Journal of Occupational Rehabilitation, Vol. 5, No. 2, 1995
Employee Ergonomics Training: Current Limitations and Suggestions for Improvement Phyllis M. King 1~-
Employee ergonomics training programs are increasingly being called upon as a strategy to reduce illness and injury in the workplace. A review of the literature on ergonomics training revealed a variety of methodologies and practices. Programs varied in structure, content and method of delivery. These variances, along with a number of obstacles purported to influence the acceptance and effectiveness of training programs, reflect some of the current limitations to effective ergonomics training. This paper recommends the application of adult education principles to improve program planning and training practices. KEY WORDS:ergonomics; training; evaluation.
INTRODUCTION Ergonomic-related injuries and illnesses in the workplace are significant contributors to soaring workers' compensations costs. At the 1990 National Safety Congress, the Secretary of Labor noted that 48% of the Occupational Safety and Health Administration's (OSHA) reported incidents were ergonomic-related. Aetna Life and Casualty Co. has concluded that nearly 50% of workers' compensation claims reported and about 60% of their attendant costs were ergonomic-related. The monetary base of these percentages have been estimated at over $1 billion (1). Corporations, regulators and unions are now beginning to recognize the potential value of early intervention and prevention of work-related injuries. Ergonomics is being viewed as a key element to improving employee safety, health, and productivity. Growing interest in education and training programs in ergonomics is fueled by OSHA guidelines related to the training of workers in recognition, avoidance, and prevention of unsafe or unhealthful working conditions. 1Occupational Therapy Program, University of Wisconsin-Milwaukee,
P.O. Box 413, Milwaukee,
Wisconsin 53201. 2Correspondence should be directed to Phyllis M. King, MS, OTR, Occupational Therapy Program, University of Wisconsin-Milwaukee,P.O. Box 413, Milwaukee,Wisconsin53201. 115 1053-0487/95,9600-0115507.50/09 1995PlenumPublishingCorporation
116
King
Training is the oldest and most commonly used approach to injury prevention. In its narrowest form, training can provide the skills and motivation for workers to assume self-responsibility for their own protection and safety (2). It is assumed a more competent worker is more likely to be a safe worker. In its broadest form, training can go beyond affecting individual compliance. It can also prepare workers to take an active role in recognizing and controlling hazards. Workers have an invaluable role to play in preventing injury and illness in the workplace. Technical experts who do not know the job from daily experience cannot anticipate the full range of potential hazards or potential solutions. Good training can tap a wealth of knowledge held by workers--the practical experts--and provide the opportunity for them to share their knowledge with the technical experts (3). Informed and active workers not only protect themselves but may benefit management as well, both by reducing lost time and compensation costs and by increasing productivity. Table 1 lists examples of potential outcomes of employee ergonomics training from the organizational and individual employee perspectives. Actively involved and trained workers also protect society as a whole. Costly government inspection and enforcement programs have a much smaller role to play in a society in which effective cooperation is taking place between informed labor and management. The widely held assumption underlying the training of workers in job safety and health is that education increases safe behavior in work practices (4). Although the number of empirical studies is still relatively small, it has been demonstrated that changes in safety behavior can significantly influence conditions associated with occupational hazards (5-7). Thus, a primary reason for training workers in health and safety is its assumed ability to affect health risks. The widespread belief that education is effective in improving safe behavior of workers has led many employers, on their own initiative, to implement ergonomic training programs as a means to reduce work-related injuries and occupational illnesses (8).
Table I. Potential Outcomes of EmployeeErgonomicsTraining Organizational Improvement in qualityand productivity Stimulation of innovation Reduction in employeeturnover and absenteeism Improved union-managementrelations Reduction in Injuries, errors, defects, and costs Reduction in workers' compensationcosts Individual Employee Increased knowledgeand awareness of ergonomics and health risk factors Improvement in recovery time after injury Improvement in employeemorale and satisfaction Increased skill/behaviorin the recognition,reporting and analysisof ergonomicrisk factors
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ERGONOMICS TRAINING PROGRAMS Ergonomics, from an occupational or industrial standpoint, may be defined as the design or modification of the workplace to match human characteristics and capabilities (9). The goal of ergonomics training programs then is to educate and involve employees in the recognition, reporting, analysis, and resolution of ergonomics problems. The literature that exists on ergonomics training programs consists largely of course descriptions, lesson plans, and programs in use by companies or individuals. There are no uniform guidelines for how training programs should be designed or delivered. Programs range from a single session using training packages "off the shelf," showing a videotape and other materials, to ongoing, progressive sessions aimed at teaching the workers the broadest range of skills so as to involve them in defending and expanding their rights to an illness- and injury-free workplace (2). The amount of time devoted to employee training is an element of tremendous variation among programs in the literature. Some authors reported studies exposing workers to a one-time, several-hour training program (1, 10), while others revealed training to be on a periodic basis over several weeks (11-13). Content varied from task specific training, as exemplified by much of the literature on "back schools" emphasizing lifting techniques (14), to broad-based general ergonomics principles. Straker (13) emphasized the importance of a small group format for the delivery of ergonomics training. Several authors stressed the importance of feedback and ongoing reinforcement following training (6, 15). The majority of studies on addressing ergonomics training issues recognized the need for training at all levels of the organization, from top management to line staff (16--18). q~ain-the-trainer presents another approach to education and training in ergonomics (12, 19, 20). The objectives of this approach are reportedly to provide trainers with the necessary skills to teach adults and provide sufficient practice to gain confidence in preparing and presenting material of ergonomics content. Perhaps one of the best known prescriptions for training is that described in OSHA 3123, Ergonomics Program Management Guidlelinesfor Meatpacking Plants (21). These guidelines integrate training within a comprehensive ergonomics program which includes worksite analysis, hazard prevention and control and medical management. OSHA views training as a method which allows managers, supervisors, and employees to understand ergonomic and other hazards associated with a job or production process, their prevention and control, and their medical consequences. The guidelines suggest the training include all affected employees, engineers, supervisors, managers and health care providers. The program should provide an overview of the potential risk of illnesses and injuries, their causes and early symptoms, the means of prevention, and treatment. Evaluation of training by using employee interviews, testing, and observing work practices is encouraged. Another form of training is associated with action research and other participatory methods (20, 22). Action research can be defined as a process whereby experts and non-experts work together to identify problems and solutions (23). It is participatory, in the sense that both researchers and subjects identify the issues that need to be addressed. It is designed to be a collaborative, co-learning and empow-
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ering process, in that it increases workers' awareness of their own problems, their rights to safe and healthful workplaces, and stimulates them to take action within their organization (24). Participatory ergonomics training seeks to involve workers in the design, implementation, and follow-up of training (25, 26). The intent is to make health and safety training a microcosm of a more broadly participatory work environment. The role of the ergonomics content expert is to promote dialogue and trust that help the group define problems, identify their causes, and develop action strategies (27).
