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AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 52:1–16 (2009)
Impact of Implementing the Washington StateErgonomics Rule on Employer Reported Risk
Factors and Hazard Reduction Activity
Michael Foley, MA,1� Barbara Silverstein, PhD, MPH, CPE,1
Nayak Polissar, PhD,2 and Blazej Neradilek, MS2
Background In Washington State an ergonomics rule was adopted in 2000 that focusedon primary prevention. The implementation process followed a 6-year phase-in schedulewhere employers came into compliance based upon their size and industry. In late 2003 therule was repealed by an industry-funded voter initiative. Evaluating the implementation ofthis rule offers a unique opportunity to observe the general deterrent effect of a new publichealth regulation and to study how employers and workers responded to new requirements.Methods Weighted survey regression methods were used to analyze the results from threeemployer surveys covering more than 5,000 workplaces administered in 2001, 2003, and2005. These were compared to a baseline employer survey conducted in 1998 before therule was promulgated. Questions covered the following topics: WMSDs experienced at theworkplace; levels of employee exposure to musculoskeletal hazards; steps being taken, ifany, to address these hazards; results of these steps; and sources of ergonomic information/assistance used.Results From 1998 to 2003 there was a reduction in reported exposures amongworkplaces in the highest hazard industries. Following the rule’s repeal, however, hazardexposures increased. While more workplaces reported taking steps to reduce exposuresbetween 1998 and 2001, this gain was reversed in 2003 and 2005. Employers who tooksteps reported positive results in injury and absenteeism reduction. Large workplaces inthe high hazard industries were more active in taking steps and used a wide variety ofresources to address ergonomics issues. Small employers relied more on trade associationsand the state. Am. J. Ind. Med. 52:1–16, 2009. � 2008 Wiley-Liss, Inc.
KEY WORDS: ergonomics; work-related musculoskeletal disorders; regulation;public health law; occupational injuries; occupational diseases; economic impacts;regulatory effectiveness
INTRODUCTION
The field of public health practice, including workplace
or occupational safety and health, is grounded in law because
it is a field of public concern. The essence of public health
practice includes regulation, rules and enforcement of sound
public health/safety practices identified in implementation
of standards and rules adopted by the legislature or an
administrative agency [Grad, 1990]. It is not uncommon to
have such rules, affecting millions of people and businesses,
� 2008Wiley-Liss, Inc.
1Safety and Health Assessment and Research for Prevention (SHARP) Program,Washington State Department of Labor and Industries, Olympia,Washington
2The Mountain-Whisper-Light-Statistical Consulting, Seattle,Washington*Correspondence to: Michael Foley, Safety and Health Assessment and Research for
Prevention (SHARP) Program, Washington State Department of Labor and Industries,PO Box 44330, Olympia,WA 98504-4330. E-mail: [email protected]
Accepted10 September 2008DOI 10.1002/ajim.20650. Published online in Wiley InterScience
(www.interscience.wiley.com)
in place for long periods of time with no evaluation of effect.
Often those covered by the rule are not aware that it exists,
thereby limiting the possible effectiveness of the rules. While
rules may be carefully conceived, their implementation plans
are often only rudimentary and evaluation neglected. Some
have argued that rules and regulations are not necessary,
that given the appropriate information; employers will
voluntarily comply with guidelines that will improve health.
Others have argued that specification standards are outdated
and overly rigid, that employers would be more likely to
adhere to standards or rules that are process oriented to
provide employer flexibility in how to achieve the intended
results [Cunningham and Johnstone, 1999]. If there has to be
a standard, larger employers have argued for more process
oriented standards while smaller employers have argued for
simple specifications as being easier to implement. While
there has been limited research investigating the effective-
ness of a particular rule or standard [Nelson et al., 1997],
there has been virtually no research evaluating the actual rule
implementation process.
Prevention of work-related musculoskeletal disorders
(WMSDs) has been a national priority for well over a decade
[NIOSH, 2001], yet WMSDs still account for approximately
30% of all workers compensation claims and more than
40% of all costs [Silverstein and Adams, 2007]. The US
Bureau of Labor Statistics reported 357,160 musculoskeletal
disorders in 2006. A considerable body of epidemiological
and laboratory studies has established a strong association
between physical as well as psychological and social load at
work and the development or exacerbation of WMSDs and
long term disability [Hagberg et al., 1995; NIOSH, 1997;
Viikari-Juntura and Silverstein, 1999; National Research
Council, 2001]. Additionally primary prevention efforts have
demonstrated significant results at the company level [GAO,
1997; Silverstein and Clark, 2004; Tompa et al., 2007]. A
number of voluntary guidelines, standards and educational
materials have been developed to assist employers in
reducing risk of WMSDs. These have sporadic use and
limited evaluation. These voluntary efforts have been
necessary but not sufficient to reduce the burden of WMSDs.
A number of jurisdictions (primarily outside of the US) have
had ergonomics related rules or regulations in place for a
number of years including manual handling and visual
display unit (VDU) regulations (Australia, New Zealand,
Brazil, European Union countries). In the United States,
different regulatory approaches have been undertaken to
address WMSDs. California implemented a rule that relies
on reported WMSDs in a job before action is required to
improve the job. In 2000, OSHA issued a rule focusing on
reported WMSDs in manual handling and production jobs.
Congress and President Bush repealed this rule in 2001.
In Washington State, more than 65,000 workers
compensation claims for WMSDs are accepted each year,
averaging more than $743 million in direct workers
compensation costs each year [Silverstein and Adams,
2007]. Washington is the only state that has both an exclusive
workers compensation insurance system and a state OSHA
program (DOSH) in the Department of Labor and Industries
(L&I) that have provided voluntary guidelines, workshops
and consultations on preventing WMSDs for more than
10 years. Rarely has there been enforcement activity under
DOSH’s general accident prevention program or Safeplace
regulations. In 1998, L&I began developing a comprehensive
strategy on musculoskeletal disorders to help address the
agency’s first priority: reducing injuries, illnesses, fatalities
and hazards in Washington workplaces. At that time the first
industry-wide survey of employers on musculoskeletal
hazards, steps taken to reduce hazards and where employers
go for help to address WMSDs was published [Foley and
Silverstein, 1999]. As part of the overall L&I strategy, which
had included training programs, guidelines, consultations
and inspections conducted under the ‘‘general duty’’ clause,
an ergonomics rule (WAC 296-62-051) was promulgated
in 2000 that focused on primary prevention: finding and
fixing hazards before they cause WMSDs. The history of
Washington State Department of Labor and Industries’
efforts to address WMSD hazards is extensively discussed in
Silverstein [2007].
An extensive phase-in period with demonstration
projects, development of training materials and ‘‘ergonomics
toolboxes’’ with labor and business was part of the DOSH
ergonomics rule implementation process. Companies were
phased into compliance based on size and SIC code. This
6-year phase-in provided a unique opportunity for evaluation
of public health regulations. Evaluation of intermediate steps
leading to reduction in hazards and WMSDs provide
important information on the general deterrent effect of
regulation. It also allows for assessment of how the regulation
is implemented in specific companies within the ‘‘high risk’’
industries that are the focus of initial compliance activities.
