How effective are safe resident handling programs? In a 10-year research project, a team at the Center for Promotion of Health in the New England Workplace (CPH-NEW) set out to measure the impact of one such program that was implemented across 200 nursing home centres. In this plenary, project manager Alicia Kurowski shares the team’s findings on outcomes such as ergonomic exposures, self-reported back pain, injury rates, return-to-work outcomes and return on investment.
Throughout the year, the Institute for Work & Health holds plenaries that are open to the public at which scientists talk about their research in the work and health field. Upcoming plenaries are listed on the main plenaries page. Presentation slides from past plenaries, where available, can be downloaded here.
The features of mental illnesses pose challenges when designing disability income support (DIS) programs, yet there is limited evidence about the process. In this plenary, Dr. Ashley McAllister shares the results of a study in Australia and Ontario, which interviewed policy designers of DIS programs about the challenges related to mental illnesses. She outlines five main challenges and considers the ramifications of ignoring them—including distrust among policy designers of physicians' evidence to support DIS applications.
The right of worker representation has been a central tenet of occupational health and safety for over 40 years. While evidence shows that it improves health and safety at work, few attempts have been made to show how. In this plenary, a team of academics and labour representatives known as LOARC (short for Labour/OHCOW/Academic Research Collaboration) share their work examining what worker representatives actually do to achieve change. How much does it matter whether worker representatives adopt a more legal/technical approach or a more knowledge activist approach? Findings on effective worker health and safety representation styles are discussed.
The management of low-back pain has changed from a passive approach calling for bed rest, traction and massage to a more active approach, one focused on staying active, exercise and multidisclipnary rehabilitation. This is in line with the change from a biomedical to a biopsychosocial model for understanding low-back pain over the last 20 years. However, the burden of low-back pain is still high, and the evidence for the biopsychosocial approach is still small. In this plenary, Dr. Maurits Van Tulder discusses the need for a new revolution in low-back pain research and the obligation researchers have to contribute to improving clinical practice.
In February of this year, the World Health Organization (WHO) released a report titled Rehabilitation in health systems, which includes nine recommendations to improve rehabilitation services around the world. The Institute for Work & Health (IWH) played a key role in the development of these recommendations, being one of three research organizations contracted by WHO to canvas the evidence on the best ways to strengthen and expand the availability of quality rehabilitation services. While the report primarily targets low- and middle-income countries, as noted by Dr. Andrea Furlan, lead researcher of the IWH evidence-gathering team contracted by WHO, “the recommendations resonate in Canada as well, given that rehabilitation plays an important role in keeping people in an aging population independent for longer, and helping people with chronic and acute injuries participate in school and work.” At this plenary, Dr. Furlan and Emma Irvin (also on the IWH research team) discuss the WHO’s recommendations for improving rehabilitation services globally, as well as the evidence behind them.
On July 1, 2014, a new occupational health and safety requirement took effect in Ontario. All employers in the province now have to provide employees and supervisors with training about the duties and rights of workers, employers and supervisors under the Occupational Health and Safety Act (OHSA); the roles of joint health and safety committees; the Ontario Ministry of Labour (MOL) and the Workplace Safety and Insurance Board; workplace hazards and workplace violence, controlled products (if applicable) and occupational illness. In this plenary, Dr. Peter Smith shares the results of a study that examined differences in the level of self-reported occupational health and safety (OHS) awareness and empowerment among employed workers in Ontario before and after the introduction of the mandatory training. He also discusses the implications of the results for future province-wide initiatives focusing on the primary prevention of work-related injuries and illnesses.
How are the roles of doctors in the workers’ compensation system different in Quebec and Ontario? In this plenary, Professor Katherine Lippel shares findings from a qualitative and comparative regulatory study, conducted in both provinces, to examine the impact of regulatory contexts on the roles and practices of doctors and other players in the system.
We currently don't fully understand why some people develop Parkinson's disease as they age while others do not. Since genetic inheritance accounts for a very small proportion of cases, researchers have been interested in environmental causes, including workplace exposures. In this plenary, epidemiologist Dr. Anne Harris talks about the evidence for or against several candidate risk factors, including pesticides, head injury, and whole body vibration.
Research around the world has shown that health-care providers have a key role in the return-to-work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient’s workplace can thwart meaningful engagement. In a two-year study conducted in four Canadian provinces, Dr. Agnieszka Kosny focused on the experiences of health-care providers within the workers’ compensation system and their role in the RTW process. She shares her findings in this plenary.
Arthritis is one of the most common causes of work disability in Canada. Among those with arthritis, three in five are in their working years (ages 18 to 65 years). Yet, little research has looked into the work experiences of young and middle-aged adults with arthritis. In this plenary, Dr. Arif Jetha shares his research examining the impact of important life transitions on the work experiences of young, middle-aged and older adults with arthritis.
Returning to work after a work injury can be a complex process involving multiple episodes of time-loss. In this plenary, Dr. Christopher McLeod looks at newly available detailed calendar data on RTW among injured workers with accepted time-loss claims in British Columbia. He outlines how this data can be used to identify distinct clusters of RTW trajectories and highlights key demographic, clinical and work characteristics that may be associated with shorter and/or longer and more complex trajectories. He also explores the relevance of these data and methods in identifying effective interventions that can improve RTW outcomes.
Can best practices in manufacturing and occupational safety be complementary or even synergistic? Or is there necessarily a trade-off between the two? What practices are important for achieving high performance in both manufacturing operations and safety? Dr. Lynda Robson presents results from an inter-disciplinary mixed-method research project. She highlights the “joint management system practices” associated with positive effects on both operational outcomes (e.g. product quality) and safety outcomes.
Physicians have an important role in the return to work (RTW) process, but research shows that they sometimes struggle to manage RTW consultations and help patients return to work after an injury. As part of a broader exploration into the role played by doctors in RTW, an IWH team led by Dr. Agnieszka Kosny sought to examine resources, policies and guidelines that have been developed for physicians by workers’ compensation boards, governments and other organizations across Canada. In this plenary, Kosny highlights resource gaps that may hinder physicians’ understanding of their roles and responsibilities in the workers' compensation system and RTW process, and which may ultimately delay workers’ RTW after injury.
Whole-body vibration (WBV) is a significant health risk for four to seven per cent of the workforce, primarily operators of heavy mobile vehicles. Negative health outcomes are associated with excessive vibration exposure, including lower-back pain, spinal degeneration, gastro-intestinal tract problems, sleep problems, headaches, neck problems, autonomic nervous system dysfunction, hearing loss, and nausea. In this plenary, Dr. Jim Dickey describes two approaches that have been successfully used to evaluate seating in heavy mobile machinery. He also shares why optimized seating should be considered for some workplaces.
Sleep disturbance is a common problem experienced by those with mild traumatic brain injuries (TBI). While the disruption subsides relatively quickly for some, up to half of those with mild TBI report chronic sleep disturbances—which in turn can seriously impair day-to-day function and return to work. In this plenary, Dr. Tatyana Mollayeva discusses the relationship between sleep and relevant clinical and non-clinical factors as well as outcomes in a sample of Ontario workers with mild TBI. She also presents known risks for sleep dysfunction in mild TBI and the implications for work disability prevention.
Studies conducted in the U.S. and other countries have shown that truck drivers are at increased risk for such medical conditions as cardiovascular disorders, sleep apnea, diabetes and obesity. Drivers have multiple risk factors associated with these conditions such as high rates of smoking, poor diet and low levels of physical activity. In this plenary, Dr. Philip Bigelow discusses a two-phase program of research that examines the prevalence of driving-related chronic diseases and risk factors among Canadian truck drivers, and proposes an intervention to improve their health and wellness.
While previous research has identified that recent immigrants are at increased risk of work injury and illness, little is known about the specific mechanisms that lead to this elevated risk. In this plenary, Institute for Work & Health (IWH) research associate Morgan Lay presents preliminary results from a recent IWH collaboration with settlement agencies to better understand the workplace and social contexts that lead to increased risk of work injury among new immigrants. Looking at the responses to a new measure of occupational health and safety vulnerability, she compares the responses of new immigrants to those of a general sample of workers in Ontario.
While integrating ergonomics into the process of designing production systems has been seen as the so-called Holy Grail for injury prevention, it has not proven to be easy. In this plenary Dr. Patrick Neumann presents lessons from an "action research" project at Blackberry, aimed at learning how to achieve such integration into the engineering design process. He provides a conceptual framework for considering this process of change, as well as practical methods and tools that were applied in the case to gain buy-in from key stakeholders.
There has been much attention on concussions and traumatic brain injuries in the military and in professional sports. In this plenary, Dr. Angela Colantonio reviews the epidemiological profile of traumatic brain injury in other work environments, highlighting the sex and gender differences in this profile. She discusses injury rates across industries in Ontario and elsewhere, the leading causes of injury, as well as return-to-work challenges for people with persistent symptoms after an occupational brain injury.
How do researchers measure the impact of precarious work on health indicators, including physical and mental health? How do they tease out the interaction between poverty, precarious employment and health outcomes? In this plenary, Dr. Wayne Lewchuk talks about the survey data collected by the Poverty and Employment Precarity in Southern Ontario (PEPSO) research group in 2011 and 2014. He compares the Employment Precarity Index developed by this group with the data collected by Statistics Canada on temporary employment, and highlights in particular how crude measures of precarity can lead to misleading conclusions regarding the impact of insecure employment on health outcomes.
2016 marks the 20th anniversary of the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure. In 1996, when the DASH was developed by the Institute for Work & Health (IWH) and the American Association of Orthopedic Surgeons (AAOS), no measure had previously existed to assess the disability and function of the arm, shoulder and hand as a whole. Today, this outcome measure is used across the world in 55 languages and dialects. It has also been cited in about 1,500 journal articles. The DASHBash year kicks off with this seminar that highlights the achievements of this “little tool that grew.” This presentation reviews the conceptual foundations of the DASH, summarizes how the DASH is being used and how it is performing, and addresses some frequently asked questions from our users.
Agricultural work is hazardous for all workers, but migrant farm workers are especially vulnerable. Because their status in Canada hinges on their employment, they live under the shadow of a particular kind of job insecurity, one that may compromise their right to workplace health and safety and to workers' compensation. In this plenary, Theresa Aversa examines OHS vulnerability among migrant workers under two different programs: the Seasonal Agricultural Worker Program (SAWP) and the Temporary Foreign Workers Program. She shares findings from her research, drawn primarily from interviews with advocates and system stakeholders, and from participant observation at advocate-organized events. She also discusses what the findings suggest as possible avenues to improved health and safety of migrant workers.
Agricultural work is performed around the world at a huge range of scales and in a wide variety of ecosystems—from small plots to extensive holdings, from semi-deserts to lush jungles and low-lying wetlands. Tremendous change is taking place, both in terms of how agricultural commodity and labour markets are regulated, and how ecosystems are affected by climate change. How do work and health researchers develop an understanding of the evolving relationships between agricultural work and health, given all these different contexts? In this plenary, Dr. Donald Cole draws on many decades of work and shares reflections on how a research program can address this and related questions.
Please note that this plenary has been cancelled. Stay tuned for rescheduling information.
There has been a lot of discussion about an aging workforce, including questions about loss of productivity and higher absenteeism when older workers have chronic diseases such as arthritis and diabetes. In this plenary, Dr. Monique Gignac presents findings on her research on the availability, need and use of diverse workplace benefit and accommodation policies for workers with these conditions. She looks what types of accommodations are needed by people with diabetes and arthritis. She also compares health and work outcomes when people had their needs for accommodation met and when these needs are not met.
The prevention of musculoskeletal disorders (MSDs) has often been treated as a purely occupational health and safety issue. While this approach has made gains over the past few decades, more can be done. Ergonomics has the dual goals of improving both wellbeing and performance. In this plenary, Dr. Richard Wells shows how both MSD and poor product quality share many risk factors, and by addressing organizational goals of quality within an organizations’ management systems, MSD prevention can result in additional resources, effectiveness and sustainability.
