Recipe for health

first_imgRelated posts:No related photos. A paper describing a project to tackle musculoskeletal injury in a largebakery made Joe Patton, nursing adviser with Rank Hovis McDougall, a highlycommended runner-up in this year’s Roche Diagnostics Occupational Health Award.  By Joe Patton This paper describes the result of a three-year occupational health project,designed to reduce musculoskeletal injury in a large bread making bakery. Thebakery is capable of producing 10,000 loaves every hour, meeting the 10million-a-day demand from British supermarkets and comer shops. To achieve thislevel of production, a healthy workforce is essential. The current thinking behind the role of occupational health in workplacehealth promotion is cited by HSE1 and the RCN2,3. One way of promoting healthis to ask a simple yet fundamental question, “What is it about work thatmakes employees sick?” The next step is to do something about the answer. Ill health at the bakery was previously managed by reacting to datacollected on absenteeism in terms of days off, which did little to actuallypromote health. But with this method, sickness recurred and one-time healthyemployees began to develop avoidable illness. In order to address the causes of ill health it was felt that datacollection needed to be more detailed – describing and quantifying the reasonsgiven for illness. Bakery employees returning from sickness would often ofsubmit a self certificate that lacked a recognised medical diagnosis and wouldread “felt sick” or “had a bad back”. Against this backgrounda form was designed to record non-diagnostic reasons for sickness, separatingpublic health issues from essential occupational health information. Within the food industry people are not allowed at work if products are atrisk of bacteriological contamination. Setting this group aside, illnessescaused or aggravated by work formed the basis of an occupational healthpromotion initiative which is described here. Musculoskeletal illness In 1997 a workforce of 623 reported an average of 76 episodes of sicknessevery month. An analysis of the reasons given revealed that musculoskeletalproblems accounted for 33 per cent of all absences. This matched the expectedrate for episodes of absence due to musculoskeletal causes for workers involvedwith manual handling operations in the food and drink industry4. Within the setting of a large bread production unit, the weight of loads isnot the most significant factor in the cause of musculoskeletal injuries.Sustained or repeated spinal flexion or hazardous postures present a risk ofinjury to the musculoskeletal system. Then there are activities that riskmusculoskeletal injury. These include twisting the trunk, bending the back,reaching above shoulder height or awkward positions of the legs and feet whichaffects the body’s stability. The risk of musculoskeletal injury extends beyond posture, too. Theenvironment will decide how well a person can work and personal fitness canalso reduce the risk of injury. Musculoskeletal problems may be related to homeor leisure activities5. To make this distinction, a suitable assessment tool was required; one thatappreciated the fact that work and leisure activities can produce similarsymptoms. Such a tool was the Nordic Musculoskeletal Questionnaire. Thisquestionnaire distanced itself from using diagnostic labels and asked aboutpain, discomfort or numbness arising in nine body areas: the neck, shoulders,upper back, lower back, elbows, wrist and hands, thighs, knees and ankles6. Inorder to define any relationship to occupational factors, the severity ofsymptoms are analysed alongside activities at work and during leisure time7. The questionnaire was piloted on six bakery employees and minor changes weremade to improve the layout of questions. By the end of 1997, 132 employeesrepresenting despatch (n=52), engineering (n -3 1), hygiene (n=33) and officestaff (n=16) had been circulated with the questionnaire; 81 were returned, aresponse rate of 61 per cent. Of those who responded, the average age was 37, most were male and 34 of the81 smoked. Some 20 employees attributed their condition solely to workactivities that involved distribution, maintenance and cleaning tasks. Theremaining respondents (n – 6 1) inferred their condition was caused by acombination of lifestyle and work activities. Specific interventions Those who attributed their condition solely to work were singled out as astudy group. All were male whose average age was 46 years and the majority (70 percent) smoked cigarettes. During 1997 the study group had accumulated a total of26 episodes of ill health, resulting in 286 days absence from work. Each member of the study group received a functional assessment of fitnessand a health interview. Although they knew what part of their body had beenaffected by muscular pain, most did not attribute their condition to aparticular event, suggesting they were victims of cumulative strain. Gentlequestioning established whether any lack of job satisfaction was influencingtheir motivation to attend work. It was clear, however, that absence onlyoccurred when pain prevented them from earning a living. Emphasis was placed on the fact that smoking might increase the risk ofmusculoskeletal injury and delay the healing of an injury. The side-effects ofreduced blood flow with a depleted oxygen content were described. Those whowished to stop smoking, were helped to do so. Following the health interviews, workplace observations were made whichrevealed widespread bad practice in manual handling operations. No obviouspreparation was made in the work environment and, as a result, people were notmaking tasks safer and easier for themselves. Aids to make tasks easier wereeither not used, or were used incorrectly. To improve the situation it was clear that changes in behaviour wererequired. Each employee would need to take greater responsibility for their owncare. The Prochaska and Di Clemente model of care The conceptual framework being applied to the 20 people in this study8 wasoriginally devised to treat addictive behaviours. It is based on a belief thatpeople can be educated to change any behaviour that risks illness. Thisinvolves six stages of change: Pre contemplation: this sets the scene for people who would otherwisenot consider making changes. In the context of this study an analysis ofsickness absence placed a high priority to reducing musculoskeletal illness.The