impact of implementing the washington state ergonomics rule on employer reported risk factors and...

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 52:1–16 (2009)

Impact of Implementing the Washington StateErgonomics Rule on Employer Reported Risk

Factors and Hazard Reduction Activity

Michael Foley, MA,1� Barbara Silverstein, PhD, MPH, CPE,1

Nayak Polissar, PhD,2 and Blazej Neradilek, MS2

Background In Washington State an ergonomics rule was adopted in 2000 that focusedon primary prevention. The implementation process followed a 6-year phase-in schedulewhere employers came into compliance based upon their size and industry. In late 2003 therule was repealed by an industry-funded voter initiative. Evaluating the implementation ofthis rule offers a unique opportunity to observe the general deterrent effect of a new publichealth regulation and to study how employers and workers responded to new requirements.Methods Weighted survey regression methods were used to analyze the results from threeemployer surveys covering more than 5,000 workplaces administered in 2001, 2003, and2005. These were compared to a baseline employer survey conducted in 1998 before therule was promulgated. Questions covered the following topics: WMSDs experienced at theworkplace; levels of employee exposure to musculoskeletal hazards; steps being taken, ifany, to address these hazards; results of these steps; and sources of ergonomic information/assistance used.Results From 1998 to 2003 there was a reduction in reported exposures amongworkplaces in the highest hazard industries. Following the rule’s repeal, however, hazardexposures increased. While more workplaces reported taking steps to reduce exposuresbetween 1998 and 2001, this gain was reversed in 2003 and 2005. Employers who tooksteps reported positive results in injury and absenteeism reduction. Large workplaces inthe high hazard industries were more active in taking steps and used a wide variety ofresources to address ergonomics issues. Small employers relied more on trade associationsand the state. Am. J. Ind. Med. 52:1–16, 2009. � 2008 Wiley-Liss, Inc.

KEY WORDS: ergonomics; work-related musculoskeletal disorders; regulation;public health law; occupational injuries; occupational diseases; economic impacts;regulatory effectiveness

INTRODUCTION

The field of public health practice, including workplace

or occupational safety and health, is grounded in law because

it is a field of public concern. The essence of public health

practice includes regulation, rules and enforcement of sound

public health/safety practices identified in implementation

of standards and rules adopted by the legislature or an

administrative agency [Grad, 1990]. It is not uncommon to

have such rules, affecting millions of people and businesses,

� 2008Wiley-Liss, Inc.

1Safety and Health Assessment and Research for Prevention (SHARP) Program,Washington State Department of Labor and Industries, Olympia,Washington

2The Mountain-Whisper-Light-Statistical Consulting, Seattle,Washington*Correspondence to: Michael Foley, Safety and Health Assessment and Research for

Prevention (SHARP) Program, Washington State Department of Labor and Industries,PO Box 44330, Olympia,WA 98504-4330. E-mail: [email protected]

Accepted10 September 2008DOI 10.1002/ajim.20650. Published online in Wiley InterScience

(www.interscience.wiley.com)

in place for long periods of time with no evaluation of effect.

Often those covered by the rule are not aware that it exists,

thereby limiting the possible effectiveness of the rules. While

rules may be carefully conceived, their implementation plans

are often only rudimentary and evaluation neglected. Some

have argued that rules and regulations are not necessary,

that given the appropriate information; employers will

voluntarily comply with guidelines that will improve health.

Others have argued that specification standards are outdated

and overly rigid, that employers would be more likely to

adhere to standards or rules that are process oriented to

provide employer flexibility in how to achieve the intended

results [Cunningham and Johnstone, 1999]. If there has to be

a standard, larger employers have argued for more process

oriented standards while smaller employers have argued for

simple specifications as being easier to implement. While

there has been limited research investigating the effective-

ness of a particular rule or standard [Nelson et al., 1997],

there has been virtually no research evaluating the actual rule

implementation process.

Prevention of work-related musculoskeletal disorders

(WMSDs) has been a national priority for well over a decade

[NIOSH, 2001], yet WMSDs still account for approximately

30% of all workers compensation claims and more than

40% of all costs [Silverstein and Adams, 2007]. The US

Bureau of Labor Statistics reported 357,160 musculoskeletal

disorders in 2006. A considerable body of epidemiological

and laboratory studies has established a strong association

between physical as well as psychological and social load at

work and the development or exacerbation of WMSDs and

long term disability [Hagberg et al., 1995; NIOSH, 1997;

Viikari-Juntura and Silverstein, 1999; National Research

Council, 2001]. Additionally primary prevention efforts have

demonstrated significant results at the company level [GAO,

1997; Silverstein and Clark, 2004; Tompa et al., 2007]. A

number of voluntary guidelines, standards and educational

materials have been developed to assist employers in

reducing risk of WMSDs. These have sporadic use and

limited evaluation. These voluntary efforts have been

necessary but not sufficient to reduce the burden of WMSDs.

A number of jurisdictions (primarily outside of the US) have

had ergonomics related rules or regulations in place for a

number of years including manual handling and visual

display unit (VDU) regulations (Australia, New Zealand,

Brazil, European Union countries). In the United States,

different regulatory approaches have been undertaken to

address WMSDs. California implemented a rule that relies

on reported WMSDs in a job before action is required to

improve the job. In 2000, OSHA issued a rule focusing on

reported WMSDs in manual handling and production jobs.

Congress and President Bush repealed this rule in 2001.

In Washington State, more than 65,000 workers

compensation claims for WMSDs are accepted each year,

averaging more than $743 million in direct workers

compensation costs each year [Silverstein and Adams,

2007]. Washington is the only state that has both an exclusive

workers compensation insurance system and a state OSHA

program (DOSH) in the Department of Labor and Industries

(L&I) that have provided voluntary guidelines, workshops

and consultations on preventing WMSDs for more than

10 years. Rarely has there been enforcement activity under

DOSH’s general accident prevention program or Safeplace

regulations. In 1998, L&I began developing a comprehensive

strategy on musculoskeletal disorders to help address the

agency’s first priority: reducing injuries, illnesses, fatalities

and hazards in Washington workplaces. At that time the first

industry-wide survey of employers on musculoskeletal

hazards, steps taken to reduce hazards and where employers

go for help to address WMSDs was published [Foley and

Silverstein, 1999]. As part of the overall L&I strategy, which

had included training programs, guidelines, consultations

and inspections conducted under the ‘‘general duty’’ clause,

an ergonomics rule (WAC 296-62-051) was promulgated

in 2000 that focused on primary prevention: finding and

fixing hazards before they cause WMSDs. The history of

Washington State Department of Labor and Industries’

efforts to address WMSD hazards is extensively discussed in

Silverstein [2007].

An extensive phase-in period with demonstration

projects, development of training materials and ‘‘ergonomics

toolboxes’’ with labor and business was part of the DOSH

ergonomics rule implementation process. Companies were

phased into compliance based on size and SIC code. This

6-year phase-in provided a unique opportunity for evaluation

of public health regulations. Evaluation of intermediate steps

leading to reduction in hazards and WMSDs provide

important information on the general deterrent effect of

regulation. It also allows for assessment of how the regulation

is implemented in specific companies within the ‘‘high risk’’

industries that are the focus of initial compliance activities.

