Wellness?!? What does ergonomics have to do with wellness? Much more than you may realize. Major initiatives by US national governing bodies are focusing on improving the health and wellness of employees and the community at large. They are using, and one might even say co-opting the word “ergonomics” or words that describe ergonomics in their initiatives with very little, if any, involvement from professional ergonomists. We, as a profession, need to be aware of these activities and even if we don’t want to be involved in wellness, we need to get involved as others have taken ergonomics into the realm of wellness.
[Editor’s note: this article elicited a spirited response from others, including CPH-NEW Responds to: Wellness — Why Ergonomists Need to Get Involved]
Let’s start by tackling the obvious thoughts that are probably going through your mind right now. What is this all about? I don’t see the wellness—ergo connection. If you’re like me the first things that come to mind when I hear the word wellness is smoking cessation, weight loss and nutrition. Other topics could’ve crossed your mind as well, such as health risk assessments, yoga, stress reduction, etc. since the word wellness can cover a very broad spectrum of ideas and programs. However, I doubt ergonomics even entered your mind. Well, this article is to inform you on what’s going on, why there is a wellness-ergo connection and why professional ergonomists should and need to get involved in wellness. Not convinced? Read on…
There are two influential national organizations that are focusing on employee wellness. The first being National Institute for Occupational Safety and Health (NIOSH)1, a US agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. The second is the National Prevention Council (NPC) which is probably a new name to most readers. It is also a US organization whose purpose is to focus on prevention to improve the health of Americans2. Both, through Total Worker Health™5,6 and the National Prevention Strategy2,4,8,9, respectively, are focusing on finding ways to increase the health and wellness of employees by addressing the roles and responsibilities of the employer. One frequent component that is cited over and over in their health protection/promotion efforts is ergonomics! However, I have to ask how many professional ergonomists are involved in collaborating with NIOSH and the National Prevention Council on these initiatives? I have a strong feeling based on researching some of the names of people involved and from presenting on this topic at the Applied Ergonomics Conference in March 2012 that very few, if any, are involved. I asked the approximately 40 people who attended my “Ergonomics and Wellness: An Integrated Approach” presentation if they had heard of NIOSH’s Total Worker Health or the National Prevention Council’s National Prevention Strategy. No one raised their hands—not one person was even remotely aware. What does that say about those of us in ergonomics? Where are we focusing our attention? Ergonomics is being talked about in these initiatives and yet we have no knowledge. How does that happen? You’ll understand the need for ergonomists to get involved in these efforts once you understand what they are doing and saying.
NIOSH Total Worker Health™
In the early 2000’s NIOSH started to look at employee health at both work and at home. What started with a couple of symposiums on the topic has evolved into a full funded program/initiative called Total Worker Health™. According to NIOSH, Total Worker Health™ (TWH)4 “is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.” A new concept, “The Whole Worker”, is being promoted throughout TWH. This means that life at work and at home has to be addressed in order to achieve full worker health and well-being. In order to do this, NIOSH is promoting and recommending that occupational health and safety programs (OHS) and Workplace wellness programs (WWP) be integrated into one program. They term this as “health protection” and “health promotion”. OSH and WWP have a common goal and that is to protect and improve worker health. Since health is complex and multidimensional issue TWH places emphasis on integrating health protection and health promotion programs as it believes the programs are more effective when combined than separate. For example, stress is a common home and workplace hazard. Stress at work can spill over into personal lives and vice versa. We know that stress can negatively affect worker performance in many ways such as increasing unsafe work practices, accident rates and errors.3 Ergonomists deal with the effects of worker stress in that we focus on designing systems and work environments in which unsafe acts and errors cannot be easily performed and ideally, not performed at all. In this context we use human factors to control the effect of worker stress; we don’t “treat” the stress of the individual. We do this through our knowledge of human cognitive and psychological abilities and limitations of the human, which we incorporate into the equipment and work area design to prevent the wrong choices from being made. This is just one example of how ergonomics fits very well with wellness.
