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After the Storm: Weighing in on the OSHA Ergonomic Guidelines

A little more than 2 years have passed since OSHA released its voluntary ergonomic guidelines. The storm that enveloped the process leading up to the release of the nursing home, poultry processing and grocery retail guidelines has ceased. The big question: Have the guidelines produced results?

The controversy started in November 2000, when OSHA released an ergonomics rule that, according to industry representatives, would cost them anywhere from $20 billion to more than $100 billion a year. Businesses would be required to slow the pace of production, hire more workers, increase rest periods and redesign workstations or even operations, business representatives claimed. They also argued that such action would "federalize" the workplace.

OSHA, on the other hand, pointed to an estimated 4.6 million workers over a 10-year period who would be spared repetitive motion injuries if the ergonomics standard was allowed to stand. The agency estimated repetitive stress injuries, such as carpal tunnel syndrome and tendentitis, cost employers as much as $20 billion per year in workers' compensation costs, and estimated total savings from the standard would amount to $9.1 billion per year. It was not to be.

When Congress repealed the ruling in March 2001, labor organizations were dismayed. The unions, along with powerful figures in Congress, pressured OSHA and the Department of Labor to develop an effective, alternative plan for reducing workplace injuries related to poor ergonomic design or work practices. After months of brainstorming and head scratching, they did.

The plan: A new, flexible ergonomics plan that focused on industry-specific guidelines in lieu of regulations. The first set of guidelines, developed for nursing homes, was released in 2003, and subsequent ones developed for poultry processing and the grocery retail industry were released in 2004.

The new plan drew immediate condemnation from the labor sector, and Sen. Edward Kennedy, D-Mass., called the effort a collection of "small, symbolic gestures designed to protect big businesses." This time, OSHA was not backing down.

Present Day

Today, the question of whether the guidelines have had a substantial impact on the industries they were designed to help still is not entirely clear, as injury rates for workplace musculoskeletal disorders (MSDs) have been decreasing substantially for all three industries for over a decade.

It might be a bit early to judge the efficacy of the guidelines, warns Don Robinson, corporate ergonomist with Goldkist, one of the nation's largest chicken companies.

"Since the guidelines were issued about 2 years ago, companies that did not have some of them already in place in their programs probably spent a good part of 2005 doing so, so they only have had the additional year to look at results," he said.

Goldkist, according to Robinson, made only two modifications to its already-extensive ergonomics and safety program, which was established before OSHA's poultry processing guidelines were released. So, the impact the guidelines had on the company was minimal. But, he admits, the company's injury rates have been decreasing 20 percent for the past 5 years, and in addition, other poultry companies also have reported reduced injury rates.

"It's hard to tell if the guidelines contributed to our continued decreasing injury rates. Someone would have to do a detailed study," says Robinson. "But I believe the guidelines, along with some other elements, have helped contribute to our continued downward trend."

Another reason why it is difficult to assess the impact of the OSHA voluntary guidelines is because 2005-06 data from the Bureau of Labor Statistics on MSDs such as back sprains and carpal tunnel syndrome is not yet available. An OSHA spokesperson told Occupational Hazards only that the agency has not yet performed major studies of the guidelines' effectiveness, adding, "Many organizations have reported that our guidelines have been favorably received."

Increased Awareness

Cynthia Roth, president and CEO of Ergonomics Technologies Corp., an ergonomics and training firm based in New York, says she also has relied on information she received while visiting various companies several that fall under the industries for which OSHA designed the guidelines. Although she cannot absolutely attribute the success rates to the guidelines, Roth says it is too much of a coincidence.

"When you are there and you actually see the reduction in injuries, you realize what a big success it's been," Roth says. "Companies are learning ergonomics works."

One of the ways the guidelines have had a tremendous impact is by stimulating awareness among industry employers, Roth says. She believes employers, especially small companies such as "mom and pop" nursing homes, are becoming more attentive to how important ergonomics is for their business. "When you have a 20 percent reduction in workers' comp and a 20 percent reduction in lost work time, you can't argue with those numbers," she says. "That's money in the bank."

And money talks, which is the prime incentive for employers to follow the guidelines as if they were enforceable standards, according to Roth. Employers, she says, have acquired a total understanding of what their commitment to an ergonomic process means in terms of financial gain.

One industry where Roth says she has seen a lot of changes and where the cost-effectiveness of ergonomics is bearing fruit is in the grocery retail industry. Although she believes there is a lot of room for improvement, she's noticed that many grocery stores have taken steps to change the equipment and teach their employees to perform their duties in a much more ergonomic way for example, by having patrons bag their own groceries or having self check-out aisles so that the lines move faster.

"People like to shop at grocery stores where they don't have to wait forever in line," she explains. "So there's productivity intertwined with ergonomics."