The Washington Ergonomics Rule, promulgated in
May 2000, was focused on reducing employee exposure to
workplace hazards that can cause or aggravate WMSDs.
Under this rule, all employers in the state with ‘‘Caution Zone
Jobs’’ would be covered by this rule. A ‘‘Caution Zone Job’’
is a job where an employee’s typical work includes any of the
following physical risk factors: awkward postures, high hand
forces, highly repetitive motion, repeated impact, heavy
frequent or awkward lifting, or moderate to high hand/arm
vibration. Employers were required to determine whether
they have Caution Zone Jobs based on the duration or
frequency of exposure, and if so, to provide ergonomics
awareness education to employees in such jobs and their
supervisors, determine if exposure to WMSD hazards exist,
and reduce exposures to those hazards to the degree feasible.
Requirements for complying with this rule were to be phased
in over a 6-year period, with large employers in the 12 highest
risk industries (50 or more full-time equivalent employees,
2 Foley et al.
FTEs) required to have completed hazard identification and
ergonomics awareness education by July 2002 and hazard
reduction achieved by July 2003. These were followed in
each additional phase-in year by (a) all other large employers
and small employers in high risk industries, (b) all other
medium-sized employers, and (c) all other small employers.
The text of the rule and the full schedule of rule compliance
phase-in periods can be found at http://www.lni.wa.gov/
Safety/Topics/Ergonomics/History/default.asp. The rule was
repealed by an industry funded voter initiative on the ballot in
November 2003 [Silverstein, 2007].
Evaluating the implementation of the Washington State
Ergonomics Rule (WAC 296-62-051) offered a unique
opportunity to observe the effect of a regulation prospec-
tively and to study how employers and workers responded
to new requirements. It is also valuable to determine how
well the prevention approach specified in the Washington
ergonomics rule worked in practice. Although WMSDs
are widely recognized to be among the most costly and
debilitating occupational injuries and illnesses, only one
other state, California, has been able to promulgate an
ergonomics regulation. Following the effectiveness of this
rule from the beginning permits other states and the federal
government to learn from the Washington State experience.
This research was reviewed by the Washington State
Institutional Review Board, and determined to be exempt.
METHODS
An employer survey was conducted in the spring of 1998
which became the model for the surveys administered in the
three subsequent survey years [Foley and Silverstein, 1999].
We used Washington Employment Security Department
(ESD) Quarterly Unemployment Insurance files to obtain
the addresses of approximately 10,000 workplaces in
Washington State to whom we mailed the employer survey.
We used ESD data because ESD collects all Standard
Industrial Classification (SIC code) information in the state
and surveys all employers over a 3-year cycle to insure the
SIC codes are still valid.
In all four surveys our focus was on the workplace as the
unit of observation and analysis. We were concerned with
how managers coped with the risks for WMSDs in their
workplaces and how their strategies may have shifted as the
regulatory environment changed. Our goal was to estimate
for each survey year: (1) the proportion of workplaces
experiencing WMSDs, (2) the proportion of workplaces that
had employees exposed to a variety of WMSD hazards for
extended periods of time, (3) the proportion of workplaces
taking various types of steps to address these hazards, and (4)
the proportion of workplaces availing themselves of a variety
of sources of information on ergonomic solutions. For
each question we were interested in how these proportions
changed over time.
Sampling Strategy
1998 survey
We randomly drew an unweighted sample of 9,862
Washington State workplaces, representing about 6% of all
workplaces from the Washington Employment Security
Department’s (ESD) unemployment insurance employer
database for the third quarter of 1996. The sample was
drawn so as to be representative of size and 2-digit Standard
Industrial Classification (SIC) for the state as a whole. SIC
classes in which there were less than three employers were
excluded to maintain anonymity. Names, addresses and
telephone numbers were collected from the ESD database
and matched to the Labor and Industries claims database.
These records were sent to a survey administration firm
which delivered a cover letter as well as the 4-page
questionnaire to each employer. A follow-up postcard was
sent to those who had not responded after 30 days and for
whom there were no surveys returned as undeliverable,
unknown, wrong address or out of business. For those who
did not respond after the postcard, a telephone interview was
attempted where telephone numbers were available. For all
analyses, data were grouped by Rule Phase Group, based
upon SIC and size as explained below.
2001, 2003, and 2005 employer surveys
In preparing for the employer surveys in 2001, 2003, and
2005 we determined that a change in sampling strategy was
warranted. The population of Washington State workplaces
is distributed very unevenly across industries and across
workplace size categories. Large workplaces, defined as
having more than 50 employees, comprise only 6% of all
workplaces. Medium-sized workplaces with 11–49 employ-
ees, account for 19% of all workplaces, while small
workplaces are about 75% of the total. Workplaces are also
distributed across industries in a similarly uneven pattern;
with relatively fewer workplaces in the manufacturing SIC
codes and a much greater fraction in the service sectors.
Therefore an unweighted sampling strategy like that used in
1998 would allocate most of the sample space to
small workplaces in relatively low risk industries. Our new
approach was to draw a sample so as to yield more
information about companies that had to undertake more
steps to fully comply with the rule earlier than is typical of the
average workplace. We therefore divided the sample into four
groups that reflected both the differing levels of expected
WMSD hazard exposure, as established in L&I’s annual
WMSD workers’ compensation claims report, and the four
‘‘rule phase-in groups’’ under the rule [Silverstein and
Adams, 2007]. Large firms in industries with the highest
average rankings for WMSDs by incidence rate and count of
claims, called the ‘‘Top 12,’’ were identified by L&I to be
Evaluation of Ergonomics Rule Implementation 3
brought in to full compliance with the rule first. These formed
what was called Rule Phase Group 1, and our sample was
designed so as to pull in as many such workplaces as possible,
as discussed below.
Under the Washington State Ergonomics Rule work-
places were classified into four Rule Phase Groups (RPGs)
for purposes of scheduling compliance dates as follows:
(1) Rule Phase Group 1 consisted of large workplaces in
the Top 12 most hazardous industries, as established
under the ergonomics rule:
(2) Rule Phase Group 2 comprised all other large work-
places regardless of industry as well as medium and
small workplaces in the Top 12.
(3) Rule Phase Group 3 comprised all medium workplaces
in industries other than the Top 12.
(4) Rule Phase Group 4 comprised all small workplaces in
industries other than the Top 12.
To underline the highly skewed distribution of work-
places across the four rule phases, the following table presents
the full population counts of workplaces by Rule Phase
Group in the fourth quarter of 2001 in Washington State:
As can be seen in Table I, nearly 60% of all workplaces
were in Phase 4: workplaces with fewer than 11 employees in
industries other than the Top 12. Though all results discussed
here will be presented in terms of the Rule Phase Groups, we
wanted to draw our sample so as to overweight toward those
industries in which there was a higher expected exposure to
WMSD risks. Accordingly we increased the sample space
devoted to workplaces that, though not in the Top 12 as
defined by the Rule, were nonetheless in industries shown to
have higher than average WMSD workers’ compensation
claims rates in previous published reports [Silverstein and
Adams, 2007]. We also wanted to take advantage of the fact
that we had conducted a baseline survey in 1998 and ensure
that we had some workplaces in as many strata as possible
from the original survey. The sample frame included all
workplaces having a record in the Washington State
Employment Security Department’s Quarterly Unemploy-
ment Insurance file for the most recent quarter available. This
was about six quarters prior to the actual quarter in which
the survey was conducted. Before drawing the sample we
dropped all records lacking complete address fields. We
further eliminated those not having a valid Universal
Business Index (UBI) record, as this would prevent us from
matching the record to the State workers’ compensation
database. These two adjustments eliminated about 3% of all
records.