Staying at work with chronic illness can be difficult. But it's especially so for those with fibromyalgia, a condition that carries considerable stigma. In this plenary, Dr. Margaret Oldfield shares her research on how women with fibromyalgia, along with their family members and co-workers, manage others' perception to avoid stigma and remain at work. She also discusses implications of her findings on workplace practices and policies.
"Flexicurity" policies represent a relatively novel approach to the regulation of work and welfare that aims to combine labour market flexibility with social security. Advocates of this approach argue that, by striking the right balance between these two components, such policies can protect workers from the adverse health and social consequences of flexible employment. In this plenary, Faraz Vahid Shahidi presents his study, which uses data from the European Social Survey to test the theory of flexicurity, with a focus on health inequalities between temporary workers and their permanent counterparts.
Musculoskeletal prevention (MSD) programs are seldom integrated into broader management system frameworks. This disconnect can result in poor sustainability and weak management buy-in. In this plenary, Dr. Amin Yazdani makes the case for the integration of MSD prevention into organization's management systems and examines harmonized approaches and tools that can bring MSD prevention "to the table."
Our knowledge of musculoskeletal disorders (MSDs) has increased substantially in recent years. But even when workplace interventions designed to prevent MSDs are developed, they are of little use if not properly implemented. In this plenary, Paul Rothmore discusses how implementation could be improved with a better understanding of the process of behaviour change. He shares the latest research on what's called a "stages of change" approach and ways it can be incorporated into the development of workplace interventions.
What are the unique return-to-work challenges facing injured workers at the age of 55 and older? What about the challenges facing those with psychological injuries? Drawing on preliminary findings from a large-scale longitudinal cohort study in Victoria, Australia, IWH Senior Scientist Dr. Peter Smith discusses the differences in return-to-work by age group and by type of injury—and the implications for workers' compensation systems that were designed for worker demographics and work injuries that were very different from today's.
Whether they are healthcare workers or family members providing care, caregivers are injured at alarming rates. And increasingly, the greatest challenges are seen in the home environment, as hospital care gives way to home care. In this plenary, Dr. Tilak Dutta joins Tara Kajaks to share research on reducing the risk of musculoskeletal injury in caregivers. This research is aimed at identifying activities that place caregivers at greatest risk of injury, developing new tools for caregivers that reduce the risk of injury and developing new methods of training and coaching caregiver on safe work.
In tandem with a systematic review on the quantitative literature on occupational health and safety (OHS) regulatory enforcement, this systematic review by Dr. Ellen MacEachen and her team looks at the qualitative literature on how OHS laws are planned and implemented. Qualitative studies are particularly useful for providing context—whether social, legal, economic or otherwise—to help explain events. In this plenary, Dr. MacEachen discusses how the implementation of OHS laws is shaped by ideas around "general duty" laws, coordination between agencies, worker participation in injury prevention, among others.
Organizational context plays a key role in the safety of work-related drivers. To improve driving behaviour, it is necessary to look beyond individuals’ compliance with safety procedures and at the influence of workplace factors, supervisors and senior management. In this presentation, Dr. Sharon Newnam talks about a research program on workplace road safety that addresses these inter-linked contexts and describes interventions designed to mitigate driving risk.
Mental health problems among workers are a growing concern, but there is a dearth of intervention studies on this issue, whether due to long timelines, high costs, or other feasibility challenges. In this presentation, Dr. Tony LaMontagne describes epidemiological methods to capture changes in work, working conditions and associated changes in mental health. He makes the case that capturing natural experiments in such a way offers a valuable and efficient complement to experimental studies.
Developing workplace ergonomic solutions, such as physical demands analyses (PDAs), physical demand descriptions (PDDs) and physical employment screens, requires collaboration and mutual consensus among all workplace parties. Involving all stakeholders in the process can be challenging, particularly when there are potentially conflicting viewpoints. In this presentation, registered kinesiologist Dr. Kathryn Sinden discusses how using integrated knowledge translation, informed by the Knowledge-to-Action Framework, can be useful in developing a PDA/PDD for firefighters and a physical employment screen for paramedics.
Change is hard, especially in a large organization. However, some leaders do succeed—often spectacularly—at transforming their workplaces. What makes them able to exert this sort of influence when the vast majority can’t? A team led by Dr. Tiziana Casciaro set out to gain that insight by focusing on organizations in which size, complexity, and tradition make it exceptionally difficult to achieve reform. In this plenary, she shares what she discovered were the predictors of change agents’ success.
A summary of Dr. Casciaro's findings have been published:
Battilana, Julie, and Tiziana Casciaro. "The Network Secrets of Great Change Agents." Harvard Business Review 91, nos. 7/8 (July–August 2013): 62–68.
How effective are regulatory inspections and other forms of enforcement in improving health and safety at workplaces? In this plenary, Dr. Emile Tompa shares results from a systematic review guided by this question. He also discusses the research evidence on awareness campaigns, smoking bans, and inspections backed up by the threat of penalties.
Front-line employees in health care and workers’ compensation frequently make challenging decisions about the most appropriate treatments for injured workers to help facilitate return-to-work. Clinical Decision Support (CDS) tools are designed to inform these decisions based on individual worker characteristics. In this plenary, Dr. Ivan Steenstra outlines the existing literature on these tools and examines the extent to which research evidence supports their use.
An evidence-based assessment tool has been developed to help joint health and safety committees (JHSCs) establish improvement goals and ensure sustained effectiveness. In this plenary, Dr. Linn Holness shares the research behind the 21-item tool and discusses how this study, conducted in a health-care setting, could have application across Canadian workplaces.
Can a measure be created to indicate how the risk of work-related injury and illness differs from sector to sector? In this plenary, Dr. Cameron Mustard, senior scientist and president of the Institute for Work & Health, shares the research findings and research methods behind the development of an occupational hazard exposure index for 56 sectors in Ontario.
Workplaces and jurisdictions are looking for valid, reliable and practical indicators of occupational health and safety (OHS) performance. In light of this, OHS professionals from prevention system partners in Ontario, in collaboration with the Institute for Work & Health (IWH), developed a leading indicator known as the IWH Organizational Performance Metric (IWH-OPM). Prior testing of the eight-item IWH-OPM suggests it has acceptable internal consistency and structural validity, and is also predictive of future OHS performance (as measured by claims rates).
In this plenary, Dr. Basak Yanar, a researcher and lecturer in organizational behaviour at the University of Windsor, reports on a further qualitative study of the IWH-OPM that contributes to the ongoing analysis of its measurement properties. The construct validity of the IWH-OPM was examined through case studies in five organizations, comparing the item and scale scores with observational and interview data on OHS performance. Results indicate good construct validity; that is, organizations that scored high on the scale also had the best OHS practices compared to those that scored lower on the scale.
In 2004, the Institute for Work & Health (IWH) published a mixed-method systematic review on workplace‐based return‐to‐work (RTW) interventions. Recently, IWH and the Institute for Safety, Compensation and Recovery Research (ISCRR) in Australia worked together to update and expand this review to include system-level or jurisdictional interventions and mental illness. In this plenary, IWH's Emma Irvin and Kim Cullen discuss the latest findings and what they mean to the practice of evidence-based return to work.
One key aspect of the research program at the Centre for Ergonomics and Human Factors is the development and evaluation of a "toolkit" for managing the risks of musculoskeletal injuries and disorders (MSDs). In this plenary, program coordinator Dr. Jodi Oakman presents this toolkit, a survey-based tool for assessing risk from both manual handling and psychosocial hazards. She also shares findings about the MSD hazard profiles across three industry sectors—manufacturing, warehousing and health-care—and discusses implications for workplace management of MSD risks.
High reliability organizations are those with the potential for catastrophic failure, yet are nearly error-free in performance. Think aircraft carriers, electrical power grids or wildland firefighting crews. What lessons can these types of organizations, which are amply discussed in high-risk industries, offer to more conventional workplaces? In this plenary, organizational behaviour assistant professor Dr. Marlys Christianson details practices used by these organizations to address emerging problems—including some that may seem counterintuitive.
What can we learn from people in occupational health and safety (OHS) about their access to, and use of, OHS research? In this plenary, Institute for Work & Health associate scientist Dwayne Van Eerd discusses findings from a study of OHS knowledge users, including factors that help or hinder their use of OHS research in decision making.
What commuting challenges do new immigrants in precarious jobs face, and how do these challenges in turn affect their employment prospects? In this plenary, Dr. Stephanie Premji shares results of a qualitative study on new immigrants working in precarious jobs and the commuting issues they face, including the health impact of those commutes.
There are about 4,000 garment factories in Bangladesh, employing 4 million, mostly young women, in harsh conditions with minimal or non-existent workplace health and safety regulations and policies. In this presentation, Dr. Hasanat Alamgir looks at the actions and responsibilities of local and Western stakeholders and outlines the progress made so far. He also shares findings of recent research on fire safety knowledge and awareness among workers and on the health status and disability of the survivors of the 2013 Rana Plaza building collapse.
Dr. Karen Messing, professor emeritus of ergonomics at the Université du Québec à Montréal, talks about her latest book, Pain and Prejudice: What Science Can Learn about Work from the People Who Do It. In her book, Messing reflects on her 35 years as a researcher in occupational health in Canada. She suggests that many current mechanisms for the support and publication of research prevent scientists from expressing and even experiencing empathy with injured workers. The resulting empathy gap can affect the quality of occupational health science, as well as its ability to prevent damage to workers' health.
Please note that this plenary will not be available in webinar or slidecast formats.
Although safety inspectors play a key role in safety management systems, there has been little scholarly research on how they do their jobs. In this plenary, Dr. Kathryn Woodcock presents a model of safety inspections developed through her study of safety inspections of amusement park rides and discusses strategies to support inspectors and help their knowledge acquisition.
The term "vulnerability" is used increasingly in occupational health and safety (OHS) in Ontario. Although certain groups in the labour market (e.g. younger workers, temporary workers or immigrants) are often labelled as “vulnerable workers,” there is very little discussion about what the broader workplace and occupational factors are that lead to increased risk of injury among these groups, and whether these risk factors are similar across the groups. In this plenary, Dr. Peter Smith, a scientist at the Institute for Work & Health, provides an overview of the conceptual framework of OHS vulnerability. He also shares preliminary findings from a survey capturing different dimensions of OHS vulnerability across a sample of workers in Ontario and British Columbia.
Note: Since this plenary, Smith's study on the development of the questionnaire has been published in the September 2015 edition of the journal Accident Analysis & Prevention (Vol. 82, pp. 234-243: doi:10.1016/j.aap.2015.06.004). The open-access paper is available to all to read, and offers a link to a shorter slidecast summarizing his work on the development of the measure.
Independent medical assessors play a key role in many workers' compensation boards (WCBs), conducting investigations on a range of issues, from medical diagnosis to extent and duration of disability. In this plenary, Institute for Work & Health Scientist Dr. Agnieszka Kosny shares findings from her study on the use of independent medical assessments across 17 jurisdictions in Canada, Australia and New Zealand. She also highlights challenges from the perspectives of policy-makers and service providers, and discusses ways the use of independent medical assessments could be improved.
How long does it take for someone with low-back pain to recover enough to return to work? That's a question often asked by the worker, the employer, and the workers' compensation agency alike. In this plenary, Dr. Ivan Steenstra shares prognostic factors for subacute and chronic low-back pain and compares them with prognostic factors for acute pain. He also discusses how stakeholders use prognostic information, and how their understanding of prognostic factors compares to his own findings.
On the Move is a research partnership exploring issues related to workers' extended travel and related absences from home due to their employment. A project of the SafetyNet Centre for Occupational Health & Safety Research at Memorial University, On the Move's scope of interest encompasses a range of workers, from individuals doing hours-long commutes to people leaving home for weeks, months, even years, for the job.
