psychiatric – Page 76 – SafetyAtWorkBlog

New research on behavioral safety

The New York Times (and other newspapers) reported on an article in the latest edition of the NSC Journal of Safety Research. It is worth considering when the behavioural-based safety advocates come a-knocking.

According the media reports the article reports on “knowledge gaps” in research into behavioural safety. It summarises the discipline, or alchemy depending on your experience with the advocates, very well.

“Behavioral safety” is becoming more popular as safety practitioners seek to better understand and develop strategies to prevent workplace injuries. Behavioral safety is the science of observing workers’ behaviors to determine where a different behavior or set of behaviors may have prevented or lessened the severity of injury. The study defines behavioral safety as an approach to improve safety performance through peer observations, goal setting, feedback, and celebrations or incentives for reaching safety goals.”

Thankfully it sensibly recommends that behavioural safety be applied as part of a broader safety management system. In fact broader than many others suggest. The study says that “psychological, social, engineering and organizational factors” should be considered and it acknowledges that how these factors affect behavioural safety is still poorly understood. It suggests these areas for further research attention:

“Impact of behavioral safety interventions on rates of injury, illness and fatalities.
Appropriateness of the basic elements of behavioral safety across different industry sectors.
Relationship between behavioral safety and a greater safety culture.
Role of performance feedback in creating behavioral change.
Effectiveness of tangible and non tangible rewards on behavioral change.”

Some of these factors would best apply through research by the OHS regulators – a rare commodity – but they indicate some of the areas which OHS professionals should consider more carefully.

Clearly behavioural safety is still a developing area of study and application. It reinforces the position that behavioural safety is still not a panacea, regardless of the claims of spruikers. Behavioural safety is one of the tools available to OHS professional and perhaps one that should not distract us from more effective and practical safety initiatives.

Kevin Jones

A sort-of resolution for Paula Wriedt

Paula Wriedt, a Tasmanian Member of Parliament who attempted suicide in August 2008, resigned on 18 January 2009. According to her media statement

“I have made a significant recovery since my hospitalisation in August, but I believe it is in my best interests, and the interests of my family, to concentrate on improving my health away from the daily pressures of being a member of Parliament.

“This illness has had a significant impact on my life.

“The many demands I faced last year, on both a professional and personal level, meant I neglected to take stock of my health until it was too late.

“During this time, I made a mistake by forming an inappropriate relationship with a member of my staff. This had significant implications for the families involved, and I am not proud of my actions.

“I deeply regret the hurt that has been caused by this.”

She goes on to speak positively of undertaking meaningful work outside of politics. It is hoped that Paula does not feel obliged to follow other politicians into promoting depression support services. For most Australians Paula Wriedt will be associated with her affair and suicide attempt. Tasmanians should remember her as a good parliamentarian, as mentioned by the current Premier David Bartlett (who is only slightly older than Paula at 41), and for her achievements in the education portfolio.

Kevin Jones

Other post concerning Paula’s situation are available by searching for “Wriedt” in the field below.

Eliminating hazards

In the aims of most of the Australian OHS legislation is

“to eliminate, at the source, risks to the health, safety and welfare of employees and other persons at work…”

I have written elsewhere on how this conflicts with the push for “reasonably practicable” but the need to remember this important aim was emphasised by a study undertaken by the Graduate School of Public Health and the School of Medicine at the University of Pittsburgh and published in the January 2009 issue of “Neuropsychology”, which is published by the American Psychological Association.

The researchers followed up on the 1982 Lead Occupational Study, which assessed the cognitive abilities of 288 lead-exposed and 181 non-exposed male workers in eastern Pennsylvania. It measured “five primary cognitive domains: psychomotor speed, spatial function, executive function, general intelligence, and learning and memory.”

According to the media statement, in the 2004 follow up study,

“Among the lead-exposed workers, men with higher cumulative lead had significantly lower cognitive scores. The clearest inverse relationships – when one went up, the other went down – emerged between cumulative lead and spatial ability, learning and memory, and overall cognitive score.

