improving work organization to reduce injury and illness · 2016-09-19 · improving work...

AUTHORS:Donna Baines, Karen Hadley, Bonnie Slade, Krissa Fay, Shoshana Pollack,

Ann Sylvia Brooker, Susan Preston, Wayne Lewchuk, Dima Dimitrova

Improving Work OrganizationImproving Work Organizationto Reduce Injury and Illness:to Reduce Injury and Illness:

Social Services, Stress, Violence and Workload

IMPROVING WORK ORGANIZATION TO REDUCE INJURY AND ILLNESS:Social Services, Stress, Violence and Workload

For more information on this study please contactProfessor Donna Baines, Labour Studies and Social Work,

McMaster University,Hamilton, Ontario M6R 2A9

(905)-525-9140

[email protected].

Copyright 2002Institute for Work in a Global Society

Hamilton, Ontario

Simultaneously published on the WIGS websitehttp:/www.socsci.mcmaster.ca/labrst/wigs.htm

1


Executive Summary.................................................................................................... 2

Acknowledgments...................................................................................................... 3

Introduction ............................................................................................................... 5

Services in the Developmental Sector: The Broader Social Context .............................. 7

Methodology .............................................................................................................. 9

Findings and Discussion..............................................................................................11

The Agencies – A Diverse Group ..............................................................................12

Conflict and Negotiations ........................................................................................12

After-the-fact Discipline ...........................................................................................12

Management-Worker Ratios .....................................................................................13

Staff-Client Ratios...................................................................................................13

Work Organization and Shifts...................................................................................13

Workload...............................................................................................................14

Violence ................................................................................................................15

Workplace Culture – Bullying and Trauma.................................................................16

Sick Leave.............................................................................................................17

Reporting Practices.................................................................................................17

Best Practices ........................................................................................................18

Conclusion ..................................................................................................................19

Recommendations......................................................................................................20

Endnotes.....................................................................................................................21

References..................................................................................................................22

TABLE OF CONTENTS


ExecutiveSUMMARY

THIS REPORT COMPARES work organization andworkload at three developmental service agenciesin order to identify factors that precipitate andcontribute to injuries, stress and health problemsin the social services. The restructuring of servicesin this sector has resulted in reduced funding andtherefore workloads and health risks associatedwith overwork and burnout appear to haveincreased dramatically in all three sites studied.Restructuring has also exposed workers andclients to higher levels of stress and violence. Thisstudy also uncovered serious incidents ofworkplace bullying and traumatic work cultures.While workplace bullying certainly predatesrestructuring, some studies show that it is aphenomena that has seen rapid growth within thecontext of restructured public sector and non profit

workplaces. Given the serious under funding ofthis sector it may appear that there is little thatcan be done to improve health and safety in theshort term. However, this report recommendsseveral measures including an immediate increasein government funding, the incorporation ofworker’s knowledge into how work is to beorganized and planned, guarantees to part-timeworkers of enough hours of work to supportthemselves, an end to the use of split shifts, a capon overtime and subsequent hiring additional full-time staff in order to ensure workplace stabilityand the introduction of immediate, assertive,transparent measures to improve workplacemorale and eradicate traumatic workplacecultures.

2

3IMPROVING WORK ORGANIZATION TO REDUCE INJURY AND ILLNESS: Social Services, Stress, Violence and Workload

AcknowledgementsTHE AUTHORS OF this report wish to thank the staff, management and clients at the threesites for their cooperation and commitment to this project. Funding for the project from theWorkplace Safety and Insurance Board of Ontario is gratefully acknowledged. For expertadvice and support, the Research Team would like to extend our appreciation to the CUPENational Staff, in particular Margot Young and Anthony Pizzino. Assistance from theadministrative staff in at McMaster University was essential to the project especially the workof Delia Hutchinson and Diane Allen.

5


INTRODUCTION


THIS REPORT COMPARES work organization andworkload at three developmental service agenciesin order to identify factors that precipitate andcontribute to injuries, stress and health problems inthe social services. While injury and illness rateshave been dropping across job categories, WSIBliability in the social services sector is high andrising.

The focus of numerous studies has been thedelineation of the various links between workorganization, job stress and injury (Karasek andThorell, 1990; 1977; Kohn, 1983, 1976 ;Messing and Reveret, 1983; Gardell, 1980, 1971;

Karasek, 1979). Using the concept of job strain,these studies attempt to ascertain how to balanceworkplace demands, worker control and workplacesupports in order to ensure healthy workplaces. Intheir pivotal study, Karasek and Thorell (1990)argue that if negative health effects are associatedwith certain kinds of work organization thenpositive health effects and behaviors such asimproved productivity and interpersonal relation-ships may be associated with better organizationand design of work. Their focus mirrors our owninterests in modifying work organization in order toprevent negative health impacts and improveaspects of service delivery such as workerproductivity and the helping relationships that arecentral to the social services endeavor. In relationspecifically to the social services sector, Solderfeldtet al (1997) undertook a survey of 8296employees in two Swedish human serviceorganizations and found that aspects of health suchas worry, anxiousness, sadness, sleep difficulties,restlessness, and tension as well as fatigue andfeelings of being used up and overworked weresignificantly determined by work organizationrather than by individual personality traits and

coping skills. In a separate study Solderfeldt et al(1996) argued that specific models of job strainand work organization evaluation must be develop-ed that reflect the specificities of the worker-clientrelationship in the social services and the impactsthis relationship has on the workers’ capacity tocontrol their own work. Within their model of jobstrain, Solderfeldt et al fine tune the work controlvariable to include administrative control, outcomecontrol, choice of skills, closeness of supervision,control within and over a situation and ideologicalcontrol. They assert that research using this orsimilar conceptualizations of work control will moreclosely reflect the complexity of the social servicecaring relationship.

