Creating a Culture of Safety: The Role of MSD Prevention

Introduction to a culture of safety

When it comes to defining corporate culture, in general, the terms get vague, definitions vary, and confusion abounds. When discussions turn to a culture of safety, the confusion is no less. This article aims to:

• Explain how to keep your employees safe through an optimal safety culture.
• Objectively clarify the definition of a culture of safety.
• Discuss the rationale for promoting a safety culture.
• Explain the important steps and components of creating a culture of safety.
• Highlight the importance of an effective MSD prevention program in creating a safety culture.
• Define comprehensive “Hire-to-Retire” MSD prevention.
• Illustrate how to enhance MSD prevention with technology.
• Help you measure the effectiveness of your safety culture.

This article aims to provide a clearer understanding of safety culture and how to promote it. It will also explain the importance of MSD prevention in creating a true culture of safety.

What is safety culture?

If you conduct an internet search on “definition of safety culture,” you’ll find definitions from all the usual suspects: Centers for Disease Control (CDC)/ National Institute for Safety and Health (NIOSH), Wikipedia, and The National Safety Council (NSC). But perhaps my favorite definition is one from leaderfactor.com. (1) And I like it because it operationalizes the term “safety culture.”  In other words, it is a definition that has actionable meaning. This source describes safety culture in the following ways:

1. “more than just following protocols or rules”
2. created through “an organization's values, behaviors, and attitudes toward safety.
3. “a shared commitment to prioritizing safety in all aspects of work.”
4. “a commitment that “goes beyond lip service – it's a collective dedication to fostering an environment where the well-being of every individual takes precedence.”
5. encompasses “deeply ingrained values that guide decisions and actions.”
6. “emphasizes the importance of safeguarding lives and well-being above all else.”
7. “manifested through behaviors – the day-to-day actions that reflect the organization's unwavering focus on safety.”
8. “employees willingly and proactively adhere to safety protocols, even in the absence of supervision.”
9. “nurturing a mindset that inherently understands the significance of each person's safety and its ripple effect on the entire organization.”
10. “fostering a culture where open communication about safety concerns is not only encouraged but celebrated.”
11. “a living, breathing entity within the workplace.”
12. “a constant reminder that safety is not an afterthought, but a core element that permeates every decision, every action, and every interaction.”

The concepts of dedication, prioritizing, emphasizing, precedence, unwavering, core element, and commitment are key throughout these phrases describing safety culture. All point towards the idea that in organizations with a true safety culture, safety is not second, not third, and certainly not an afterthought—safety is first!

Why create a culture of safety?

The reason to create a culture of safety can be summed up in three words: productivity, profitability, and retention.

Productivity and Profitability

In a recent review of 18 case studies (17 of which were published by the National Safety Council), researchers found an average increase of 66% in productivity, 44% in quality, and 71% (38%–100%) in cost benefits. In a few of the cases, it took only 8 months to obtain financial payback for the company’s investment. These studies indicate that safety can assist in achieving operational sustainability and achieve a long-term competitive advantage. (2) While these studies don’t prove causality, the correlations were particularly strong.

Through literature review and case studies, an EU-backed project supported by partner countries of the ‘Health and Safety at Work in Relation to Productivity Project’ (HESAPRO) supports the idea that health and safety management programs have positive impacts on productivity. (3) They found that safety programs had an impact at the enterprise, individual, and social levels. The report points out that safety programs support company goals and performance in the workplace and are key to business excellence.

The Engineering Management Institute states that “safety in the workplace translates directly into measurable business benefits. Accidents and mishaps don’t only harm individuals — they have a ripple effect across the entire operation. Fewer accidents naturally lead to less downtime. When a project runs without unexpected halts, it maintains momentum and ensures that resources are utilized optimally.”

