Proposed ergo rule has had little impact so far
Debate over provisions clouds need for change
Hospitals have made relatively little progress on ergonomics despite the pending federal standard that would require them to address musculoskeletal disorder (MSD) hazards, ergonomics experts say.
Some leading hospitals began working on ergonomics issues long before the most recent proposed standard was released last year, in an effort to reduce injuries and the costs associated with them. But the proposed standard doesn’t seem to have prompted a new wave of interest in ergonomics, experts say.
"A lot of attention has been focused on regulatory compliance issues rather than the underlying problem," says Bradley Evanoff, MD, MPH, director of employee health at Barnes-Jewish Hospital in St. Louis.
The Occupational Safety and Health Admini-stration (OSHA) made ergonomics a priority, as top officials promise the standard will become final by the end of the year. More than 1,000 people testified during 45 days of hearings earlier this year, and another 7,000 submitted written comments. OSHA must respond to all comments before issuing its final standard.
Many comments focused on the clause providing work restriction protection, which grants employees reporting an MSD 100% pay and benefits for light duty and 90% pay and 100% benefits for time off work to recover for up to six months. Critics of the provision noted that it would treat workers with MSD injuries differently from those receiving workers’ compensation for other job-related injuries.
Gary Orr, PE, CPE, an OSHA ergonomist, says the agency is taking a close look at that provision. However, he noted that it is designed to remove a financial barrier that delays the reporting of MSDs. "We want them to come forward earlier rather than later. One of the reasons [employees] may wait is because the policy of the company may say, If you’re not 100%, you need to go home. By the way, we don’t pay for that.’
"In most cases with MSD, [employees who delay treatment] are just going to get worse and the medical treatment options become fewer and fewer. That’s why we put it in place."
Meanwhile, OSHA hoped to provide an incentive for employers to move forward even before the standard becomes final. A grandfather clause recognizes pre-existing, effective ergonomics programs.
"If you have an existing program and you have the elements — management commitment, employee participation — and you’re controlling hazards in the workplace, we want you to continue and we’re not going to hold you to every provision," says Orr.
"Basically, if you’re waiting for OSHA, the grandfather clause is an opportunity to get started early," he says. "The results not only have an impact on injuries and illnesses, but on performance and quality of work life."
Little response to grandfather clause
To qualify for the grandfather clause, hospitals "need to have the elements in place," says Orr. "They need to start looking at controlling some jobs that are the major problems. They need to show that the process they implemented resulted in controlling hazards."
While the potential impact on ergonomics in health care has been gaining more attention, the OSHA standard itself may not get a lot of the credit. "I don’t know if everyone’s really aware of the grandfathering," says Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester and a leading ergonomics expert. "I don’t think that’s having a huge amount of influence right now."
For some, the sheer numbers of back injuries provide reason enough to adopt an ergonomic approach. In 1998, 59% of the lost workday injuries of registered nurses involved strains and sprains, according to the Bureau of Labor Statistics. Overall, about 20% of lost workday injuries and illnesses in hospitals involved lifting.
"Hospitals are beginning to do something about their back injuries because they’re just costing too much," says William Charney, DOH, a consultant specializing in health care safety who is based in Camano Island, WA.
Most hospitals, however, do not yet appreciate the savings they could reap from a relatively small investment in ergonomics equipment, job analysis, and training, he says. For example, rather than just looking at workers’ comp and medical costs, hospitals need to consider lost workdays, lost productivity, pay for replacement workers, and other hidden costs. Employee health professionals can play a role in bringing to light the advantages of ergonomics, Charney says.
"They need to learn the science of cost-benefit analysis," he says. "When they do that and they show what their specific institution is really spending on these injuries, they’ll have a lot easier time getting prevention dollars."
For example, Brigham and Women’s Hospital in Boston established an ergonomics committee and is installing new beds that will enable the sickest patients to move from a lying to sitting position with a lift. The purchase came in response to employee feedback about sprains and strains, says Steven Bloom, MS, director of environmental affairs.
"Certainly when the [OSHA] standard comes out, we’ll read it closely and comply with the needs of the standard," he says. "But as far as meeting our own staff needs, that’s a very high priority for us."
The University of Massachusetts Medical Center has long been involved in ergonomics efforts. But Fragala is still trying to expand the commitment and focus on the hazards of patient handling.
"We’re continuing to gain ground as far as interest and awareness, but we’re by no means done with the efforts," he says.
Fragala credits OSHA’s ergonomics standard with raising the profile of this issue. "We need to get it firmly established in the health care industry that this is a high priority problem that needs to be addressed," he says.
| Causes of Lost Workday Injury and Illness in Hospitals, 1998 |
|
| Contact with object | 11,287 |
| Falls | 11,996 |
| Lifting | 18,007 |
| Other overexertion | 16,283 |
| Repetitive motion | 2,251 |
| Exposure to harmful substance or environment | 4,503 |
| Transportation accidents | 1,234 |
| Fires and explosions | 26 |
| Assaults and violent acts | 4,090 |
| Other | 8,285 |
| Total injuries | 80,682 |
| Source: Bureau of Labor Statistics, Washington, DC. | |
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