This linkage was more significant in the older lead-exposed men, of at least age 55. Their cognitive scores were significantly different from those of younger lead-exposed men even when the researchers controlled for current blood levels of lead. In other words, even when men no longer worked at the battery plants, their earlier prolonged exposure was enough to matter…”

“The men who built lead batteries were exposed to it in the air and through their skin. Other occupations, including semiconductor fabrication, ceramics, welding and soldering, and some construction work, also may expose workers. The authors wrote that, “Increased prevention measures in work environments will be necessary to reduce [lead exposure] to zero and decrease risk of cognitive decline.””

Lead has been identified as a major occupational hazard for a very long time and is a good example of how “reasonably practicable” is not always a reasonable solution. Lead paint products have been banned in many countries. Asbestos similarly so. The attitude that there are “safe” levels of exposure to some industrial products is not worth pursuing in most circumstances.

Safety is similar to medicine in that both aim to “do no harm”. If Hippocrates, or Galen, were alive today they would not say

“do no harm, as far as is reasonable practicable”.

That is not a belief that will establish a centuries-old profession and it should not be blindly accepted by the safety profession in the 21st century.

Kevin Jones

Workplace health initiatives in unstable economic times

All through the Presidency of George W Bush, safety professionals have been critical of the lack of action on workplace safety. As with many issues related to a new Democrat President in Barack Obama, organisations are beginning to publish their wishlists. The latest is the American College of Occupational and Environmental Medicine (ACOEM).

On 9 January 2009, ACOEM released a media statement which began

“American College of Occupational and Environmental Medicine (ACOEM) calls on the Health and Human Services Secretary-designee Tom Daschle to address the critical link between the health, safety, and productivity of America’s workers and the long-term stability of its health care system and economy as he begins work on the Obama administration’s health care agenda.”

The requested changes could be interpreted as a criticism of what the situation has been under George W Bush. ACOEM says the next government

“must put a greater emphasis on ensuring the health of the workforce in order to meet the twin challenges of an aging population and the rise of chronic disease…”

ACOEM President Robert R. Orford, MD goes into specifics

“…calling on Daschle to focus on preventive health measures aimed at workers that could range from screening and early detection programs to health education, nutritional support, and immunizations.”

The ACOEM reform program is based on the following

“investing in preventive health programs for workers;
creating new linkages between the workplace, homes and communities to reinforce good health;
providing financial incentives to promote preventive health behaviors among workers; and
taking steps to ensure that more health professionals are trained in preventive health strategies that can be applied in the workplace.”

Accepting that one Australian State, Victoria, is considerably smaller than the US (Victoria has a population of around 5,200,000, the US had 301,621,157 in 2007), it is interesting to remember what the Victorian Government proposed (or promised) just on 12 months ago concerning its WorkHealth initiative.

“Over time the program is expected to free up $60 million per year in health costs, as well as:

Cut the proportion of workers at risk of developing chronic disease by 10 per cent;

Cut workplace injuries and disease by 5 per cent, putting downward pressure on premiums;

Cut absenteeism by 10 per cent; and

Boost productivity by $44 million a year.”

[It would be of little real benefit to simply multiple the Victorian commitments by the differential with the US population to compare monetary commitments, as there are too many variable but if the WorkHealth productivity was imposed on the US, there could be a $2.6 billion, not a lot considering the size of President Bush’s bailouts and Barack Obama’s mooted bailout package. However, in the current economic climate, in order to gain serious attention, any proposal should have costs estimated up front and, ideally, show how the initiative will have minimal impact on government tax revenues – an approach that would require.]

