Focus Group Consultation Summary Materials August 19, 2005

1. Focus Group ConsultationSummary MaterialsAugust 19, 2005 Many thanks to those who have participated in the focus groups. Your ideas, opinion, and advice are very valuable to us and will help us in our decision-making.

2. CRE-MSD has now conducted focus groups with the following stakeholder groups : • Kinesiologists (educational influentials) • Ergonomics (through ACE) • Representatives from JHSCs (at the IAPA conference) • WSIB ergonomists • HCHSA consultants • Union H & S specialists through the OFL • Safety specialists from small businesses (EAC Safety Group) • WSIB managers and directors • Steelworker Union H & S activists • Union representatives through the CAW, • Input from a focus group run by the HCHSA with health-care stakeholders • Two more are planned (injured workers, and safety professionals in the electrical utilities sector)..

3. Focus Group Questions • What do you need to know to prevent MSDs? • What is the best way to get research knowledge on MSDs to workplaces? • What is preventing the use of research knowledge in MSDs in workplaces? Why is the information not getting out into workplaces? • Who would you go to for advice, information or direction on prevention of MSDs from? • What research would you like to see on MSD prevention? • What one thing should be done to accelerate the adoption of research into MSDs by workplaces? • What is the best way to involve workplace parties in the research process on MSDs?

4. Ideas from Stakeholders (1) • ACE Ergonomists : need practical tools (audit and measuring tools) • JHSC Worker representatives - they go to their HSAs for information and do not go directly to research. What they want is guidelines on what can be implemented. • Kinesiologists : they get their information off the web (would like a synthesis of recent research) • Health-care stakeholders : want user-friendly, easy-access products and tools to guide clients • WSIB ergonomists: the needs and resources of large, medium, and small companies is very different; ergonomists use each other as their primary source of information; they would like their work evaluated; they believe that they should be involved at the design stage.

5. Ideas from Stakeholders (2) • HCHSA consultants: Health care workers should not be expected to read research. They look to us, and the other major health-care associations and organizations for information. Use us as your multipliers. • Union reps at the OFL: We don’t need any more research that identifies the issues; we know what the problems are. We need research that gives us solutions that are easy to implement, inexpensive, context-specific, and proven to work. Give us case studies of what works. • The safety specialists at the Safety Group meeting facilitated by the Employer Advocacy Council: We need to know how to get injured workers motivated, wanting to return to work, and then how to modify work for them. We also need the family physicians on board; their instructions to the workplace are not very helpful. • The health and safety specialists at the CAW: Very important to look at the design of the job right at the beginning. Research done in collaboration with unions has credibility. Get companies to participate in research by negotiating it in the collective agreement.

6. Ideas for Stakeholders (3) • The WSIB managers and directors would like to know: How to get employers motivated to make changes, how to bring invisible injuries like MSDs onto the radar, and how to effectively get injured workers back to work. “Stop investigating the causes, and tell us how to prevent and intervene. We need to know if MSDs can be prevented”. • The Steelworker H & S activists need help in understanding the recommendations given to them by ergonomists and physicians; need to understand the impact of the whole system on the whole body; and workers should be consulted at the purchasing and design stages of production. Also say that case adjudicators need to learn more about the workplace; researchers need to include applications of their research findings in their reports/articles; and company employers need economic arguments to make changes.

7. Challenges to Using Research 1.1 Every company’s needs are different. 1.2 Provincial differences 1.3 Demographics of the workforce (age, language, education) 1.4 Small workplaces do not have the expertise 1. Uniqueness of the Context 2.1 Lack of knowledge of OHS and MSD-issues in particular 2.2 Won’t take ownership -- need a champion 2.3 Not part of the workplace culture – unsupportive 2.4 MSDs have not been identified as “an issue” of risk; they are invisible 2.5 Resistance to change from supervisors 2.6 Lack of desire or motivation to change 2.7 You need both the top leadership and the workers to buy into the change 2. Leadership To Overcome Workplace Barriers 3.1 Fear 3.2 Time -- workplaces want ‘quick fixes’ 3.3 May take resources away from production and quality 3. Survival Issues 4.1 Research needs to be translated to specific sectors/workplaces 4.2 Difficult to understand 4.3 Don’t know how to access research or evaluate it 4.4 Lack of credibility of the researcher delivering the message to workplaces 4.5 Research is not practical; needs to focus on what can be implemented or done 4. Disconnect with research 5.1 Lack of regulations or legislation 5.2 “Managed Care” 5.3 Benefit structure 5.4 Safety is relegated to human resources (and not to production) 5.5 Ergonomics is at the heart of management’s control 5.6 There are incentives not to report injuries 5.7 Staffing (in healthcare) is such a key issue that nothing else is on the radar 5. Structural Barriers GOAL THEMES SPECIFIC IDEAS