EVALUATION OF ERGONOMICS TRAINING Little is known about the effectiveness of teaching ergonomics principles directly to employees (14). Rigorous program evaluations do not appear to be done for the majority of worksite health and safety training programs, including ergonomics training. Vojtecky and Berkanovic (15) reported only 55% of a sample population of 266 individuals providing health education and injury prevention training in industries performed impact evaluation. This type of evaluation determines whether or not training results in changes in knowledge, attitude, or behavior of those trained. It appears a great majority of health and safety professionals rely on subjective judgments regarding the effectiveness of these programs. As a consequence, resources continue to be allocated for such programs because those responsible for such allocations believe these programs are both effective and beneficial (28). The literature suggests a number of obstacles to evaluating the effectiveness of ergonomics training programs. Artificial distinctions have occurred in the relationship between ergonomics and training. They are often presented as alternatives, rather than complementary recommendations (29). An example of this is the literature on the prevention of back pain, a focal issue in ergonomics for many years. The "conflict" between training and ergonomics in this field has arisen from the fact that while many organizations put great emphasis on training their employees, particularly those involved in manual handling, this has appeared to have had little effect on the incidence of back problems. The persistence of high back pain statistics suggested that training alone was not effective (14). It was "apparent" then that ergonomic job redesign was conclusively the better approach. A further criticism of these studies is that most often the training focused on a specific task, such as proper lifting techniques (2) and "lift for an occasion" (30). The underlying dogma offered for many years was that of a "correct lift" that keeps the back straight and bends the knees (2). The scientific basis for this is not clear and over the years researchers have questioned the validity of the advice (31, 32). Most studies evaluating the effectiveness of training focused on a reduction in existing injury rates or improvement in recovery time after injury (33, 34). Even though these are the most desirable end points, the studies do not isolate the effectiveness of the training per se. In fact, the investigators often have several strategies being used simultaneously, and hence, the training effectiveness cannot be
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119
separated from other possible contributing factors. Further, the type of training used was often quite varied. Variance among programs in the contents of ergonomics training, and methodologies of implementation, make it difficult to empirically study the effects of such efforts. Other issues related to the utiliration of ergonomics information within organizations further compound the difficulties encountered in determining effective training programs.
OBSTACLES TO UTILIZING ERGONOMICS KNOWLEDGE Liker et al. (35) identified six general obstacles to the utilization of ergonomics knowledge (see Table II). 1. Lack of general ergonomics knowledge. Human factors engineering is a multidisciplinary science, including an understanding of human capabilities and limitations, physiology, psychology, manufacturing processes, machine design, and process design. Manufacturing processes are generally designed by mechanical engineers who are trained primarily in the machine side of the human-machine system. Likewise, the professional backgrounds of ergonomics practitioners influence their own capabilities and limitations. For example, the health care provider's major concern may rest more with the specific pathophysiological risk factors influenced by a particular job design or work process. The engineer may focus efforts on how the machine operator interacts with the controls. And the management consultant's major concern may be the organizational structure of the organization (36). Table !I. General Obstacles to Utilizing Ergonomics Knowledge Lack of general ergonomics knowledge Example: Mechanical engineers are trained primarily in Machine side of human-machine system. Lack of specific job knowledge Example: Professional staff inexperienced with machine and and knowledge of how employees perform the job. Poor interdepartmental communication Example: Medical director and industrial engineer hold unshared aspects of ergonomics knowledge. Perceived Cost-Benefit Example: Incentive systems based on pay for production impede adoption of workplace design changes which may slow production but reduce risks to health. Organizational Politics Example: Professional staff having no authority over production propose changes which impact production output Emotions/Attitudes Example: Workers feel insecure due to unknowns of job changes.
