Is bullying or harassment just a school or workplace health and safety concern?

Edit ​Recent media coverage on bullying has focused on tragic cases like that of Amanda Todd, the British Columbia teen who ended her life after years of bullying. But the analysis and discussions over what we can do to prevent bullying has not been extended beyond the school system to a broader community: the workplace. A simple Google search shows that news stories on bullying in the workplace amount to less than a tenth of the volume of stories on bullying in schools. The relative silence on the issue of workplace bullying is somewhat surprising. Does the incidence of bullying dramatically decline after graduation? Maybe. However, there may be other explanations worth exploring.   One possibility relates to a societal tolerance or resignation that there is nothing that can be done about about workplace bullying. In 2008, WorkSafeBC did a survey on workplace bullying. While more than 54 percent of the 800 British Columbians surveyed agreed with the statement: “workplace bullying is a serious problem in British Columbia today," a much higher percentage (62 percent overall, 66 percent of women) said: "workplace bullying is an inevitable part of life in the workplace."   Another explanation may be the words we use to discuss this issue. A colleague and I looked at claims for workplace stress not involving a single traumatic event. What we found was a tendency for women to use the term “bullying” to describe behaviours male victims might describe as “harassment.” The legal term may be “vexatious conduct”; HR records might speak of “personality conflicts”; a colloquial definition might include “hazing” for acts that are more physical or “razzing” for more verbal ones. Perhaps the diversity of language is masking a problem that is much larger than media reports suggest.   Whatever words we use, the issue of bullying and harassment is not confined to the K-12 education system. Workers’ compensation systems are increasingly recognizing workplace injuries arising from bullying/harassment. This is not to say bullying is on the increase; it's an affirmation that workplace bullying and harassment can have serious consequences for the victim. It's also a wakeup call for all workplace participants to pay attention and stop thinking about bullying as something that stops when you reach 18 years of age.   The issue of workplace bullying and associated disability due to stress or mental injury comes up more often than any issue of traumatic injury or specific occupational disease from conference audiences I present to and from participants in courses I facilitate. Those who specialize in DM and RTW for employers almost universally report situations within their experience that meet the definition of bullying. They also report the challenges they face in accommodation and RTW in these cases. Having a policy that says, “thou shalt not bully” is not enough. A growing number of companies now carry out risk assessments, craft and enforce corporate policies against harassment, and provide training on the issue. Whether or not such actions are mandated by law or policy, they're the right things to do.   Acts of bullying or harassment extend beyond school and work environments. Playgrounds, sports venues, and even streetscapes are locations where the victimization of individuals occurs. Eliminating bullying and harassment in school settings and the workplace may not solve the greater societal issue but it is a step toward changing the perception that bullying is inevitable.

What is the “right” premium rate for workers’ compensation?

Most people would agree that workers’ compensation is an important form of social insurance. How should it be administered, what benefits should be offered, and how permanent partial and total disability ought to be calculated are all matters of debate. Every jurisdiction makes up its own rules on workers’ compensation through public policy, legislation, and practice. The unique combination of these public policy positions and how they are administered set the stage but work-related injuries are what drive the financial cost of workers’ compensation in each jurisdiction. And costs are mainly met by premiums paid (almost) exclusively by employers.

Premium levels and the cost of workers’ compensation have been in the news a lot lately. The Oregon Workers’ Compensation Premium Rate Ranking study and the National Academy of Social Insurance’s publication on Workers’ Compensation Benefits, Coverage and Costs are perhaps the highest profile studies to hit the headlines, but there are many jurisdictions where workers’ compensation premium levels have been the focus of attention. Morley Gunderson’s report, The Impact of High Worker's Compensation Premiums on Newfoundland & Labrador, WorkComp Strategies’ Consultation Services on Workers’ Compensation Laws, Processes, and Costs in Tennessee, and the recently announced external review by Paul Petrie on Workers’ Compensation Process for Setting Employer Rate in Manitoba are but a few of the many examples recently garnering attention.

At the basis of all this attention is the fundamental question: “What is the right premium for workers’ compensation?”

As with all insurance, premiums must ultimately cover benefits and administration costs. There are other costs in workers’ compensation that may be included in premiums (reserve funding, second injury funds, uninsured employer protection, insurance guarantee funds, prevention, oversight, appeal bodies, and more) although many jurisdictions pay for these through additional assessments. Premiums may also be adjusted up or down to cover changes in funded status, investment returns, or changes in actuarial valuations. These costs generally pale to the main financial costs of medical, indemnity, rehabilitation, and permanent disability benefits.

