How does new safety technology protect workers?

Many of us use laptops and are familiar with the long power cords from the wall to the adapter and the cord from the adapter that eventually connects to the computer.  Some of us think about the tripping hazard but we are not always as careful as we ought to be about taping down the cord.  Most power cords will break apart from the adapter block—a feature that further reduces the consequences should someone trip over the cord.  Those with MacBooks have the added engineering protection of a magnetic breakaway power cord that further reduces the tripping hazard. 

A few days ago, I was sent a picture of a product that takes the idea of a breakaway cord even further.  The “safety socket” appears to be sold under both the Stanley and Westinghouse brands.  It takes the magnetic breakaway to the wall socket with a two-part assembly. 

This sort of technology is not rocket science and it doesn’t replace proper taping of cords or other procedures but it can make a difference—if it is used.   Some of you will also be familiar with a table saw that stops and retracts instantly if it senses the blade is touching flesh .  This technology does not replace the need for saws to have guards.  Proper adherence to safe work procedures does effectively reduce the risk of injury.  So, what does a $20 breakaway socket or a $70 brake cartridge (and the marginal extra cost at purchase) in a table saw add to the safety equation?

To answer this question, you need to remember that most work activities carry risks.  Safety is about reducing or eliminating the active risks and effectively managing the residual risks.  We manage the residual risks by putting in place barriers, safeguards and defenses.  Knowledge is one of the best defenses so training is one way we can reduce risk.  Safe work procedures, personal protective equipment, and effective supervision further reduce the risk of the inherent danger of a cut from a saw blade or a fall injury because of a trip over a power cord. 

James Reason, an expert in human factors that lead to injury, speaks in terms of barriers and holes that protect workers from injury.  In his "Swiss cheese" model, the inherent danger in a work situation can only harm a worker if there is a hole in each of the defenses, barriers, or safeguards, AND these holes align.   

In my own view, I think of these holes as active or latent defects in the barriers, safeguards, and defenses that protect the worker from harm.  The effect of improved supervision, better training, more complete adherence to safe work procedures is the reduction of the number and size of the defects in the barriers and safeguards that protect workers.  And that is effectively what the design solutions the breakaway power cord and the sawstop device provide.  These are examples that make the barriers and safeguards more complete, which further lessen the opportunity for the inherent risk of tripping or being cut by a spinning saw blade. 

This blog is not intended as an endorsement of these products.  I think, however, they are good illustrations of how technology and good design can contribute to safer work environments by reducing the size and number of holes in the barriers, safeguards, and defences that can protect workers from harm. 

What does the Ontario Expert Panel mean for OH&S?

A year ago, four workers died in Ontario on Christmas eve.  The tragedy triggered the government to set up an Expert Panel on Occupational Health and Safety.  Chaired by the well-respected Tony Dean and supported by representatives from Labour and Employers as well as other academics (including H. Allen Hunt who recently completed a reappraisal of WorkSafeBC’s system), the Panel’s report was released December 16, 2010.  You can review the entire report online or download it from the following link:   http://www.labour.gov.on.ca/english/hs/eap/report/index.php

As widely anticipated, the report recommends bringing all workplace prevention and enforcement activities under one Chief Prevention Executive in the Ministry of Labour.  This effectively means the Workplace Safety and Insurance Board (WSIB) will transfer its prevention programs and services to the new body within the Ministry. 

There are forty-six recommendations in all.  The final one lists the recommendations the Panel believes should be acted upon first:

1.       A new prevention organization should be created within the Ministry of Labour. The new organization would be headed by a Chief Prevention Executive, and would feature a multi stakeholder Prevention Council; each would have specific powers explicitly defined in the Occupational Health and Safety Act. (Recommendation 1)

2.       The Ministry of Labour should work with the new prevention organization to create a health and safety poster that explains the key rights and responsibilities of the workplace parties, including how to obtain additional health and safety information and how to contact a Ministry of Labour inspector. It should be mandatory to post this in the workplace. (Recommendation 10)

3.       The Ministry of Labour should create a mandatory requirement for training of Health and Safety Representatives. (Recommendation 13)

4.       The Ministry of Labour should require mandatory health and safety awareness training for all workers. (Recommendation 14)

5.       The Ministry of Labour should require mandatory health and safety awareness training for all supervisors who are responsible for frontline workers. (Recommendation 15)