Because of the highly skewed distribution of
workplaces across size categories we weighted our sample
toward large- and medium-sized workplaces. Out of
approximately 140,000 workplaces in the population, only
about 1,250 were in Phase 1, the first group required to fully
comply with the rule. Since this was our primary group of
interest, we drew all workplaces in this category into our
sample. The remaining spaces were allocated as follows:
40% for Phase 2, 40% for Phase 3, and 20% for Phase 4. This
distribution means that construction and manufacturing will
be over-represented in the sample, while services and public
administration will be under-represented. This approach
reflects the low level of hazards expected in the under-
represented sectors, where compliance with the rule will be
achievable without undertaking many steps. An exception is
nursing homes which is under services but is a high risk
industry that was included in Phase 1 or 2 depending on size.
Within Phase 2, we drew in all large workplaces from the
29 higher risk industries listed above and allocated 30% of
the remaining spaces to medium workplaces and 70% to
small workplaces from the Top 12 high risk industries listed
in the Rule. Within Phases 3 and 4, 30% of sample spaces
were taken by medium workplaces and 70% by small
workplaces. Again, this approach over-represented larger
workplaces where there is a greater likelihood of steps being
required to control hazards. This brought our total sample
TABLE I. Total Workplace Population, by Ergonomics Rule Phase Group
Rule Phase-In Groups
Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total
n % n % n % n % n %
1,851 1 37,344 25 21,097 14 87,132 59 147,424 100
Industry SIC code
Landscape and Horticultural Services 078
Residential Building Construction 152
Masonry, Stonework and Plastering 174
Carpentry and Floor Work 175
Roofing, Siding and Sheet Metal Work 176
Concrete Work 177
Sawmills and Planing Mills 242
Trucking and Courier Services, Ex. Air 421
Air Transportation, Scheduled 451
Grocery Stores 541
Nursing and Personal Care Facilities 805
Residential Care 836
4 Foley et al.
count to 10,000 workplaces. Finally, since we wanted to
make estimates for the population of Washington State
businesses taken as a whole, we drew in additional records
from across industries and size categories not already
represented in the sample, so as to have at least one
workplace in every SIC and size ‘‘cell’’ with at least three
workplaces in the population. This brought our final sample
size to 10,759 in 2001, 10,624 in 2003, and 10,314 in 2005.
To allay employers’ concerns that reporting WMSD
injuries and hazard levels might expose them to greater
probability of inspection, employers were informed in a
cover letter that the survey was being administered by a
contracted survey research company which would randomly
assign a tracking number and remove any identifying
information from each record before sending the complete
survey dataset to L&I staff. We also asked that the survey be
completed by someone with detailed knowledge of the
workplace who could answer the questions about employee
exposures, injuries and company programs to address
WMSD hazards.
After the sample surveys were mailed out, we tracked the
number of surveys that were returned by the post office as
undeliverable. An undeliverable survey can mean either that
the address does not exist (i.e., is misspelled, non-existent or
incomplete) or the workplace no longer exists at that address
and there is no forwarding address available.
Table II summarizes the number of survey responses
available for analysis and the response rate, adjusted for
unreachable workplaces, by Rule Phase Group and year of
survey. The number and proportion of employers which were
unreachable due to undeliverable mailing addresses, out-of-
business status or non-working telephone number was: 3,332
(34%) in 1998; 1,768 (16%) in 2001; 1,436 (14%) in 2003,
and 2,710 (26%) in 2005.
Data Cleaning
Following each employer survey the survey adminis-
tration firm removed all fields that could identify the
employer. Prior to sending us the final dataset, the survey
responses and administrative data (workers compensation
claims counts and hours worked) were merged. Steps taken
to prepare the dataset for analysis included coding non-
responses as missing, and attaching a field to identify the
Rule Phase Group to which the record belonged. In less than
1% of cases we also corrected main question responses that
were inconsistent with dependent question responses. For
example, in some instances a respondent did not respond to
the question ‘‘Did you take any steps to address WMSDs
in your workplace?’’ But they then checked ‘‘yes’’ to one or
more of the possible steps listed in the dependent question.
In addition, for each survey a file was prepared containing
the population and sample counts for each combination of
three-digit SIC industry and size category for each of the four
phase-in groups. Weights were calculated using these counts
and used as the basis for the weighted analyses of the results
for all surveys.
Statistical Methods
We used the statistical software STATA 8.2 (STATA
Corporation, 2003) to set-up the datasets and to recode
values. All calculations were carried out in the statistical
language R 1.8.0 (R Project, 2003). Proportions of positive
answers to all dichotomous questions were estimated for
the entire State of Washington using statistical weighting of
proportions in survey strata. The purpose of weighting was to
provide an unbiased estimate of a specific proportion for the
entire State. Proportions of positive answers were calculated
for all workplaces combined as well as for separate sectors of
workplaces as defined by the Rule Phase Group to which they
belonged under the rule. Weights were derived from the
number of workplaces in a stratum in the state and the number
of workplaces in the stratum in the specific survey.
For each question, the proportion of positive answers
was compared between each pair of years in the four annual
surveys. The difference between the proportions in each pair
of comparison years was also estimated. Standard errors and
P-values for the differences were obtained from the survey
(weighted likelihood) regression methods.
RESULTS
The total number of responses varied across the four
surveys, due both to the differing mixture of large, medium,
and small workplaces surveyed in 1998 versus 2001, 2003,
TABLE II. Total Number of Survey Responses Available forAnalysis and Survey Response Rate, by Rule Phase Group and Year
Survey year
Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total
n % n % n % n % n %
1998 27 63 673 85 752 84 3,025 73 4,477 752001 519 46 1,972 58 984 70 2,125 69 5,600 622003 448 45 2,062 60 1,081 65 2,102 73 5,693 622005 422 45 1,872 67 959 68 1,880 80 5,133 68
Evaluation of Ergonomics Rule Implementation 5
and 2005 and due to a varying number of incomplete
employer addresses found in the datasets sent to the survey
administrator.
As can be seen from Table II the change in sampling
strategy from a proportionate, unweighted draw toward a
sample drawn more heavily from larger and higher-risk
industries made a great difference in the sample count
available for analysis. It also meant that comparisons with the
1998 survey for workplaces in Phase 1 were difficult, given
the very small numbers in that category in 1998.
The respondents were asked to describe their position at
the workplace by choosing from a list of occupational titles.
