Work Organization and Stress-Related Disorders
Outcomes
Outcomes are events, occurrences, or conditions that indicate progress
in achieving the purpose of the program. Outcomes can be viewed from
two different perspectives-ultimate and intermediate. For an occupational
safety and health research program like the NIOSH Work Organization
and Stress-related Disorders Program, ultimate outcomes
are reductions in a particular type of worker injury or illness, or
a reduction in exposures that result in injury or illness. Injuries
and illnesses have complex causes, and any effect of program activities
on rates can take years to be seen. Therefore, outcomes are often
measured on an intermediate timeframe. Intermediate outcomes
are necessary steps that lead to ultimate outcomes, for example, development
and implementation of guidelines that will lead to reductions in exposures
and risk of injury or illness. For occupational safety and health
research programs, achieving intermediate risk reductions is as important
as achieving the ultimate outcome of decreasing injury and illness
incidence rates.
Intermediate Outcomes
NIOSH works with Florida Department of Health to reduce safety and
health risks in emergency responders
NIOSH is working with the Florida Department of Health to minimize the
extreme stresses to which their workers are exposed during hurricane
response and recovery, and to improve emergency response operations.
Survey data from 5,000 emergency response workers are being used to
identify and reduce organizational problems and other factors that
create stress and obstruct emergency response operations during hurricanes.
Fifteen thousand Florida emergency response workers stand to benefit
from this effort, leading to improvements in the effectiveness of
emergency response and well-being for virtually the entire population
of Florida.
Improved rest break schedules developed by NIOSH implemented among
office workers
An experimental rest break schedule developed by NIOSH was found to reduce
musculoskeletal discomfort, fatigue, and eyestrain during evaluations
at three Internal Revenue Service (IRS) Centers, and was subsequently
implemented for 1,000 IRS data entry workers. Improved rest break
schedules of this nature are now being heavily marketed for application
in workplaces with computer-intensive tasks, and these interventions
are expected to result in significant reductions in worker morbidity.
This expectation is supported by the results of epidemiological research
demonstrating that improved rest break schedules are significantly
associated with long-term (2-year) reductions in medically-diagnosed
musculoskeletal disorders.
NIOSH research to improve standards for limiting exposure to
hand-transmitted vibration
In the United States, more than 1.5 million workers are exposed to
hand-transmitted vibration through the use of powered and pneumatic
hand tools. NIOSH has designed studies to directly assess how various
characteristics of vibration exposure, the duration of exposure, and
other work organization factors affect the risk of developing a vibration-induced
injury. These data, along with the data from other labs are being
used by the International Standards Organization (ISO), the American
National Standards Institute (ANSI), and the European Union to revise
dose-response relationships and establish daily limits on the amount
of time that workers should be exposed to vibration. Workplaces use
these standards to limit the exposures of the workers to vibration
by setting up work rotation schedules or using devices to protect
workers from the exposure.
NIOSH Web site widely used to improve methods in work organization
research
NIOSH recently developed a searchable database
of assessment methods for characterizing the organization of work
to facilitate research on the associations between work organization
and worker safety and health. The database presently maintains records
for more than 40 assessment instruments containing more than 185 measures
of work organization. Evidence suggests this resource is being used
extensively by NIOSH stakeholders in academia to improve research
on understanding and preventing workplace illness and injury related
to work organization factors. In the first 6 months of operation,
the Web site received more than 3,800 visitors who queried more than
1,500 topics.
NIOSH training exercise to improve work organization and reduce farm
injury widely adopted by agricultural training programs
In collaboration with extramural partners, NIOSH has developed a
computer-based training program that enables farmers and their families
to better understand the close connection between farm workload demands
and risks for injury and stress, and ways to reduce these risks. This
participatory exercise ("The Kayles' Difficult Decisions") allows
farm family members to see how easy it is to be caught up in the day-to-day
requirements of keeping their farm running without realizing the degree
to which family members are exposed to serious injury-including injuries
that might cause the family to lose their farm. The exercise is being
used widely to improve farm worker awareness of ways to reduce their
risks of injury. Working with the Southeast Center for Agricultural
Health and Injury Prevention, the University of Kentucky College of
Agricultural Economics, the American Farm Bureau, and other groups,
this simulation exercise is being delivered in county extension meetings,
farm safety training groups, and college and high school classes;
it has also been used to introduce a farm safety intervention to promote
rollover protective structures on tractors.
NIOSH tools widely used to improve work organization research
NIOSH developed the Generic Job Stress Questionnaire (GJSQ) to provide
NIOSH stakeholders in academia with a new tool for assessing work
organization factors in studies on work organization and worker stress,
safety, and health. The GJSQ measures a wide variety of work organization
variables, including job control, job demands, social support, job
security, work schedules, etc. The GJSQ has become a standard research
tool and is used extensively in work organization research internationally
to better understand the safety and health risks of work organization and
ways to reduce these risks. It has been translated into Japanese, Korean,
and Spanish.