This study undertook an exploration of workorganization in a sub section of the social servicessector, the developmental services sector, in orderto better understand the connections between workorganization, work demands, controls and supportsfor those employed in this busy sector. Based onfindings from our three Ontario study sites, thisreport makes recommendations and identifiesprevention strategies and “best practices” that cancontribute to the reduction or elimination ofinjuries, stress and health hazards in social serviceworkplaces. The study was conducted by a re-search team centred at McMaster University thatincluded experts on work organization, social work,violence and health and safety. All three study sitesprovided the research team with very generousaccess to workers, managers and supervisors,agency programmes, and documentary data.

This report makes recommenda-tions and identifies preventionstrategies and “best practices” thatcan contribute to the reduction orelimination of injuries, stress andhealth hazards in social serviceworkplaces.

7


Services in the Developmental Sector:THE BROADER SOCIAL CONTEXT


THE DEVELOPMENTAL SERVICES field has under-gone extensive changes in the last thirty years. Inthe 1970s, people with developmental disabilitieswere usually institutionalized and treated as“patients”. The 1980s and 90s saw a move frominstitutional to community-based care. De-institutionalization meant that between 1970 and2000, the number of people with intellectual

disabilities living in institutions in Ontario fell from10,900 to less than 1000. While some argue thatcost cutting was the primary motivation behinddeinstitutionalization, others argue that aphilosophical shift from “patient” to “person” wastaking place . The introduction of the CanadianCharter of Rights and Freedoms during the sameperiod reflected a growing recognition of the rightsof people with disabilities and society’s res-ponsibility to provide services that facilitateindividual growth and self reliance in the context ofa caring community. Unfortunately, resources havenever been sufficient to realize these goals.

Often at the forefront in lobbying for rights andresources, agencies working with people withintellectual disabilities have significantly alteredhow they provide services. Supports for peoplewith intellectual disabilities have tended to bemedically (hospital)- or family-based. Communityservices have sought to include aspects of both aswell as a recognition of the individual in relation toa larger social system of opportunities andresponsibilities. At present, most communityagencies work within an “empowerment model”wherein people with disabilities and their familiesare encouraged to make choices regarding work,education, residence and lifestyle. Funding cutsacross the health and social services sector hasmade many of these choices difficult or impossibleto fulfill as a general lack of resources has limitedmeaningful options for well being and individualdevelopment.

Funding began to be restricted in the humanservices sector starting in the early 1980s. In mostcases, funding for community agencies servingpeople with intellectual disabilities has not beenincreased in eight years. Diminished hospital andhome-based supports have increased demands onthese agencies resulting in program and staffingstress. At this point, advocates in the sector arguethat clients’ entitlements to service must beentrenched in legislation in order to ensure thatfamilies and individuals who need support are notwaiting years for service and that services meet areasonable standard of quality, care and safety.

Given the highly uneven levels of service thatcurrently exist across the system, disability advo-cates assert that uniform standards of practiceshould be developed similar to those found in ChildWelfare and that monies must be made immed-iately available for staff training and development.They argue further that services and supports mustremain public and non-profit.

In all three sites, this study was seen as a chanceto build a shared understanding of health issuesand hazards in the work environment. Our datareveal a number of places where positive actionand intervention could reduce health hazards.

While some argue that cost cuttingwas the primary motivation behinddeinstitutionalization, others arguethat a philosophical shift from“patient” to “person”was takingplace. Advocates in the sector argue that

clients’ entitlements to service mustbe entrenched in legislation in orderto ensure that families andindividuals who need support arenot waiting years for service andthat services meet a reasonablestandard of quality, care andsafety.


A MULTI-METHOD ETHNOGRAPHIC approachwas used to gather interview, participantobservation and document data. A total of forty-one in-depth, semi-structured, audio taperecorded interviews took place in the three sites.A purposive (Lincoln and Guba, 1985) samplewas built for the key informants such as theexecutive director, union president, managersand so forth. In two of the three sites, a snowballsampling method was used to compile the list offront-line interviews. In one of the sites, at therequest of the Executive Director (E.D.), thesample of front-line workers was drawn from astaff list supplied by the E.D.. Starting at acompletely random point in the list, every ninthworker was contacted and asked to participate inthe study. This process continued until a fullsample was achieved.

The study also included eleven participantobservations. The participant observation siteswere selected through a process in which keyinformants were asked to suggest program sitesthat might provide the most valuable data.Recommendations were cross referenced andsites were selected based on which seemed tooffer the greatest diversity and richness in data.Field notes were taken at the participantobservations which ranged from 4 to 20 hours ineach site with an average observation period ofeight hours. Finally, the study included a reviewof documents related to health and safety.Document data was compiled and comparedacross reporting forms, and statistical profileswere developed.

