GAO study endorses use of ergonomic programs to reduce employee injuries

Major report profiles effective programs, finds costs can be controlled

In a recent report, the federal government concluded, without a doubt, that comprehensive ergonomic programs in the workplace are effective.

The report may represent a significant step toward a federal ergonomics rule. Particularly critical in the General Accounting Office (GAO) report is the finding that ergonomic programs don’t have to be expensive or burdensome to work. In fact, the investigators found that some informal approaches to solving ergonomic programs are often the most effective. (See related article on a program studied by the GAO, p. 127.)

The GAO compiled the report for the Congressional Committee on Labor and Human Resources, the Subcommittee on Workforce Protections, and the Committee on Education and the Workforce. Members of Congress had requested the report as part of their efforts to assess the need for a federal ergonomic standard. The federal Occupational Safety and Health Administration (OSHA) in Washington, DC, has attempted to create an ergonomics rule in recent years, but politicians squelched that effort by threatening to sharply cut OSHA funding. Congressional leaders argued an ergonomics rule would be an unreasonable burden on employers.

Congress has included budget restrictions in the 1998 budget that prohibit OSHA from issuing a proposed or final ergonomics rule that year, but OSHA is allowed to develop such a proposal in the meantime. As one indicator of whether a federal rule would be beneficial, the GAO was asked to assess whether current ergonomics programs in the workplace have improved workers’ safety and health.

The 137-page answer issued recently can be summarized in one word: "Yes."

The government report doesn’t really surprise anyone working in ergonomics, but it is a welcome stamp of approval nonetheless. Bonnie Rogers, DrPH, COHN-S, FAAN, president of the American Association of Occupational Health Nurses (AOHN) in Atlanta, says the report confirms what she and most others in the association already know.

"A lot of our nurses work in ergonomics, and those programs are an important part of what they do," Rogers says. "Even if we already knew what the government is just finding out, it’s very good to see the report."

A similar response comes from Sheree Gibson, BSME, MSE, PE, CPE, an ergonomics consultant in Simpsonville, SC, and past chair of the American Industrial Hygiene Association’s committee on ergonomics. She says the report is "vindication" for every occupational health provider who ever struggled to prove the value of a comprehensive ergonomics program for the workplace. "It looks like this may be a strong point in favor of a federal ergonomics rule," Gibson says.

The AAOHN’s Rogers agrees, saying it’s about time the government endorsed workplace ergonomics. "This report is something we’ve really been waiting for," Rogers says. "It’s really overdue."

The GAO studied five employers who have implemented comprehensive ergonomics programs in the workplace. In addition to reaching the overall conclusion that ergonomics programs work, the report dissects the programs to identify the necessary elements of a successful program. After combining that information with information offered by occupational health professionals, the GAO makes this recommendation for the core elements of a successful ergonomics program and offers examples of how to carry them out:

1. Get management commitment.

• Assign staff specifically to the ergonomics program.

• Provide time during the work day to deal with ergonomic concerns.

• Establish goals and evaluate results.

• Communicate the importance of the program to all staff.

• Make resources available for the ergonomics program.

2. Involve employees.

• Create teams to receive information on ergonomic problems, analyze it, and make recommendations for corrective action.

• Establish a procedure to encourage prompt and accurate reporting of signs and symptoms so that employees can be evaluated and treated.

• Solicit employee reports of problems and suggestions for improvement.

• Conduct periodic surveys to obtain employee reactions to workplace conditions.

3. Identify problem jobs.

• Follow up on employee reports of symptoms, discomfort, physical fatigue, or stress.

• Review OSHA 200 logs and other existing records, such as workers’ compensation claims.

• Conduct interviews and symptom surveys, and administer periodic medical examinations.

4. Develop solutions.

• Observe workers performing the tasks, interview workers, and measure work surface heights and reach distances.

• Videotape jobs, take still photos, and make biomechanical calculations to break jobs down into component tasks and identify risk factors.

• Administer special questionnaires.

• Encourage "brainstorming" by employees performing the job.

5. Train and educate employees.

• Provide overall ergonomics awareness training to help employee recognize risk factors, learn the procedure for reporting problems, and become familiar with how the facility is identifying and controlling ergonomic risks.

• Target training for specific groups of employees because of the jobs they hold, the risks they face, or their roles in the program (such as line supervisors).

• Provide appropriate medical management.

• Encourage early reporting of symptoms.

• Ensure that employees do not fear reprisals.

• Ensure prompt evaluation by health care providers.