6.       The Ministry of Labour and new prevention organization should develop mandatory entry-level training for construction workers as a priority and consult with stakeholders to determine other sectors that should be subject to mandatory training for workers. (Recommendation 16)

7.       The Ministry of Labour and new prevention organization should develop mandatory fall protection training for workers working at heights as a priority and consult with stakeholders to determine additional high-hazard activities that should be subject to mandatory training for workers. (Recommendation 17)

8.       The Minister of Labour should appoint a committee under Section 21 of the Occupational Health and Safety Act to provide advice on matters related to the occupational health and safety of vulnerable workers. (Recommendation 29)

9.       The Ministry of Labour and the Ontario Labour Relations Board should work together to develop a process to expedite the resolution of reprisal complaints under the Occupational Health and Safety Act. (Recommendation 33)

10.   A worker or employer involved in a reprisal complaint should have access to information and support from an independent, third-party organization, such as the Office of the Worker Adviser or Office of the Employer Adviser. 

11.   The Minister of Labour should create a small business Section 21 committee and appoint members that can represent the needs and interests of employers and workers in small businesses. (Recommendation 36)

The Panel reflected a concern over the reliability and validity of data, noting, “This is evident in fatality statistics, where WSIB and MOL figures differ because they relate to different populations of workers, due to differences in legislative coverage. Data on non-fatal lost-time injuries may be even less reliable as an indicator, due to the potential for misrepresentation of the actual incident through claims management.” 

This difference in mandate affects more than data.  It can impact priorities, policies, and strategies.  If the population insured for workers’ compensation is essentially the same population covered by the prevention mandate, common systems make sense.  Where there is a substantial difference in the workers’ compensation and prevention mandates, there are likely to be differences in what and how data are counted.  This is particularly evident in Ontario where the Occupational Safety and Health law and policy applies to virtually every workplace but WSIB covers only 70% of the employed labour force.  This is vastly different from BC where WorkSafeBC covers about 94% of the employed labour force. 

The policy implications of these top items will cause all jurisdictions to review their own structures and policies.  Fostering increased awareness of worker rights, supervisor responsibility, fall protection and small business should be on everyone’s list.  The recommendations, however, are context-specific.  What is right for Ontario may or may not have any application outside Ontario.  That said, I believe the recommendations of the Ontario expert panel will cause every OH&S focused organization to review its priorities.

Are the costs of workers’ compensation funded solely by employers?

I am not often asked, “Who pays for workers’ compensation?”  because most people think they already know the answer.  Most people think employers pay the full cost of work-related injury, illness and disease through premiums paid to a workers’ compensation insurer.  The true costs, however, are borne much more widely.

Workers pay the biggest price.  The loss of health, function, range of movement and even life itself is a huge cost that must be figured into the equation.  Families, friends, dependents, community members, and neighbours also bear the costs in terms of tangible losses in their lives.  In some provinces and states, workers also have to bear the first few days (for example, two-fifths of a week in Nova Scotia, three days in Washington State) as a waiting period.

In some jurisdictions the costs are also borne in part by the state.  For some cases, the appeal structures, prevention programs,  rate approval authorities, insurance commissioners, advocacy and ombudsman offices are often paid out of general revenues of the state or province.  Certain states fund these, in whole or in part, by direct assessments over and above the premiums charged to employers. 

In Oregon, for example, a charge of $0.028 (just under three cents) is collected from workers and employers for every hour —or part of an hour— worked, to fund cost-of-living increases to permanent disability and survivor recipients.  The workers and employers split this charge; workers generally pay this as a payroll tax or deduction and the employers match and remit the total to the state.  To augment federal funding, the state’s Occupational Health and Safety program assesses employers a straight 6.4% premium tax (2011; up from 4.6% in 2010). 

New Mexico assesses workers $2.00 and employers $2.30, per quarter, to fund the operation of the New Mexico Workers’ Compensation Administration (WCA), which regulates, adjudicates, and provides education and assistance services to the workers’ compensation system.

California recently announced its assessments for 2011 as follows:

• 
  
  WC Administration Revolving Fund Assessment/User Funding   0.014721             


• 
  
  Uninsured Employers Benefit Trust Fund Assessment                   0.004101         


• 
  
  Subsequent Injuries Benefits Trust Fund Assessment                   0.001776          


• 
  
  Occupational Safety & Health Fund                                                  0.002467            


• 
  
  Labor Enforcement & Compliance Fund                                           0.002315            


• 
  
  WC Fraud Account Assessment                                                          0.004348              

That totals 0.029728  or about 3% in assessments paid as a tax on premiums.  Self-insured employers have to pay assessments that currently total about 5.5%. 