In this plenary, On the Move project director Dr. Barbara Neis, a research professor in the Department of Sociology at Memorial University and co-director of the SafeyNet Centre, explains why greater attention should be paid to the relationship between occupational health and safety (OHS) and employment-related geographic mobility. She also discusses On the Move's preliminary findings on the OHS policy challenges—including gaps in current laws and regulations—related to workers while travelling to or from work, while at work, while living at work, or while maintaining a life at home when travelling for work.
Institute Scientist Dr. Smith shares details about his new five-year research program into how sex and gender shape risk of work injury, time off work after a work injury, and the relationship between the work environment and chronic illnesses.
“Women make up nearly half of labour force participants, yet much of what we know about the relationship between working conditions and health is based on measures developed for men and frameworks tested in male-dominated workplaces,” says Smith. "By engaging with leading occupational health and safety stakeholders throughout the research process, this new research knowledge will help shape the development of gender- and sex-sensitive policies and practices to improve the health of all working Canadians.”
The program is being supported through the Institute of Gender and Health at the Canadian Institutes of Health Research (CIHR). Smith is one of nine research chairs in gender, work and health.
Dr. Zena Sharman, assistant director of the Institute for Gender and Health at CIHR, opened the plenary with an overview of the gender, work and health funding program. Her opening remarks are available on the IWH YouTube channel.
There are about 60 well-established workplace carcinogens, and still more to-be-identified occupational carcinogens. Yet Canada still lacks a rapid, systematic means to assess increased cancer risk associated with occupational exposures. Although Canada collects timely and high quality information on every new cancer that is diagnosed through provincial and national registries, occupational cancer surveillance data has been limited by the lack of information on industry and occupation. In a pilot study, a research team linked Workplace Insurance and Safety Board (WSIB) lost-time claims data with the Ontario Cancer Registry (OCR). In this plenary, Dr. Paul Demers, director of the Occupational Cancer Research Centre, discusses the results of the pilot study, focusing on the feasibility of this new approach to assessing and monitoring workplace risk factors for cancer.
Knowledge has been building about the adverse effects of mental health disorders in the workplace, from absenteeism and long-term work disability to poorer work functioning while present at work (presenteeism). In this plenary, Coronel Institute of Occupational Health assistant professor Karen Nieuwenhuijsen looks at a variety of intervention studies on mental health problems. She discusses the challenges they faced and shares evaluations of stay-at-work and return-at-work strategies for workers with mental health disorders.
Occupational health and safety management systems (OHSMS) provide a valuable framework for assessing and managing health and safety risks in many work environments, particularly in manufacturing and industrial sectors. However, they seem to have difficulty addressing psychosocial hazards, which tend to be more prevalent in the service and public sectors. In this plenary, Aalborg University PhD student Anne Helbo looks at the practice of internal auditing as an instrument of quality control in an OHSMS—and in particular its effectiveness in addressing psychosocial risks.
Workers in all industries are vulnerable to painful and potentially disabling injuries and disorders of the neck, shoulders, upper arms, forearms, elbows, wrists and hands—areas known as the upper extremities. The Institute for Work & Health (IWH) has conducted a systematic review on the effectiveness of workplace intervention programs to prevent and manage upper extremity musculoskeletal disorders (MSDs). In this plenary, the team shares the updated findings and the key messages from the latest research available.
Employers can help prevent work disability due to low-back pain by offering temporary work accommodations. And often it's the supervisor who plays a key role in making offers of accommodation available. In this plenary, Associate Scientist Dr. Vicki Kristman outlines her study of supervisors, and shares the individual and organizational factors that are more likely to increase their support for work accommodation.
What do workplaces that manage to turn around their poor health and safety records have in common? In an innovative, case-study-based study called "Breakthrough Change," Dr. Lynda Robson examined the experiences of four Ontario workplaces that dramatically brought down their injury claim rates over a 10-year period. In this plenary, she shares the common themes that have emerged from her study—some of them unexpected.
An increasing number of Canadians live with lifelong episodic disabilities that result from chronic conditions, including arthritis, multiple sclerosis, HIV, mental illness, diabetes, lupus, cancer and other rare diseases. Despite their ability to work, these people face barriers to employment, job retention and income supports. In this plenary, Tammy Yates of the Canadian Working Group on HIV and Rehabilitation talks about the barriers to full workforce participation by those living with episodic disabilities and issues a call to action.
When CSA standards are developed for occupational health and safety (OHS), what does the process look like? In this plenary, Andrea Holbeche, project manager in OHS at CSA Group (formerly the Canadian Standards Association), lays out the methodology for developing, writing and reviewing standards to ensure they remain current and technically valid. CSA standards are used by a broad base of stakeholders to help enhance safety for people and businesses. When implemented by industries or regulators, CSA standards help contribute to a wide range of safety and sustainability goals.
The work firefighters do can be very physically demanding, putting them at risk of musculoskeletal injuries (MSI). In this plenary, Tara Kajaks presents her research on the use of gaming and simulation technology to ergonomically assess firefighters in their training environment. In addition to presenting the study results, she also discusses the strengths and weaknesses of this technology for field-based movement analysis and ergonomics assessment.
Occupational diseases are typically under-recognized and under-reported, in part because awareness of occupational disease and its prevention is low. The Centre for Research Expertise in Occupational Disease (CREOD) has been working with occupational health and safety system partners over the past several years to address occupational disease.
In this plenary, occupational health physician Dr. Linn Holness, CREOD director and professor in the Dalla Lana School of Public Health and Department of Medicine at the University of Toronto, tells the story of her team's journey as they undertook this work. In particular, she talks about a recent study exploring the knowledge, skill and resource needs of front-line prevention system partners for occupational skin disease prevention and CREOD's current approach to addressing these needs.
Ontario's Office of the Worker Adviser (OWA) provides free and confidential services to 10,000 non-unionized workers every year in matters related to workplace insurance and occupational health and safety reprisals. In this presentation, OWA Director Alec Farquhar highlights the range of services provided, the partnerships within the workplace insurance system and the broader community, as well as the emerging challenges for vulnerable workers.
Work disability is an issue that touches most people at some point over their lifetime. Increasingly, policy-makers, employers, labour organizations, disability communities and academics are realizing that labour force productivity and output are contingent on the inclusion of all adults who can and want to work, regardless of ability status. But the backdrop of this recognition is a fragmented Canadian work disability policy system, comprised of a variety of support programs that were developed in a different historical context and to meet different needs. Due to conflicting requirements across different programs such as social assistance, workers’ compensation and employment insurance, people are shuffled from one to another and often fall through the cracks.
In this plenary IWH senior scientists Drs. Emile Tompa and Ellen MacEachen describe the new Centre for Research in Work Disability Policy, recently launched to address work disability policy challenges through a seven-year SSHRC Partners grant. They describe the centre’s mandate and how it's organized to create a new generation of research on work disability policy.
In a recent quasi-experimental field trial, an Institute for Work & Health (IWH) research team compared the impact of in-person office ergonomics training with e-learning office ergonomics training. Both training programs took the same amount of time and delivered the same content.
For each type of training, workers were further split into two groups. One group was given enhanced training—i.e. supervisor coaching and in-person follow-up—while the other group was not. A fifth comparison group was given no training and was included to ensure any observed changes in the other four groups could be attributed to the training and not to other factors.
In this plenary, the IWH's Dr. Ben Amick, the lead researcher on this project, presents the findings of the 12-month trial, including which form of training had the greatest impact on worker knowledge, attitudes and behaviour with respect to office ergonomics.
What is developmental evaluation? Why might this approach to program development be relevant for Ontario's health system? In this plenary, Sanjeev Sridharan, director of the Evaluation Centre for Complex Health Interventions at St. Michael's Hospital's Li Ka Shing Knowledge Institute, shares his thoughts on the many ways developmental evaluations can contribute to accountability and learning.
In April 2013, the Law Commission of Ontario released its final report on vulnerable workers and precarious work. The project addressed part-time, contract and temporary work—including work under the federal foreign worker programs. Among its 47 recommendations are those related to the distribution of information to new employees, increased pro-active inspections in high risk workplaces and the expediting of reprisal complaints. In this plenary, Patricia Hughes, the Commission's executive director, explains the vulnerable workers/precarious work project: its focus, its most significant recommendations, as well as its seen and potential impact.
In 2007, Ontario introduced a regulation to promote the adoption of safety-engineered needles for the prevention of needlestick injuries. However, needlestick injury declines in the province from 2004 to 2011 have not been substantial. Ontario’s regulatory standard, designed to allow for local flexibility in the selection and implementation of these safety devices, relies heavily on the actions and conditions of regulated workplaces. In this plenary, Andrea Chambers shares findings on how implementation of the regulation played out at three acute-care hospitals.
To what extent do work injuries vary from one region to another, from one province to another? And what factors are associated with these variations? IWH Scientist Dr. Curtis Breslin and Research Operations Coodinator Sara Morassaei share the findings of a study that helped answer these questions, based on data from the 2003 and 2005 Canadian Community Health Survey.
Continued improvements in occupational health and safety (OHS) can only be ensured if decisions about interventions are based on the best available evidence. To ensure this is the case, scientific evidence should meet the needs of decision-makers. In this plenary, Hanneke van Dongen shares the results of a qualitative study that explores the OHS decision-making process and information needs of decision-makers in the context of bridging the gap between the economic evaluation literature and daily practice in workplace health and safety.
There has been growing literature on participatory ergonomics (PE) programs, in which teams work together to identify risks, and change tools, equipment and work processes to improve workplace conditions. But how do PE programs fit in with occupational health and safety management system (OHSMS) standards? In this study, Dr. Richard Wells examines elements of PE programs and contrasts them against key themes of OHSMS. The findings may not bode well for successful implementation of PE programs.
The population is aging in Canada and in the rest of the world. Death rates continue to fall and, as a result, life expectancy is increasing. Moreover, fertility rates are low in Western countries—where they are below replacement—and falling elsewhere in the world. These two phenomena are leading to a change in the age structure of the population, with projections forecasting that the proportion of the population over 65 will rise substantially.
Concerns about the viability of social programs have prompted governments to encourage workers to remain in the workforce. What will persuade older workers to stay in employment? What needs to be done to ensure they remain healthy and productive? This talk examines these issues. The health effects of normal aging are reviewed, as well as the implications for health and safety. Some possible ways to manage the aging workforce are discussed. Finally, questions that need to be answered are outlined, and methodological challenges for epidemiological studies are described.
Health-care workers may be exposed to hazardous antineoplastic drugs—i.e. drugs used in chemotherapy—when handling them and/or when touching surfaces contaminated by them. Most studies looking at exposures to antineoplastic drugs in hospitals have been limited to select departments and/or workers with certain job titles. This may lead to an underestimation of the risk if all exposures during the circulation of the drug within a facility from cradle to grave (known as the hospital medication system) are not taken into account.
In this plenary, Chun Yip Hon, an assistant professor in Ryerson University's School of Occupational and Public Health, talks about his study of antineoplastic drugs and the hospital medication system. His results suggest that contamination is more widespread than initially believed and that a wider range of job categories are at risk of exposure to antineoplastic drugs.
Although a growing number of Cochrane reviews of intervention studies have included non-randomized studies, how and why these studies have been included has not been evaluated to date. In this plenary, Jani Ruotsalainen, managing editor of the Cochrane Occupational Safety and Health Review Group, talks about the practice of including non-randomized studies in Cochrane systematic reviews, focusing on the reasons why these studies were included. He also looks at the methods used by the studies to assess risk of bias.
A longitudinal study is underway in New Zealand to identify the predictors of disability following an injury. This study, called the Prospective Outcomes of Injury Study, involves 2,856 participants who were selected from the entitlement claims registry of the country’s no-fault compensation insurer, the Accident Compensation Corporation. Participants were recruited between 2007 and 2009, and follow-ups were done at 12 months and 24 months after their injuries. In this plenary, principal investigator Sarah Derrett provides a brief overview of the study design, participant characteristics (including health and disability status), and findings on the factors associated with disability.
Health and safety regulators are relying more and more on visuals to communicate information and change behaviour, especially among diverse populations. Peter Stoyko, a social scientist and information designer, draws upon scientific findings, design principles and his own field research in Asia to discuss the crafting of workplace safety visuals that are both engaging and effective.
