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Frances Pisano, CEO and founder of Pisano & Associations LLC (the parent company of The ERGOLAB at Ergonomic Edge) was published in the most recent version of the Design-Build Institute of America‘s (DBIA) monthly publication, Design Build DATELINE.  Design-Build is a membership organization bringing together thousands of organizations and individuals representing architects, engineers, public and private owners, general and specialty contractors, manufacturer and suppliers, students, college and university faculty, legal and finance professionals and many more. 

Frances was asked to share her point-of-view on Hospital Ergonomics, the article is titled “Hospital Design; Ergonomics Should Be The Next Big Trend” – check it out!

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Do you know where your employees are?

Ask any business owner or executive about the impacts of Healthcare costs on their business and you will get an EARFUL.  Healthcare accounts for 15.4% of payroll costs…and that percentage is increasing.  Today’s business enterprise spends significant time and resource energy on the aggressive management of that number.  Very little if any savings will come from that number (unless REAL healthcare reform happens; don’t hold your breath for it)…today the exercise is about holding the line.   Just keep treading water.

An unexplored SAVINGS opportunity does exist; it’s not as sexy or polarizing as healthcare costs BUT it can drive very real cost savings.  

Did you know that the total cost of unplanned employee work absences – not vacation or personal time – represents 9.2% of the average company’s payroll expense? (Source – Marsh Mercer 2008 online survey http://www.kronos.com/AbsenceAnonymous/)

Why?

Absences impact your business in three ways:

  • Direct costs for the benefits or wages paid to employees while absent,
  • Indirect costs for lost productivity or the replacement worker expenses to “cover”
    absences and minimize loss of productivity, and
  • Administrative expenses, whether due to internal staffing and overhead, or to vendor
    services.

The impact on Productivity is even more alarming:

Absenteeism or “Incidental unplanned absences” result in the highest net loss of productivity per day (i.e., missed or postponed work not being covered by others): 21%versus 15% for planned absences and 17% for extended absences.

Absenteeism is a MANAGEABLE cost driver and a sound Ergonomics strategy can help.

How?

Trapped in that 9.2% number are unreported employee pain and discomfort issues.    In many cases, ERGONOMIC workplace issues are the cause of this pain and discomfort.  A recent study from Spain estimates that > 6.4 million people take an unplanned absence each week citing muscular-skeletal problems as the reason.  Out of these, 40.9 per cent of the work force experiencing lower back pain, 40 per cent with neck pain, and 22.9 per cent with upper back pain.

Poor environmental and task design within the work environment drives this pain and discomfort.   ERGONOMICS can help. 

Do you have an in-house program that documents absenteeism drivers?   Probably not.   Our ERGOLAB team works with business leadership to build a proactive approach to absenteeism through;

  • Employee pain and discomfort surveying,
  • Task assessment and redesign consulting and
  • Ergonomics education and training

Interested ?  We’d love to hear from you – fpisano@ergonomicedge.com or 401 529 8398

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The ERGOLAB practice is a part of Pisano & Associates LLC, an Environmental Health & Safety consulting firm headquartered in Pawtucket RI.  A growing part of our Health & Safety consulting work is in support of healthcare providers; hospitals, nursing homes and medical practices.  Hospitals in particular, are under pressure to drive costs down (do more with less), while ensuring 100% quality at the point of patient care.  An often overlooked aspect in this equation, is the role EMPLOYEE SAFETY plays in supporting or enabling patient safety. Healthy employees are more productive, better focused and less prone to mistakes or mental errors. A healthy hospital employee CONTRIBUTES directly to a safe patient experience.

Our mission at Pisano & Associates / ERGOLAB, is to work with clients to assess the current state of employee safety, identify and eliminate risk factors through Health, Safety and Ergonomics programs. Following is a case study of some recent work; our Safety and Ergonomics teams partnered in the ‘deep dive’ analysis of historical OSHA recordable data across a large hospital ownership group.  The objective?  Identify the all risks factors and build a plan to build a “best-in-class’ safety culture. This initiative was the first step on that journey.

Challenge:

As the largest industry in 2009, health care provided over 16 million jobs. Combining medical technology and the human touch, the health care industry administers care around the clock, responding to the needs of millions of people—from newborns to the critically ill.

 In 2006 (most current data available), the incidence of occupational injury and illness in hospitals was 8.1 cases per 100 full-time workers, compared with an average of 4.4 for industry overall. Nursing care facilities had a higher rate of 9.8. Health care workers involved in direct patient care are at great risk back strain(s) and other MSDs from lifting patients and equipment; potential to exposures to radiation and caustic chemicals; and to exposures to infectious diseases, such as AIDS, tuberculosis, and hepatitis.  