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All of these issues are important and need to be addressed. The integration of knowledge from the various disciplines may serve to provide the most comprehensive understanding of ergonomic factors impacting the work environment. 2. Lack of specific job knowledge. A good workplace design requires a thorough understanding of the specific jobs performed by people. This comes from careful task analysis (37) and experience with the machinery and knowledge of how employees perform their jobs. Along with the scientific literature defining appropriate ergonomic job designs, employees who actually do the work themselves serve as the most valuable resources. From their firsthand experience they know the problems and, in many cases, have a good intuitive sense of how to fix them (36). 3. Poor interdepartmental communication. Typically, it is a group of people within an industry that collectively have knowledge of all areas (medical director, engineers, safety professionals, human resource personnel, etc.) that comprise ergonomics. The problem is getting them to communicate with each other on a collaborative basis. 4. Perceived Cost-Benefits. Individuals tend to act in correspondence to their position in the organization. They perceive the benefits of training primarily from the standpoint of how it directly impacts upon them in their present job situation, and not necessarily how training affects other employees and the organization as a whole. It is this narrowed, short-term focus that prohibits them from understanding the situation in ergonomic terms. 5. Organizational Politics. Form of influence is always a consideration in workplace design. Ergonomics consultants generally have no direct authority over production. Once they propose changes in workplaces and jobs, they introject changes into the workplace which may create conflict. 6. Emotions~Attitudes. People have a bias toward the status quo. They develop emotional attachments to habitual work methods (38, 39). This presents a great challenge to the consultant trying to make ergonomic changes and introduce new knowledge of work practices. Despite the numerous obstacles, and absence of valid information documenting the effects of ergonomics training upon employees, programs continue to proliferate. ~ainers continue to develop ergonomics programs for which there are no criteria for appropriate teaching methods, organizational structures, or program evaluation (40). Without some general guidelines, it is quite possible a lot of time and money are being wasted. Literature on adult education and training methods offers guidance in the development of effective ergonomics training programs. Adult education research addresses the variables of program planning, instructional methods, procedural techniques, and program evaluation.
RECOMMENDATIONS FROM ADULT EDUCATION TRAINING LITERATURE Raining programs are usually based upon a set of learning objectives. Exampies of learning objectives specific to employee ergonomics training are:
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1. Gain a general understanding of ergonomics with special reference to cumulative trauma. 2. Identify basic ergonomics issues and some ideas for improvement in work areas. 3. Understand the company's ergonomics program. 4. Understand some basics for choosing optional work methods (i.e., suspected low risk). 5. Understand how to work effectively with the facility's ergonomics committee or task force (41). An instructional approach frequently used for training in more procedural matters, has been the "Tell, Show, Do" technique. "Tell" has been found to be the least effective form of training. It requires a very high degree of learner motivation and demands a high level of interpretive skill. The addition of "Show" increases the learning capabilities by providing audio and visual aids. However, these aspects keep learning at an intellectually passive level. No major demands are imposed on the learner. The inclusion of the "Do" aspect involves the learner in a practical activity in which he/she performs the operation learned. Considerable research has shown that the "doing" aspect is by far the most powerful factor facilitating knowledge gain and behavioral change (42). When deciding upon a format for training, it is important for the trainer to be aware of the advantages and disadvantages of the various types of presentation methods. The lecture method of training, utilized by several of the above-mentioned ergonomics training studies, is one of the oldest training methods. Some advantages of the lecture are: (1) the lecturer is in full control of the material, (2) the lecturer is in full control of time, (3) all material is covered in a logical order, and (4) it is fairly easy to replace the trainer. Disadvantages include the fact that the audience is passive, repetition is encouraged, and little feedback is gained on the effectiveness of the program. The training programs emphasizing learner participation and learning in groups has the advantages of providing the most cost-effective method of training and the availability of other people with whom problems can be discussed. The primary disadvantage centers around the fact that a hetergeneous group may have different learning speeds, varying levels of motivation, and personal barriers that restrict their active involvement in the group (42). Research on training emphasizes the fact that training does not exist outside a context (43). The norms of the workplace impinge on the receptivity of participants. Therefore, an environment of trust, cooperation, and top management support are recommended to ensure the success of training (26, 35). Research on the effects of various training components yields interesting insights. Lecture or theory-only training primarily increases participants' knowledge, whereas theory or principles combined with demonstration, practice and feedback has been shown to have the greatest effect upon participants' learning (43). Learning theory emphasizes the importance of positive reinforcement of what is learned in the training and the establishment of new norms of behavior (22). It also stresses instructions should be based on examples specific to the work situation and behaviors being taught. "l~ranslatingthese to ergonomics training and education,
12,2
King
trainers should have a full understanding of the work situations they are addressing, allow the participants to have an opportunity to practice what they learn, and provide feedback on the effectiveness of the program.
CONCLUSION Upon reviewing the literature on current ergonomics training practices and adult education literature, it is obvious the lecture-based, short-term training method presents greater limitations to effecting change in employee attitudes and behavior. The content and method of delivery of information is in the hands of a few individuals. This achieves greater control over the situation and what is learned, while at the same time, it may stifle the potential for growth in knowledge and opportunity for feedback. Incorporating the components of demonstration, practice, and feedback should enhance the effectiveness of such an approach. The literature advocates for training and ergonomic intervention to be viewed as complementary actions (31). Furthermore, it suggests these activities should be ongoing and participatory in nature. By including all individuals affected by the process, the organization is demonstrating a concern and committment to improvement in the quality of work life. Employee participation in the identification and resolution of health risk factors in the workplace, given broad-based general ergonomics training, shows the greatest potential for increasing not only knowledge, but improving job satisfaction, commitment, perceived cost-benefit, and behavior which leads to a potentially healthier and productive workforce. This article identifies some of the current limitations of employee ergonomics training programs. The systematic application of adult education principles is recommended for improved program planning and training practices. Well controlled outcome research is needed to empirically support these suggestions.
