Is the blitz an effective prevention technique?

The following story was posted on the Australian Broadcast Corporation news website:

WorkSafe warns of asbestos blitz Posted Thu Mar 10, 2011 12:13pm AEDT

WorkSafe [Western Australia] will inspect a number of work sites across regional Western Australia to check safety provisions for asbestos.

Inspectors will target the construction and demolition industries over the next two months, checking licenses, protective equipment and waste procedures are up to standard.

Acting WorkSafe commissioner Lex McCulloch says businesses can face serious fines if they knowingly break the law.

"If they are made under 'duty of care' provisions of the Act then it can be up to $400,000," he said.

"If they are made under the regulations for an individual it can be $25,000 and for a company it can be $50,000, it just depends."

The story highlights a couple of important points. First, is that asbestos is the once and continuing threat to the long-term health of workers. Despite what we know about asbestos and what we can do to protect workers, workers are still getting exposed to asbestos without the protection they need. The second point is that we know many places where asbestos likely exists but that information is not always transmitted to everyone who might need to know.

The third aspect of this story is the compliance/enforcement technique employed: the blitz. By focusing attention on a few key issues (often in a particular region or industry) and publicly declaring their intention to enforce, the prevention organization heightens awareness. This may trigger questions in advance of the action that create consultation and education opportunities, and generates greater workplace vigilance and adherence to safe work procedures.

This technique is not unique to Australia. Other jurisdictions are using similar techniques but rarely do these initiatives gain the profile they do in Australia. Part of that may be timing. It is no coincidence that asbestos exposure stories—particularly in schools—have gained significant profile in the Australian press. The death of a young service station attendant in B.C. generated a lot of press, and a blitz of training and safety procedures in that industry. It also resulted in Canada’s first pay-before-you-pump standard.

I think the blitz is an important and effective prevention technique. It is important that people understand the blitz is just one technique of many, and one that will have a different impact on different workplaces. It certainly can heighten awareness and get people thinking and talking about safety. For workplaces with great safety cultures, the blitz will have little effect. Workers and employers in these workplaces know what to do and are doing it every day. The advance notice of a blitz will help other workplaces where the participants in the workplace mean well but do not have the knowledge or lack the skill or resolve to make safety a priority. The blitz announcement can be the impetus to make changes. For the minority of workplaces where participants know better (or should know better), advance notice of the blitz may cause some workplaces to take note, but it is unlikely to make any difference at all to places that routinely ignore safety precautions. For these workplaces, the orders or “improvement notices” issued when the blitz actually takes place, may prove to be the wake-up call that will start the workplace on the road towards a changed safety culture.

Does a timely First Report of Injury really matter or is it just a bureaucratic requirement?

My last post was about the requirements many jurisdictions have for timely reporting of work-injury claims to the workers’ compensation authority. I stated my reasons in support of timely reporting and compliance with whatever standard set by the jurisdiction: health and safety of other workers, timely treatment and benefits for the workers. A number of people commented to me about the post. Most agreed that there was some value in requiring employers report injuries on a timely basis but thought short legislative reporting requirements imposed by the workers’ compensation authority were simply a bureaucratic requirement. They argued there is no real harm done to the worker, the authority or the system if firms failed to comply with the first report of injury (FROI) requirements. Some also suggested that the penalties imposed and the fines collected in some jurisdictions looked more like a “money grab”.

As if in answer to these criticisms, a summary of recent research on this topic arrived in my inbox. Under the heading “Benefits of Early Reporting”, the article from the Utah Workers’ Compensation Fund noted:

· The faster the claims process is started, the lower the workers compensation costs.

· When there was a delay in reporting, there were higher medical costs, higher rates of attorney involvement and litigation, and disputes over causation, and longer than normal periods of disability for a particular injury.

· After seven days, claims costs began to escalate, and when reporting was delayed 29 or more days, the claims costs were about 45 percent higher.

· A study by a private insurer on back injuries, carpal tunnel syndrome and other nerve disorders, they discovered the claims filed five or more days after an injury cost an average of 15 percent more than similar claims filed within 48 hours

· Injuries reported within 10 days cost an average of $12,082. Injuries reported between 11 and 20 days cost $15,582, and those reported between 21 and 30 days cost $17,920 -- an increase of 48 percent more than those reported in 10 days or less.

I think this evidence is compelling. Holding employers to a timely FROI is not just a bureaucratic requirement. It has the proven potential to reduce both the human and financial costs of injury.

Regardless of any jurisdictional requirement for early reporting, getting that FROI in is a benefit to both workers and employers.

How long should it take for a First Report of Injury to be submitted?

A story out of Jefferson City, Missouri, got me thinking about how long it should take an employer to file the first report of injury in worker’s compensation systems. Because timely prevention activity, claim decision making, and payment all depend on reporting, it stands to reason workers’ compensation agencies would be concerned about late reporting.

The Missouri story starts out as follows:

A-G Reaches Settlement Over Worker's Comp Violations

Attorney General Chris Koster said today he has reached agreements with two companies who violated Missouri’s workers’ compensation law by knowingly failing to report worker injuries to the Division of Workers’ Compensation within the prescribed time frame.

