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Workplace Factors
Are work-related health conditions well reported?

At a glance:
Many workers suffer from work-related conditions, but few formally report the condition. This is true even of workers who require sickness absence, or a modification of their duties.

Employees often feel that management discourages formal reporting. Some believe that if they report they will get in trouble or lose their job. Others believe that pain is an ordinary consequence of work, or ageing and not worth reporting.
Perspectives:
Employee
More than half the population have long-term musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 pain. The problem is even more common for people who work in an awkward posture, or perform repetitive tasks.

It you have some musculoskeletal pain, it is best to report it early. Doing so means action can be taken to prevent the problem getting worse. If it seems that management discourages reporting, it is worth remembering that “upsetting the applecart' now can prevent much bigger problems later on.
Employer
More than half the population suffers from long term musculoskeletal pain, many of these cases are due to work activities. People who work in manufacturing, or perform repetitive tasks are at particularly high risk of developing musculoskeletal pain.

Most people do not report their problem.

Early reporting allows the employer to minimise longer term problems. A culture of support encourages early reporting and has been shown to improve long-term outcomes.
Treater
This study shows that a failure to report workplace conditions is common. Reasons for under-reporting include bureaucratic ‘red tape,' concerns about employer reactions, and an ability to ‘live with' the problem.

If people do not report their condition it is more likely to cause greater problems down the track. 

It is probably sensible for the treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 to note the condition in the patient's file and provide a medical certificate. Whether or not the patient reports the condition to their employer, however, is their own choice. The employee may choose not to provide the certificate to their employer, but the documentation remains useful if problems develop at a later date.
Insurer
Only a small proportion of workers report workplace illness or injury.

People only report if they perceive that the advantages of reporting outweigh the disadvantages. This means that management responses to reports need to be positive. A positive workplace culture encourages people to report problems early, which can reduce long-term disability.
Original Article, Authors & Publication Details:
G. Pransky1, T. Snyder2, A. Dembe1 and J. Himmelstein1 (1999).

Under-reporting of work-related disorders in the workplace: a case study and review of the literature.  Ergonomics; 42(1):171-182

1Occupational and Environmental Health Program, Department of Family and Community Medicine, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655-0309, USA
2P.S. Associates Inc., Sudbury, MA, USA
Background, Study Objectives, How It Was Done:
This study was conducted in the United States, where organisations with more than ten employees must report all conditions thought to be caused, or worsened, by work to the Occupational Safety and Health Administration (OSHA). 

All work-related injuries and illnesses must also be reported to the employer's compensation insurer. 

Under-reporting of work-related conditions is common. Some causes are: 

         Inaccurate Occupational Health and Safety log-keeping
         Safety incentive programs: These often reward staff for low injury rates and punish them for high rates. This encourages under-reporting.
         Involvement of multiple insurers: Cases requiring medical treatment may not be reported through the workers' compensation system if workers draw compensation from their own insurer.

This paper aimed to explore the extent of under-reporting and its causes.

The authors reviewed survey and interview information from a manufacturing plant, and the log of cases that were reported to the OSHA.   
Study Findings:
The manufacturing plant had:

         8200 employees

          A commitment to a safe workplace

o   over 24 full-time safety staff

o   investment in ergonomic
ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
 and other safety improvements

o   A safety incentive program with bonuses for low numbers of OHSA injury reports

         Three plants requiring manually intensive packing work. Each had:

o   110 packers

o    An occupational health nurse and full-time safety director

o   A requirement for employees to inform the nurse of any pain or injury from work activities

Only 5% of workers had a condition recorded in the OSHA log in the previous year. Given the repetitive nature of the work, a much higher injury rate would be expected. 

A survey was used to ask workers about symptoms caused or worsened by their work. The severity of these symptoms and the treatment provided were also investigated. 

85% of the packers responded to the survey. Of these:

         85% said they had work-related symptoms. 

         Nearly 50% experienced these symptoms throughout the working week or constantly. 

         At least 15% said their symptoms affected their home activities.

         20% were experiencing pain and discomfort at home, but didn't modify their activities.

         9% said they had time off work due to work-related symptoms. 

         6% were formally assigned modified work duties due to pain (arranged by the nurse).

         15% were assigned informal modified work duties due to pain (arranged by co-workers).

This means that at least 30% of workers who completed the survey had conditions that should have been recorded in the OSHA log.

53% of workers said they had not reported their hand and wrist symptoms to the nurse.

         Nearly 10% said they were worried about being disciplined.

         25% felt the pain and discomfort came with the job.

         Nearly 25% had reported symptoms to the nurse and been given treatment and/or modified duties, but had returned to their normal job and symptoms had returned.

         27% thought their symptoms weren't serious enough to report to the nurse.

o   Half of these said their symptoms were severe enough to affect their work.

Other reasons for not reporting injuries were:

         Fear of being assigned lighter jobs the workers didn't like

         Loss of overtime pay

         Separation from co-workers

         Concern about abandoning the team during heavy work loads

         Feeling their pain was due to age

         Feeling their symptoms would reduce once the workload lessened

         Not wanting to miss out on promotions/pay rises

         Not wanting to appear weak

Interviews were also conducted with the plant's manufacturing managers, safety officers and nurses.  The company's safety department aimed to reduce injury rates to 2 per 100 workers. 

Safety officers and nurses acknowledged that there was pressure from management to not record injuries. Although new employees were told to report any work-related pain to the plant nurse they were not told to record injuries in the OSHA log. Safety staff were not clear on which injuries needed to be reported, and each plant had a different definition of a “recordable' injury. Plant physicians often treated injured workers, meaning that injuries were not reported to workers' compensation.
 
This study showed that work-related injuries in a manufacturing plant were significantly under-reported. In the year prior to the study, 30% of workers had injuries which should have been formally reported, but only 5% of workers had made such a report.

One cause of under-reporting was an unrealistic goal set by the company's safety department. This led supervisors and managers to discourage reporting. Plant nurses and safety officers gave first aid, informal modified duties, or classed injuries as non-work-related to avoid reporting them. Workers often weren't educated about the rules for OSHA recording of injuries.

Workers said they didn't report injuries because they were afraid they'd lose:

         Pay

         Overtime work

         Respect

         Opportunity for promotion

         Bonuses

Conclusions:
Not reporting injuries may prevent conditions from being identified and treated early. This can lead to greater disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 and generate higher costs in the long run. Early reporting and treatment could increase productivity and improve morale.

Management should clearly encourage supervisors and employees to accurately report injuries. Safety incentive programs should not suppress reporting of injuries. Alternative systems to measure workplace injury should also be considered.
References:
PubMed Abstract
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