The Changing Organization of Work and the Safety and Health of Working People

Knowledge Gaps and Research Directions

Chapter 3: Safety and Health Effects Research

• Gaps in Research on Safety and Health Effects of the Changing Organization of Work
  • Uncertain Effects of New Organizational Practices
  • Organization of Work and the Changing Profile of the Workforce
• Safety and Health Effects Research Needs
  • New Organizational Practices, Workplace Effects, and Risk of Illness and Injury
  • Effects in Worker Subpopulations: Women, Ethnic and Racial Minorities, and Aging Workers
  • Effects in High-Risk Sectors

Gaps in Research on Safety and Health Effects of the Changing Organization of Work

Several disciplines have contributed to a steady accumulation of research attesting to the importance of organization of work as a determinant of workplace safety and health. However, this area of study remains loosely organized and has been unable to keep pace with new organizational practices and safety and health concerns raised by these practices. This section provides examples of prominent trends in the organization of work (including human resource practices) that have arisen in recent years and highlights areas of uncertainty about their safety and health consequences. Workforce characteristics are treated as an additional and cross-cutting topic of research need because the effects of these trends cannot be fully understood without considering the changing makeup of the workforce.

Uncertain Effects of New Organizational Practices

Process reengineering, organizational restructuring, and flexible staffing are prime examples of practices that have swept through industry in recent years but have been insufficiently studied from an occupational safety and health perspective. In the following discussion these practices and other prominent developments (e.g., hours) are examined together with gaps in understanding how they may influence the jobs, safety, and health of workers.

Reengineering of production processes

Beginning in the mid-1980s, organizations in the United States invested heavily in innovative production processes to foster improvements in quality and efficiency and increase their ability to respond rapidly to changing market demands. Various names have been given to these new work systems, including high performance and high involvement work systems, flexible workplace practices, total quality management (TQM), and lean production. Theoretically, and in contrast to mass production technologies and traditional command and control management systems, these types of work systems seek to capitalize on the ingenuity, creativity, and problem-solving ability of workers to make the production process more efficient. High performance or high involvement work systems profess to shift decision-making authority downward to teams of workers who are trained to be proficient in a variety of tasks. TQM and lean production try to reduce production impediments by using process simplification to eliminate wasted time and motion, paring inventories through just-in-time methods, and by emphasizing continuous improvement. In principle, TQM and lean production give greater voice to workers to achieve these goals, but generally, this influence extends to problem solving at the point-of-production only. A hierarchical management structure may still be retained.

Aspects of high performance and lean production work practices seem to be spreading rapidly throughout the economy. Surveys suggest 30% to 50% of organizations with 50 or more workers engage in teamwork [Gittleman et al. 1998; Kaminski 2001; Osterman 1994], 25% of these organizations practice job rotation [Gittleman et al. 1998; Osterman 1994], and 25% to 50% employ TQM practices [Gittleman et al. 1998; Osterman 1994].

On the surface, these practices resemble positive principles of work organization (i.e., emphasizing worker autonomy, task variety, learning opportunities, etc.) that are highlighted in job enrichment theory and contemporary models of healthy work [Karasek and Theorell 1990]. Thus they would appear to hold promise for improvements in worker health and organizational performance. However, the limited research data on these practices are less encouraging, showing mixed effects on employee empowerment or control and raising fears of work intensification. Further, studies of lean production in the automotive industry demonstrate increased risk of musculoskeletal disorders although evidence of adverse outcomes in other industrial settings is more equivocal (see Landbergis et al. [1999] and Smith [1997] for a summary of these concerns and findings).

Additional study is needed to permit generalizations regarding safety and health effects of these new work systems and to gain insights regarding circumstances under which they promote safe or unsafe and healthy or unhealthy work. Since, in practice, these work systems are seldom implemented in a standardized fashion, their effects on worker safety and health may depend on their specific characteristics and the implementation process.

Organizational Restructuring and Downsizing

Organizational downsizing reached record levels by the early 1990s, when a third or more of major organizations engaged in broad workforce reductions on a yearly basis [AMA 1997]. Although risk of job displacement receded steadily in subsequent years [AMA 2000; Hipple 1999], the present economic downturn has produced a new wave of workforce reductions as confirmed by BLS data showing a substantial increase in mass layoffs in 2001 [BLS 2001]. Also, the fraction of job loss due to structural reasons (abolishment of positions or shifts) has continued to grow over the last two decades and presently accounts for 25–30 percent of all job displacement [Hipple 1999]. The continuing risk of involuntary job displacement has coexisted with periods of brisk job creation that has resulted in high levels of turnover due to voluntary separations [BNA 2000]. This volatility in the recent job market poses a threat to stable and long-term relationships between employers and workers. Recent analyses indicate declining job stability from the 1980s to the 1990s for male workers and longer-tenured workers, and to the early 1990s for African American workers [BLS 2000; Neumark et al. 1997].

