Bus Driver Occupational Health and Ergonomic Evaluation

Introduction and Background

Chronic health problems arise from a multitude of causes. When they are work-related, they can be difficult to prevent. Bus drivers experience work-related illness at a higher rate than workers in virtually any other occupation or industry (ATU, 2016). Such illnesses can stem from exposure to common diseases due to the close proximity of numerous strangers entering the bus each day. Bus drivers may also become chronically ill because of the seated position they maintain for hours at a time. Job-related hazards from bus driving contribute to a rate of chronic illness that is 120% above average (ATU, 2016). When researchers identified the epidemic of work-related illnesses among bus drivers, some sought ways to prevent and combat the problem. The first major step was ergonomic evaluation.

Ergonomic Evaluation

Bus driving can be a difficult activity to manage over time. Bus drivers often experience lower back pain, as well as pain in the ankles, neck, and knees from their continued sitting position (Tranchard, 2012). It is a demanding job, and bus drivers in the UK and Europe require the development of comfortable seating through ergonomic evaluation in order to successfully endure long driving hours. Ergonomic evaluation, also termed workstation assessment, ensures that a bus driver's workstation is ergonomically designed to maximize productivity and reduce the risk of injury (Patchong, 2014). Such assessments are also performed to help decrease the employee turnover rate that rises due to work-related injuries.

Ergonomic evaluation considers driver fatigue in both its cognitive and physical forms. "Physical fatigue is related to perceptual-motor adjustments specific to the driver task and to discomfort caused by prolonged sitting. Cognitive fatigue can be subdivided into task-related and sleep-related fatigue" (Vink, 2014, p. 522). While possible countermeasures to physical fatigue include passive and active micro-movements along with stimulation of macro-movements, sleep-related fatigue within the cognitive fatigue category is known to be resistant to intervention (Vink, 2014). This means ergonomic evaluation should aim primarily for the elimination of physical fatigue.

Fatigue symptoms are a common occurrence for bus drivers throughout the world, particularly in the UK and Europe. A study examining the effects of prolonged bus driving alongside overall job quality found that bus drivers face a multitude of health problems due to long work hours in a seated position. The researchers noted "the risk of heart disease for bus drivers to be twice that of their conductor colleagues. They also suffer gastrointestinal disorders, musculoskeletal problems and poor mental health" (Williamson et al., 2013, p. 189). The study also noted that bus drivers endure high levels of fatigue, stress, and low job satisfaction, and referenced the European Working Conditions Survey's finding that bus driving in Europe represents some of the worst working conditions, working hours, and potential risks of physical violence among all occupations surveyed.

Occupational Stress and Stress Prevention

Bus drivers go through many challenges while performing their duties. They encounter violent outbursts from customers (Williamson et al., 2013), they suffer from back problems and other health issues, and all of these factors contribute to a high employee turnover rate (Lannoo and Verhofstadt, 2016). The high turnover rate is attributable to high demands (such as reaching each bus stop on time while navigating traffic), low support (little in the way of ergonomic seating design or structured access to exercise or physical therapy), and low control (limited ability to choose shifts or how to manage job demands) (Lannoo and Verhofstadt, 2016). Because occupational stress among bus drivers is so consistently reported, it can no longer be regarded as an infrequent occurrence. Occupational stress in bus drivers is a wide-ranging phenomenon both in the UK and throughout Europe (Patchong, 2014). Exploration of measures that can improve and prevent this stress is therefore necessary, and ergonomic evaluation of seating and driver positioning represents one such potential solution.

Bus drivers endure physical fatigue and stress, creating potential occupational hazards and safety concerns by the very nature of their work. They work long hours, typically in the same position for extended periods (Arezes et al., 2013). When driving, they often face difficult access to bus cabins due to engine placement and seating that has not been ergonomically designed. "It was observed that the bus cabins of all companies surveyed did not allow easy access due to the presence of the vehicle engine. The height and distance from the steering wheel did not allow the driver a good posture" (Arezes et al., 2013, p. 602). When seating is not ergonomically designed, it creates potential problems for the bus driver's posture, back, and limbs.