The Washington Ergonomics Rule, promulgated in

May 2000, was focused on reducing employee exposure to

workplace hazards that can cause or aggravate WMSDs.

Under this rule, all employers in the state with ‘‘Caution Zone

Jobs’’ would be covered by this rule. A ‘‘Caution Zone Job’’

is a job where an employee’s typical work includes any of the

following physical risk factors: awkward postures, high hand

forces, highly repetitive motion, repeated impact, heavy

frequent or awkward lifting, or moderate to high hand/arm

vibration. Employers were required to determine whether

they have Caution Zone Jobs based on the duration or

frequency of exposure, and if so, to provide ergonomics

awareness education to employees in such jobs and their

supervisors, determine if exposure to WMSD hazards exist,

and reduce exposures to those hazards to the degree feasible.

Requirements for complying with this rule were to be phased

in over a 6-year period, with large employers in the 12 highest

risk industries (50 or more full-time equivalent employees,

2 Foley et al.

FTEs) required to have completed hazard identification and

ergonomics awareness education by July 2002 and hazard

reduction achieved by July 2003. These were followed in

each additional phase-in year by (a) all other large employers

and small employers in high risk industries, (b) all other

medium-sized employers, and (c) all other small employers.

The text of the rule and the full schedule of rule compliance

phase-in periods can be found at http://www.lni.wa.gov/

Safety/Topics/Ergonomics/History/default.asp. The rule was

repealed by an industry funded voter initiative on the ballot in

November 2003 [Silverstein, 2007].

Evaluating the implementation of the Washington State

Ergonomics Rule (WAC 296-62-051) offered a unique

opportunity to observe the effect of a regulation prospec-

tively and to study how employers and workers responded

to new requirements. It is also valuable to determine how

well the prevention approach specified in the Washington

ergonomics rule worked in practice. Although WMSDs

are widely recognized to be among the most costly and

debilitating occupational injuries and illnesses, only one

other state, California, has been able to promulgate an

ergonomics regulation. Following the effectiveness of this

rule from the beginning permits other states and the federal

government to learn from the Washington State experience.

This research was reviewed by the Washington State

Institutional Review Board, and determined to be exempt.

METHODS

An employer survey was conducted in the spring of 1998

which became the model for the surveys administered in the

three subsequent survey years [Foley and Silverstein, 1999].

We used Washington Employment Security Department

(ESD) Quarterly Unemployment Insurance files to obtain

the addresses of approximately 10,000 workplaces in

Washington State to whom we mailed the employer survey.

We used ESD data because ESD collects all Standard

Industrial Classification (SIC code) information in the state

and surveys all employers over a 3-year cycle to insure the

SIC codes are still valid.

In all four surveys our focus was on the workplace as the

unit of observation and analysis. We were concerned with

how managers coped with the risks for WMSDs in their

workplaces and how their strategies may have shifted as the

regulatory environment changed. Our goal was to estimate

for each survey year: (1) the proportion of workplaces

experiencing WMSDs, (2) the proportion of workplaces that

had employees exposed to a variety of WMSD hazards for

extended periods of time, (3) the proportion of workplaces

taking various types of steps to address these hazards, and (4)

the proportion of workplaces availing themselves of a variety

of sources of information on ergonomic solutions. For

each question we were interested in how these proportions

changed over time.

Sampling Strategy

1998 survey

We randomly drew an unweighted sample of 9,862

Washington State workplaces, representing about 6% of all

workplaces from the Washington Employment Security

Department’s (ESD) unemployment insurance employer

database for the third quarter of 1996. The sample was

drawn so as to be representative of size and 2-digit Standard

Industrial Classification (SIC) for the state as a whole. SIC

classes in which there were less than three employers were

excluded to maintain anonymity. Names, addresses and

telephone numbers were collected from the ESD database

and matched to the Labor and Industries claims database.

These records were sent to a survey administration firm

which delivered a cover letter as well as the 4-page

questionnaire to each employer. A follow-up postcard was

sent to those who had not responded after 30 days and for

whom there were no surveys returned as undeliverable,

unknown, wrong address or out of business. For those who

did not respond after the postcard, a telephone interview was

attempted where telephone numbers were available. For all

analyses, data were grouped by Rule Phase Group, based

upon SIC and size as explained below.

2001, 2003, and 2005 employer surveys

In preparing for the employer surveys in 2001, 2003, and

2005 we determined that a change in sampling strategy was

warranted. The population of Washington State workplaces

is distributed very unevenly across industries and across

workplace size categories. Large workplaces, defined as

having more than 50 employees, comprise only 6% of all

workplaces. Medium-sized workplaces with 11–49 employ-

ees, account for 19% of all workplaces, while small

workplaces are about 75% of the total. Workplaces are also

distributed across industries in a similarly uneven pattern;

with relatively fewer workplaces in the manufacturing SIC

codes and a much greater fraction in the service sectors.

Therefore an unweighted sampling strategy like that used in

1998 would allocate most of the sample space to

small workplaces in relatively low risk industries. Our new

approach was to draw a sample so as to yield more

information about companies that had to undertake more

steps to fully comply with the rule earlier than is typical of the

average workplace. We therefore divided the sample into four

groups that reflected both the differing levels of expected

WMSD hazard exposure, as established in L&I’s annual

WMSD workers’ compensation claims report, and the four

‘‘rule phase-in groups’’ under the rule [Silverstein and

Adams, 2007]. Large firms in industries with the highest

average rankings for WMSDs by incidence rate and count of

claims, called the ‘‘Top 12,’’ were identified by L&I to be

Evaluation of Ergonomics Rule Implementation 3

brought in to full compliance with the rule first. These formed

what was called Rule Phase Group 1, and our sample was

designed so as to pull in as many such workplaces as possible,

as discussed below.

Under the Washington State Ergonomics Rule work-

places were classified into four Rule Phase Groups (RPGs)

for purposes of scheduling compliance dates as follows:

(1) Rule Phase Group 1 consisted of large workplaces in

the Top 12 most hazardous industries, as established

under the ergonomics rule:

(2) Rule Phase Group 2 comprised all other large work-

places regardless of industry as well as medium and

small workplaces in the Top 12.

(3) Rule Phase Group 3 comprised all medium workplaces

in industries other than the Top 12.

(4) Rule Phase Group 4 comprised all small workplaces in

industries other than the Top 12.