The average age of those interviewed across thethree sites was 37.1 years with a range of 34 to40 (see chart) and an average of 9.9 yearsemployment in the agency. Similar to thebroader social services field, the sample waspredominantly female. As workers of colour andyouth have been identified in the literature asvulnerable to stress and injury a small sample ofeach of these groups was interviewed.Interviews were transcribed verbatim and readmultiple times for similarities and differences.

Observation and field notes were typed up andcoded along with the interviews using a corecode list. Data was analysed for commonalitiesand differences using a qualitative data proces-sing package called NUD*IST 5 until a mappingof the data could occur.

Methodology

Interviewees were asked questions suchas: What changes have you seen in yourpaid work over the last five years or so?Have the changes generally made yourwork easier, or more difficult? Are thereparticular times of day that are moredifficult than others? What makes themeasier or more difficult? What about thepace of your work, is it about the same orfaster or slower? What about yourworkload? Is it the same, more, less and inwhat ways? Can you comment on howmuch of your work is physical labour? Howmuch of your work is planning, keepingtrack of people or tasks, dealing withconflicting demands? How complex is yourjob? Have you noticed any change in thestress experienced by yourself and your co-workers? Have you experienced any healthproblems related to stress (headaches,stomach discomfort, fatigue, minor sleepdisturbances, anxiety or depression)? Howdo you generally cope with theseproblems? What has been helpful? Whatwould be helpful? Have you noticed anyproblems to do with abuse or violence inyour workplace? Who does violence mosteffect? What kinds of unpaid or familylabour are you involved with — eg. takingcare of your own or other people’s kids,volunteer work, activist work, frail elderlyparents, neighbors, union work, etc.. Haveyou noticed any changes in this kind ofwork?

Are there any questions we’ve forgotten toask that you think might add somethingimportant?

11


FINDINGSand DISCUSSION


Conflict and NegotiationsThe three agencies have different approaches toproblem solving and negotiations with theirunionized work force. Since a short peak in1996/97, strike frequency is down and in anygiven year less than 3% of union negotiations willresult in strike action. Two of the three agenciesstudied had recently been involved in lengthystrike/lockouts regarding classic issues in the era ofrestructuring. At Agency C the central issue of thestrike/lockout was the client-worker ratio while atAgency A the central strike issue was pensions, anot uncommon concern in this sector. In the falloutof the strike/lockout, the Board of Directors at

Agency C felt a new approach was needed andreplaced the Executive Director. Morale at bothagencies has been low since the strikes althoughAgency C has made significant strides in a numberof areas relating to health and safety and there aresome indications that communication is improvingat Agency A. During the time of this study, AgencyB, successfully concluded the negotiation of a newcollective agreement with its workforce whichincluded innovative wording on a number of healthand safety issues such as violence. The differentapproaches to industrial relations highlight thediversity of approaches and priorities across thissector. These highly varied experiences underscorethe ways that the agencies are not all beginning atthe same starting line, nor do they approach issuesin similar ways.

After-the-fact DisciplineBoth Agency A and C reported low staff moralefollowing the strike/lock outs at their work sites.While Agency C saw a change in ExecutiveDirectors as well as an improvement in the overallspirit and direction of the agency, both agencies

The Agencies –A DIVERSE GROUP

This study gathered data at three develop-mental service agencies in Ontario. Together,the three agencies provide services to morethan 1150 clients with intellectual disabilitiesin Ontario. They employ 219 full-time, 260part-time and 30 casual front-line staff. Thegroup of people in our society known as theintellectually disabled are often presented asif they all have similar needs, goals andcapacities. In reality, they are as varied as thenon-disabled population. It is not surprising,then, that the client population at the threeagencies differed significantly.

The clients at Agency A were less able bodiedthan those at the other two agencies, adifference that reflects the aging clientpopulation in this sector. An aging and oftenphysically limited client population increaseslifting and transferring tasks and createschallenges in terms of age appropriateprogramming and activities. Many of theclients at Agency A require 24 hour care inwhich the staff provide full or partialassistance with the tasks associated withdaily living including but not limited to eating,dressing, bathing, toiletting, transferring,transportation, daily programming and stimu-lation, dispensing medications and givinghome-based medical treatments.

Of the three study sites, the clients at AgencyB represented the greatest diversity of clientsin terms of level of ability and need forsupport. Their diverse client population wasalso described as aging although most of theclients are still quite active and fully mobile.

Agency C, on the other hand, providesservices exclusively to clients who require avery high level of support. Mobility is not anissue for these clients although self-injuriousbehavior and, largely unintended, violencetowards others necessitates lower client-worker ratios and individualized program-ming. In short, the agencies are quitedifferent from each other and have engagedin a variety of ways with the challenges ofmeeting client needs in a climate of fundingconstraints.

During the time of this study,Agency B successfully concludedthe negotiation of a new collectiveagreement with its workforce whichincluded innovative wording on anumber of health and safety issuessuch as violence.


