OSHA standard would require ergonomic fix’ for workplace injuries

New standard includes pay protection, quick fix’

Hospitals would be required to create ergonomics programs to prevent lifting and repetitive motion injuries and provide guaranteed wages for health care workers recovering from those injuries under a proposed standard released by the U.S. Occupational Safety and Health Administration (OSHA).

The long-awaited standard could reduce the incidence of the most common workplace injury in hospitals by prompting the purchase of lifting devices or changes in work practices. In 1996, according to the U.S. Bureau of Labor Statistics in Washington, DC, 44,813 hospital workers suffered a lifting-related injury that required days off from work, usually from patient handling.

While OSHA estimates that the ergonomics standard will reduce work-related musculoskeletal disorders (MSDs) by at least 26%, the annual cost to the hospital industry alone will be $740 million, or $735 per worker. Ergonomics experts say the costs will pay off in the long term. Some hospitals have seen far greater benefits from ergonomics programs, with overall reductions in injuries of 48% to 83%.1

"I’ve worked with some hospitals in the past and have seen some dramatic savings, some big decreases in occupational injury rates, lost work days, and workers’ compensation dollars," says Guy Fragala, PhD, PE, CSP, director, environmental health and safety, at the University of Massachusetts Medical Center in Worcester and a leading ergonomics expert.

But while hospital employee health professionals generally supported the move toward ergonomics programs, they expressed concern about the costly new burden the standard places on hospitals and other employers. The standard requires employers to provide 90% of pay and 100% of benefits for employees who take time off work to recover from injuries. Just one injury triggers a review of MSD hazards.

And hospital employee health professionals note that the employee need only report that an injury was work-related to gain the benefits provided by the standard. The work activities of the job must be "reasonably likely to cause or contribute" to the type of MSD reported, and the activities must be a "core element" or "make up a significant amount" of the employee’s work.

An employer who asserts that the injury occurred outside work could face an OSHA complaint. An OSHA inspector would make a final determination.

"In terms of proof of this, the employee wouldn’t have to have overwhelming proof," acknowledges Gary Orr, PE, CPE, an ergonomist with OSHA who was involved in drafting the standard. "They just need to say, I believe this is a work-related problem.’"

Hospitals move toward ergonomics

In general, ergonomics — fitting the task to the worker — isn’t a hard sell in the hospital setting. Lifting causes more workplace injuries in hospitals than any other hazard, according to the Bureau of Labor Statistics. With average medical costs of $3,080 per MSD, as estimated by OSHA, those injuries cost hospitals about $138 million a year. With lost work, lower productivity, disability payments, and workers’ compensation premiums, hospitals pay out many millions more.

In the seven years since OSHA began working on an ergonomics standard, many hospitals have adopted systems to reduce the risk of lifting and moving incapacitated patients. In fact, the proposed OSHA standard rewards hospitals that have set up ergonomics programs — even in this year before the draft becomes final — by "grandfathering" them. (For more information on one new "no-lift" program, see related article, p. 15.)

Employers to meet basic obligations’

"We’ve laid out some basic obligations. If you’re doing those, we’re not going to make you do anything else in the proposal," says Orr. "You have an effective program. In our minds, you’ve met all the obligations in the proposal." (See related story on OSHA’s user-friendly approach, p. 17.)

Workers’ compensation costs also have produced financial incentives, such as that offered by the Workers Compensation Trust of the Connecticut Hospital Association in Wallingford. "If [health care facilities] can achieve a 30% reduction in patient-handling injuries, we’ll give them a 5% premium reduction credit immediately to help pay for lifts," says Jack LaDue, ARM, director of loss control for the trust.

Eventually, the lower injury rates lead directly to lower costs, as premiums and other costs decline, LaDue says. In some cases, the payback period is less than two years. "If you invest $50,000 to buy equipment, you may save more than $50,000 every year for a large number of years," agrees Arun Garg, PhD, professor and director of the ergonomics laboratory in the department of industrial and manufacturing engineering at the University of Wisconsin-Milwaukee. "The economic benefits are there."

OSHA estimates that ergonomics also increases productivity because the work design better accommodates employees’ needs.

Not surprisingly, unions representing health care workers hailed OSHA’s action.