Employers in many Australian jurisdictions are responsible for the first week or two of wage-loss benefits—a kind of employer deductible—and the first $592 of medical costs.

WorkSafeBC has no waiting periods, no employer deductibles, and no additional assessments over the published rates.  Workers still bear the cost of injury, loss of function, perhaps visible scarring or invisible pain.  Employers nominally pay the premiums but ultimately workplace injury, illness and disease are borne by all of us in the prices of goods and services we consume, the productivity of our workforce and even our standard of living.  We all bear some of the costs… All of us bear the responsibility to make work-related injury, illness, and disease unacceptable. 

Does a vision statement really mean anything in a workers’ compensation organization?

Most public and private organizations have a corporate “vision” statement.  Some people view the creation and use of a vision statement as another one of those things you are supposed to do that doesn’t really matter on a day-to-day basis.   If the vision statement is simply a perfunctory piece of prose, then it is dispensable.  On the other hand, if the vision statement is truly a shared conception of the ultimate future your organization is striving for, then a vision statement is a crucial element of your strategy. 

Working in Corporate Planning, I get to look at a lot of vision statements.  Some vision statements are famous.  Jack Welch, the former CEO of General Electric lead his organization with the following vision statement “To become the most competitive enterprise in the world by being number one or number two in every business in which we compete.”

Other vision statements are less transformational and more directive.  Hewlett Packard has the following vision statement:

"To view change in the market as an opportunity to grow; to use our profits and our ability to develop and produce innovative products, services and solutions that satisfy emerging customer needs."

Amnesty International's vision is of “a world in which every person enjoys all of the human rights enshrined in the Universal Declaration of Human Rights and other international human rights standards.”

Vision statements can certainly be inspirational and are usually aspirational—a state that is wished for involving a stretch from the present.  Workers’ compensation systems generally get their mandate from legislation but it is the leadership (usually the board of directors) that establish the organization’s  vision.  WorkSafeBC’s vision statement clearly fits the inspirational/aspirational category: 

“Workers and workplaces safe and secure from injury, illness, and disease”

It is certainly aspirational (we aren’t there yet)  and  is very descriptive of the world we are striving for.  

WorkSafe Victoria is focused on the worker:  “Victorian workers returning home safe everyday”.

WorkSafeMT "... envisions a future without injury, illness and fatality in Montana's workplaces"

If you really believe in that vision, then the programs and initiatives you design will be aligned with and contribute to that vision. (If an initiative does not align, you really have to ask “Why are we doing this?”)

These last three vision statement are very different from WorkCover Queensland’s vision “To excel in workers’ compensation insurance” and  WorkCover Western Australia’s vision “ A workers’ compensation scheme valued by all.”  When you think about these two vision statements, the programs and initiatives you might design will likely have different features and emphasis than the previous three.    

Vision statements crystallize the future state of nature your organization is working toward.  Actually getting there requires commitment, goals, objectives, strategies and programs (including projects and initiatives).  Each part of the organization has its own mission with its own plans and projects that are aimed at contributing to the overall strategy.  Aligning vision, mission,  strategy and actual operations is critical to performance. 

If you have a favourite vision statement, post it and tell us what makes it great.

Aren’t "Safety" and "the Absence of Injuries" the same thing?

In the last 30 years, I have probably been asked this question in one form or another about a hundred times. If you think the question is just playing with semantics, you might want to think again. In workers’ compensation and occupational safety and health terms, "safety" means control of recognized hazards to achieve an acceptable risk. The "absence of injury" is a pretty straightforward and seemingly concrete concept. It is supposed to mean that workers involved in a process have not been injured. It sounds objective because we can count injuries. If injuries amount to zero, one might be tempted to say the employers and workers involved in the process have been working safely. This might or might not be true.

The first problem is the definition of injury. Most of us would accept that the amputation of an arm is an injury—a reportable, recordable, countable work-related injury. Perhaps fewer would classify a slice of an index finger that requires no stitches as a reportable injury or recordable injury. As you can see, how you define injury or what you qualify as a reportable or recordable injury may change what you mean by the absence of injury and what that implies about safety.