To underline the highly skewed distribution of work-

places across the four rule phases, the following table presents

the full population counts of workplaces by Rule Phase

Group in the fourth quarter of 2001 in Washington State:

As can be seen in Table I, nearly 60% of all workplaces

were in Phase 4: workplaces with fewer than 11 employees in

industries other than the Top 12. Though all results discussed

here will be presented in terms of the Rule Phase Groups, we

wanted to draw our sample so as to overweight toward those

industries in which there was a higher expected exposure to

WMSD risks. Accordingly we increased the sample space

devoted to workplaces that, though not in the Top 12 as

defined by the Rule, were nonetheless in industries shown to

have higher than average WMSD workers’ compensation

claims rates in previous published reports [Silverstein and

Adams, 2007]. We also wanted to take advantage of the fact

that we had conducted a baseline survey in 1998 and ensure

that we had some workplaces in as many strata as possible

from the original survey. The sample frame included all

workplaces having a record in the Washington State

Employment Security Department’s Quarterly Unemploy-

ment Insurance file for the most recent quarter available. This

was about six quarters prior to the actual quarter in which

the survey was conducted. Before drawing the sample we

dropped all records lacking complete address fields. We

further eliminated those not having a valid Universal

Business Index (UBI) record, as this would prevent us from

matching the record to the State workers’ compensation

database. These two adjustments eliminated about 3% of all

records.

Because of the highly skewed distribution of

workplaces across size categories we weighted our sample

toward large- and medium-sized workplaces. Out of

approximately 140,000 workplaces in the population, only

about 1,250 were in Phase 1, the first group required to fully

comply with the rule. Since this was our primary group of

interest, we drew all workplaces in this category into our

sample. The remaining spaces were allocated as follows:

40% for Phase 2, 40% for Phase 3, and 20% for Phase 4. This

distribution means that construction and manufacturing will

be over-represented in the sample, while services and public

administration will be under-represented. This approach

reflects the low level of hazards expected in the under-

represented sectors, where compliance with the rule will be

achievable without undertaking many steps. An exception is

nursing homes which is under services but is a high risk

industry that was included in Phase 1 or 2 depending on size.

Within Phase 2, we drew in all large workplaces from the

29 higher risk industries listed above and allocated 30% of

the remaining spaces to medium workplaces and 70% to

small workplaces from the Top 12 high risk industries listed

in the Rule. Within Phases 3 and 4, 30% of sample spaces

were taken by medium workplaces and 70% by small

workplaces. Again, this approach over-represented larger

workplaces where there is a greater likelihood of steps being

required to control hazards. This brought our total sample

TABLE I. Total Workplace Population, by Ergonomics Rule Phase Group

Rule Phase-In Groups

Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total

n % n % n % n % n %

1,851 1 37,344 25 21,097 14 87,132 59 147,424 100

Industry SIC code

Landscape and Horticultural Services 078

Residential Building Construction 152

Masonry, Stonework and Plastering 174

Carpentry and Floor Work 175

Roofing, Siding and Sheet Metal Work 176

Concrete Work 177

Sawmills and Planing Mills 242

Trucking and Courier Services, Ex. Air 421

Air Transportation, Scheduled 451

Grocery Stores 541

Nursing and Personal Care Facilities 805

Residential Care 836

4 Foley et al.

count to 10,000 workplaces. Finally, since we wanted to

make estimates for the population of Washington State

businesses taken as a whole, we drew in additional records

from across industries and size categories not already

represented in the sample, so as to have at least one

workplace in every SIC and size ‘‘cell’’ with at least three

workplaces in the population. This brought our final sample

size to 10,759 in 2001, 10,624 in 2003, and 10,314 in 2005.

To allay employers’ concerns that reporting WMSD

injuries and hazard levels might expose them to greater

probability of inspection, employers were informed in a

cover letter that the survey was being administered by a

contracted survey research company which would randomly

assign a tracking number and remove any identifying

information from each record before sending the complete

survey dataset to L&I staff. We also asked that the survey be

completed by someone with detailed knowledge of the

workplace who could answer the questions about employee

exposures, injuries and company programs to address

WMSD hazards.

After the sample surveys were mailed out, we tracked the

number of surveys that were returned by the post office as

undeliverable. An undeliverable survey can mean either that

the address does not exist (i.e., is misspelled, non-existent or

incomplete) or the workplace no longer exists at that address

and there is no forwarding address available.

Table II summarizes the number of survey responses

available for analysis and the response rate, adjusted for

unreachable workplaces, by Rule Phase Group and year of

survey. The number and proportion of employers which were

unreachable due to undeliverable mailing addresses, out-of-

business status or non-working telephone number was: 3,332

(34%) in 1998; 1,768 (16%) in 2001; 1,436 (14%) in 2003,

and 2,710 (26%) in 2005.

Data Cleaning

Following each employer survey the survey adminis-

tration firm removed all fields that could identify the

employer. Prior to sending us the final dataset, the survey

responses and administrative data (workers compensation

claims counts and hours worked) were merged. Steps taken

to prepare the dataset for analysis included coding non-

responses as missing, and attaching a field to identify the

Rule Phase Group to which the record belonged. In less than

1% of cases we also corrected main question responses that

were inconsistent with dependent question responses. For

example, in some instances a respondent did not respond to

the question ‘‘Did you take any steps to address WMSDs

in your workplace?’’ But they then checked ‘‘yes’’ to one or

more of the possible steps listed in the dependent question.

In addition, for each survey a file was prepared containing

the population and sample counts for each combination of

three-digit SIC industry and size category for each of the four

phase-in groups. Weights were calculated using these counts

and used as the basis for the weighted analyses of the results

for all surveys.

Statistical Methods

We used the statistical software STATA 8.2 (STATA

Corporation, 2003) to set-up the datasets and to recode

values. All calculations were carried out in the statistical

language R 1.8.0 (R Project, 2003). Proportions of positive

answers to all dichotomous questions were estimated for

the entire State of Washington using statistical weighting of

proportions in survey strata. The purpose of weighting was to

provide an unbiased estimate of a specific proportion for the

entire State. Proportions of positive answers were calculated

for all workplaces combined as well as for separate sectors of

workplaces as defined by the Rule Phase Group to which they

belonged under the rule. Weights were derived from the

number of workplaces in a stratum in the state and the number

of workplaces in the stratum in the specific survey.

For each question, the proportion of positive answers

was compared between each pair of years in the four annual

surveys. The difference between the proportions in each pair

of comparison years was also estimated. Standard errors and

P-values for the differences were obtained from the survey

(weighted likelihood) regression methods.

RESULTS

The total number of responses varied across the four

surveys, due both to the differing mixture of large, medium,

and small workplaces surveyed in 1998 versus 2001, 2003,

TABLE II. Total Number of Survey Responses Available forAnalysis and Survey Response Rate, by Rule Phase Group and Year

Survey year


n % n % n % n % n %

1998 27 63 673 85 752 84 3,025 73 4,477 752001 519 46 1,972 58 984 70 2,125 69 5,600 622003 448 45 2,062 60 1,081 65 2,102 73 5,693 622005 422 45 1,872 67 959 68 1,880 80 5,133 68


and 2005 and due to a varying number of incomplete

employer addresses found in the datasets sent to the survey

administrator.

As can be seen from Table II the change in sampling

strategy from a proportionate, unweighted draw toward a

sample drawn more heavily from larger and higher-risk

industries made a great difference in the sample count

available for analysis. It also meant that comparisons with the

1998 survey for workplaces in Phase 1 were difficult, given

the very small numbers in that category in 1998.