REFERENCES I. Manuele FA. Workers' compensation cost control through ergonomics. Pro Safety 1991; 12: 27-32. 2. Syme S. Strategies for health promotion. Prey Med 1986; Medicine 1986; 15: 492-507. 3. Cohen A, Smith MJ, Anger W. Self-protective measures against workplace hazards. Y Safety 1979; 11: 121-131. 4. Komaki J, Barwick K, Scott L. A behavioral approach to occupational safety: Pinpointing and reinforcing safe performance in a food manufacturing plant. JAppl Psychol 1978; 63: 434-664. 5. Zohar D, Cohen A, Azar N. Promoting increased use of ear protection in noise through information feedback. Human Factors 1980; 22: 69-79. 6. Vojtecky MA. Workplace health education. J Occup Med 1985; 27: 29-33. 7. Sluchak T. Ergonomics: Origins, focus, and implementation considerations. AAOHN 1992; 40: 105-112. 8. Troup JD, Ranhala HH. Ergonomics and training. Inter J Nursing Stud 1987; 24: 325-330. 9. Girling B, Binnbaum R, Pheasant S. Prevention of musculuskeletal stress in hospital employees: An ergonomic approach to training. In: Megaw E, ed. Contemporary ergonomics 1988 proceedings of the ergonomics socieO~.Manchester, England: Taylor & Francis, 1988, pp. 369-374. 10. Parenmark G, Engvall B, Maimkvist A. Ergonomic on-the-job training of assembly workers. Appl Ergon 1988; 19: 143-146.
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11. Robins T, Hugentobler M, Kuminski M, Klitzman S. Implementation of the federal hazard communication standard: Does training work? Y Occup Med 1990; 32; 1133-1140. 12. Straker L. Work-associated back problems: Collaborative solutions. 3" Soc Occup Med 1990; 40: 13-19. 13. Snook S. Approaches to the control of back pain in industry: Job design, job placement and education/training. Prof Safety 1988; 8: 23-31. 14. Vojtecky MA, Berkanovic E. The evaluation of health and safety training, lnt Quart Commun Health Educ 1985; 5: 277-286. 15. Kogi tC Training in practical ergonomics improvements. 3"Human Ergon 1989; 18: 147-150. 16. Halpern M. Prevention of low back pain: Basic ergonomics in the workplace and the clinic. Bailleres C/in Rheum 1992; 6: 705-724. 17. Miller M. Advantage Health Systems, Inc.: Offering industry the advantage. Work 1993; 3: 48-51. 18. Silverstein B, Richards S, Alcser K, Schnrman S. Evaluation of in-plant ergonomics training. Int .I Ind Ergon 1991; 8: 179-193. 19. Liker J, Nagamachi M, Lifshitz Y. A comparative analysis of participatory ergonomics program in U.S. and Japan manufacturing plants, lnt 1 Ind Ergon 1989; 3: 185-199. 20. U.S. Department of Labor. Ergonomics program management guidelines for meatpacking plants. OSHA 3123. Washington, D.C.: U.S. Department of Labor, 1991. 21. Liker J, Evans S, Ulin S. The strengths of lecture-based training in the acquisition of ergonomic knowledge and skill. Int J Ind Ergon 1990; 5: 147-159. 22. Brown M, Nguyen-Scott N. Evaluating a training-for-action job health and safety program. Am 3. Ind Med 1992; 22: 739-749. 23. Israel B, Schurman S, House J. Action research on occupational stress: Involving workers as researchers. Int 3"Health Services 1989; 1: 135-155. 24. LaMontagne A, Keisey K, Ryan C, Christiani D. A participatory workplace health and safety training program for ethylene oxide. Am 3"lnd Med 1992; 22: 657-664. 25. Noro K. Concepts, methods, and people. In: Noro K, Imada A, eds. Partic~atory Ergonomics. London: Taylor and Francis, 1991, pp. 3-29. 26. Weinger M, Lyons M. Problem-solving in the fields: An action-oriented approach to form worker education about pesticides. Am 3"Ind Med 1992; 22: 677-690. 27. Wright C. Cost containment through health promotion programs. J Occup Med 1982; 24: 965-968. 28. Simpson G. Training as an outcome of ergonomics investigations. In: Megan E. ed. Contemporary ergonomics 1988proceedings of the ergonomics society. Manchester, England: Taylor & Francis, 1988, pp. 375-379. 29. Ruckert A, Rohmert W, Pressel G. Ergonomic research study of aircraft luggage handling. Ergonomics 1992; 35: 997-1012. 30. Graveling R. The prevention of back pain from manual handling.Ann Occup Hyg 1991; 35: 427-432. 31. Van Akkerveeken PF. Teaching aspects. Ergonomics 1985; 28: 371-377. 32. Chaffin D, Gallay L, Woolley C, Kuciemba S. An evaluation of the effect of a training program on worker lifting postures. Int 3"lnd Ergon 1986; I: 127-136. 33. Office of Technology Assessment. Training and education for prevention of work-related injury and illness. In: Preventing illness and injury in the workplace, Washington, D.C.: Office of Technology Assessment, 1985, pp. 189-202. 34. Rae L. The skills of training. Hants, England: Gower. 35. Joyce B, Showers B. The design of training: Providing the conditions for learning. In: Joyce B, Showers B. eds., Student Achievement Through Staff Development. Longman, NY: Gower, 1988, pp. 65-80. 36. Pope M, Gilbert J. Personal experience and the construction of knowledge in science. Sci Educ 1983; 67: 193-203.
