Protocol for a mixed-methods study on leader-based interventions in construction contractors' safety commitments

BACKGROUND

Owing to high injury rates, safety interventions are needed in the construction industry. Evidence-based interventions tailored to this industry are, however, scarce. Leader-based safety interventions have proven more effective than worker-based interventions in other industries.

OBJECTIVE

To test a leader-based safety intervention for construction sites. The intervention consists of encouraging safety coordinators to provide feedback on work safety to the client and line management. The intention is to increase communication and interactions regarding safety within the line management and between the client and the senior management. It is hypothesised that this, in turn, will lead to increased communication and interaction about safety between management and coworkers as well as an increased on-site safety level.

SETTING

A group-randomised double-blinded case study of six Danish construction sites (three intervention sites and three control sites). The recruitment of the construction sites is performed continuously from January 2010 to June 2010. The investigation of each site lasts 20 continuous weeks.

METHODS

Confirmatory statistical analysis is used to test if the safety level increased, and if the probability of safety communications between management and coworkers increases as a consequence of the intervention. The data collection will be blinded. Qualitative methods are used to evaluate if communication and interactions about safety at all managerial levels, including the client, increase.

OUTCOME MEASURES

(1) The proportion of safety-related communications out of all studied communications between management and coworkers. (2) The safety level index of the construction sites.

Safety walkarounds predict injury risk and reduce injury rates in the construction industry

BACKGROUND

"Safe Workplace"-a simplified and educational version of the Finnish building construction methodology involving safety walkarounds where a number of safety indicators are inspected and evaluated-is in widespread use in the Danish construction sector to evaluate physical safety standards proactively at construction work sites.

METHODS

Data from the construction of the Copenhagen Metro were analyzed to determine the method's ability to predict injury risk related to joint responsibilities and individual worker responsibilities.

RESULTS

A statistically significant association between the risk level as measured by the Safe Workplace methodology and injury risk was found. The relative risk of injury increased with the number of safety indicators violated and was elevated for safety indicators reflecting both individual and joint safety responsibility. The observed injury risk was not elevated in the post-safety walkaround period for safety indicators of individual responsibility, but the joint responsibility indicators retained an elevated injury risk level.

CONCLUSIONS

The data support the hypothesis that safety walkarounds both predict and prevent injuries. Safety indicators of individual responsibility are more likely to be corrected than those of joint responsibility.

Disability retirement among workers involved in large construction projects

BACKGROUND

The aim of this study was to evaluate the incidence of disability pension among workers engaged in the construction of the Øresund Link or the Copenhagen Metro, representing high levels of safety management.

METHODS

The study subjects (n = 1,808) were followed for disability retirement. Age standardized incidence ratios (SIRs) were calculated and compared with SIRs of disability pension established in a previous study of workers engaged in the construction of the Great Belt Link (N = 5,882), representing a low level of safety management.

RESULTS

Compared with all economically active men, the age SIR of disability retirement was 2.22 (95% CI = 1.61, 2.98) among the study subjects and 2.29 (95% CI = 1.9, 2.67) among workers at the Great Belt Link.

CONCLUSION

No significant progress was found in the incidence of disability pension among the study subjects despite substantial improvements in safety management compared with the Great Belt Link.

Social inequalities in injury occurrence and in disability retirement attributable to injuries: a 5 year follow-up study of a 2.1 million gainfully employed people

Background

Inequalities in injury related disability retirement may be due to differences in injury risk and or differences in retirement given injury. The aim of the present study was to measure social inequalities in injury occurrence and injury related disability retirement.

Methods

All people in the Danish labour force aged 20–59 years 1 January 1997 were followed for injury related hospital contacts during 1997 and all people in the Danish labour force aged 21–54 years 1 January 1998 were followed for injury related hospital contacts during 1997 and for disability retirements during 1998–2002. As inequality indices we used excess fractions (EF) i.e. the proportions of the cases that would not have occurred if the risks in each social group had been as low as they were in the occupational group with the highest skill requirements.