These trends raise multiple questions and concerns that have received only sparse study. Too little is known about the safety and health risks to workers who face or survive episodes of downsizing, or the effects of downsizing and outsourcing on the capacity of organizations to provide occupational health services and programs for workers. Also, concern exists that high rates of job destruction and creation in an organization may threaten its ability to accumulate and store safety knowledge. High rates of job destruction and creation may also lead to high levels of stress from chronic employment uncertainty, particularly since the jobs created may not provide the same level of compensation and benefits nor the same quality of working conditions.

Flexible Staffing and Other Human Resource Innovations

Agency-supplied temporary workers and workers in other alternative employment arrangements (independent contractors, contractor-supplied labor, and on-call workers) constitute nearly 10% of the workforce according to data from the BLS CPS [DiNatale 2001]. Data from the BLS Current Employment Statistics Survey (CES) and other sources suggest, however, that the temporary help sector of the economy is larger than reflected in the CPS and has been growing steadily [Brogan 2001; CRS 1999; Franklin 1997; Houseman 1997]. According to the CES, for example, the total number of jobs in the temporary help industry multiplied 6-fold to nearly 3 million during the period 1982–1998, whereas total employment during this period grew about 40% [CRS 1999; GAO 2000].

Flexible employment practices seem to result from strategic efforts by organizations to adjust staffing in response to fluctuating market demands, seasonal needs, and absent permanent workers. At the same time, labor costs are contained by relying on a contingent workforce to whom the organization has minimal or no obligation for long-term employment, benefits, training, or responsibilities under labor law [CRS 1999; DOL 1999b; Houseman 1997; Jorgensen 1999; Peck and Theodore 1998]. Increased labor supply from youth, women, and aging workers (who may not always desire longterm employment relationships) may also contribute to the upward trend in temporary employment.

Little is known, however, about the impact of flexible employment practices on worker safety and health, and a host of concerns have been raised. Proponents of alternative employment arrangements point to flexible scheduling (that can lead to improved work-life balance) and avenues to permanent employment as potential benefits for workers. Critics charge, however, that flexible employment practices are leading to a downward restructuring of the labor market that evades legal and contractual obligations to workers and exposes them to financial and health risks. In this regard, statistics show that most agency-supplied temporary workers do not prefer temporary employment, and they are less likely than traditional workers to receive health or pension benefits [DiNatale 2001; Houseman 1997]. Concern also exists that organizations may shift hazardous jobs and tasks to members of the alternative workforce, that these workers may be less likely to recognize and report hazards and injuries, and that they may be at increased risk of stress owing to precarious employment.

However, speculation far outstrips the empirical data on all of these concerns. For example, despite the strong growth in temporary employment since the mid-1980s, empirical study of safety and health experiences among temporary workers is scarce.

Other human resource programs have emerged in recent years and may ease or exacerbate risk of stress, illness, and injury among workers. Examples include incentive pay systems (e.g., gainsharing), defined contribution and self-managed health benefits, work-life programs (e.g., flexible work arrangements, dependent care programs, concierge benefits), and absenteeism polices that penalize workers for taking any type of leave. However, like flexible staffing arrangements, the implications of these practices for worker safety and health have received little investigation.

Long hours of work

American workers are spending more and more time on the job. Especially dramatic is the steady increase in working hours for women and primeage working couples, the latter contributing nearly four additional months of annual work time since the 1970s [Bluestone and Rose 1998; DOL 1999a]. Average annual working hours in the United States presently exceed the average for Japan and all of Western Europe, except for the Czech Republic and Hungary [ILO 1999]. Evidence of risk to safety and health from long hours of work is found in the research literature [Hanecke et al. 1998; Rosa 1995; Spurgeon et al. 1997]. In a recent study of German workers, an exponential increase in injury risk was observed beyond the 9th hour of work [Hanecke et al. 1998]. However, the body of research literature on safety and health effects of long work hours is surprisingly small. Furthermore, little is known about the interaction of long work hours with demanding work schedules (nightwork, shiftwork, etc.), with different job characteristics and exposures, with the intensification of work, and with mandatory and unplanned overtime.