The respondents were asked to describe their position at

the workplace by choosing from a list of occupational titles.

Across all surveys the proportions were stable. For all Rule

Phase Groups combined we found in 2003 that the largest

category of respondents was the owners of the business being

surveyed (44%), followed by managers/supervisors (26%),

administrative assistants (10%), personnel managers (9%),

and safety/health officers (5%). However, these fractions

varied across Rule Phase Groups. In Phase 1, with only

large workplaces, the largest category of respondents was

managers/supervisors (43%), then safety/health officers

(18%) and personnel managers (16%). Owners made up

only 6% of respondents in Phase 1. In Phase 4, on the other

hand, owners accounted for 63% of all responses, followed

by managers/supervisors (20%) and administrative assistants

(9%). This undoubtedly reflects the finer division of labor

present in larger workplaces as opposed to small workplaces.

Again, these proportions remained stable across all

survey years.

Workplaces With Gradual-OnsetMusculoskeletal Injuries

In the 1998 questionnaire, ‘‘musculoskeletal injuries’’

were described as:

‘‘Injuries involving bones, joints, ligaments, tendons,

muscles and related vessels and nerves. These injuries can be

either:

ACUTE—one that occurs suddenly such as a

fractured arm, severed finger or sprained ankle; or:

GRADUAL ONSET—one that occurs slowly

over time, such as overexertion that results in low back

injury or tendonitis resulting from repetitive movement and

awkward postures. These are also known as repetitive strain

injuries (RSI), cumulative trauma disorders (CTD) or

occupational overuse syndromes (OOS).’’

In the 2001–2005 surveys this question was re-worded

so that only gradual onset injuries were covered. Table III

compares the proportion of workplaces which have experi-

enced gradual onset WMSDs over the prior 3 years across

each Rule Phase Group for each survey year. Statistically

significant differences from the previous survey year are

denoted in boldface type:

For back-related WMSD injuries, there was a

decline from 2001 to 2003 in the proportion of workplaces

reporting cases amongst Rule Phase Groups 1 and 2,

followed by a rise from 2003 to 2005 to a higher level than

in 2001. For Rule Phase Groups 3 and 4, which were

not yet required to implement any part of the rule’s

requirements during this time, the proportion of workplaces

reporting cases was lower in 2005 than in 2001. For upper-

extremity WMSD injuries, only Rule Phase Group 1 showed

an increase in the proportion of workplaces reporting

cases. All other employers reported a decline from 2001 to

2005.

Workplace Risk Factors

Employers were asked about physical movements or

positions while employees were working at their tasks. In all,

TABLE III. Workplaces Reporting Any Gradual Onset WMSDs, by Body Part and Rule Phase Group in the Previous 3 Years

Injury Year


% Sig % Sig % Sig % Sig % Sig

Upper extremities 1998a 46.2 22.2 22.2 7.9 13.22001 52.0 35.9 27.4 10.1 20.42003 52.7 29.9 ** 23.1 * 7.5 ** 15.9 ***2005 57.4 33.7 23.0 7.4 17.0

Back 1998a 41.9 19.5 19.5 5.8 10.82001 47.6 28.5 19.2 7.8 15.72003 46.4 26.7 20.2 5.9 * 13.7 **2005 49.6 29.7 17.2 5.6 14.0

aFigures for 1998 were estimated from the percent of workplaces reporting any WMSDs in previous 3 years, multiplied by the percent of such injuries which were deemed‘‘gradual’’ onset by employers.Asterisks show level of significance of difference in proportion for a given question between one survey year and the prior survey year: *P< 0.10; **P< 0.05; ***P< 0.0001.

6 Foley et al.

the survey included 15 hazardous exposures similar to those

covered by the ergonomics rule. These were:

(1) Lift/lower objects above shoulder or below knee while

twisting.

(2) Lift 10þ lbs more than once per minute.

(3) Carry heavy loads (30þ lbs) more than 7 feet.

(4) Push or pull heavy loads (wheeling 200þ lbs, or

dragging 60þ lbs) more than 7 feet.

(5) Using the hand or knee as a hammer.

(6) Use vibrating tools, such as a grinder or an impact

wrench.

(7) Repeated pinching of small object or tool, or pinch

hold for long periods.

(8) Working with non-powered hand tools.

(9) Working with hands above shoulder level.

(10) Repetitive movement of whole arm including

shoulder muscles more than twice per minute.

(11) Holding a fixed position while working.

(12) Moving lower arm(s) or hands more than ten times

per minute (excluding typing).

(13) Using a keyboard or mouse intensively.

(14) Sitting on vibrating surfaces, machines or vehicles.

(15) Lifting or lowering 50þ lbs unassisted at least

ten times per hour.

For each risk factor to which any employees were

reported to be exposed, the employer was asked to estimate

how many employees were exposed for less than 2 hr per

shift, 2–4 hr per shift, or more than 4 hr per shift. A

dichotomous variable was created with the value ‘1’ for an

employer reporting having any workers exposed to a given

risk factor for more than 4 hr, and ‘0’ if the employer reported

no employees exposed for more than 4 hr. Since under the

ergonomics rule, exposures of over 4 hr triggered require-

ments to reduce exposures hours, we were particularly

interested in the change over time in the proportion of

workplaces reporting any employees exposed to risk factors

at this higher level of duration. Figure 1A–E reports these

proportions for the five most common risk factors, by Rule

Phase Group and year.

Because larger workplaces were more likely than

smaller workplaces to have at least one employee exposed

to a given hazard for more than 4 hr, we expected the

proportion of larger workplaces reporting exposure to be

higher. This is borne out by the results. In Phase 1, which

contains only larger workplaces from the highest hazard

industries, the exposure proportions were distinctly higher

than for the other groups. Phase 2, with a mixture of large

workplaces from other industries and medium and small

workplaces from the Top 12, had a higher exposure

proportion than Phase 3. Finally, Phase 3, containing

medium-sized workplaces from non-Top 12 industries, had

a higher exposure proportion than Phase 4, which contained

small workplaces in non-Top 12 industries. Thus it is only

meaningful to compare exposure proportions within Rule

Phase Groups across survey years, not across Rule Phase

Groups.

The results show that there is evidence of a decline in

high-duration exposures when comparing the pre-rule period

to the period following repeal. Indeed, for 14 of the

15 hazardous exposures for which data are available from

1998 to 2005, levels of exposure for over 4 hr declined

within all Rule Phase Groups. The exception is for intensive

keyboarding, where an increase in exposure proportions

is shown for Phases 2 and 4. But within this overall trend

there is another pattern of interest: in every case, exposure

proportions for Phase 1 declined from 2001 to 2003, and then

reversed course and rose from 2003 to 2005. Recall that

Phase 1 comprised the large workplaces in the high-

hazard industries, which were scheduled under the rule to

begin phasing in implementation first. The decline from

2001 to 2003 was statistically significant for all exposure

types except working with hands above the head and heavy

lifting. The same pattern appeared in a weaker form for

Phase 2, but did not hold for every type of exposure.

