Injury and Illness Prevention Within the Workplace

Unlike our predecessors in the mines and mills and factories - and even offices - we today expect our workplaces to be safe. We consider this a birthright - that our employers should design and monitor the workplace in such a way that we are allowed to do our job without any undue risk for ourselves. And yet, of course, this is not a birthright but rather a legal protection that was fought for by workers and workers advocates (including unions) in previous generations. There seems to be little if any natural inclination of even good employers to ensure the safety of their workers, and it is for this reason that government regulations exist to protect workers. This research project examines one very specific example within the contemporary workforce of the ways in which government regulation is sometimes a necessary supplement - or bulwark - to the good intentions of employers to keep their workers safe.

But of course workplace safety is not only the responsibility of the government and the employer. Workers must (and are usually eager to) take an active role in keeping themselves safe. Indeed, occupational safety and health training of each worker in a way appropriate to their job is a key aspect of reducing and even preventing altogether workplace injuries and illnesses. To be able to train workers to protect themselves properly requires those workers, in concert with their employers as well as government regulators, to be able to identify the specific job hazards that they may face because such a specificity of recognition allows everyone to work to maintain a safe work environment. Not only is this a humane thing to do, but it also makes sense from a purely economic point-of-view: A workplace in which people are injured or are fearful of being injured is not one in which people can accomplish their best work.

For workers in the state of California, the most important government agency involved in keeping workers safe if the California Occupational Safety and Health Administration, more commonly called Cal-OSHA. This agency's mission is both straightforward and daunting: Straightforward because its aim is to improve the safety conditions of every working Californian, daunting because of the array of dangers to which Californians may be subjected on their jobs.

The agency has, for the past 19 years been working with employers to ensure that they use the most current methods to protect the life, safety and health of their employees.

You have a right to a safe and healthful workplace. The California Occupational Safety and Health Act of 1973 was enacted by the California Legislature to assure safe and healthful working conditions for all California working men and women.

Cal/OSHA wants every worker to go home from work each day safe and healthy.

Cal/OSHA was created by the Occupational Safety and Health Act of 1973 to enforce effective standards, assist and encourage employers to maintain safe and healthful working conditions, and to provide for enforcement, research, information, education and training in the field of occupational safety and health.

While (one would hope!) most people should agree with the statement that workers deserve a safe place to work and that employers must take all reasonable steps to comply with OSHA regulations (and common sense) to ensure this safety, there is often a great deal of disagreement in the case of any specific workplace exactly what such "reasonable" steps might be. Sometimes employers do not want to spend money on precautions that they deem to be excessive. Sometimes employees do not want to be hindered from doing their jobs by regulations that they deem to be excessive. A safe workplace depends on both employers and employees agreeing to what is safe and necessary, and each side taking the steps necessary to be in compliance to a safe and productive workplace.

Cal-OSHA outlines the importance of responsible behavior by both employers and employees. For example, some of the requirements made of employers are:

That they establish, implement and maintain an Injury and Illness prevention program and keep this program current.

That they inspect their workplace to identify and correct unsafe and hazardous conditions.

That they supply their employees with safe tools, that these tools are maintained and that workers actually use them That they clearly post warnings to all employees about potential hazards in the workplace

That they keep operating manuals current employees can always educate themselves about workplace safety procedures.

That they provide medical examinations and training when required by Cal/OSHA standards.

However, workplace safety is not considered to be a one-way street: Workers too have a number of obligations under California state law. Among these are the following:

Employees must follow all lawful employer safety and health rules and regulations, including using all prescribed protective equipment.

Employees must promptly report any hazardous conditions that they discover to their employer.

Employees must report any job-related injury or illness to your employer, and after they report it seek prompt treatment.

Employees must cooperate fully with the Cal/OSHA enforcement personnel when they are conducting an inspection.

A if they inquire about safety and health conditions in your workplace.

Ideally, it should be clear from the description above, that in a well-run workplace, everyone works together to make sure that the law is uphold and that everyone is given a safe enough workplace that they can in turn provide their employee with their best work. Because working conditions in any workplace are constantly changing, often the ways in which workers are kept safe must be adjusted as well, and ideally (again) this should be a process in which everyone concerned is included in the process.

