Though count is down, injuries stay high
Though count is down, injuries stay high
Push continues for better records
Every year, the U.S. Secretary of Labor - whoever that may be - declares America's workplaces to be safer than the last. The proof: Lower injury rates reported by the U.S. Bureau of Labor Statistics.
"The 21% decline in the workplace injury and illness rate over the past six years and a 4.5% decline over the past year show the effectiveness of the strategy of targeted enforcement coupled with prevention through compliance assistance to promote a culture of safety at the workplace," then-Secretary of Labor Elaine L. Chao declared a year ago.
"This report shows that employees are now safer in the workplace than ever before. This success validates our efforts, and we are redoubling this commitment to make workplaces even safer," added Edwin G. Foulke Jr., then head of the U.S. Occupational Safety and Health Administration.
In fact, workplaces are probably not much safer than they were a decade ago, and most of the reported decline in injuries and illnesses relates to changes in record keeping rather than improvements in safety, according to an analysis by Lee Friedman, PhD, research assistant professor at the University of Illinois at Chicago (UIC) School of Public Health, and Linda Forst, MD, MPH, MOS, a professor of environmental and occupational health at UIC.
Based on other data sources of occupational injuries, Friedman estimates that injuries in high-risk industries have declined in total by about 4% since 1992.1 "There's a minor safety benefit occurring; however, it's nothing as dramatic as what the survey of injuries and illnesses is showing," says Friedman. "It's an inaccurate and inappropriate claim to make [that injury rates have declined substantially]."
Friedman's work has been bolstered by other similar findings. In 2008, a Congressional hearing focused on underreporting of workplace injuries and U.S. Sens. Edward Kennedy (D-MA) and Patty Murray (D-WA) requested a General Accounting Office investigation, which is pending. The Obama administration allotted $1 million for a one-year OSHA "record-keeping enforcement initiative" and $250,000 for the National Institute for Occupational Safety and Health (NIOSH) to conduct research on underreporting.
At press time, details of a National Emphasis Program on recordkeeping were not available. NIOSH is considering tracking occupational injuries in health care through the Internet-based National Healthcare Safety Network (NHSN), including: musculoskeletal disorders related to patient handling; slips and falls; workplace violence; dermatitis due to workplace exposure; work-related asthma; and airborne tuberculosis transmission in the workplace (edocket.access.gpo.gov/2009/E9-22656.htm). The NHSN is currently a system used to track patient safety concerns, such as health care-acquired infections.
There are numerous forces at work that lead to underreporting of workplace injuries, says Friedman. First, OSHA has literally changed the rules several times, most notably in 2001. The new rule redefined what injuries are recordable on the OSHA 300 log and led to a steep decline in overall injuries and illnesses. The BLS also changed from the Standard Industrial Classification (SIC) to the North American Industry Classification System (NAICS) in 2003, further complicating comparisons.
With the new rules, it was easier to consider an injury "first-aid only" and thus not recordable, notes Kenneth D. Rosenman, MD, chief of the Division of Occupational and Environmental Medicine at Michigan State University in East Lansing, who has also researched the issue of work-related injury and illness underreporting. Rosenman's research in Michigan found that the reporting system there missed about two-thirds of injuries and illnesses across different types of industries.
The current reporting system also leaves out government workers - including employees at county or state hospitals or in the Veterans Health Administration system.
Meanwhile, "there is a probable and strong disincentive for employers and industry itself to have accurate reports of injuries and illnesses," says Friedman, noting that workers' compensation premiums are based, in part, on injury rates for the industry.
Employers also may create disincentives for employees to report injuries, he says, for example by providing awards to units that have few or no reported injuries. And many injuries may go unreported simply by mistake - either because the personnel didn't know what needed to be reported or how to report.
Other reporting data, such as the National Electronic Injury Surveillance System (NEISS), which tracks injuries and illnesses for which workers sought treatment in hospital emergency departments, showed "little change over the past 20 years," Friedman and Forst reported.
Multiple data sources needed
Yet even with tougher enforcement of recordkeeping - and even if employers were diligent in recording injuries and illnesses - the undercount would remain significant, occupational health researchers say.
In 1987, the National Academies of Science highlighted problems with the survey-based system in its report, Counting Injuries and Illnesses in the Workplace: Proposals for a Better System. The method of counting work-related fatalities changed in 1991 to use multiple data sources, and the number of fatalities doubled, says Rosenman. "What makes anyone think the number of injuries wouldn't double if you had multiple data sources [for nonfatal injuries and illnesses]?" he says.
In April 2009, the Occupational Health Surveillance Work Group of the Council of State and Territorial Epidemiologists issued recommendations for using multiple data sources, including employee reports on existing surveys such as the National Health Interview Survey and workers' compensation data. Electronic medical records should include information about the "work-relatedness of health conditions," the workgroup said.
"Surveillance of the impacts of work on health currently ... is grossly inadequate and has not kept up with changes in risk connected to the rapid changes in our economy and the demographics of our work force," the workgroup said.
Better tracking of work-related injuries and illnesses is important both at the worksite and for broad surveillance, says Friedman. "It's very important that we understand the health and safety status of the work force both in terms of protecting workers, as well as improving the [functioning of] businesses in America," he adds.
After all, if you don't know where your injuries are occurring, you won't be able to address them, says Rosenman. "The key to prevention - and occupational injuries and illnesses are all preventable conditions - is to know where they're occurring, to intervene and evaluate your interventions," he says. "If you can't accurately count, you may not know where to intervene. And then you may not know whether [the intervention] was successful or if you just have a lousy counting system."
Every year, the U.S. Secretary of Labor - whoever that may be - declares America's workplaces to be safer than the last. The proof: Lower injury rates reported by the U.S. Bureau of Labor Statistics.Subscribe Now for Access
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