Engineering and Management also site Toyota’s Production System (TPS) central to which is the jidoka principle: “automation with a human touch.” It refers to the capability to stop production immediately when irregularities surface or safety is an issue, ensuring top-notch quality and worker safety. Jidoka significantly cuts downtime, creates a consistent workflow, and bolsters morale and efficiency. TPS and the jidoka principle have spread to industries worldwide, recognizing the correlations between safety and productivity.

In addition to the research, common sense tells us that with fewer injuries, injury costs decrease, which for many self-insured companies translates directly into cost reduction and bottom line increases in profitability.

 Retention

A strong safety culture profoundly impacts employee retention if employees are injured and unable to work. (6) A strong safety culture prevents these injuries from happening in the first place and keeps workers on the job. By eliminating work-related injuries, employers could gain back 103,000,000 days of production — the equivalent of (retaining) 394,636 full-time workers.

However, safety doesn’t just improve retention by preventing accidents and injuries. It can also impact employee engagement, job satisfaction, and morale — all of which affect employee retention. Especially in a time of workforce shortage, a safer workplace can help organizations attract high-quality employees for the future.

A safe workplace doesn’t just prevent injuries but also instills trust, which, in turn, significantly reduces turnover rates: employees thrive in work environments where they feel valued and protected. Recognition as a company that prioritizes safety provides a competitive edge, better business opportunities, and a strong brand image.

Improved Work Environment and Employee Engagement 

A strong safety culture also creates a positive work environment where employees feel valued and supported. Employees who feel that their safety is a top priority are more likely to be engaged and motivated, leading to increased productivity and overall job satisfaction. According to the Occupational Safety and Health Administration(OSHA), "Employees who feel that their employer cares about their safety and health are more likely to take pride in their work and be more productive." Engagement and motivation begets productivity, which begets engagement and productivity. It’s a positive reciprocal reaction.

Increased Compliance and Legal Defensibility

In addition to the financial and motivational benefits, a strong safety culture can help an organization comply with regulations and avoid legal issues. When an organization has a strong safety culture, it sets high standards for all safety processes, including strict processes for reporting, inspections, training, and overall safety management. This helps the organization meet regulatory requirements and avoid costly fines and legal issues. A strong safety culture can also help an organization defend itself during a lawsuit or OSHA investigation, as it demonstrates a company's commitment to safety and a proactive approach to risk management.

How can you create a better safety culture? Five elements:

To develop a strong culture of safety, organizations need to consider five elements: Education, Encouragement, Engineering, Enforcement, and Evaluation. (5)

1. Education:

Enhancing your organization's safety culture requires educating employees on worksite hazards and their controls. Education provides workers with the knowledge of the required safe work practices.

2. Encouragement:

In order to achieve active participation in safety programs, workers must have confidence and enthusiasm. They must believe the solutions will work and trust in the process to solve safety concerns. The emphasis is on positive feedback.

3. Engineering:

“Engineering Safety” involves careful design, development, analysis, implementation, and maintenance of safety measures as they are being rolled out.

4. Enforcement:

All programs work best if compliance is voluntary and established through encouragement. Training must be structured to encourage employees to follow guidelines and understand safety is their responsibility. Rather than “enforcement,” perhaps the term reinforcement would be better received by employees and supervisors alike.

5. Evaluation:

Regular safety audits that are compliant with the current safety standards are essential. Having a cadence of semi-annual or annual audits to review safety practices and procedures goes a long way toward compliance. The old saying “inspect what you expect” is never truer than with the implementation of a strong safety culture. Accountability is key.

What are the four key steps to change the safety culture in your organization?

Creating and maintaining a strong safety culture takes the entire organization's time, effort, and commitment. It requires ongoing communication, training, and reinforcement procedures. It also requires effective leadership who makes a top-priority commitment to safety. Creating a strong safety culture requires a long-term commitment from the entire organization at all levels – executive, management, supervisors, and employees. Here are four key steps to help improve performance and productivity through a culture of safety:

Step 1: Commitment from the Top

For a safety culture to thrive, leadership must be fully committed and prioritize safety. This includes setting clear safety goals and objectives, allocating resources for safety initiatives, attending safety meetings, and leading by example. When leadership is committed to safety, it sets a tone for the entire organization and shows that safety is a core value.

