health – Page 113 – SafetyAtWorkBlog

From worker safety to patient safety

Many of us grew up under the “shadow of the mushroom cloud” and have strong suspicions towards radiation of any kind but the OHS achievements of those working with radiation should be acknowledged.

In the latest edition of the IAEA Bulletin (May 2009) this achievement is clearly summarised as it relates to those in medical radiation.

The early emphasis on staff protection did pay rich dividends in terms of making staff safer. Currently, most (nearly 98%) of those who work with ionizing radiation in any area of medical practice receive a radiation dose that is lower than what they get from natural radiation sources — the so-called background radiation, e.g., cosmic radiation, radon, radiation from building material, earth, food, etc. Background radiation depends on the place you live, but typically is 1 mSv to 3 mSv per year, although in some places can be up to 10 mSv. The dose limit for staff currently recommended by the International Commission on Radiological Protection (ICRP), and adopted by the IAEA and most countries with few exceptions, is 20 mSv/year, expressed as 100mSv over a period of five years. Such has been the success of occupational radiation protection programmes that not even 0.5% of staff members who work in medical facilities (or in any nuclear facility) reach or exceed the dose limit.”

The siginifcance of the article from which this paragraph is taken comes from the next sentence:

“Since there are no dose limits for patients, many may incorrectly assume that there are no controls on patient exposure.”

The article by Madan M Rehani, and thankfully available online, discusses the possibility of introducing an ongoing monitoring system that records the cumulative exposure to radiation by patients. The smart card project launched by the International Atomic Energy Agency will be one to watch as there could be applications of such a system to other occupations and work-related hazards.

The importance of such a program is high as Rehani writes:

“The risk of cancer from radiation doses imparted through a number of CT scans is not insignificant. Most other radiation effects (such as skin injury, just to name one) can be avoided rather effectively, but this is not true for the risk of cancer. There are estimates of few million excess cancers in the USA over the next two to three decades from about 60 million CT scans done annually.”

Kevin Jones

Why isn’t safety and health a continuum in a worker’s life?

Several years ago I attended a safety seminar hosted by Seacare. Maritime safety is not part of my “brief” but safety is, and I was seeking alternate perspectives on my specialist area. Seacare conducted a session where the treatment and management of an injured worker was work-shopped from incident to return-to-work.

It was the first time I had seen a panel of experts deal with the life of a worker across the injury management continuum. The session showed the necessity to communicate across several disciplines and to always keep the focus on the injured worker. I had never seen a better example of risk management in relation to an employee’s welfare.

If only the real world was as organised.

WorkLife Book Covers 003 Work/life balance in Australia is skewed towards those workers who have young families or a role as a carer. This is due to work/life balance evolving from the feminist and social concepts of the 1970s and in response to the increased number of women in paid employment. Barbara Pocock sees these matters in the 1970s as themselves a reaction to the “male-dominated employing class” that, in one exampled, believed that 3 month’s long-service leave was more important than maternity leave. (p212, The Work/Life Collision)

Work/Life Balance Origin

(Wikipedia has a peculiar article on work/life balance that has some interesting points and reference links but then undoes its good work by relying on a couple of major sources and many of them are commercial consultants. That the Australian work in this area is not referenced, indicates a major deficiency. Please note that the concept of balancing work life and non-work life existed well before “work/life balance” was first used. SafetyAtWorkBlog would point the concept’s origin to around the same time as Australia’s introduction of the eight hour day in the mid-1800s or even earlier with Robert Owen in the UK calling for a 10-hour day.)

In the 2000s the emphasis remains not on work/life balance but work/family. As a result, work/life balance will remain an issue handled in the management silo of human resources and being seen as relevant to a lifestage of an individual rather than the individual themselves. There is also an inherent gender bias that could be minimised if the silo was removed.

The Seacare workshop illustrated for me that an injured worker is managed by different silos throughout their rehabilitation. Wherever possible the employer outsources this management to experts in OHS, trauma counselling, medicine, physiotherapy, return-to-work coordinators, and other specialists. The common element through all of these silos is the individual and that person’s health.

OHS & Work/Life Conflict

Occupational health and safety has a big advantage over work/life balance in that it focuses on the individual first. Employers must provide for the health and safety of the worker and, by and large, employers get the safety obligation right. This part of the process has long-established practices based principally on engineering solutions – stopping things falling on a worker, stopping the worker falling into machinery, stopping the inhalation of toxic dust – effectively “blue collar” solutions to “blue collar” hazards.