Employee Ergonomics Training: Current Limitations and Suggestions for Improvement Phyllis M. King 1~-
Employee ergonomics training programs are increasingly being called upon as a strategy to reduce illness and injury in the workplace. A review of the literature on ergonomics training revealed a variety of methodologies and practices. Programs varied in structure, content and method of delivery. These variances, along with a number of obstacles purported to influence the acceptance and effectiveness of training programs, reflect some of the current limitations to effective ergonomics training. This paper recommends the application of adult education principles to improve program planning and training practices. KEY WORDS:ergonomics; training; evaluation.
INTRODUCTION Ergonomic-related injuries and illnesses in the workplace are significant contributors to soaring workers' compensations costs. At the 1990 National Safety Congress, the Secretary of Labor noted that 48% of the Occupational Safety and Health Administration's (OSHA) reported incidents were ergonomic-related. Aetna Life and Casualty Co. has concluded that nearly 50% of workers' compensation claims reported and about 60% of their attendant costs were ergonomic-related. The monetary base of these percentages have been estimated at over $1 billion (1). Corporations, regulators and unions are now beginning to recognize the potential value of early intervention and prevention of work-related injuries. Ergonomics is being viewed as a key element to improving employee safety, health, and productivity. Growing interest in education and training programs in ergonomics is fueled by OSHA guidelines related to the training of workers in recognition, avoidance, and prevention of unsafe or unhealthful working conditions. 1Occupational Therapy Program, University of Wisconsin-Milwaukee,
P.O. Box 413, Milwaukee,
Wisconsin 53201. 2Correspondence should be directed to Phyllis M. King, MS, OTR, Occupational Therapy Program, University of Wisconsin-Milwaukee,P.O. Box 413, Milwaukee,Wisconsin53201. 115 1053-0487/95,9600-0115507.50/09 1995PlenumPublishingCorporation
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King
Training is the oldest and most commonly used approach to injury prevention. In its narrowest form, training can provide the skills and motivation for workers to assume self-responsibility for their own protection and safety (2). It is assumed a more competent worker is more likely to be a safe worker. In its broadest form, training can go beyond affecting individual compliance. It can also prepare workers to take an active role in recognizing and controlling hazards. Workers have an invaluable role to play in preventing injury and illness in the workplace. Technical experts who do not know the job from daily experience cannot anticipate the full range of potential hazards or potential solutions. Good training can tap a wealth of knowledge held by workers--the practical experts--and provide the opportunity for them to share their knowledge with the technical experts (3). Informed and active workers not only protect themselves but may benefit management as well, both by reducing lost time and compensation costs and by increasing productivity. Table 1 lists examples of potential outcomes of employee ergonomics training from the organizational and individual employee perspectives. Actively involved and trained workers also protect society as a whole. Costly government inspection and enforcement programs have a much smaller role to play in a society in which effective cooperation is taking place between informed labor and management. The widely held assumption underlying the training of workers in job safety and health is that education increases safe behavior in work practices (4). Although the number of empirical studies is still relatively small, it has been demonstrated that changes in safety behavior can significantly influence conditions associated with occupational hazards (5-7). Thus, a primary reason for training workers in health and safety is its assumed ability to affect health risks. The widespread belief that education is effective in improving safe behavior of workers has led many employers, on their own initiative, to implement ergonomic training programs as a means to reduce work-related injuries and occupational illnesses (8).
Table I. Potential Outcomes of EmployeeErgonomicsTraining Organizational Improvement in qualityand productivity Stimulation of innovation Reduction in employeeturnover and absenteeism Improved union-managementrelations Reduction in Injuries, errors, defects, and costs Reduction in workers' compensationcosts Individual Employee Increased knowledgeand awareness of ergonomics and health risk factors Improvement in recovery time after injury Improvement in employeemorale and satisfaction Increased skill/behaviorin the recognition,reporting and analysisof ergonomicrisk factors
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ERGONOMICS TRAINING PROGRAMS Ergonomics, from an occupational or industrial standpoint, may be defined as the design or modification of the workplace to match human characteristics and capabilities (9). The goal of ergonomics training programs then is to educate and involve employees in the recognition, reporting, analysis, and resolution of ergonomics problems. The literature that exists on ergonomics training programs consists largely of course descriptions, lesson plans, and programs in use by companies or individuals. There are no uniform guidelines for how training programs should be designed or delivered. Programs range from a single session using training packages "off the shelf," showing a videotape and other materials, to ongoing, progressive sessions aimed at teaching the workers the broadest range of skills so as to involve them in defending and expanding their rights to an illness- and injury-free workplace (2). The amount of time devoted to employee training is an element of tremendous variation among programs in the literature. Some authors reported studies exposing workers to a one-time, several-hour training program (1, 10), while others revealed training to be on a periodic basis over several weeks (11-13). Content varied from task specific training, as exemplified by much of the literature on "back schools" emphasizing lifting techniques (14), to broad-based general ergonomics principles. Straker (13) emphasized the importance of a small group format for the delivery of ergonomics training. Several authors stressed the importance of feedback and ongoing reinforcement following training (6, 15). The majority of studies on addressing ergonomics training issues recognized the need for training at all levels of the organization, from top management to line staff (16--18). q~ain-the-trainer presents another approach to education and training in ergonomics (12, 19, 20). The objectives of this approach are reportedly to provide trainers with the necessary skills to teach adults and provide sufficient practice to gain confidence in preparing and presenting material of ergonomics content. Perhaps one of the best known prescriptions for training is that described in OSHA 3123, Ergonomics Program Management Guidlelinesfor Meatpacking Plants (21). These guidelines integrate training within a comprehensive ergonomics program which includes worksite analysis, hazard prevention and control and medical management. OSHA views training as a method which allows managers, supervisors, and employees to understand ergonomic and other hazards associated with a job or production process, their prevention and control, and their medical consequences. The guidelines suggest the training include all affected employees, engineers, supervisors, managers and health care providers. The program should provide an overview of the potential risk of illnesses and injuries, their causes and early symptoms, the means of prevention, and treatment. Evaluation of training by using employee interviews, testing, and observing work practices is encouraged. Another form of training is associated with action research and other participatory methods (20, 22). Action research can be defined as a process whereby experts and non-experts work together to identify problems and solutions (23). It is participatory, in the sense that both researchers and subjects identify the issues that need to be addressed. It is designed to be a collaborative, co-learning and empow-
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ering process, in that it increases workers' awareness of their own problems, their rights to safe and healthful workplaces, and stimulates them to take action within their organization (24). Participatory ergonomics training seeks to involve workers in the design, implementation, and follow-up of training (25, 26). The intent is to make health and safety training a microcosm of a more broadly participatory work environment. The role of the ergonomics content expert is to promote dialogue and trust that help the group define problems, identify their causes, and develop action strategies (27).