The City of Long Beach's Departmant of Health and Human Services is currently in a position that it is reconsidering whether the current protections in place in this department are sufficient to protect its workers. Current debate was prompted at least to some extend by changes in the state labor code (which went into effect Jan. 1, 2000) that now explicitly require managers to be responsible for ensuring that all of their employees are effectively trained in work-related hazards so as to reduce or prevent workplace injuries and illnesses.

If employees do not abide by the Injury and Illness Workplace Policy within any organization, individual supervisors as well as the company (or government department) as a whole can now be held legally liable for the workplace-caused injuries and illnesses of workers in their care.

In response to the increased numbers of safety incidents as well as to the need to ensure implementation of the new OSHA standards, the Long Beach Department of Health and Human Services wishes to determine if there is a need for additional safety training sessions or safety offices to improve organizational safety.

The health department is a large department with that supplies a diverse range of services to the people of the city of Long Beach, including:

Early Child Care and Education

Women, Infants & Children (WIC)

Lead Poisoning Prevention Program

HIV/STD Testing

Family Planning

Immunizations

Laboratory Services

The overall mission of the department is to:

improve the quality of life of the citizens of Long Beach by addressing the public health and human service needs ensuring that the conditions affecting the public's health afford a healthy environment in which to live, work and play.

This study examines the current state of the safety training operations in the city and makes an initial determination about the feasibility of creating a safety officer position specifically and solely assigned to the Department of Health and Human Services as a cost-effective method of ensuring that workers are kept safe and that managers and the department itself are protected from legal actions against them - so that workers and managers together can dedicate themselves to protecting the health of the citizens of Long Beach.

The model for this addition of a safety worker is easily found close at hand. The Department of Parks and Recreation has just added a department-specific safety officer because of the (previously) high level of injuries to workers in this department.

Statement of the Problem

The City of Long Beach has four primary safety officers. One each is assigned to the Department of Water, the Department of Energy and the Parks and Recreation Department. The remaining city safety officer is responsible for the remaining 18 city departments' overall safety training.

Under the direction of the risk manager for the city, this fourth city safety officer is assigned to develop and maintain loss prevention and control programs for the remaining 18 departments. This city safety officer develops, implements and administers citywide program policies and procedures in the areas of occupational safety, industrial hygiene, fleet safety, emergency preparedness and city property loss prevention.

In addition to these duties, this city officer is assigned with the task of maintaining open and effective communication with all levels of city personnel to foster a proactive, citywide culture of concern for workplace safety.

Because of these diverse and numerous responsibilities, the person in this position must have a number of distinct skills and technical expertise in a number of areas, including engineering principles, fire and systems operations, industrial hygiene, legal requirements, hazard analysis and statistical methods needed to evaluate potentially hazardous conditions and/or work practices. In addition, this safety officer must be able to provide feasible, cost-effective solutions to the workplace challenges faced by the city.

The city's safety officer provides members of these 18 departments with initial training in workplace safety. While this initial training is quite competent, there is the distinct possibility that there are inconsistencies or varied training passed down from the selective committees of each of the 18 departments that the fourth city safety officer is responsible for. The selective committees of each of these 18 departments (whose members are trained by the city safety officer) are then responsible for training the remaining staff of each of these departments. If each department were to have its own safety officer, this possibility of the dilution of training would be significantly diminished.

Against the clear advantages of having a safety officer assigned to each department is the cost involved. However, it should be clear that an increase of workplace injury or illness also has its costs. This is the question at hand: Will costs be saved by the hiring of an additional safety officer whose presence can prevent at least some workplace injuries or illnesses.

It is because the amount of work and responsibility borne by the city safety officer that at last some members of the Department of Health and Human Services are arguing for a safety officer to be assigned solely to this large department. Such a dedicated safety worker could help to reduce or even prevent workplace injury in the department, which currently has over 500 employees.

Under its current structure, the chair of the department's safety committee is assigned to the administrative analyst, who is responsible for conducting committee meetings - with the result that a great deal of knowledge about workplace safety can be dissipated along this chain of command, much like what occurs in the children's game of "Telephone."