Results

With regard to the risk that an injury will occur, the EF was 36% among men and 10% among women. With regard to the risk that an injury will lead to disability retirement, the EF was 43% among men and 47% among women. The combined effect of the two types of inequalities rendered an EF for injury related disability retirement of 64% among men and 53% among women. The correlation between the case disability rate ratios among men and those among women was low (r = -0.110, P = 0.795).

Conclusion

The social inequality in injury related disability retirement lies only to some degree in the differences in the injury risk. More important are differences in the consequences of an injury. This was especially pronounced among the women.

Prospective analysis of disability retirement as a consequence of injuries in a labour force population

The aim of the present work was to investigate the influence of different types of injury on the risk for disability retirement among economically active people in Denmark.

MATERIAL AND METHODS

In this prospective study, all people in the Danish labour force aged 21-54 years 1 January 1997 (N = 2 211 057) were followed for disability retirement during 1997-2001. Age and gender standardised incidence ratios (SIR) were calculated to compare retirement rates among those who received treatment for an injury during 1996 (N = 252 468, including both work-related and non-work related types) with the rates in the total labour force. Life-table methodology was used to calculate years of lost economically active life (YLEAL) by injury type.

RESULTS

Among the injured people we observed a total number of 5580 cases of subsequent disability retirement and 45% of these could be statistically attributed to the injury. The SIR for disability retirement by injury type ranged from 1.38 to 7.00. The least severe types, superficial injuries and dislocations, sprains, and strains, were most prevalent and generated the highest numbers of YLEALs.

CONCLUSION

The high frequency of injuries and their influence on retirement rates suggest that injury prevention is a highly relevant approach to reduce future costs from disability retirement. YLEAL calculations can be used to set priorities.

Prioritizing occupational injury prevention in the construction industry: injury severity or absence?

PROBLEM

National occupational injury prevention goals often prioritize the reduction of serious injuries. This study analyzed whether this prioritization is credible in respect to lost-time injuries and short and long term work absence, and the implications this has for injury severity-based versus injury absence-based prevention approaches.

METHOD

The data consisted of national and work-site specific injury and absence data from construction workers in Denmark, including workers from the Copenhagen Metro construction sites, during the period 2000-2001.

RESULTS AND IMPACT ON INDUSTRY AND GOVERNMENT

Absence length was significantly dependent on the type of injury. Sprains and strains were most prevalent and accounted for approximately one third of injuries and absence. Fractures accounted for one sixth of injuries and the greatest proportion of long-term absence. The results give credibility to the need for targeting sprains and strains in injury and absence prevention initiatives.

Disability retirement among former employees at the construction of the Great Belt Link

OBJECTIVE

To investigate incidences of disability retirement among men who had been employed at the construction of a large traffic link in Denmark, which involved long working hours and long distances between home and work place.

METHODS

Men aged 20-54 years at baseline who had been engaged in the construction of the Great Belt Link (n = 5882) were followed-up for disability retirements from 1996 to 2000. Age-standardized incidence ratios (SIR) were calculated and compared with those of other construction workers (n = 117,157). All economically active men in Denmark were used as the standard population.

RESULTS

The SIRs for the two groups were 2.29 (95% confidence intervals (CI): 1.95-2.67) and 0.98 (95% CI: 0.93-1.03), respectively.

CONCLUSIONS

The Great Belt construction workers had an elevated risk for disability retirement compared with other construction workers and with economically active men in general.

Efficiency in reducing lost-time injuries of a nurse-based and a first-aid-based on-site medical facility

OBJECTIVES

The purpose of the study was to evaluate the efficiency of two standards for on-site medical facilities in reducing lost-time injuries during the construction of the link across the Oresund sound between Sweden and Denmark. One medical facility employed licensed nurses, who had advanced medical assistance at their disposal. The other medical facility utilized first-aid-trained watchmen. The on-site medical facilities aimed both at providing immediate medical assistance to workers subjected to occupational injuries and at reducing lost worktime.

