Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions

"I am responsible": Perceptions of employees on health and safety program implementation in small and medium sized businesses in Indonesia

BackgroundPrior research conducted in the small bag manufacturing sector in Indonesia reported that occupational injuries occurred almost every month, with some workers reporting severe injuries that led to their fingers being amputated. Another study mentioned that the food manufacturing sectors tend to be more focused on improving their production activities than on paying attention to protecting their workers. Despite these conditions, employees are commonly seen by the owners as being responsible for their own safety at the workplace. Additionally, research examining how employees perceive occupational safety and health (OSH) and the current OSH programming available in SMB food and bag manufacturing in Indonesia is still limited.ObjectiveThis study aims to identify the perceptions among SMBs employees on OSH implementation in small and medium sized food and bag manufacturing businesses in Indonesia.MethodsThis qualitative study utilized in-depth interviews with employees of small and medium sized food and bag manufacturing businesses located in Bogor City, West Java Province.ResultsOccupational injuries happened to employees in almost all the businesses participated in the study. However, almost all the employees are not covered by insurance and accounted themselves to be responsible for both the injuries and to have the insurance. The employees often have casual or 'family-like' relationships with the business owners.ConclusionsThe 'family-like' relationship between business owners and employees in small and medium sized businesses can contribute to employees taking the responsibility for injuries that occur to themselves or their colleagues.

Evaluating the Effectiveness of an Occupational Health and Safety Management System Certification Program on Firm Work Injury Rates in Alberta, Canada

BACKGROUND

Occupational health and safety management systems (OHSMS) certification programs have the potential to improve workplace health and safety. In Canada, the Certificate of Recognition (COR) program is an example of such program and has been introduced in many industries and provinces. This study's objective was to identify whether the implementation of the COR program led to greater reduction in firm work-related injuries in Alberta, Canada.

METHODS

Using firm- and claim-level data from the Workers' Compensation Board of Alberta and COR registration data from Government of Alberta, the effect of becoming COR-certified on firm-level injury rates was assessed using a matched difference-in-differences study design with population-averaged negative binomial regression models.

RESULTS

A total of 14,377 certified firms were matched with 11,338 non-certified firms during the years 2000 to 2015. Firms that became certified had a greater reduction in the lost-time injury rate (IRR: 0.86, 95% CI 0.83-0.88) and disabling injury rate (IRR 0.97, 95% CI 0.94-1.00) relative to the change in injury rates among similar non-certified firms. The effectiveness of OHSMS certification was strongest in the transportation, manufacturing and trade sectors, in more recent years, and among firms certified using the standard COR program as opposed to the program adapted for small employers.

CONCLUSIONS

The findings suggest that COR can be an effective program, but that the effectiveness of this program is dependent on the context in which it is implemented, such as the industry sector, time period, and type of audit program.

Effectiveness of Occupational Safety and Health interventions: a long way to go

Background

Occupational Safety and Health (OSH) has become an area of increasing concern for organizations and institutions. As it evolves, it has gradually posed ongoing challenges, becoming more complex, for organizations. Consequently, more comprehensive studies are required to advance academic and institutional research. From this perspective, this study aims to gather research contributions on the effectiveness of existing interventions for OSH improvement and identify areas for further exploration.

Methods

According to the nature of scientific literature, the overall process of a literature review was investigated following an integrative approach, which involved searching for, selecting, and analyzing various literature in a creative and integrated manner, without a predefined structure.

Results

The analysis suggests that there is room for improvement in understanding the effectiveness of OSH interventions and more concrete guidance is still desirable. Based on the literature, some research areas for future developments in OSH interventions are identified. One potential area to explore further is fostering human-centered technological development and a more conscious network of stakeholders, with higher coordination, shared knowledge, and open communication.

Implications

Focusing on the proposed directions will support scholars and practitioners in pursuing continuous OSH improvement through more effective and well-grounded workplace interventions and encourage organizations to be proactive in daily OSH management.

