There are three key steps for taking a holistic, participative and evidenced-based approach to musculoskeletal injury prevention, according to David Trembearth, national safety business partner – safe design and ergonomics for Coles Group.
The first step is to use a systems-based, end-to-end methodology that is focused on risk management and commissioned through to an end-of-life cycle.
“Focus on all hazards that influence work-related musculoskeletal disorder (WMSD) risk,” he said.
The second step is to identify all key stakeholders as early as possible and build respectful collaborative working relationships, according to Trembearth.
“The third step is to use objective rationale to validate why change is required and use metric data to validate good design intervention through iterational design from concept to full implementation,” said Trembearth, who pointed to the resources for Chapter 16: Work-related Musculoskeletal Disorders of the OHS Body of Knowledge, which is co-authored by Trembearth together with Joanne Crawford, WorkSafe New Zealand Chair in Health and Safety, Victoria University of Wellington, New Zealand.
Crawford echoed Trembearth’s comments and said that participation is a key part of any ergonomics intervention, so involving workers in any intervention is essential.
“Good work design involves engaging with workers to find out what their issues are, observing the work in progress so you can see the tasks completed, the different jobs, the tools used and the working environment,” she said.
“Problem-solving is where design changes are proposed, evaluated and prototyped. This process is carried out with workers and their managers to identify trade-offs that might reduce risks and costs,” said Crawford, who explained that when a design is agreed and fully tested, wider implementation of the workplace change can commence.
More broadly, Trembearth and Crawford observed that there are a number of reasons why organisations struggle to manage musculoskeletal injuries. “Some organisations do it well and some not so well,” said Trembearth, who also serves as a sessional lecturer in ergonomics and human factors at RMIT University.
“Metrics may be focused on lag indicators rather than lead indicators with a focus on prevention, including good work design and psychosocial hazards and sustainable risk controls.”
Crawford said the data “speaks for itself” in that the two most common reasons why people are absent from work are work-related musculoskeletal disorders and poor mental health – which suggests musculoskeletal injuries are not being managed well.
“While we know organisations complete risk assessment for WMSD, in some cases, this is where the process stops, because it becomes too difficult, or training is given as the answer. We certainly know from back pain research that training to lift is not an effective control measure when the work needs to be redesigned,” she said.
Part of the reason organisations struggle with WMSD management is that musculoskeletal injuries are often not just the result of a single injury, but the cumulative impact of poor posture, high levels of force, repetition or vibration acquired through poor ergonomics at work, according to Crawford.
“Rather than looking at injuries, looking at simple measures of pain and discomfort might give you more information about where you need to focus your inquiry,” she said.
“We also need to think about which tools should be used to risk assess in organisations. In NZ we have the recrafted HSE tools to use for risk assessment. Australia has developed the APHIRM toolkit which assesses both physical and psychosocial risks and gives the user a priority list. Using these tools requires some knowledge and expertise around ergonomics as the difficult part mentioned above is how to make change in a workplace or organisation to reduce the risks from poor ergonomics.”
Crawford also noted that, at times, some of these problems come down to poor work design and layout where the human has not been considered in the workplace or work system. “Making large changes is expensive and many companies will say this is not reasonably practicable. In these cases, you have to make smaller changes which are likely to be less effective in reducing the risks. Having a HFE (human factors and ergonomics) professional working with you at the start when designing workstations, will actually help in the longer term,” she said.
Trembearth said one of the common challenges for organisations is an unclear understanding of what a MSD is, why action is required to identify/assess/control and how this can save money and increase productivity.
He referenced the HFESA position statement and said there are three other related challenges:
- Identification of where the gaps are, the real costs of MSDs (direct and indirect) and the level of commitment to drive sustainable change in good work design. “This requires a level of financial commitment, pursuit of new technologies and preparedness to address gaps in states of knowledge about MSDs,” he said.
- Investigating the root cause of why MSDs occur and to transform this new state of knowledge into change. “This requires a top-down and bottom-up approach where all key stakeholders must be involved,” Trembearth added.
- Understanding the requisite duties of key stakeholders, including designers, manufacturers, importers, suppliers and end-users.
“The OHS profession needs to be clear about the role of the OHS professional and when you need to bring in an HFE professional,” said Crawford.
“OHS professionals are often the first to identify particular workplace hazards so they need to have a level of knowledge around HFE so they understand what is happening when consistent patterns of pain and discomfort are reported. Unless they have received further training in human factors and ergonomics, passing this on to a registered ergonomist would be a good option.”
Apart from informing themselves about WMSDs, Trembearth said OHS professionals should also:
- Gain a clear understanding about why the organisation’s MSD performance is in its current state
- Look at the metrics for MSD performance and ask ‘why’?
- Look at the culture of reporting and where there are disconnects between the espoused and practised with specific interest in ‘disconnects’ at key levels of the organisation.
- Review the management and performance regarding MSD and the commensurate resourcing and commitment directed toward continuous improvement.
- Don’t shy away from actively seeking the ‘disconnections’ and be seen as a disruptor
- Be able to present research evidence as outlined in Chapter 16: Work-related Musculoskeletal Disorders of the OHS Body of Knowledge to advocate for and support a holistic, participative approach to the management of WMSDs.