How Managers Can Reduce Cumulative Trauma
The Manager/Worker Relationship
There are a number of ergonomic issues that relate specifically to management. Managers have the opportunity to promote conditions that have a lower potential to cause injury, and to identify early signs that someone might be having a problem - then help prevent it from becoming serious.
Much of the following is supported by research, some of it is just plain common sense.
The quality of the relationship between worker and manager has a great influence on the potential for cumulative trauma injury. Ergonomics researchers doing a study at the San Francisco Chronicle found that with good ergonomics but a poor supervisory relationship, symptoms were more severe. In other words, a poor supervisory relationship - in essence - canceled the beneficial qualities of an ergonomically correct workstation.
A very real factor that increases risk is a workers' perception of a managers' attitude, often different from what they're actually thinking. The manager really does set the overall tone, but it takes a little extra effort to get across to people that they shouldn't overwork themselves, that in fact they should pace themselves and not compromise the group by risking their ability to contribute.
It's not easy being a middle manager - trying to balance the needs of the people who work for you against the expectations of upper managers.
When we're dealing with an issue as delicate as work-related injury, people tend to be afraid to report problems for fear they won't get a supportive response. It's an unfortunate fact that in many cases that's exactly what happens. The result is that the worker aggravates their early symptoms, works even harder trying to prove themselves, and in the end everyone loses.
A report from the Rochester Medical Center on what they call "Workstyle" says, "Many patients reported that they continued to work with pain for months because of their keen interest in keeping their job, need to achieve at work, perception of the important contribution of their work to the organization, or a strong work ethic." In other words, they're concerned the group either can't get along without them, or that their need to reduce their own load - or even go off on disability - would add stress to their coworkers.
Very few people view Cumulative Trauma as a chance to malinger. People generally want to work, though obviously there are exceptions. But, since this is a problem of over-use, it follows that the workers who are at greatest risk are the ones who work the hardest. These injuries are costing our workforce its most valued people. In the Rochester study they also found that the following factors were associated with work-related musculoskeletal disorders. They include uneven workloads, lack of decision making opportunities, perception that management didn't value the importance of ergonomics, job future ambiguity, lack of necessary skills, deadline pressure, and fear of being replaced by computers.
Ways to Reduce Injury for Workers
1. Promote Effective Time Management
Normally you might not think of time management as a health and safety issue, but remember that stress can have very real negative effects on the body. There's a lot of opportunity to reduce stress through time management.
Ask yourself some of these questions:
- How common is it for deadlines to pile up on your group?
- Does everyone generally have a sense of where they are in the process and a grasp of how much is left to be done?
- Are their roles well defined?
- Do they have a sense of progress, or do they feel they're just plugging away as it comes? Do they have the opportunity to offer input into the process, to contribute to its continuing refinement?
Sometimes mistakes are made or information missed because the system of work isn't clear or has holes that information might fall through. Someone may be required to redo a task simply because a needed piece of information wasn't available or in a clearly defined location. People don't mind working hard on a tight deadline in an efficient system. It's when the crunch seems to be due to inefficiency that people get stressed and resentful. In work that involves repetitive motion such as computing, this increases the risk of injury.
So an efficient system of managing the work process is related to the protection of workers by reducing stress and therefore the muscular tension, early fatigue, hormonal and immune system changes associated with risk of tissue damage over the long run.
2. Improve Job Design
Since the major cause of injury is uninterrupted computer work, the goal should be to break up computer sessions into portions separated by tasks that don't involve repetitive motions or extensive cumulative postures. A study from the University of Massachusetts says, "The most consistent evidence for work-related injury involved the intensity of cumulative exposure to keyboard use." Certainly this is partly a matter of individual time management, but can be promoted to a considerable degree by the design of the job itself.
You might consider looking at each job, breaking it down by actual tasks - keyboard work, writing by hand, talking on the phone, using books or binders, stapling, meetings, reading, and so on. Try to get a sense of what portion of the workday is spent doing each task and then look for ways to spread them out more evenly, particularly tasks which involve repetitive motion.
You want to be careful of over-specializing jobs. In fact, it's become a feature of modern work that jobs are getting more specialized, and that's exactly part of the problem. By doing some cross-training you not only spare people unnecessary injury but the group in general becomes more flexible. People enjoy their jobs more when there's variety.