Problem Statement

The occupation of bus driver carries with it the potential for several serious health problems, primarily due to the core job responsibilities of long work hours and uncomfortable seating. Preventative measures must be taken to reduce bus driver turnover rates and increase comfort for drivers on duty. The focus of this qualitative study is ergonomic evaluation and the ways in which it can improve bus driver occupational health and safety. Given the growing evidence of work-related illnesses among bus drivers, ergonomic evaluation may become a standard practice capable of minimizing the risk of physical fatigue and occupational hazards for bus drivers in the UK and Europe.

Although some bus companies in the UK and Europe have included ergonomic evaluation among their preventative measures, evidence continues to show work-related health problems as the primary concern for bus drivers, alongside a persistently high employee turnover rate (Musson, 2013). This may be due to the failure to establish a consistent standard, or to improper adherence to existing policy. If the issue of occupational health and safety goes unresolved, it could lead to continued work grievances and work-related diseases among bus drivers.

Research Questions

The following research questions guide this study:

• Can ergonomic assessment lead to effective preventative measures for bus drivers during long shifts?

• What does ergonomic evaluation of bus cabins entail?

• How is physical fatigue and stress reduced through the implementation of ergonomic evaluation?

• What standards do bus companies implement in relation to ergonomic evaluation?

• If bus companies in the UK and Europe have already implemented ergonomic evaluation, has implementation improved bus driver health outcomes?

Significance of the Problem

High employee turnover and increased health problems associated with bus driving are important concerns to address. Because employee turnover among bus drivers remains so high, bus companies often lack effective and experienced drivers. Less experienced drivers are associated with more fatal vehicle accidents (Scenario Committee on Accidents and Traumatology, 2012). Without the necessary standards and strategies to minimize bus driver turnover, bus companies may face continual instability, prompting lower quality service for customers and decreased profits.

The various health problems bus drivers experience on an ongoing basis — including high blood pressure, obesity, and back and neck pain (Committee, 2012) — add to the high employee turnover rate and negatively affect the quality of driving and service that customers receive. If bus drivers receive training to combat physical fatigue brought on by long hours of driving, and if they are provided with ergonomically designed cabins, this may help address the chronic physical ailments that plague bus drivers in the UK and Europe. It may also lead to higher quality service, greater customer satisfaction, and increased profits for bus companies.

Literature Review

The primary topic of this literature review is the improvement of occupational health and safety for bus drivers and others who work long, tiring driving hours. In recent years, the wellbeing of professional drivers has become an escalating matter of concern for organizations and regulatory bodies responsible for employee welfare. Lethal and non-lethal injuries among truck drivers and other professional drivers are among the highest of all occupational groups (Spurgeon et al., 1997). Truck driving is a vital yet demanding occupation. Drivers spend extended periods confined to a small space, maintaining a static posture with lower and upper extremities largely still, while absorbing whole-body vibration. The literature suggests that continuous exposure to such risk factors has contributed to conditions including musculoskeletal disorders, obesity, hypertension, cardiovascular disease, stroke, sleep disorders, and psychological distress.

The European Community Directive on Working Time, which member states were expected to implement by November 1996, contains requirements relating to working hours, including the right of employees to refuse work in excess of 48 hours per week. The United Kingdom government attempted to limit the Directive, arguing there was insufficient evidence that working hours should be restricted on health and safety grounds. Much of the research in this area has concentrated on shift work, and prior reviews have consequently emphasized that aspect of working hours. There is considerably less information about the effects of overtime work, which is a central element of the Directive's provisions (Okunribido et al., 2007).

This literature review examines evidence relating to the potential health and performance effects of extended working days. Several gaps in the research are identified. Studies to date have been limited to a narrow range of health outcomes — notably mental health and cardiovascular disorders. Other potential effects commonly associated with stress — such as gastrointestinal disorders, musculoskeletal disorders, and immune suppression — have received little attention (Kompier, 1996). There have also been few systematic investigations of performance effects, and little consideration of the implications for occupational exposure limits when the working day is extended.

