Efforts to implement workplace ergonomic programs aimed at reducing the burden of work-related musculoskeletal disorders (WMSD) have to address multiple physical and psychosocial aspects of work environments yet often contextual factors limit their success. We describe the processes involved in an ergonomic program to reduce neck and upper limb WMSDs at a large Canadian newspaper. Using qualitative data collection and analysis methods, we illustrate the impact of key contextual characteristics of: (1) the program (management commitment, union involvement, experience and skill of program leaders, and researcher involvement); (2) the organization (drive for productivity, management control, organizational culture); and (3) the broader social context (economic climate, nature of newspaper work, technology and nature of WMSD). We argue for increased attention to identification and response to the contextual factors affecting program implementation in order to more successfully address upstream determinants of WMSD.
A broad range of physical (Bernard, 1997) and psychosocial (Bongers et al., 1993) factors have been epidemiologically established as risk factors for the development of work-related musculoskeletal disorders (WMSDs) (Punnett and Bergqvist, 1997). In a multi-causal framework, different risk factors may be mutually reinforcing in the production or aggravation of WMSDs through complex biologic pathways (Moon and Sauter, 1996; Carayon et al., 1999). Workplace interventions seeking to reduce the burden of WMSDs need to improve both physical and psychosocial aspects of work environments, at the job and organization levels, combining both macro- and micro-ergonomic approaches (Hendrick, 1994). Addressing organization-level (or “upstream”) factors at a workplace level, holds the promise of reducing “downstream” risk factors for WMSDs (Hagberg et al., 1995), while at the same time contributing to healthier workplaces (Robson et al., 1998; Lindstrom et al., 2000).
However, making the organization of work “healthier” has proved difficult (Kompier and Cooper, 1999). Challenges include bringing human considerations into design (Wulff et al., 1999; Burns and Vicente, 1999), dealing with other ongoing organizational change initiatives (Westlander, 1995), and working through adversarial industrial relations (Laitenen et al., 1998). Such challenges have prompted closer examination of the processes through which workplace interventions are implemented (Griffiths, 1999; St-Vincent et al., 2000) and clearer delineation of the context for implementation of organizational changes aimed at improving worker health (Haslam, 2002).
An opportunity for such examination arose out of collaborative research initiated by a union and management of a large Canadian newspaper to deal with repetitive strain injury or RSI, a common lay term for WMSDs of the neck and upper limb (Polanyi and Cole, 2003). Earlier research on burden, potential causes and existing activities addressing RSI (Polanyi et al., 1997) was used during joint management, union and researcher sessions to formulate recommendations for reducing RSI/WMSDs among employees. Backed up by a formal agreement during collective bargaining, the company's health, safety and environment manager drafted an ergonomic policy with accompanying mission, objectives, activities and responsibilities (Cole et al., 2002). The draft policy was revised by the joint labour–management RSI Committee, embodied in the “Stop RSI Program”, officially launched in November 1998, and implemented over the following four years.
In this paper, we report findings on contextual factors that influenced the process of ergonomic policy/Stop RSI Program implementation. A quantitative impact evaluation, based on repeat surveys of workers, is to be reported elsewhere. Using a qualitative approach, we address the following questions:
(1)
What were the expectations and intentions of the designers and implementers of the ergonomic policy?
(2)
How did other workers and managers perceive, understand and account for implementation of the ergonomics policy?
(3)
How did ergonomics policy implementation interface with broader organizational processes, norms and structures?
2. Methods
Our qualitative analysis of the implementation process of an ergonomics program found that program (management commitment, union involvement, experience and skill of program leaders, and researcher involvement), organization (drive for productivity, management control, organizational culture) and broader social (economic climate, nature of newspaper work, technology and nature of WMSD) contexts each affect the implementation of ergonomics programs. More reflective approaches to interventions, involving a fuller analysis of context, open dialogue with workplace parties, and encouragement to expand mandates “upstream” may increase the likelihood of successful actions to reduce the burden of WMSD.