Denmark faces large and growing problems integrating youth into education and gainful employment. The proportion of younger disability pensioners is increasing and, in some parts of the country, more than one third of those not enrolled in secondary education rely on social benefits related to ill health and unemployment. The concept of a generation for whom working life is over before it begins is also recognized in other north European countries. In order for policy-makers to make informed and evidence-based decisions, a multi-centre research initiative (referred to as FOCA) has been set up to explore the successful integration of youth into education and employment. This plenary discusses the current and planned studies being undertaken through FOCA, as well as the data currently available and the possibilities for future collaboration.
A Campbell systematic review on the effectiveness of workplace disability management programs promoting return to work (RTW)—as implemented and practiced by employers—was published in 2012. Due to insufficient data, the systematic review was unable to determine if specific workplace-based programs or program elements improved RTW effectiveness. However, the studies of workplace programs included in the review were rich in describing RTW program components, procedures and implementation issues, allowing the researchers to develop a classification system for workplace-based programs that may help workplaces identify gaps in their RTW strategies. This plenary talks about the Campbell systematic review and the resulting classification system.
There is much enthusiasm globally for reducing health inequalities by socio-economic status. However, only a few jurisdictions internationally have put substantial effort into robustly monitoring such inequalities over several years. Scotland is perhaps the best example of a country that has.
In this plenary, Dr. John Frank of the Scottish Collaboration for Public Health Research and Policy presents the results of a half-decade of annual Scottish government reports on reducing health inequalities by socio-economic status (SES). These reports monitor nearly one dozen health outcomes that have been routinely collected since the late 1990s. Dr. Frank focuses on the measurement properties of these routinely collected health statistics, which are found in virtually all such reports internationally—especially their responsiveness to feasible public health policies and programs that should theoretically reduce SES inequalities.
Dr. Frank discusses the “insensitivity to prompt change” for almost all of the routinely collected population health outcomes that are in wide use. He argues for the universal use of more “upstream” indicators that are more capable of being changed by currently feasible interventions, within the usual “attention span” of democratically elected governments (typically less than five years). He uses the example of a measure of child development at school entry at the local community level: the Early Development Instrument (EDI), which was originally developed in Canada and is in wide use internationally.
Worker perceptions of organizational fairness are linked to a host of productive and counter-productive worker attitudes and behaviours (e.g. organizational commitment, absenteeism, theft, worker well-being), yet few studies have examined organizational fairness within the context of accommodating injured and ill workers. This plenary looks at recent research into the perceptions of fairness among both workers needing accommodation and their co-workers. It also explores the impact of these perceptions.
Since the early 1990s, the time on benefits has been increasing for Ontario workers’ compensation claims. In particular, over the last decade there has been a notable increase in the number of total compensated days per lost-time claim and an increase in the rate of claims remaining active and open for extended periods of time. This trend is in contrast to the trend of declining claim rates experienced over much of the 1990s.
This plenary profiles a study that investigated how Ontario workers’ compensation claimants from different time periods fared in terms of labour-market earnings recovery. More specifically, this study investigated the labour-market earning patterns of Ontario workers’ compensation long-term disability claimants from three different time periods and receiving benefits under three different programs. The study provides insights into the individual and contextual factors that contribute to labour-market engagement and earnings recovery.
Occupational health and safety professionals persist in their efforts to eliminate, minimize and treat risk. Although much progress has been made over the last few decades, workplace incidents continue to occur. When it comes to industrial incidents, being proactive and concentrating on prevention are the keys to improved performance. In light of this, Atotech Canada Ltd. has decided to broaden its safety culture by emphasizing the reporting of near misses. This plenary talks about this effort and how it has raised awareness of industrial risks.
Ms. Woodhall’s research, the subject of this plenary, investigates the views that fast-food workers hold regarding health and eating to uncover how these workers negotiate their own food and lifestyle choices. This work draws on the body of research on the implications of proximity to fast food, fast-food work structures and the socioeconomic explanations for eating high caloric food outside of the home. The argument is that these fast-food workers participate in an internalized negotiation process to determine their food consumption patterns at work. These workers are constrained in their choices, due to socioeconomic status, time concerns and food availability at work.
In this plenary, John Speers provides a comparative overview of the standards, certifications and awards that an organization may use in its pursuit of occupational health and safety, wellness, quality and excellence. He also provides perspectives from his own organization's experiences, including why and how it has used certifications and awards, and what limitations and benefits were discovered.
Existing surveillance work has documented a parallel decline in work-related injuries and illness over the period 2004-2008 in two administrative data sources: emergency department visits and workers’ compensation lost-time claims. This plenary reports on a cross-sectional, observational study based on these administrative records, for occupationally active adults age 15+ in Ontario. Work injuries were classified to one of five economic regions and to eight categories defining the event of the injury. Percentage change in counts of visits or claims were estimated over the period 2004-2008. Although the two data sources document generally consistent work-related injury/illness trends in incidence by region and by injury event, there are unexplained differences in the regional incidence of compensation claims and emergency department visits.
Identifying workers at high risk for longer duration away from work following a workplace injury is very appealing. In this plenary, Dr. Steenstra discusses how the research team developed a prediction rule to determine time away from work based on data readily available through Ontario workers’ compensation records augmented with data from the Readiness for Return to Work (R-RTW) cohort study.
Recent legislative changes in Australia parallel those of other nations and require employers to take increased responsibility for the return to work of injured employees. In this context, work disability research has found co-worker support to be important to work reintegration success. This plenary provides insights into the experience of co-workers who have worked alongside returning injured workers. It is based on a qualitative pilot study that was conducted in Toronto in 2011.
Under-reporting of occupational health problems can have significant consequences including under-estimation of the occupational injury and disease burden, sub-optimal prevention and treatment, reduced access for workers to compensation, and displacement of costs from the compensation system to the public health system. But to date we do not have sufficient understanding of why and how under-reporting occurs. This plenary discusses a project that took this issue on and set the stage for future research investigation by examining key concepts, stakeholders’ language and logic, new potential units of analysis and determinants, and the socio-politics of doing research in this area.
With improvement in diagnosis, treatment and survival rates, returning to work after cancer is of increasing importance to individuals and employers. However, studies looking at work and employment in cancer survivors indicate areas of uncertainty and lack of information. The contradictory nature of the findings and dependence on cultural factors suggest further work is needed. In this plenary, Dr. Amir presents the findings from two recent UK surveys, both of which suggest that employers/supervisors need to be provided with support and resources that help them facilitate employment and job retention for individuals diagnosed with cancer.
As virtually everyone is exposed to the sun on a daily basis, ultraviolet (UV) radiation is an important environmental health hazard. Additionally, there are many occupations that receive substantial exposures to either natural UV or UV from artificial sources. Even though the adverse effects of UV exposure have been well known for some time, there is still much that we don't know about occupational UV exposure. In the occupational setting, managing the risk of occupational UV exposure is particularly challenging. This plenary will discuss the current state of knowledge and some key risk management challenges relating to occupational exposure to UV.
The topic of this plenary is the new metric system and set of ergonomics criteria launched across 120 North American plants in 2007 and another 136 plants later in Europe and Asia. The new structure ensured a more systematic and robust method for identifying and reducing ergonomic risk in all plants. A central database increased the ease of sharing information. In 2011, Magna received the Ergonomic Innovation Award from the Michigan Occupational Safety and Health Administration (MIOSHA) for the this newly developed database system.
How do you measure stress in the workplace? For the last two years, a working group of health, safety and compensation representatives, the Occupational Health Clinics for Ontario Workers (OHCOW) and academic researchers have evaluated a strategy to measure psychosocial risk factors in the workplace. Using the Copenhagen Psychosocial Questionnaire (COPSOQ), the working group piloted the survey at several conferences and workplaces. In this plenary, John Oudyk, an occupational hygienist at OHCOW, reports on the findings from these surveys and demonstrates the working group’s tool kit.
A key goal of compensation research is to improve policy and practice within injury compensation systems, but realizing the benefits of evidence-informed policy and practice requires a shift in thinking and practice. In this plenary, Dr. Alex Collie describes the development of a consensus statement in Australia and New Zealand regarding the use of research evidence in personal injury compensation policy and practice. The statement identifies eight major factors affecting the uptake of research evidence and six opportunities to improve uptake.
Current trends in evaluation and the steps by which evaluation can matter for public health are two key topics in this plenary. Based on ongoing evaluations and evaluation capacity projects in a number of settings, Dr. Sridharan explores conditions under which evaluation can make a difference. Key questions in building evaluation as a field are identified.
Dr. Sridharan is director of the Evaluation Centre for Complex Health Interventions at St. Michael’s Hospital and associate professor of Healthy Policy, Management and Evaluation at the University of Toronto.
There are 60 well-established workplace carcinogens identified by the International Agency for Research on Cancer. But there are over 100 industrial chemicals (and other agents) that are suspected to cause cancer. Canada lacks any rapid, low-cost means to assess whether exposures, occupations or industries pose an increased risk. In this plenary, the director of the Occupational Cancer Research Centre shares two projects currently being undertaken to establish alternative models for occupational cancer surveillance in this country. If successful, these projects will create two, alternative platforms for the surveillance of occupational cancer in Canada.
Temporary work agencies are a growing phenomenon and an increasingly established part of new flexible labour markets, where the workforces of organizations can be quickly increased or decreased in line with demand for labour. Studies have shown that agency workers are at greater risk for occupational accidents and diseases than permanent workers. However, we know little about the management of injury prevention and return to work within temporary work agency contexts.
In this plenary, IWH Scientist Dr. Ellen MacEachen presents her findings from an IWH study on the organization of health and safety in temporary work agencies. The findings suggest that a core problem to health and safety management is that, as the ‘employer’ of temporary workers, agencies cannot control clients' worksites and have only limited knowledge of them. The three-way worker-agency-client employment relationship poses challenges to the effectiveness of agency injury prevention initiatives.
Individuals with chronic physically disabling illnesses experience a number of challenges when working.This plenary discusses three separate studies of individuals with inflammatory arthritis and osteoarthritis, and highlights the episodic nature of many chronic conditions like arthritis, the work-health balance and perceived “job lock” (that is, being trapped in a job because of one’s health).Those reporting "job lock" were more likely to report absenteeism related to their disease, job disruptions and lower productivity. These findings are discussed, along with the need for workplace interventions to target work-related and psychosocial issues that could facilitate or undermine employment.
Both safety and operations scholars conduct research on safety practices and outcomes, and yet they sometimes reach different conclusions about the relationship between creating a safe workplace and creating a productive workplace. This plenary discusses research that examined safety practices and outcomes in the wider context of business operations.The goal was to enhance the understanding of the practices critical for safe workplaces, and the business value (positive or negative) of safety. The results provide new and novel insights.
To date, evaluations of participative ergonomics (PE) interventions have shown mixed results. In a multiple case study of four worksites in different companies, Dr. Wells' team examined process, implementation and effects of PE interventions. This study was based on fieldwork and interviews with 90 people. The team was able to introduce 10 to 21 changes over 10 to 20 months, despite some challenges. This plenary describes the research, which ultimately showed limited effects of PE interventions, and potential reasons that may account for this.
Transportation workers are more susceptible to chronic disease as a result of higher prevalence of selected risk factors, working conditions and certain lifestyle choices. Researchers conducted focus groups with drivers and trucking-firm managers to inform the development of health and wellness surveys administered to drivers in 13 transport companies in 2011. This plenary describes results of the focus groups and surveys, and outlines ongoing initiatives and collaborative directions that have come about from stakeholder strategic planning meetings. This research was jointly undertaken by McMaster University and the City of Hamilton’s Public Health Services.
When examining workers’ compensation claims data, it is usually assumed that each claim represents an independent event. However, claimants often file repeatedly. Little is known about repeat claimants. This plenary discusses research into repeat claimants in several provinces.