However, if the Department of Health and Human Services were structured in the same way that the departments of water, energy and parks and recreation were structured, with a dedicated safety officer, then the employers of this department along with their managers - and the large segment of population that this department serves - would be better protected.

Literature Review

The literature on the importance of safety training is to some extent split along partisan lines, with some findings tending to shore up the claims of workers that they need greater protection and some findings tending to shore up the claims of employers that more regulations simply reduce efficiency without increasing safety.

As noted above, the agency primarily in charge of guaranteeing the safety of all American workers is the Occupational Safety and Health Administration, almost always known by its acronym of OSHA. This federal department, which is an agency within the U.S. Department of Labor (and which was established by an act of Congress in 1970), works hand-in-hand with state occupational safety agencies.

The mission of OSHA, like that of Cal-OSHA, is extremely broad:

The mission of the Occupational Safety and Health Administration (OSHA) is to save lives, prevent injuries and protect the health of America's workers. To accomplish this, federal and state governments must work in partnership with the more than 100 million working men and women and their six and a half million employers who are covered by the Occupational Safety and Health Act of 1970.

The mission of OSHA has always been to work for the workplace safety of each and every American worker by reducing hazards in the workplace to the greatest degree that is reasonably possible. The most important tool that OSHA has in carrying out this mission is its abilities (in partnership with state agencies) to carry out inspections that have as their mission the goal of enforcing mandatory job safety standards. These standards (it should be noted) are not universal but are set for each different industry according to the specific hazards each type of workplace holds for workers.

OSHA and its state partners have approximately 2100 inspectors, plus complaint discrimination investigators, engineers, physicians, educators, standards writers, and other technical and support personnel spread over more than 200 offices throughout the country. This staff establishes protective standards, enforces those standards, and reaches out to employers and employees through technical assistance and consultation programs.

Nearly every working man and woman in the nation comes under OSHA's jurisdiction (with some exceptions such as miners, transportation workers, many public employees, and the self-employed). Other users and recipients of OSHA services include: occupational safety and health professionals, the academic community, lawyers, journalists, and personnel of other government entities.

It should be noted that from its founding as an agency - indeed even before its founding, during the congressional debate leading up to its establishment as an agency, OSHA has generated what might well seem to be more than its share of controversy. Perhaps as a sign that it is indeed doing its job, it has drawn considerable criticism from both industry and business and labor groups. This in fact should hardly surprise us: The entire idea of having the government responsible for workplace safety has long stirred resentment by employers who wish to set their own conditions (and in private industry to maximize profits).

Labor groups have also predictably been displeased with the group - which they believe does not do enough to protect workers from the greed and carelessness of employers.

Business leaders have tended to respond that while they too are interested in workplace safety, OSHA regulations are arcane and difficult to understand or implement - and often irrelevant to the actual hazards of particular workplaces. The outcry from business over proposed ergonomics regulations two years ago exemplifies this type of complaint:

Industry criticism of OSHA's proposal centers on several aspects. Chief among them is that the proposal is too vague, costly, and conflicts with existing laws. Some feel the new rules do not adequately address causation factors, resulting in employer liability for injuries that occurred outside the workplace. Others feel that vague standards may require employers to modify essential job functions by instituting job rotation, job enlargement, increasing the number of workers on a specific job, redesigning jobs, limiting workplace exposure, and transferring employees. There is a view that the new program will cover conditions that do not qualify as disabilities under the American Disabilities Act, resulting in increased costs and demands on employers to deal with conditions that do not meet the current federal standard for disabilities. The proposal has incorporated a "single event" threshold to trigger the provisions of the program rather than a more traditional "frequency of same injuries in same job" standard. The program also adopts policies that could deprive management of its ability to promote workplace safety. Employee drug testing, for example, is singled out as a management tool that might discourage reporting of injuries. Employee incentive or award programs that focus on reducing workplace hazards are also specifically identified as employer policies that may "discourage" reporting of injuries in order to qualify for an award. Other restrictions on management prerogatives are seen as an invitation for fraudulent and invalid employee claims under the program.