In Missouri, the prescribed time for an employer to submit the first report of injury (commonly called FROI in many states) is defined by the Workers' Compensation Law (Missouri Revised Statutes Chapter 287 Section 287.380.1)

“Every employer or his insurer …shall within thirty days after knowledge of the injury, file with the division … a full and complete report of every injury or death to any employee for which the employer would be liable to furnish medical aid, other than immediate first aid which does not result in further medical treatment or lost time from work…”

In practice, employers in many U.S. states buy their workers’ compensation insurance from an insurance company and the insurance company staff or a third party administrator (TPA) manages the claim. Whether the employer or the insurer or the TPA informs the state agency of the time-loss injury, it must be done promptly. In Missouri, the promptness standard is set at 30 days.

The news story goes on to say that two TPAs who were the ones who were repeatedly delaying. In many jurisdictions, the TPA claims managers are located in a different state, and that was the case in this story. As part of their contracts with various firms, the TPAs had taken on the responsibility of filing the first report of injury to the State workers’ compensation agency. The Missouri “Division of Workers’ Compensation” requires the data to ensure timely and appropriate treatment of injured workers and to make certain workers and their families are fully aware of their rights. More generally, that FROI can be used as a prevention tool to protect other workers from similar injuries.

Rather than go to Court, the two TPAs settled with the Attorney General who was prosecuting the case. The two offending TPAs agreed to pay the state just over $100Kbetween them and to admit to violating the law. They also agreed to remain in compliance for two years and to take necessary steps to prevent recurrence of future violations.

Not every state applies a penalty for late filing of the first report of injury. To the best of my knowledge, Alabama, Arizona, Colorado, Michigan and North Dakota are among those that don’t, but I don’t have any data on how compliant employers are in these states with the statutory reporting time (typically 7 or 14 days). Wisconsin has a 14-day standard and publishes an indicator which currently shows more between 74 and 77% of first reports of injury being received promptly.

In Canada, the timeframe for reporting an injury varies from province to province but three- and five-day standards are common. The AWCBC posts the reporting requirements and the penalties prescribed for late reporting and other offenses at the following links:

•  Summary Requirements for Reporting a Claim


•  Penalties for Delay in Reporting (General)

Ohio reports that 74.5% of FROIs are received within that state’s 7-day time limit. This is impressive but some other states do even better. Maine requires the FROI within 7 days after the employer receives notice or knowledge of an employee lost-time injury. The state has an 85% compliance target but was tracking closer to 90% in mid 2010. My understanding is that Maine applies a $100 penalty for each late filing (beyond 7 days) of the first report of injury.

Minnesota assesses progressively higher penalties for late filing of the first report of injury (typically beyond 10 days of the first day of disability) with each violation. The first offense in any 12 month period attracts a warning but penalties go up after that for each subsequent offense ($125, $250, $375, $500 for five or more offenses). In 2009, the state assessed 694 penalties totalling more than $309,000 for late filing of the first report.

Other states have even more aggressive levels. I understand Texas has a 10-day limit with a fine of up to $25,000 per day for violations although I could not confirm if any firms had to pay anywhere near that amount.

Does the threat of financial penalties increase timely reporting behaviour? I could not find any comparative figures on compliance or penalties but am interested in any data you may have on this topic. I think the Missouri story and published compliance rates from Maine and Ohio certainly send important messages about the seriousness with which these states take the timely reporting of injuries.

Are there any great OH&S apps?

We are living in a time when digital information is literally at your fingertips. In the case of the WorkSafeBC’s Occupational Health and Safety Regulation, it has made the leap to an iPod/iPhone app. Seeing how well that works on my iTouch, it got me thinking about other apps that might be good to have at my fingertips.

You will find a lot of apps out there that range from a simple app that generates a white screen, (works really well as substitute flash light), to one that provides the complete US Army Survival Guide. There are also a lot of simple utilities that can provide a ready and useful source of information, when access to the internet or print material is not readily available.

A good companion item might be American Heart Association's Pocket First Aid & CPR. It has a price tag of $3.99, but it's a good reference document with an efficient interface to get the information you need in a hurry.

I was impressed with the idea behind Safety Button from Sillens AB. The app presents a single red HELP button that can be preprogrammed to text and or email your current position, make a distress call, and sound an alarm. You hope never to have to use the messaging part of the app. Chances are, however, there will be times when you want to initialize the app and have it ready. As soon as you turn it on, your GPS location is tracked by the application and updated to their server every 20 seconds, creating a record of time and location. The inexpensive app comes with three prepaid text messages: one for testing, and two just in case, with refills for the messaging part available for a nominal fee. There is no ongoing subscription required.

The YWCA apparently offers a free app that has some of the same functionality. This operates more like the portable personal siren alarms you may have seen marketed primarily to women. This one, however, comes with a feature that sends an emergency email to a pre-set contact, with the user's approximate coordinates. It can also send out an emergency call to a pre-programmed phone number. The YWCA Safety Siren comes with facts and contacts for women’s health and wellness.

I’m certain there many of you have found workplace health and safety apps for your iPhone, iPad, iTouch, Blackberry, Android, Galaxy… that are really useful. I am equally certain there are applications you would like to see created to fill a particular occupational safety and health need, (for example, I would like to see an app that allows you to decipher the meaning of a warning symbol just by pointing your device’s camera at it). If you have an OH&S app or an idea for one you would like to see, post a comment and maybe we can make workplaces safer one app at a time!

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.