Job demands and resources of managing directors of micro- and small enterprises: A qualitative study of the German transport industry

BACKGROUND: In many European countries, entrepreneurs have to consider psychosocial factors in the workplace risk assessment. Little is known about psychosocial working conditions in micro- and small companies. Even less is known about the entrepreneur in these settings. OBJECTIVE: The present study was conducted to develop and examine the job demands and resources of small business owners and managers, who serve as important designers of their businesses’ working characteristics. METHODS: N = 29 semi-structured interviews with a unique sample of owners and managers of the transportation sector were analysed via qualitative content analysis. RESULTS: The data suggest the presence of specific demands (time-, management-, and organisational demands) and resources (support and feedback). In particular, the variability and load of the demands indicate that the existing theoretical framework for employees is inadequate for evaluating the working characteristics of micro- and small business managers. CONCLUSION: Occupational health activities in small companies should include the working situation of the entrepreneur/manager.

Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators

Purpose We conducted a systematic review to understand the impact that return-to-work coordinators (RTWCs) have on return to work (RTW) outcomes for sick/injured workers. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and ABI Inform were searched from January 1, 2000 to September 16, 2020. Of 2,927 retrieved and screened citations, 14 quantitative articles fulfilled the eligibility and quality criteria. Quality assessment, data extraction, and evidence synthesis followed article screening. Results We focused on the impact of RTWCs for outcomes of work absence, RTW rates, quality of life, and cost-benefit. Our final synthesis included 14 articles. We found strong evidence that work absence duration was reduced when workers had face-to-face contact with a RTWC. As well, there was strong evidence linking face-to-face RTWC interventions with higher RTW rates and moderate evidence that this reduced intervention costs. RTWC interventions involving the identification of barriers and facilitators to RTW also showed promising results. However, only limited evidence was found that RTWCs improved quality of life for workers. Conclusions Our synthesis identifies key features of RTW interventions that improve RTW outcomes. Future high-quality research should measure long-term outcomes of RTWC interventions to evaluate sustainability and consider the nature of work. They should also focus on RTWC impact on worker quality of life assessments and for older workers and workers with chronic health conditions.

Lessons learned from Ohio workers' compensation claims to mitigate hazards in the landscaping services industry

BACKGROUND

The landscaping services industry is one of the more dangerous in the United States, with higher rates of both fatal and nonfatal injuries than the all-industry average. This study uses claims from the Ohio Bureau of Workers' Compensation (OHBWC) database to identify high rates of occupational injuries and illnesses in this industry in Ohio. The causes of those illnesses and injuries are highlighted to identify common factors.

METHODS

The OHBWC database includes injured-worker industry identification, occupation, business size, demographics, diagnoses, and free-text descriptions of injury circumstances. We identified landscaping service industry claims from 2001 to 2017, and describe annual claim counts and rates.

RESULTS

Over the 17-year period, 18,037 claims were accepted, with "Struck by object or equipment" and "Overexertion involving outside sources" being the most common events or exposures. Sprains and fractures were the most prevalent of the more serious lost-time (LT) injuries. Free-text descriptions of claims indicate that arborist work and loading/unloading of work vehicles and trailers are particularly hazardous. Younger and shorter-tenured workers were injured most frequently, although the average workers' age was higher for LT claims. The total cost of claims to the OHBWC from the landscaping services industry for 2001-2017 was over $226,000,000. Almost $214,000,000, or 94.4%, was for LT injuries and illnesses, even though LT claims comprise only 18% of total claims.

CONCLUSIONS

Targeted improvements in landscaper safety could come from controlling events leading to LT claims. Engineering controls and improved training are strongly recommended to reduce falls, overexertion, and struck-by injuries.

The Italian National Surveillance System for Occupational Injuries: Conceptual Framework and Fatal Outcomes, 2002-2016

