Presentation by Chris Plott, US West
MR. LEGRANDE: Chris Plott is the ergonomist for US West. He has 13 years of experience and is a Certified Professional Ergonomist. He holds Masters degrees in Industrial Engineering and Business Administration, and a Bachelors degree in Kinesiology. His work experience entails a number of areas of ergonomics, including applied ergonomics, user computer interface design, human performance modeling, simulation and human factors evaluation and test of complex systems. It is, indeed, a treat to work with Chris, directly and indirectly, from 2,000 or so miles away, in part because I know in working with Chris the work is being done pretty much as if the union were doing it or an extremely competent person was doing it. That is, needless to say, what objectively both the union and the company would like. Chris.
MR. PLOTT: Thank you. Dave is a little generous there, I think, in his comments, but the first thing I am going to talk about is our medical management program. In 1991-92, we started to be more aggressive in implementing this program, and it has had very nice payoffs for us. Part of what we have done is to make it easier for early reporting through an 800 number that all employees are made aware of and that they can call to report any injury, illness or incident. We try to remove some of those barriers to get some of the reporting taken care of.
We have early treatment by an appropriate type of professional healthcare provider. We work with the local healthcare providers to pursue conservative treatment strategies, we have negotiated with the union a return-to-work-light-duty policy and have had that implemented by local managers. This is relatively consistent, if any of you went to the presentation yesterday on medical management with a lot of the approaches they were advocating there as well. The results of this have been a real dramatic reduction in our cost per case and workers' compensation cost. As you can see, in 1990 we were at about $9,000 per case. In the last quarter of '96, we were down just under $2,000 per case. There is a dramatic reduction in our cost per case in addressing these injuries and illnesses.
With that I am now going to move into some quick case studies. I hope I don't turn the fire hose on too fast for you, but I have a fair amount of information to cover here. Operator and Information Services, as Nance mentioned, are the folks who will answer when you call up and ask for information. They give you phone numbers information or help in making calls. These are the folks at their desks, pretty much tied to the phone most of the day. There is not real high intensity keying, but just call after call after call, in terms of the processing that they are doing. It is the character of the job.
That was the first work group with which we had cumulative trauma disorders occurring and where we first started taking action. Management of that organization took ownership of this and wanted to try to address these issues within their organization. They developed training and bought specialized equipment tailored specifically to the job functions and how they were done. A work smart training program was established in 1990, and this was specifically targeted at these jobs. It talked about body postures and the risk factors associated with those and how to get into good body postures. They had stretching and exercising activities. It had keying technique activities in terms of keying lightly and timing of keying and so on and even some biofeedback to achieve desired postures of the hand and wrist.
All centers were done on a center by center basis over this 1987 to 1985 period it. It wasn't a flash cut. It was rolled out over time. They upgraded to state-of-the-art furniture and equipment. By state-of-the-art, I mean fully adjustable for a wide range of the working population and for sit/stand capability and also fully adjustable seating. Another part of this program they had regular follow up and assessment by the managers and coaches. The managers and coaches would, on a regular basis, sit with the employees and not only assess their ability to do the job but also their posture and techniques and give them feedback on that and make sure that they were using good ergonomic practice.
I will do a quick review of one of latest and greatest work stations. We have a fully adjustable chair there, the terminal and keyboard for the system. There is no mouse with this. The stand is independently adjustable for the keyboard surface and work surface. This one happens to be powered. You can just press a button and it will also raise and lower it. We have counter balance and cranking type mechanisms as well. These are shared work stations. This is a seven-day-a-week, 24-hour operation. When a person takes a break they may not end up at the same work station, so they have the capability of moving some of their accessories and so on around with them and they do that.
As a result of this, we have had a very nice drop off. We had a little dip in '91 and then it bounced back up. We had a very nice drop off since that time in these work groups and in bringing our rates down. They are still a higher rate work group, three cases per hundred employees, but we are moving it down considerably with some of these interventions.