EVALUATION OF ERGONOMICS TRAINING Little is known about the effectiveness of teaching ergonomics principles directly to employees (14). Rigorous program evaluations do not appear to be done for the majority of worksite health and safety training programs, including ergonomics training. Vojtecky and Berkanovic (15) reported only 55% of a sample population of 266 individuals providing health education and injury prevention training in industries performed impact evaluation. This type of evaluation determines whether or not training results in changes in knowledge, attitude, or behavior of those trained. It appears a great majority of health and safety professionals rely on subjective judgments regarding the effectiveness of these programs. As a consequence, resources continue to be allocated for such programs because those responsible for such allocations believe these programs are both effective and beneficial (28). The literature suggests a number of obstacles to evaluating the effectiveness of ergonomics training programs. Artificial distinctions have occurred in the relationship between ergonomics and training. They are often presented as alternatives, rather than complementary recommendations (29). An example of this is the literature on the prevention of back pain, a focal issue in ergonomics for many years. The "conflict" between training and ergonomics in this field has arisen from the fact that while many organizations put great emphasis on training their employees, particularly those involved in manual handling, this has appeared to have had little effect on the incidence of back problems. The persistence of high back pain statistics suggested that training alone was not effective (14). It was "apparent" then that ergonomic job redesign was conclusively the better approach. A further criticism of these studies is that most often the training focused on a specific task, such as proper lifting techniques (2) and "lift for an occasion" (30). The underlying dogma offered for many years was that of a "correct lift" that keeps the back straight and bends the knees (2). The scientific basis for this is not clear and over the years researchers have questioned the validity of the advice (31, 32). Most studies evaluating the effectiveness of training focused on a reduction in existing injury rates or improvement in recovery time after injury (33, 34). Even though these are the most desirable end points, the studies do not isolate the effectiveness of the training per se. In fact, the investigators often have several strategies being used simultaneously, and hence, the training effectiveness cannot be
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separated from other possible contributing factors. Further, the type of training used was often quite varied. Variance among programs in the contents of ergonomics training, and methodologies of implementation, make it difficult to empirically study the effects of such efforts. Other issues related to the utiliration of ergonomics information within organizations further compound the difficulties encountered in determining effective training programs.
OBSTACLES TO UTILIZING ERGONOMICS KNOWLEDGE Liker et al. (35) identified six general obstacles to the utilization of ergonomics knowledge (see Table II). 1. Lack of general ergonomics knowledge. Human factors engineering is a multidisciplinary science, including an understanding of human capabilities and limitations, physiology, psychology, manufacturing processes, machine design, and process design. Manufacturing processes are generally designed by mechanical engineers who are trained primarily in the machine side of the human-machine system. Likewise, the professional backgrounds of ergonomics practitioners influence their own capabilities and limitations. For example, the health care provider's major concern may rest more with the specific pathophysiological risk factors influenced by a particular job design or work process. The engineer may focus efforts on how the machine operator interacts with the controls. And the management consultant's major concern may be the organizational structure of the organization (36). Table !I. General Obstacles to Utilizing Ergonomics Knowledge Lack of general ergonomics knowledge Example: Mechanical engineers are trained primarily in Machine side of human-machine system. Lack of specific job knowledge Example: Professional staff inexperienced with machine and and knowledge of how employees perform the job. Poor interdepartmental communication Example: Medical director and industrial engineer hold unshared aspects of ergonomics knowledge. Perceived Cost-Benefit Example: Incentive systems based on pay for production impede adoption of workplace design changes which may slow production but reduce risks to health. Organizational Politics Example: Professional staff having no authority over production propose changes which impact production output Emotions/Attitudes Example: Workers feel insecure due to unknowns of job changes.