METHODS

The distributions of injuries treated on-site (the worker resumed work after treatment) and injuries sent to hospitals or to specialists were compared for each type of injury and for each category of injured body part.

RESULTS

The on-site medical facilities dealt, in particular, with the treatment of ocular injuries (21%), wounds (21%), and sprains or strains (15%). The study showed a statistically significant on-site treatment (and resume work) rate ratio of 3.3 between the nurse-based (76%) and the first-aid-based (23%) medical facility.

CONCLUSIONS

The construction of the Oresund Link shows a need for on-site medical facilities, particularly at remote construction sites, and that it is essential that the medical personnel have both the qualifications and authorization to treat site-specific workplace injuries effectively in order to obtain high on-site treatment rates.

Mortality and morbidity among bridge and tunnel construction workers who worked long hours and long days constructing the Great Belt Fixed Link

OBJECTIVES

This study aimed at estimating the mortality and morbidity of hospital treatment among bridge and tunnel workers who worked round the clock, long hours, and long weeks to construct the Great Belt Fixed Link.

METHODS

A cohort of all Danish workers in the construction industry was followed for death and first hospitalization and outpatient or emergency ward treatment over 6 years. Standardized mortality and morbidity ratios (SMR) were calculated for selected diagnoses, and 5123 bridge and tunnel construction workers were compared with all 109 383 Danish construction workers.

RESULTS

The comparison showed an overall SMR of 124 with a 95% confidence interval (95% CI) of 97-155. For infectious diseases and intestinal infectious diseases, the corresponding values were 156 (95% CI 132-184) and 167 (95% CI 117-230), respectively. For diseases of the nervous system, it was 138 (95% CI 118-160), and including nerve, nerve root and plexus disorders it was 135 (95% CI 104-171), for instance, mononeuropathies of the upper limbs (SMR 136, 95% CI 101-180). The SMR was 139 (95% CI 126-153) for circulatory diseases, 157 (95% CI 130-189) for ischemic heart disease, 129 (95% CI 114-146) for diseases of the respiratory system, 124 (95% CI 114-135) for diseases of the digestive system, and 115 (95% CI 108-123) for diseases of the musculoskeletal system and connective tissue, including other intervertebral disc disorders (than cervical) (SMR 130, 95% CI 109-154).

CONCLUSIONS

Bridge and tunnel workers who work round the clock, long hours, and long weeks have a mortality rate that is as high as that of other construction workers, and they are treated more often in hospitals.

Industrial differences in disability retirement rates in Denmark, 1996-2000

OBJECTIVES

The objective of the study was to identify industries associated with a high risk of disability retirement and to roughly estimate the fraction of the retirements that can be attributed to a non-optimum work environment.

MATERIALS AND METHODS

All economically active people in Denmark, aged 20-54 years, in the beginning of 1996 (1196235 men and 1063058 women) were followed-up from 1996 to 2000. Gender stratified and age standardized incidence ratios (SIR) for disability retirement were calculated for each of 58 baseline industries. A Monte-Carlo simulation model was used to estimate attributable fractions.

RESULTS

In total, we observed 17242 disability retirements among the men and 20910 among the women. The attributable fraction was 38% for the women and 40% for the men. Twenty-six of the SIR-values (13 among the men and 13 among the women) were statistically significantly high. Twenty-two of the 26 groups with a high SIR had been identified by previous research as groups at high risk of circulatory disease and/or musculoskeletal disorders. Two of the remaining four groups with a high SIR were associated with hard physical work (men and women engaged in horticulture and forestry) while the other two consisted of men in female-dominated industries (child-care and cleaning).

CONCLUSIONS

The present study identified a series of high-risk industries. It also corroborated previous findings, which state that circulatory disease and musculoskeletal disorders are major risk factors and that hard physical work is an independent risk factor of disability retirement. Further research is needed to find out why men in some stereotypically feminine industries are at high risk of disability retirement.