Background: A national database of work-related injuries has been established in Italy since 2002, collecting information on the injured person, his/her work tasks, the workplace and the risk factors contributing to incident dynamics, according to a model called Infor.Mo. Methods: A descriptive study of occupational fatal injuries, excluding work-related fatal traffic injuries, that occurred in Italy from 2002 to 2016 (15 years) was performed. Results: Among 4874 victims involved, all were males, mainly >51 years of age (43.2%), predominantly self-employed (27.8%) or workers with non-standard contracts (25%). About 18.4% and 17.3% of fatal events occurred in micro-enterprises belonging to, respectively, construction and agriculture. A wide range of nationalities (59 countries in addition to Italy) was identified. Overall, 18.9% of work-related fatal injuries were due to some form of hazardous energy—mechanical, thermal, electrical or chemical—that was normally present in the workplace. Workers’ falls from height (33.5%), heavy loads falling on workers from height (16.7%) and vehicles exiting their route and overturning (15.9%) were the events causing the greatest proportion of occupational fatal injuries in the present study (from 2002 to 2016) and in the initial pilot phase, focused on years 2002–2004, with a similar distribution of fatal events between the two time periods. The activity of the injured person made up 43.3% of 9386 risk factors identified in 4874 fatalities. Less common risk factors were related to work equipment (20.2%), work environment (14.9%), third–party activity (9.8%), personal protective equipment/clothing (8.0%) and materials (3.7%). The activity of the injured person remained the most relevant contributing factor even when the incident was caused by two or more risk factors. Discussion: Occupational fatal injuries occurred mainly in small size firms (up to nine employees) in hazardous workplaces. Small companies, which account for 68% (2888/4249) of all firms in the present study, generally have fewer resources to remain current with the continuously evolving health and safety at work regulations; moreover, these firms tend to be less compliant with health and safety at work regulations since they are less likely to be inspected by occupational vigilance services. Perspectives: An approach being introduced in Italy relies on the use of economic incentives to promote safe and healthy workplaces. The comparison of pre-intervention and post-intervention rates of work-related injuries by means of interrupted time series analyses could detect whether the intervention will have an effect significantly greater than the underlying secular trend.

The Impact of Enforcement Capabilities on the Effectiveness of Public Assessment on Occupational Safety

(1) Objective: The objective of this study was to evaluate the effect of enforcement capabilities on the efficacy of two public interventions to improve occupational safety in olive mills. (2) Method: The difference in efficacy was evaluated by comparing the risks detected in two groups in an initial assessment (with visits in the 2006-2008 period) to the risks detected in a later assessment, either after an intervention by Authorized Technicians with enforcement capabilities or after an intervention by Technical Advisors without enforcement capabilities (2011-2013). The assessments identified risks in the companies, according to a specific risk map for olive oil mill enterprises. (3) Results: Statistically significant differences were observed in the comparison of the risk reductions of the two groups, with regard to the initial assessment. The greatest reductions in risk were found in the companies that received interventions by Authorized Technicians with enforcement capabilities, in the sections of individual protection equipment and the storage of dangerous products. (4) Conclusion: Interventions by Authorized Technicians with enforcement capabilities are more effective than interventions by Technical Advisors without enforcement capabilities.

Conference Summary Understanding Small Enterprises Conference, 25-27 October 2017

Objectives

The specific objectives of the 2017 Understanding Small Enterprises Conference were to: (i) identify successful strategies for overcoming occupational safety and health (OS&H) barriers in small and medium-sized enterprises (SMEs); (ii) disseminate best practices to research and business communities; (iii) build collaborations between different stakeholders including researchers, insurers, small enterprises, government agencies; and (iv) better inform OS&H research relevant to SMEs.

Methods

A two and a half day international conference was organized, building upon three previously successful iterations. This conference brought together researchers, practitioners, and other stakeholders from 16 countries to share best practices and emerging strategies for improving OS&H in SMEs.

Findings

Cross-cutting themes that emerged at the conference centered around: 1) stakeholder and intermediary involvement; 2) what occupational health and safety looks like across different industries; 3) intervention programs (tools and resources); 4) precarious and vulnerable work and the informal sector; and 5) Total Worker Health® in SMEs.

Conclusion

A number of innovative initiatives were shared at the conference. Researchers must build collaborations involving a variety of stakeholder groups to ensure that OS&H solutions are successful in SMEs. Future OS&H research should continue to build upon the successful work of the 2017 Understanding Small Enterprises Conference.

Firefighters as distributors of workplace safety and health information to small businesses

BACKGROUND

Small businesses bear a large burden of injury and death, and are difficult to reach with occupational safety and health (OSH) information. The National Institute for Occupational Safety and Health (NIOSH) developed a pilot study testing the feasibility of fire departments disseminating OSH information to small businesses during fire inspections.

METHODS

Two sets of postcards were developed with unique, trackable URLs for the NIOSH Small Business Resource Guide. One set was distributed by firefighters, the other was mailed to small businesses. Participating inspectors were met with to discuss their experience.

RESULTS

Neither distribution method resulted in a substantial number of site visits. Inspectors believed distributing postcards was an easy addition to their duties, and saw value in safety information.