In each circumstance there is the logic that unhealthy people are less productive than healthy people. This sounds right but it depends very much on the type of work tasks being undertaken. It is an accepted fact [red flag for contrary comments. ED] that modern workloads are considerably more supported by technology than in previous labour-intensive decades. Perhaps there are better productivity gains through (further) increased automation than trying to reverse entrenched cultural activity.

In late 2008 an OHS expert said to a group of Australian safety professionals in late-2008 that WorkHealth

“is not well-supported by the stakeholders. The trade unions feel it is a diversion away from regulated compliance and that it is going to refocus the agenda on the health of the worker and the fitness of the worker as the primary agenda, which is not what the [OHS] Act is setup to focus on. The employers are basically unkeen to get involved on issues they think are outside their control.”

The expert supported the position of some in the trade union movement that WorkHealth was always a political enthusiasm, some may say folly.

This is going to be of great importance in Australia with the possibility of new OHS legislation to apply nationally but also muddies the strategic planning of any new government that needs to show that it is an active and effective agent of change, as Obama is starting to do. In the US, the public health system is not a paragon and the workplace safety regulatory system is variable, to be polite. Fixing the public health system would seem to have the greater social benefit in the long term, and a general productivity benefit.

(It has to be admitted that the packaging of health care in employment contracts in the US is attractive employment benefit and one that seems to be vital to those who have it. Australia does not have that workplace entitlement but those employers struggling to become employers-of-choice should serious consider it, particularly as a work/family benefit.)

Each country is trying to reduce the social security cost burden on government and it would seem that public health initiatives would have the broader application as it covers the whole population and not just employees, or just those employees who are unfit.

Work health proposals in both jurisdictions need to re-examine their focuses and to pitch to their strengths. Business has enough to worry about trying to claw its way out of recession (even if the US government is throwing buckets of money to reduce the incline from the pit). OHS professionals have enough work trying to cope with the traditional hazards and recent, more-challenging, psychosocial hazards. Workplace health advocates are muddying the funding pool, confusing government strategic policy aims, and blending competing or complementary approaches to individual health and safety in the public’s mind.

Kevin Jones

Update 16 January 2009

More information on this issue is available HERE

Mental support research

In SafetyAtWorkBlog in 2008 there have been several posts concerning suicide. There is a growing research base on the matter and The Lancet adds to this through an article published in December 2008.

Researchers have found that the type of mental health services provided to the community can affect the rate of suicide. This is important research even though SafetyAtWorkBlog regularly questions the applicability of research undertaken in Scandinavian countries to the rest of the world. Bearing the cultural differences in mind, the research will stir debate and, hopefully, localised research along the same lines.

Below is the text of the press release about the research:

WELL-DEVELOPED COMMUNITY MENTAL-HEALTH SERVICES ARE ASSOCIATED WITH LOWER SUICIDE RATES

Well-developed community mental-health services are associated with lower suicide rates than are services oriented towards inpatient treatment provision in hospitals. Thus population mental health can be improved by the use of multi-faceted, community-based, specialised mental-health services. These are the conclusions of authors of an Article published Online first and in an upcoming edition of The Lancet, written by Dr Sami Pirkola, Department of Psychiatry, Helsinki University, Finland, and colleagues.

Worldwide, the organisation of mental-health services varies considerably, only partly because of available resources. In most developed countries, mental-health services have been transformed from hospital-centred to integrated community-based services. However, there is no decisive evidence either way to support or challenge this change.

The authors did a nationwide comprehensive survey of Finnish adult mental-health service units between September 2004 and March 2005. From health-care or social-care officers of 428 regions, information was obtained about adult mental-health services, and for each of the regions the authors measured age-adjusted and sex-adjusted suicide risk, pooled between 2000 and 2004 – and then adjusted for socioeconomic factors.

They found that, in Finland, the widest variety of outpatient services and the highest outpatient to inpatient service ratio were associated with a significantly reduced risk of death by suicide compared to the national average. Emergency services operating 24 hours were associated with a risk reduction of 16%. After adjustment for socioeconomic factors, the prominence of outpatient mental-health services was still associated with a generally lower suicide rate.