In the best possible world, workers and workplaces are safe, healthy, and free from work-related injury, illness, disease, and death. In that world, a workers’ compensation premium at or near zero makes perfect sense. However, in the real world of today, workers and their families pay a huge personal cost for work-related injuries and the total cost of compensation is significant. Without slashing benefits or externalizing costs to others, what is the right workers’ compensation premium?

Perhaps the best way to approach this question is to first look at the extremes, while assuming the true benefit cost is somewhere in between. Suppose workers’ compensation premiums paid by an employer to cover one employee were greater than the payroll cost of that employee for a year —don’t laugh, this sort of premium has existed for certain classifications in certain states in the recent past. What sort of behaviour would we expect this high rate to incentivize?

On the positive side, such high rates may spur technological innovation, training, investment in new plant, improved supervision — all aimed at reducing the costs associated with workplace injuries in this sector. On the negative side; however, the extremely high premiums set up conditions where underreporting of payroll, hours of exposure, and injuries may have extremely high payoffs. Think about it: if I have to pay $100 in premium for every $100 of payroll, then for every $100 of payroll I pay under the table I cut my effective labour cost at least in half.

On the other hand, what if premiums were effectively $0.00 per $100 of payroll? The employer pays nothing, zilch, nada. Some classification are close to that. In B.C., for example, the Interior Design classification’s base premium is $0.10 per $100. On the positive side, there would be no incentive to hide or suppress the report of a workplace injury. We would have, perhaps, a more accurate grasp of what is happening in the workplace. On the flip side, extremely low premiums could lead to under-investment in health and safety. In the extreme case, a very uncaring (and unethical employer) would ask, “why buy safety equipment, invest in safety training, or purchase safer technology if the cost to the employer of workplace injuries is essentially zero? Assuming replacement labour is readily available, why not spend money elsewhere on expansion or other initiatives to raise profit or shareholder value?”

I’ve presented the moral hazards at the extremes to make a point. The “right” workers’ compensation premium is not necessarily the lowest possible one. High variation in competing jurisdictions may be an issue for concern but a relatively low dispersion rate among nearby competitors may simply indicate that the employers and workers in these jurisdictions are facing similar risks and cost structures. The right base premium, in my view, should always be close to the total benefit cost. It's at that point where the investment in safety, health and return-to-work/stay-at-work initiatives will have their greatest impact.

That’s my perspective. I would be interested in hearing yours.

How do leading indicators fit into the planning and implementation of health and safety plans?

I’ve had a lot more questions about leading indicators and how they fit into the planning and implementation of health and safety plans, and so, I thought a further example and simple graphic organizer may help.

A few years ago, I was speaking with the head of the safety and wellness program for a large US manufacturing firm. The company has factories in several states. I asked her how she knew her programs were working. Her responses gave me a practical insight how leading indicators fit into that process. 

 

Central to her approach, was a sound theory of behavioural change and a clear logic model of the factors that lead to injuries.

Occupational injuries and illnesses, near misses, and individual health issues like obesity, diabetes, and hearing loss are usually multi-causal. The physical plant, equipment design, training, and behaviours such as the adherence to safe work procedures, were very important but underlying these are attitudes. She pointed out that behaviours such as violating safe-work procedures had a feedback effect: the more violations of safe-worker procedures that occur and tolerated or ignored, the more they will occur. Before she could change the behaviours that opened employees to injury, she needed a model of what drives behaviour and a way to integrate that into planning and implementation of health, safety and wellness. 

 

From a planning perspective, the “theory of reasoned action” and its revised version, the “theory of planned behaviour,” suggest that attitudes and beliefs determine much of voluntary behaviour. Changing behaviour must rely on changing attitudes and beliefs. This is consistent with concepts such as “bounded rationality” and safety culture. Workers and managers act rationally and if safety and health are demonstrably important to supervisors and upper management, that will get translated to the shop floor.

 

My US contact described her approach to eliminating eye injuries in their plants. Her model included many components. She and her staff looked at design (including guards), considered awareness sessions, worked to have supervisors insist on and reinforce compliance with wearing eye protection, as well as consistently modelling the behaviour will likely contribute to your goal.

 

Her final planning step was to decide the inputs, resource, activities, and products her plan would encounter (and to seek budgetary approval where required).