CONCLUSIONS

There are barriers beyond awareness of availability that prevent small business owners from seeking OSH information. Research should focus on identifying barriers and developing better OSH information diffusion mechanisms.

Injured workers and their return to work

Purpose

– The purpose of this paper is to study the factors affecting the return to work (RTW) of injured workers in an institutional setting where workers’ earnings are fully compensated during the disability period.

Design/methodology/approach

– The authors use a unique data set matching employer-employee panel data with Italian workers’ compensation records. The authors estimate survival models accounting for workers’ unobserved heterogeneity.

Findings

– Workers with higher wage growth, higher relative wages and from firms with better histories of stable employment, RTW sooner. More vulnerable workers – immigrants, females, members of smaller firms – also tend to return sooner. But even when we control for such measures of commitment, status, and job security, high-wage workers RTW sooner.

Research limitations/implications

– The authors use proxies as measures of commitment and status. The authors study blue-collar workers without finer job qualifications. The authors estimate a reduced form model.

Practical implications

– In an institutional environment where the immediate cost of workers’ compensation benefits falls largely on firms, employers seem to pressure those workers whose time off is more costly, i.e., high-wage workers. The lack of evidence of ex post moral hazard behavior also demands for a better understanding of the relationship between benefits and RTW.

Social implications

– Workers who are induced to RTW before full recovery jeopardize their long- term health and employability. Firms that put such pressure on employees might generate social costs that can be particularity high in the case of high productivity workers.

Originality/value

– The paper offers the first quantitative analysis of an institutional setting where injured workers face 100 percent benefits replacement rate and have job security. This allows focus on other workers’ or employers’ reasons to speed RTW. It is one of very few economics studies on this topic in the European context, providing implications for human resource managers, state regulators, and unions.

The relationship between worker, occupational and workplace characteristics and whether an injury requires time off work: a matched case-control analysis in Ontario, Canada

BACKGROUND

The objective of this study was to examine individual, occupational, and workplace level factors associated with time loss following a similar injury.

METHODS

Seven thousand three hundred and forty-eight workers' compensation claims that did not require time off work were matched with up to four claims that required time off work on the event, nature, and part of body injured as well as injury year. Conditional logistic regression models examined individual, occupational, and workplace level factors that were associated with the likelihood of not requiring time off work.

RESULTS

Employees from firms with higher premium rates were more likely to report no time loss from work and workers in more physically demanding occupations were less likely to report no time loss from work. We observed no association between age or gender and the probability of a time loss claim submission.

CONCLUSIONS

Our results suggest that insurance costs are an incentive for workplaces to adopt policies and practices that minimize time loss following a work injury.

The Collision Auto Repair Safety Study (CARSS): a health and safety intervention

BACKGROUND

Collision repair employs approximately 205,500 people in 33,400 shops. Workers are exposed to a diverse array of chemical, physical, and ergonomic hazards.

METHODS

CARSS was based on a random and purposeful sample. Baseline and one baseline and one-year evaluations consisted of 92 questions addressing issues, such as Right-to-Know, fire protection, painting-related hazards, ergonomics, electrical safety, and personal protective equipment. Owners received a report and selected at least 30% of items found deficient for remediation. In-person and web-based services were provided.

RESULTS

Forty-nine shops were evaluated at baseline and 45 at follow-up. At baseline, 54% of items were present. This improved to 71% at follow-up (P < 0.0001). Respiratory protection improved 37% (P < 0.0001) and Right-to-Know training increased 30% (P < 0.0001). Owners completed 61% of items they selected for remediation.

CONCLUSIONS

Small businesses' interventions should address the lack of personnel and administrative infrastructure. Tailored information regarding hazards and easy-to-use training and administrative programs overcome many barriers to improvement.

Application of a model for delivering occupational safety and health to smaller businesses: Case studies from the US

Smaller firms are the majority in every industry in the US, and they endure a greater burden of occupational injuries, illnesses, and fatalities than larger firms. Smaller firms often lack the necessary resources for effective occupational safety and health activities, and many require external assistance with safety and health programming. Based on previous work by researchers in Europe and New Zealand, NIOSH researchers developed for occupational safety and health intervention in small businesses. This model was evaluated with several intermediary organizations. Four case studies which describe efforts to reach small businesses with occupational safety and health assistance include the following: trenching safety training for construction, basic compliance and hazard recognition for general industry, expanded safety and health training for restaurants, and fall prevention and respirator training for boat repair contractors. Successful efforts included participation by the initiator among the intermediaries' planning activities, alignment of small business needs with intermediary offerings, continued monitoring of intermediary activities by the initiator, and strong leadership for occupational safety and health among intermediaries. Common challenges were a lack of resources among intermediaries, lack of opportunities for in-person meetings between intermediaries and the initiator, and balancing the exchanges in the initiator-intermediary-small business relationships. The model offers some encouragement that initiator organizations can contribute to sustainable OSH assistance for small firms, but they must depend on intermediaries who have compatible interests in smaller businesses and they must work to understand the small business social system.