This plenary outlines a collaborative effort between Workplace Safety and Prevention Services (WSPS), one of Ontario's health and safety associations, and the Institute for Work & Health (IWH) to develop a pictogram-based hazard identification system. The organizations worked together to develop and evaluate pictograms (i.e. visual symbols) and a corresponding training program for kitchen prep workers in restaurants across Ontario. The plenary details the pictogram and training development process and the following pilot study evaluation.
Anne Rochon Ford is leading the project "Women, Plastics and Breast Cancer National Network on Environments and Women's Health" at York University. In this plenary, she presents a 'snapshot' of recent studies that give rise to emerging health concerns for women workers in the auto sector, specifically plastics manufacturing. In particular, there are strong reasons to believe that there may be an elevated incidence of breast cancer and reproductive problems in women plastics workers. For the over 25,000 women plastics workers in the auto industry in southwestern Ontario, the stakes are high.
In this presentation, Dr. Grace-Edward Galabuzi examines major trends in the labour market in the last 25 years, chief among them the growing gap between workers and the managerial/professional class. This gap is increasingly racialized. This is manifest in the analysis of income and employment data of racialized/immigrant and non-racialized/Canadian-born cohorts. Dr. Galabuzi discusses the impact on key aspects of life experience, such as disproportionate exposure to low income, differential health status and residential segregation. This comes at a time when racialized group members are projected to become a third of the Canadian population over the next 20 years.
In this presentation, Dr. Peter Smith discusses a recent project that considered the impact of changes in job strain on the risk of depression. More specifically, this research assessed the impact of changes in dimensions of the psychosocial work environment – job control, psychological demands, job strain and social support – on the risk of depression in a longitudinal cohort of 3,735 Canadians. Results of this analysis are presented and discussed in this plenary.
In this presentation, Cam Mustard and Andrea Chambers provide a summary of the preliminary findings of a study that examined the incidence of work-related injury and illness in the Ontario labour force across the 24-hour clock. They also review the study methods. Two data sources were used (WSIB lost-time claims and records of non-scheduled visits to Ontario emergency departments), while information on hours worked was obtained from Statistics Canada sources.
The presentation explores various strategies in the development and implementation of regulation to address workplace bullying and harassment in developed and developing countries, while identifying strengths and weaknesses of the different approaches. The analysis includes reflections on the relationship between research and regulation and provides illustrations drawn from studies on occupational violence, gender issues and precarious employment.
Marieke van Wier, a researcher in the Department of Epidemiology and Biostatistics at the Institute for Health and Care Research at the VU University Medical Center in Amsterdam, discusses a study that compared the cost-effectiveness of three different forms of distance lifestyle counselling for overweight workers. An economic evaluation was conducted alongside a three-arm randomized controlled trial that compared the effectiveness of a six-month counselling program offered through self-help brochures, phone intervention or internet intervention, with a two-year time horizon. The internet intervention was found to be more effective for weight loss than self-help brochures alone, and at relatively the same cost. The phone intervention was not cost-effective compared with self-help brochures.
The Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD) is holding a discussion forum on Monday, June 27 on the development of an Ontario manual materials handling (MMH) program to prevent musculoskeletal disorders (MSDs). The forum is being organized in response to Ontario’s focus on high-impact claims and CRE-MSD's wish to be involved in the next version of Ontario's MSD strategy. The forum will include speakers from British Columbia, United States, United Kingdom and Australia, who will talk about efforts in their own jurisdictiosn to protect workers from injury related to MMH.
Jean Mangharam, principal scientific officer/inspector of the Human Factors & Ergonomics Team at WorkSafe in Western Australia, is one of the speakers at the CRE-MSD discussion forum. At this plenary, which takes place the day after the forum, she will talk about Western Australia's experiences with the design, dissemination, workplace implementation and evaluation of a guidance on MMH, and the responses it received from workplace parties during the process. She will also give her impressions of the discussion forum and describe how the Australian experience can relate to the development of an Ontario strategy to prevent MSDs due to MMH.
This presentation discusses a body of research aimed at understanding the complex link between work and health in the context of HIV disease. Grounded in the study of causation hypothesis – i.e. employment leads to better health – this talk will draw from several studies that have used secondary data to examine the association between employment, job security and health-related quality of life. It presents baseline enrolment data from a community-based study designed to examine the health effects of employment transitions in HIV. This work acknowledges the difficulties inherent in analyzing data where the structure of benefit programs may create incentives for people with HIV to remain at work when their health is compromised (in order to maintain access to insurance) or disincentives to go back to work when their health improves (to avoid losing disability income or medication coverage).
In 2007, based on good evidence from mouse studies and limited evidence from epidemiological studies, IARC declared that shift work involving night work was a probable carcinogen (mainly regarding breast cancer). Since then, several studies on shift work and breast cancer have been released, which are less supportive of the association. In the epidemiological literature, the dominant hypothesis regarding the underlying mechanism for the association is that light at night suppresses melatonin, resulting in a diminution of the anti-carcinogenic effects.
In this talk, Lin Fritschi, cancer epidemiologist and head of the Epidemiology Group at the Western Australian Institute for Medical Research in Perth, will outline the framework that includes an additional four possible mechanisms. This framework has been used to design a questionnaire that can disentangle various aspects of shift work, in order to determine which of the mechanisms are most related to any effect. Fritschi's group is using this questionnaire in a current case-control study of breast cancer.
Dr. Vicki Kristman from the Dalla Lana School of Public Health at the University of Toronto will discuss a study that set out to determine if radiating spinal pain from the low back, mid back and neck is associated with future use of health-related benefits and their duration. A cohort of 22,952 subjects was formed from the 2002 survey of the Danish Twin Registry. The survey contained information on spinal pain and important confounding factors. Work disability over an eight-year period was determined through data linkage with the Danish DREAM register of government transfer payments. The researchers calculated the incidence rate ratio for receipt of sickness benefit and the mean duration of the first and total sickness benefit periods by radiating and non-radiating spinal pain. Relative risks for the occurrence and number of sickness benefit episodes were calculated by radiating spinal pain status.
The political shift towards an economic liberalism in many developed market economies, emphasizing the importance of the marketplace rather than government intervention in the economy and society, has featured a prominent discourse focused on the need for business flexibility and competitiveness in a global economy. Alongside these developments has been an increasing pressure for corporate social responsibility (CSR). The business case for CSR – that corporations would benefit from voluntarily being socially responsible – was promoted by many governments and corporations as part of the justification for increasing self-regulation in public policy.
This presentation examines more closely the proposition that the business case and self-regulatory frameworks work in achieving workplace safety. It is argued that major flaws exist in the business case deriving from its salience and instrumentality, linked with the nature and priorities of cost-benefit analysis in a global market economy. Moreover, the current predominant management discourse and practice focusing on safety management systems (OHSMS) resonate well with a government and corporate preference for the business case and self regulation. But the centrality of individual rather than organizational factors in OHSMS means that inherent workplace hazards and collective, union-safety representation are downplayed, making it less likely that employers will tackle the more difficult and costly remedies needed for substantial and long term improvement. If it is used at all, the business case must be supplemented by strong legislation and worker/union co-determination.
Little is known about the information recent immigrants receive as they enter the Canadian labour market. Are there resources aimed at newcomers that speak to their rights at work, including those surrounding workplace safety? Are materials available for newcomers to inform them of what to do in the event of an injury or how to successfully return to work if injured on the job? Are resources centred mainly in jurisdictions such as British Columbia, Quebec and Ontario, which have historically been common destinations for new immigrants? Are materials typically translated and, if so, into what languages?
In this plenary, Dr. Agnieszka Kosny and Marni Lifshen will talk about a project that helped answer these questions by examining the services, programs and resources available to newcomers to Canada that focus on employment standards, occupational health and safety and workers’ compensation. Kosny and Lifshen reviewed the local resources available through community organizations, employers, settlement groups and unions, as well as the resources available through provincial and federal prevention agencies and workers’ compensation boards. During the presentation, they will discuss trends in the types of resources available, identify important gaps, and highlight case studies of programs that present interesting opportunities for providing this information to newcomers.
Approximately 30,000 migrant farm workers come to Canada annually through two federal temporary labour migration programs. Working in one of the country’s most dangerous industries, such workers often find themselves in precarious positions. Health concerns are common. Numerous issues, such as their temporary work and immigration status, language and cultural differences, vulnerable employment positions, dependency on employers to access services and high levels of mobility, pose challenges to accessing health-care and workers’ compensation systems.
This plenary will present preliminary findings from an ongoing research project, funded by the WSIB, that is interviewing 100 primarily male migrant farm workers in Ontario about their experiences with workplace health and safety. The research also features dozens of interviews with stakeholders such as employers, health-care providers, worker advocates and WSIB representatives, as well as 30 in-depth case studies of injured workers.
As workers navigate health and compensation systems between Canada (their country of employment) and countries such as Mexico and Jamaica (their places of citizenship), their experiences demonstrate the profound risks and consequences of transnational livelihoods, which for millions of migrant workers worldwide has become a necessary means of survival. As temporary foreign worker programs expand rapidly across Canada, this research offers insights and recommendations for how health-care systems and compensation boards can better assist and service vulnerable, transient populations.
Job acquisition for people with severe mental disorders (e.g., schizophrenia) is still difficult and complex, yet it is considered by many rehabilitation specialists to be a key component in the recovery and rehabilitation of this clientele. Several authors have presented a comprehensive list of barriers or facilitators for people with mental disorders to explain their work integration, including not only individual or internal characteristics, but also programmatic characteristics.
Obtaining a job involves multiple planning and decision-making processes. These processes can be experienced as especially challenging for people with mental illness who might feel overwhelmed by the barriers to overcome and, consequently, feel less confident in their ability to meet their occupational goals. New initiatives designed to help diminish the stigma towards people with mental disorders are currently being studied, and evidence-based practices in vocational services, such as supported employment programs, have already been demonstrated and are currently being implemented in various countries.
This presentation has two main goals:
- to comprehensively portray the underlying relationships between the personal concepts that explain the work integration of people with severe mental disorders and, thus, evaluate the strength of variance explained by each concept analyzed in the model (the theory of planned behaviour and self-efficacy theory)
- to evaluate the salient components in supported employment programs according to perspectives from employment specialists and clients.
Case management is increasingly used to oversee incoming claims accepted for wage-replacement benefits; however, there is no standard definition of what constitutes case management, and the impact on return to work is uncertain. IWH Scientist Dr. Jason Busse and his team recently conducted a systematic review of all randomized controlled trials that have assessed case management. At this plenary, Busse will discuss the different forms of case management that have been formally assessed, and present a meta-analysis describing the effect that case management has on return to work for patients in receipt of disability benefits.
Communicable respiratory illness is a serious occupational threat to health-care workers. A key reason for occupational transmission is failure to use appropriate barrier precautions. Facial protective equipment, including surgical masks, respirators and eye/face protection, is the type of personal protective equipment least used by health-care workers, yet it is an important barrier precaution against communicable respiratory illness. This plenary will present the findings of a study that was undertaken to describe nurses’ adherence to recommended use of facial protective equipment and to identify the factors that influence adherence. A two-phased study was conducted.The first phase was a cross-sectional survey of nurses in selected units of six acute-care hospitals in Toronto, Ontario. The second phase was a direct observational study of critical care nurses.
Depression is a common psychiatric illness with personal and economic consequences: 3.7 per cent of the employed population in Canada aged 25 to 64 years experienced an episode of depression in the previous year. The economic impact relates to lost productivity due to absenteeism and reduced productivity while at work. Canadian employers have identified depression as one of the principal causes of workplace absenteeism. Stakeholders from Ontario’s health and safety system were invited to several meetings with the research team to provide direction and feedback on the review. The objective of our study was to determine which intervention approaches to manage depression in the workplace have been successful and yielded values for employers in developed economies.
Many of the factors associated with risk of work-related injury and associated disability are well-known. Analysis of workers' compensation data has contributed to knowledge in this area. Such analysis almost exclusively treats each workers' compensation claim as a discrete event. A different approach would be to examine risk of injury within an individual worker over a defined period of time. This study sought to describe factors associated with repeat workers' compensation claims and to compare the work disability arising in workers with single and multiple claims.