The next work group we will talk about is Remittance Processing Services. These people open up the payment envelope, take a look at the bill, take a look at the check, record how much you paid and send the check off to the bank. Historically, this was a semi-automated work process involving repetitive hand movements, often with awkward hand and sitting postures. It was a real hot bed for us for awhile.
This is an example of the before hand postures. What this person is doing is holding the bill and the check in one hand, separating them out so they can see the amounts and then 10 keying into the system. This person happens to be a one finger 10 keyist, so you can see the improper posture associated with that. So it is not too surprising we were having some cases here.
In 1993, management decided to redesign and upgrade the centers to increase productivity through the introduction of new automation technology. At this time, labor and management discussed the impacts of the changes on people's jobs because of the injuries and illnesses they were having in these work environments, the desire to introduce automation and so on. Because they were going to be totally revamping these centers and introducing new technology, management agreed to introduce concepts such as job enlargement, job rotation and ergonomic principles into the new center design. So this was up front before they ever started picking and purchasing equipment. They agreed to try to pursue these processes with the union, and management largely did the design and implementation of this.
The new centers were implemented in 1995 and '96. Once they got to the final implementation, local labor management teams worked out the details of how the different centers would operate. In the redesigned centers, the mail flows through several automated processes which are controlled by the workers. If the mail is clean, so to speak, it will flow right through with people only having to move the mail from work station to work station. There are other cases where you have to handle fall out, but again, this is managed by the employees. The production criteria is that you get a pile of mail in the morning and you want it out by the end of the day. That is the basic goal of these centers.
All employees learn all job functions and are rotated between the functions, both during their shift and across shifts over time. So they are not doing the same thing over long periods of times. In addition, detailed ergonomics analysis were conducted for each of the individual work stations and any specialized engineering or training interventions were put in place so that we could have folks working safely.
This is a picture of one of the new machines with the person at the work station. Have you ever noticed the little bars on the bottom of your check? That is a little magnetic strip that a machine can read. Our bills have the same little strips. If you put your bill in right side up, facing forward, the check behind it, right side up, facing forward, with no bending, spindling or mutilating or staples, it will flow right through the system. A person will never have to interact with it, other than to move it around. What this machine does is to magnetically read the account information off the bill and the person's check. It will optically scan the check amount and read that, and if it can read it and understand it, it will reconcile the books. Any fall out of that process is where we get the people doing the different tasks, perhaps having to open letters, reorient the mail, or do the billing reconciliation.
I remember what that person was doing before with having to separate that check and that bill and doing a 10 key, now we have an optical image that comes up on the computer screen, with the person's account information as well, and the person can just reconcile it right from that.
Automation was used in a good fashion to eliminate a lot of the ergonomic hazards in this particular work setting. As we can see, our rates are very dramatic in this case. We are almost to the point where we have completely eliminated cumulative trauma disorders in these work centers. They have only been in place since '94 or '95 so there are dramatic effects in this particular case.
Our last case study is with our mass markets group. These are the people who process customer orders, handle billing questions and so on for our customers of residential and small business service. Whenever you order phone service you talk to one of these people. They were our second large work force affected by CTDs, and they have the second highest rates for us. So, again, it was a group of special attention for us.
In 1993 and '94, we went through a reengineering process and went to a mega center concept where we consolidated people from around the region into about 16 centers in major city hubs. With this consolidation there were also total remodels of facilities, and with this we introduced, again, state-of-the-art ergonomic work stations and seating into these new mega centers. So we were very opportunistic in this case to bring in these work stations when we were doing a major rework anyway. We just paid an incremental cost for ergonomic furniture instead of having to buy it out right.
This is an example of one of the new work stations. Again, the unit fully adjusts up and down. The keyboard try is independent, room for the mouse and so on. These can be adjusted to sit/stand for most of the work force. They aren't quite sit/stand for very tall people. The results in this case is a nice drop. We had a drop in '93 prior to the installation, and it also drops in '94 and '95.