In order to drive holistic safety improvements for both employee and patient across the entire hospital ecosystem a shift in philosophy will be essential to successfully keep up with the demands of this industry.  The symbiotic relationship between patient safety and employee safety cannot be dismissed. As first noted by E. Scott Geller, Ph.D., Professor of Psychology at Virginia Tech, “What impacts one group, impacts the whole”.  Positive changes in hospital safety environments can only come by focusing time, energy and investment on employee programs to compliment already robust patient safety programs.

Our client is large healthcare network operating over 75 Health Care Facilities across the United States and employing over 100,000 associates and their foremost concerns are to maintain a safe environment and reduce both direct and indirect Workers Compensation Costs.  

Solution:

As part their continual improvement efforts Pisano & Associates team was brought in to conduct a 3rd party OSHA Recordable Trends Analysis for (4) hospitals within the client’s network, using the OSHA 300 Log data over a 3 year period.    The P&A team developed a database tool that provided a deep dive assessment of the data and reviewed over 10,000 OSHA recordable looking for key drivers of workplace accidents and injuries.  From there some very basic questions needed to be answered:

  • Which employees’ are at the greatest risk for injury and illness? 
  • Are there common denominators between the high risk group(s)?  Type of Injury? Behavior? Location? Activity?  Job Title?
  • Does the existing Incident Investigation Database System capture the necessary data for an accurate and valuable data analysis? For example, if a patient is also injured during an employee incident does the system make it possible to make a “connection” between employee injury and patient injury?
  • Based on the findings, what existing or new safety and health programs need to be enhanced, or developed and implemented that will drive the greatest reduction in employee injury and result in a safer patient environment?
  • What approach should be taken to efficiently and successfully implement these programs?

 Result:                                                                    

This extensive analysis of 10,000 OSHA Recordable Incidents showed that 80% of the total incidents, restricted/transfer days, and days away from work involved one of the following:

  • Patient Handling
  • Materials Handling
  • Needlesticks/sharps
  • Slips/Trips/Falls

The following programs were recommended:

  • ERGONOMICS: Focus – Patient Handling & Material Handling
  • EXPOSURES: Focus – Needlestick/Sharps
  • SLIPS/TRIPS/FALLS

In addition, RN’s accounted for approximately 30% of the total incidents, the restricted/transfer days, and the total away from work. As a result a Safety & Ergonomics effort both focusing on and involving RN’s was also recommended as part of a total safety culture effort.

Finally the results showed that 40% of all incidents occurred in the Patients room, they accounted for 35% of all restricted/transfer days and 30% of all days away from work.  It was also recommended that they integrate employee and patient incident tracking and reporting in the existing database. This will allow for a much more accurate estimate of potential cost savings and liability cost avoidance when developing and implementing the recommended programs.

As a result of the project our client is doing the following:

  • Moving aggressively towards adopting and embracing the ‘Total Safety Culture’ philosophy.
  • Addressing the limitations of their OSHA reporting system that were identified during the project and investigating how to capture and integrate both employee and patient incidents and how they relate to each other.
  • Targeting an 80% reduction in employee injuries and related workers compensation costs both direct and indirect base based on recommendations
  • The safety and well-being of the nursing staff is at the center of hospital group’s strategy – nurses’ are active in all phases of program development and rollout.
  • Employees and management participate in specific safety task forces to promote both employee and patient safety and to develop programs, policies and procedures. Some of these task forces include: the Needle Stick Prevention Task Force, Safe Patient & Material Handing, Medication Safety, and Emergency Management. Hazard surveillance and environmental rounds are done on a regular basis. This activity provides inspection and review of all work areas. Recommendations for improvements are reviewed by the Environment of Care Committee and evaluated and implemented by management.
  • Working collaboratively with OSHA and other regulatory organizations to ensure a high level of employee safety.

If you’d like to know more about this project – feel free to contact me via email or phone – cdavis@ergonomicedge.com or 401 527 7047

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There is an old carpenter’s axiom, ‘measure twice, cut once’.  The lesson? Careful, informed planning is essential to ensure a positive outcome.  Hurry to complete a project, and you do so at your peril. A lot of wasted wood cut just a skosh too short.  

Ideally, Ergonomics should play a central role in the design and build out of any building where people will work.  Understanding the needs and limitations of the human body at rest and in movement should inform the work of architects, designers and builders.   Have you ever worked in a business environment where the building structure, layout, space allocation for job tasks, movement & pass-through, while up to all current day building codes, seems to interfere or impede productivity?   The workspace allocated per employee in office environments is often driven by cost issues (cost per sq foot), rather than building an understanding of the tasks employees would be asked to perform….THEN DESIGN TO MEET THOSE NEEDS.   Or, perhaps the business, like most, have gone through significant expansion in their use of technology. New tools are forced into existing environments; this reality introduces risk factors into the workplace.  Or, the employer needs to support as many workstations in an area as possible, with little or no regard for human factors and ergonomic realities.  (think CALL CENTER – have you ever walked through a large call center – YIKES – an MSD factory). 