The health-care sector is an important context for understanding the experience of workers with mental health and/or addictions issues.
Concerns have been expressed regarding growing rates of mental health-related absenteeism as well as presenteeism among Canadian health-care workers. Although the extent of the problem has been documented from a managerial perspective, little is known about the problem from the perspective of workers themselves, or about how their experiences are shaped by the organizational context within which they work.
Findings will be presented from a study conducted within a large mental health-care facility. An institutional ethnography method of inquiry was adopted, including interviews with 32 workers and workplace stakeholders, and a review of organizational texts related to health, illness and productivity. Analysis of the transcripts and texts revealed how institutional practices of silence were enacted at all levels of the organization, often communicating that it was not acceptable for staff to be ill. Discourses related to stigma, staff-client boundaries and responsibility for action shaped the practices of silence.
The pervasive, complex, often paradoxical nature of silence surrounding the mental health of health-care workers will be discussed, as well as the role that silence serves in maintaining institutional order.
Organizational policies and practices (OPPs) are one of a group of leading indicators being examined in Ontario to assess occupational health and safety performance of organizations.
In the Institute for Work & Health Readiness for Return-to-Work Cohort, the relationship between OPPs and return to work and successful work functioning are examined. In particular, we examine two ways through which OPPs may operate to affect important return-to-work outcomes.
We consider data over a one-year period. We find that in a multidimensional model of return-to-work, OPPs are a strong predictor of both return to work and successful work-role functioning. Additionally, we find that work accommodation offers and change in an injured worker’s self-efficacy in managing pain in the return-to-work process are two pathways through which OPPs operate to affect RTW and successful work-role functioning. Interestingly, self-efficacy appears to be more important in successfully functioning in the work role, while work accommodation is more important in the injured worker returning to work. The implications of these results for policy and practice are discussed.
This presentation will describe the association between unemployment and cause-specific mortality for a cohort of working-age Canadians. The cohort is based on the census mortality follow-up study, a representative 15 per cent sample of the non-institutionalized population of Canada aged 30-69 at cohort inception in 1991 who were followed for 11 years (888,000 men and 711,600 women who were occupationally active). Hazard ratios for risk of death for the unemployed compared to the employed were estimated from cox proportional hazard models, for six causes of death. Hazard ratios were estimated for two consecutive five year periods and across four age groups.
Consistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for conditions associated with both traumatic causes and causes attributed to chronic disease. The persistency of an elevated mortality risk over two consecutive five-year periods suggests that the exposure to unemployment in 1991 may mark persons at risk of cumulative socioeconomic hardship.
The discovery and characterization of the causal factors underlying health and disease in the community and the translation of such knowledge to clinical and public health applications will ultimately depend upon the availability of large-scale population-based, longitudinal data and linkage to statutory health data so that all those with and without disease, their risk and protective factors, including both genetic and environmental contributions, can be studied in an unbiased way throughout the whole life span. Such linkages and resources already exist in Ontario. We are in the process of developing a world-class cohort resource that will build on the unique Ontario population health data collected and managed over the last four decades.
The Ontario Health Study (OHS) is the biggest community-based health study ever undertaken in North America. The OHS is a long-term study that will help us understand the causes, prevention and treatment of diseases such as cancer, heart disease, asthma and diabetes.
The Ontario Health Study is seeking to collect health data from all consenting members of the adult population of Ontario (n~9.5 million people). The study began with an initial phase in which more than 8,000 adults living in three communities in Ontario took part. We hope to follow participants in the study for at least 20 years. This will allow researchers to see how environment, lifestyle and genes affect the risk of common diseases. The OHS is also part of the Canadian Partnership for Tomorrow Project made up of five regional health studies across Canada.
Medical researchers at universities, research institutes and hospitals across Ontario are conducting this study, which is funded by the governments of Ontario and Canada. We anticipate that significant new initiatives and collaborations relevant to health policy and promotion, interventions, clinical and genetic epidemiology, new therapies, preventive medicine, and pharmacogenomics will ensue at the national and international level.
In addition to being the stimulus for vision, there is increasing evidence that light influences biology and behaviour through other mechanisms. Laboratory studies, clinical evidence, and epidemiological studies are elucidating effects on hormone regulation, neurotransmitter function, and revealing behavioural and health effects not previously recognized. For instance, daytime light exposure influences both immediate social behaviours and night-time sleep quality.
The evidence suggests that good health requires a minimum daily dose of light, although we do not yet know what the dose ought to be. The presentation will give an overview of recent research, give an indication of research gaps, and summarize possible implications for practical applications through workplace design, architecture, and individual light hygiene habits.
Research over the last few years has advanced our understanding of the impact of precarious employment on health. Approaches such as the Employment Strain Model developed by Lewchuk, Clarke and deWolff point to the interaction between employment uncertainty, effort finding and keeping employment, and support at work as key determinants of the health outcomes of workers in precarious employment. At the same time, workers in precarious employment face a health and safety regulatory system that was designed at time when the standard employment relationship was the norm and unions had some influence in Canadian workplaces. This presentation will use our understanding of how work affects the health of precarious workers to explore the limitations of the existing health and safety regulatory framework. Much of the discussion will focus on the kinds of policies and initiatives that will improve the health of those in precarious employment.
This plenary was held on Thursday, November 11.
Hospital nurses, like many other providers of health and human services, work in complex organizations, collaborate extensively with a number of different disciplines, and both their work experience and the quality of their clients’ outcomes is heavily influenced by layers of contexts, including the management and policy decisions. Health care as an industry is in a profound state of uncertainty with escalating costs and unrelenting demand joining uncertainty in the stability of financing and the long-term ability of workforce supply to meet demand. After outlining a framework for thinking about organizational context in relation to nurse and patient outcomes in hospital settings, results from a series of studies examining incidence and predictors (both worker and organizational characteristics) of needlestick injuries — at one time a serious occupational health risk in hospital nurses — will be presented in addition to some work regarding psychosocial outcomes (notably burnout and job satisfaction) and patient health outcomes in relation to organizational context. The presentation will then conclude by discussing historical and newer workforce and workforce policy developments related to potential applications of this research, as well as directions for future study.
Organizations such as the International Agency for Research on Cancer have identified over 60 workplace carcinogens, and many more suspected carcinogens, to which thousands of Canadians continue to be exposed. However, relatively little is known regarding how many are exposed, where and how they are exposed, and their level of exposure. This data is essential for effective cancer prevention efforts and CAREX Canada was created to fill this data gap. In this presentation I will present an overview of the project, including the creation of a Canadian Workplace Exposure Database, and present some key results for high priority carcinogens in Ontario.
Since 1991, Ontario has seen a divergence in workers’ compensation claim rate trends for injuries that do and do not require time off work. While claims requiring time off work (lost-time claims) have reduced by 46 per cent, claims that do not require time away from work after the day of injury (no-lost-time claims) have remained relatively stable (declining by 9 per cent). At this plenary we will report the results of a recently completed project at the Institute for Work & Health which sought to examine: the factors associated with an increased risk of no-lost-time claims (between 1991 and 2006); trends in the health-care costs associated with no-lost-time claims (between 1991 and 2006); and compare the nature of injury and event leading to injury associated with no-lost-time claims during the introduction of a mandatory experience rating program in the province of Ontario (by extracting injury information from 9,250 no-lost-time claims over four different time periods (1991, 1996, 2000 and 2005). Results related to these objectives will be presented and implications for occupational health and safety injury surveillance and workers’ compensation policy will be discussed.
Leading indicators of occupational health and safety system performance help leaders and decision-makers make evidence informed decisions about targeting strategies, policy needs, organizational changes needed and system equity issues. They create a common ground for discussion and debate about what key occupational health and safety system actors are doing, how well they are doing it and where policy influences practice. A key group of leading indicators are about organizational performance. Yet there remains little consensus on what are the best leading indicators of organizational performance are reflecting little consensus in the scientific community. In Ontario, the Ministry of Labour (MOL), Workplace Safety and Insurance Board (WSIB) and the Health and Safety Associations (HSAs) collaborated to develop a leading indicator. The work was lead by the Health and Safety Associations and supported by the Institute for Work & Health. The project resulted in a short two-page questionnaire to be administered to management representatives of 1000 Ontario employers. Over 800 employers participated and IWH linked the employer data to WSIB claims data. Results will be presented to show the reliability and validity of the eight questions developed as a leading indicator of organizational performance. Next steps for the use of the metric will be discussed. The project raised many questions and has resulted in a larger survey of 5000 Ontario employers to build on this work and to determine the feasibility of developing a benchmarking knowledge base for the Ontario Prevention System.
Although worker participation in OHS is much discussed in theory and practice, worker representation receives much less attention. A key element in improving OHS throughout history, worker representation was formally recognized by the Ham Commission in Ontario in 1976 as a constitutive element of a fair occupational health and safety system. It has been subject to evolving policies since, many of which seek to minimize its significance and reduce worker participation to individual responsibility. The Labour OHCOW Academic Collaboration (LOARC) was created to provide a forum for exploring the role and potential of worker representation. In this presentation, we will discuss the origins of worker representation in OHS, the importance of activism, the significance of Ham’s recommendations and their subsequent adoption into legislation, the challenge of globalization and economic restructuring, and the threat of relativism.
Futures studies are developing as a discipline, and are increasingly being used by business and government in strategic planning. The Institute for Safety, Compensation and Recovery Research (ISCRR) is a new Australian institute that has been modelled on the Institute for Work & Health in Toronto. It will be using a futures methodology to determine trends relevant to safety (and health), compensation and recovery for up to the period 2030, knowledge needs for the future and thus research priorities for 2011/14. The theory underpinning this work will be presented, along with the proposed method which will combine data text mining for relevant future trends and structured consultations, both virtual and face-to-face, through a Think Tank supported by leading- edge social network and collaborative project management technology.
The methodology will be illustrated with a case study of work undertaken in the Centre for Military and Veterans’ Health in 2007-08, led by the author.
Models, as theoretical representations of complex individual and social issues, help to understand issues and find appropriate solutions. Modeling work disability prevention is progressively developing from several domains and is in search of its own unifying perspective. A practical use of this will be discussed.
The most effective methods of knowledge transfer (KT) for rehabilitation providers are still unknown. Due to an observed mismatch between clinical practice and current evidence in work disability prevention by physical therapists, clinician- and system-level KT initiatives aimed at fostering best practice have been developed and implemented in Alberta.
The clinician-level project included development and dissemination of a best practice resource guide and “tool kit” for work disability prevention by physical therapists, creation of a network of peer-selected Educationally Influential physical therapists, province-wide seminars for practicing clinicians, and use of these resources in the academic training curriculum. The system-level initiative involved a soft tissue injury continuum of care model designed by the Workers’ Compensation Board of Alberta that involved staged, evidence-based application of various types of physical therapy and rehabilitation services. Both projects were evaluated for their impact on return-to-work outcomes.
Implementation of a clinician-level KT initiative appears to have had little impact on clinical practice patterns or workers’ compensation outcomes. However, the system-level continuum of care model appears to have resulted in more sustained return-to-work and dramatic cost savings.
Future KT interventions for rehabilitation professionals should consider the funding structures and organizational culture of the settings in which they practice, which may be a barrier or facilitator of research uptake.
Previous studies have suggested that temporary employment and job tenure are associated with work-related health risk exposures and the ability to take a sickness absence, but these studies have not considered the nature of the employment contract in a longitudinal framework. This study investigates the impact of temporary employment on work-related and all-cause sickness absences of one week or more with a focus on how these outcomes are moderated by factors related to social protection (job tenure, union membership and firm size). Longitudinal data from a Canadian labour market survey is used to conduct a duration analysis of the time from the start of a job to the first sickness absence.
Nursing is a profession that is at high risk for injuries. The successful return of nurses to their pre-injury role is essential given the global nursing shortage.