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All of these issues are important and need to be addressed. The integration of knowledge from the various disciplines may serve to provide the most comprehensive understanding of ergonomic factors impacting the work environment. 2. Lack of specific job knowledge. A good workplace design requires a thorough understanding of the specific jobs performed by people. This comes from careful task analysis (37) and experience with the machinery and knowledge of how employees perform their jobs. Along with the scientific literature defining appropriate ergonomic job designs, employees who actually do the work themselves serve as the most valuable resources. From their firsthand experience they know the problems and, in many cases, have a good intuitive sense of how to fix them (36). 3. Poor interdepartmental communication. Typically, it is a group of people within an industry that collectively have knowledge of all areas (medical director, engineers, safety professionals, human resource personnel, etc.) that comprise ergonomics. The problem is getting them to communicate with each other on a collaborative basis. 4. Perceived Cost-Benefits. Individuals tend to act in correspondence to their position in the organization. They perceive the benefits of training primarily from the standpoint of how it directly impacts upon them in their present job situation, and not necessarily how training affects other employees and the organization as a whole. It is this narrowed, short-term focus that prohibits them from understanding the situation in ergonomic terms. 5. Organizational Politics. Form of influence is always a consideration in workplace design. Ergonomics consultants generally have no direct authority over production. Once they propose changes in workplaces and jobs, they introject changes into the workplace which may create conflict. 6. Emotions~Attitudes. People have a bias toward the status quo. They develop emotional attachments to habitual work methods (38, 39). This presents a great challenge to the consultant trying to make ergonomic changes and introduce new knowledge of work practices. Despite the numerous obstacles, and absence of valid information documenting the effects of ergonomics training upon employees, programs continue to proliferate. ~ainers continue to develop ergonomics programs for which there are no criteria for appropriate teaching methods, organizational structures, or program evaluation (40). Without some general guidelines, it is quite possible a lot of time and money are being wasted. Literature on adult education and training methods offers guidance in the development of effective ergonomics training programs. Adult education research addresses the variables of program planning, instructional methods, procedural techniques, and program evaluation.
RECOMMENDATIONS FROM ADULT EDUCATION TRAINING LITERATURE Raining programs are usually based upon a set of learning objectives. Exampies of learning objectives specific to employee ergonomics training are:
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1. Gain a general understanding of ergonomics with special reference to cumulative trauma. 2. Identify basic ergonomics issues and some ideas for improvement in work areas. 3. Understand the company's ergonomics program. 4. Understand some basics for choosing optional work methods (i.e., suspected low risk). 5. Understand how to work effectively with the facility's ergonomics committee or task force (41). An instructional approach frequently used for training in more procedural matters, has been the "Tell, Show, Do" technique. "Tell" has been found to be the least effective form of training. It requires a very high degree of learner motivation and demands a high level of interpretive skill. The addition of "Show" increases the learning capabilities by providing audio and visual aids. However, these aspects keep learning at an intellectually passive level. No major demands are imposed on the learner. The inclusion of the "Do" aspect involves the learner in a practical activity in which he/she performs the operation learned. Considerable research has shown that the "doing" aspect is by far the most powerful factor facilitating knowledge gain and behavioral change (42). When deciding upon a format for training, it is important for the trainer to be aware of the advantages and disadvantages of the various types of presentation methods. The lecture method of training, utilized by several of the above-mentioned ergonomics training studies, is one of the oldest training methods. Some advantages of the lecture are: (1) the lecturer is in full control of the material, (2) the lecturer is in full control of time, (3) all material is covered in a logical order, and (4) it is fairly easy to replace the trainer. Disadvantages include the fact that the audience is passive, repetition is encouraged, and little feedback is gained on the effectiveness of the program. The training programs emphasizing learner participation and learning in groups has the advantages of providing the most cost-effective method of training and the availability of other people with whom problems can be discussed. The primary disadvantage centers around the fact that a hetergeneous group may have different learning speeds, varying levels of motivation, and personal barriers that restrict their active involvement in the group (42). Research on training emphasizes the fact that training does not exist outside a context (43). The norms of the workplace impinge on the receptivity of participants. Therefore, an environment of trust, cooperation, and top management support are recommended to ensure the success of training (26, 35). Research on the effects of various training components yields interesting insights. Lecture or theory-only training primarily increases participants' knowledge, whereas theory or principles combined with demonstration, practice and feedback has been shown to have the greatest effect upon participants' learning (43). Learning theory emphasizes the importance of positive reinforcement of what is learned in the training and the establishment of new norms of behavior (22). It also stresses instructions should be based on examples specific to the work situation and behaviors being taught. "l~ranslatingthese to ergonomics training and education,
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trainers should have a full understanding of the work situations they are addressing, allow the participants to have an opportunity to practice what they learn, and provide feedback on the effectiveness of the program.
CONCLUSION Upon reviewing the literature on current ergonomics training practices and adult education literature, it is obvious the lecture-based, short-term training method presents greater limitations to effecting change in employee attitudes and behavior. The content and method of delivery of information is in the hands of a few individuals. This achieves greater control over the situation and what is learned, while at the same time, it may stifle the potential for growth in knowledge and opportunity for feedback. Incorporating the components of demonstration, practice, and feedback should enhance the effectiveness of such an approach. The literature advocates for training and ergonomic intervention to be viewed as complementary actions (31). Furthermore, it suggests these activities should be ongoing and participatory in nature. By including all individuals affected by the process, the organization is demonstrating a concern and committment to improvement in the quality of work life. Employee participation in the identification and resolution of health risk factors in the workplace, given broad-based general ergonomics training, shows the greatest potential for increasing not only knowledge, but improving job satisfaction, commitment, perceived cost-benefit, and behavior which leads to a potentially healthier and productive workforce. This article identifies some of the current limitations of employee ergonomics training programs. The systematic application of adult education principles is recommended for improved program planning and training practices. Well controlled outcome research is needed to empirically support these suggestions.