Be certain, of course, that you're not rotating people between two equally repetitive tasks.
3. Encourage Micro-Breaks
Often a worker is afraid to even stop and close their eyes or take a deep breath for fear they will be seen as unproductive. Yet making a habit of this several times an hour - particularly during significant computing sessions - has been shown to increase productivity at the same time it reduces risk of injury.
Micro-breaks truly are a very important element of any prevention strategy. Workers must know that they're welcome to practice this habit, that it's sanctioned by management.
At the least, they are a way of delaying the fatigue point. Again, taking these many moments throughout the day to simply breathe, rest the eyes, stand up for a moment, and so on, allows the body to continually replenish itself and maintain a more relaxed state, but it's amazing how rarely people do these things as they work. Particularly in the computer-based office, people are tiring themselves unnecessarily by not moving around enough and gluing their eyes to the screen. Research by the well-known ergonomist Ettienne Grandjean has shown that sanctioned, small micro-breaks in fact increases productivity. Grandjean found that breaks divide into four types:
- Pauses in the nature of the work - such as waiting for the machine
- Prescribed pauses - defined by management i.e. snacks, lunch
- Spontaneous pauses - the brief pauses we naturally take. These increase when we become fatigued.
- Disguised pauses - doing an easier, more routine task in order to relax from the main job
His research concluded that, "Introducing rest pauses (micro-breaks) actually speeds up the work, leading to fewer spontaneous and disguised pauses."
4. Provide Training
An unfortunate feature of technology in the workplace is that many people are not getting properly trained in its use, or, even worse, are simply placed over their heads with tasks they're not prepared to perform or with software more complex than they're able to grasp.
There are two problems with this. The first and most obvious is the stress that results as people struggle trying to find a certain command or get just plain lost in the program.
The next problem is that they waste hand movement, either doing work over because of mistakes, or by not using automated features in a program, such as style sheets or macros. It's very common that people do things the long way around, wasting time as well as performing unnecessary repetitive motion of the hands.
5. Manage High Risk Conditions
There are certain times when the risk of cumulative trauma is higher than normal. These are situations that come up in our work and can't be avoided. At these times you want to pay particular attention to safety.
Studies show that job workstyles are established within the first two weeks of taking a new job, so you want to watch with extra care when you have a new employee and support their establishing safe patterns.
Installing new equipment or technology is a high stress time. We have a lot to learn at those times, and it takes a while to reach a new comfort level. We also find bugs or other problems and spend a lot of time on the telephone to customer support lines.
Inevitable work pileups and deadline crunches are obvious times of stress. Times of stress in personal life - moving, divorce, family illness, etc.
Other workers away from office - vacations, pregnancy, disability, etc. and others have to take up the extra load.
6. Support Safe Work Habits
One way to support your staff is with gentle reminders when you see them practicing some of the more risky work habits. Watch out for keyboard habits such as extending the fingers while typing or hitting the keys too hard. Notice when someone is craning their neck, leaning into the screen as a typical pattern in their posture. If they are slumping in the chair, it may be because they are fatigued and should take a break. Get people sitting back in their chairs! Encourage people to drink water. These are all difficult behavioral patterns to change, yet very typical of computer users. Obviously without making a pest of yourself, when you see someone doing these as a matter of habit, you can help them change the habit with an occasional, gentle reminder.
7. Provide Proper Space Planning
The layout of the general office has the potential to contribute to our overall program of safety. While the individual workstation certainly has to be the prime focus, there are a few helpful points to have in mind for the overall scheme.
People need the chance to rest their eyes by looking to a distance of 25 feet or more, yet often the office plan doesn't allow someone to look down the hallway much less out a window. This is why many modular office system designs include transparent panels to give people the option of looking to a distance.
The layout of individual stations also often mandates the position of the computer. A corner layout is the most common example, and if the window is directly behind or at an angle to the screen then the design has, in effect, forced the added cost of glare screens on the company because there's no way to achieve a non-glare relationship to the window.
For people who do a great deal of printing, they certainly benefit from having a printer at their desk, but this also has the effect of keeping them in the same place even longer. Others in the office can actually benefit more by being made to move around by walking to the printer. Think of radiating zones emanating from the printer in which those who use it the most get the closest location.