Across all surveys the proportions were stable. For all Rule
Phase Groups combined we found in 2003 that the largest
category of respondents was the owners of the business being
surveyed (44%), followed by managers/supervisors (26%),
administrative assistants (10%), personnel managers (9%),
and safety/health officers (5%). However, these fractions
varied across Rule Phase Groups. In Phase 1, with only
large workplaces, the largest category of respondents was
managers/supervisors (43%), then safety/health officers
(18%) and personnel managers (16%). Owners made up
only 6% of respondents in Phase 1. In Phase 4, on the other
hand, owners accounted for 63% of all responses, followed
by managers/supervisors (20%) and administrative assistants
(9%). This undoubtedly reflects the finer division of labor
present in larger workplaces as opposed to small workplaces.
Again, these proportions remained stable across all
survey years.
Workplaces With Gradual-OnsetMusculoskeletal Injuries
In the 1998 questionnaire, ‘‘musculoskeletal injuries’’
were described as:
‘‘Injuries involving bones, joints, ligaments, tendons,
muscles and related vessels and nerves. These injuries can be
either:
ACUTE—one that occurs suddenly such as a
fractured arm, severed finger or sprained ankle; or:
GRADUAL ONSET—one that occurs slowly
over time, such as overexertion that results in low back
injury or tendonitis resulting from repetitive movement and
awkward postures. These are also known as repetitive strain
injuries (RSI), cumulative trauma disorders (CTD) or
occupational overuse syndromes (OOS).’’
In the 2001–2005 surveys this question was re-worded
so that only gradual onset injuries were covered. Table III
compares the proportion of workplaces which have experi-
enced gradual onset WMSDs over the prior 3 years across
each Rule Phase Group for each survey year. Statistically
significant differences from the previous survey year are
denoted in boldface type:
For back-related WMSD injuries, there was a
decline from 2001 to 2003 in the proportion of workplaces
reporting cases amongst Rule Phase Groups 1 and 2,
followed by a rise from 2003 to 2005 to a higher level than
in 2001. For Rule Phase Groups 3 and 4, which were
not yet required to implement any part of the rule’s
requirements during this time, the proportion of workplaces
reporting cases was lower in 2005 than in 2001. For upper-
extremity WMSD injuries, only Rule Phase Group 1 showed
an increase in the proportion of workplaces reporting
cases. All other employers reported a decline from 2001 to
2005.
Workplace Risk Factors
Employers were asked about physical movements or
positions while employees were working at their tasks. In all,
TABLE III. Workplaces Reporting Any Gradual Onset WMSDs, by Body Part and Rule Phase Group in the Previous 3 Years
Injury Year
Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total
% Sig % Sig % Sig % Sig % Sig
Upper extremities 1998a 46.2 22.2 22.2 7.9 13.22001 52.0 35.9 27.4 10.1 20.42003 52.7 29.9 ** 23.1 * 7.5 ** 15.9 ***2005 57.4 33.7 23.0 7.4 17.0
Back 1998a 41.9 19.5 19.5 5.8 10.82001 47.6 28.5 19.2 7.8 15.72003 46.4 26.7 20.2 5.9 * 13.7 **2005 49.6 29.7 17.2 5.6 14.0
aFigures for 1998 were estimated from the percent of workplaces reporting any WMSDs in previous 3 years, multiplied by the percent of such injuries which were deemed‘‘gradual’’ onset by employers.Asterisks show level of significance of difference in proportion for a given question between one survey year and the prior survey year: *P< 0.10; **P< 0.05; ***P< 0.0001.
6 Foley et al.
the survey included 15 hazardous exposures similar to those
covered by the ergonomics rule. These were:
(1) Lift/lower objects above shoulder or below knee while
twisting.
(2) Lift 10þ lbs more than once per minute.
(3) Carry heavy loads (30þ lbs) more than 7 feet.
(4) Push or pull heavy loads (wheeling 200þ lbs, or
dragging 60þ lbs) more than 7 feet.
(5) Using the hand or knee as a hammer.
(6) Use vibrating tools, such as a grinder or an impact
wrench.
(7) Repeated pinching of small object or tool, or pinch
hold for long periods.
(8) Working with non-powered hand tools.
(9) Working with hands above shoulder level.
(10) Repetitive movement of whole arm including
shoulder muscles more than twice per minute.
(11) Holding a fixed position while working.
(12) Moving lower arm(s) or hands more than ten times
per minute (excluding typing).
(13) Using a keyboard or mouse intensively.
(14) Sitting on vibrating surfaces, machines or vehicles.
(15) Lifting or lowering 50þ lbs unassisted at least
ten times per hour.
For each risk factor to which any employees were
reported to be exposed, the employer was asked to estimate
how many employees were exposed for less than 2 hr per
shift, 2–4 hr per shift, or more than 4 hr per shift. A
dichotomous variable was created with the value ‘1’ for an
employer reporting having any workers exposed to a given
risk factor for more than 4 hr, and ‘0’ if the employer reported
no employees exposed for more than 4 hr. Since under the
ergonomics rule, exposures of over 4 hr triggered require-
ments to reduce exposures hours, we were particularly
interested in the change over time in the proportion of
workplaces reporting any employees exposed to risk factors
at this higher level of duration. Figure 1A–E reports these
proportions for the five most common risk factors, by Rule
Phase Group and year.
Because larger workplaces were more likely than
smaller workplaces to have at least one employee exposed
to a given hazard for more than 4 hr, we expected the
proportion of larger workplaces reporting exposure to be
higher. This is borne out by the results. In Phase 1, which
contains only larger workplaces from the highest hazard
industries, the exposure proportions were distinctly higher
than for the other groups. Phase 2, with a mixture of large
workplaces from other industries and medium and small
workplaces from the Top 12, had a higher exposure
proportion than Phase 3. Finally, Phase 3, containing
medium-sized workplaces from non-Top 12 industries, had
a higher exposure proportion than Phase 4, which contained
small workplaces in non-Top 12 industries. Thus it is only
meaningful to compare exposure proportions within Rule
Phase Groups across survey years, not across Rule Phase
Groups.
The results show that there is evidence of a decline in
high-duration exposures when comparing the pre-rule period
to the period following repeal. Indeed, for 14 of the
15 hazardous exposures for which data are available from
1998 to 2005, levels of exposure for over 4 hr declined
within all Rule Phase Groups. The exception is for intensive
keyboarding, where an increase in exposure proportions
is shown for Phases 2 and 4. But within this overall trend
there is another pattern of interest: in every case, exposure
proportions for Phase 1 declined from 2001 to 2003, and then
reversed course and rose from 2003 to 2005. Recall that
Phase 1 comprised the large workplaces in the high-
hazard industries, which were scheduled under the rule to
begin phasing in implementation first. The decline from
2001 to 2003 was statistically significant for all exposure
types except working with hands above the head and heavy
lifting. The same pattern appeared in a weaker form for
Phase 2, but did not hold for every type of exposure.
Finally the pattern broke down completely for Phases 3 and 4,
where there were no distinct trends across between 2001 and
2005.