Finally the pattern broke down completely for Phases 3 and 4,

where there were no distinct trends across between 2001 and

2005.

Employers’ Injury Prevention Activities

In each survey year, employers were asked: ‘‘In the last

three years, has your organization taken steps to prevent or

reduce musculoskeletal injuries?’’ Figure 2A summarizes the

results by Rule Phase Group and year:

As might be expected, the proportion of workplaces

taking steps to address hazards was highest among industries

where the underlying level of hazard is highest, as in

Phase 1. Another result was the apparent correlation between

size of workplace and hazard reduction activity, with the

larger workplaces being more likely to address hazards

than smaller workplaces. The results also show that overall

there was no change from 1998 to 2005 in the proportion

of employers who reported taking steps to address WMSD

hazards in their workplaces reported taking steps to

prevent WMSDs. However, between the year 2001 and

2003 there was a distinct drop in the proportion of Phase 1

employers taking steps to address hazards. A similar decline

in activity was reported as well among workplaces in all other

Rule Phase Groups. The drop was especially large for

workplaces in the first phase-in group. From 2003 to 2005

there was a slight increase in the fraction of employers

addressing hazards, although this was not statistically

significant.

Since one might expect there would be differences in the

proportion of employers addressing risks between those

workplaces who had had a recent WMSD and those who


0%

5%

10%

15%

20%

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30%

Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 4

1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

0%

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Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 41998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

0%

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45%

Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 41998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

0%

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15%

20%

25%

30%

35%

40%

45%

50%

Rule Phase Group 1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total

1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

0%

2%

4%

6%

8%

10%

12%

14%

16%


1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

A B

DC

E

FIGURE 1. Proportion of workplaces with employees exposed to WMSD risk factors for more than 4 hr, by Rule Phase Group,

1998^2005. A: Lifting>50 lbs, 10þ per hour.B: Lifting>10 lbs per min,>4 hr/day. C: Awkward lifting,>4 hr/day.D: Using keyboard

intensively,>4 hr/day.E:Hands above head,>4 hr/day.

8 Foley et al.

had not, we examined the proportion of workplaces which

had had at least one WMSD in the previous three years and

were still not taking steps to address the underlying hazards.

Figure 2B has the results:

The results show that overall there was a decline since

1998 in the number of employers who were not addressing

WMSD hazards even when their employees were getting

injured. However, most of this decline occurred between

1998, before the rule was adopted, and 2001 when rule

implementation was under way. If we look at trends within

each Rule Phase Group we find that in Phase 1 there was a

significant decrease in workplaces with WMSDs not

addressing risks between 1998 and 2001, but then this

fraction rose from 2001 to 2003 and 2005. A similar, though

weaker, trend occurred with workplaces in Phase 2, the next

group scheduled to implement the rule. Only in Phase Groups

3 and 4 was the decrease sustained. It should be noted that, in

all Rule Phase Groups, those workplaces who reported

having had WMSDs recently were much more likely to be

taking steps than were workplaces which had not had

WMSDs. Conversely, in all Phases except Phase 1 a majority

of employers without recent WMSDs reported no steps taken

to address hazards.

There was no significant difference between the large

workplaces in Phase 2 and the workplaces in Phase 1, which

are all large, in terms of the proportion of them taking steps.

Far fewer of the medium and small workplaces in Phase 2

were taking steps than were the larger workplaces in Phase 2,

in spite of the fact that all of the medium and small

workplaces in Phase 2 were in the Top 12 high risk industries,

while the large workplaces in Phase 2 were not. It appears that

size of workplace played a greater role in predicting

employer activity in addressing WMSDs than industry alone.

Factors Affecting Employers’Decisions to Address WMSD Hazards

Among the roughly 40% of employers who reported that

they had taken steps to address WMSDs in their workplaces

the predominant reason given was that they wished to reduce

the number of worker injuries they experienced. The next

most common reason given was that they expected to reap

gains in productivity and reduced absenteeism as a result.

Another reason commonly given was that they wanted to

reduce their workers’ compensation claims and/or costs.

Finally, and especially in Phase 1, an important reason given

was that they had been requested to do so by either their

employees or by their safety and health committee. The

importance of factors affecting the decision to take steps is

summarized in Table IV. Proportions are out of those stating

that they had taken steps to address WMSDs.

The sharp increase in workplaces citing ‘‘recommended

by DOSH’’ from 1998 to 2003, as the rule came into effect,

followed by a substantial fall from 2003 to 2005 when it was

repealed, should be noted. The percentage of employers who

listed ‘‘required by insurance company’’ as a factor in their

decision to take steps never rose above 3% in any year. The

State Fund, administered by L&I, provides workers’

compensation insurance to all but about 400 employers in

the state, covering about two-thirds of all employees.

For the roughly 60% of employers in each survey

indicating that they had NOT taken steps to address WMSDs

in the last 3 years, one or more of the following factors was

cited as a reason not to act: that WMSDs were not a problem

in their workplace; that the employer lacked the skills to

make changes; that other problems were a higher priority;

that changes would be too expensive to implement; or that

0%

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40%

50%

60%

70%

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90%

100%


1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

0%

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10%

15%

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30%


1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

A B

FIGURE 2. A:Percent of workplaces takingsteps to addressWMSD risks,by survey yearand Rule Phase Group.B:Percent of work-

placeswithWMSDsbutNOTtakingsteps to addressrisks,by survey yearand Rule Phase Group.


changes were planned but had not yet been effected. The

only reason listed by more than 5% of employers was that

WMSDs were not a problem in their workplace. The pattern

over time and across Rule Phase Groups is shown in Table V.

Proportions given are of those workplaces stating that they

had not taken steps to address WMSD hazards.

Overall, fewer employers believed WMSDs were not a

problem for their workplace in 2005 than in 1998, with

the largest decline occurring among the large, high-

hazard workplaces comprising Phase 1. Interestingly, fewer

employers claimed WMSDs were not a problem in 2005,

when the rule was gone, than in 2003 when the political battle

TABLE IV. Reasons Provided forTaking Prevention Steps, by SurveyYear and Rule Phase Group

Reason Year

Rule PhaseGroup1

Rule PhaseGroup 2

Rule PhaseGroup 3

Rule PhaseGroup 4 All


To reduce worker injuries 1998 100.0 83.3 79.0 68.1 74.92001 92.5 83.2 75.4 ** 65.2 74.82003 91.2 82.7 77.6 68.8 75.92005 94.9 * 82.6 74.4 73.1 * 77.5 *

Expected other benefits (improved productivity, 1998 91.3 51.4 51.9 42.4 47.5less absenteeism) 2001 71.2 ** 56.5 ** 50.9 46.0 ** 51.7 **