8. What Practitioners Want (1) 1.1 Forms (audit tools, guidelines) that are simple to use 1.2 Tools for lay users (JHSC members rather than ergonomists) 1.3 Tools that can evaluate and rank risk 1.4 Tools to evaluate products (equipment, machinery) 1.5 Evaluation of existing tools 1.6 Guideline of what tools to use, when. 1.7 Training materials that will inform workers about how the body works, how injuries occur, and how not to injure themselves 1.8 How to identify psychosocial risk factors 1. Research on ergonomic tools for the workplace 2.1 How do we account for cumulative loading? 2.2 What are the norms for previously injured workers; dose/response? 2.3 Impact of body size and shape and how workers ‘fit’ with the workplace design 2.4 How do we take into account tissue tolerance affected by stress? 2.5 What is “repetitive” and what is “heavy”? 2.6 Effect on whole-body vibration and cumulative loading 2.7 What is the impact of shift work; increasing the length of shifts? 2. Research that furthers the understanding of Injury and thresholds To develop research that is relevant to our partners and stakeholders 3.1 Research that links MSDs to productivity and quality 3.2 The cost benefits of early interventions 3.3 The cost benefits of treating symptoms, regardless of source 3.4 What is the impact of a delay in treatment because of focus on ‘who pays’? 3. Research that will help build a strong financial case for prevention 4.1 Small businesses/workplaces 4.2 Office environments 4.3 Specific to health care, service sector, electrical utilities 4.4 Focus on aging workforce and ways to keep them at work 4.5 How to made ergonomically safe workboots 4. Research that is context- population or part-specific GOAL THEMES SPECIFIC IDEAS

9. What Practitioners Want (cont’d) 5.1 How ergonomics can be built into design 5.2 Job rotation 5.3 Best practices that are unique to small businesses 5.4 How to separate work-related from non-work-related injuries 5.5 Need guidelines for rest periods 5.6 Tools that are lighter, more flexible, made of new materials 5.7 Can there be industry-specific guidelines? 5.8 Focus on those workplaces that have already been open to change to find out what got them wanting to make changes 5. Research on Interventions 6.1 The issues around return to work -- individual risk or population risk 6.2 What rest breaks are appropriate for an injured worker in an 8-hour period? 6.3 Why work-plans for return-to-work fail? 6.4 A tool that will help match PDAs to medical physicians’ restriction guidelines 6.5 How do we motivate injured workers to return to work 6.6 How should graduated hours be used in RTW 6.7 How to make modified work productive 6.8 How to ensure informed, and knowledgeable physicians who will make reasonable demands and set reasonable restrictions. 6.9 How to make return to work sustainable 6. Research that will help injured workers return to work To develop research that is relevant to our partners and stakeholders 7.1 Should we be concerned with population or individual risk? 7.2 Are there unique concerns with contingent workers; contract workers; casual workers? 7.3 Development of a model that explains how MSDs develop 7.4 How we account for, measure, and weigh psychosocial factors 7.5 Are there factors that distinguish between high MSD and low MSD companies? 7.6 What is unique about “good performers” that can be emulated? 7.7 New research models that can capture the complexity of the workplace and the “hidden-ness” of non-compensated-for disorders (i.e. stress and mental illness) 7.8 How cultural factors influence an organization’s readiness-to-change 7. Research that furthers the understanding MSDs GOAL THEMES SPECIFIC IDEAS