The authors conclude: “We have shown that different types of mental-health services are associated with variation in population mental health, even when adjusting for local socioeconomic and demographic factors. We propose that the provision of multifaceted community-based services is important to develop modern, effective mental-health services.”

In an accompanying Comment, Dr Keith Hawton and Dr Kate Saunders, University of Oxford Department of Psychiatry, UK, say: “The message to take from these findings must be that while well thought out and carefully planned new developments that increase access to secondary care services for mental-health patients are to be encouraged, measured progress towards flexible community care, not rapid ongoing change, should be the order of the day.”

The insidiousness of “reasonably practicable”

WorkSafe Victoria recently released a guideline, or clarification, on what it considers to be the issues surrounding “employing or engaging suitably qualified persons to provide health and safety advice“.

SafetyAtWorkBlog remains to be convinced that such a process will lead to better safety outcomes in the small to medium-sized enterprises at which this program is aimed. The OHS legislation clearly states that the employer is the ultimate decider on which control measures to implement to address a workplace hazard. This is echoed in the WorkSafe guideline

“It is important to note that employing or engaging a suitably qualified person to provide OHS advice does not discharge the employer from their legal responsibilities to ensure health and safety as required under Part 3 of the OHS Act. This duty cannot be delegated.”

A business manager will weigh up the advice sought or given from a variety of sources and make a decision. A good business manager will take responsibility for the good or bad results of their decision. But they need to have a clear understanding of their obligations and Victoria’s legislation could be confusing.

The guideline says that

“Employers are expected to take a proactive approach to identify and control hazards in the workplace before they cause an incident, injury, illness or disease.”

This reitereates one of the safety principles in the 2004 OHS Act

“Employers and self-employed persons should be proactive, and take all reasonably practicable measures, to ensure health and safety at workplaces and in the conduct of undertakings.”

But the principles are not legislative obligations. As Michael Tooma writes in his “Annotated Occupational Health and Safety Act 2004”

“… it is the intention of the Parliament that the principles be taken into account in the administration of the Act.”

The principles are there for judicial colour and community reassurance but with no real impact.

The obligations on an employer, the section that determines the actions and plans of the business owner or managers, are, as well as general duties:

“Duties of employers to employees

(1) An employer must, so far as is reasonably practicable, provide and maintain for employees of the employer a working environment that is safe and without risks to health……..

(2) Without limiting sub-section (1), an employer contravenes that sub-section if the employer fails to do any of the following-

(a) provide or maintain plant or systems of work that are, so far as is reasonably practicable, safe and without risks to health;

(b) make arrangements for ensuring, so far as is reasonably practicable, safety and the absence of risks to health in connection with the use, handling, storage or transport of plant or substances;

(c) maintain, so far as is reasonably practicable, each workplace under the employer’s management and control in a condition that is safe and without risks to health;

(d) provide, so far as is reasonably practicable, adequate facilities for the welfare of employees at any workplace under the management and control of the employer;

(e) provide such information, instruction, training or supervision to employees of the employer as is necessary to enable those persons to perform their work in a way that is safe and without risks to health. “

The “as far as is reasonably practicable” insertions allow business considerable flexibility in arguing the validity of their decisions after an incident but hamper the employer in being “pro-active” – (a hateful and lazy piece of business jargon).

The impediments to “pro-activity” can be seen in the general duties of Section 20 where

“to avoid doubt, a duty imposed on a person…to ensure, as far is reasonably practicable, health and safety requires the person –

(a) to eliminate risks to health and safety so far as is reasonably practicable:…..”

This contrasts with the objects of the, same, Act which states that one of the aims is

“to eliminate, at the source, risks to the health, safety and welfare of employees and other persons at work:…”

It is strongly suspected that a crucial element of OHS legislation and management will likely disappear and this is to eliminate hazards “at the source”. Outside of the objects of the Act this aim is not mentioned anywhere else in the legislation. “Reasonably practicable” will erase this important social and moral clause.