2003 63.5 ** 55.4 53.7 43.6 50.12005 67.6 60.0 ** 55.7 43.3 52.3 *

To reduce workers compensation claims and/or costs 1998 77.6 42.3 38.3 21.7 31.52001 73.5 46.5 30.2 ** 21.7 34.2 **2003 60.2 *** 43.1 * 25.3 ** 13.6 ** 27.5 ***2005 63.0 39.5 * 19.4 ** 12.5 25.1 *

Requested by employees or safety/health committee 1998 14.8 22.9 25.3 14.0 19.02001 44.2 *** 32.9 *** 29.3 ** 15.5 25.6 ***2003 34.7 ** 29.8 24.1 ** 14.5 22.2 **2005 37.2 33.3 * 24.2 14.6 23.8

To gain competitive advantage 1998 32.8 19.8 14.9 13.0 15.42001 40.3 20.8 18.0 17.1 * 19.4 ***2003 28.2 *** 23.2 13.6 ** 16.1 18.62005 27.3 20.8 15.5 13.1 16.8

Recommended by DOSH 1998 2.8 4.2 3.5 2.2 3.02001 5.6 6.1 4.9 3.4 4.7 **2003 9.1 ** 4.6 5.4 0.7 ** 3.1 **2005 0.6 *** 0.5 *** 1.0 *** 1.4 1.0 ***

Asterisks show level of significance of difference in proportion for a given question between one survey year and the prior survey year: *P< 0.10; **P< 0.05; ***P< 0.0001.

TABLE V. Reasons Provided for Not Undertaking Prevention Activities, by SurveyYear and Rule Phase Group

Reason Year

Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 All


WMSDs are not a problem 1998 74.3 69.9 78.6 78.8 77.8at workplace 2001 55.7 ** 72.2 75.8 80.1 77.9

2003 63.9 ** 76.4 * 80.3 ** 84.2 ** 82.1 **2005 63.0 71.5 ** 69.8 *** 76.2 ** 74.5 ***


10 Foley et al.

over the rule was at its height. When looking within each year

across phase-in groups there is considerable evidence that

more employers in Rule Phase Groups 3 and 4 believed

WMSDs were not a problem for them. It should also be noted

that very few employers indicated that they were not taking

steps because it was too costly to do so or because they lacked

the skills.

Perceived Results ofPrevention Activities

Employers were asked whether, as a result of their

WMSD prevention activities, the number of injuries, absentee-

ism, turnover and quality of product or service increased,

decreased or was unchanged. Figure 3A–D summarizes their

responses for the number of WMSD injuries and levels of

absenteeism following steps. For similar results of steps on

injury severity, turnover, cost of production, employee morale

and quality of product see Silverstein et al. [2004]. It should be

remembered that these proportions are out of those stating that

they had taken steps to address WMSDs.

A higher fraction of Phase 1 workplaces took steps to

address WMSDs. They also reported better overall success

with their prevention activities than workplaces in Phase 2,

who in turn showed more reported success than workplaces

in Phases 3 and 4. For all groups the vast majority of

workplaces reported that the number of injuries fell or was

unchanged. Injuries were more likely to be unchanged for

the smaller workplaces in lower hazard industries which

comprised Phase 4. The same pattern applied across all

results measures: successful outcomes, or at least no change,

were reported by large majorities of workplaces across all

groups, with the best outcomes reported by workplaces in

Phase 1.

Similar patterns across survey years and Rule Phase

Groups were seen for turnover, quality of product or

service, severity of injuries, cost of doing business and

employee morale.

0%

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80%


1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

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1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

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1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

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1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133

A B

DC

FIGURE 3. Reported results of prevention activities, by survey year and Rule Phase Group. A: Injuries decreased following steps.

B: Injuries increasedfollowingsteps.C: Absenteeism decreased followingsteps.D: Absenteeism increasedfollowingsteps.


Sources of Ergonomics Information

In order to uncover what resources employers used

when seeking ergonomics information we asked employers

to answer whether they used any or all of the following

internal and external sources of information: business/trade

associations, ergonomic product vendors, literature searches,

private consultants, health care providers, training/HR staff,

safety and health committees, DOSH or OSHA or that they

do not obtain any information at all. Table VI summarizes,

in order of importance, the proportion of workplaces using

each ergonomics information source, by survey year and rule

phase-in group:

They show that the large workplaces in the higher hazard

industries that comprised Phase 1 were much more likely to

use multiple sources of information, including in-house

TABLE VI. Sources of Ergonomics Information, by SurveyYear and Rule Phase Group

Source Year



Do not obtain any information 1998 22.2 30.5 27.6 45.0 39.52001 7.9 * 18.0 *** 22.7 * 33.8 *** 27.4 ***2003 12.5 * 24.0 ** 31.0 ** 44.0 *** 36.7 ***2005 6.1 ** 22.0 27.2 40.1 * 33.1 **

Business/trade association 1998 30.9 24.6 25.6 18.9 21.02001 36.3 30.1 ** 29.4 * 25.9 *** 27.7 ***2003 38.8 26.1 * 28.4 20.0 ** 23.0 ***2005 32.6 * 26.1 25.9 16.0 ** 20.2 **

DOSH/OSHA 1998 21.8 21.8 20.4 10.4 14.02001 37.9 * 32.8 *** 23.5 16.8 *** 22.5 ***2003 45.1 ** 34.1 25.7 13.5 ** 20.82005 41.2 32.8 22.0 14.8 20.8

Data searches, books, articles 1998 23.9 18.7 16.0 14.5 15.52001 25.0 25.8 ** 19.8 * 16.0 19.3 ***2003 25.0 23.0 17.4 13.9 16.8 **2005 20.7 16.7 ** 13.9 10.0 ** 12.4 **

Health care provider 1998 22.2 16.8 14.7 12.3 13.52001 15.4 16.4 19.0 ** 12.1 14.42003 13.9 12.5 ** 12.8 ** 9.5 * 10.8 **2005 14.2 14.1 12.6 9.1 10.9

Personnel or training staff 1998 44.6 12.8 14.2 6.6 9.12001 30.8 19.7 ** 13.4 6.9 11.7 **2003 25.7 15.7 * 8.0 ** 5.5 8.7 **2005 29.3 17.2 10.4 6.0 9.8

Safety/health committee 1998 36.3 13.7 15.0 4.0 7.62001 37.8 22.2 ** 15.0 3.7 11.0 ***2003 30.9 ** 16.3 ** 10.3 ** 3.9 8.3 **2005 37.8 * 19.5 * 9.5 3.6 9.0

Ergonomic product vendor 1998 23.8 9.1 8.4 6.1 7.12001 11.2 11.4 8.2 6.1 7.92003 10.0 9.2 9.8 4.8 6.7 *2005 11.6 10.4 7.7 5.0 6.9

Private consulting firm 1998 14.1 5.8 3.8 1.6 2.72001 9.9 9.5 ** 5.7 1.9 4.6 **2003 11.2 8.8 4.8 1.5 3.92005 14.2 6.1 ** 5.4 2.4 3.9


12 Foley et al.

personnel or training staff, than workplaces in Phase 3 or 4.