10. Getting Research into Workplaces 1.1 Safety System: WSIB, MoL, the HSAs, the Safety Groups, WHSC, OHCOW 1.2 Sector/industry networks , the suppliers and distributers 1.3 Practitioners in the field (consultants, physicians, nurses, ergonomists, physiotherapists) 1.4 Organizations of practitioners (ACE ergonomists, physiotherapists, occupational nurses, occupational therapists) 1.5 Sector organizations (OANHSS, OHA, OLTCA, college of nurses in the health-care sector) 1.6 In-house experts (Ford ergonomist, specialists at WSIB) 1.7 Unions (OHCOW and the Workers Centre) and JHSC reps. 1.8 Legal clinics, Injured Worker Consultants, Office of the Worker Advisor, Unemployment Help centres. 1. Use multiplier groups as a way of getting the research into workplaces . Improving the way research is communicated and used 2.1 Make it relevant for the audience 2.2 Use scenarios, success stories, case studies, videos, cartoons 2.3 Make it fun/enjoyable 2.4 Has to be “do-able” -- be specific in your advice/guidelines 2.5 Use plain language 2.6 Deliver research in “manageable bites” 2.7 Be clear on what you are recommending as the expert 2.8 Package the information for workers 2.9 Package information for senior executives that focus on financial benefits 2.10 Offer practical solutions that are not difficult and are cheap to implement 2.11 Use social marketing techniques that hits workers and employers (e.g. their children are at risk, injured workers who commit suicide) 2,12 Create a central repository for case law, Ministry of Labour decisions. 2. Communicate the research message so that it is relevant for the audience 3. Use targeted electronic communication 3.1 Use a listserve with links to research and that has highlights of pertinent research 3.2 Build on things like Safetynet GOAL THEMES SPECIFIC IDEAS

11. Accelerating the adoption of MSD research 1.1 Need to bring practical knowledge (“real” experience) to research 1.2 Use small interactive groups/workshops like focus groups 1.3 Involve unions at the outset so the research questions are relevant 1.4 Collaborate from the beginning; need to have an exchange of ides of what is needed to be researched. 1.5 Have researchers and union people sitting down together to discuss research and the implications it has for workplaces. 1. Involve stakeholders within the research process using Interactive engagement Involving Decision-Makers in the Research Process 2. Use traditional ways of communicating the research 2.1 Hold high-profile “round-table” discussion on MSDs with business leaders 2.2 Hold presentations and workshops at professional seminars and conferences (IAPA) 3.1 provide research that helps inform the debate on ergonomic legislation or regulations (eg. Cross-country/cross-jurisdiction comparisons) 3.2 make sure published research includes a section on recommendations for change, and the applicability of the findings 3.3 Educate adjudicators 3.4 Offer suggestions on small changes that will not cost too much 3.5 Ergonomists involved in workplace design, and consulting on purchasing 3.6 Involve labour in the dissemination of research recommendations 3.7 Get companies to participate in research by negotiating that in the collective agreements, in a language that ensure labour is in control of its dissemination. 3. Other initiatives that would make a difference GOAL THEMES SPECIFIC IDEAS

12. Can work-boots be more comfortable and less damaging over the long term of using them? What should the guidelines be for bed heights in the healthcare sector? What is the relationship between the workplace, work, and MSDs (work-relatedness)? How do you track the work-relatedness of MSDs and a worker’s full work history? Are the new advances in technology helping or hurting us? How do you ensure that ergonomic guidelines are built into the initial design stage of assembly lines? What are the guidelines for pace-of-work and recovery time? What are guidelines for micro-pauses and rest breaks? What standards should be used to evaluate assessment tools? Can a business case be built for MSD prevention? What is the significance of aging on strength and wear-and-tear? Can a regulation be put in place for ergonomic training? Can a dictionary of common-use terminology be created for ergonomics? What are the permanent impacts of MSDs, and what impact do these injuries have on daily living? What interventions are effective and sustainable in reducing MSDs and getting workers safely back to work? What is the relationship between fitness and MSDs? Do we know whether MSDs can be prevented, and what do we mean by “prevention”? How do we bring ergonomics into the design of machines, tools and equipment? How do we make cultural change in workplaces? What makes the workplaces that invite researchers in, or invite consultants in, or “magnet hospitals”, different? What can we learn from them? What are some practical, easy, cheap changes that can be made by small workplaces? What are the implications of whole-body vibration? What are the advantages and disadvantages of job rotation, and the best way of instituting job rotation? What are the implications of organizational culture and psychosocial factors? Research Questions from Practitioners