Eliminating something “at the source” encourages research into new ways of eliminating hazards by placing an obligation on us to determine the source. “Reasonably practicable” encourages us to research control measures until it is practicable to do so no more. That is a half-quest that solves nothing. What if Frodo was asked to dispose of the ring in Mordor only if “reasonably practicable”? The story would have been a novella instead of a classic trilogy.

Employer associations are lobbying for increased workplace flexibility. That has nothing to do with the health and safety benefits of the employees but rather the health and safety of the balance sheet. “Reasonably practicable” similarly focuses on business management and not safety management.

The battle against this insidious weakening of the OHS profession is not lost. Heart should be taken from the preparedness of governments to roll-back unpopular legislation such as some industrial relations initiatives. Hindsight can be an important motivator for change.

Recent fatalities data may sway some in government that OHS regulators are achieving their social and operational targets but OHS professionals know that fatality rates are not an accurate indication of the success of safety initiatives. New workplace hazards are appearing regularly and many of the new ones don’t result in death but lead instead to misery and an incapacity to live a healthy life or to work again in a chosen profession.

“Reasonably practicable” allows businesses to try, in differing degrees, to eliminate the hazards, such as psychosocial hazards, of its workforce and then shift them to social security and disability benefits. And why not? It seems that corporations can serve their clients and stakeholders “as far as is reasonably practicable” and then expect a bailout from government over their mismanagement. Immorality applies to much more than economics.

Sexual harassment and occupational health and safety

Some old-time safety professionals are struggling with the inclusion of psychosocial hazards in their safety management programs. Some deny the relevance of sexual harassment to their duties and hope that the issue can be contained within the human resources department, the “dark arts” of workplace safety.

Many of these same safety professionals are calling for more evidence-based decisions on workplace safety.

Evidence is now in on the social and work impact of sexual harassment. Australia’s Human Rights Commission has issued Effectively preventing and responding to sexual harassment: A Code of Practice for employers‘ which states on page 48

Employers have a common law duty to take reasonable care for the health and safety of their employees. This common law duty is reinforced by occupational health and safety legislation in all Australian jurisdictions.

An employer can be liable for foreseeable injuries which could have been prevented by taking the necessary precautions. As there is considerable evidence documenting the extent and effects of sexual harassment in the workplace, it has been argued that the duty to take reasonable care imposes a positive obligation on employers to reduce the risk of it occurring.

A work environment in which an employee is subject to unwanted sexual advances, unwelcome requests for sexual favours, other unwelcome conduct of a sexual nature, or forms of sex-based harassment, is not one in which an employer has taken reasonable care for the health and safety of its employees. A work environment or a system of work that gives rise to this type of conduct is not a healthy and safe work environment or system of work. An employer could be regarded as not having acted reasonably to prevent a foreseeable risk if practicable precautions are not taken to eliminate or minimize sexual harassment in the workplace.

Failure to fulfil the duty of care can amount to a breach of the employment contract as well as negligence on the part of the employer. This means that an employee who has been harmed could bring an action against their employer in contract or tort.

The guide can do with considerable translation to what businesses see as useful codes of practice in the application of safety management but perhaps that is for the private sector and State OHS regulators to work on.

There seems to be enough information available now on sexual harassment, fatigue, bullying, violence, fitness for work, shift work, depression and other matters, that the safety profession should be more embracing of these concepts in their own planning. Let’s hope that in this discipline we do not have to wait for generational change to achieve a change in approach.

Category: psychiatric

New research on behavioral safety

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A sort-of resolution for Paula Wriedt

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Eliminating hazards

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Workplace health initiatives in unstable economic times

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Mental support research

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The insidiousness of “reasonably practicable”

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Sexual harassment and occupational health and safety

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