Work Reorganization and ShiftsEach of the agencies has its own particular ways ofreorganizing work. At Agency A, restructuringprojects adopted the principle of work forceflexibility. To this end, the number of part-timeworkers has increased while full-time havedecreased. Shifts vary in length from four to twelvehours and split shifts, wherein workers may comein for an hour or two in the morning and returnmany hours later in the day to complete their shift,have emerged as common forms of workarrangements.

Stress is particularly acute for part-time and splitshift employees at Agency A. Most part-timers donot receive enough hours to support themselvesand report a high level of stress associated withkeeping themselves free of other commitments sothey can pick up extra shifts when they becomeavailable. Agency A’s process for filling extra shiftsgenerates significant stress. For example, if a staffmember is unable to take a shift and turns it down,these hours are counted against the maximum 70hours/week that part-timers will be allowed to workin any two week period. In other words, if thestaffer turns down a 10 hour shift, s/he isconsidered to have only 60 left to work in that 2week period. Those working split shifts also

seem to have adopted management styles thatfeature formal disciplinary measures whenproblems with individual workers arise rather thanmore preventive, consultative, problem solvingapproaches. News of disciplinary measuresspreads quickly through the tightly knit workforcein these two agencies generating considerableapprehension and doubt at a time when trust andconfidence in the agency’s leadership is required tore-establish a sense of shared mission. These aresmall agencies and it should not be difficult orcostly to establish mechanisms for inviting theparticipation of employees in problem solving,trouble shooting and negotiating solutions toagency, and even sectoral-level, problems. The cost

savings in terms of stress reduction, improvedemployee health and higher overall client careshould be sufficient impetus to develop strategies toavoid confrontational ways of dealing with anddisciplining the workforce.

Agencies seem to have adoptedmanagement styles that featureformal disciplinary measures whenproblems with individual workersarise rather than more preventive,consultative, problem solvingapproaches.

Stress is particularly acute forpart-time and split shift employees.

Management-WorkerRatios

The management of Agency B decided that inorder to avoid lowering client-worker ratios,the most recent round of funding cuts wouldbe absorbed by management rather thanfront-line staff. This means that Agency B hasthe leanest ratio of management to staff at1:25. During the most recent round of cuts,Agency C maintained its relatively low ratio ofmanagement to workers at 1:19 whileAgency A maintained a large managementcomplement of 1 manager for every 12.5staff.

Staff-Client RatiosAgency C has maintained a very low staff-client ratio which all agree is essential for theprovision of an appropriate level of support fortheir higher need client population. The otheragencies in this study have had difficultymaintaining lower staff-client ratios. Forexample, despite management’s willingness toabsorb the last round of cuts and staff andmanagement’s shared belief that lowering theirstaff-client ratio would lower stress and injuryat Agency B, staff-client ratios have beenundercut by significant increases in thenumber of clients the agency serves.


reported numerous stress related symptoms. Aninability to plan life outside of work and to jugglefamily and work commitments seems to be themajor source of stress for split-shift workers, all ofwhom were part-time. We further recommend anend to the use of split shifts and a guarantee topart-time workers of enough hours to supportthemselves.

Shift replacement generates considerable stressamong front-line workers at Agency C. If someonecalls in sick, which is frequent in Agency C, thosepresently on shift must find a replacement. Whenno one can be found, workers work double or tripleshifts resulting in an extremely high level ofovertime, as well as high levels of stress andexhaustion. In contrast, Agency B’s relatively stablework force and traditional length of shifts standsout as a practice that lowers stress and preventscycles of overwork and burn out, although theirincreased reliance on casual staff in the newprogramming areas may mitigate this achievement.

WorkloadOur data shows that workload has increased in allthree agencies although not always for the samereason. In Agency B an increase in the number ofclients and in documentation has produced anincrease in the pace of work. An increase in thenumber of clients multiplies the volume of directservice work on any shift as well as the associateddocumentation. Workers reported that they oftenlack the infrastructure such as computers, copymachines, faxes or even reliable phones necessaryfor efficient completion of required written reports

and other required paper work. This coupled withan increase in documentation requirements meantthat workers, reluctant or unable to take time fromclient care, felt that they had to complete theirdocumentation on their own time or leave the workincomplete. Both options generate considerablestress and are sub optimal for the agency and clientcare.

In Agency A the post-strike layoff of housekeepingand grounds staff has resulted in an expandedworkload for front-line staff. Cleaning, cooking,shopping, snow shoveling and sidewalk clearing as

well as increased duties such as lifting andtransferring of aging clients has multiplied theincidents of strains, falls, and other injuries relatedto physical duties. In addition, the heavier work-load has left many workers feeling rushedthroughout their shifts and exhausted by their end.Stress is the by-product of this hectic pace andsymptoms such as headaches, fatigue, stomachdisruptions, insomnia and other sleep disruptions,depression and various body pains were reportedby workers during our interviews and participantobservations.