Two-year follow-up of the Collision Auto Repair Safety Study (CARSS)

This paper presents an evaluation of the sustainability of health and safety improvements in small auto collision shops 1 year after the implementation of a year-long targeted intervention. During the first year (active phase), owners received quarterly phone calls, written reminders, safety newsletters, and access to online services and in-person assistance with creating safety programs and respirator fit testing. During the second year (passive phase), owners received up to three postcard reminders regarding the availability of free health and safety resources. Forty-five shops received an evaluation at baseline and at the end of the first year (Y1). Of these, 33 were evaluated at the end of the second year (Y2), using the same 92-item assessment tool. At Y1, investigators found that between 70 and 81% of the evaluated items were adequate in each business (mean = 73% items, SD = 11%). At Y2, between 63 and 89% of items were deemed adequate (mean = 73% items, SD = 9.5%). Three safety areas demonstrated statistically significant (P < 0.05) changes: compressed gasses (8% improvement), personal protective equipment (7% improvement), and respiratory protection (6% decline). The number of postcard reminders sent to each business did not affect the degree to which shops maintained safety improvements made during the first year of the intervention. However, businesses that received more postcards were more likely to request assistance services than those receiving fewer.

A model for design of tailored working environment intervention programmes for small enterprises

Objectives

Small enterprises have higher exposure to occupational hazards compared to larger enterprises and further, they have fewer resources to control the risks. In order to improve the working environment, development of efficient measures is therefore a major challenge for regulators and other stakeholders. The aim of this paper is to develop a systematic model for the design of tailored intervention programmes meeting the needs of small enterprises.

Methods

An important challenge for the design process is the transfer of knowledge from one context to another. The concept of realist analysis can provide insight into mechanisms by which intervention knowledge can be transferred from one context to another. We use this theoretical approach to develop a design model.

Results

The model consist of five steps: 1) Defining occupational health and safety challenges of the target group, 2) selecting methods to improve the working environment, 3) developing theories about mechanisms which motivate the target group, 4) analysing the specific context of the target group for small enterprise programmes including owner-management role, social relations, and the perception of the working environment, and 5) designing the intervention based on the preceding steps. We demonstrate how the design model can be applied in practice by the development of an intervention programme for small enterprises in the construction industry.

Conclusion

The model provides a useful tool for a systematic design process. The model makes it transparent for both researchers and practitioners as to how existing knowledge can be used in the design of new intervention programmes.

Workplace health understandings and processes in small businesses: a systematic review of the qualitative literature

INTRODUCTION

Small businesses (SBs) play an important role in global economies, employ half of all workers, and pose distinct workplace health problems. This systematic review of qualitative peer-reviewed literature was carried out to identify and synthesize research findings about how SB workplace parties understand and enact processes related to occupational health and safety (OHS).

METHODS

The review was conducted as part of a larger mixed-method review and in consultation with stakeholders. A comprehensive literature search identified 5067 studies. After screening for relevance, 20 qualitative articles were identified. Quality assessment led to 14 articles of sufficient quality to be included in the meta-ethnographic findings synthesis.

RESULTS

This review finds that SBs have distinctive social relations of work, apprehensions of workplace risk, and legislative requirements. Eight themes were identified that consolidate knowledge on how SB workplace parties understand OHS hazards, how they manage risk and health problems, and how broader structures, policies and systems shape the practice of workplace health in SBs. The themes contribute to 'layers of evidence' that address SB work and health phenomena at the micro (e.g. employer or worker behavior), meso (e.g. organizational dynamics) and macro (e.g. state policy) levels.

CONCLUSIONS

This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social relations can limit workers' and employers' apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcontracting) can complicate occupational health responsibilities. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interventions and improved worker representation.