In '96, you noticed that that bounced up just a touch. Basically, the size of our work force in ‘96 reduced and bounced us up. The reason the size of the work force reduced wasn't because of the downsizing but because when they originally did the mega centers, they also moved in some of the operations people who do the initialization of service and repair calls. They ended up moving those people back into our network operations work force. So we got the incidents, but the population shifted back to another work group. It is a little bit of an artificial blip up there in '96.
Some observations and conclusions -- and this should really be called some odd things that we have seen, in addition to our successes. It is some stuff that we can't quite explain and bothers us, but it indicates that there is some other phenomena going on.
The first is what I call the mega center spike. There are a couple of interesting things going on in this slide. We had such a nice drop in 1995 that I kind of got concerned. It was almost too good to be true that we could reduce our injuries and illness rates by that much. So I went back to look at the data in a little more detail, and much to my surprise, this is what I found.
On the right-hand side here, we have our mega center implementation. It was about here in the fourth quarter of '94 that we started actually building out these centers, and it wasn't until in here that people started actually moving in. So we had our drops starting kind of before the centers were actually installed. Perhaps we had instantaneous affects of the furniture. That is hard to make plausible, but we had these drops happening there. Then here we had this huge spike in our second quarter of 1994, which basically made 1995 look good. It was because 1994 had such a high spike in it. It was during this period that people in these centers were actually having to reapply for their jobs and find out if they were going to get moved, if they had jobs, if so where, and so on.
There was some downsizing that occurred. Most of the people who left the company did so voluntarily. There were less than 10 percent who left involuntarily, but in this mega center shift and the way it was going to go had been known since early in 1993.
We had this spike that occurred right here. I am not entirely sure exactly why it happened. Anecdotally, in talking to our union folks and talking to managers and things like that, one thing that may be happening is that because people are worried about whether or not they are going to have a job, or whether they will leave the company voluntarily or not, they may be reporting before they lose their benefits if they are suffering from these symptoms. So that may be one explanation. It is probably the most plausible explanation for why we have this spike.
One less savory explanation is that if a person is on benefits, it is harder to let them go. So maybe people were getting on the benefits wagon to be able to ride out their jobs longer and so on.
Then another possibility is that the stress of this period could have resulted in higher actual rates and so on. If OSHA had come in during the second quarter of '94, we would have been a little concerned about what we were seeing. But, again, it was a transitional spike based on a reorganization that we saw.
The second phenomenon that we see in our operators services environment is the location affect. NIOSH found this as well when they went and did their examination. They found that there were very powerful affects based on where people were at.
What you have here is all of our operator services offices in a scatter plot. Each point is an office, and here we have the incident rate for that office and there we have the number of people. Now, down here these are all relatively small offices, fairly well clustered. There are less than three cases in any of these offices.
What I am interested in are these up here. We have our larger offices, over 200 people, but with dramatically different rates. This is an environment where we have very consistent training, very consistent job functions, very consistent furniture and equipment. All the standard ergonomic interventions had taken place. Yet, we have these dramatic differences in rates. These are in geographically different regions. This is in the Southwest. These two are Rocky Mountain regions and these are Midwest here.
This one out here we can kind of explain because of the particular state that it is in. Until the fourth quarter of this year, they didn't really recognize a keyboard related CTD as a worker compensable claim. So that is likely to result in some under reporting in those environments.
These are a little bit harder to explain, however. Anecdotally what we are hearing in talking to different people is that in some cases the work ethic of the community is different. In other cases it is the management style in these different offices that are different. Union activism is different in the different offices. In one of these cases we have had a very successful attorney who has obtained some very large settlements in that particular office. So that may be influencing it as well. I don't know exactly what is going on. The illustration here is just to point out that even when we have done a good job and have incident rates going down, there still there appears to be other factors that can powerfully affect the reporting of these type of injuries and illnesses.
Standard ergonomic interventions can be very effective and we can do well with them, but there is no cookbook approach. We have had to take unique approaches to each of these different environments to address the issues. Other factors also seem to have equally powerful affects, at least on a local basis.
