Don't simply treat, discover root cause

'The avenue is there for investigation'

When an employee comes to you and tells you his shoulder is bothering him, you can do one of two things. You can either treat the problem and send him on his way, or you can dig deeper.

Thomas Slavin, safety and health director at Navistar International, a Warrenville, IL-based manufacturer of trucks and diesel engines, recommends the latter approach. He notes that the Japanese term "genchi genbutsu" is used in the Lean Manufacturing process, which translates as "go see the problem."

"The most effective occupational health professionals that I've worked with are the ones who actually go to the worksite to see what the person is doing, when someone comes in with a problem," he says.

By doing so, you may learn the real cause of the employee's pain or symptom. "A lot of things can be discovered when you see what their actions are. The symptom they come in with is really just a clue. And it's an important clue, that maybe no one else is aware of," says Slavin.

Take what a "root cause attitude," he advises. "People come in with a problem, but there are reasons for that problem," he says.

One investigative technique is the "Five Why," which means asking "Why?" repeatedly to get at the underlying cause of a problem. If an employee comes in with a foreign body in his eye, the reason is because he wasn't wearing safety glasses.

"A lot of people will stop there, and just say, 'You are not following the rules.' But you have to keep asking why," says Slavin. "When you start going deeper and asking additional questions, you uncover problems that can be corrected. There are a lot of benefits when you do correct them."

It may be that the glasses don't fit, fog up, that the person can't do a quality job with the glasses, or the lighting is poor.

Often, too, an employee has symptoms before an injury becomes severe. "When someone is having some pain, that is the first early indication that you need to look into that deeper," says Slavin.

Great opportunity

"The employee in your office for shoulder pain offers you a great opportunity to connect with the employee, as well as his or her department," says Carol S. Harris, RN, BSN, COHN-S/CM, an occupational health nurse at Replacements, a Greensboro, NC-based supplier of old and new china, crystal, silver, and collectibles with 550 employees.

By asking routine questions about the shoulder pain, you might discover a personal health issue that makes the employee more subject to occupational injury than another employee doing the same job.

"This is a great way to connect with that employee during the health investigation, evaluation and perhaps medical intervention to improve that individual's health," she says. "In doing so, the potential is there for he or she to become a more productive employee."

There may be a problem at home that is negatively impacting the employee's health. "Once again, this shoulder evaluation may afford the employee time to address emotional problems," she says.

Simple questions during the exam about work processes can open the door for questions about morale or other issues that are creating a problem.

"This may not be the case, but the avenue is there for investigation," says Harris. "Saying, 'Let's go look at your job process together' speaks volumes to that employee. You show concern for them, and validate their importance."

When you go out into the field, the employee's co-workers then see your concern for their safety. "Spend time in the department to watch the employee do the job that is in question," she recommends.

As a result of these observations, you're in a better position to offer suggestions for work practices to decrease potential injuries in the future. "Demonstrate sincere concern for the employee," Harris says. "Then provide support for the management team by demonstrating concern for department safety, as well as production."

[For more information on learning more about an employee's injury, contact:

Carol S. Harris, RN, BSN, COHN-S/CM, Replacements, Greensboro, NC. Phone: (336) 697-3000, ext 2044. E-mail:]