The mental health of the worker was not a big concern. This is partly because in most of Australia, legislation only ever related to health and safety, and rarely to welfare. Where welfare was a legislated consideration for the management of workers, the social context of the worker was acknowledged myuch earlier and work/life issues began to grow.

The regrettable element of this evolution was that “health” remained a narrow workplace definition instead of embracing the “welfare” or mental health of the worker. If health had been supported by a definition that included welfare in all Australian States’ OHS legislation, the mental health needs of workers and the social contexts of worker management would have been discussed much earlier and in parallel.

Work/Life Balance Awards – A Missed Opportunity

An example of the divergence and the need, in my opinion, to reintegrate work/life balance and occupational health comes from some correspondence I have had with the organisers of the National Work/Life Balance Awards in the Australian Department of Education, Employment and Workplace Relations (DEEWR). Until very recently, these awards were called the National Work and Family Awards.

DEEWR includes in its structure Safe Work Australia, the organisation responsible for monitoring OHS across the country. It seemed odd to me, from the big holistic picture, that DEEWR has not included Safe Work Australia in the judging panel for the 2009 Work/Life Balance Awards. DEEWR advised me that it believes the OHS experience of two of the judging panel, the Australian Council of Trade Unions and the Australian Chamber of Commerce and Industry, was sufficient. Perhaps but why not draw on the OHS expertise of one’s own staff as well?

It also seemed odd that one organisation would conduct two national awards programs – the National Work/Life Balance Awards and the Safe Work Australia Awards. DEEWR advised me that

“The [National Work/Life Balance Awards] recognise organisations that are outstanding in achieving positive outcomes through the implementation and communication of work-life balance policies, practices and initiatives which meet the needs of both the employer and its employees. The Safe Work Australia Awards focus on OHS more broadly and recognise businesses and individuals for their outstanding efforts in OHS and for making safety a high priority in their workplace.”

If the Safe Work Australia Awards focus on “OHS more broadly” why not have one set of awards that acknowledges both the work and social contexts of employees? This is harder to answer when

“Applicants for awards must consent to an assessment to determine whether they have complied with the Fair Work Act 2009, the Workplace Relations Act 1996 and any relevant state or territory legislation, award or other industrial instruments” [my emphasis]

This would surely include the OHS legislation of each State and the Commonwealth.

DEEWR does not involve any of the state OHS regulators in the awards process. The judging panel does not analyse the workers’ compensation premium awards rates of award contenders. State regulators could surely provide a useful perspective as it is mostly under their jurisdictions that businesses are prosecuted for OHS breaches. Worker’s compensation premiums are used by all regulators as a major (sometime the only) indicator of safety performance and for targeting of enforcement programs. The judges of the National Work/Life Balance Awards do not.

OHS professionals and return-to-work coordinators acknowledge that the non-work life and mental health of workers are important elements in regaining a fully-functional employee.

DEEWR made the decision to rebrand the awards to Work/Life instead of “work and family”. This does not reflect the complex interrelations of the social and individual contexts of the health and safety of individual workers.

DEEWR is coordinating the reforms of laws into both OHS and workers compensation. The Australian Government is working on legislative harmonisation across all legislative jurisdictions in workplace health and safety. These OHS laws are likely to extend employer obligations well beyond workers to the public and those potentially affected by work practices..

However DEEWR is missing a major opportunity to set the agenda for the future by acknowledging that the impacts on an individual of the work life and the home life should be managed across the social and employment disciplines.

Kevin Jones

The images included in this posting show some of the many terrific books dealing with, or mentioning, work/life management.

OHS and workload – follow-up

SafetyAtWorkBlog has had a tremendous response to the article concerning Working Hours and Political Scandal. Below are some of the issues raised in some of the correspondence I have received from readers and OHS colleagues.

The Trade Union Congress Risk e-bulletin has a similar public service/mental health case which has been resolved through the Courts. The site includes links through to other media statements and reports.

Australia’s Department of Education, Employment and Workplace Relations has launched its work/life balance awards for 2009. The information available on the awards is strongly slanted to a work/family balance which is very different from work/life and excludes employees making decisions for the benefit of their own mental health – a proper work/life balance which is the philosophical basis underpinning OHS legislation. SafetyAtWorkBlog is investigating these awards with DEEWR.

SafeWork in South Australia is working on a code of practice on working hours and has been providing OHS advice on this matter since 2000.

The WA government has had a draft code on working hours for some time.