REFERENCES I. Manuele FA. Workers' compensation cost control through ergonomics. Pro Safety 1991; 12: 27-32. 2. Syme S. Strategies for health promotion. Prey Med 1986; Medicine 1986; 15: 492-507. 3. Cohen A, Smith MJ, Anger W. Self-protective measures against workplace hazards. Y Safety 1979; 11: 121-131. 4. Komaki J, Barwick K, Scott L. A behavioral approach to occupational safety: Pinpointing and reinforcing safe performance in a food manufacturing plant. JAppl Psychol 1978; 63: 434-664. 5. Zohar D, Cohen A, Azar N. Promoting increased use of ear protection in noise through information feedback. Human Factors 1980; 22: 69-79. 6. Vojtecky MA. Workplace health education. J Occup Med 1985; 27: 29-33. 7. Sluchak T. Ergonomics: Origins, focus, and implementation considerations. AAOHN 1992; 40: 105-112. 8. Troup JD, Ranhala HH. Ergonomics and training. Inter J Nursing Stud 1987; 24: 325-330. 9. Girling B, Binnbaum R, Pheasant S. Prevention of musculuskeletal stress in hospital employees: An ergonomic approach to training. In: Megaw E, ed. Contemporary ergonomics 1988 proceedings of the ergonomics socieO~.Manchester, England: Taylor & Francis, 1988, pp. 369-374. 10. Parenmark G, Engvall B, Maimkvist A. Ergonomic on-the-job training of assembly workers. Appl Ergon 1988; 19: 143-146.
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11. Robins T, Hugentobler M, Kuminski M, Klitzman S. Implementation of the federal hazard communication standard: Does training work? Y Occup Med 1990; 32; 1133-1140. 12. Straker L. Work-associated back problems: Collaborative solutions. 3" Soc Occup Med 1990; 40: 13-19. 13. Snook S. Approaches to the control of back pain in industry: Job design, job placement and education/training. Prof Safety 1988; 8: 23-31. 14. Vojtecky MA, Berkanovic E. The evaluation of health and safety training, lnt Quart Commun Health Educ 1985; 5: 277-286. 15. Kogi tC Training in practical ergonomics improvements. 3"Human Ergon 1989; 18: 147-150. 16. Halpern M. Prevention of low back pain: Basic ergonomics in the workplace and the clinic. Bailleres C/in Rheum 1992; 6: 705-724. 17. Miller M. Advantage Health Systems, Inc.: Offering industry the advantage. Work 1993; 3: 48-51. 18. Silverstein B, Richards S, Alcser K, Schnrman S. Evaluation of in-plant ergonomics training. Int .I Ind Ergon 1991; 8: 179-193. 19. Liker J, Nagamachi M, Lifshitz Y. A comparative analysis of participatory ergonomics program in U.S. and Japan manufacturing plants, lnt 1 Ind Ergon 1989; 3: 185-199. 20. U.S. Department of Labor. Ergonomics program management guidelines for meatpacking plants. OSHA 3123. Washington, D.C.: U.S. Department of Labor, 1991. 21. Liker J, Evans S, Ulin S. The strengths of lecture-based training in the acquisition of ergonomic knowledge and skill. Int J Ind Ergon 1990; 5: 147-159. 22. Brown M, Nguyen-Scott N. Evaluating a training-for-action job health and safety program. Am 3. Ind Med 1992; 22: 739-749. 23. Israel B, Schurman S, House J. Action research on occupational stress: Involving workers as researchers. Int 3"Health Services 1989; 1: 135-155. 24. LaMontagne A, Keisey K, Ryan C, Christiani D. A participatory workplace health and safety training program for ethylene oxide. Am 3"lnd Med 1992; 22: 657-664. 25. Noro K. Concepts, methods, and people. In: Noro K, Imada A, eds. Partic~atory Ergonomics. London: Taylor and Francis, 1991, pp. 3-29. 26. Weinger M, Lyons M. Problem-solving in the fields: An action-oriented approach to form worker education about pesticides. Am 3"Ind Med 1992; 22: 677-690. 27. Wright C. Cost containment through health promotion programs. J Occup Med 1982; 24: 965-968. 28. Simpson G. Training as an outcome of ergonomics investigations. In: Megan E. ed. Contemporary ergonomics 1988proceedings of the ergonomics society. Manchester, England: Taylor & Francis, 1988, pp. 375-379. 29. Ruckert A, Rohmert W, Pressel G. Ergonomic research study of aircraft luggage handling. Ergonomics 1992; 35: 997-1012. 30. Graveling R. The prevention of back pain from manual handling.Ann Occup Hyg 1991; 35: 427-432. 31. Van Akkerveeken PF. Teaching aspects. Ergonomics 1985; 28: 371-377. 32. Chaffin D, Gallay L, Woolley C, Kuciemba S. An evaluation of the effect of a training program on worker lifting postures. Int 3"lnd Ergon 1986; I: 127-136. 33. Office of Technology Assessment. Training and education for prevention of work-related injury and illness. In: Preventing illness and injury in the workplace, Washington, D.C.: Office of Technology Assessment, 1985, pp. 189-202. 34. Rae L. The skills of training. Hants, England: Gower. 35. Joyce B, Showers B. The design of training: Providing the conditions for learning. In: Joyce B, Showers B. eds., Student Achievement Through Staff Development. Longman, NY: Gower, 1988, pp. 65-80. 36. Pope M, Gilbert J. Personal experience and the construction of knowledge in science. Sci Educ 1983; 67: 193-203.