Step 2: Employee Participation 

Encouraging employee participation in safety is crucial for building a strong safety culture. This includes giving employees a voice in safety decision-making and involving them in identifying and resolving safety issues. When employees feel that their input is valued and that they have a stake in the safety of their work environment, they are more likely to be engaged and motivated.

Step 3: Clear Communication

Effective communication is essential for building a strong safety culture. This includes communicating safety expectations, providing regular safety training, and encouraging open communication about safety concerns. Organizations can proactively identify and address potential risks before they become incidents by fostering an environment where employees feel comfortable speaking up about safety issues.  The tone of all discussions should focus on the issues rather than punishing wrong-doers.

Step 4: Continuous Improvement & Training 

Creating a strong safety culture is an ongoing process that requires continuous improvement. This includes regularly reviewing and updating safety policies and procedures, conducting regular safety audits and ergonomic assessments, and tracking and analyzing safety performance data. By continuously improving safety processes, organizations can identify areas for improvement and make ongoing progress toward a more robust safety culture.

Why MSD Prevention is essential for promoting a culture of safety.

According to the US Bureau of Labor Statistics, “musculoskeletal disorders (MSDs), also referred to as ‘ergonomic injuries’ or ‘strains and sprains,’ occur when the body uses muscles, tendons, and ligaments to perform tasks, oftentimes in awkward positions, with heavy weights, or in frequent activities which over time can create pain and injury. Overexertion and repetitive motion are the primary causes of these injuries.”

In 2018, there were nearly 1M Days Away from Work (DAFW) cases in the U.S. private sector with 30% being MSD cases. The incidence rate of MSD cases was 27.2 per 10,000 full-time workers. The median days away from work for MSD cases was 12 days.

According to the Center for Disease Control (CDC), US companies spent 50 billion dollars on direct costs of MSDs. According to OSHA, indirect costs can be up to five times the direct costs of MSDs. (8)  Taking into account both direct and indirect costs, the MSD problem is costing US employers an astounding $250 billion dollars.

According to one survey of 2,000 workers by Willis Towers Watson, more than two-thirds of people (68 percent) say that their job caused or exacerbated their MSD. Ergonomics, or the science of the interface between humans and their work environment, significantly influences these injuries. And ergonomic conditions are largely dictated by employers and the nature of the work. Sixty-four percent of those who experience an MSD think their condition is exacerbated by work, and one-third said their employer was aware of their condition but failed to make the necessary changes.

It's not only older workers who suffer. One survey showed that workers aged 18-24 were found to be more likely than any other generation to claim that their work had contributed to their MSD (87 percent of workers in this age range).

Given the size of their impact, MSDs must be addressed to create a comprehensive safety culture.

Six elements of comprehensive “Hire-to-Retire” MSD Prevention.

What can be done to prevent MSDs?

There are seven elements to a comprehensive “Hire-to-Retire” MSD prevention plan.

1. Pre-Hire Physical Abilities Testing

Preventing MSDs begins at the time of hire. Many MSDs occur because there is a mismatch between the job requirements and the physical abilities of job candidates. By administering a pre-hire/post-offer Physical Abilities Test (PAT), the employer can determine if the candidate can perform the job safely and, thus, be less likely to sustain an injury.

Tests can be performed onsite or at a nearby rehab clinic and usually take approximately 30 minutes to complete. They have been shown to decrease injuries and costs, on average, by 78% among new hires, with an 11:1 return on investment for the employer. In addition to employee selection, the employer can also use these tests to place the candidate into the most appropriate position.

