As costs have risen, so has interest in prevention. Many companies have already taken steps in an effort to reduce their injury and illness rates and to reduce costs. These steps include improved safety awareness, the development of formal safety programs, better training of workers and supervisors, and ergonomic modifications of the workplace. In addition, the federal government and many state governments have introduced legislation and developed guidelines aimed at protecting workers from unnecessary harm.
One particularly interesting aspect of this problem is the growing interest in ergonomics, i.e., the science of matching the worker with the workplace. With the hiring of its first ergonomist in 1979, the Occupational Safety and Health Administration (OSHA) has focused an ever-increasing amount of attention both on the problem of WRMDs and on ergonomic solutions. For the past decade, OSHA has been working toward a series of ergonomic standards that would mandate how industry deals with the problem of WRMDs. In spite of significant opposition from the business community, on November 23, 1999, OSHA published its current version of the proposed ergonomic standards in the Federal Register. When these standards are implemented, they will have a significant impact on the American workplace, with an estimated cost to employers of $4.2 billion annually.
What are the standards, and what effect, if any, will they have on the chiropractor? OSHA's proposal focuses on jobs in industry that have a high rate of injury and ergonomic solutions that are well-understood. Somewhat scaled back from earlier versions, the recent proposal calls for changing individual jobs rather than entire workplaces.
According to the text of the proposal, a covered musculoskeletal disorder (MSD) is an OSHA recordable MSD that is directly related to the work activities of the job an employee performs. An MSD is recordable when it is diagnosed by a health care provider; when an employee reports an objective sign of the disorder; or when an employee has a symptom, medical treatment, takes days away from work, is restricted from doing work, or has a job transfer. All covered MSDs must be directly related to the physical work activities that the injured worker performs, and they must be specifically related to the physical work activities that form a core of (or significant part of) the worker's job.
If a MSD occurs that is covered, the employer must implement a full ergonomics program for that specific job, or, if the problem can be remedied in 90 days, the employer can perform a quick fix. Some suggested quick fixes include:
- adjusting the height for working surfaces;
- providing the right tool for the job;
- adding a platform;
- providing mechanical lifting equipment;
- providing ergonomic chairs or stools;
- repositioning tools or equipment;
- padding hand tools and work surfaces;
- providing foot rests; and
- changing the size of grips or knobs.
One of the more interesting aspects of the proposed standards is an item termed work restriction protection. This item is listed to provide 100% pay and benefits for light-duty work, and 90% pay with 100% benefits for time off work to recover. OSHA estimates that this will reduce costs for employers by $300 million. It would appear from this that OSHA hasn't really done its homework in this area. There is a significant body of literature which demonstrates that slower recovery and increased costs may be directly associated with degree of compensation and benefits. Simply put, the better the compensation, the less the incentive to recover.
Whatever you think of the standards, you're probably wondering what they have to do with the chiropractic profession. If you've read my column much over the past few years, or if you've heard me lecture on this topic, then you know it has long been my contention that chiropractors have a great deal to offer in the area of occupational health problems, particularly those affecting the musculoskeletal system. You may also know that I have spent a considerable amount of time working in this arena, and I expect to be a great deal busier in the near future.
The proposed OSHA standards signify, among other things, that American industry needs help. According to OSHA, more than 70% of companies with 20 or fewer employees have yet to address ergonomic issues. For obvious reasons, the situation is a bit better for larger companies (i.e., those with more than 250 employees). OSHA estimates that three-fourths of such companies have already begun implementing ergonomic changes. With so much work to be done, employers need credible, knowledgeable help, and they're willing to pay for it. I don't mean to sound mercenary, but if they're going to pay someone for advice, I'd like it to be chiropractors.
My company is gearing up! We've already begun to implement a marketing strategy designed to take advantage of the heightened awareness that discussions of the standards have created. We're incorporating the standards into our programs and marketing. We're even going to begin a series of classes designed to teach other chiropractors how to perform a practical ergonomic assessment of the workplace.
Someone once asked me: "What credentials do you have that enable you to do this type of work? You're a chiropractor." The question initially caught me off guard. After all, nobody would think to ask a medical doctor, or even a physical therapist, such a question. However, after thinking for a minute, I responded, "I'm a chiropractor. That's what gives me the credibility. Who better to teach prevention than someone who sees the injured worker after-the-fact?"
Please appreciate that I'm not saying that every chiropractor is equipped to provide legitimate advice on prevention and ergonomics to employers. Nor am I saying that I am an ergonomic specialist. I do, however, have a fair amount of common sense, and if you'll glance at the list of quick fixes mentioned earlier, common sense is often enough to rectify many problems. I n fact, my favorite definition of ergonomics is "common sense in the workplace." To be realistic, a fair amount of effort is required to obtain the information necessary to be successful in this arena. There are books to read, seminars to attend, classes to take and experience to be gained. But the chiropractor has a unique view of the world of musculoskeletal disorders. While ergonomists have a greater knowledge and understanding of anthropometrics, engineering principles and workstation design, they are not clinicians. In contrast, the clinician trained in the treatment of musculoskeletal disorders brings a unique perspective to the workplace. It's time, in my opinion, for the chiropractor to take a leadership role in this area.
These proposed OSHA standards warrant a good deal of attention and will generate a considerable amount of discussion during the next few months. Therefore, I am going to address different aspects of the standards in the next few issues of my column. If you have any questions that I can help you with, let me know. My e-mail addresses are listed at the end of this column. If you don't have an email account, get one! It's time to get connected!
By the way, you can download a copy of the standards from the OSHA website (www.osha.gov ). If you'd like a list of other websites that I have found useful, e-mail me.
Click here for previous articles by Paul Hooper, DC, MPH, MS.