The smaller workplaces that comprised Phase 4 were much

more likely to only rely on business/trade associations for

their information or not to obtain any information at all. From

2001 to 2003 there was a rise in the fraction of workplaces in

Phases 2, 3, and 4 reporting that they did not obtain any

information at all. One source of information showing greater

usage by all workplaces across all survey years is DOSH/

OSHA education and outreach. Ergonomic product vendors

and private consultants were the least-used sources.

Steps Taken by Workplaces toComply With the Rule

In the surveys administered in 2003 and 2005 we asked

employers to report whether they had initiated any of the

steps that were to be required under the rule. Specifically, we

asked whether they had: done an initial assessment of their

jobs to see if they would be in the ‘‘caution zone’’ under the

rule; instituted any control measures to reduce the hazards;

and provided ergonomics training for supervisors and

employees. Table VII shows the results.

The results show once again that employers in Rule

Phase Groups required to comply earlier with the ergonomics

rule were more likely to report that they were reviewing their

jobs and instituting control measures in 2003 than were firms

in the Rule Phase Groups who were not required to be taking

these steps until later. The results also show that from 2003 to

2005 the proportion of workplaces doing initial job assess-

ments and instituting hazard control measures increased

across all Rule Phase Groups, particularly in Phase 1. On the

other hand, the proportion of firms stating they were not

instituting hazard control measures increased even more.

There was also a substantial drop from 2003 to 2005 in

the proportion of firms stating that they did not have any

jobs requiring hazard controls. Finally, the proportion of

firms stating they were providing ergonomics training to

workers and supervisors was unchanged from 2003 to 2005.

DISCUSSION

To date, there have been no other large scale US surveys

of employers reporting prevalence of physical load exposures

in the workplace published in the peer reviewed literature.

There have been a number of studies using national or state

survey data to estimate prevalence of musculoskeletal

disorders such as 46% of respondents reporting heavy in

their job and 36% of those reporting back pain, or 51%

reporting either repetitive hand movements or awkward

postures and 37% of those with arm pain [Waters et al., 2007].

In the European Union, a large survey of workers across all

industries on their working conditions found no change in the

prevalence of exposures to heavy lifting, repetitive motion

and painful/tiring positions between 1990 and 2000 [Paoli

and Merllie, 2001]. In a 1996 telephone survey of upper

extremity risk factors for WMSDs among Connecticut

workers, Morse et al. [2007] estimated that about 1 million

Connecticut workers were exposed to repetitive work, bent

wrists and job stress. The only question which is roughly

comparable with our study was with computer use more than

4 hr per day where 28% of the Connecticut workers reported

exposure whereas 15–18% of Washington employers

reported they had at least one worker with such exposure. It

should be noted, however, that the Connecticut study

estimates the prevalence of exposure among workers,

whereas our focus in this study was the prevalence of

exposures among workplaces. The distribution of positive

responses across industry sectors was similar between the

two studies.

We were unable to ensure that, across all four

survey years, the same individual from the same workplace

would complete the survey. Indeed, we did not have sufficient

TABLE VII. StepsTaken to Comply With the Rule, by SurveyYear and Rule Phase Group

Step Year



Initial assessment of jobs 2003 53.6 37.9 30.7 24.7 29.32005 62.9 ** 44.6 ** 40.9 ** 33.7 *** 37.9 ***

Control measures-yes 2003 38.7 34.3 27.0 18.3 23.72005 54.7 ** 39.4 * 29.6 20.0 27.0 *

Control measures-no 2003 24.3 27.7 29.9 26.0 27.02005 37.6 *** 48.3 *** 45.9 *** 53.5 *** 50.8 ***

Control measures-not needed/no hazards 2003 37.0 38.0 43.2 55.6 49.32005 7.7 *** 12.3 *** 24.4 *** 26.4 *** 22.2 ***

Provided training 2003 51.6 30.1 18.0 11.4 17.52005 53.3 30.1 21.3 12.6 18.9



numbers of repeat responding workplaces to be able to track

responses from individual workplaces over time and still be

able to break out results by Rule Phase Group. Instead, we

focus on tracking the movement of responses of each

Rule Phase Group across the four survey years. If the surveys

are answered by individuals with a similar role in the

workplace across survey years, the responses should be

comparable. We found that, within each Rule Phase Group,

the distribution of respondents by job title remained quite

stable over time. Respondents from the large firms in Phase 1

tended to be managers and supervisors, while those from the

small firms comprising Phase 4 tended be business owners.

The interpretation of the trends in reported WMSD

exposures, injuries and steps being taken by employers may

be aided by an understanding of the political and legal

context which might have shaped employers’ expectations of

the rule’s survival at each period in which the survey was

fielded. At the time of the first survey, which was

administered in the summer of 1998, L&I had not yet

announced a proposed rule. The rule was adopted in May

2000, with the phase-in of compliance scheduled to start in

July 2002. By the spring of 2001, when the second survey was

administered, the rule had survived its first challenges in the

state legislature. L&I had developed and delivered many

training sessions and demonstration projects tailored to each

industry sector and these were well-attended by industry

representatives. In the fall of 2001, a business coalition began

litigation against the rule in district court. By the summer of

2003, when the survey was administered a third time,

enforcement had been delayed by 2 years by Governor

Locke. Also, the legal challenge to the rule was headed to the

Washington State Supreme Court, and an initiative to repeal

the rule, filed by the Building Industry Association of

Washington, had qualified for the November 2003 ballot. In

summer 2005 when the survey was administered once again,

the rule had been repealed for more than 1 year. A more

complete presentation of the regulatory and political context

surrounding the rule is in Silverstein [2007].

Throughout this study we were concerned that em-

ployers’ reporting of the number of WMSD injuries sustained

in their workplaces might tend to underestimate the number

of actual WMSD injuries. Evidence suggests that the

undercount of injuries reported to the employer-based

Bureau of Labor Statistics Annual Survey of Occupational

Injuries and Illnesses could range from 33% to 69% [Leigh

et al., 2004]. Increased publicity about the ergonomics rule

adoption, as well as the ebb and flow of the political battle

surrounding the rule’s implementation, may also have played

a role in shaping employer’s reports of WMSD injuries and

claims in their workplaces. To check for this, we compared

survey-reported WMSD rates per 100 FTE with those

found in L&I’s workers’ compensation database. The

survey-based claims rates accorded fairly well with

the administrative rates. For example, the survey-based rate

for non-traumatic WMSD claims in 1998, covering the years

1995–1997, was 3.5 per 100 FTE. The rate as reported by

L&I’s workers’ compensation database was 3.1 per 100 FTE

for non-traumatic WMSDs of the neck, back and upper

extremities [Silverstein and Adams, 2007]. In 2001, the

survey-based rate was 3.6 per 100 FTE, while that from

the workers’ compensation database was 3.1 per 100 FTE. In

2003, the survey-based rate fell to 2.6 per 100 FTE while

the workers’ compensation claim rate showed no change,

remaining at 3.1 per 100 FTE. In the 2005 survey the survey-

based rate rose to 3.6 per 100 FTE, while the L&I-reported

claims rate was 3.3 per 100 FTE. So with the exception of

2003, the survey-based rates tracked closely with the

workers’ compensation rates. The fact that in 2003, when

political challenges to the rule were clearly gaining

momentum, the survey-based rate fell well below that shown

L&I workers’ compensation data may reflect the desire of

some employers to downplay the significance of WMSD

injuries in their workplaces for political purposes.