Pre-Hire PAT should be designed to be job-specific to meet the requirements of the EEOC and ADA. Therefore, the physical requirements of the job should be carefully assessed, and the tests should be specifically customized for each job. If applicants are hiring into a pool of jobs, all jobs must be assessed, and a tiered or matrix-type test must be designed to determine which job is best for each employee.

2. Onboarding and Training

In addition to the pre-hire PAT, most employees benefit from new-hire training and practice in ergonomics, lifting techniques, and safe work practices. Especially in physically demanding and/or outdoor jobs, these onboarding programs also have an element of acclimation.

3. Ergonomic Assessment, Abatement, and Training

Even if companies select and train the right associates, some jobs are so demanding that, over time, the wear and tear on the human body will eventually create injuries. These companies are advised to continuously analyze and make every effort to reduce the physical stress of the work. Periodic ergonomic assessments can be performed to quantify the risks of the jobs and prioritize the development of ergonomic abatements that will lower the risk. In addition to changing the worksite, employees can be trained in the best ergonomic work practices.

4. OSHA-Compliant Early Intervention

Early detection of MSDs increases the chances of a resolution and avoidance of a lost or restricted work time injury. OSHA allows the administration of 3 non-medical first aid interventions specific to MSDs that do not turn the issue into a recordable injury:

• Hot and cold packs
• Massage
• Non-rigid supports

In addition to the first aid treatments, ergonomic principles of job performance can be reviewed. Most of these programs occur at the worksite but can also be administered in a nearby rehab clinic.

5. Return-to-Work/Fitness for Duty (RTW/FFD) Testing

Despite all your efforts, there will inevitably be lost time, injuries, and employees who must be out of work for FMLA for extended periods of time. And just because an employee reaches maximum medical improvement, doesn’t mean they have reached full functional improvement.  For that reason, it’s important to administer a Return-to-Work/Fitness for Duty (FFD) Test, which will significantly reduce the chances of re-injury or a new injury occurring after return to work.

6. Work Conditioning and Ergonomic Training

If employees fail the RTW/FFD test, they can enter a daily work conditioning program and often return to work full duty after a couple of weeks of program participation. The program focuses on helping the employee improve the strength, endurance, flexibility, balance, and coordination needed for return to work.

Implementing any one of these programs will significantly decrease injuries and lower workplace injury costs – both direct and indirect. They all have dramatic positive effects on safety culture. However, the maximum injury prevention and safety culture benefit occurs when they are all implemented to create a MSD prevention from the time of hire until the employee leaves the company.

Augmenting MSD Prevention with technology

Today’s MSD prevention programs are more effective and efficient than ever due to technology. And different technologies apply to each step of the process.  See Table 1. below.

Table 1. Technology applicable to Hire-to-Retire MSD Prevention.

Web-based testing allows recruiters to schedule the test online, the applicant to complete medical history forms online, and the clinician to enter test scores online and provide immediate results back to the recruiter. Thus reducing the time required for recruiters and applicants to get test results.

Computer vision AI uses video, computer software, and AI algorithms to convert video of job tasks into stick figure limb segments, joint angles, and hazard scores. The technology is useful in quantifying ergonomic hazards and suggesting possible abatement strategies. Ergonomic assessments and hazard scores that previously took hours to calculate can be done in minutes. The technology is also useful in ergonomic training. The old adage “a picture is worth a thousand words” is never truer than when it comes to ergonomic training. Employees can literally see an improvement in hazard scores when they perform the task more ergonomically. Those images are motivating and engaging.

Wearable sensors function like an “always-on” ergonomic coach, providing haptic feedback (otherwise known as vibration) when lifting or bending exceeds a pre-set threshold. Over time, employees are trained to avoid haptic feedback and improve their ergonomic work postures. Those who don’t improve benefit from additional coaching or modifications to their workstations.   One-time instruction is rarely adequate for permanent behavior change. By comparison, several weeks with the wearable sensor feedback engrains improved movement and material handling patterns.