A growing part of our ERGOLAB practice is consulting within a hospital environment.  Nursing injuries are on the rise. OSHA accident and injury data has identified nursing as one of the most dangerous professions in the US.   Why?  THE PERFECT STORM OF FACTORS; 

  • HEAVY LIFTING – On average, a nurse  lifts 1.6 TONS of human body weight every shift.  Injuries from heavy lifting leave 50% or more working in chronic pain
    or at least 12% leaving the profession, many with permanent disabling injuries.  The rate of Musculoskeletal Disorders or MSDs in healthcare workers exceeds that of workers in construction, mining and manufacturing.
  • FATIGUE – Nurses walk 1/3 of every shift due to poorly designed floor layouts and inadequate storage at the point of care. A nurse walks more than 6  miles per shift.
  • TECHNOLOGY – New technologies have transformed healthcare; unfortunately, many of the nation’s hospitals were built before the invention of computers. Tools and technology is crammed into every nook and cranny on patient care floors.  Nurses spend HOURS at computer workstations that are poorly designed, forcing out of neutral body postures and increasing the risk of MSDs. 
  • EMPLOYEE SAFETY NOT A PRIORITY – Present day hospital culture is about PATIENT SAFETY concerns and conversations; employee safety is a distant second.   The typical hospital will have a Patient Safety Officer, with enterprise level responsibilities and resources. That same hospital will relegate Employee Safety responsibilities to any number of ‘owners’ at the middle management level. 
  • MORE WITH LESS – Financial challenges resulted in nursing layoffs – nurses are asked to do more…..much more….with less.  40 % of nurses today work in excess of 12 hours
    per shift. Longer hours, more shifts, less down time.  

Intelligent hospital design, leveraging human factor and ergonomics expertise would alleviate MANY of the factors listed above.  Lifting tools and technologies exist that could eliminate injuries due to heavy lifting.  Floor plan design must evolve to eliminate unnecessary walking that contributes to fatigue, then injury.  Technology can be better integrated at the point of care, with ergonomic solutions to minimize MSD risk.   Any design must have adaptable, changeable and flexible enough to meet accommodate changes in technology. 

The good news….a VERY real opportunity exists in the coming decade to address hospital design issues and create the care center of the future.  The healthcare industry is experiencing a construction boom: 

  • Hospital construction spending is forecasted at $36.8 billion by 2011 with expected annual increases year to year (source – Center for Medicare & Medicaid Service)
  • 58% of existing hospitals plan to add beds in the next few years to accommodate aging baby boomer populations (source – Nurse Executive Center – CNO Survey)

Ergonomics must be one of the guiding principles in future hospital design.   Let’s not ‘assume’ that Ergonomics is central to the design methodology….DEMAND IT.  Make sure the development teams have MEASURED TWICE…before they finalize design.  The costs of business as usual are too high.

Have something to say on this topic?  Please add your comments. 

If you’d like to discuss our consulting services in this area, please contact Frances Pisano at 401-529-8398 or fpisano@pisanoassociates.com

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Our ERGOLAB team spends a lot of time working in office environments; the day man met PC was a glorious one for workplace accountability – nothing like a digital trail to keep things on the up and up….not so great for the human body.  Why?  As work tasks became more and more automated, our work days became more sedentary. 

Our body was not designed to sit for 8 hours a day; we’re all familiar with the Ergonomics axiom, “the best body posture (position) is the NEXT body posture (position).  Our bodies were designed to hunting, gathering, foraging for food, and sometimes running away VERY quickly when WE became the potential ‘food’ (…and NO, battling the crowds at your local farmer’s market does not qualify as ‘foraging’).   We need movement, we need a variety of position and posture to maintain good body health and flexibility. 

In the past, corporate Health & Safety leadership often overlooked the needs and risks within their office environments; cubicle dwellers don’t use pneumatic equipment, drive a forktruck or work with hazardous materials. Accidents and injuries occurred in other places in the enterprise, except the occasional slip, trip or fall, the office harbored few (or so they thought) risks.  Now, with 20+ years of data  and learning behind us, we understand the very real and very expensive risks associated with unmanaged office ergonomics.  With the average cost of ONE musculoskeletal disorder averaging $25,000 in direct costs and 5 to 8 times that number in indirect costs…a passive approach to office ergonomics is NOT good business. 

Still…old myths and misconceptions in Office Ergonomics die hard. 