Existing data relate largely to situations where working hours exceed 50 per week, with a lack of information about hours below that threshold — which is of direct relevance to European Community proposals. Research on shift work also makes clear that a range of moderating variables influences the level and nature of health and performance outcomes (Ragland et al., 1998). These include the attitudes and motivation of the workers, the demands of the job, and various aspects of the organizational and social environment. There is presently sufficient evidence to raise concerns about the risks to health and safety posed by long working hours (Johanning, 2000), though considerably more research is needed to define the level and nature of those risks. Long hours of sitting or exposure to vibration may cause psychological or physical fatigue and have been identified as primary reasons for the health problems found among professional drivers.

According to the American Transportation Research Institute (2004), the trucking industry transported 68.9% of all freight in the United States in 2003, totaling approximately 9.1 billion tons. The industry represented a $610 billion sector and accounted for 86.9% of the nation's freight bill. Among service-providing private industries, transportation and warehousing experienced injury rates of 7 and 6.5 cases per 100 workers in 2005 and 2006 respectively. In terms of numbers of non-fatal injuries and illnesses, heavy tractor-trailer drivers consistently ranked second highest among all occupational groups.

Prevalence rates for subjective symptoms — such as tinnitus, neck pain, and low back pain — and current diseases — including hypertension, gastrointestinal ulcers, back injuries, whiplash injuries, and hemorrhoids — were substantially higher among truck drivers than among office workers. In logistic regression analyses, many work-related variables, along with age, body mass index (BMI), and smoking habits, showed significantly higher odds ratios for subjective symptoms and current illnesses among truck drivers. Odds ratios for hypertension, heart disease, and related subjective symptoms among local truck drivers were significantly increased by awkward posture, whole-body vibration, and driving stress (Johanning, 2000).

Odds ratios for gastro-duodenal disorders were significantly increased by limited working space, sleeping in the truck, driving distance, squatting posture, and driving stress. Odds ratios for tinnitus were significantly increased by long working hours, limited working space, sleeping in the truck, and driving stress. Odds ratios for musculoskeletal disorders were significantly increased by overwork, vibration, narrow working space, sitting posture, and short rest and break durations. Odds ratios for fatigue symptoms were significantly increased by insufficient breaks, vibration, and driving stress. As this body of research suggests, truck drivers face greater risk for most major and minor health problems compared to workers in occupations that do not require prolonged sitting, whole-body vibration exposure, and sustained mental alertness.

Several studies highlighted in this review cover bus driver illness, high employee turnover, work disability, and absenteeism. Others address constraints within bus drivers' working situations and examine how ergonomics and the ergonomic layout of the bus driver's cabin contribute positively to occupational health and safety outcomes.

Historical Background and Related Studies

Bus Driving in the UK and Turnover Rates

The United Kingdom has a rich history of bus use. The horse-bus era began when John Greenwood inaugurated the first omnibus service in the UK in 1824, along the route between Pendleton and Manchester. It was a horse-drawn omnibus favored by the middle class as a less expensive alternative to private cab rides. "This no-frills vehicle was 'little more than a box on wheels.' Although short journey stagecoaches were not new, the omnibus plied for hire along its route, picking up and setting down passengers along the way" (Higgs, 2014, p. 82). At the time, omnibuses were staffed by a conductor and driver and drawn by two horses. Even then, conditions for both passengers and crew were difficult.

Higgs describes the presence of fleas in the dry hay lining the floor, and the filth and discomfort that came when the hay became wet. "The interior of the omnibus is notoriously stuffy and poorly ventilated, with no air except when the door is opened. Add in the steam of damp umbrellas and the hazard of pickpockets and you have the journey from hell" (Higgs, 2014, p. 83). Although the conditions were unpleasant for passengers, they must have been far worse for the driver and conductor, who had to endure them daily for hours at a time. Even in the earliest years of bus transport in the UK, drivers contended with an array of problems that contributed to occupational stress and hazards. Combined with longstanding low wages, bus drivers have had difficult working lives for a long time. Average monthly salaries for bus drivers in parts of Europe and the UK have been reported at approximately $1,900 in the UK, rising only to about $2,300 in Norway (WorldSalaries, 2016).