The importance of Total Worker Health™ by NIOSH is reflected in its support and funding of five Centers for Excellence to Promote a Healthier Workforce. Two of the centers are part of the Center for the Promotion of Health in the New England Workplace (CPH-NEW) at the University of Massachusetts and at the University of Connecticut. The other three are the Harvard School of Public Health Center for Work, Health and Wellbeing, Oregon Healthy WorkForce Center (ORhwc) and University of Iowa Healthier Workforce Center for Excellence (HWCE). The Harvard center released a paper in February titled “SafeWell Practice Guidelines: An Integrated Approach to Worker Health” and in it was the image below. Take a close look at it. Do you see the similarities to ergonomics? It contains the three main categories of ergonomics: Physical, Cognitive and Organizational. It includes process improvement principles which most ergonomists use to measure, track and improve their efforts. It includes the well-being of the human and organizational system performance (although it does include a community context which ergonomics doesn’t routinely take into account unless the work we do involves the community, e.g. design of buildings, roads, signage, etc.).
How many centers of excellence in ergonomics are there? The obvious answer is none. However, the potential for becoming part of one or more of these centers would allow us to further study and understand the role and effect of ergonomics on human (and employer) wellness. This could be a major gain for our profession.
National Prevention Strategy
I must admit I was not aware of the National Prevention Council (NPC) or the National Prevention Strategy (NPS) until I started taking a closer look at the possible initiatives that may impact our profession. The NPC was recently created as part of the Affordable Healthcare Act (otherwise known as “Obamacare”) in 2010. The council is chaired by the US Surgeon General and the other members are the leaders of 17 federal departments, agencies and offices. The council’s purpose is to promote injury and illness prevention and wellness. The council released its National Prevention Strategy in June 2011. According to Surgeon General Regina Benjamin, MD, the strategy will “move us from a system of sick care to one based on wellness and prevention”. She goes on to say, “We also know that many of the strongest predictors of health and well-being fall outside of the health care setting (emphasis mine). Our housing, transportation, education, workplaces (emphasis mine), and environment are major elements that impact the physical and mental health of Americans. This is why the National Prevention Strategy helps us understand how to weave prevention into the fabric of our everyday lives.”
One of the priorities of the strategy is to prevent injuries. One of the recommendations is to “Promote and enhance policies and programs to increase safety and prevent injury in the workplace.” The recommendation goes on to say “Comprehensive workplace prevention programs that include management commitment, employee participation, hazard identification and remediation, worker training, and program evaluation can successfully reduce workplace injuries and illnesses. Effective prevention strategies for workplace deaths and injuries include developing and implementing engineering controls and protective technologies; comprehensive, written programs that are part of formal work site safety training initiatives; and training on work practices that promote a culture of safety within the workplace. Electronic tracking systems help identify hazards, inform prevention planning, and measure progress. In multiemployer work sites, enhanced safety communication is also critical.”
The above recommendation sounds a great deal like ergonomics. Ergonomics and human factors are used to prevent injuries. It utilizes engineering controls and protective technologies. Ergonomic programs involve training of employees and management. In addition, programs use tracking systems and continuous improvement to measure progress and make improvements.
What It Means To Ergonomists
Ergonomists whether employed in companies or consultants need to take time to review the purpose and goals of TWH and NPS, and develop ways to fit and integrate ourselves into their strategy. We are part of the “prevention workforce”. Here are a few key points to remember as you review the two initiatives:
At this time the TWH™ and NPS initiatives are just that, they aren’t laws or regulations. However, TWH when combined with the National Prevention Strategy certainly has a potential to develop into that, whether or not it does in the coming months and years remains to be seen. That being said, there’s no need to wait for regulations before we proceed to emphasize ergonomics as the best way to combine health protection (safety) with health promotion efforts (wellness). The effectiveness increases and therefore so does the benefits of the program to both the company and the workers. The advantages of healthier, engaged and more productive workers are both tangible (reduce work comp/benefits costs and profits) and intangible (better moral, high satisfaction, low absenteeism) to the company.
