investigation, ergonomic risk factors can be identified.
Workers who go to their front-line supervisors with symptoms of pain must begin to be viewed as workers who have "found a production inefficiency" rather than the workers are "complainers." Facilitating this shift in thinking allows the focus to progress beyond the employee and the injury to identifying and correcting the risk factors involved. It is essential to use language that coincides with industry "lingo" to increase the credibility of the therapist and success of the intervention.
Typical work risk factors include increased force, excessive repetition, and awkward postures. To ensure that one area is not being overlooked, it is helpful to complete an ergonomic risk assessment to capture all of the aggravating factors. Ergonomic risk assessments allow for a more complete review of all aspects of the job placing the worker at risk, not only the risks that the worker identifies. Following the completion of an ergonomic risk assessment, jobs or job tasks can be ranked according to the severity of the risk, and prioritized as to where to focus intervention strategies.
According to Isernhagen, physicians often over-restrict workers due to not understanding the work the employee is engaged in and fear to further injure the employee.6 Kirsh and McKee state in a study of workers with injuries, that on average only 33% of the employees believed that their employer followed their physician's recommendations and 28% of employers made required accommodations.7 In many cases where the physician demonstrates lack of understanding and is unable to observe the job first hand, the physician may request an ergonomic job analysis to be completed on the job tasks the employee performs.
Performing an ergonomic job analysis provides an opportunity to complete a detailed evaluation of the physical requirements required of the employee and assess the severity of any ergonomic risk factors. This analysis provides both the treating physician and the employer with valuable information. The information can assist in determining injury causation, identifying contributing factors that if resolved can decrease or eliminate the risk of further injury, and methods to decrease wasted movements, potentially increasing productivity.
The information that is provided will allow the physician to gain a greater understanding of the job that is required of the employee. With this knowledge, the physician may feel more confident in providing suitable restrictions that will allow the employee to return to work, but protect the injured body part and allow it to rest and facilitate the healing process. The benefit for the employer includes the ability to implement a solution that decreases or eliminates the risk for exposure among other employees.
There are many differing opinions on what to include in a comprehensive ergonomic job analysis, as there is no set protocol.8 Typical steps to follow when completing an ergonomic job analysis include reviewing the complete job description, interviewing employees and supervisors due to possible variances as job tasks differ on various shifts, and breaking the job into tasks and evaluating the ergonomic risks. To capture the data more objectively, it is best to videotape the job tasks. Videotaping allows the workers to perform their tasks at a regular rate and using typical work methods. Before videotaping work processes, obtain permission from the employer and the employee(s) to ensure that proprietary and personal information remains confidential. Employers may request that a proprietary agreement is reviewed and signed.
To increase the effectiveness of the report, it is essential that component parts and job tasks are properly identified according to company-given names of these items. To increase the validity of the ergonomic job analysis with the treating physician, often it can be an advantage to have the supervisor review and sign the report, validating that it is a true description of the job tasks.
|Implementing the proper ergonomic program ensures a safer, more productive work environment.|
During the time that a worker is away from the job task that resulted in an injury, it is imperative that steps are taken to implement a solution that decreases the ergonomic risk.5 The following considerations must be made when determining an ergonomic control.
Seek input and feedback from the worker with an injury, as well as other workers who may perform the job. This can be one consideration that can "make or break" an ergonomic solution. The worker knows most of the idiosyncrasies of the job task and has often thought through differing interventions that could be used. Ensuring that this data source is used will increase the success of the improvement due to having gained approval and commitment from the worker.
Even the most scrutinized plans have the ability to create new ergonomic risk factors once they are implemented. One of the best ways to decrease this risk is to introduce the improvement on a trial basis. Whether it is a high dollar piece of equipment or a tool fabricated with parts from the hardware store, trialing a product offers many advantages. Implementing an improvement on a trial basis allows the product to be evaluated first hand prior to full implementation and the associated cost. The following questions can be asked to help in the evaluation process. Does the implementation accomplish what was desired? Do the workers using the implementation feel that it will improve the job? Are new ergonomic or safety issues raised that were not foreseen in the planning phase? Are the workers properly trained to use the improvement correctly?
Once the final improvement is agreed upon and implemented, it is necessary to establish a plan to follow up on the implementation to evaluate the effectiveness. When workers have returned to their normal work routine, using the new improvement for a period of time, they will have a better idea if it is helping. Also, employees may have found better ways to use the improvement that were not initially foreseen and if it has reduced or minimized the ergonomic risk. As workers with an injury return to full duty, they will feel more comfortable performing a job task that does not place them at risk for a reinjury. Once an injury has occurred, there is an increased chance of reoccurrence.
The final key that promotes injury prevention and decreases the chance that a reinjury will occur is employee training. There are six factors, which come into play when workers resist proposed improvements. The workers (a) are not aware of what they are doing, they are on "autopilot"; (b) are not aware that they are being unsafe; (c) are not aware that there is another way to perform the job; (d) do not have the skills to do it differently; (e) do not see the value in changing; and (f) feel pressure from others.9
Providing education and training on an ergonomic improvement is crucial for the overall success of the return to work process.3 Workers generally receive training to perform their job tasks. However, often they are not educated in how to properly move physically to perform their job tasks, using good body mechanics, working in a more neutral position, or avoiding specific postures for select jobs. Job simulation, when possible, provides the atmosphere where a worker can be trained and evaluated on these aspects, rather than focusing on the work or production requirements. Worker education must not only instill the best way to perform the movement, but also address the impact that working incorrectly places on the body.
To increase the success of the return to work process, it is essential to include a multidisciplinary team approach of the employer, physician, and therapist. In working together, the employee can feel more confident to return to work in a timelier manner and with a decreased risk of being reinjured. Identifying injury and illness early, supplementing medical intervention with ergonomics, and promoting injury prevention can improve the outcomes of a return to work process. In this type of environment, the therapist can become a vital component in bringing together the medical and employer intervention through addressing ergonomics. Ergonomics no longer needs to be addressed in a vacuum, but openly so that all parties can better understand and reap the inherent benefits.
Jason L. Baxter, MHS, OTR/L, is an occupational therapist at Apex Physical Therapy, Effingham, Ill.