Employers’ Injury Prevention Activities
In each survey year, employers were asked: ‘‘In the last
three years, has your organization taken steps to prevent or
reduce musculoskeletal injuries?’’ Figure 2A summarizes the
results by Rule Phase Group and year:
As might be expected, the proportion of workplaces
taking steps to address hazards was highest among industries
where the underlying level of hazard is highest, as in
Phase 1. Another result was the apparent correlation between
size of workplace and hazard reduction activity, with the
larger workplaces being more likely to address hazards
than smaller workplaces. The results also show that overall
there was no change from 1998 to 2005 in the proportion
of employers who reported taking steps to address WMSD
hazards in their workplaces reported taking steps to
prevent WMSDs. However, between the year 2001 and
2003 there was a distinct drop in the proportion of Phase 1
employers taking steps to address hazards. A similar decline
in activity was reported as well among workplaces in all other
Rule Phase Groups. The drop was especially large for
workplaces in the first phase-in group. From 2003 to 2005
there was a slight increase in the fraction of employers
addressing hazards, although this was not statistically
significant.
Since one might expect there would be differences in the
proportion of employers addressing risks between those
workplaces who had had a recent WMSD and those who
Evaluation of Ergonomics Rule Implementation 7
0%
5%
10%
15%
20%
25%
30%
Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 4
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
5%
10%
15%
20%
25%
30%
Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 41998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 41998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Rule Phase Group 1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
2%
4%
6%
8%
10%
12%
14%
16%
Rule Phase Group 1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
A B
DC
E
FIGURE 1. Proportion of workplaces with employees exposed to WMSD risk factors for more than 4 hr, by Rule Phase Group,
1998^2005. A: Lifting>50 lbs, 10þ per hour.B: Lifting>10 lbs per min,>4 hr/day. C: Awkward lifting,>4 hr/day.D: Using keyboard
intensively,>4 hr/day.E:Hands above head,>4 hr/day.
8 Foley et al.
had not, we examined the proportion of workplaces which
had had at least one WMSD in the previous three years and
were still not taking steps to address the underlying hazards.
Figure 2B has the results:
The results show that overall there was a decline since
1998 in the number of employers who were not addressing
WMSD hazards even when their employees were getting
injured. However, most of this decline occurred between
1998, before the rule was adopted, and 2001 when rule
implementation was under way. If we look at trends within
each Rule Phase Group we find that in Phase 1 there was a
significant decrease in workplaces with WMSDs not
addressing risks between 1998 and 2001, but then this
fraction rose from 2001 to 2003 and 2005. A similar, though
weaker, trend occurred with workplaces in Phase 2, the next
group scheduled to implement the rule. Only in Phase Groups
3 and 4 was the decrease sustained. It should be noted that, in
all Rule Phase Groups, those workplaces who reported
having had WMSDs recently were much more likely to be
taking steps than were workplaces which had not had
WMSDs. Conversely, in all Phases except Phase 1 a majority
of employers without recent WMSDs reported no steps taken
to address hazards.
There was no significant difference between the large
workplaces in Phase 2 and the workplaces in Phase 1, which
are all large, in terms of the proportion of them taking steps.
Far fewer of the medium and small workplaces in Phase 2
were taking steps than were the larger workplaces in Phase 2,
in spite of the fact that all of the medium and small
workplaces in Phase 2 were in the Top 12 high risk industries,
while the large workplaces in Phase 2 were not. It appears that
size of workplace played a greater role in predicting
employer activity in addressing WMSDs than industry alone.
Factors Affecting Employers’Decisions to Address WMSD Hazards
Among the roughly 40% of employers who reported that
they had taken steps to address WMSDs in their workplaces
the predominant reason given was that they wished to reduce
the number of worker injuries they experienced. The next
most common reason given was that they expected to reap
gains in productivity and reduced absenteeism as a result.
Another reason commonly given was that they wanted to
reduce their workers’ compensation claims and/or costs.
Finally, and especially in Phase 1, an important reason given
was that they had been requested to do so by either their
employees or by their safety and health committee. The
importance of factors affecting the decision to take steps is
summarized in Table IV. Proportions are out of those stating
that they had taken steps to address WMSDs.
The sharp increase in workplaces citing ‘‘recommended
by DOSH’’ from 1998 to 2003, as the rule came into effect,
followed by a substantial fall from 2003 to 2005 when it was
repealed, should be noted. The percentage of employers who
listed ‘‘required by insurance company’’ as a factor in their
decision to take steps never rose above 3% in any year. The
State Fund, administered by L&I, provides workers’
compensation insurance to all but about 400 employers in
the state, covering about two-thirds of all employees.
For the roughly 60% of employers in each survey
indicating that they had NOT taken steps to address WMSDs
in the last 3 years, one or more of the following factors was
cited as a reason not to act: that WMSDs were not a problem
in their workplace; that the employer lacked the skills to
make changes; that other problems were a higher priority;
that changes would be too expensive to implement; or that
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 4
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
5%
10%
15%
20%
25%
30%
Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 4
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
A B
FIGURE 2. A:Percent of workplaces takingsteps to addressWMSD risks,by survey yearand Rule Phase Group.B:Percent of work-
placeswithWMSDsbutNOTtakingsteps to addressrisks,by survey yearand Rule Phase Group.
Evaluation of Ergonomics Rule Implementation 9
changes were planned but had not yet been effected. The
only reason listed by more than 5% of employers was that
WMSDs were not a problem in their workplace. The pattern
over time and across Rule Phase Groups is shown in Table V.
Proportions given are of those workplaces stating that they
had not taken steps to address WMSD hazards.
Overall, fewer employers believed WMSDs were not a
problem for their workplace in 2005 than in 1998, with
the largest decline occurring among the large, high-
hazard workplaces comprising Phase 1. Interestingly, fewer
employers claimed WMSDs were not a problem in 2005,
when the rule was gone, than in 2003 when the political battle
TABLE IV. Reasons Provided forTaking Prevention Steps, by SurveyYear and Rule Phase Group
Reason Year
Rule PhaseGroup1
Rule PhaseGroup 2
Rule PhaseGroup 3
Rule PhaseGroup 4 All
% Sig % Sig % Sig % Sig % Sig
To reduce worker injuries 1998 100.0 83.3 79.0 68.1 74.92001 92.5 83.2 75.4 ** 65.2 74.82003 91.2 82.7 77.6 68.8 75.92005 94.9 * 82.6 74.4 73.1 * 77.5 *
Expected other benefits (improved productivity, 1998 91.3 51.4 51.9 42.4 47.5less absenteeism) 2001 71.2 ** 56.5 ** 50.9 46.0 ** 51.7 **
2003 63.5 ** 55.4 53.7 43.6 50.12005 67.6 60.0 ** 55.7 43.3 52.3 *
To reduce workers compensation claims and/or costs 1998 77.6 42.3 38.3 21.7 31.52001 73.5 46.5 30.2 ** 21.7 34.2 **2003 60.2 *** 43.1 * 25.3 ** 13.6 ** 27.5 ***2005 63.0 39.5 * 19.4 ** 12.5 25.1 *
Requested by employees or safety/health committee 1998 14.8 22.9 25.3 14.0 19.02001 44.2 *** 32.9 *** 29.3 ** 15.5 25.6 ***2003 34.7 ** 29.8 24.1 ** 14.5 22.2 **2005 37.2 33.3 * 24.2 14.6 23.8
To gain competitive advantage 1998 32.8 19.8 14.9 13.0 15.42001 40.3 20.8 18.0 17.1 * 19.4 ***2003 28.2 *** 23.2 13.6 ** 16.1 18.62005 27.3 20.8 15.5 13.1 16.8
Recommended by DOSH 1998 2.8 4.2 3.5 2.2 3.02001 5.6 6.1 4.9 3.4 4.7 **2003 9.1 ** 4.6 5.4 0.7 ** 3.1 **2005 0.6 *** 0.5 *** 1.0 *** 1.4 1.0 ***
Asterisks show level of significance of difference in proportion for a given question between one survey year and the prior survey year: *P< 0.10; **P< 0.05; ***P< 0.0001.