When comparing the pre-rule period to the period

following repeal, the surveys show evidence of a decline in

high-duration exposures across all Rule Phase Groups. The

sole exception to this trend was for intensive keyboarding,

where the trend was decreasing for Phase 1 and Phase 3 firms,

but increasing for Phases 2 and 4 firms. The reasons for these

mixed patterns are not known. It may be that the diffusion

over this period in document imaging and web-based

document processing technologies did not reach the mainly

smaller firms comprising Phase 4 and most of Phase 2. The

other pattern that is clear is that, in Phase and Phase 2, there

was a decrease in reported exposures from 2001 to 2003 to all

hazards, and then an increase by 2005. The third ergonomics

survey was conducted in June–July 2003 when the political

and legal battle against the rule was at its height. Well before

the 2005 survey period it was clear that there would be no

ergonomics related enforcement inspections in the foresee-

able future.

Results from this research suggest that the extended

controversy over the rule outpaced and overwhelmed the

phased-in implementation process. From the first three

surveys, there was some suggestion of reduction in exposure

between 1998 and 2003 (Fig. 1A–E). However, while more

workplaces reported taking steps between 1998 and 2001,

there was no further improvement by the summer of 2003

when the rule was likely to be repealed. Instead, there was a

significant decrease in the percent of workplaces reporting

having taken steps in Phase 1 (large workplaces in high risk

industries) and Phase 3 (all other medium sized workplaces,

11–49 FTEs), and decreases in the other groups that were not

statistically significant.

Employers across all Rule Phase Groups said they took

steps to address WMSD hazards primarily in order to reduce

worker injuries and to improve productivity and reduce

absenteeism. But reducing workers’ compensation costs

14 Foley et al.

appeared to be a more important concern to the larger firms

comprising Rule Phase Group 1 than it was to the smaller

firms in Rule Phase Groups 3 and 4. This could be because

large firms have a more direct financial incentive to avoid

workers’ compensation claims due to the fact that experience

rating plays a larger role in determining their premiums than

is the case with smaller firms. Because of their size, smaller

employers might have more difficulty coping with the

staffing impact that the loss of an employee due to injury

would have on the business. Other factors cited as reasons for

addressing WMSD risks showed the importance of employee

recommendations through their workplace safety commit-

tees and the desire to obtain a competitive advantage by

obtaining a productivity improvement through improving the

ergonomics of the workplace. Relatively few employers cited

recommendations by DOSH/OSHA as playing a part in their

decision to take steps to address hazards.

It is likely that employers decided to take a ‘‘wait-and-

see’’ stance with respect to the ergonomics rule before

instituting control measures. This was likely strengthened by

the downturn in the economic cycle during 2001–2003. By

the 2005 survey the percent of Phase 1 employers taking steps

was lower than in 2001, while the fraction not taking steps

despite having experienced a WMSD injury was higher.

Nonetheless, for those employers who did take steps, a high

percent reported positive results in injury and absenteeism

reduction, product quality and employee morale.

Large workplaces in the high hazard industries tended to

use a variety of resources, including in-house personnel, to

address ergonomics issues. Among medium and smaller

workplaces outside of the Top 12 industries the major sources

of information were trade associations and DOSH. Private

consultants were used by relatively few firms. One of the

more interesting results in the 2001–2003 comparison was

the increase in employers from all groups who stated that they

did not obtain any information on ergonomics. This trend

reversed course from 2003 to 2005, perhaps reflecting the

changed political climate following repeal of the rule in late

2003. From 2001 to 2005 there was a similar trajectory in the

proportion of employers claiming that WMSDs were not a

problem in their workplace and in the trend of employer-

reported WMSD claims on the surveys. These results may

reflect a tendency among some employers to downplay the

importance of a hazard which is the subject of new regulatory

activity.

The elimination of ergonomics regulations at the state

and federal level was not without economic and social

consequences. These surveys have demonstrated increases in

employer reported exposures and reduced efforts to reduce

these hazards once the ergonomics rule was unlikely to

survive. Those employers who did take steps reported

positive outcomes in terms of reduced injuries, injury

severity, turnover, and absenteeism. Employee costs in terms

of lost earnings and workdays have been estimated by Biddle

and Roberts [2004] and Foley et al. [2007] and have been

shown to extend for many years.

In addition to the losses suffered by those with WMSDs,

the social costs of not reducing exposures present a

significant burden to society. By combining the data on

exposures from these surveys together with the cost-benefit

analysis of the repealed ergonomics rule it is possible to

estimate the likely costs of not having the ergonomics rule

[Foley and Nothstein, 2000]. The cost-benefit analysis used

workforce exposure fractions derived from the 1998

employer survey to estimate the number of jobs which would

require hazard reduction. Costs of the rule were based upon

expenditures for businesses to comply with the various

elements of the rule, including rule review, hazard identi-

fication, engineering and administrative controls, training

and administrative time. Benefits of the rule were based upon

the cost savings associated with the decrease in WMSDs that

would follow from the reduction of hazards in the workplace.

Savings would come from a reduction in workers compen-

sation expenditures, long-term wage losses, lost taxes and

fringe benefits, unreported WMSDs and indirect employer

expenditures.

The present value of annualized net benefits would have

been approximately $260 million per year over 10 years had

the rule been fully implemented. However, since the rule was

repealed in 2003 there was only partial implementation of

hazard reduction followed by a partial regression toward pre-

rule levels of exposure. Thus, rather than the expected 50%

reduction in costs under full rule implementation, only about

a 15% reduction was realized. This suggests that the social

cost of having repealed the rule might be approximately $182

million in forgone social net benefits per year.

CONCLUSIONS

This large scale industry-wide survey study is unique in

that it spans the rise and fall of the Washington State

ergonomics rule, from 1998 to 2005 from an employer

perspective based on four surveys. The large employers in the

highest-hazard industries were well on the way to reducing

hazards by 2003 when the rule was repealed. Likewise, it is

evident that hazard reduction was no longer a priority once

the threat of enforcement was gone. It is unknown whether

having a less lengthy phase-in would have resulted in quicker

acceptance or even more resistance to change. It is possible

that employers would have focused more on the components

of the rule because of the need to act sooner.

Although there is good evidence that ergonomic

interventions result in reduced injuries and costs [Tompa

et al., 2007], this research suggests voluntary efforts, without

the plausible threat of enforcement may do little to encourage

action by employers most in need of improvement. The

failure of this extraordinary effort to develop a significant


health and safety rule at the state level through the non-

deliberative citizen initiative process raises serious concern

about the future of health and safety protection in the United

States.

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