Misconception #1

The right chair will solve ALL your problems.  WRONG!   A personal pet peeve and a myth that must DIE (and remember, we SELL ergonomic chairs and tools at www.ergonomicedge.com ).  The office chair, while very important, is one element within an INTEGRATED Ergonomic solution.  Office system manufacturers spend millions to reinforce the belief that a chair (more importantly, their chair) is the answer.  There is no magic chair. Or for that matter keyboard tray, mouse, docking station or document holder.  Products are tools our ERGOLAB Ergonomists use, case by case, client by client, to build an Ergonomic solution, properly designed, personally adjusted, with adequate employee education and product training (you’d be amazed how many companies have NO IDEA how their existing chairs adjust…).  At ERGOLAB, we lead with Ergonomic guidance first…products are a very very distant second.  

Misconception #2

Repetitive Motion is the #1 cause of ergonomic injury.   WRONG!    Yes, repetitive ‘Out-of-Neutral’ motions can and do cause injuries. An example would be anyone who works on spreadsheets for long periods of their day; these folks do A LOT of cutting and pasting within the spreadsheets.  Over the long term, overuse can lead to pain, discomfort and injury.   What surprises most corporate Health & Safety Managers, is that STATIC  “Out-of-Neutral” body postures cause far more injuries….we are a generation of leaners and reachers.   Sitting in a chair for hours at a stretch invites poor postures; next time you are in a lengthy meeting, check out the body positions of everyone around you…..leaning, slouching, etc.  All positions that put extreme stress and pressure on our bodies.   

This underscores the value of careful, thoughtful office design; the cubicle footprint is often driven by ECONOMIC imperatives, rather than ERGONOMIC imperatives.  Think  adjustability of worksurfaces, up/down, in/out.  Make sure all employee tools fall within the REACH ENVELOPE…don’t ask an employee to reach and lean to talk on the phone or lean forward to view a monitor.    

Misconception #3

Office Ergonomics is a ‘hard sell’ in these tough economic times.   WRONG!   Now is precisely the time to integrate Office Ergonomics into your Health & Safety plans for your next fiscal year.  Let’s face it, everyone is working with reduced headcount. This means your current work staff needs to do more…..MUCH MORE….with less.  You need these employees to stay healthy and productive.  Beyond this, Worker’s Compensation costs are soaring…a proactive Ergonomics approach is about preempting injury. Fewer injuries, fewer claims, lower PREMIUMS.   In tough economic times, you can’t afford NOT to invest in Office Ergonomics. 

Misconception #4

Every employee needs the same Ergonomic tools.  WRONG!      Ergonomic solutions are personal; an employees height and body size, health conditions, work functions and personal habits all contribute to and inform an Ergonomic solution.   A good starting place for 90% of the employee population is an adjustable Ergonomic chair and quality adjustable keyboard – but REMEMBER – the workstation MUST be designed with the employee’s idiosyncratic needs in mind. As before, an Ergonomic solution. There is no one size fits all.

 Need some guidance in creating and implementing an Ergonomics program for your business?   Give us a call – 401-527-7047, or email me at cdavis@ergonomicedge.com.

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Yesterday was a good day.  The ERGOLAB team is working with a leading luxury goods manufacturer and marketer to address high risk tasks within production facilities.  The program is moving forward nicely, our redesign is in test phase, solution validation is right around the corner.  Company A is thrilled with the outcome.  

The day BEFORE yesterday…that day wasn’t quite as good.  Similar work on behalf of a different ERGOLAB client continues to stall out, lose momentum and  focus.  This task redesign work lauched months before the above mentioned case study, yet we have little to show for it.  Company B is frustrated, and rightly so.   

At first blush, the clients are very similar; industry leaders, global brands, organizational commitment to Ergonomic practices.  So….why the difference?  Why is Company A so much further along that Company B?   

One word.  EMPOWERMENT.  

At Company A, the culture encourages and rewards employee ‘intrapreneurship’ (think entrepreneurship BUT inside a company structure, not out).  Have a new idea to streamline a process and improve productivity?  Pitch the idea to your up line manager.  Company A employees are expected to partner with management in the continuous improvement initiatives of the company.  As consultants, ERGOLAB gets to partner with client employees who are engaged and invested in the program and it’s outcomes.  There is nothing better than working within a client community of people with pride, enthusiasm, and passion for their work and workplace.   Empowered employees make us look good.  

Company B does not practice an Empowerment management philosophy.  Employee roles are narrowly defined.  Suggestions are accepted, but rarely acted upon.  The employees want to participate in making their workplace a better place, but the current management style doesn’t allow for that type of a role.  Driving positive change at Company B is a challenge; as our ERGOLAB methodologies require employee participation and collaboration in all phases of solution development and testing.   Our biggest hurdle is often MANAGEMENT; their need to control and edit employee involvement and access to ALL the information is a real roadblock. 

So…what about your company?   As an employer, have you created an environment that encourages employee empowerment?      

To paraphrase Lao Tzu in the Tao of Leadership; 

The leader is best… 

When his work is done, his aim fulfilled,  

The people say, ‘We did it ourselves.

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