TABLE V. Reasons Provided for Not Undertaking Prevention Activities, by SurveyYear and Rule Phase Group
Reason Year
Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 All
% Sig % Sig % Sig % Sig % Sig
WMSDs are not a problem 1998 74.3 69.9 78.6 78.8 77.8at workplace 2001 55.7 ** 72.2 75.8 80.1 77.9
2003 63.9 ** 76.4 * 80.3 ** 84.2 ** 82.1 **2005 63.0 71.5 ** 69.8 *** 76.2 ** 74.5 ***
Asterisks show level of significance of difference in proportion for a given question between one survey year and the prior survey year: *P< 0.10; **P< 0.05; ***P< 0.0001.
10 Foley et al.
over the rule was at its height. When looking within each year
across phase-in groups there is considerable evidence that
more employers in Rule Phase Groups 3 and 4 believed
WMSDs were not a problem for them. It should also be noted
that very few employers indicated that they were not taking
steps because it was too costly to do so or because they lacked
the skills.
Perceived Results ofPrevention Activities
Employers were asked whether, as a result of their
WMSD prevention activities, the number of injuries, absentee-
ism, turnover and quality of product or service increased,
decreased or was unchanged. Figure 3A–D summarizes their
responses for the number of WMSD injuries and levels of
absenteeism following steps. For similar results of steps on
injury severity, turnover, cost of production, employee morale
and quality of product see Silverstein et al. [2004]. It should be
remembered that these proportions are out of those stating that
they had taken steps to address WMSDs.
A higher fraction of Phase 1 workplaces took steps to
address WMSDs. They also reported better overall success
with their prevention activities than workplaces in Phase 2,
who in turn showed more reported success than workplaces
in Phases 3 and 4. For all groups the vast majority of
workplaces reported that the number of injuries fell or was
unchanged. Injuries were more likely to be unchanged for
the smaller workplaces in lower hazard industries which
comprised Phase 4. The same pattern applied across all
results measures: successful outcomes, or at least no change,
were reported by large majorities of workplaces across all
groups, with the best outcomes reported by workplaces in
Phase 1.
Similar patterns across survey years and Rule Phase
Groups were seen for turnover, quality of product or
service, severity of injuries, cost of doing business and
employee morale.
0%
10%
20%
30%
40%
50%
60%
70%
80%
Rule Phase Group 1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
2%
4%
6%
8%
10%
12%
14%
Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 4
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Rule Phase Group 3Rule Phase Group 2Rule Phase Group 1 TotalRule Phase Group 4
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Rule Phase Group 1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 Total
1998: N=4477 2001: N=5600 2003: N=5693 2005: N=5133
A B
DC
FIGURE 3. Reported results of prevention activities, by survey year and Rule Phase Group. A: Injuries decreased following steps.
B: Injuries increasedfollowingsteps.C: Absenteeism decreased followingsteps.D: Absenteeism increasedfollowingsteps.
Evaluation of Ergonomics Rule Implementation 11
Sources of Ergonomics Information
In order to uncover what resources employers used
when seeking ergonomics information we asked employers
to answer whether they used any or all of the following
internal and external sources of information: business/trade
associations, ergonomic product vendors, literature searches,
private consultants, health care providers, training/HR staff,
safety and health committees, DOSH or OSHA or that they
do not obtain any information at all. Table VI summarizes,
in order of importance, the proportion of workplaces using
each ergonomics information source, by survey year and rule
phase-in group:
They show that the large workplaces in the higher hazard
industries that comprised Phase 1 were much more likely to
use multiple sources of information, including in-house
TABLE VI. Sources of Ergonomics Information, by SurveyYear and Rule Phase Group
Source Year
Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 All
% Sig % Sig % Sig % Sig % Sig
Do not obtain any information 1998 22.2 30.5 27.6 45.0 39.52001 7.9 * 18.0 *** 22.7 * 33.8 *** 27.4 ***2003 12.5 * 24.0 ** 31.0 ** 44.0 *** 36.7 ***2005 6.1 ** 22.0 27.2 40.1 * 33.1 **
Business/trade association 1998 30.9 24.6 25.6 18.9 21.02001 36.3 30.1 ** 29.4 * 25.9 *** 27.7 ***2003 38.8 26.1 * 28.4 20.0 ** 23.0 ***2005 32.6 * 26.1 25.9 16.0 ** 20.2 **
DOSH/OSHA 1998 21.8 21.8 20.4 10.4 14.02001 37.9 * 32.8 *** 23.5 16.8 *** 22.5 ***2003 45.1 ** 34.1 25.7 13.5 ** 20.82005 41.2 32.8 22.0 14.8 20.8
Data searches, books, articles 1998 23.9 18.7 16.0 14.5 15.52001 25.0 25.8 ** 19.8 * 16.0 19.3 ***2003 25.0 23.0 17.4 13.9 16.8 **2005 20.7 16.7 ** 13.9 10.0 ** 12.4 **
Health care provider 1998 22.2 16.8 14.7 12.3 13.52001 15.4 16.4 19.0 ** 12.1 14.42003 13.9 12.5 ** 12.8 ** 9.5 * 10.8 **2005 14.2 14.1 12.6 9.1 10.9
Personnel or training staff 1998 44.6 12.8 14.2 6.6 9.12001 30.8 19.7 ** 13.4 6.9 11.7 **2003 25.7 15.7 * 8.0 ** 5.5 8.7 **2005 29.3 17.2 10.4 6.0 9.8
Safety/health committee 1998 36.3 13.7 15.0 4.0 7.62001 37.8 22.2 ** 15.0 3.7 11.0 ***2003 30.9 ** 16.3 ** 10.3 ** 3.9 8.3 **2005 37.8 * 19.5 * 9.5 3.6 9.0
Ergonomic product vendor 1998 23.8 9.1 8.4 6.1 7.12001 11.2 11.4 8.2 6.1 7.92003 10.0 9.2 9.8 4.8 6.7 *2005 11.6 10.4 7.7 5.0 6.9
Private consulting firm 1998 14.1 5.8 3.8 1.6 2.72001 9.9 9.5 ** 5.7 1.9 4.6 **2003 11.2 8.8 4.8 1.5 3.92005 14.2 6.1 ** 5.4 2.4 3.9
Asterisks show level of significance of difference in proportion for a given question between one survey year and the prior survey year: *P< 0.10; **P< 0.05; ***P< 0.0001.
12 Foley et al.
personnel or training staff, than workplaces in Phase 3 or 4.