NIOSH method to improve miner safety behaviors widely adopted for mine
safety training
NIOSH pioneered a new training method to improve miners' decision-making
skills in responding to mine emergencies (e.g., first aid, self-rescue,
and escape), and to integrate safety concepts within the context and
performance of routine mine work. The training
exercises are based on events in actual mine accidents and emergencies
and reflect the problems and predicaments encountered by miners in these
real-life events. Each problem-solving story is presented in a booklet
as an unfolding story, and trainees make a series of choices among good
and bad action alternatives at critical decision points. Feedback is
provided about the consequences of chosen actions. One hundred and forty-seven
organizations purchased the exercises from the National Mine Health
and Safety Academy over a 2-year period and were subsequently queried
about the exercises. Sixty percent of the 52 respondents rated the exercises
as more useful than traditional instructional materials, 40% as equally
useful, and 0% as less useful. Ninety-four percent of the trainers judged
the exercises as a good value; 92% planned to order more simulations
in the future. http://www.cdc.gov/niosh/mining/pubs/pubreference/outputid48.htm
NIOSH increases professional capacity for research and practice to
address work organization problems
In 1996 NIOSH entered into a cooperative agreement with the American
Psychological Association to foster graduate training in safety, health,
and the organization of work. By 2002, start-up funding had been provided
to 11 universities for interdisciplinary graduate programs that blended
training in psychology and occupational safety and health. Fifty-three
graduate students completed this course of study within the timeframe of
the cooperative agreement (1996-2002). By 2004, two universities (U.
Connecticut; Portland State U.) had successfully competed for NIOSH
training grants for sustained graduate training programs with this
interdisciplinary focus. This effort has significantly increased the
supply of researchers and practitioners with the capacity to address work
organization problems in the workplace.
NIOSH-funded research instrumental in setting safe limits for medical
resident working hours
Three studies conducted at Harvard University and co-funded by NIOSH
examined the impact of long and extended work hours on medical interns'
clinical performance and risk for car crashes. The findings were included
in the rationale for standards setting by the Accreditation Council for
Graduate Medical Education (ACGME), which instituted standards in 2003
that limit duty hours for resident physicians in all accredited programs.
ACGME accredits more than 8,000 programs that provide for the education of
100,000 residents, and is the entity that enforces resident duty hour
limits. Two years after the establishment of the ACGME duty hour
standards, the vast majority of residency programs are complying with
these standards according to a confidential internet survey
NIOSH report instrumental in standards to improve safety in commercial
vehicle operation
The NIOSH publication Overtime and Extended Work
Shifts: Recent Findings on Illnesses Injuries and Health Behaviors was
influential in the Federal Motor Carrier Safety Administration's 2005
final rule that established hours of service for commercial drivers. This
rule places an upper limit on the daily drive time and on-duty time to
reduce the risk of fatigue-related crashes and illness in commercial
vehicle operation, affecting more than three million drivers nationally.
End Outcomes
NIOSH developed training exercise saves lives during mine
emergencies
NIOSH developed the Mine Emergency Response Interactive Training
Simulation (MERITS) to improve the ability of mine emergency response
leaders to operate a command center during a major mine emergency.
MERITS is an internet delivered, computer-based exercise that simulates
an emergency in a small underground coal mine. It can be used in settings
with limited resources available for larger-scale mock drills, and
can be used to train small numbers of individuals cost-effectively.
In the fall of 2003, the Pennsylvania Bureau of Deep Mine Safety adapted
this exercise for its annual refresher training for rank-and-file
miners and for its training course for new miners. In testimony before
the U.S. Senate Appropriations Subcommittee on Labor, Health and Human
Services, and Education, David E. Hess, Secretary, Pennsylvania Department
of Environmental Protection, stated that training, including this
exercise, was a key factor in the success of the Quecreek mine disaster
response. Copies of the exercise have been requested from safety and
emergency response professionals in 28 states, the District of Columbia,
and 19 foreign countries.
NIOSH research on work organization and universal (standard)
precautions used to reduce injury among health care workers
In a series of studies, NIOSH partnered with Johns Hopkins University
to assess work organization factors associated with worker compliance with
Universal (Standard) Precautions, and then entered into cooperative
agreements to develop and test work organization interventions to improve
worker compliance with standard precautions to reduce exposure to
HIV/AIDS. One intervention, involving worker feedback on safe work
practices, was associated with fewer needlestick injuries, fewer exposures
to blood and body fluids, and a higher frequency of using gloves when
performing invasive procedures. In another intervention, the creation of
total quality improvement (TQI) teams resulted in a 37% decline in
needlestick injuries after the intervention. These NIOSH-sponsored work
organization HIV/AIDS exposure studies have inspired additional
intervention activities. Questions from the NIOSH studies were used in
surveys of Costa Rican health care facilities, and the results used to
train 3,731 workers from 14 hospitals and 19 clinics on the importance of
work organization factors for improving safety and health in health care
settings.
Sources:
Compliance
with universal precautions among health care workers at three regional
hospitals
Am J Infect Control 1995 Aug;23(4):225-236
The
impact of multifocused interventions on sharps injury rates at an
acute-care hospital
Infect Control Hosp Epidemiol 1999 Dec;
20(12):806-811