And therein lays the second problem: even with a broad and agreed upon definition of what constitutes a work-related injury, the absence of injury or a low count of injuries may say little or nothing about safety. When a piece of plate iron drops and strikes a worker’s foot, the only difference between a broken little toe and an amputated foot may be a matter of centimetres. In order for the iron plate to injure the worker, there was likely a failure in design, work procedures, supervision and training. In most such cases, it takes a defect in each of these safeguards and an alignment of these defects that results in the worker being injured. It is in examining the injury trajectory that safety (or the lack thereof) can be determined. The truth is, most unsafe work situations do not result in injuries; an injury may provide a reason to determine the defects in the safe work procedures, design, supervision and training/education that existed before the worker was harmed.

"Safety" and "the absence of injuries" are not synonymous terms. Any well-run safety program is going to want to know about all the injuries and all the near misses but more importantly, will be focused on the leading indicators of safety (adherence to safe work procedures, identification of hazards, interactions with specific safety-oriented content between supervisors and workers, etc.). The investigation of injuries and near misses will reveal where the defects were (and maybe still are) and how they aligned to allow a hazard to reach through the safeguards and barriers to harm the worker. Fixing the active and latent defects in the barriers, defenses and safeguards will arguably increase safety.

Safety is not fall protection or Personal Protective Equipment (PPE) or any other piece of equipment or protective gear. Safety is not the absence of injury (although effective safety is intended to have that result). Safety is an attitude, a disposition, a belief, a value. Safety is maximized when the defects in the design, safe work procedures, supervision, and training/education are minimized. It is because safety and the absence of work-related injury, illness and disease are not the same thing that prevention continues to be our top priority.

How would you design a completely new workers' compensation system?

I was asked a few weeks ago how I would design a workers’ compensation system.  I’ve actually given this a lot of thought over the years and have come up with some principles that I believe would optimize a new workers’ compensation system in a society similar to the Canadian context.   

Before you even glance at the following statements, let me make one point crystal clear.  I am not advocating any existing system change to adopt any of the following items. This is just a conversation starter intended to help in a ‘green field’ exercise.   Each item in the list is in some way dependent on others so the list is intended to be applied in its entirety to a hypothetical jurisdiction. 

Remember, these are my personal opinions based on my own experiences and observations; these items are not intended to be a statement of direction for WorkSafeBC or a prescription for any other existing system. 

Let me also add that each item here could fill pages of discussion and analysis.  I would be happy to discuss any one of them. 

Finally, the list is not comprehensive.  There are lots of other items that I would add for the design of a complete system but that is beyond the scope of a personal blog.

Keeping that in mind, here are my top dozen design criteria/features for such a hypothetical new workers’ compensation system in a society similar to Canada:

1.        Prevention orientation:  This has to be at the top of the list.  Employers would be required to report all work-related injuries to the agency within three working days.

2.       Universality:  Every worker and employer should be within the scope of coverage… and all work-related injuries, illnesses and diseases should be included within scope.  This takes away workers’ rights to sue but creates a comprehensive no-fault coverage system.

3.       Integrated: Given the universality of coverage, it makes sense to combine and integrate the compensation and prevention (consultation, education, promotion and compliance enforcement) functions.  It also makes sense to have the rate-making and financial authority integrated into this model.

4.       Accessibility:  workers and employers should have instant electronic access to information about their claim or claims, be able to communicate, and transact all business with the workers’ compensation insurer without temporal, language, bureaucratic or other barriers.

5.       Actuarially based:  full funding (capitalization of costs) for injuries should be maintained by injury year (premiums should cover all incurred costs including prevention and future administration).

6.       Comprehensive:  All medical diagnostic, treatment, and rehabilitation (physical, social, psychological and vocational) should be covered.  This ensures that the costs of injuries are born by industry and not the taxpayer.  It also is consistent with the current Canada Health Act, which does not include payments made by a workers’ compensation system in the definition of an insured health service.

7.       Supporting of the worker-employer relationship:  all claims of less than 8 weeks should be paid directly to the worker by the employer (at the prescribed rate).  The employer would be reimbursed by the workers’ compensation agency dollar-for-dollar for all wage-loss benefits paid to the worker through week six of the claim.