population group, identified from the Nordic assessment tool, attributedtheir musculoskeletal condition solely to work activity. Health interviews andobservations of work practice then identified the need to take greaterresponsibility for self care. Contemplation: once the need to take greater responsibility for selfcare has registered, people then require further information to help theirthinking; In January 1998 this process began with an injury analysis. Theanalysis was designed to explain the health risks associated with manualhandling followed by a description of the damage that people were doing tothemselves as a result of poor handling techniques. Preparation: when the perceived benefits of change outweigh thedesire to continue with present behaviour, people are motivated to seek andaccept extra knowledge or skills to support such a move. In February 1998 thiswas delivered by manual handling retraining. The risk of personal injury wasreduced by demonstrating and practising the correct technique for activitiesthat involved lifting, carrying, pushing or pulling. Making Change: the early days of change require positive decisions todo things differently. Support through practical help provides the necessaryencouragement to make those changes work. From February 1998 job specificguidance was given to make the working environment safer with instruction onthe correct use of equipment that would make tasks easier. In March 1998,manual handling risk assessments were updated with improved controls that aimedto further reduce the likelihood of musculoskeletal injury. Maintaining Change: when new habits become established, the person isseen as moving out of the change process and into a long term safer lifestyle.Maintaining this required vigilance and support, so in May 1998 healthsurveillance interviews checked what progress had been made and during thefollowing two months a programme of flexibility exercises was organised. Peoplewere reminded how to prepare their body for activity and how to relaxafterwards. Relapsing: when a person is unable to maintain change, old habitsreturn. This is because the change is no longer perceived to be worthwhile, afeature that Prochaska and Di Clementi consider to be expected. Throughout thisstudy individuals received constant vigilance and support to prevent a relapse.Observations of work practice ensured that correct techniques were becomingcommon place. “Lifting and Carrying” wall posters were displayed,self care leaflets issued and constant reminders given about the action to takein the event of musculoskeletal injury. Ultimately it became less difficult forpeople to maintain the changes that had occurred. Measures of effectiveness: without measures of effectiveness there isno way of knowing whether occupational healthcare is leading to improvements.In this project three measures of effectiveness were taken. First, members ofthe study group were invited to express an opinion. Second, their absence wasused to calculate a financial cost of musculoskeletal illnesses to thebusiness. Third, sickness data for all bakery workers measured the effect ofthe initiative among the total workforce. A total of 16 study group members (80 per cent) responded to a request fortheir opinion about the project. Professionally, the most important outcome wasa unanimous statement of having less musculoskeletal pain and a greater senseof well-being. They commented on the ease of using the correct technique formanual handling and the need to improve their working environment. In 1997 the 20 members of the study group had reported a combined total of26 musculoskeletal illness that had been solely attributed to work. Thisresulted in 209 days absence, costing the business around £15,000. By March1999 episodes of musculoskeletal illness had reduced to 13, resulting in 107days absence at a cost of about £9,000. This constitutes a relative riskreduction of 50 per cent and a financial saving of £6,000. Finally, the number of musculoskeletal absences among all bakery workers hadaccounted for 33 per cent of illness. By March 1998 this decreased to under 30per cent but other reasons for sickness increased. Fortunately, this situationwas not reflected in subsequent months. By March 1999 musculoskeletal illnessreduced to 22 per cent. Conclusion Sickness data enabled occupational healthcare to be prioritised towards thereduction of musculoskeletal illness. The Nordic questionnaire proved avaluable tool to identify bakery workers who had not reported a recognisedmedical diagnosis, but suffered with problems that were solely attributed towork. Observations of work practice identified that faults in technique werethe cause of many injuries and the change from being an “injuryvictim” to a “healthy worker” occurred through education thatled to safer behaviour. While the project has succeeded in reducing the recurrence ofmusculoskeletal problems, further work is required to reduce the incidence ofmusculoskeletal injury. Data seems to suggest that within bakery settings, theoccupational group with most “work specific” musculoskeletal problemsare male smokers aged over 40. Further research will be required to check thereliability of this suggestion, which can then form the basis of a moreproactive approach to promoting musculoskeletal health at work. References1 Developing an occupational health strategy for Great Britain, (1998),Health & Safety Executive 2 The OH nurse – towards professional practice, (1991), Royal College ofNursing 3 The Occupational Health Nurse: opportunities for developing professionalpractice, (1993), Royal College of Nursing 4 A recipe for safety: health and safety in the food and drink industries,(1999), Health & Safety Executive 5 Deakin et al, The use of the Nordic Questionnaire in an industrialsetting: a case study, (1994), Applied Ergonomics, Vol 25 pp182-185 6 Kuorinka, I, Standardised Nordic Questionnaire for analysis ofmusculoskeletal symptoms, (1987), Applied Ergonomics, Vol 18, pp233-237 7 Dickinson, C E et al, Questionnaire development: an examination of theNordic Musculoskeletal Questionnaire, (1992), Applied Ergonomics, Vol 23,pp197-201 8 Prochaska J and Di Clementi C, Model of care – in search of helping peoplechange: application to addictive behaviours, (1992), American Psychologist,September 1992, pp1102-1113 Comments are closed. Recipe for healthOn 1 Jan 2000 in Musculoskeletal disorders, Personnel Today Next Articlelast_img read more