But even as many business and industry leaders argue that the entire issue of worker safeguards and workplace safety should be left up to individual employers, labor leaders and often individual employers (especially those who are in government work, as is the case here, rather than in a private company) continue to argue that OSHA's enforcement procedures are far too weak. Moreover, advocates for workers' rights have made persuasive arguments that OSHA has in fact failed to make significant reductions in occupational hazards at least in large measure because the agency has not kept current with new hazards that are daily introduced into the workplace.

This has become especially true during the last two years as the Bush Administration has served more as an advocate for employers and businesses than for employees. This assessment in the Daily Labor Report - a watchdog publication for labor concerns published in Washington DC - outlines these concerns:

The Occupational Safety and Health Administration's proposed budget for fiscal year 2003 reflects an imbalance in how it treats outreach for workers and consultation for employers, according to a member of the National Advisory Committee on Occupational Safety and Health.

Peg Seminario, labor representative on the advisory committee, made her remarks in a discussion following an update March 12 by OSHA Administrator John Henshaw.

A number of subjects including the agency's FY 2003 budget, were covered in Henshaw's update. Seminario charged that the agency is doing very little to support direct contact with workers.

Seminario, who is the safety director for the AFL-CIO, said that up to 1980, the agency had balanced outreach consultation, but today the proposed OSHA budget contains $52 million for an employer-only consultation program and $4 million for programs for workers.

The Bush administration is proposing to cut nearly $8 million in federal job safety and health programs in fiscal 2003 -- from modest cuts in enforcement to deep reductions in long-running training grants provided to labor unions, industry groups, and others. The proposed budget would require the agency to cut 84 full-time positions, though OSHA said no frontline enforcement personnel would be affected. The most severe cuts would come in the Susan Harwood Training Grants, which were begun in the late 1970s to fund safety training in communities and states. The Bush administration would slash the current $11.2 million grant program by $7.2 million.

While OSHA (and state agencies like Cal-OSHA) are certainly the primary legal aids that both workers and employers have to keep the workplace safe, it is also true that there are legitimate concerns about whether OSHA standards are enough, especially as they are being vitiated during the current administration. Workers and employers worried about their legal liabilities might do well to consider expanding their own occupational programs beyond their current levels.

OSHA standards (although this is to some extent less true of Cal-OSHA) should be considered to provide a minimum level of protection rather than a maximum one, as this occupational health and safety officer at a large company in downtown Los Angeles argues:

I've been working in occupational safety for 34 years - since before it was called occupational safety, since before there was an OSHA. Now, I know that a lot of people have their own personal gripes with OSHA, and no, I'm not going to sit here and tell you that it's a perfect agency.

But there's no way that I'm going to sit here and tell you that it doesn't matter either. OSHA tells you where to start: It gives you a standard. Sure, a lot of times it seems like there are just too many damn rules about everything in the world. But in my book, you just can't have enough rules about safety. Well, I guess you can have too many rules about anything. But to me - and I'm not saying this is true where I work now, but it has been true in a lot of the places that I've worked over the years - there are a lot of bosses out there who would do anything to save a buck. And if a few people got blinded or lost their hands or got cancer, well too bad for them. With OSHA - when any worker knows that they can drop a dime and call for an inspection - well, it's a better world for all of us to work in.

Conscientious safety officers working with conscientious employees do not dismiss OSHA standards, but they do recognize that often OSHA regulations are not enough. This may well be the case in the Department of Health and Human Services in the City of Long Beach, which is certainly in compliance with OSHA standards and yet in which both supervisors and employees believe that everyone concerned might best be served by the addition of a dedicated safety officer for their department.

It is true that in some specific areas of workplace hazards OSHA provides sufficient detail in its recommendations that a safety officer can simply rely upon them and not have to work in an area for a long time to gain required expertise. One of these areas with relevance to the Department of Health and Human Services, is the issue of needlestick injuries. This is a significant issue of concern for workplace safety because a needlestick (the unintentional breaking of the skin by a needle that has been used on another person and still contains that person's blood on it) may transmit AIDS, Hepatitis C and a variety of serious diseases to health workers.

OSHA lists five different activities that are linked to the majority of needlestick injuries. They are:

Disposing of needles, including collection and disposal of materials used during patient care procedures

Administering injections

Recapping needles (not allowed under the Bloodborne Pathogens Standard)

Handling trash and dirty linens safety officer with relatively little experience can use these OSHA regulations to implement a safety plan for an area of potential occupational safety hazard such as this. However, many questions of workplace safety are more complex and more ambiguous and are much better dealt with by a safety officer with direct and significant experience in a particular area.