A legal reader has pointed out that “the 38 hour week issue is not set in stone …[and] is not a maximum for non-award employees.” So expect more industrial relations discussion on that issue over the next two years.

One reader generalised from the Grech case about decision-making at senior levels, a concern echoed by many others.

“The Grech case illustrates the gradual disintegration of effectiveness, and the employee’s own inability to recognise that it is not a personal failing of efficiency, rather an unrecognised systemic risk.

When the employee is at senior level, there is more likelihood there will be poor attention to the warning signs. Any ‘underperformance’ would be seen as a personal failing. For those of us in the safety business, it is obvious that the system itself is in need of urgent risk management.”

There were congratulations from many readers for raising a significant and hidden OHS issue.

“Many people in industry work more than 70 hour a week. This affects their health and personal relationships.”

“Overwork and under-resourcing lead to poor decision making, adverse business outcomes, and in the long term psychological and physical ill health. Both the government and corporate sectors are paying little attention to this issue.”

The workplace hazards resulting from fatigue are being addressed in several industries such as transport, mining and forestry, where attentiveness is hugely important because of the catastrophic consequences of poor judgement.

One of the issues from the Grech case is that the quality of judgement in non-critical, or administrative, occupations can be severely affected by fatigue, mental health and other psychosocial issues. These may not affect the health and well-being of others but can have a significant effect on the individual. OHS does not only deal with systemic or workplace cultural elements but is equally relevant to the individual worker.

Kevin Jones

[Thanks to all those who have written to me and continue to do so. KJ]

Handling trauma

The Rural Health Education Foundation (RHEF) produced a DVD recently as part of its professional development program on managing trauma. It is an introduction for rural medical practitioners on how to identify trauma and how to advise on management. The video was produced in conjunction with the Australian Centre for Posttraumatic Mental Health and is unavailable at the moment due to a lack of funding. However, the video, and others, are available online through a free registration at the RHEF website.

Health and safety practitioners rarely prepare themselves adequately for handling a traumatized worker whether it is from a work experience or an issue outside the workplace. OHS practitioners often have a linear perspective where an incident occurs, the personal damage is handled or referred on and the avoidance of recurrence is prevented.

The cycle of incident, rehabilitation and reintegration to the workplace is not widely understood in the OHS field. The “Recovery From Trauma: What Works” video illustrates the personal and psychological cost of an incident. Through a case study it also shows the early signs of trauma, when a worker may “not be himself” – the clues to a possible bigger problem. One case study, John, specifically includes the impact of his situation on his work performance.

In the early stages of trauma, around a week after an incident, the video advises that people avoid

Alcohol and drugs
Keeping overly busy
Involvement in stressful situations
Withdrawing
Stopping yourself doing things you enjoy
Taking risks

If the worker is out of sorts for longer than a week, professional assistance should be sought.

The video was broadcast in February 2009 so the information is current.

The program continues with issues of post-traumatic stress disorder with additional case studies including a policeman talking about his counseling and the therapy he undertook after a traumatic event.

RHEF does not try to do everything by itself and draws upon subject matter experts on trauma and recovery. The video is a very professional production and RHEF should be supported in its initiatives. Readers are encouraged to watch the videos online and, if you can, consider supporting RHEF financially so that these important resources can be made available to medical professionals throughout Australia.

Kevin Jones

Working Hours and Political Scandal

Over the last month or so, Australian politics has been scandalised by a senior Treasury official admitting to faking an email that implied political favouritism by the Australian Treasurer, Wayne Swan, and the Prime Minister, Kevin Rudd.

Godwin Grech is the public servant who has admitted faking the email and there are many reasons he has put forward, and journalists have endlessly speculated on, for his actions. SafetyAtWorkBlog will discuss a minor element of the “Ozcar affair” that has been almost entirely overlooked – OHS.

Since the scandal broke in a Senate inquiry, Godwin Grech kept a fairly low profile and was last reported to be receiving treatment in a Canberra psychiatric facility. It has been reported that Grech has a history of physical health problems and it has been reported, in an investigation into the affair by the Australian National Audit Office (ANAO), that administering the scheme was taxing on Grech. The report says

“The under‐resourcing of the implementation phase of the policy placed at risk the anticipated policy outcomes. It also placed a considerable workload on Mr Godwin Grech, the Treasury official primarily responsible for the development and implementation of the policy measure, particularly in light of his medical condition.”

It needs to be noted that additional resources were offered to Grech to assist in administering the scheme. But Treasury was also criticised in the report.