Robinson agrees that ergonomics makes good business sense. "When an ergonomic change is made at Goldkist, sometimes we measure dollar savings from that and some of the numbers are very impressive," he says.

Although the poultry processing industry has reduced occupational injuries and illnesses by almost half during the last 10 years, BLS reported that out of the 3,000 cases with days away from work that occurred in poultry processing in 2002, more than 30 percent or 976 cases were MSDs. And in the grocery retail industry, there were 20,778 MSD cases involving days away from work.

MSD Rates High at Nursing Homes

Nursing homes, too, have yet to see a significantly reduced number of MSDs. Although ergonomics-related injuries have fallen, MSDs still account for more than a third of all workplace injuries that require time off from work, according to BLS. From 2003-04, the total cases of MSDs decreased 12.9 percent and the incidence rate fell from 14.97 to 12.77 per 1,000 workers.

William Charney, a national healthcare safety consultant and ardent critic of the OSHA voluntary guidelines, says that these numbers, despite the decrease, are still high. "If you look at BLS data from state to state, you can see that nursing homes are still having outrageous incidence rates," he says. Charney states that impact can't be proven and he challenges "anyone in OSHA to do that because even if there is a slight decrease, the incidence rate still is much higher and outpaces the voluntary guideline implementations."

A reason why there is no impact, according to Charney, is that by making the guidelines voluntary, companies tend to not implement them, and if they did, they would do so in a haphazard way. Evidence of this already can be seen in the nation's nursing shortage, both in health care and in nursing homes, Charney explains. If every nursing home was abiding by the OSHA guidelines, there wouldn't be as high a turnover rate in that industry, he argues, which in turn becomes a dangerous situation for its residents.

According to various labor groups, one of the reasons why nurses are leaving the profession is because of their continued risk of back and shoulder sprains as well as other ergonomic injuries as a result of lifting patients without any assistance. Although the guidelines provide examples of how mechanical lifting devices have proven effective for some nursing homes such as the Wyandote County Nursing Home in Sandusky, Ohio, which is cited in the guidelines many nursing homes do not use mechanical lifting devices.

Charney, seeing that the shortage of nurses has spun out of control, proposed a bill in the state of Washington signed into law March 8 in which the state will mandate hospitals to provide mechanical lift equipment for the safe lifting and moving of patients. Although it doesn't cover nursing homes yet, Charney says it will do so in the next year or two. He plans to tour the country in hopes that every state will follow Washington's lead.

"We are facing an epidemic, a crisis," he says. "People need to understand that when a nurse from a nursing home or hospital is putting themselves at risk of injury, they are also putting the patient at risk. This is why there is a need to put a mandate on protecting workers."

Gary Orr, an ergonomist who helped set up the ergonomics standard for OSHA and helped devise the guidelines, says that companies willing to improve working conditions in their companies will look at the guidelines, regardless of whether they are mandated or not. He states the increased numbers of MSDs, at least in the nursing home industry, are due to the fact that the guidelines are working.

"One of the goals of the guidelines is to increase reporting of injuries," he says. "If you are basing the success or failure of the guidelines based on just that, that's not a correct assessment."

The one problem he sees is that workers are not getting involved in improving the process. He cites the example of a small nursing home in Idaho where employees were against using the ceiling lifts the nursing home had purchased because they didn't understand what their use was. "It's important to get employees to understand why they need to use the equipment," he says. "They will become more receptive to using the equipment and also will become knowledgeable of their rights as the guidelines states."

"Vague Language"

Many critics of the OSHA guidelines have pointed out that the language used in the guidelines is very vague. Charney explains the federal government needs "to get out of this non-prescriptive language motif that they are in and go after more descriptive language." Robinson, on the other hand, believes that the general nature of the guidelines benefits companies as it gives them the flexibility to adapt some of OSHA's elements to their own plan.

Mary Matz, an ergonomics consultant with the Department of Veterans Affairs and one of the consultants for the nursing home guidelines, says since there is new technology now available, the language can use some tweaking. "Somehow new information needs to be included and made available to those who read the document online," she says.

Matz, despite having helped OSHA devise the guidelines which mirror the guidelines VA already has in place says the guidelines probably would be more beneficial if they were enforced. Another concern she has is that although the nursing home guidelines do mention they are applicable to other clinical areas, she says she believes such a guideline should encompass all health care organizations that provide direct patient care.

"Although injury statistics point to nursing homes as higher risk than others, pain and discomfort due to patient handling is found universally throughout most clinical areas in health care organizations,' she says.

But for the time being, Matz says she is grateful for at least having the guidelines available as opposed to not having anything at all.

"It is no mystery that because of ergonomics, the injury rates have gone down," she says. "I'm not sure the OSHA guidelines alone have been responsible for the increased interest and commitment to improving ergonomic safety, but I do see increased awareness of the problem by many, but certainly not all or even enough."

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