The primary problem with a system like that used in 18 of the city of Long Beach's department is that information tends to degrade at each transmission and that a safety officer who oversees a number of departments is necessarily less experienced in the details of each department. This can lead to the kind of hypothetical accident discussed below (by the Canadian analogue of OSHA) in which a worker is hurt by a saw:

There is usually more than one cause for a hazardous occurrence. A competent investigator notes all causes and follows the trail to a conclusion. After precise analysis, he or she will be able to suggest corrective action for each of these causes.

An inexperienced investigator may stop short of the end of the investigative trail and apply a "quick fix" which may work for a time. The root cause, however, is still left to endanger the workers, and eventually this could cause another hazardous occurrence.

Note that the investigator does not simply say, "Oh, he wasn't wearing protective glasses," or "This wouldn't have happened if he had been wearing his glasses." By continuing to ask, "And what caused this?" The investigator eventually comes to the root of the problem - the nail in the wood. Only then can the investigator make recommendations for followup action to improve the overall safety and health of the workplace.

Expertise is based on experience, and experience is drawn from daily contact with the problems that need to be addressed. No matter how hard working and how conscientious a safety officer is, the thinner he or she is spread the more likely accidents are to occur.

One factor that must come into play here is how much an additional safety officer would cost. Current job listings for such positions suggest the range in salaries runs from the low $40,000 to, on average, the mid-$60,000. With the additional cost of providing benefits to this worker, the cost would climb to perhaps $60,000 to $80,000. This is clearly a relatively large sum; it is also clearly less than might be incurred by the city by a single lawsuit.

The addition of a department specific safety officer could prevent "noise" building up in the system. It is a well-known phenomenon that the more links there are in a communications chain the more likely mistakes are to creep into the message. This man, who has worked as an occupational safety officer for a food company in Riverside, describes this phenomenon. The work structure in this company is analogous to the one currently in place in the Long Beach Department of Health and Human Services.

If I could change one thing about my job it would be the lines of communication. The way that things work now are that I make regular inspections but I'm not supposed to tell the guys on the line what I find out.

And, you know, I think that it's just out-and-out racism on the part of the company owners, who are all white. The line workers are all Latino, and the owners think of them basically as ignorant spics.

So I make my inspections and I see a hazard and I make a note and one of the workers comes over and asks me what I'm writing down - what he can do to make the job safer for himself and his friends. And I'm supposed to tell him that I can't tell him, that he has to wait until a weekly meeting with the safety committee.

So what happens is that I write up a report, and I give it to the five safety-committee members, and they read it out to all of the workers - about 250 with all the shifts - and nobody can hear them and no one really knows which comment applies to them or to someone else.

This is why I'm looking for another job: You can't keep people safe if you can't talk to them directly.

Clarke etal (2000) have created a formal system for predicting the ways in which information breaks down along a communication chain that provides support for having the shortest possible chains, especially when the information is essential for safety.

Without a short line of communication, the result can all too often be like the children's game of Telephone, as suggested above. What is charming in a children's game can be deadly in the workplace.

The oldest person should think of a message. When the oldest person thinks of a message they pass it to the person sitting next to them, then the person sitting next to them passes the message to the next person and so on. If one person should not understand the message they may say operator and the person sitting in front of them repeats the message to that person again. If anyone needs to say operator, they can only say it once.

When the last person gets the message they stand up and they say the message out loud. If the message is right, then the person who thought of the message says "yes" and the last person wins the game. If the message is wrong, then the person who thought up the message wins the game. The point of this game is not winning. The point of the game is to see if the last person can say the message correctly. The fun thing about this game is that usually the last person never says the message correctly. It is fun to hear the message all scrambled up.

Methodology

One of the most important choices that a researcher makes in designing a research project is to make a choice between qualitative and quantitative methodologies. Although the two can certainly be used together, most research projects rely far more heavily on one than on the other either because of the nature of the data themselves or because of personal preferences by the researcher, or both. (Although it is primarily the researcher's own preferences that are more important one suspects).