• Make health care providers familiar with jobs through periodic facility walk-throughs or review of job analysis reports, detailed job descriptions, or videotapes of problem jobs.

• Give employees with musculoskeletal problems restricted or transitional duty assignments

The report notes that all the companies studied incorporated those elements in sometimes entirely different ways. The good news? None of these efforts has to be expensive or difficult.

"This variety typically resulted from factors such as differences in the facilities’ industries and product line, corporate culture, and experiences during the program’s evolution," the GAO reports. "Also, the processes used by the case study facilities to identify and control problem jobs were typically informal and simple and generally involved a lower level of effort than was reflected in the literature. Controls did not typically require a significant investment or resources and did not drastically change the job or operation."

GAO investigators concluded that ergonomics programs can yield positive benefits without creating an unreasonable burden on the employer. The report endorses the general concept of a federal ergonomic rule, but it underscores the finding that it need not be terribly specific or binding.

"Our findings suggest that as OSHA proceeds with its efforts to protect workers from ergonomic hazards, it may be useful for it to consider an approach that sets a framework for a worksite ergonomics program while providing employers the flexibility to implement site-specific efforts and the discretion to determine the appropriate level of effort to make, as long as the efforts effectively address hazards."

The chief ergonomist at one of the five programs profiled in the General Accounting Office’s (GAO) report to Congress on ergonomic programs says one of the most important findings is that "informal controls" can succeed in the workplace.

Christine Meier, PhD, CPE, manages ergonomics at American Express Financial Advisors (AEFA) in Minneapolis. She worked closely with the Washington, DC-based GAO in preparing the report, which calls her operation an example of how well an ergonomics program can benefit workers and their employers without being overly expensive or burdensome.

"The report really captures what we actually do as ergonomists in corporate America," Meier tells Occupational Health Management. "Sometimes, people think that it always concerns an in-depth scientific analysis, and that’s certainly part of it, but it’s important to see that a program can be successful with more of an informal process."

AEFA has a comprehensive ergonomics program that any occupational health provider would be proud of, but Meier notes that some of the less sophisticated components are the most successful. She sees that as a major point in the GAO report and a strong argument in favor of the federal ergonomics rule. In the past, employers have argued that a federal rule would require too much money and time while unreasonably disrupting operations. Meier says her program refutes that notion.

Especially in an office environment, many ergonomic problems can be addressed inexpensively and with little disruption, she says. For example, she cites how she and her staff conduct ergonomic evaluations of individual workstations.

"We go out to the individual work area and observe the person working while we all brainstorm with the employee about what the problems might be and how we could solve them," she says. "It’s informal as opposed to looking at it purely as a scientific analysis to be performed. We do that too when necessary, but it’s much more often that we do the informal evaluation that takes about 30 minutes."

Other aspects of the AEFA approach to ergonomics emphasize dealing with problems early enough to avoid the more expensive and difficult solutions. One part of the program is a weekly ergonomics training session for employees. The training is open to anyone who wishes to attend, but it is required for new employees and anyone switching departments.

The 90-minute session provides an overall education about workplace ergonomics, but it also includes information specific to AEFA workstations. Slides of the workspaces and actual equipment in use at the site are included to make the training specific to the employees.

As part of the meetings, the employees are asked to fill out a "discomfort survey" asking them to report any types of body discomfort. (See the form on p. 128.) The survey is anonymous, so it’s not intended to be a way for employees to seek help with specific problems. Employees are encouraged to request an evaluation of their worksites if they think there may be ergonomic hazards, and the ergonomic team responds within 48 hours. Any reported injuries also result in an evaluation.

The discomfort survey is used as a data gathering tool, helping the company track how well the ergonomic program is improving the work situation for employees. When the survey was first used in 1993 before many of its current ergonomic initiatives were in place, 75% of the employees reported headaches, 76% reported neck pain, and 70% reported back pain. The latest results show significant improvement, with 26% reporting headaches, 32% reporting neck pain, and 29% reporting back pain.

Employees also receive a list of ergonomically correct accessories that may make them more comfortable, and they are free to request items off the list whenever they want to. Each workstation is customized when the worker first takes that position, with everything adjusted to fit the employee’s body. Everyone attending the weekly ergonomic education sessions is measured in several ways, and those measurements are used to prepare the workstation. The measurements also are added to the employee’s personnel record so they are available whenever the worker’s job changes.

"Our facilities department has access to all the files, so when an employee moves from one workstation to another, they can tailor the workstation for that employee. The links with other departments are very important and help us to be proactive," Meier explains. "This should all give skeptical employers evidence that ergonomic programs are working."