8.       Supportive of complete claims reporting:  Experience rating would not apply to claims of less than 8 weeks duration; this creates an incentive for firms to report all injuries (employers get to recover what they spend on wage-loss benefits they paid the worker) while retaining the experience rating that most employers feel adds a fairness to the system for those with poor performance.

9.       Encouraging of early and safe Return-to-Work:  Employers will be directly responsible for wage-loss costs payable in week 7 and 8 of every claim.  Experience Rating will apply for claims of greater than 8 weeks duration.  These features provide incentives for early return to work and accommodations consistent with Disability Management procedures.

10.   Value the injury of all workers equally:  Experience rating based on duration of disability not cost.  This avoids the criticism that most experience rating systems are cost-driven and thereby devalue injuries to low wage earners.

11.    Compensate long term claims equitably:  Permanent Disability (not impairment) to be roughly comparable for workers with similar age, gender, education, industry, and occupational backgrounds relative to their counterparts without work-related injury.

12.   Credibility and independence in all classifications:  Pools of firms with similar risks should be self sustaining for the costs they incur.  Very limited possibilities for cross subsidization and re-insurance.

I repeat, these features are the general parameters and very brief rationales for a new system and are not intended to be a roadmap for reform of any particular system.  Any system is a product of its history, societal values, politics, and even geography.   The present design of any system is responsive to a particular environment.  I am not injecting these ideas into any particular reform process. 

I have conveniently left off how dispute resolution mechanisms would operate, how premium rates would be established and what one would do with exceptional cases (this is only a blog post, not a thesis).    

Perhaps you have your own ideas.  I would be interested in how you would design a system if you were starting from scratch.

What drives Duration... and what can we do about it?

Duration of disability is a complex measure within workers’ compensation systems.  Duration has natural drivers such as age (it takes longer to recover as we get older), injury type (more severe injuries take longer to recover), and even obesity (obese of workers as a group take longer to recover than non-obese workers with similar injuries) can drive duration higher.  We can’t do much about these drivers once an injury takes place. 

After an injury, there are some things we can do to speed recovery and militate against excessive duration.  We have strong disability management programs that can speed return-to-work (assuming the programs are well staffed, the staff well trained in DM principles, and stakeholders are willing to support DM efforts).  There are guidelines for expected recoveries and programs that encourage early and safe return to work (research literature shows that work is actually good as therapy and contributes rather than works against good health).  Medical science and physiotherapy have advanced dramatically over the last century and each of these can contribute to more rapid recover and return-to-work outcomes. 

External factors put pressure on duration.  In a slowing economy, durations tend to rise.  This makes sense since workers not on wage-loss benefits are likely in a position to carry some of the extra load at no direct or current cost to the payroll.   Rising and hot economies tend to contribute to shorter duration.  Workers are enticed to return to work and are more likely to be accommodated by their employers in these circumstances.  

Access to healthcare can also delay recovery.  If it takes a year to get an MRI and six months to see a surgeon, you can bet that duration statistics will rise.   

Despite these factors, it appears some general measures of duration of disability from work-related injury have remained remarkably stable over time.  In Sir William Meredith’s Final Report, Meredith muses “…it may, I think, fairly be assumed that the great bulk of the accidents for which compensation would be payable under the proposed law will incapacitate the workman for short periods—84 per cent probably for less than fourteen weeks.”

I looked at WorkSafeBC claims with an injury date in 2008 where there was at least one day away from work.  WorkSafeBC pays wage-loss benefits beginning the day following the day of injury so our way of counting may not fully match with Meredith’s assumption.  That said, his projection looks pretty good— 85.14% of time-loss claims with an injury date in 2008 had durations of less than 14 weeks. 

One factor contributing to the relative stability of duration is the common denominator of human biology and physiology.  Healing times have not really changed over the last 100 years for many conditions.  Fractures still take the same time to mend; lacerations take about the same to heal.  Yes, we have antibiotics and new technology.  These save lives.  Many victims of severe injury would not have survived in Meredith’s time. They survive today… but their recovery and return to work can take a lot longer.

I’ve also looked at duration by age category. Over the last couple of decades for which I have data, the average duration for 20-24 year olds or 35-40 year olds has barely changed.  What has changed is the demographic mix with older workers now dominating the distribution of injured workers.   This change in mix is another factor that will continue for some time to put upward pressure on duration. 

Of all the factors listed, effective disability management is the leading candidate to counter the upward pressures on duration.