 

Remember, her goal was to eliminate eye injuries. Counting the number of workers who suffer eye injuries is a trailing indicator. She developed several possible leading indicators including the percentage of staff participating in awareness sessions and observational data on violations detected by her safety officers. She also made the inspection of guards and shields routine with a plant manager report on guards filed monthly.

 

I hope this example helps. Leading indicators are a powerful prevention tool that may make your prevention program more effective.

How do you develop leading indicators for occupational safety and health?

Most of us are familiar with the concepts of “lagging” (sometimes referred to as “trailing”) and “leading” indicators from the world of economics. GDP and “average duration of unemployment claims” tell us about where we have been and, therefore, are generally considered lagging indicators of the relative health of the economy. Housing starts and permits are great examples of leading indicators. If these are rising, the demand for labour and supplies to build the new housing units is likely to rise in the near future. As the housing units are completed, demand for consumer goods like furnishings to fill them is also likely to rise.



The power of leading indicators is obvious to those gauging current conditions and making plans. If housing starts are rising, retailers of furniture and appliances are more likely to increase orders and hire new staff; manufacturers are likely increase production and inventories in anticipation of rising demand.


In workers’ compensation and OH&S, traditional measures tend to be lagging indicators. Injury rates, injury counts, and “days injury free” are, at best, lagging indicators of safety—they may tell us something about where we were but little (if anything) about where we are going. These measures are heavily weighted to the past and may mask serious safety and health risks in the current workplace. Developing leading indicators at the operational, sectoral and even jurisdictional levels helps focus resources and attention where it is most needed and provides early signals of the effectiveness of current programs or initiatives.


To design a leading indicator, you need a logic model, a framework that takes into account the near-term, mid-term and long-term objectives that will lead you to your goal.


Suppose your goal is a safer, healthier workplace and you have an objective of reducing strain injuries in your manufacturing plant. You might want to start by identifying the factors that lead to these injuries. Ergonomics is an obvious factor but you could get more granular or more general in your consideration. Loads, repetitions, and workstation design might be factors at the individual level while work procedures, the pace of work, and safety culture might be important factors at the operational or corporate levels.


Now that you have a model of how the injuries occur, you can think about interventions at the causative level that will contribute to greater prevention. Perhaps you have been convinced as I have that safety culture is vitally important and you have initiatives to improve safety culture in your operation. Annual external audits or random quarterly surveys could help you determine both the current climate and trend over time. If your model is correct, improvements in your safety culture will lead to outcomes like improved adherence to safe work procedures, more safety-oriented content in supervisor-worker interactions, more rapid time from hazard identification to removal—all of which have been proven to reduce injuries and make workplaces safer and healthier.


Other examples of leading indicator metrics for the objective of reducing strain injuries I’ve come across in industry include:

• % of workstation ergonomic evaluations completed

• % of employees/supervisors trained in ergonomics

• % of ergonomic action items addressed

• % of employees engaged in fitness and wellness program


Developing a logic model and selecting a leading indicator forces you to understand your business, how injuries occur and what research tells us will prevent them. That understanding is critical for good management as well as OH&S.



Don’t bother developing logic models, selecting leading indicators, and continually measuring indicators if you think it will be easy. Making the time and effort is hard but worthwhile.



My favourite quote on this topic makes the point very well:

"Measurement is the first step that leads to control and eventually to improvement.

If you can't measure something, you can't understand it.

If you can't understand it, you can't control it.

If you can't control it, you can't improve it.”


- H. James Harrington (Author, columnist, a Fellow of the British Quality Control Organization and the American Society for Quality Control).

Can you rewire your safety culture?

I was invited to deliver the keynote presentation at the “Make It Safe” conference a few days ago. The event was hosted by the FIOSA-MIOSA Safety Alliance of BC, the Canadian Manufacturers & Exporters of BC, and WorkSafeBC.




The FIOSA — MIOSA Safety Alliance of BC, is a not-for-profit industry organization that seeks to address challenges and opportunities specific to food & beverage processing and manufacturing and to set industry standards for health and safety.



The industries represented in the room were ideal for my topic, “Rewiring your Safety Culture.” Most participants had great safety backgrounds, but my goal was to take their thinking about safety beyond the lagging indicators such as injury free days, injury counts, and reportable injury frequency rates. The manufacturing sector has made huge strides in improving safety and health but to take the industry to the next level of safety will mean rewiring the way we think about safety and how we measure our progress.



