real world

You Can’t Have Good Work Conditioning Without Good Job Descriptions

Quin Bond, CEAS IIILeave a comment

Recently**, a physical therapist who I’ve known for years reached out to me for some advice. She had two patients that were being sent for “work conditioning” to her. The problem was that job descriptions weren’t provided for either of the two patients. She knew that the “I only have to do this…..I never have to do that” wasn’t the whole story. She also knew that I had been involved in writing job descriptions for those positions for some of our clients. Having performed Functional Capacity Evaluations with us in the past, she also knew that having a solid job description is key in matching up demonstrated performance to essential physical and postural demands.

Work conditioning is defined by the American Physical Therapy Association as “work related, intensive, goal-oriented treatment program specifically designed to restore an individual’s systemic, neuromusculoskeletal and cardiopulmonary functions. The objective is to restore the injured employee’s physical capacity and function for return to work.”

Without understanding what the functional demand is for a specific position, it is difficult to define the goals of a work conditioning program. One of the patients that she had inquired about was a school bus driver. He had told my friend that he “really didn’t have to do much beyond sit in the driver’s seat and drive. Maybe, open the door every so often to let the kids on in the morning or off in the afternoon.” He was returning to work from a lower extremity injury that resulted in a joint replacement. Having performed FCEs for school bus personnel before, she knew that the demands were more but was unsure of the other tasks.

School bus drivers are tasked with performing pre- and post- inspections of their vehicles. This involves checking in and around the vehicle, checking storage compartments (if the bus has one), ensuring that all emergency exits (including the roof exits) are operational, and being able to check under the seats for both children and their belongings. Also, in some districts, bus drivers may be switched to different routes based on employer needs. Switching routes may require drivers to pick up students who may be in wheelchairs. When the wheelchair lift malfunctions, drivers use a manual, hydraulic pump to elevate and lower the lift as needed. This task requires the driver to be able to squat or kneel to a level to operate the manual pump. Drivers, if an aide is not present, may have to secure wheelchairs to floor mounted devices, which requires the ability to kneel while reaching. With demands such as those listed, she needed to work with this patient on being able to step up/down to get into and out of the bus, to be able to kneel to perform tasks, and make sure that the driver demonstrated the ability to perform the overhead tasks of checking the emergency exits. The ability to perform these demands are even more important as a result of the NTSB school bus driver recommendations that I mentioned in a January blog post.

Based on the APTA definition, work conditioning covers a larger swath than when the patient was being treated solely for the injury that brought them to physical therapy. During that initial portion of the treatment, therapy focused on the needs of healing for the specific body part along with improving range of motion and strength as appropriate based on the healing process. Work conditioning helps to pick up to make sure that the other aspects of the injured worker such as their cardiovascular endurance, strength, power, and muscular endurance are not impaired when they are returned back to work. As a result, work conditioning includes activities to improve physical capacity in all of these areas. When an individual begins a work conditioning program, their initial status in these components should be documented – both as a baseline as well as for comparison to the essential postural and physical demands. This will help the therapist communicate to the patient, the case manager, the physician, and the employer as to where the patient is in regard to return to duty.

When quarantine/shelter in place orders begin to be lifted, work conditioning is going to play an important role in returning workers that had been out on workers comp prior to the pandemic to their previous roles. For many of these patients, they may have been shifted over to telerehab as clinics closed for safety issues. Telerehab and “virtual physical therapy” are great for keeping in contact with the worker and moving them along in their rehab journey as best as can be done in these circumstances. However, they may not have access to the resources or guidance to recondition themselves for work prior to returning to their job. Correcting this deconditioning is going to be vital to their success upon return to work as well as for reducing their risks for suffering another injury after return to work.

Yellow school bus. Vector illustration
Yellow school bus. Vector illustration

** – I had started writing this several weeks before all of the “shelter in place” orders started to come down from the different states and it sat in a draft folder for a while. As I revisited the draft after a little over 3 weeks in quarantine, it made me think about the fact that some injured workers currently in PT may be deconditioned if not by now, but definitely by the time the shelter in place orders are lifted. Getting these workers into a work conditioning program at the soonest appropriate time point may be the best chance for a successful return to work process.

Gary Vee, ROI, and workplace safety

Quin Bond, CEAS IIILeave a comment

In a recent podcast, Gary Vaynerchuk talked about Return on Investment (ROI) and the fact that ROI isn’t necessarily driven by what is spent but “is predicated on how good you are at it”.

This is so important in the area of occupational health and safety. Often, companies will purchase equipment with the best of intentions in mind – make the job easier for the employees and reduce the potential risk of injuries. But what happens once the equipment is installed and the trainers leave? This is an issue more often than not, on initiatives large and small.

Several years ago, I was doing an ergonomic walkthrough at a large retail grocery store. Towards the end of the visit, we were standing near the check out lanes. As we were talking, I noticed that one cashier was fairly tall – a little over 6 feet – but the cashier next to him was an older woman who was just a little over 5 feet. A few minutes before, the safety manager had explained that they had purchased adjustable monitors for the cashiers to be able to see the items that had been rung up. As I was looking at these cashiers, I noticed that both had their monitors set to exactly the same height. Despite the best efforts of the employer to provide equipment to make the job easier and safer, the employees weren’t using it. They did not adjust the monitor heights.