Example of Where It Makes Sense
The great majority of wellness programs are voluntary, i.e. the employer offers wellness activities and employees sign up on their own accord. According to ADP Research Institute participation in wellness programs averaged 51 percent of employees in mid-sized companies and 39 percent of employees in large companies.12 Now compare that to ergonomics. Ergonomics focuses on eliminating or reducing the problem usually through engineering solutions. Ergonomics does not rely on employees volunteering to comply with a wanted behavior or action. Ergonomics modifies the work environment, workstation, equipment, process, etc. in order to achieve the wanted behavior. Employers can use ergonomics to achieve their wellness objectives.
A very topical example of how ergonomics and wellness fit together involves office ergonomics and ‘sitting disease’11. “Sitting disease” is a term that has been created to describe the correlation between prolonged sitting and an elevated risk of mortality found by recent research studies. The studies have suggested that prolonged sitting contributes to obesity, diabetes, heart disease and cancer. The basic solution to sitting disease is to get people to move. The question for employers is how they can get their office (sitting) employees to move while still maintaining or increasing productivity. From an ergonomics point of view the best solution is one in which the workstation environment and equipment easily allows an employee to alter postures and incorporate moving at their workstation, i.e. by providing sit-stand workstations. Sit-stand workstations solve several problems—ergonomic and wellness. Some of the problems addressed include the elimination of problems caused by fixed height workstations which may or may not fit the user, reduction/elimination of users’ complaints about hotness and sweating from sitting in non-mesh chairs by altering between sitting, increase in calories burned as standing uses bigger muscles of the body and increase in employee satisfaction and productivity as users are in control of their workstation, i.e. sit or stand when they want. The key wellness function of sit-stand workstations is the movement and increased calories burned. One can theorize that a small increase in standing of up to 2 more hours per day will result in more calories burned which can result in keeping weight off or weight loss which in turn can positively impact the amount or severity of diabetes and heart disease. (Note: There are no studies as of yet that proves this theory although research is currently being conducted at Mayo Clinic by Dr. James Levine on this.) This is a perfect example of how ergonomics can and should be used by employers to improve the health and wellness of employees.
One important aspect of ergonomics is the focus on being proactive and prevention. Both the Total Worker Health™ and the National Prevention Strategy fits nicely into our model. As ergonomists, we should embrace the challenge and changes the NPS and TWH™ present to us. When you get right down to it ergonomics has been the “wellness” program for employers and employees from its very beginning. According to the IEA10 (International Ergonomics Association) the official definition of ergonomics states that the purpose of ergonomics is to “…optimize human well-being and overall system performance.” We’ve been doing the combination of health promotion and protection for years but unfortunately we never came up with those buzz words ourselves. We can’t afford to be ignorant of the wellness topic and initiatives that are going on all around us. We need to continue to educate the importance of ergonomics and ergonomists as the necessary critical component for employee (and company) wellness and productivity. We need to get involved in these national centers of excellence and councils. I don’t want to see us fall behind, like we did with Lean and Process Improvement, and try to play catch up in the months and years ahead. All too many people outside of our profession look at ergonomists as the people who know chairs. That has to change on many fronts. We need to take this opportunity to be seen and heard as the leaders on wellness by employer and government organizations alike.
[Editor’s note: this article elicited a spirited response from others; be sure to also read CPH-NEW Responds to: Wellness — Why Ergonomists Need to Get Involved]
About the Author
Jill Kelby, PT, CEA, president and owner of Kelby Ergo Design, LLC, Eden Prairie, MN, leads her business clients through a process designed to change operations to not only solve problems related to efficiency, productivity and safety but also help them save money. Through Kelby Ergo Design (KED), Ms. Kelby focuses on developing and delivering strategic solutions to today’s productivity, safety, and health and wellness issues through training and consulting services. Jill may be contacted at [email protected] or 612.454.1432.