Are you ready? Workplace rules have changed for employers
OSHA sets forth new ergonomics program rules
Ergonomics is the name of the game, according to a new set of workplace rules that the Clinton administration has introduced. When the rules go into effect sometime this spring, employers whose employees engage in some form of either production and manufacturing or manual handling — which includes health care workers — will be required to devise basic ergonomics programs. Even if only a few employees develop work-related musculoskeletal (MSD) injuries, employers will need to adopt a full-scale ergonomics program. (See box, p. 14.)
A bit of background
The White House’s move, timed to occur when Congress had ad-journed, has more than its share of detractors. In fact, the concept of a broad-based ergonomics program has been at the forefront of a lengthy and heated debate.
In an attempt to forestall the implementation of a workplace ergonomics program, opponents in the House of Representatives passed legislation to delay the rules pending further investigation. However, by the time Congress adjourned in November, the Senate had still not acted and the Labor Department, through the Occupational Safety and Health Administration (OSHA), was free to put the rules into effect.
Among the most fervent opponents are those in the small business community who claim that such a program is largely unnecessary and will cost employers more than it saves them. Opponents estimate costs to employers could easily reach — and even surpass — $18 billion annually. OSHA, commissioned to draft the workplace rules, has estimated that in the first year, employers will spend about $3.5 billion on various fixes and changes to roughly 4.5 billion jobs. The savings, claims OSHA, will be in the neighborhood of $9 billion each year. (See chart, above.) That’s about $22,500 of direct costs for each MSD that is prevented. Currently, MSDs cost between $15 billion and $20 billion in workers’ compensation costs, with total costs running as high as $60 billion annually.
How much will amount in savings if this plan is implemented remains to be seen. "This [work place rules] centers around a larger issue than just adapting the environment," says Greg Solecki, vice president of Henry Ford Home Health in Detroit.
"Assuming there’s a corollary to all this, aside from intrinsic desire to do right by people, I’m also interested in the motive behind this push to reduce [workers’] compensation. There are possibly other motives at play there. I can’t help but wonder if we’re not fooling ourselves into thinking we’ll see a great savings when in reality we’ll end up spending even more money to be ergonomically responsive to the rules," he says.
"It’s not that I disagree with the intent and philosophy. It’s anchored in some very altruistic principles, and we want to do right by American workers, but I, from time to time, have to question the government’s approach of how it comes to the aid of the worker and at what cost? It’s a philosophical question that we must address," he concludes.
The quick fix
In response to the small business community’s fears, the administration has put into place some measures that it hopes will ease the perceived burden on small businesses. One such relief comes in the form of the Quick Fix, which can be taken with jobs whose problems can be fixed within 90 days and whose benefits can be checked at the end of the next 30 days.
The Quick Fix calls for job-specific, rather than companywide, ergonomics programs. "People in our business are traveling to patients’ homes where they’re simply not able to completely adjust that environment to meet their own physical needs" Solecki says.
"Even in our brick-and-mortar environment, there are so many different types and sizes and weights of people that finding something that fits everyone would be very difficult. The U.S. Chamber of Commerce has said the rules seem vague so I’m hoping there will be attempts to improve the behavioral definitions so that we don’t have to guess as to whether we’re in compliance," he says.
In an attempt to grant employers some degree of leeway in how they handle the new workplace regulations, OSHA has created a variety of options in addition to the Quick Fix. A grandfather clause, for example, allows companies with ergonomics programs already in place to continue them so long as they meet the standards for a basic program. Other ways of taking some of the onus off the employers are:
• allowing them to limit their ergonomics program efforts to a particular employee if it can be shown that other performing the same job do not share the same degree of risk of developing a MSD;
• using an incremental abatement process, whereby one control is tried to see if it has any effect on reducing the MSD hazard and then others are added one by one if needed;
• allowing employers to discontinue major parts of their ergonomics program if no MSDs are reported in a problem job within three years after it is fixed;
• allowing employers to opt out of using records if they have fewer than 10 employees;
• recognizing to be in compliance, an employer need not necessarily have eliminated all MSDs but rather have a good system to quickly respond to problems;
• Allowing employers to phase in compliance over three years.
As a business sector heavily involved in many of the tasks that can cause carpal tunnel (data entry, record keeping) and MSDs (lifting and moving patients and equipment), home health agencies have a vested interest in how OSHA’s proposed standards play out. This is especially important if agencies consider the preponderance of women in the industry and the high incidence of MSDs occurring in women.
According to an OSHA handbook, almost 230,000 women miss work each year as a result of work-related MSDs — not because they are more vulnerable physically but simply because of the work they perform. Many women, for instance, work in jobs requiring heavy lifting (lifting nursing home patients), highly repetitive motion (using a keyboard), awkward postures (sewing clothing), and other physical stresses.
In spite of the potential costs upfront, Linda Rashba, MS, RN, BSN, administrator of St. Francis Home Care Services in Poughkeepsie, NY, says it will be a good idea if it prevents injuries. "If that’s the case, I’m all for it." Rashba adds that while there will be some initial costs involved, the long-run savings will far outweigh them. Her agency may be spared much of that initial outlay because it already has an ergonomics program in place.
"Ergonomics consultation services are already provided," she says, "and we had a presentation at the hospital to help us understand the benefits. We now have a mandatory back safety program here, and we have begun implementing ergonomics changes for our administrative staff." Already, she says, they have replaced the support staff’s chairs with ergonomically engineered ones and are using wrist pads for the keyboards and similar devices.
Don’t neglect body mechanics
Solecki also places a premium on proper body mechanics: "Teaching people how to sit and stretch properly, and even how to take a break and what exercises to do is very important," he says. "I think it’s important to note that ergonomics correctness has as much to do with individual behavior as the setting in which the employee is situated.
"The interesting thing with all of this is how we will deal with work-set rules with respect to the community worker. Even so, I don’t see us a behaving any differently than we have in the past in terms of teaching proper body movement and what you should and should not do. We might just build more classes into our monthly inservice routine."
While inservice offerings may solve the problem of how to educate employees, it doesn’t begin to address the subject of the problems associated with high turnover. As Solecki points out, the home health care industry is faced with a high turnover — not just of health care practitioners but of office personnel, as well.
"If every worker who has an ergonomics injury diagnosed by a doctor is entitled to have the work environment fixed to relieve the cause of that injury, . . . what I keep thinking is that with the turnover in home health care this [adjusting the work environment], too, will become a repetitive exercise of its own," he says.
Although Miami-based Healthsouth Home Health Services doesn’t have a formal ergonomics program in place, Linda von Cannon, MHM, performance improvement/education/ research coordinator for the agency says that the impact of OSHA’s ergonomics program "will be extremely positive because we’re talking about prevention. I’m all for it."
She says employers just aren’t taking as good care of their employees as they did in the past. "From my experience, when you’re dealing with executives, they don’t want to shell out the initial costs but then are quick to cry wolf when something happens. Administrators of any health care organization need to look beyond the one-year budget and do some futuristic planning."
• Linda Rashba, MS, RN, BSN, Administrator, St. Francis Home Care Services, 366 Violet Ave., Poughkeepsie, NY 12601-1034. Telephone: (914) 485-4888.
• Greg Solecki, Vice President, Henry Ford Home Health, 1 Ford Place, 4C, Detroit MI 48202. Telephone: (313) 874-6500.
• Linda von Cannon, MHM, Performance Improvement/ Education/Research Coordinator, Healthsouth Home Health Services, 7000 S.W. 62nd Ave., Miami, FL 33143-4721. Telephone: (305) 669-4434.
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