How do you judge the effectiveness of your work safety culture?

One of the barriers to creating a culture of safety is a lack of objective measures of safety culture. One such approach is to conduct onsite audits rather than relying on employee perception. (9)  Researchers at Saint Mary’s University in Halifax, Nova Scotia, developed, pilot-tested, and validated an instrument to measure safety culture in 2006. They focused on objective measures of concrete indicators of safety culture rather than asking the opinions of employees and management. Their resulting instrument consisted of 6 elements subdivided into 12 indicators:

1. Incident investigation team
2. Workforce involvement
3. Training frontline employees, supervisors, and managers
4. Manager and supervisor performance evaluation
5. Safety Communications
6. Commitment to Safety (planned maintenance, rules and procedures, and management and supervisory visits to worksite).

Each of the six indicators is rated on a scale of 0-4 (with 4 being the highest level) according to the level of maturity of that indicator or system within the organization. Each level is operationally defined in concrete objective terms, enhancing the instrument's reliability.

Such an instrument can be used annually, quarterly, or semi-annually to assess the maturity of the safety culture within the organization. Alternatively, the instrument can be used before and after implementing a program designed to improve the organization’s safety culture.

Other indirect measures of an organization's safety culture include near misses, incidences, days away from work, restricted duty days, and the cost of work-related injuries and illnesses.

Some parting thoughts on safe work culture…

When an organization has a strong safety culture, it sets high standards for all safety processes, including clearly communicated procedures for reporting, inspections, training, and overall safety management. The high standards are achieved with accountability systems that promote a sense of commitment to safety and encourage employee participation in workplace safety. As a result, the organization experiences fewer incidents and related costs, such as medical expenses and lost productivity.

But don't just take our word for it. Numerous reputable institutions have recognized the importance of a strong safety culture. The Centers for Disease Control and Prevention (CDC) also states that "a strong safety culture can be a powerful tool for improving the health and well-being of workers."

A strong culture of safety contributes to a positive work environment that ultimately improves employee satisfaction and retention. A strong safety culture can also improve a company's reputation and brand image. Consumers are increasingly choosing to do business with companies that prioritize safety, so that a strong safety culture can help attract new customers and business partners.

ErgoScience Can Help

At ErgoScience, we understand the importance of a strong safety culture that includes MSD prevention solutions. So don't wait. You can start building a strong safety culture at your organization today. The benefits are clear, and the time to act is now.

Help your employees today!

References

1. https://www.leaderfactor.com/learn/what-is-safety-culture-in-the-workplace
2. https://onlinelibrary.wiley.com/doi/abs/10.1002/hfm.20106 Volume18, Issue2 Special Issue: Evidence‐Based Safety and Health Engineering, March/April 2008, pages 152-179.
3. Chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://hesapro.org/files/Background_Research.pdf
4. https://engineeringmanagementinstitute.org/correlation-between-workers-safety-and-productivity/
5. https://www.irwinsafety.com/blog/what-are-the-5-elements-of-safety-hint-they-all-start-with-an-e#:~:text=Whether%20you%20are%20developing%20HSMS,safety%20elements%20one%20by%20one.
6. https://www.lisam.com/news/staying-safe-how-safety-affects-employee-retention/#:~:text=However%2C%20safety%20doesn't%20just,quality%20employees%20in%20the%20future.
7. https://www.bls.gov/iif/factsheets/msds.htm#:~:text=In%202018%2C%20there%20were%20900%2C380,2018%2C%20and%2035.4%20in%202011.
8. https://ohsonline.com/articles/2020/02/13/the-relationship-between-msds-and-the-workplace.aspx#:~:text=Musculoskeletal%20Disorders%20(MSDs)%20are%20both,of%20Labor%20Statistics%20(BLS).
9. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://publicsafetyaviation.org/images/Resources/Measuring%20Safety%20Culture%20on%20Audits%20Rather%20Than%20Questionaires.pdf