Lynda S. Robson

Methodological criteria for evaluating occupational safety intervention research

We describe the importance of evaluating workplace safety interventions. Based on the literature and other scources, we list eight areas for which readers can assess the quality of reports evaluating these interventions. The areas are: intervention objectives and their conceptual basis; study design; external validity; outcome measurement; use of qualitative data; threats to internal validity; statistical analysis; and study conclusions. Good quality evaluations can help avoid wasting limited time, money and effort on ineffective or even harmful interventions.

A systematic review of the effectiveness of occupational health and safety training

OBJECTIVES Training is regarded as an important component of occupational health and safety (OHS) programs. This paper primarily addresses whether OHS training has a beneficial effect on workers. The paper also examines whether higher engagement OHS training has a greater effect than lower engagement training. METHODS Ten bibliographic databases were searched for pre-post randomized trial studies published in journals between 1996 and November 2007. Training interventions were included if they were delivered to workers and were concerned with primary prevention of occupational illness or injury. The methodological quality of each relevant study was assessed and data was extracted. The impacts of OHS training in each study were summarized by calculating the standardized mean differences. The strength of the evidence on trainings effectiveness was assessed for (i) knowledge, (ii) attitudes and beliefs, (iIi) behaviors, and (iv) health using the US Centers for Disease Control and Preventions Guide to Community Preventive Services, a qualitative evidence synthesis method. RESULTS Twenty-two studies met the relevance criteria of the review. They involved a variety of study populations, occupational hazards, and types of training. Strong evidence was found for the effectiveness of training on worker OHS behaviors, but insufficient evidence was found of its effectiveness on health (ie, symptoms, injuries, illnesses). CONCLUSIONS The review team recommends that workplaces continue to deliver OHS training to employees because training positively affects worker practices. However, large impacts of training on health cannot be expected, based on research evidence.

A randomised controlled study to evaluate the effectiveness of targeted occupational health and safety consultation or inspection in Ontario manufacturing workplaces

Objective From 2004 to 2008, the prevention system in Ontario, Canada ran the High Risk Firm Initiative, an injury-experience based targeted consultation or inspection programme. Our objective was to establish whether prevention system targeting of firms was effective in improving injury outcomes. Methods Randomised controlled parallel groups. Population included all manufacturing firms registered with the Ontario Workplace Safety & Insurance Board in 2005. Firms ranked between the 2nd and 10th percentile on a composite measure of occupational health and safety performance were randomised to three study arms in 2006: targeted for Health & Safety Association (HSA) consultation, targeted for Ministry of Labour (MOL) inspection, or services as usual. Data included firm characteristics (sector, size, years in business, region, branches), work injury claims 2002–2008 and measures of consulting and inspecting activity. Negative binomial generalised estimating equations modelled claim and disability day rates by study arm and year, controlling for firm characteristics. Results Among 2153 firms, firm characteristics and 2002–2005 rates of work injury claims and disability days were similar across arms. Firm outcomes were significantly different from year to year, but study arm by year interactions were insignificant indicating similar trends for all three study arms. 83% of HSA targeted firms were contacted and 63% engaged while 75% of MOL targeted firms were inspected with orders written in 56%. Conclusions Consultation and enforcement programmes as implemented were not sufficient to reduce work injury outcomes over 21 month follow-up. Lack of benefit could be due to non-specific firm selection methods, limited firm participation in interventions, low intervention intensity or insensitivity of available outcomes.

Something Might be Missing From Occupational Health and Safety Audits: Findings From a Content Validity Analysis of Five Audit Instruments

Objective: The objective was to examine the content validity of occupational health and safety (OHS) management audit methods. Methods: The documentation used by five broader public sector service organizations to audit OHS management in workplaces was analyzed with reference to a recent OHS management standard (CSA Z1000). Results: A relatively high proportion of CSA Z1000s content (74%) was partially or fully represented on average in the audit methods. However, six management elements were found to be incompletely represented in three or more of the methods. The most extreme example is the Internal Audits element whose content was completely missing for three of the audit methods. Conclusion: Some OHS management audit instruments in current use are incomplete relative to a recent OHS management standard. It may be that some instruments warrant revision to better reflect current expert consensus.

Managing Safety and Operations: The Effect of Joint Management System Practices on Safety and Operational Outcomes.

Objective: The aim of this study was to determine whether management system practices directed at both occupational health and safety (OHS) and operations (joint management system [JMS] practices) result in better outcomes in both areas than in alternative practices. Methods: Separate regressions were estimated for OHS and operational outcomes using data from a survey along with administrative records on injuries and illnesses. Results: Organizations with JMS practices had better operational and safety outcomes than organizations without these practices. They had similar OHS outcomes as those with operations-weak practices, and in some cases, better outcomes than organizations with safety-weak practices. They had similar operational outcomes as those with safety-weak practices, and better outcomes than those with operations-weak practices. Conclusions: Safety and operations appear complementary in organizations with JMS practices in that there is no penalty for either safety or operational outcomes.

The development and testing of a tool to assess joint health and safety committee functioning and effectiveness

BACKGROUND Concern regarding functioning and effectiveness of joint health and safety committees (JHSCs) in Ontario hospitals was raised following the Severe Acute Respiratory Syndrome outbreak in 2003. A subsequent literature review revealed a lack of studies focused within the healthcare sector. METHODS A tool to measure JHSC effectiveness was developed by a panel of occupational health and safety experts based on a framework from the healthcare sector. Usability testing was conducted in two phases with members of five hospital JHSCs before, during and after a committee meeting. RESULTS Usability of the tool was scored high overall with an average of > 4 on a 5 point scale across twelve items. Downward adjustment of self-assessment scores was reported following JHSC meetings. CONCLUSION Findings demonstrated that the tool was easy to use, effective in supporting discussion and in assisting participants in reaching consensus on rating a large number of JHSC characteristics. Am. J. Ind. Med. 60:368-376, 2017.