Our data suggests that in Agency C the workload iscomplicated by increased reliance on part-time andcasual rather than full-time workers. Staff andmanagement agreed that clients often react withchallenging and volatile behaviors when faced witheven small changes in their daily schedules. Therisk of injury and stress related health issuesincreases when workers are placed in a situationwhere they must support and care for clients whoare disrupted and anxious due to ongoing staffchanges. This situation is further complicated bythe fact that the agency has no cap on overtime, infact, it has an exemption from the LabourStandards Act. As noted earlier, shift replacementgenerates considerable stress among front-lineworkers at Agency C. When a workers calls in sickthose currently on shift must find a replacement.When no one can be found, workers end upworking phenomenal numbers of hours often overa period of weeks, finally calling in sick when theyare too exhausted and stressed out. Calling in sickre-starts the cycle of last minute shift replacement,

Symptoms such as headaches,fatigue, stomach disruptions, insom-nia and other sleep disruptions,depression and various body painswere reported by workers duringour interviews and participantobservations.

Our data shows that workload hasincreased in all three agenciesalthough not always for the samereason.


double shifts, extensive overtime and staff burnout. A cap on overtime, and the hiring of more full-time staff is the obvious remedy to Agency C’s sky-high expenditures on overtime wages, equally highnumbers of sick days, client disruptions andlowered quality care.

ViolenceOur data suggests that in Agency C the disruptionof clients precipitated by ongoing changes instaffing described above produces higher levels ofinjury. These injuries have their source in violenceperpetrated by clients. In Agency C, the violencefrom clients cannot be said to be entirelyintentional. That is, the clients do not consciously

intend to harm their care providers rather they arereacting to anxiety produced by changes in theirworlds. While largely normalized and excused byworkers and management, our findings show thatviolence is a fairly common occurrence in bothAgency C and B and not infrequent at Agency A.This violence includes punching, gouging, kicking,pinching, hair pulling, biting, wrenching, choking,verbal abuse, or verbal threats against the staffmember and her/his family (usually children) or

possessions (such as a car). At Agency B it appearsthat this violence is largely intentional. Forexample, the violence is directed more often atfemale rather than male employees and often atparticular body parts. Similar to other forms ofviolence against women, this kind of behavior

occurs as a result of deliberate, although sociallyconditioned, choices.

Our findings suggest the violence is an everydayoccurrence in the agencies although largelyunreported and unevaluated. Instead, manyworkers confirmed that they were reluctant toreport violence or even call it violence because theyfelt this reflected badly upon the clients for whomthey felt considerable affection and respect. Despitethis empathy for clients and reluctance to recognizeassaultive behavior as injurious and stressful,workers did note that violence escalates the level ofstress among workers and clients. This stressimpacts negatively on their health as well as theworkplace climate and morale. In many cases,violence clusters at certain points in the day (forexample: end of the programming day,transportation points, after dinner in group homes)suggesting that increased staffing focused on thosetimes is needed to diffuse tensions and lower injuryrates.

As discussed briefly above, workers reported, andmanagement agreed, that violence is more likely tooccur and becomes a greater problem when clientshave to deal with changes in their environment.Hence, it is highly recommended that, in order tolower violence, the agency needs a stable workforce with detailed knowledge of and experienceworking with the client group as well as predictableand dependable work schedules. The increasedreliance on part-time and casual staff in allagencies introduces instability to the workenvironment and increases the likelihood ofviolence and injuries for workers and clients.

Management agreed that stability and adequatelevels of staffing are key to violence preventionhowever they point to funding constraints andargue that there is little they can do. Arguably, it isthe government’s responsibility to provideincreased funding to this sector, however it ismanagement’s responsibility, regardless of thefunding level, to keep the workplace safe.Increasing the numbers of full-time staff at AgencyC is a distinct possibility as significant savings arepossible in the area of overtime and sick time thatcan be transferred to full-time wages and benefits.In Agency B, during this period of funding

Violence includes punching, goug-ing, kicking, pinching, hair pulling,biting, wrenching, choking, verbalabuse, or verbal threats against thestaff member and her/his family(usually children) or possessions(such as a car).

Our findings suggest the violence isan everyday occurrence in theagencies although largely unreport-ed and unevaluated.


constraint, the solutions will have to be morecreative. In seeking those solutions, managementshould turn, in part, to their own workers.Management in all three agencies agreed that theirstaff have front-line knowledge that is key to thesafe running of the agency. The occupational healthliterature show that workers with greater controlover their work experience less stress relatedsymptoms and illnesses (Solderfelt et al, 1997,1996; Karasek and Thorell, 1990; Kohn, 1983;Gardell, 1980). Unfortunately, none of theagencies had any formal mechanism for staff inputinto programme or policy development. As this isnot a new or major cost, it is recommended that theagencies develop ways to integrate worker’s praxisknowledge, or knowledge developed through thedirect experience of working closely with the sameclients over a long period of time, into decisionmaking processes around work organization, clientcare, policy development and violence prevention.

As many clients at Agency A have limited mobility,the risk of workplace violence is lowered althoughnot eradicated. Employees at Agency A reportedminor injuries resulting from slaps, pinches, hairpulling and punches. Like the other agencies, theworkers largely ignored this source of injuryemphasizing work load and work culture as theirmajor sources of stress.