This study sought to describe the return-to-work processes in southern Ontario hospitals through the experiences of injured registered nurses (IRN). The purpose of the study is to describe with a sample IRNs and others involved in hospital injury management how return to work happens in hospitals.
This research employed institutional ethnography as the approach to examine the topic. Participants in this study included a convenience sample of six IRNs and 22 others involved in hospital injury management practices. Most IRNs interviewed in this study were unable to return to work. Hospitals faced challenges in finding accommodated work for IRNs given organizational commitments to patient safety and fiscal efficiency. The findings afford new insights and can inform hospital injury management practices used with registered nurses.
Although there have been many studies of return to work, we know little about the situation of injured workers who cannot return to their old workplace and go through a workers’ compensation vocational retraining program. This qualitative study examined how vocational retraining works in practice in Ontario’s Labour Market Re-Entry (LMR) program in order to provide some understanding of this neglected dimension of return to work. Interviews and focus groups were conducted across Ontario with 71 injured workers, employers, WSIB staff, and worker representatives as well as the program’s outsourced labour market re-entry service providers and educators. Publicly available documents were also included, and the analysis followed general analytic approaches of grounded theory and discourse analysis.
We found that providers and workers struggled with fulfilling contradictory elements of the LMR Program. Although the LMR program logic rests on retraining goals as compatible with workers’ remaining functional abilities, we found that worker ill-health could be a regular barrier to retraining achievement. Although the program is set up so that workers are engaged in choice over new vocational goals, we found that options could seem forced. Finally, we found that different parties had varied understandings of "LMR success", which befuddled provision and assessments of some aspects of program service quality. This presentation will discuss how subcontracting of social services to vulnerable populations such as permanently injured workers can be susceptible to limited visibility of problems. This study identifies new dimensions of the return-to-work continuum and directions for further study.
Occupational health and safety (OHS) training is widely acknowledged as an important means of addressing the risks associated with occupational hazards, but we are often not sure how effective training is. This presentation will report on a systematic literature review of recent, high quality research studies about the effectiveness of training. The review concluded that there was strong evidence that training improves worker OHS practices, but insufficient evidence that it protects health (i.e. prevents injuries, illnesses, symptoms). We will look closely at how this disturbing conclusion was drawn and compare it with results from other recent systematic literature reviews about OHS training.
In Ontario, as in other jurisdictions, return to work (RTW) and disability prevention have become high priorities for employers and insurers given the increasing duration of lost-time claims in recent years. Research evidence suggests that RTW coordination may be helpful in improving RTW. However, details on how to successfully implement a RTW program based on RTW coordination are lacking. Intervention mapping is a methodology that is used to develop and implement complex interventions or programs. We used this approach to develop a RTW program based on RTW coordination that is tailored to the Ontario setting. In this plenary, the methodology used and the findings will be described.
What role do patients’ beliefs play in their likelihood of recovery from severe physical trauma? Can these beliefs be measured in order to help predict long-term outcomes?
Dr. Jason Busse, an IWH scientist, will present findings from a study that explored these questions. He and his research team developed and validated an instrument designed to capture the impact of patients’ beliefs on functional recovery from injury. The instrument, called the somatic preoccupation and coping (SPOC) questionnaire, was administered to 359 patients who had undergone operations for tibial shaft fractures. The relationship between their SPOC scores and functional outcomes one year later were then measured.
Busse found that the six-week SPOC scores were a far more powerful predictor of functional recovery than age, gender, fracture type, smoking status or the presence of multi-trauma. This led him to conclude that the SPOC questionnaire is a valid measurement of illness beliefs in tibial fracture patients and is highly predictive of their long-term functional recovery.
Over its 20 year history, the Occupational Health Clinics for Ontario Workers (OHCOW) has a rich experience in linking efforts to detect and prevent occupational injury and disease. Much has been learned about the best ways for an interdisciplinary clinical team to support participatory prevention interventions in the workplace. This presentation will review that history and the lessons learned for the future.
Ian Moore, a post-doctoral fellow at IWH, will discuss a study that investigated three forecasting models to assess which one works best with time-series data on workers’ compensation lost-time, no-lost-time and total claim rates.
The researchers compared business cycle fluctuations between monthly workers' compensation claim rates and the unemployment rate, over the same time period. They determined that most of the significant periodic behaviour in monthly workers' compensation claim rates is seasonal. A three-month positively correlated lag was found between the seasonal components of the unemployment rate and workers' compensation claim rates.
Moore will present overall findings that show workers' compensation claim rates from 1991 to 2007 were driven by (in order of relevance) a strong negative long-term growth trend, periodic seasonal trends and business cycle fluctuations.
More than 60,000 full-time equivalent workers are employed in the long-term care sector in Ontario and more than 14,000 in British Columbia. How do the rates and nature of their workplace injuries compare? How do experience rating programs and other policy initiatives in the two provinces influence injury prevention and disability management practices within their respective long-term care sectors? Answers to these questions are starting to emerge from a study examining trends in workers' compensation claim activity and benefit expenditures for work-related health conditions among employees in the long-term care sectors in British Columbia and Ontario from 1998-2007.
IWH President and Senior Scientist Dr. Cam Mustard will discuss the preliminary findings of this two-year study, which is now at its mid-point. There appear to be important differences between Ontario and British Columbia in the duration of disability arising from work-related injuries among workers in long-term care. Early findings suggest longer durations of disability among workers receiving wage replacement benefits in British Columbia, and a strong temporal trend towards shorter disability durations in Ontario.
Income level is a well-known risk factor for mortality among working-aged adults. Job loss and unemployment are also often correlated with increased risk of death. Very little research has investigated income drops, a plausible mediator of a causal effect of unemployment on health, and its association with mortality.
In this presentation, Institute for Work & Health Research Associate Jacob Etches will discuss a study that is using tax and survey data to investigate the effect of income level and income drops in Canada and the United States, as well as the induction times for the effects of income level and income drops. The difficulty of establishing the direction of causality for correlations between these exposures and mortality will also be discussed.
The evaluation and comparison of return-to-work (RTW) programs and interventions is difficult because no standard, valid outcome measure exists. RTW outcomes are typically measured using administratively based scales that fail to take the perspectives of workers and other stakeholders into consideration. As a first step in developing any outcome measure, the outcomes of interest and importance to key stakeholders need to be established.
In this presentation, Rhysa Tagen Leyshon of the Graduate Program in Health and Rehabilitation at the University of Western Ontario, will discuss a study that set out to generate a trusted and credible conceptual framework of successful RTW reflecting the values of all stakeholders equally and fairly. An integrated form of concept mapping was employed using a multi-stakeholder, Ontario perspective. Participants generated concepts around worker performance, worker job satisfaction, human rights, worker well-being, seamless RTW process through collaborative communication, and satisfaction of stakeholders other than workers.
The concepts will be used to develop a return-to-work outcome tool that goes beyond administrative-type scales by reflecting the perspectives of all stakeholders and by measuring work based on criteria deemed important to key stakeholders. These results may also shed light on what could be missing from RTW programming.
Over the last decade in Ontario, the number of total days per lost-time claim compensated by the Workplace Safety and Insurance Board (WSIB) has increased dramatically, as has the rate of claims remaining active and open. In other words, there has been an increase in claim duration. The trend is in contrast to a declining claim rate experienced over much of the 1990s.
Why has there been this increase in the persistence of lost-time claims? Is it due to WSIB policy changes in January 1998 under Bill 99? Could changes in worker demographics, injury characteristics or workplace characteristics account for the increase? IWH Senior Scientist Dr. Sheilah Hogg-Johnson is conducting research to find out. In this presentation, she will discuss this research and what she has found so far.
This presentation examines the diverse theories, concepts and practices that address the quality of jobs, work environments and individuals’ work experiences. On this broad canvas, we can identify points of convergence around key sets of determinants and outcomes. However, a common conceptual vocabulary is lacking, which impedes cross-fertilization across disciplines and between researchers and practitioners. The most promising opportunity for an integrated approach is around the connection between work environments, employee well-being and organizational performance. Practitioners and policy-makers need a basic model explaining these complex dynamics. By taking up this challenge, researchers would help ensure that future decisions to improve job quality are informed by evidence.
Graham Lowe is president of The Graham Lowe Group Inc., a workplace consulting and research firm. He is also a professor emeritus at the University of Alberta, a research associate at Canadian Policy Research Networks, and a member of IWH’s Scientific Advisory Committee. His new book, Creating Healthy Organizations, will be published in early 2010 by University of Toronto Press.
Research on disability prevention and return to work (RTW) over the last decades has concluded that involving all relevant stakeholders in rehabilitation and disability prevention is important, and that the responsibilities of the stakeholders need to be coordinated. The coordination of RTW stakeholders is promoted by international institutions such as the European Union, and cooperative initiatives have been put into practice in several countries. In the Scandinavian countries, for instance, stakeholder cooperation in rehabilitation and RTW has been the subject of legislation and institutional reforms. Since the 1990s, Sweden has been creating structures for stakeholder cooperation. A more recent initiative is the creation of Coordination Associations (CAs), made up of four central stakeholders in the Swedish social security system: the Social Insurance Agency, the Public Employment Service, municipal social services and primary health care. The CAs act on a local level to coordinate services of participating stakeholders in order to restore or enhance the work ability of individuals and to facilitate their return to work. At the same time, the Swedish sickness insurance system has been undergoing some dramatic changes. Since 2006, a right-wing government has introduced new elements into the system, including a one-year time limit for sickness benefits and an end to temporary disability pensions. The changes aim to speed up the RTW process, promote activation and put pressure on rehabilitation providers and participants. In this presentation, Christian Stahl of Sweden's National Centre for Work and Rehabilitation will discuss the Coordination Associations, how people employed by the authorities and in health care perceive cooperative work and how recent policy changes affect their practice, as well as recent policy changes from an internationally comparative perspective.
Studies of exposures in the workplace have made major contributions to our understanding of human carcinogenesis. In the International Agency for Research on Cancer (IARC) Monographs on the Evaluation of Carcinogenic Risks to Humans, occupational exposures account for 31 per cent of the factors classified with "sufficient" evidence for human carcinogenicity, for 42 per cent of those listed as "probable" human carcinogens, and 42 per cent of those listed as "possible" human carcinogens. Given the prominent role played by occupational exposures in our understanding of human carcinogenesis, it is worthwhile to take stock of where we are regarding studies of occupational cancer. In this presentation, Dr. Aaron Blair will look at how successful research has been in reducing the burden of cancer, and what we should be doing in the future. Dr. Blair is the interim director of the new Occupational Cancer Research Centre, the first of its kind in Canada. Prior to this role, he was the chief of the Occupational and Environmental Epidemiology Branch of the U.S. National Institutes of Health’s National Cancer Institute. He remains scientist emeritus at the U.S. National Institutes of Health.
What understanding do most Canadians have of disability benefits, and why is it so difficult to have a national discussion about a comprehensive disability benefit program? This presentation will look at the various types of disability income and service programs we have in Canada and why they are so hard to reform.
John Stapleton worked for the Ontario Ministry of Community and Social Services and its predecessors for 28 years in the areas of social assistance policy and operations. During his career, Stapleton was the senior policy advisor to the Social Assistance Review Committee, as well as the Minister's Advisory Group on New Legislation. He was also involved in the implementation of the National Child Benefit.
Most recently, Stapleton was the research director for the Task Force on Modernizing Income Security for Working Age Adults in Toronto and co-chair of the working group associated with this project. He also completed an analysis of the legal aid needs test in Ontario. Currently, Stapleton is completing an Innovations Fellowship with the Metcalf Foundation on the disincentives faced by adults in the Toronto area with multiple subsidies. He maintains an active interest in the history of social assistance in Ontario.
Despite worldwide attention, work-related musculoskeletal disorders (MSDs) remain a substantial concern at work, and result in considerable personal and societal burden. Information from a recent survey indicates that a minority of workplaces are taking action. Identifying hazards and performing risk assessments are key steps in workplace prevention activities. Do workplaces have the tools and training to do this? In order to then perform intense MSD prevention activities, interventions need to address important risk factors for a large proportion of exposed workers. The presentation explores these challenges.