The smaller workplaces that comprised Phase 4 were much
more likely to only rely on business/trade associations for
their information or not to obtain any information at all. From
2001 to 2003 there was a rise in the fraction of workplaces in
Phases 2, 3, and 4 reporting that they did not obtain any
information at all. One source of information showing greater
usage by all workplaces across all survey years is DOSH/
OSHA education and outreach. Ergonomic product vendors
and private consultants were the least-used sources.
Steps Taken by Workplaces toComply With the Rule
In the surveys administered in 2003 and 2005 we asked
employers to report whether they had initiated any of the
steps that were to be required under the rule. Specifically, we
asked whether they had: done an initial assessment of their
jobs to see if they would be in the ‘‘caution zone’’ under the
rule; instituted any control measures to reduce the hazards;
and provided ergonomics training for supervisors and
employees. Table VII shows the results.
The results show once again that employers in Rule
Phase Groups required to comply earlier with the ergonomics
rule were more likely to report that they were reviewing their
jobs and instituting control measures in 2003 than were firms
in the Rule Phase Groups who were not required to be taking
these steps until later. The results also show that from 2003 to
2005 the proportion of workplaces doing initial job assess-
ments and instituting hazard control measures increased
across all Rule Phase Groups, particularly in Phase 1. On the
other hand, the proportion of firms stating they were not
instituting hazard control measures increased even more.
There was also a substantial drop from 2003 to 2005 in
the proportion of firms stating that they did not have any
jobs requiring hazard controls. Finally, the proportion of
firms stating they were providing ergonomics training to
workers and supervisors was unchanged from 2003 to 2005.
DISCUSSION
To date, there have been no other large scale US surveys
of employers reporting prevalence of physical load exposures
in the workplace published in the peer reviewed literature.
There have been a number of studies using national or state
survey data to estimate prevalence of musculoskeletal
disorders such as 46% of respondents reporting heavy in
their job and 36% of those reporting back pain, or 51%
reporting either repetitive hand movements or awkward
postures and 37% of those with arm pain [Waters et al., 2007].
In the European Union, a large survey of workers across all
industries on their working conditions found no change in the
prevalence of exposures to heavy lifting, repetitive motion
and painful/tiring positions between 1990 and 2000 [Paoli
and Merllie, 2001]. In a 1996 telephone survey of upper
extremity risk factors for WMSDs among Connecticut
workers, Morse et al. [2007] estimated that about 1 million
Connecticut workers were exposed to repetitive work, bent
wrists and job stress. The only question which is roughly
comparable with our study was with computer use more than
4 hr per day where 28% of the Connecticut workers reported
exposure whereas 15–18% of Washington employers
reported they had at least one worker with such exposure. It
should be noted, however, that the Connecticut study
estimates the prevalence of exposure among workers,
whereas our focus in this study was the prevalence of
exposures among workplaces. The distribution of positive
responses across industry sectors was similar between the
two studies.
We were unable to ensure that, across all four
survey years, the same individual from the same workplace
would complete the survey. Indeed, we did not have sufficient
TABLE VII. StepsTaken to Comply With the Rule, by SurveyYear and Rule Phase Group
Step Year
Rule Phase Group1 Rule Phase Group 2 Rule Phase Group 3 Rule Phase Group 4 All
% Sig % Sig % Sig % Sig % Sig
Initial assessment of jobs 2003 53.6 37.9 30.7 24.7 29.32005 62.9 ** 44.6 ** 40.9 ** 33.7 *** 37.9 ***
Control measures-yes 2003 38.7 34.3 27.0 18.3 23.72005 54.7 ** 39.4 * 29.6 20.0 27.0 *
Control measures-no 2003 24.3 27.7 29.9 26.0 27.02005 37.6 *** 48.3 *** 45.9 *** 53.5 *** 50.8 ***
Control measures-not needed/no hazards 2003 37.0 38.0 43.2 55.6 49.32005 7.7 *** 12.3 *** 24.4 *** 26.4 *** 22.2 ***
Provided training 2003 51.6 30.1 18.0 11.4 17.52005 53.3 30.1 21.3 12.6 18.9
Asterisks show level of significance of difference in proportion for a given question between one survey year and the prior survey year: *P< 0.10; **P< 0.05; ***P< 0.0001.
Evaluation of Ergonomics Rule Implementation 13
numbers of repeat responding workplaces to be able to track
responses from individual workplaces over time and still be
able to break out results by Rule Phase Group. Instead, we
focus on tracking the movement of responses of each
Rule Phase Group across the four survey years. If the surveys
are answered by individuals with a similar role in the
workplace across survey years, the responses should be
comparable. We found that, within each Rule Phase Group,
the distribution of respondents by job title remained quite
stable over time. Respondents from the large firms in Phase 1
tended to be managers and supervisors, while those from the
small firms comprising Phase 4 tended be business owners.
The interpretation of the trends in reported WMSD
exposures, injuries and steps being taken by employers may
be aided by an understanding of the political and legal
context which might have shaped employers’ expectations of
the rule’s survival at each period in which the survey was
fielded. At the time of the first survey, which was
administered in the summer of 1998, L&I had not yet
announced a proposed rule. The rule was adopted in May
2000, with the phase-in of compliance scheduled to start in
July 2002. By the spring of 2001, when the second survey was
administered, the rule had survived its first challenges in the
state legislature. L&I had developed and delivered many
training sessions and demonstration projects tailored to each
industry sector and these were well-attended by industry
representatives. In the fall of 2001, a business coalition began
litigation against the rule in district court. By the summer of
2003, when the survey was administered a third time,
enforcement had been delayed by 2 years by Governor
Locke. Also, the legal challenge to the rule was headed to the
Washington State Supreme Court, and an initiative to repeal
the rule, filed by the Building Industry Association of
Washington, had qualified for the November 2003 ballot. In
summer 2005 when the survey was administered once again,
the rule had been repealed for more than 1 year. A more
complete presentation of the regulatory and political context
surrounding the rule is in Silverstein [2007].
Throughout this study we were concerned that em-
ployers’ reporting of the number of WMSD injuries sustained
in their workplaces might tend to underestimate the number
of actual WMSD injuries. Evidence suggests that the
undercount of injuries reported to the employer-based
Bureau of Labor Statistics Annual Survey of Occupational
Injuries and Illnesses could range from 33% to 69% [Leigh
et al., 2004]. Increased publicity about the ergonomics rule
adoption, as well as the ebb and flow of the political battle
surrounding the rule’s implementation, may also have played
a role in shaping employer’s reports of WMSD injuries and
claims in their workplaces. To check for this, we compared
survey-reported WMSD rates per 100 FTE with those
found in L&I’s workers’ compensation database. The
survey-based claims rates accorded fairly well with
the administrative rates. For example, the survey-based rate
for non-traumatic WMSD claims in 1998, covering the years
1995–1997, was 3.5 per 100 FTE. The rate as reported by
L&I’s workers’ compensation database was 3.1 per 100 FTE
for non-traumatic WMSDs of the neck, back and upper
extremities [Silverstein and Adams, 2007]. In 2001, the
survey-based rate was 3.6 per 100 FTE, while that from
the workers’ compensation database was 3.1 per 100 FTE. In
2003, the survey-based rate fell to 2.6 per 100 FTE while
the workers’ compensation claim rate showed no change,
remaining at 3.1 per 100 FTE. In the 2005 survey the survey-
based rate rose to 3.6 per 100 FTE, while the L&I-reported
claims rate was 3.3 per 100 FTE. So with the exception of
2003, the survey-based rates tracked closely with the
workers’ compensation rates. The fact that in 2003, when
political challenges to the rule were clearly gaining
momentum, the survey-based rate fell well below that shown
L&I workers’ compensation data may reflect the desire of
some employers to downplay the significance of WMSD
injuries in their workplaces for political purposes.