"Ergonomics interventions do make a difference," says Bill Borwegen, MPH, occupational health and safety director of the Service Employees International Union in Washington, DC, which represents some 650,000 health care workers. "They save backs and they save dollars."

Yet some supporters of ergonomics still have concerns about specific provisions of the proposed OSHA standard.

One hot button is the "work restriction protection," which specifies the pay and benefits for sidelined employees. OSHA estimates that this provision alone would cost the hospital industry $140 million.

To Charlene M. Gliniecki, RN, MS, COHN-S, director of employee health and safety at El Camino Hospital, Mountainview, CA, the provision creates a potential inequity for workers who have experienced other injuries but aren’t provided with the same guarantee.

"I believe it is not in our interest — of the employees or the organization — to treat this condition differently from other conditions," she says. "This is a benefits issue, not a health and safety issue."

Lack of pay could hinder reporting

OSHA was concerned about potential disincentives to reporting injuries, particularly because the implementation of an ergonomics program is tied to the employee reports, says Orr.

"If the employer’s response was, If you have a back problem you have to go home and rest, and by the way, you’re not going to get paid for that,’ we thought that was a huge barrier to reporting," he says. "If the employee can stay at work and do some restricted work, they should get 100% of pay and benefits. If they have to go home, they should retain 90% of pay and 100% of benefits for as long as six months."

In another element of the standard that concerns some hospital employee health practitioners, the "OSHA-recordable MSD" initiates a sequence of steps. "[The proposed standard] doesn’t talk about a diagnosed disorder. It talks about a reported disorder," says Gliniecki. "If I say I have tingling in my toes and I think it’s caused by my chair, instead of my gardening hobby," that would trigger implementation of an ergonomics program. (For highlights of the OSHA proposal, see p. 18.)

In some cases, employers could respond to a single injury with a "quick fix" — corrective action and follow-up without the same training and program evaluation requirements.

"For example, [suppose hospital employee health practitioners investigating a back injury] find 100-pound sacks of sugar are starting to arrive in the dietary area," explains Orr. "We’ve never had that before. We’re going to go back to 25-pound bags. It’s instantly clear what the problem is, what the fix is, the employer puts that in place and it’s done."

However, Garg notes that the standard requires some response to any single MSD, including an analysis of the job and a remedy.

"Most of us will agree that no matter how safe your job is, still you’re going to have some injuries," he says. "Expecting that you have a safe workplace and you’re going to have absolutely no injuries is [unrealistic. That would be] very, very rare.

"A hospital or a nursing home may do the best they can within reasonable means. They will have injuries," says Garg. "Any time they have injuries, they have to go through this whole process."

Political opposition that delayed the ergonom ics proposal since it was first drafted in a different form in 1995 is unlikely to derail OSHA’s plans to release a final version by the end of 2000. President Clinton vowed to veto any legislation that would delay or restrict OSHA’s ergonomics standard.

However, during OSHA’s comment period, which ends Feb. 1, 2000, and at hearings to be held this spring, health care organizations will be among those urging changes.

OSHA urged to wait for study

In written comments, the Association of Occu pational Health Professionals in Healthcare in Reston, VA, commended OSHA for promoting ergonomics as a way to improve the work environment. But the association urged OSHA to wait for a second National Academy of Sciences study to determine a scientific basis for the definition of work-related MSDs.

"It’s imperative to establish the work relatedness of the musculoskeletal disorder and for an accurate medical diagnosis to be made by a qualified medical provider in order for the employee to receive appropriate treatment," the association said.

The work restriction protection could actually act as a disincentive for employees to return to work, even when a modified duty program could contribute to the employees’ rehabilitation, the association said.

Some criticisms were more semantic in nature. OSHA should refer to "at-risk jobs," rather than "problem jobs," the association suggested. And the list of examples of jobs with MSDs related to manual handling should include "patient handlers."

"They talk about targeting health care facilities, yet they don’t have [the category] identified on their list," says Mary Ann Gruden, MSN, CRNP, NP-C, COHN-S/CM, the association’s executive president and employee health nurse practitioner at Sewickley (PA) Valley Hospital. "It then also gives people who are in our position a little more clout to say we really need to look at the ergo nomics of our employees."


1. Fragala G, Santamaria D. Heavy duties? On-the-job back injuries are a bigger — and costlier — pain than you think. Health Facilities Management 1997; 10:22-27.