Manufacturing has been the focus of much research on safety culture. The rich research in this sector provided me with examples from oil refineries, commercial bakeries, electronics manufacturing, and metal fabrication to illustrate my point.



I also happen to like James Reason’s work on human factors because I find it connects with audiences. Briefly, his “Swiss Cheese” model is widely used and easy to visualize. Reason conceptualizes the barriers, safeguards and defences (like training, supervision, safe work procedures, and equipment design) that protect workers as being imperfect with holes of varying sizes and location representing active and latent gaps in the protection. Workers can only get hurt when the hazard in the work environment follows a trajectory through the holes to harm the worker.



Adding “Six Sigma” (an innovation born in the manufacturing sector) to Reason's model allowed the audience to visualize my argument for a rewired safety culture. They agreed that active defects in training, supervision, adherence to safe work procedures can be eliminated or reduced by applying the Six Sigma methodology.



Taking Reason’s model, I argued for a re-conceptualization of the holes as “defects” in the barriers, safeguards, and defences that would protect workers from harm. Six Sigma methodologies are all about reducing variation and improving processes to ensure defects fall below the 3.4 million per million level. Through improvements in training, supervision, and adherence to safe work procedures, we can reduce the number, and size, of defects in these defences and reduce the probability of harm to workers. As defects approach Six Sigma levels, injuries to workers will approach zero. Selecting leading indicators consistent with the approach completes a rewired approach to safety and safety culture.



In this competitive world, the one big question audiences ask about rewiring their thinking about safety and changing their safety culture, relates to costs. The good news is that most of this rewired thinking about safety is not expensive. Small investments and equipment can have a big effect. The big change is in mindset; the big benefit is in saved lives, lowered costs, and improved productivity.



Because my job for much of the last thirty years has involved environmental scanning, I collect stories and examples from other jurisdictions. One of my current favourites from the manufacturing world is for Simms Fishing Products. WorkSafeMT has highlighted this small manufacturing firm in a video available on YouTube that makes the point: it is possible — and worth it — to rewire your safety culture.



Take a look at the video and take the next step: start rewiring!

What were the rehabilitation and return-to-work highlights from the PIEF Conference?

I’ve recently returned from speaking at the Personal Injury Education Foundation (PIEF) conference in Brisbane, Queensland, Australia. PIEF has no exact counterpart in Canada or the United States. It was established in 2006 as a not-for-profit organization by a consortium of Australian and New Zealand accident compensation regulators, insurers, and claims management organisations. They wanted to create programs, initiatives and events focused to raise the common standard of knowledge, skills, and professionalism in the personal injury industry, which covers what North Americans would think of as workers’ compensation, transport accidents compensation, and other injury compensation programs.




My assignment as a keynote speaker was to give a North American perspective on rehabilitation and return to work. (In the interest of full blog disclosure, PIEF funded my travel and registration costs while WorkSafeBC funded salary and other expenses). Highlights for me included hearing the other presenters in the concurrent sessions, other keynote speakers in plenary sessions, and the discussions in the halls, meals, and social events.



The conference opened with a brief talk from an injured worker, Edward Bailey — an ex-pat Canadian who suffered severe back injuries and surgeries that left him unable to work in his 30-year career as a mechanic. He relayed how scary this was, how depressed he became and how the assistance he received to be a trainer and assessor as well as his additional work he does as a technical writer have made all the difference. He said the pain is still there but the rewards of his work allow him to carry on.



That theme of "work being important and good for you and your recovery" was echoed in many sessions. The employer representative who spoke next was Amy Sproule, the Health and Wellness coordinator for Carlton United Brewers — supplier or a quarter of Australia’s beer. She outlined their extensive program which includes on-site physiotherapists (PT) and access to Occupational Therapy (OT), physiatrists, and other allied professionals. She noted that some of the costs for referrals are picked up by WorkCover or by their benefits program but some are just absorbed as an HR cost. She acknowledge that onsite PT was expensive but said it was a visible commitment to early intervention, prevention and RTW — part of a culture they have and want to foster. She concluded that the program makes good business and good moral sense.



The next speaker was Jon Schubert, the president and CEO of the Insurance Corporation of British Columbia (ICBC). He gave a detailed talk focused on transport accidents but some of the research he presented certainly got a reaction from the delegates. For example, he showed how whiplash claims frequency were the lowest in Quebec, a province with a no fault system. He spoke about the Quebec taskforce on whiplash that is widely used for neck pain and the work he was involved in with Saskatchewan that has gone beyond that to focus on a functional model. Interestingly, following the research leads to some surprising outcomes. He noted that some interventions, such as early fitness programs, actually delay recoveries and others have no effect. It raises important questions about what should be funded. Are we doing harm by funding interventions that delay recover, increase disability, or have no effect?