Following the horse-bus era came the first motor buses. While some experiments in public transportation took the form of steam buses in the 1830s, 1903 saw the official start of motor bus services — first in Eastbourne, then in Helston (Dodgshon, 2013). Within a decade, motor buses had replaced horse buses and grown to over 3,500 in number. "By 1913 there were 3,500 licensed buses in London, each seating 35 passengers. By 1914, because of their speed, low fares, appeal to the working class, and the ease with which they could be placed on new routes, they were a close competitor to the electric tramway in the capital" (Dodgshon, 2013, p. 471). The growth of motor bus usage brought new challenges for drivers, including greater exposure to infectious diseases (Dodgshon, 2013) and an increased workload due to higher demand.

In the decades following the adoption of motor buses, the nationalization of bus services came with the Transport Act of 1947, which allowed the British Transport Commission (BTC) to acquire Thomas Tilling bus services and the large independent Red and White operator (St. John Thomas, 2014). After the wartime era, poor management of buses, coaches, cars, and railways led to a reassessment of working practices in light of the persistently high employee turnover rate among bus drivers (Anderson, 2004). Bus drivers had to endure long hours with strangers entering and leaving the bus, bringing illness or occasionally displaying violent behavior. Although violent incidents were not everyday occurrences, they took a cumulative toll on bus drivers' health, as many became increasingly stressed, sick, and fatigued (Anderson, 2004).

This historical record helps illustrate how, over time, working conditions for bus drivers have not improved significantly and in some respects have worsened. As more people use buses and more drivers are required, the need for effective occupational health and safety measures increases accordingly.

Related Studies

One 2012 quasi-experimental study examined the effect of urban bus driving on musculoskeletal problems and blood pressure. Researchers noted high levels of stress consistently associated with poor health outcomes. Bus drivers were found to endure long work hours that contributed to greater rates of high blood pressure compared to other occupations, as well as higher instances of musculoskeletal problems associated with extended hours driving in the same position (Johansson et al., 2012). The researchers concluded that urban bus driving combined with long work hours can lead to potentially toxic psychosocial and physical effects. "The findings provide evidence for a positive association between the number of hours of bus driving and blood pressure and musculoskeletal problems" (Johansson et al., 2012, p. 89).

A 2016 study analyzed work disability among bus drivers due to constant physical and mental occupational stress. "In comparison with other jobs, public transport drivers show an increased risk in job-related health problems. The consequences are frequent and long absences from work as well as temporary and permanent disabilities for driving services" (Bockelmann, Arlinghaus and Nachreiner, 2016, p. 1). The study also examined potential interventions, concluding that "while no substantial evidence was found for the long-term effectiveness of person-oriented interventions, interventions addressing the work load of the drivers directly by improving their working conditions seem to be more effective, supporting the importance of structural prevention over behavioral prevention" (Bockelmann, Arlinghaus and Nachreiner, 2016, p. 1). Improving the physical work environment — for example, by making bus cabins more spacious and easier to enter and exit — appears more effective than targeting individual driver behavior alone.

A 2013 study investigated the specific causes of high stress among bus drivers that lead to absenteeism, health problems, and high turnover. "Results indicated bus drivers experienced considerably lower stress levels under a new control strategy that shifts the performance objective from schedule adherence to service regularity. Higher stress levels were recorded during extreme weather conditions and peak hours and among inexperienced drivers" (Hlotova, Cats and Meijer, 2014, p. 13). To reduce bus driver stress, companies may benefit from prioritizing service regularity over strict schedule adherence. A potential gap in the literature is whether training bus drivers to drive in poor weather conditions can meaningfully reduce stress in those situations.

Stress also contributes to high rates of short, unscheduled absences. A 2014 study covering bus driver absenteeism identified several contributing factors, including unfavorable scheduling patterns, shift transfers, work interruptions, holiday periods, and lack of monetary incentive. The study recommended avoiding scheduled interruptions on Thursdays, Fridays, and Mondays; minimizing interruptions during October, November, and December; reducing the number of drivers working spare shifts; limiting schedules exceeding five days per week; and providing financial incentives to reduce absence among early-morning and late-morning shift workers (Diab, Wasfi and El-Geneidy, 2014, p. 36). Bus companies can reduce absence and turnover by removing situations that promote stress and by using monetary incentives to encourage attendance and retention.