Workplace Culture –Bullying and TraumaAgency A seems to have roughly the same type ofHuman Resource and operating policies as mostagencies in this sector. However, data suggest thatthe way these policies are translated into actiongenerates considerable concern and even fearamong many employees. In particular, the researchparticipants reported that certain individuals or

groups, such as union or environmental activists,received unfair and bullying treatment. Einarsen’s(1999) studies show that employees need not

experience trauma themselves in order to be co-traumatized by merely witnessing or beingassociated with harmful events. Indeed, traumaticwork environments produce more work relatedstress than all other work-related stressors puttogether (Einarsen, 1999; Zapf et al, 1996; Niedl,1995). Research substantiates that bullying ortraumatic work environments can fosterharassment by managers, co-workers, or both(Tehrani, 2001; Einarson, 1999) producing aclimate that is generally harmful and negative.

Workers may experience symptoms includingheadaches, back pain, stomach ailments,insomnia, depression, post-traumatic stressdisorder, chronic fatigue syndrome or suicidalfeelings (Einarson, 1999; UNISON, 1994).Research participants in Agency A reported manyof these symptoms in their interviews and duringour field visits.

Traumatic work environments are costly anddebilitating places to work or to provide qualityservices. Organizations can expect to loseconsiderable work time and compensation,management time and legal costs, as well as anincreasing number of civil law suits. As theUNISON (1994) report based on findings from theStaffordshire University Business School argues, “Itis an organizational issue which needs anorganizational response” (p.2). Management musttake the lead in changing this negative climate asthey and the Board of Directors are the only oneswith the power to effect change across the agency.We recommend the adoption of guidelines thatencourage clearly transparent practices in alldealings with staff so that management practicesare not only fair, but seen to be fair. Guidelines ora Code of Behavior should also be established formanagement including what sorts of words,phrases and behaviors are appropriate in workplace environments including social events. Whileinformality may have been helpful to this agencywhen it was smaller, it is no longer productive or

Traumatic work environments arecostly and debilitating places towork or to provide quality services.

Bullying work environmentsproduce more work related stressthan all other work-relatedstressors put together.


helpful. An independent tribunal with a setschedule for periodic review should be set up bythe agency. This tribunal should be convened by anindependent, outside auditor who has the trust ofmanagement and employees and to whom all canmake reports in anonymity and without fear ofreprisal. Team building exercises and mechanismsthat involve the staff in conflict resolution, problemsolving and policy work and other strategies thatbuild public accountability are crucial to nurturingtrust between those attempting to carry out theimportant work of this agency and cannot beemphasized enough. On a positive note, uppermanagement at Agency A was aware of the needfor more staff involvement in decision making andpolicy development and indicated a strongintention to make more extensive use of staff praxisknowledge and ideas. We strongly endorse thisintention. Research in the U.K. shows that bullyinghas taken over from pay as the top concern amongworkers (Anaova, 2002). Other research showsthat bullying is on the rise in public sectorworkplaces (Tehrani in Summerskill, 2002). As it iscostly and highly unhealthy this sort of workplaceculture needs to be prevented whenever possiblethrough openness and employee participation andfirmly addressed whenever it is found to exist.

Sick LeaveOur data suggests that many workers use their sicktime as a way to deal with their stressful workenvironments and the negative health symptomsgenerated within these environments. At this point,the agencies are absorbing stress leaves throughtheir sick time provisions. These costs run high andare difficult for smaller agencies to absorb.Increased reliance on workers who do not have sick

time provisions, such as part-time and casual staff,means that the cost of sick time will be entirelytransferred to the individual. These kinds ofsolutions are inadequate to the magnitude of thisproblem. There are two strategies that need to beadopted regarding the inappropriate use of sick

leave. First, given that stress is endemic in thissector and shows no signs of abating, werecommend that the WSIB extend its coverage toinclude stress related leaves. Providing stressleaves and strategies now may avoid costly andlong term stress related illnesses in the future.Secondly, agencies must focus on prevention ofstress in the workplace in order to improve thehealth of their employees and eventually reduce oreliminate stress related illnesses and time off.These include the factors discussed throughout thereport and summarized in the final section.

Reporting PracticesReporting practices concerning injuries, illnesses,and violent incidents are completely inconsistentwithin agencies (between programmes) and amongagencies in this sector. Our attempts to compareWSIB data and incident reports has been almostimpossible as reporting practices are highlyvariable. Supervisors, such as some at Agency B,

encourage employees to document everything,while other supervisors, also at Agency B as well asmost at Agency A, seem to discourage any form ofreporting. Indeed, many workers were unaware ofhow or when to complete an incident report andhad little or no idea of what their rights wereregarding WSIB compensation. Our findings showthat the majority of workers require education andclarification on how and when to report workplaceincidents, injuries and illnesses.

Agency C has launched a promising strategy toencourage all employees to report all incidents nomatter how small they may initially seem. This notonly ensures easier compensation should it berequired in the future, it also permits the agency totrack their progress over time in addressing areas ofconcern and risk. We recommend that reportingpractices be standardized within agencies andamong agencies. Without standardized reporting

We recommend that the WSIBextend its coverage to includestress related leaves.