“There were no indications that these matters, or Mr Grech’s medical condition, were given due weight in the implementation planning and delivery.”

Grech admitted to the ANAO that he had not informed his employer, the Department of Treasury, of his ongoing struggle with depression.

“What senior Treasury management did not know – as I have only very recently discovered – was that I have also been suffering from chronic clinical depression for some years, dating back to at least 2003. This had not been treated.”

Page 100 of the ANAO report has Grech quoting the OHS Act’s employer obligation to “take all reasonably practicable steps to protect the health and safety at work of [its] employees’”, and then lists his working hours required by the scheme.

“My work on the Oz Car program required me to work between 75‐85 hours per week including on weekends from late October 2008 until the onset of my bowel obstruction in early February 2009. My hours varied from 60‐70 hours per week from late February to June 2009.”

The amount of hours expected is phenomenal and there is little surprise that health problems or poor judgement occurred on this hazard alone.

However, what Grech fails to quote in the information to the ANAO is another section of the OHS Act 1991 – Section 21

“Duties of employees in relation to occupational health and safety

(1) An employee must, at all times while at work, take all reasonably practicable steps:

(a) to ensure that the employee does not take any action, or make any omission, that creates a risk, or increases an existing risk, to the health or safety of the employee, or of other persons (whether employees or not) at or near the place at which the employee is at work; ……”

Employees have a legislative obligation to not put themselves at risk. It would be interesting to know why Grech took on more than was healthy for him.

This dichotomy of choice is a crucial but difficult one for all employees in all industries. When is it the right time to say no more or to ask for help or to say something is unsafe or unhealthy?

A further complexity to employment relations comes when industrial relations legislation specifies a maximum amount of working hours. The Australian Government’s very recent Fair Work Act 2009 specifies maximum weekly hours of 38. So what does this say about the employer’s OHS obligations to civil servants, such as Godwin Grech?

The Fair Work Act says (Division 3, Section 62 (1))

“An employer must not request or require an employee to work more than the following number of hours in a week unless the additional hours are reasonable:

(a) for a full time employee—38 hours; or
(b) for an employee who is not a full time employee—the lesser of:

(i) 38 hours; and
(ii) the employee’s ordinary hours of work in a week.

Employee may refuse to work unreasonable additional hours.”

In May 2008, the Prime Minister, Kevin Rudd, said the following about public service workloads:

“I understand that there has been some criticism around the edges that some public servants are finding the hours a bit much ….. Well, I suppose I’ve simply got news for the public service — there’ll be more. This Government was elected with a clear-cut mandate. We intend to proceed with that. The work ethic of this Government will not decrease. It will increase.”

Godwin Grech could be considered one example of the Rudd Government work ethic.

In this political scandal OHS is an oblique and fringe issue but its existence cannot be ignored and it raises legitimate questions about how a Labor Government, the traditional friend of the worker, manages the safety of its employees.

Kevin Jones

Forest not required – indoor air quality and plants

Ever since modern offices have relied on air conditioning for ventilation, indoor air quality has been a contentious occupational issue from other people’s smells to thermal comfort to photocopier toner dust.

The prominence of air quality in offices as an OHS issue can be illustrated by a paragraph from the 1997 edition of Officewise when cigarette smoke remained a real hazard. No mention was made of plants.

Air in offices may be contaminated by several different

sources, including odours and micro-biological and

chemical contaminants. In an office environment, the

quality of the air is often controlled through an air

conditioning system. A building’s air conditioning

system may be considered as its lungs. The function

of such a system is to draw in outside air, filter, heat,

cool or humidify it and circulate it around the building.

The system expels a portion of the air to the outside

environment and replaces this expelled portion with

fresh or outside air.

“Air in offices may be contaminated by several different sources, including odours and micro-biological and chemical contaminants. In an office environment, the quality of the air is often controlled through an air conditioning system. A building’s air conditioning system may be considered as its lungs. The function of such a system is to draw in outside air, filter, heat, cool or humidify it and circulate it around the building. The system expels a portion of the air to the outside environment and replaces this expelled portion with fresh or outside air.”

Continue reading “Forest not required – indoor air quality and plants”

Depression and workplace stress rehabilitation

In January 2009, SafetyAtWorkBlog reported on the end of a political saga involving parliamentarian Paula Wriedt. Ms Wriedt has since become a spokesperson for the treatment of depression and on 10 August she spoke with the Australian Broadcasting Corporation about more resources for the treatment of mental health issues in the young.

Kevin Jones

Category: health

From worker safety to patient safety

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