Other key developments—new technology, telecommuting, and home work

Although home work is not new, increasing numbers of people are working from home or virtual workplaces, aided by new computer and communications technologies. Extrapolation from various surveys suggests that the number of telecommuters has increased dramatically to 16 million workers or more during the decade of the 1990s [DOT 1993; International Telework Association and Council 2000; Kensington Technology Group 1998], although these numbers underestimate the prevalence of work at home in general [Edwards and Field-Hendrey 1996]. This trend toward a seamless work-life paradigm revisits questions about safety and health in home work. On one hand, home work and telecommuting arrangements may reduce stress and injury risk by harmonizing work and family demands and minimizing daily commutes. Balanced against these presumed benefits are risks from loss of safety oversight, introduction of occupational hazards into the home environment, blurring of work and family roles, and isolation from peers yet feeling constantly tethered to the workplace.

Organization of Work and the Changing Profile of the Workforce

Researchers acknowledge that the occupational safety and health field, including the job stress literature, has not given due attention to the special circumstances and risks encountered by women [Stellman 1999] and by racial and other minority populations in the workforce [Frumkin and Pransky 1999]. Present trends in the organization of work and employment create an even more acute need to attend to these populations. For example, evidence shows that (1) women are disproportionately represented in the growing service sector [DOL 2001a] and in less favorable jobs (lower pay with restricted benefits and flexibility) [Beers 2000; DOL 2001b; Heyman 2000]; (2) they account for almost all of the recent growth in working hours [Bluestone and Rose 1998; DOL 1999a]; and, (3) as their presence in the workplace has increased, their risk of job displacement has surpassed the risk for men [Hipple 1999]. Also, the growing pool of agency-supplied temporary labor is disproportionately young, female, and African-American. African-American women, for example, constitute 21% of the workforce provided by temporary help firms—nearly twice their representation in the traditional workforce [DiNatale 2001].

Nonetheless, few studies have investigated the implications of the changing organization of work for the safety and health of women and minority populations. To what extent do these employment circumstances expose women and minorities to hazardous work and the stresses of marginal employment? To what extent do their jobs provide otherwise unavailable access to the benefits of employment? What are the net effects on worker safety and health?

Changes in organization of work also interact with the aging of the workforce to raise questions regarding safety and health risk. The population of workers 55 and older is projected to grow much faster than the population of workers aged 25–54 [Fullerton 1999] and, among longer-tenured workers (3 or more years tenure), this older group is at higher risk for displacement with greater earnings losses [Helwig 2001; Hipple 1999]. Researchers have not investigated the safety and health implications of these and other circumstances among older workers. It is unclear, for example, whether evolving organizational practices (such as long work hours and new production methods involving teamwork, continuous improvement and learning, etc.) create special risks and safety and health training needs for aging workers. In this regard, concern exists that lean production practices may be leading to reduced availability of lighter duty jobs for older workers [Lewchuk and Robertson 1996]. Such risks could be exacerbated in workplaces that are disproportionately populated by older workers as a result of seniority systems.

Safety and Health Effects Research Needs

Our limited understanding of risks posed by today’s turbulent work environment illustrates the need for a more expansive program of research on this topic. In particular, research is needed to better understand how emerging trends in organizational practices influence job demands, employee development, hazard exposures, health services, worker behaviors, work-family balance, and other conditions that may influence risk of stress, illness, and injury in the workforce. In this section we provide some examples of specific research needs targeting the effects of new organizational practices on job conditions and, in turn, on the safety and health of workers. The section begins, however, with a discussion of broader directives for safety and health research on the changing organization of work.

Of primary significance, evidence points to both positive and negative effects of changing organizational practices [Berg 1999; Jackson and Martin 1996; Jackson and Mullarkey 2000; Kaminski 2001; Landsbergis et al. 1999; Smith 1997; Sprigg et al. 2000]. These mixed findings suggest that an important focus of research should be the clarification of circumstances (for whom and under what conditions) in which these practices protect workers or place them at increased risk.

Also, research on effects of changing organizational practices should include a wide range of outcomes, including safety risks and associated injuries. Safety outcomes have been particularly neglected in prior research. Additional outcomes (such as disability, health care and employee assistance program utilization, socioeconomic costs, and work-family conflict) should be studied in order to portray more fully the burden of illness and injury associated with organizational stressors.

