Preventing Musculoskeletal Disorders

Smart companies deploy risk assessment tools to reduce OSHA events and gain a competitive edge.

IT is a tough, competitive world out there. Every day, the news reminds us that capital is footloose and labor is fungible: For the price of group health benefits for a single American worker, a firm can hire a Ph.D. engineer offshore. And many do.

But even more have risen to the challenge by making their companies more competitive here in the United States, raising U.S. productivity to record levels through intelligent application of technology, quality, and process improvement throughout the enterprise. What have these smart companies been up to lately?

The Quality Lens
According to the National Academy of Sciences, musculoskeletal disorders are a major national health problem. More than 1,000,000 workers miss time from their jobs at a cost of more than $50 billion a year. Add in the indirect costs of reduced productivity, replacement labor, and business interruption costs, and the total yearly cost of workplace injuries jumps to well more than $1 trillion (yes, trillion!), or 10 percent of U.S. gross domestic product. With the Bureau of Labor Statistics forecasting a skilled labor shortage ranging from 3 million to 10 million workers by 2010, protecting and retaining employees will directly affect a company's productivity and competitiveness.

MSDs are an employee's most common entry ticket into the worker's compensation system, where clinical outcomes are consistently worse, according to a recently published meta-study in the Journal of the American Medical Association. The dirty little secret? Every one of these injuries was preventable.

Smart, competitive companies possess a relentless drive for quality, because quality processes yield satisfied end clients with reduced time, cost, and waste. They see musculoskeletal disorders as a classic shop-floor quality problem to be isolated, measured, and "engineered out of the workflow."

Where to start? While most worker's compensation professionals focus on claims, smart companies start at the other end of the factory floor: the hiring office. Consider the fact that employees with less than one year of tenure are 131 percent more likely to sustain injuries than the average employee and 64 percent more likely to incur costs as a result of those injuries, and that 40 percent of workers injured in the first year of employment ultimately leave the workplace.

Spending $1 to avoid a $100 problem makes sense, doesn't it? A standard "Six Sigma" axiom is the 1-10-100 Rule: If it costs $1 to prevent a problem at the beginning of a process, it will cost $10 to inspect and fix inside the factory and $100 to find and fix in the field with a customer. Building injury prevention into the employment process is just like building quality into other products or services: It's about measurement, feedback, and reducing the variation in upstream raw materials. So, these companies reason, why not put at least as much energy into measuring and reducing the variation in new hires as in reducing the variation from suppliers in the quality of steel, plastic, or other critical inputs?

Effective prevention of workplace illnesses such as MSDs through active intervention is not only possible, but also can result in powerful, sustained savings for the employer while reducing the disability experienced by the individual employee. At "best practice" firms, quality-focused injury/disability prevention programs have resulted in long-term savings of 50-90 percent in direct worker's compensation costs versus their peers.

What Can Your Organization Do?
In the typical enterprise, more than 47 percent of injury costs are MSD sprains/strains. Emerging clinical research suggests that up to 65 percent of MSD risk can be attributable to individual risk factors, while as little as 35 percent can be attributable to the job or workstation. In other words, while ergonomics at the worksite are critical, the biggest risks at work are the ones we bring every day from home.

Leading-edge employers have embraced a new breed of tools that measure the likelihood of MSDs as part of regular risk assessment programs at hire, promotion, transition, and injury. Many have previously introduced functional testing to ensure that employees hired are physically capable of doing the jobs they are hired for. But these tests help only once--when an employee is hired--and are less predictive where MSD injuries occur due to repetition. When hiring for low-to-moderate physical function jobs, companies are challenged by the limitations of traditional weight/force functional testing. And they want testing that helps long after the hire, guiding employee placement, post-injury job accommodations, and ergonomic support throughout the employment lifecycle.

Risk Assessment Testing's Potential
Risk assessment testing is one tool that is growing in popularity due to its tangible deliverable: Each employee's MSD risk is stratified on a 1-7 point scale, directing job placement, conditioning, and ergonomic decisions toward those who can benefit the most. At an enterprise level, risk assessment data can help companies allocate their limited safety and prevention budgets and set pre-claim metrics and milestones.

CtdMAP testing, a predictive instrument pioneered by Dr. J. Mark Melhorn, assesses individual risk of an OSHA-recordable MSD event within a year of taking the test with 90 percent accuracy. This ADA- and EEOC-compliant test is offered as an online or paper-based written evaluation that complements traditional functional testing by collecting employee information such as age, gender, physical characteristics, and activities in order to measure a person's predisposition to an MSD.

CtdMAP was pioneered by a team of researchers led by Melhorn, who has validated the process during the past 15 years with more than 200 companies. The test's accuracy, reproducibility, validation, and successful application have been documented in numerous peer-reviewed journals. This concept works well for industries in which repetition and endurance are key aspects of most jobs, as well as for companies with an aging workforce and/or low turnover. Targeted industries include call centers, manufacturing/assembly, casino/gaming, banking, and health care.

Melhorn is an occupational orthopedic physician who specializes in the hands and upper extremities and serves as program director for the American Academy of Orthopedic Surgeons' continuing education course on "Occupational Orthopedics and Workers' Compensation: A Multidisciplinary Perspective," as well as on the board of the American Academy of Disability Evaluating Physicians, the Committee for Occupational Health, Industrial Injuries and Prevention Committee for the American Society for Surgery of the Hand, Return to Work Committee for the American College of Occupational and Environmental Medicine, and the Medical Advisory Board for Medical Disability Advisor--Disability Duration Guidelines. "Risk assessment for the individual and job allows employers to develop more effective intervention models for the reduction of musculoskeletal pain in the workplace. Successful management of occupational musculoskeletal problems goes beyond the traditional medical dimension by allowing engineering controls to be applied in a prioritized approach, resulting in real solutions for the problems facing the American worker," he says.

At a time when most worker's compensation solutions address post-injury failure rather than injury prevention, risk assessment testing is a concept that greatly expands the traditional notions of functional testing by ensuring that individuals will be placed appropriately and guided to success, not set up for failure.

This article appeared in the September 2005 issue of Occupational Health & Safety.

This article originally appeared in the September 2005 issue of Occupational Health & Safety.

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