The third keynote speaker in this two-day conference was Professor Sir Mansel Aylward CB, Chair, Public Health Wales and Director, Centre for Psychosocial and Disability Research, Cardiff, Wales. His talk was primarily based on the bio-psycho-social model but his message was clear: We have to change our current thinking and models of disability. He called this focus on outcomes, on health and work, “a moral obligation”. He noted that the bio-psycho-social model is now supplanted the standard medical model and has the published, peer-reviewed data with biochemical, neurotransmitter, and other evidence to back it up. “There is a limited correlation with illness, disability and the capacity for work,” he said — a statement that most in the field of vocational rehabilitation would agree with. He advocates return-to-work outcomes becoming an objective of primary care.



Other topics at the conference included how to define and measure client outcomes, the effects on health, psychological, and work status following compensable injury, and predicting common law claims. I took copious notes at this event and know I will be following up on much of what was presented.



Although the event is only held every two years, based on having attended two of the last three I have no hesitation in recommending the PIEF conference. The next one will be Auckland and will be held in conjunction with the International Forum on Disability Management (IFDM). ​

Is there only one way to keep workers safe?

Last week I was in Brisbane, Queensland on Australia’s east coast. Here’s a jurisdiction a bit bigger in population than British Columbia, a little smaller than Washington State, with a low injury rate and low workers’ compensation premiums (“workcover” as it’s called in Australia).

Brisbane is a modern, cosmopolitan city of three million. There are obvious signs of a vital economy. Buildings are going up, transportation networks are expanding, and unemployment is around five percent (vs. B.C. and Washington state where unemployment is hovering around the eight percent mark).

The workers that keep this economy running are engaged in similar activities to those in any large city. Perhaps because I’m aware of occupational safety and health issues, I couldn’t help but notice some similarities and differences.

Above the city, the complex choreography of cranes carries on as it does over urban construction sites everywhere. The cranes; however, are predominantly luffing jib cranes rather than the straight boom, hammerhead slewing cranes more commonly seen in many North American cities.

Brisbane South Bank construction - August 2012

Workers wear hardhats, but given the greater exposure to the sun, many have wide brim tinted visors and neck shades. Brightly coloured safety garments are seen everywhere. Fluorescent green or orange and contrasting blue polo shirts, fleece, and jackets are common on, and, off the jobsite. Delivery drivers, traffic patrol, baggage handlers — even cyclists — can be seen wearing these distinctive (from a North American perspective), high-visibility garments. It’s not that wearing hi-viz garments in jobs other than construction or traffic control is unheard of in North America, it’s just that wearing of this type of apparel outside the usual job sites is more common in Brisbane.

I’m not certain if Australians generally have a richer “safety culture” than North Americans. Overall, the workers’ compensation injury and fatality rates appear lower than most North American jurisdictions, although true “apples to apples” comparisons are, in my view, absent from the published, peer-reviewed literature.Perhaps an experience I had at the convention centre might be an indicator of something different in the way Aussies manage risk. Before several of the banquets I attended, a server came to our table and instructed us on safety procedures in the event of an emergency. That was something I’ve experienced occasionally at events in many countries. The server also explained a safety rule about always wearing shoes because of the risk posed by errant shards from occasionally broken glassware. I’ve attended a lot of conferences and this was an entirely new caution to me. It was a perfectly logical and important rule when you think about it, but (to be honest) I had never thought of broken glass as a risk in a carpeted banquet hall. And this in a brand new, spotless facility: Brisbane Convention and Exhibition Centre, on Grey Street.

I mention these examples to illustrate a point. Regardless of our national context, employers, workers, and OH&S regulators face similar workplace safety and health challenges. Each jurisdiction has developed solutions to manage risks to workers and other persons in the workplace. Not all solutions are the same. Sure, exit signs are ubiquitous, but the green and white graphic signs in Australia seemed just as clear to me as the red and black text-based exit signs we see in North America.

I’m not sure you could say any given solution is the only right way to protect workers, nor am I saying that you can simply transplant a standard from one jurisdiction to another. What I’m saying is that the diversity among developed western societies creates an opportunity for OH&S professionals to consider solutions others have implemented. Another important reason for building relationships across our jurisdictions.