Reporting practices concerninginjuries, illnesses, and violentincidents are completely inconsistentwithin agencies (betweenprogrammes) and among agenciesin this sector.


practices, it is difficult to compare the health andsafety record of agencies in the sector. We have noway of knowing if levels of injury and illness areactually lower or merely unrecognized andundocumented. This also makes it impossible todevelop informed policies and solutions to addressoccupational health problems.

B) The commitment of the staff atAgency C to their high needs clients wasexemplary and observable in almosteverything they. The detailed praxisknowledge displayed and applied byworkers improved client quality of life andsafety of both clients and workers in aworkplace with extremely high rates ofviolent incidents. This best practiceemphasizes the need for managers to findways to include workers and their richknowledge of the workplace in discussionsof work organization, health and safetypromotion and policy development.

C) The physical facilities at Agency Awere clean, bright, spacious and acces-sible. Given the aging client populationand their diminished mobility and activitylevels, accessible and pleasant indoorsurroundings are important to client wellbeing as well as for injury prevention forworkers charged with moving clients fromplace to place and attending to theiremotional and mental needs. Agenciesthat plan for accessibility and appropriateequipment to assist with lifts and transferswill see lower rates of back, ankle,shoulder, arm and neck injuries as themobility of clients decreases with age.

A) At Agency B, we observed a dayprogramme that should be a model forthe sector. The day programme washoused in a community facility that wasbright, attractive, well resourced and wellmaintained. The employees had workedtogether as a team for a long period of timeand operated cooperatively as a tightly knitteam to provide high quality service,individualized care where needed,problem solving and conflict resolution.They had access to a small fund ofdiscretionary money which was used forspecial events, field trips and extras. Theirsupervisor was supportive and permittedthe team a great deal of control over howto organize their work on a daily and evenlonger term basis. The programme didencounter various problems in their work,some of which we observed first hand, butoverall the combination of a supportive,team building supervisor, a skilled, stable,long term workplace team and the spaceand resources with which to buildproductive, long term caring relationshipswith clients and co-workers produced anoptimal work environment with observablylower levels of workplace stress, injury andillness.

Best PracticesEach agency had its own strengths and itsown areas for improvement. At all threeagencies we were impressed by thededication of the employees to their clientsdespite the often stressful and challengingconditions under which they work.

19


CONCLUSION

O the government needs to provide animmediate increase in funding to theagencies in this sector

O in this time of fiscal constraint, agenciesshould maintain low management toworker ratio and a high worker-client ratio

O agencies should lower violence and stressin the workplace by reducing suddenchanges in the workforce (ie. increase useof full-time workers rather than part-time,split shift, or casual)

O employers must guarantee part-timerssufficient hours with which to supportthemselves

O employers should streamline shift replace-ment processes

O employers should place a cap on overtimeand hire full-time, full-benefit staff with thesavings

O split shifts should be eliminated

O agencies should develop mechanismsthrough which the everyday practicalknowledge of front-line employees can beincorporated into client care, the organiz-ation of work, development of policy andoverall mission of the agency

O bullying and traumatic work environmentsshould be assertively addressed by amanagement led strategies featuringtransparent policies and practices, a Code

of Behavior for management, an inde-pendent tribunal who can receiveemployee and management concerns inconfidence and report systematically onthe progress being made

O mechanisms should be established forinviting the participation of employees inproblem solving, trouble shooting andnegotiating solutions to agency, and even,sectoral-level problems, rather thanresorting to highly confrontational meas-ures such as after-the-discipline and thebreak down of contract negotiationsresulting in strike/lock-outs

O management should ensure that reportingpractices are standardized within agenciesand across agencies, WSIB should provideeducation and support to agencies on thisissue

O WSIB should extend its coverage to includestress related leaves

O monies should be made available for stafftraining and development in all aspects ofclient care and health and safety practices


THE GOVERNMENT NEEDS to take the well being of workers and clients in this sector moreseriously and provide an immediate increase in funding. The restructuring of services in this sectorappears to have increased workloads and the health risks associated with over work and burn out.It has also exposed workers and clients to higher levels of stress and violence. While workplacebullying certainly predates restructuring, some studies show that it is a phenomenon that has seenrapid growth within the context of restructured public sector and non profit workplaces (Ananova,2002; Summerskill, 2002). Given the serious under funding of this sector it may appear that thereis little that can be done to improve health and safety in the short term. However, this report hasrecommended several measures that can prevent and reduce injury and illness but are not overlycostly. These include the incorporation of worker’s knowledge into how work is to be organized andplanned, guarantees to part-time workers of enough hours of work to support themselves, an endto the use of split shifts, a cap on overtime and the hiring additional full-time staff in order to ensureworkplace stability as well as the introduction of immediate, assertive, transparent measures toimprove workplace morale and eradicate traumatic workplace cultures.