Finally, research on safety and health effects of organizational factors needs to overcome methodological difficulties that are common, but certainly not unique, to this field of study. Most widely recognized is the need for increased use of prospective study designs to overcome limitations in causal inference with cross-sectional studies. Exposure assessment presents special challenges in this field of study. To begin with, improved standardization of exposure measures and methods is needed to enable comparisons across studies. Multimethod estimates of exposure are needed to help improve validity and overcome the risk of contamination of questionnaire or other self-report exposure measures by present health status or other factors. A particular need exists for methods to assess more reliably organizational practices (e.g., quality improvement) that are commonly measured only at the organizational level through key informants. At the same time, a need exists for economy in exposure assessment strategies so organizational practices can be assessed efficiently in large-scale epidemiologic studies. Finally, more work is needed to develop job exposure matrixes to obtain meaningful estimates of exposures to organization of work factors among today’s workers whose careers are increasingly punctuated by job transitions.

New Organizational Practices, Workplace Effects, and Risk of Illness and Injury

Emerging evidence and accounts by workers and managers suggest effects of new organizational practices on job conditions and exposures that may influence the risk of stress, illness, and injury. Examples of these effects that need further study include the following:

Work pressures and demands

Evidence points to a steady increase in workload over the last two decades [Bond et al. 1997]. Research is needed to investigate organizational practices that may contribute to the intensification of work and to examine the implications for worker safety and health. Examples of such practices include the spread of high performance/lean production work systems and teamwork structures that may lead to work intensification through processes such as the following:

1. Increased worker responsibility and accountability for production management and meeting production goals.
2. Increased vigilance (process monitoring) and problem solving demands.
3. Increased electronic monitoring.
4. Increased peer-monitoring and competition within teams.
5. Increased role demands or conflict (owing to multiple roles and blurring of manager and worker roles).
6. Demand for flexibility and continuous change.
7. Speedup and reduction in idle time.

Other potential sources of work intensification in need of study include overwork motivated by (a) the trend toward putting increasing amounts of pay at risk (pay for performance), (b) vulnerability to labor market risks (e.g., low pay, risk of job loss) among temporary workers, or (c) fear of displacement resulting from organizational restructuring and downsizing. Additionally, better understanding is needed of the risks and effects of work overload resulting from staffing reductions following organizational downsizing. At the same time, research is needed to investigate whether increased levels of worker control and learning provided by new work systems can offset adverse effects of intensified demands in today’s workplace.

Research is needed to investigate factors that may contribute to lengthening of work hours (e.g., substitution of overtime for new employment, communication technologies and organizational practices that make work impervious to time and geographical boundaries) and risks of injury and illness brought about by the demands and fatigue of long work hours. Particularly pressing is the need for research on the following:

1. Effects of modest increases in working hours.
2. How effects of long work hours might be modified by alternative work schedules and work-rest regimens, and varying domestic demands.
3. Task-specific effects of long work hours (e.g., effects of long work hours for physically demanding tasks and other hazardous exposures).
4. The effects of unplanned and mandatory overtime.

Studies need to develop improved methods for measurement of working hours, give much more attention to safety outcomes, and focus on populations most likely to work long hours.

Worker empowerment and development

Research is needed to better understand how new work systems affect workers’ capacity to influence job conditions and opportunities for learning and growth and, in turn, the impact on safety and health in the workplace. Increased worker control and learning opportunities are recognized in the job stress literature as powerful antidotes to stress and illness. But concern exists that various worker participatory or involvement strategies may often be more ceremonial than substantive, having little meaningful influence on worker empowerment—or perhaps even eroding workers’ means to influence job conditions through more traditional labor-management mechanisms such as collective bargaining. Concern also exists that cross-functional teamwork and job enlargement strategies may in some instances multiply the number of tasks workers perform with little net effect on worker competencies.

Occupational health services and programs

Research is needed to better understand how occupational health services and programs, including worker safety training, and access to these services and programs are affected under organizational restructuring and downsizing. Some indication exists, for example, that utilization of employee assistance programs may drop significantly when these programs are outsourced to off-site vendors [Collins 1999]. Additionally, information is needed on the effects of loss of health benefits among the substantial proportion of displaced workers who become re-employed but experience loss of health insurance and wage reductions.

Only a fraction of temporary workers and other members of the alternative workforce enjoy access to company-provided health benefits, and access to occupational health services and programs has not been studied among these workers. Research is needed to better understand gaps in the delivery of occupational health services to these workers. Additionally, research should examine the safety and health implications of the emerging trend toward defined contribution and selfmanaged health benefit programs that may limit health services available to members of the traditional workforce.

Worker safety knowledge and behavior

Research is needed to investigate effects of changes in the organization of work on the fund of safety knowledge available to workers and organizations. Examples of relevant questions for investigation include the following:

1. Are downsizing and employment volatility creating safety and health risks by depleting institutional knowledge of safety and health practices through loss of experienced workers and managers—or, correspondingly, is high labor turnover interfering with workers’ ability to acquire safety skills and knowledge?
2. To what extent is job combination, even among seasoned workers, adding tasks for which workers lack safety knowledge?
3. To what extent do temporary workers face increased risk of illness and injury from inexperience or insufficient safety training owing to variable and short-tenure job placements?