While filling out consent forms for a fit for duty functional capacity evaluation, a recent claimant repositioned himself in a chair in the lobby of our office that allowed me to see his feet. I noticed that one foot was in a walking boot. This was an unexpected piece of information. As I asked him about the walking boot, I learned that he had been working modified duty in the boot which was for treatment for a significant medical issue related to his foot. Both the condition and the walking boot required a quick call to the employer who he had not told about the walking boot. This employer provides safety shoes for their employees as it is a safety requirement for the position. Due to the fact that the walking boot was black as were the issued safety shoes, nobody had noticed the walking boot. A quick routine check of PPE when supervisors meet with employees throughout the day/week would have resolved this issue which could have resulted in greater medical issues for the employee.

For any project, whether it is a safety initiative such as safety equipment or equipment modifications or programs such as post-offer pre-employment or return to work testing, it all comes down to how good you are the program that you are putting in place. This requires constantly paying attention to how the program is running. Are supervisors making sure that employees are following safety guidelines? Are you making sure that your post-offer physical ability testing or return to work programs are based on accurate job descriptions? When developing a new safety initiative, make sure that you include follow-up and oversight in your planning to ensure that you get the ROI that you are expecting.

**  For those looking for the specific podcast, it is the December 4, 2019 episode entitled “You’re Not Going To Know Where To Start”

 

What Should We Do Wednesday – 10/9/19

Quin Bond, CEAS III1 Comment

In the past, I have covered different incidents that point out how things could be done differently under the guise of “What Not To Do Wednesday” blog posts.  This morning, I read an article that was written after the safe resolution of a training flight that included a mechanical failure.  In “Elevator Failure at 4,500 Feet”, instructor pilot Rich Wyeroski recounts a flight in which the elevator on the horizontal stabilizer had a malfunction while the plane was in flight.  Wyeroski provides a solid recounting of the steps that he took to safely bring the plane down after the student pilot reported difficulty with the controls.  In the article, he states that his reason for writing the article is a concern that this incident, particular to Cessna 150 airplanes built between 1959 and 1970, could occur again without a hardware modification to upgrade the elevator hardware to the same standard as Cessna 152 planes as well as some Cessna 150 planes that were later.     He also discusses the importance of training to deal with potential emergencies such as this to ensure that pilots:

“Always try and stay calm during an emergency. Don’t do anything until you assess the situation and then react slowly. (The only time I would deviate from the above recommendation is if the aircraft is on fire!)”

Wyeroski, who is not only an experienced pilot, instructor pilot, and instructor for A&P mechanics, gave a great breakdown on how the flight was handled and possible solutions.  But, my reason for bringing up this aviation article was the comments section.  Some of the comments argued that a pre-flight inspection should have caught this and that a request for planes to have the attachment system for the elevators in the older Cessna 150 models is a little too much for something that happens rarely.

The thought process of those who stated that it should have been caught in the pre-flight inspection really stuck with me when I was reading the article.  Several people did note that it would be easy to miss (either by a lack of a thorough pre-flight inspection or by seeming ok during the pre-flight but loosening in flight).  The author noted in a comment that no issues were noted during pre-flight or during a recent annual inspection.

Without Wyeroski’s recount, this near fatal flight would not be a learning experience except for those who dig through NTSB case files.OLYMPUS DIGITAL CAMERA

One of the problems in safety and workers compensation is that all too often, only the incidents that cause injuries are reported/recorded and potentially used to effect some level of change within a worksite.  Sometimes, it is because only the people involved know about the incident because of not being required to report/record or even check in with occupational health.  But these “near misses” are important to take the time and look into more deeply.  Many times, the lessons learned from a “near miss incident”  can provide the information necessary to change either policies/procedures and or change/adjust equipment to prevent future incidents.  Wyeroski even notes in the comments that one lesson that he learned from this incident was to contact Air Traffic Control rather than the local Unicom operator to make sure that the Fire Department was ready and at the runway when he landed (apparently, the Unicom operator was unable to get the fire department to understand the urgency of the request and the risk of a fatal crash).

Photo by Adrian Pingstone, Wikimedia Commons

 

Friday Five – 2/2/17

Quin Bond, CEAS IIILeave a comment

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product.

A lot of money and time has been put into exoskeletons for assisting soldiers, laborers, and individuals who have had strokes or spinal cord injuries.  This is an area that I plan on revisiting in future posts.  For now, a company called suitX has introduced a modular line of exoskeletons for assisting with specific work related tasks and body parts.

Whenever there is a change of administrations, regardless of whether there is a change in party, there are revisions to previous rules and regulations.  This National Law Review piece takes a quick look at areas of potential changes at OSHA.

Becker’s Healthcare Review has five great tips for designing an intergenerational workspace in hospital settings.

Not so much ergonomics but a question of productivity and efficiency on the Monday after the Super Bowl.  Kraft Foods is suggesting the day after should be a holiday  with an anticipated 16.5 million workers may call out sick to recover from festivities the day before.  This is an interesting question when talking about presenteeism vs. absenteeism.  How much work is actually lost with people discussing the game and the commercials when they come to work the next day?

When I was taking a tour of our local police department with my son’s Cub Scout den, my son asked the officer who gave the tour about a poster in the squad room.  The poster had a police cruiser that had been in an accident and had a slogan reminding officers that car accidents cause more line of duty deaths than some of the other more media noticed causes.  I found this article with 5 real world tips that police officers can use to make their vehicle safer for today’s tour of duty.