RECOMMENDATIONS


i In order to ensure the anonymity and confidentialityof the sites and participants, some details on thecomposition of the sample have been omitted.Please refer questions on the methodology to:

Professor Donna Baines,Labour Studies and Social Work,

McMaster University,Hamilton, Ontario M6R 2A9

(905)-525-9140

[email protected].

ii See Deborah DeAngilis, 1998 for a discussion ofthe low rate of strike frequency and Donna Baines,2000 for a discussion of the relationship betweencaring labour and strike frequency.iii This the most conservative figure we have arrivedat. It is difficult to find agreement within thisagency on the number of managers- the figure mayactually be 1:10. Recent layoffs of workers and thehiring of new managers will exacerbate thissituation.iv Research identifies the following risk factors aspredictors of a bullying or traumatic environment:

ENDNOTES

low morale, job insecurity, conflicting goals andpriorities, and negative leadership behavior inmanagers (Brown, 2000: 161). Employees as wellas some managers claimed that Agency Adisplayed the majority of these risk factors. Zapf (inEinarson, 1999) suggests that the following factorsmay be found in a traumatic or bullyingenvironment, 1. work-related bullying which mayinclude changing your work tasks or making themdifficult to perform, 2. social isolation, 3. personalattacks or attacks on your private life by ridicule,insulting remarks, gossip or the like; 4 verbalthreats where you are criticized, yelled at orhumiliated in public, and 5.physical violence orthreats of violence. In order for a workplace to beclassified as traumatic or bullying these factorsmust be in action over a period of time rather thanbeing a one time event. Our data shows that themajority of those interviewed in Agency A describeda work place in which factors 1 through 4 of Zapf’stypology were present in some form. Further, thesefactors were perceived to worsen after the strike butour data shows that they considerably predate thestrike as well.


Ananova (2002). Bullying is the worst problem in workplace.Ananova News Service, September, 2.

Baines, D. (1999). Strike frequency, gender and social caring.Canadian Review of Social Policy. Number 42, Fall.

DeAngelis, D. (1998). Up Where We Belong. Our Times.November/December: 29-35.

Einarsen, S. (1999). The nature and cause of bullying at work.Journal of Manpower. Volume 20, Issue 1/2.

Brown, O. (2000). Why workplace bullying and violence aredifferent: Protecting employees from both. In Tehrani, N.(2001) Violence at work: Supporting the employee. In Gil, M., B. Fisher and V. Bowie. (Eds.). Violence at Work. Causes,Patterns and Prevention. (Pp.151- 160) London: WillanPublishing.

Gardell, B. (1982). Scandanavian research on stress inworking life. International Journal of Health Services. 12, 31-41.

Karasek R. and T. Thorell. (1990). Healthy work: Stress,Productivity and the Reconstruction of Working Life. NewYork: Basic Books.

Karasek, R. (1984). Characteristics of task structureassociated with physiological stress and cardiovascular illness.Annual American Conference on Industrial Hygiene,8, 27-32.

Karasek, R. (1979). Job demands, decision latitude andmental health: implications for job redesign. AdministrativeScience Quarterly. 24, 285-308.

Kohn, M.L. and C.L. Scholler (1983). Work and Personality:An Inquiry into the Impact of Social Stratification. Norwood,NJ: Ablex.

Kohn, M.L. (1976). Occupational structure and alienation.American Journal of Sociology. 82, 111-130.

Lincoln, Y. S. and E. E. Guba. (1985). Naturalistic Inquiry.Newbury Park, CA: Sage.

Messing, K. and J.P. Revert. (1983). Are women in femalejobs for their health? A study of working conditions and health

REFERENCES

effects in the fish-processing industry in Quebec. InternationalJournal of Health Services. 13, 636-648.

Nedl, K. (1996). Mobbing and bell being: Economic andpersonnel development implications. European Journal ofWork and Organizational Psychology. Volume 5, Number 2,239-249.

Solderfeldt, B., M., Solderfeldt, K. Jones, P. O’Camp, C.Muntaner, C.G. Ohlson, and L.E. Warg. (1997). Doesorganization matter? A multilevel analysis of the demand-control model applied to human services. Social Science andMedicine. 44(4), 527-534.

Solderfeldt, B., M. Solderfeldt, P. O’Camp, C. Muntaner, L.E.Warg and C.G. Ohlson. (1996). Psycho social workenvironment in human service organizations: A conceptualanalysis and development of the demand-control model. SocialScience and Medicine. 42(9), 1217-1226.

Sprout, J. and A. Yassi. (1995). Occupational health concernsof women who work with the public. In Messing, K., B. Neis,and L. Dumais (Eds.) Invisible. Issues in Women’sOccupational Health. (Pp. 104- 124), Charlottetown, P.E.I.:Gynergy Books.

Steenland, K. (2000). Research findings linking workplacefactors to cardiovascular disease outcomes. OccupationalMedicine. State of the Art Reviews. Volume 15, Number 1,January-March: 7-19.

Summerskill, B. (2002). Bullying Rife in Britain’s ‘Caring”Jobs. Observer, Sunday, May 12.

UNISON(1994) Bullied. UNISON Members’ Experience ofBullying at Work. London: UNISON.

Woodfield, R. (2000). Women, Work and Computing.Cambridge: Cambridge University Press.

Zapf, D., C. Knorz and M. Kulla. (1996) On the relationsbetween mobbing factors, and content, social workenvironment and health outcomes. European Journal of Workand Organizational Psychology. Volume 5, Number 2: 215-237.


NOTES

improving work organization to reduce injury and illness · 2016-09-19 · improving work...

Documents