Young people aged 16 to 24 years who are out of school (and especially those with less than a high school diploma) are at a particularly elevated risk of work injury. To determine the optimal way to improve occupational health and safety (OHS) for this “high risk” subgroup, the Institute for Work & Health collaborated with the Ontario Association of Youth Employment Centres (OEYAC) to conduct an online survey through youth employment centres across Ontario. This plenary will outline the main findings of this survey and discuss recommendations for employers and policy-makers in Ontario. Read the report.
This presentation reports on findings from a case study of the Canadian LifeQuilt, a commemorative quilt and online memorial website dedicated to the remembrance of 100 young workers who died at work.
The LifeQuilt is an Ontario-based multipartite project that took place between 2001 and 2003 and was produced by the combined efforts of the artist, health and safety organizations, unions, employers, workers’ compensation boards, governments and families of young workers killed on the job. The LifeQuilt aims to both commemorate the lives of those fatally injured while at work and tell the stories of young people tragically killed on the job for the purposes of prevention and remembrance. A central rationale behind the project, described as serving both the goals of remembrance and prevention, is that by becoming more aware of the personal injury accounts of deceased young workers, future workplace deaths might be avoided.
The presentation will explore key narrative features of online injury commemoratives constructed as lessons in occupational injury prevention and workplace safety parables. More specifically, it will look at how these young worker deaths are described as preventable and predictable events, and what this accomplishes. Some of the strengths and challenges of engaging personal injury accounts — as a strategy to build cross-institutional collaboration within OHS and to communicate workplace safety messages to broad-based audiences — will also be considered.
This study is the dissertation research of Liz Mansfield, a medical sociologist and qualitative researcher. She is a Mustard Fellow at the Institute for Work & Health and a PhD candidate at the Dalla Lana School of Public Health at the University of Toronto. Her research interests include injury prevention media communications, the implementation and evaluation of young worker educational interventions, and the interface between prevention delivery systems and small businesses. Liz is in the final stages of her doctoral dissertation, “Injury commemoratives and the politics of prevention: Sociological perspectives on a young worker safety campaign.”
The work of customer service workers has been likened to theatre work in that it involves on-stage and backstage roles. On stage, service workers enact prescribed roles to ensure the satisfaction of their “audience” — the customers. Backstage, they step out of their on-stage roles and behave more informally.
Using this dramaturgical perspective of customer service work as a framework, Dr. Aaron Schat, assistant professor of organizational behaviour and human resource management at McMaster University’s DeGroote School of Business, will examine the emotional and behavioural responses of service agents to customer aggression. In particular, he will look at the types of backstage behaviours adopted by customer service agents to manage the stress and emotions that arise from their on-stage experiences of customer aggression. He will present the results of a recent study examining the implications of backstage behaviour on service agents’ work attitudes, behaviour and well-being.
Dr. Schat’s main research interests are in the area of work-related stress and health, with a primary focus on investigating the nature, antecedents and consequences of worker exposure to workplace aggression, and identifying strategies for workplace aggression intervention and prevention. He has taught courses and consulted on various topics in human resource management. He holds a BA (Hons.) in psychology from Redeemer University College, and an MA and PhD in industrial-organizational psychology from the University of Guelph.
Construction worker safety continues to be a major concern for the construction industry. While significant improvements have been made in the last few decades, efforts must be made to strive for the zero accident objectives. The presentation reviews the relevant research and other jurisdictions which have implemented construction design regulations in the United Kingdom.
Between 1991 and 2006, the number of claims submitted to Ontario’s Workplace Safety and Insurance Board (WSIB) for work-related injuries requiring time off work (lost-time claims) went down by approximately 46 per cent. Yet, over the same time period, work-related injuries that required health care, but not time off work (no-lost-time claims) only declined by 11 per cent. As a result, there are currently over twice as many no-lost-time claims reported to the WSIB as lost-time claims, with the money spent by the WSIB on health care related to the no-lost-time claims exceeding $20 million in 2000.
Unfortunately, we do not know if these diverging trends in no-lost-time claims and lost-time claims are the result of effective primary prevention efforts (i.e. less severe injuries occurring), better workplace accommodation (i.e. workers with injuries that previously required time off being able to return to work the day after injury), or claims management (i.e. particular workers being encouraged to report no-lost-time claims instead of lost-time claims, even though they require time off work).
In this presentation, Institute Scientist Dr. Peter Smith will review recently completed work examining trends in no-lost-time claims and lost-time claims in Ontario between 1991 and 2006. The results are based on administrative data combined with labour force survey estimates across different labour force subgroups (age, gender, industry and workplace size).
For a copy of the presentation, contact Peter Smith.
Considerable evidence links chronic physically disabling diseases like arthritis to loss of employment. However, until recently, few studies have focused on the employment experiences of these individuals.
In this presentation, Dr. Monique Gignac, a senior scientist with the Division of Health Care and Outcomes Research and a research investigator with the Arthritis Community Research and Evaluation Unit at the Toronto Western Research Institute, will present findings on psychosocial aspects of living and working with arthritis.
Specifically, she will shed light on the decision to self-disclose one’s health condition to employers and co-workers, unique sources of workplace stress for people living with a chronic illness, and work changes and transitions that may subsequently signal impending difficulties with remaining employed.
Over half of the labour force in the Canadian private sector is employed in small businesses. However, delivering occupational health and safety (OHS) support to this sector can be challenging.
Institute Scientists Dr. Ellen MacEachen and Dr. Curtis Breslin led a systematic review of international peer-reviewed literature to identify effective occupational health and safety interventions and implementation directions for small businesses. The overall research question addressed by the review was: “What understandings, processes and interventions influence OHS in small businesses?” Sub-questions were: “Do OHS interventions in small businesses have an effect on OHS outcomes?” and “How do small business workplace parties understand and enact processes related to OHS?”
In this presentation, MacEachen and Breslin will outline how they conducted this mixed-method systematic review and their key findings. The synthesis of the qualitative literature addresses the unique features of the legal and work organization contexts of small business and how they affect the way workplace health is understood and managed. The synthesis of the quantitative intervention literature shows that OHS interventions can have an effect in small businesses and describes the benefits of different types of multi-component OHS interventions.
Institute Scientific Director Dr. Benjamin Amick will outline the research directions of the Institute for Work & Health as outlined in our Five-year Strategic Research Plan. He will also invite discussion about the plan.
In developing the plan, Institute scientific staff aimed to respond to the needs of its partner organizations and agencies in Ontario, while maintaining the visionary research excellence associated with the Institute as a world-class applied-research organization. The research plan has also been shaped by the interplay of scientific and knowledge transfer and exchange principles within the Institute.
The three strategic research priorities in the plan reaffirm the Institute’s commitment to both occupational health and safety research relevant to Ontario workers and workplaces today, and to leading-edge research needed to answer the policy questions of tomorrow.
In developing this five-year plan, Institute scientists have highlighted the importance of our Foundation Research Programs. These programs represent a commitment to international excellence in systematic reviews, measurement theory and methods, statistics, and research use by Ontario’s prevention and health-care system partners.
The plenary will highlight the scientific directions of the IWH over the next five years, and provide an overview of the three research priorities. These priorities include:
Research Priority 1: To generate, synthesize and share knowledge on work and health related to:
- the changing nature of work and the workforce
- occupational health and safety and disability policy systems
- workplace policies, programs and practices
- work disability trajectories
- health-care policies, programs and practices.
Research Priority 2: Develop and evaluate interventions and methods for understanding, implementing and monitoring evidence-based change to improve work and health.
Research Priority 3: Continue to improve analytic, measurement and evidence synthesis methods in work and health research.
Note: This plenary started at 11:15 a.m. instead of 10:45 a.m.
Immigrants are an increasingly important segment of Canadian society, in particular to the Canadian labour market. While there is much Canadian research on the earnings of immigrants — documenting that recent immigrants earn less than Canadian-born workers — there has been relatively little research in Canada on the occupational health and safety (OHS) risks facing immigrant workers, or on the incidence and consequences of work injuries among immigrants compared to Canadian-born workers.
In this presentation, Dr. Peter Smith will report the results of a recently completed project at the Institute for Work & Health examining OHS risk factors, work injuries and compensation after injury among recent immigrant workers in Canada. The results suggest that recent immigrants to Canada face a number of OHS hazards that put them at increased risk of work-related injuries requiring medical attention. In addition, the results suggest recent immigrants are at an increased risk of not receiving any compensation following a work-related absence of seven days or longer.
However, considerable gaps still exist in our knowledge about immigrant workers. These knowledge gaps and policy recommendations will be discussed.
Michael Chappell is the provincial coordinator of the Construction Health and Safety Program within the Ontario Ministry of Labour’s Occupational Health and Safety Branch. He is responsible for designing effective enforcement tools to ensure stakeholder compliance, protect the public interest and provide for worker safety.
Promoting consistency among a team of 156 inspectors across the province of Ontario and addressing local stakeholder issues can prove challenging. It requires an approach that is both responsive and flexible in order to address emerging safety concerns in a timely way.
In this presentation, Chappell will focus on recent concerns around crane safety in the wake of a number of major accidents, including those in New York State that claimed several lives. He will explain how a proactive enforcement initiative was used in Ontario to address crane safety, and how this flexible, hazard-based targeting system responded to an emerging concern to prevent accidents before they occurred.
Chappell will talk about the way this system evolved and what it says about traditional enforcement approaches. He will also discuss the evolution of new targeting approaches.
Ivan Steenstra is an epidemiologist and kinesiologist working at the Institute for Work & Health. He was the Mustard Postdoctoral fellow from 2006-2008. In this presentation he will provide an overview of the work he has done during that period on sub-grouping of workers on disability/sick leave due to low back pain.
Steenstra will present the results of a validation study of the model by Shaw et al that tries to link worker and workplace characteristics to appropriate intervention. He will also present the results of an analysis that examines which workers benefit most from a workplace intervention as studied in the Amsterdam Sherbrooke Evaluation study. Future plans to study prediction of duration of work disability will be discussed briefly.
This presentation will report on an ethnographic study of front-line service work in Ontario's Workplace Safety and Insurance Board (WSIB), specifically the work of adjudicators, nurse case managers and customer service representatives servicing small businesses. The aim of the study was to understand and explain, from a sociological perspective and in relation to institutional context, the nature, logic and social relations of work at the front lines.
The presentation will outline the study's four key findings, namely that:
- work at the front lines is framed in significant ways by the disciplinary role and contradictory operating imperatives of the WSIB as an institution;
- front-line work is a professional assembly line;
- front-line work involves strategic discursive and discretionary practices; and
- front-line work with small business has a distinctive social form and is affected by the marginal status of small business within the operating framework of the WSIB.
The presentation will reflect on the relevance and implications of these findings for key stakeholders in the compensation system: injured/ill workers, employers, the WSIB and the OHS system as a whole.
The full research report upon which this presentation is based is also available as a working paper.
More than 60% of Canadians believe workplace accidents and injuries are an inevitable part of life. Many provincial workers’ compensation agencies are focusing on the challenge of changing these public attitudes to embrace values that see preventable workplace death, injury, illness and disease as unacceptable. At present, typical levels of provincial expenditures on workplace social marketing campaigns are in the range of $100 per 100 workers. Refining the effectiveness and efficiency of these campaigns is an important program objective.
The primary objective of this review was to conduct a review of evaluations of social marketing campaigns in the fields of occupational injury prevention, occupational disease prevention or the prevention of disability. In pursuing this objective, our purpose was to identify those evaluations conducted to higher quality standards and to describe the most important results reported from these higher quality studies. A secondary objective was to examine the quality of economic evaluations conducted in this field and to complete, if feasible, an assessment of the cost-effectiveness of social marketing interventions in occupational injury, disease or disability prevention.
The study was supported, in part, by funding from WorkSafeBC (RS2005-SC12)