8. Reduce Noise
People have varying abilities to shut out surroundingnoise. Some bring radios or walkmen, while others seem to be able to concentrate in a war zone! So first you want to gauge individuals by their distractibility, so to speak. Make an effort for them to be free of undue distraction. Notice where public address speakers are in the ceiling, for instance. Doors to conference rooms and elevators are areas to watch out for because people gather there increasing the noise factor. These are just not good places to position someone who has to concentrate on creative tasks like engineering, accounting, or writing for example.
You might also do a survey of noise sources such as printers, computers or hard drives which can be loud enough to distract. Sometimes these items can be located under desks - there are lots of hanger type products available these days. Where equipment must be out and available you can place acoustic materials like plants, tapestries, or specially designed panels nearby to absorb sound.
9. Watch for Symptoms
Most workers don't yet understand how important it is to respond to early symptoms. Often they're afraid of being tagged as a complainer, or simply don't think the pain is serious enough to deserve attention. Because disability is usually the result of waiting too long, you have a great deal to contribute as managers by promoting early reporting, as well as keeping your eye open for early symptoms.
There are many signs you can watch for of early appearance of symptoms.
- Shaking out the hands
- Rubbing the fingers, wrists, or elbows
- "Rolling" the shoulders or head
- Slumping posture, especially toward the end of the day
- Bottles of aspirin or other pain killers on the desk
- The blank stare
- Uncharacteristic changes in productivity or quality of work.
This last point is very important. When a person becomes burdened by the pain and the fear of what it might mean, it can affect their work and their attitude. If someone suddenly starts making mistakes or becomes difficult to work with, there's usually a reason, and to become critical of them or conclude they have "lost their touch" only serves to isolate them and miss what could be a problem, and a chance to help them reattain the quality of work and relationship they had before their injury.
Perhaps in a staff meeting or a distributed organization policy, you could promote the attitude that less severe though persistent symptoms are worth reporting, that they don't mean there's a serious problem, but that you want to make sure that there might not be some continuing source of undue strain in their work. It's your opportunity to determine if they should get treatment or could benefit from workstation adjustments which could simply remove the problem before it has the chance to become serious. Certainly this is a delicate issue. You don't want to risk generating undue concern, or distract from the work. The word "persistent" is the key. When pain is increased by work and carries over each day, or if it's waking someone up at night, early response pays off for everyone in the long run.
What to Do After a Worker is Injured
When someone reaches a stage where they have an injury that requires treatment, your support can help them recover more effectively and get back on the job. That in the end is what everybody wants - you and the worker.
During the recovery process, any additional stress carried by the individual is only going to serve to slow the recovery process. Stress interferes with the physiological processes involved in healing.
Often, someone usually needs to go to therapy, possibly twice or more per week. Most people try to do this early in the morning, during lunch, or at the end of the day to have the least impact on their jobs, and try to be especially productive to make up for it. They need to feel free of pressure that their need to be away from the office is not viewed unfavorably.
If someone has to take a period of disability off, then it's important that you stay in touch, that you call once in a while to see how they are. We are, after all, human, and work relationships are still connections between people who want to feel valued and cared for. To go off work and never hear from anyone only adds to the isolating nature of the experience. Check in, and help the process by letting the person know there's concern for their well-being. Better yet, call to ask a question about work, and let them see that they're not so easily done without. The notion that someone needs to be left unbothered while they recover is not the case. Quite the opposite, in fact. To go from full-time work to nothing is a shock to the system, and it's a relief to still feel needed.
These injuries - once they've become "permanently partial" or an "extended temporary" disability fall under the ADA, and you become responsible for "reasonable accommodation." It means that if someone can still perform the job with adaptive devices - like a different keyboard or a voice dictation system - then the ADA requires you to supply it. Of course, the "reasonable" part limits your obligations, but the point is really that this is just another good reason not to let it happen in the first place.
As a supervisor you have a lot of involvement in this issue. By doing what you can to promote safety you at the same time enhance productivity and improve working relationships. You can make a difference in the unnecessary spread of these truly preventable injuries.
Additional ergonomics articles from Onsight
Initial Thoughts on Cumulative Trauma
Why is Cumulative Trauma Happening Now?
Ergonomics - A Brief Definition
An Ergonomics Overview
Breaking Down the Myths
The Ergonomics of Sitting
Where Should the Keyboard Be?
Using Palm Support
A Warning About Wrist Braces
Keyboard Shortcuts for Microsoft Word
An Ergonomics Reading List