Evidence of substantially increased injury incidence among inexperienced workers [BLS 1999; CDC 2001; Goodman and Garber 1988] adds urgency to the need for studies addressing these questions. Studies of workers with new jobs and tasks need to investigate not only risks posed to themselves, but to their peers as well.

Studies are needed to examine the effects of new work systems and work intensification on the time and opportunity to exercise safe work practices.

Research is needed to investigate whether perceptions of insecure employment among contingent workers or traditional workers at risk of displacement discourages the reporting of hazards, injuries, and illnesses or the utilization of health care.

Hazard exposures

Research is needed to assess whether alternative employment arrangements, such as temporary and contract work, result in differential work assignments involving elevated exposures to occupational hazards. Similarly, research is needed to investigate whether job insecurity might motivate workers to accept more hazardous job duties.

Little evidence exists of organizational investment in safety training and assessment of working conditions for home workers and telecommuters. Research is needed to better characterize hazardous exposures attendant to homework, including telecommuting by white-collar and knowledge workers.

Work-life balance

Accelerated research is needed on effects of telecomuting and other organizational practices that meld work and family life, considering both the benefits presumed to result from increased flexibility and control over family obligations and risks from insufficient separation of work and family. Specific attention needs to be given to the risk of stress and family dysfunction from spillover of work demands into the family environment for telecommuters and home workers, and to technologies and organizational policies that promote or discourage intrusion of work into personal spaces. Similarly, study is needed of the sources and effects of work disruption and potential safety and health risks resulting from conditions in the homes of telecommuters and home workers.

Work-life programs and family-friendly policies to reduce work-life conflict have spread rapidly throughout industry, but empirical study of their health-related effects is sparse. Research is needed to investigate the effects of these programs and program attributes on preventing work-family conflict and stress among workers.

Other effects—access to legal protection and organizational supports

Many workers who do not participate in the traditional (full-time, direct hire) workforce fall outside the boundaries of a myriad of statutes and policies to protect the rights and welfare of workers, including protection from discrimination, rights to overtime pay and minimum pay, rights to collective bargaining, etc. Research is needed to understand the impact of these limitations on the safety and health of workers who participate in alternative employment arrangements. Many of these workers also do not receive comparable pay, fringe benefits, and access to the career ladders and organizational resources available to members of the traditional workforce. Research needs to begin to explore how these constraints may play out over the long term to affect the well-being of workers.

As the social contract between employers and employees changes, workers are increasingly required to assume greater personal responsibility for their continuity of employment. Research needs to examine how these new demands may influence stress and well-being in today’s workforce.

Research is also needed on the potential stresses among home workers and telecommuters created by nonstandard work schedules, role conflicts, and the possible loss of identity, security, status, and support from peers and supervisors that may result from inability to participate in the social environment of the organization.

Effects in Worker Subpopulations: Women, Ethnic and Racial Minorities, and Aging Workers

Research needs to examine much more vigorously the effects of organizational stressors, such as harassment and job discrimination, that are highly specific to women and ethnic and racial minorities. Studies are also needed to better understand how employment arrangements more common among women and certain minority groups in today’s economy (e.g., service work, temporary employment, home work) may disproportionately expose them to occupational risks, such as reduced health benefits and job insecurity. At the same time, studies need to investigate possible protective effects of these employment arrangements that may derive from increased access to employment, or the flexibility needed to balance work and personal or family demands more effectively.

Research is also needed to investigate whether the adjustments, learning demands, and workload pressures that may be created by new work systems and rapid technological advances place older workers at heightened risk of stress, illness, and injury. Studies of new job demands among older workers also need to examine the contribution of factors such as unavailability of light-duty work and increased probability of displacement to risk of stress, illness, and injury among these individuals.

Effects in High-Risk Sectors

An especially urgent need exists for research attention to industry sectors and occupations that have been subjected to sweeping organizational changes in recent years. For example, efforts toward cost containment in the health care sector have resulted in dramatic organizational changes involving staff reductions and a changing skill mix, long hours of work and mandatory overtime, and new work role demands as health care delivery shifts from a fee-for-service inpatient model to an outpatient managed care model. Although considerable attention has focused on the adverse effects of these widespread and abrupt changes in work practices on patient care [Aiken et al. 2001; Kohn et al. 2001], the effects of these changes on the safety and health of health care workers have received little study.