When comparing the pre-rule period to the period
following repeal, the surveys show evidence of a decline in
high-duration exposures across all Rule Phase Groups. The
sole exception to this trend was for intensive keyboarding,
where the trend was decreasing for Phase 1 and Phase 3 firms,
but increasing for Phases 2 and 4 firms. The reasons for these
mixed patterns are not known. It may be that the diffusion
over this period in document imaging and web-based
document processing technologies did not reach the mainly
smaller firms comprising Phase 4 and most of Phase 2. The
other pattern that is clear is that, in Phase and Phase 2, there
was a decrease in reported exposures from 2001 to 2003 to all
hazards, and then an increase by 2005. The third ergonomics
survey was conducted in June–July 2003 when the political
and legal battle against the rule was at its height. Well before
the 2005 survey period it was clear that there would be no
ergonomics related enforcement inspections in the foresee-
able future.
Results from this research suggest that the extended
controversy over the rule outpaced and overwhelmed the
phased-in implementation process. From the first three
surveys, there was some suggestion of reduction in exposure
between 1998 and 2003 (Fig. 1A–E). However, while more
workplaces reported taking steps between 1998 and 2001,
there was no further improvement by the summer of 2003
when the rule was likely to be repealed. Instead, there was a
significant decrease in the percent of workplaces reporting
having taken steps in Phase 1 (large workplaces in high risk
industries) and Phase 3 (all other medium sized workplaces,
11–49 FTEs), and decreases in the other groups that were not
statistically significant.
Employers across all Rule Phase Groups said they took
steps to address WMSD hazards primarily in order to reduce
worker injuries and to improve productivity and reduce
absenteeism. But reducing workers’ compensation costs
14 Foley et al.
appeared to be a more important concern to the larger firms
comprising Rule Phase Group 1 than it was to the smaller
firms in Rule Phase Groups 3 and 4. This could be because
large firms have a more direct financial incentive to avoid
workers’ compensation claims due to the fact that experience
rating plays a larger role in determining their premiums than
is the case with smaller firms. Because of their size, smaller
employers might have more difficulty coping with the
staffing impact that the loss of an employee due to injury
would have on the business. Other factors cited as reasons for
addressing WMSD risks showed the importance of employee
recommendations through their workplace safety commit-
tees and the desire to obtain a competitive advantage by
obtaining a productivity improvement through improving the
ergonomics of the workplace. Relatively few employers cited
recommendations by DOSH/OSHA as playing a part in their
decision to take steps to address hazards.
It is likely that employers decided to take a ‘‘wait-and-
see’’ stance with respect to the ergonomics rule before
instituting control measures. This was likely strengthened by
the downturn in the economic cycle during 2001–2003. By
the 2005 survey the percent of Phase 1 employers taking steps
was lower than in 2001, while the fraction not taking steps
despite having experienced a WMSD injury was higher.
Nonetheless, for those employers who did take steps, a high
percent reported positive results in injury and absenteeism
reduction, product quality and employee morale.
Large workplaces in the high hazard industries tended to
use a variety of resources, including in-house personnel, to
address ergonomics issues. Among medium and smaller
workplaces outside of the Top 12 industries the major sources
of information were trade associations and DOSH. Private
consultants were used by relatively few firms. One of the
more interesting results in the 2001–2003 comparison was
the increase in employers from all groups who stated that they
did not obtain any information on ergonomics. This trend
reversed course from 2003 to 2005, perhaps reflecting the
changed political climate following repeal of the rule in late
2003. From 2001 to 2005 there was a similar trajectory in the
proportion of employers claiming that WMSDs were not a
problem in their workplace and in the trend of employer-
reported WMSD claims on the surveys. These results may
reflect a tendency among some employers to downplay the
importance of a hazard which is the subject of new regulatory
activity.
The elimination of ergonomics regulations at the state
and federal level was not without economic and social
consequences. These surveys have demonstrated increases in
employer reported exposures and reduced efforts to reduce
these hazards once the ergonomics rule was unlikely to
survive. Those employers who did take steps reported
positive outcomes in terms of reduced injuries, injury
severity, turnover, and absenteeism. Employee costs in terms
of lost earnings and workdays have been estimated by Biddle
and Roberts [2004] and Foley et al. [2007] and have been
shown to extend for many years.
In addition to the losses suffered by those with WMSDs,
the social costs of not reducing exposures present a
significant burden to society. By combining the data on
exposures from these surveys together with the cost-benefit
analysis of the repealed ergonomics rule it is possible to
estimate the likely costs of not having the ergonomics rule
[Foley and Nothstein, 2000]. The cost-benefit analysis used
workforce exposure fractions derived from the 1998
employer survey to estimate the number of jobs which would
require hazard reduction. Costs of the rule were based upon
expenditures for businesses to comply with the various
elements of the rule, including rule review, hazard identi-
fication, engineering and administrative controls, training
and administrative time. Benefits of the rule were based upon
the cost savings associated with the decrease in WMSDs that
would follow from the reduction of hazards in the workplace.
Savings would come from a reduction in workers compen-
sation expenditures, long-term wage losses, lost taxes and
fringe benefits, unreported WMSDs and indirect employer
expenditures.
The present value of annualized net benefits would have
been approximately $260 million per year over 10 years had
the rule been fully implemented. However, since the rule was
repealed in 2003 there was only partial implementation of
hazard reduction followed by a partial regression toward pre-
rule levels of exposure. Thus, rather than the expected 50%
reduction in costs under full rule implementation, only about
a 15% reduction was realized. This suggests that the social
cost of having repealed the rule might be approximately $182
million in forgone social net benefits per year.
CONCLUSIONS
This large scale industry-wide survey study is unique in
that it spans the rise and fall of the Washington State
ergonomics rule, from 1998 to 2005 from an employer
perspective based on four surveys. The large employers in the
highest-hazard industries were well on the way to reducing
hazards by 2003 when the rule was repealed. Likewise, it is
evident that hazard reduction was no longer a priority once
the threat of enforcement was gone. It is unknown whether
having a less lengthy phase-in would have resulted in quicker
acceptance or even more resistance to change. It is possible
that employers would have focused more on the components
of the rule because of the need to act sooner.
Although there is good evidence that ergonomic
interventions result in reduced injuries and costs [Tompa
et al., 2007], this research suggests voluntary efforts, without
the plausible threat of enforcement may do little to encourage
action by employers most in need of improvement. The
failure of this extraordinary effort to develop a significant
Evaluation of Ergonomics Rule Implementation 15
health and safety rule at the state level through the non-
deliberative citizen initiative process raises serious concern
about the future of health and safety protection in the United
States.
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16 Foley et al.