Financial incentives in workers’ compensation: an analysis of the experience-rating programme in Ontario, Canada

Abstract Objectives: To investigate the incentive for health and safety and cost management at the firm level associated with the degree of experience rating in a retrospective workers’ compensation programme in Ontario, Canada. Methods: We use panel data on all firms in the principal Ontario experience-rating programme between 1998 and 2007 to estimate regression models of the relationship between the degree of experience rating and various claim rates. We control for firm characteristics and contextual factors that may be associated with the outcomes under investigation. Results: A higher degree of experience rating was found to be associated with a lower lost-time claim rate and a higher no-lost-time claim rate. The relationship with the total claim rate was insignificant. The degree of experience rating was also associated with outcomes that proxied for cost management practices. Conclusions: A higher degree of experience rating appears to be associated primarily with increased secondary prevention efforts (ie work disability prevention), rather than primary prevention. There is also some indication of an incentive for cost management. Workers’ compensation authorities need to consider how best to ensure there are appropriate checks and balances in financial incentives programmes.

941 The implementation of violence prevention policies and programs in hospitals

Introduction Violence in hospitals is a serious occupational health and safety (OHS) issue affecting the physical and mental health of front line staff, as well as, the quality of patient care. In 2010, the province of Ontario (Canada) introduced legislation that directs hospitals to put into place violence prevention and management systems. Our study examined how five Ontario hospitals have developed and implemented their violence prevention programs. Methods Semi structured interviews were conducted with eight key informants external to hospitals (legislators, union leaders, hospital associations), management and occupational health and safety specialists in hospitals (n=40), 21 focus groups (n=115) and interviews (n=6) with front line workers. Five hospitals participated in the study. Interview and focus group questions focused on the effect of the legislation on the development of violence prevention programs and how these were implemented across departments. Once data were collected, a code list was developed by the research team by reviewing the transcripts. Each transcript was coded by two researchers and then a thematic, inductive analysis was carried out. The constant comparative method was used to identify differences and similarities across hospitals and to understand factors that shape hospital policies and practices in the area of violence prevention and management. Findings Our study findings suggest that while legislation sets parameters for the development of policies, serious violence-related events and the presence of a violence prevention ‘champion’ bolster long-term commitment to violence prevention in hospitals and the development of sustainable programs. We discuss four key components related to the prevention and management of violence in hospitals, namely; security systems, patient ‘flagging’, codes and alarms and incident reporting. Discussion Our findings detail how management commitment, workplace culture and broader structural factors can shape the implementation of hospital policies around violence prevention and reporting. Study recommendations focus on the long-term sustainability of violence prevention practices in the acute care sector and the implications this can have on worker health.

Development and Evaluation of a Questionnaire to Document Worker Exposures to Mechanical Loading at a Workplace Level

OCCUPATIONAL APPLICATIONS Despite many biomechanical risk factors being clearly linked to the development of musculoskeletal disorders, little measurement of the prevalence of physical loads in workplaces is being conducted. Through a collaborative partnership with unions, a health and safety organization, and researchers, this project developed and tested a questionnaire to document exposures to physical workloads in workplaces. Surveys were first completed independently by two members of each organizations joint health and safety committee. The same survey was later completed collectively to arrive at a consensus between the two members. Results of the surveys were then compared to findings from a walk-through conducted by an ergonomist. Substantial to excellent agreement was found between the identification and assessment of exposure levels to 26 types of physical loading by the ergonomist and workplace. Such a survey could be an efficient technique to characterize the loads to which workers are exposed. Such data could have value for targeting prevention activities at a workplace or jurisdictional level.TECHNICAL ABSTRACT Background: The presence and level of exposure to mechanical risk factors can be considered leading indicators in the development of musculoskeletal disorders. Although there are multiple methods for musculoskeletal disorder risk assessment, most of these methods record data related to an individual person performing a specific task. Rather in this questionnaire, we are collecting the exposure data at the workplace level (i.e., for all people experiencing this type of load). Purpose: The aim of this study was to develop and test a survey to document the presence and levels of multiple types of physical loading in a workplace. Methods: A survey requesting information on exposure to 26 types of loading was developed. It was distributed to management and worker representatives for their individual and then their consensus ratings. The same survey was completed by an ergonomist during a site visit. Results: Complete data sets were obtained from 30 workplaces across a variety of sectors. The most prevalent loads reported were sitting, neck bent or twisted, computer use, and carrying loads. For the presence or absence of specific loads, the consensus and ergonomists ratings agreed well with over 90% for nine of 26 load types and over 70% agreement for 10 other load types. For a calculated exposure index, only four load types differed significantly across the two types of raters. Conclusions: The study demonstrates that a survey completed by individuals familiar with the workplace could be used to document exposure to physical loading at a workplace level in an efficient manner. Such a survey may be useful in understanding the nature and prevalence of such exposures and targeting prevention activities at a workplace or jurisdictional level.

Response to Weinstock and Slatin's (2012) critique of IWH-NIOSH systematic review of the effectiveness of OSH training.

This commentary responds to the recent critique by Weinstock and Slatin [1] of our systematic review on the effectiveness of occupational safety and health (OSH) training conducted jointly by the Institute for Work & Health (IWH) in Canada and the National Institute for Occupational Safety and Health (NIOSH) in the United States [2, 3]. We address misunderstandings of our perspectives on training, especially empowerment training, and the evaluation of such training.